Reducing Dental Anxiety Through Music

An important and compelling consideration when caring for children, dental anxiety is fear, nervousness, apprehension, or stress associated with a dental setting and/or procedure. ^1-3 Approximately 6.3% to 43% of children experience some level of dental anxiety.^1-4 More specifically, 51% of children and 22% of teens experience mild, moderate, or severe dental anxiety.⁴

Research indicates that age may play a significant role in the acceptance of dental care by a child with anxiety, and that levels of anxiety may decrease with age and over time.^1-4 Children who have no experiences at a dental office or who have had treatment for caries lesions are at increased risk of experiencing dental anxiety and fear.⁵

Dental fear can elicit an emotional response to a specific stimulus in the dental setting, often delaying or making treatment difficult. Generally, anxiety is a condition classified as an “intense feeling of dread” in addition to somatic symptoms that trigger the autonomic nervous system. Physiological signs of anxiety can include sweating, increased blood pressure, tachycardia, palpitations, dry mouth, diarrhea, muscle tension, and hyperventilation.⁴ Fear and stress can induce anxiety in pediatric dental patients.⁴

Dental anxiety in children is related to the lack of dental awareness, pain or fear of pain, history of a traumatic dental experience, heightened anxiety levels of the child’s parent or caregiver, and personality traits.^5-7 Pediatric patients have also reported visualization, sound, and the possibility of feeling a dental handpiece or needle as reasons for dental anxiety. Anxiety related to dental hygiene therapies may include fear of expected pain; the feeling, sight of, and/or the sound of periodontal instruments; a perceived lack of control; remarks about poor oral hygiene; smell of the office; and feeling claustrophobic.^6-8 Temperament, gender, previous negative dental experiences, and a history of a toothache are considered dominant, individual characteristics of a child that can influence the severity and prevalence of dental anxiety and fear.^7-9

A child’s first experience at a dental office can influence future compliance with dental care. Positive dental experiences in pediatric care correlate to trust and willingness to access regular care, while negative childhood experiences may lead to avoidance of dental care over time. Pediatric patients who experience dental anxiety miss appointments and suffer more often from dental pain than those without anxiety.^3,5,7,10 Avoidance of dental care can lead to poor oral health and more complex treatment plans with increased associated costs.

Music and the Brain

­­­­Music affects the brain and stimulates the limbic system by releasing endorphins and reducing anxiety.¹¹ Specifically, music’s rhythm, pitch, and tone affect specific parts of the brain. A song’s rhythm or tapping tones affect the motor cortex and cerebellum, and when the brain begins to recognize a song’s pitch/tone, the auditory cortex brings about the conscious perception of sound.^12-14

The brain works as a unit when intercepting, interpreting, and creating an emotional response to music. The central units of the brain — nucleus accumbens, amygdala, and cerebellum — are all responsible for triggering feelings when listening to music. The nucleus accumbens play an important role in stress-related behaviors.

When listening to music, dopamine and serotonin levels are increased in the nucleus accumbens, leading to a pleasurable listening experience. A portion of the neural system, the amygdala, processes emotions such as happiness, anger, anxiety, and annoyance. The amygdala receives its transmissions from the central auditory system, and in response, dopamine and serotonin are released. More specifically, when listening to music, the amygdala responds to joyful or sad music and releases neurotransmitters as needed. The cerebellum assists the accumbens by bridging the brain areas related to stress and communicating with areas used to process stress-related issues. Listening to music initiates a complex process in the brain involving memory and emotions. When applied correctly, music can reduce anxiety and improve a patient’s mood.^12-14

Music Therapy and Anxiety

Music therapy is an appealing, mind-body therapeutic intervention used to support a variety of physiological and neurological symptoms. An evidence-based practice, music therapy helps to address a patient’s physical, emotional, cognitive, and social needs. Music therapy is often used in mental health settings, schools, geriatric facilities, and dental practices. Music therapy may be specialized for patients with autism spectrum disorder, developmental disabilities, or depressive disorders.^12-17

Personality, age, personal preferences, and cultural background may influence physiological and cognitive responses to music.^18-20 For example, classical music is commonly chosen for relaxation  due to its elegant elements that help improve concentration, memory, and perception. The need for a music therapist should be identified prior to dental procedures so the patient has enough time to acquire the skills needed for music-based therapies to be effective.²⁰

Music therapists can teach patients to use music for interventions including the active refocusing of attention, deep breathing, relaxation, and guided imagery.¹⁵ Active refocusing is a technique that directs a patient’s attention to specific musical elements, such as identifying the instruments being played, to enhance concentration and engagement. Active music listening strengthens the brain’s memory center, which can improve learning, recall, emotion regulation, focus, and attention. During active refocusing, patients should be allowed to listen to their favorite genre of music and adjust the volume. Active refocusing uses music an individual has heard before and remembers. This aids in the brain’s ability to focus.^15,18,20

Music-guided deep breathing enables patients to gain perceived control while the music is used as a support mechanism.^15,18,20 Specific types of music are designed to give the patient directions on when to breathe, or how to follow rhythmic cues for inhalation or exhalation. Playlists noted for use with deep breathing are commonly found on popular music platforms.

