Is Music an Alternative to Diazepam for Reducing Anxiety in Third Molar Surgery? A Randomized Split-Mouth Clinical...

Preoperative anxiety is common in patients undergoing third molar surgery and is associated with increased stress and discomfort. Controlling anxiety during dental procedures is an important clinical goal.

The purpose of this study was to compare the effects of music and oral diazepam on anxiety, pain, and physiologic measures during and after surgical extraction of impacted mandibular third molars.

This unblinded, randomized split-mouth cross-over clinical trial was conducted at the School of Dentistry, North Khorasan University of Medical Sciences (Bojnurd, Iran). The participants were systemically healthy adults who presented between February and June 2024 for bilateral surgical extraction of impacted mandibular third molars. Exclusion criteria were unwillingness to participate and incomplete questionnaire data.

The predictor variable was anxiety management by music and diazepam. Each participant underwent 2 separate surgical sessions: one session with oral diazepam premedication and the other while listening to music. Order of interventions and surgical side were randomized. A minimum 2-week interval was maintained between the 2 sessions.

The outcome variable was therapeutic effect measured as anxiety level using the State-Trait Anxiety Inventory (STAI). Secondary outcomes were pain and physiologic measures.

Covariates were age, sex, surgical difficulty, and operator related factors, that were managed by the study design or otherwise standardized.

Data normality was analyzed using the Shapiro-Wilk test. Paired sample t-tests were used for normally distributed anxiety outcomes, whereas Wilcoxon signed-rank tests were used for pain and physiologic variables. Statistical significance was set at P < .05.

Thirty subjects (mean age 25.3 ± 4.7 years; 60% female) were included. Preoperatively, the mean state anxiety (STAI-S) scores were 33.6 ± 5.98 and 37.4 ± 4.81 for music and diazepam, respectively (P < .001), with lower scores indicating lower anxiety. At 24 hours, the mean STAI-S scores were 38.36 ± 4.41 and 36.23 ± 6.42 for music and diazepam, respectively (P = .04).

Although diazepam resulted in more pronounced reductions in physiologic measures, music offers an inexpensive, accessible, and nonpharmacologic alternative for managing anxiety during third molar surgery.