Enhancing experience of dental procedures under inhalation sedation with relaxing music: an overview to explore the potential
F. Rodrigues* BSc (Hons), BDS
Dental Core Trainee, London North West University Healthcare NHS Trust, Oral & Maxillofacial Surgery Department, Northwick Park Hospital Block L1, Level 4, Watford Rd, Harrow HA1 3UJ
*Correspondence to: Dr Francesca Rodrigues
Email: francesca.rodrigues@nhs.net
Rodrigues F. Enhancing experience of dental procedures under inhalation sedation with relaxing music: an overview to explore the potential. SAAD Dig. 2024: 40(II): 103-104
Abstract
Aims
This review will explore how relaxing music can be harnessed to positively impact the delivery of inhalation sedation for anxious dental patients.
Method
The literature was reviewed by searching electronic databases, excluding research prior to the year 2000. Data extraction involved identification of varying parameters of music (tempo, amplitude and systems of delivery) and how this impacts psychophysiology (mood, heart rate, blood pressure). Additionally, systematic reviews assessing the combined effect of music within sedation settings were also included.
Results
Research supports that patients who listen to relaxing music, while undergoing dental procedures under inhalation sedation, may have an improved experience. Some research also highlights improvements in vital signs associated with listening to music during surgery, especially for anxious patients.
Conclusion
Improvement of patient experiences of dental procedures under inhalation sedation may be possible by utilising relaxing music to promote a relaxed state.
Introduction
Dental procedures can be an unnerving combination of sensations: unsettling sounds, unpleasant flavours and application of tools that appear intimidating. From the patient’s perspective, the dental environment may be perceived as a frightening place synonymous with pain and anxiety. Sedation techniques offer a gateway for dentally anxious patients to access dental services. Inhalation sedation (IHS) is one method of conscious sedation that is relatively safe and effective. However, this form of sedation can be further improved with distraction techniques such as hypnosis and use of relaxing visual projections. The use of relaxing music has potential to be an especially effective distraction technique.
Background
Music can be emotionally polarising, eliciting moods of relaxation, happiness or even melancholy. A comprehensive review detailed the neurochemical reactions that occur when listening to music. Notably, there is a correlation between listening to low-frequency music and reduced levels of cortisol, a hormone that is typically associated with stress. Other physiological indicators of relaxation can also be observed, including lowered heart rate and respiration.1 This rhythmic calibration of physiological parameters with appropriately selected music may significantly enhance the experience for patients receiving dental treatment under IHS.
For patients who have been appropriately selected and consented for IHS, it is important to ensure their experience is a positive one. An estimated 36% of the UK population has dental anxiety, some of whom may only accept treatment under sedation while others may completely avoid visiting the dentist.2 Therefore, every effort should be made to optimise a relaxed state to avoid further intensifying a patient’s dental anxiety and to prevent the need for more consequential forms of sedation like general anaesthesia. IHS involves inhalation of nitrous oxide (N2O) to achieve relative analgesia. Though IHS alone can induce anxiolytic effects, distraction techniques are frequently used to enhance sedation in the conscious patient.
The synergistic pairing of relaxing music with IHS benefits both operator and patient. Among the variety of distraction techniques that can be honed by operators, playing relaxing music is a straightforward yet effective means of maintaining relaxation during IHS. Thus, valuable information may be derived from exploring how musical parameters can be adjusted to benefit patients.
Music Selection
Music has many different genres and taste can be incredibly subjective. Perhaps the most taxing decision, after choosing to use background music, is what type of music to use. More specifically, questions about musical parameters may also arise, including genre, amplitude and use of lyrical or instrumental music. It seems logical to select any music that is considered relaxing. However, this encompasses many different genres such as jazz, classical and nature sounds. Being able to characterise the associated parameters of relaxing music can help with its selection.
One study investigated self-reported preferences for ‘softer’ amplitudes of music to promote a relaxed state, whereby loudness ideally does not exceed 70 decibels.3 Thoughtful consideration of amplitude for patients listening to music on personal devices is especially important for maintaining clear patient and dentist communication during procedures. For example, establishing the appropriate volume of music prior to starting a procedure, to check whether the patient can still hear the operator’s commands while listening to music on their personal device. A systematic review further attempts to define relaxing music, suggesting that non- lyrical music, with a slow tempo ranging between 60 to 80 beats per minute, is significant in pain management.4 Although the operator can play music that meets a relaxing standard, it is recommended that patients choose their own relaxing music to encourage their sense of autonomy.1
Whether patients listen to relaxing music on a speaker or through personal devices, clear beneficial outcomes have been observed in patients. A systematic review highlights a reduction in pain and anxiety across many studies, including patients who listen to relaxing music before, during or after different surgical procedures. Additionally, 27% of studies which analysed vital signs, reported significantly reduced blood pressure and heart rate.5 The postulated mechanism of action underlying these responses is described in an article highlighting inhibition of sympathetic activity while the limbic system integrates auditory processing along with other environmental stimuli. Interestingly, a phenomenon known as entrainment can facilitate a relaxed state by synchronising parasympathetic activity with musical rhythms, as a result of upstream thalamic processing.6 Combined with the central nervous system depression that occurs during IHS, relaxing music can adjunctively evoke powerful anxiolytic and analgesic effects.
Patient factors and additional considerations
Relaxing music offers simplicity and wide-ranging benefits as a distraction technique. However, it is important to be considerate of patient suitability and preferences. Some patients may opt for silence while others may wish to consider alternative distraction techniques. A skilled operator may incorporate multiple distraction techniques or may not require any at all. In every case, it is paramount to be supportive and flexible so that the patient has a comfortable IHS experience.
A significant proportion of dental patients undergoing IHS are paediatric. A systematic review supports the use of relaxing music for adult patients, however, for paediatric patients the results are inconclusive.7 From a behaviour and developmental perspective, it is reasonable to use alternative methods in young children, perhaps focused more on visual stimuli, which was highly favoured by paediatric patients in one study.8
Medical history considerations may also present challenges within the sedation aspect of IHS, which render the use of music negligible. In particular, it may be difficult to achieve adequate levels of sedation in patients with psychological health struggles, such as bipolar disorder or more moderate levels of anxiety. In these cases, communication and a good understanding of the patient’s condition are likely to be more helpful than music.
If music is a chosen distraction technique, it would be interesting to consider additional variables for investigation. For example, quantifying how music may affect N2O titration; whether playing music for a certain length of time influences sedation depth; or if there is a discrepancy between how music affects males and females. This information could serve to refine how music is delivered in a dental context with IHS.
Conclusion
Music can be a helpful supplement when used in conjunction with effectively delivered IHS. Provided that the patient is comfortable with music during IHS, it is an easy and likely harmless option that should be explored as an effective distraction technique. Improving the patient’s experience of dentistry under IHS should be the main focus, with relaxing music as a simple solution to address this. However, music is one of many options and does not substitute good communication skills and empathy. Therefore, patients listening to relaxing music under IHS holds exciting potential to optimise a patient’s experience of dentistry.
Conflicts of Interest
None
Acknowledgements
I wish to thank Community Dental Services CIC where my training in inhalation sedation allowed me to explore the benefits of music as an adjunct to patient care.
References
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