Music-assisted therapies can influence a patient’s heart rate or respiratory rate. This intervention is when a patient’s preferred music from a live concert is played and gradually, the music’s tempo/harmony decreases vitals to a resting rate. If done correctly, the music guides the patient into a relaxing mood, and a patient’s vital responses would then also relax by balancing or reducing to a more acceptable baseline. Children with a heart rate between 100 and 150 beats per minute and a respiratory rate between 20 and 30 breaths per minute are considered within normal limits. Live recordings can be found on music platforms by searching the artist’s name and “live performance” or “live in concert.”^21-24

Lastly, music-guided imagery is used for patients with any level of anxiety and need for pain management. The key to this intervention is to not assume “image” always means the visualization of something physically present in the patients surroundings but that “image” could mean asking a patient to recall memories associated with a pleasant experience with music.^21-24 This technique uses music to help patients remember past experiences and to reflect on those experiences. For example, a patient may want to listen to the soundtrack of a favorite movie or a religious song, or music that reminds them of a positive, meaningful experience. When patients reflect on positive experiences through music, they may be less likely to develop anxiety during a dental or dental hygiene procedure.

Using Music in Clinical Care

Music therapy can be used in dental and medical settings to manage behavioral/mental obstacles.^5,18,20 A full assessment and intake of needs should be completed before recommending or using music therapy. Corah’s Dental Anxiety Scale²⁵ is an easy-to-follow questionnaire with a 20-point scale based on four simple questions:

1. If you had to go to the dentist tomorrow for a check-up, how would you feel about it?
2. When you are waiting in the dentist’s office for your turn in the chair, how do you feel?
3. When you are in the dentist’s chair waiting while the dentist gets the drill ready to begin working on your teeth, how do you feel?
4. Imagine you are in the dental chair to have your teeth cleaned. While you are waiting and the dental hygienist is getting out the instruments that will be used to scrape your teeth around the gums, how do you feel?

Corah’s Dental Anxiety Scale can be used with pediatric patients and modified according to the child’s age and cognitive ability. Results of the scale are scored with a point system based on answers. A score of 9-12 means a patient may have moderate anxiety due to specific stressors. Scores in the 13-14 range indicate high general anxiety, while scores over 15 may indicate severe anxiety or phobia. In addition, a dental concerns assessment could be helpful to discuss with your patient and caregiver before an appointment.²⁵ By assessing which procedures cause low to high amounts of stress, a plan can be created to work through stressful procedures.

Several factors may influence a patient’s response to music, and specific music interventions cannot be applied universally. Individual considerations such as age, gender, cognitive function, severity of the anxiety, music preference, ability to communicate, and culture should be considered.^26-28 Patients should be encouraged to create a playlist of music they enjoy listening to and that they find relaxing. The playlist should be downloaded on a device that can be used in a dental setting, in case there is no Wi-Fi or cellular service in the dental office. Caregivers need to have enough songs to last the entire dental procedure and wait times. Patients should set a comfortable volume and have access to volume controls.

Headphones vs Speakers

When deciding between headphones and speakers for music therapy, prioritize patient comfort by offering both options and observing their preferences. Headphones block out or mask sounds made by equipment. However, the inability to hear procedural sounds may cause anxiety in some patients as they may feel it prevents communication with their dentist or dental hygienist.^26-28

Age also impacts whether headphones or speakers are more appropriate. Teenagers understand they can raise their hand if they need a break or have a question, however, younger patients may need a speaker so they can feel free to ask questions and have open communication with their clinicians (Figure 1).

Patients should be encouraged to actively engage with the music.^26-28 Active listening is defined as focusing on music without interruption.^15,18,20 Actively engaging with the music can distract patients and shift their focus to the music rather than the dental procedure being completed.

Studies show that listening to music pre-operatively decreases anxiety levels compared to those who sat in silence waiting for a procedure or appointment.²⁸ Music can stimulate chemicals, such as oxytocin and endorphins, which help boost mood.^26-28 Timing of music therapy is important as younger patients may get bored if they listen to music before and through a longer dental appointment. An alternative is to have patients watch their favorite TV show while in the waiting room, then use music therapy for the procedure.

Lastly, clinicians can recommend music therapists for complex treatment plans,  patients with special needs, and those who may need more support in managing dental anxiety. Dental hygienists can write referrals to music therapists. Certified music therapists must earn a bachelor’s or advanced degree in music therapy from an accredited college and hold the credentials MT-BC from the Certification Board for Music Therapists.^15-18 Certification includes curriculum competencies in three main areas: musical foundations, clinical foundations, and music therapy foundations. Board certification is voluntary, and guidelines vary by state for licensure, certification, and/or registries.^15-18

Conclusion

Dental anxiety can lead to missed appointments and is linked to poor oral health in children.^1-3,29 Managing a child’s anxiety is critical to the success of preventive dental hygiene care and restorative treatments. Electronic device use is common among children and most households have access to a device that can play music. Music therapy is widely accepted for reducing anxiety related to medical and dental procedures. Because anxiety levels differ due to age, each patient should be assessed before recommendations are provided. An assessment of anxiety can be used to create a pretreatment plan for the management of anxiety during stressful procedures^.1-4

Oral health professionals can use music therapy as a strategy to reduce dental anxiety in pediatric patients and make referrals to a certified music therapist. Gaining trust through positive dental experiences often leads to completed procedures and care plans with a more positive response for recare appointments.³⁰

References

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From Dimensions of Dental Hygiene. July/August 2025; 23(4):28-31.