Title	Relaxation Training To Control Mild Fear Of Dental Treatment
Clinical Question	Does relaxation therapy reduce dental anxiety in adult patients better than music therapy?
Clinical Bottom Line	Based on the evidence presented in the article, there is a significant advantage in utilizing relaxation therapy over music therapy or no therapy at all when working with mildly fearful dental patients. The advantage of music therapy over no therapy is questionable due to the small differences found and small sample sizes used in this study. Further investigation is needed to examine music therapy as a meritable clinical tool to reduce dental anxiety. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18310736 Lahmann/2008 Adult with mild dental anxiety Randomized Controlled Trial Key results Both brief relaxation therapy (BR) and music distraction (MD) significantly reduced dental anxiety over the control (C) (p<0.001 and p<0.05 respectively). Brief relaxation therapy significantly reduced dental anxiety over music distraction (p<0.001). BR-C = p<0.001; MD-C=p<0.05; BR-MD=p<0.001
Evidence Search	Search (\"Dental Anxiety\"[Mesh] AND \"Relaxation Therapy\"[Mesh]) AND \"Music Therapy\"[Mesh] Limits: Randomized Controlled Trial (\"Dental Anxiety\"[Mesh] AND \"Relaxation Therapy\"[Mesh]) AND \"Music Therapy\"[Mesh] Limits: Systematic Reviews (\"Dental Anxiety\"[Mesh] AND \"Relaxation Therapy\"[Mesh]) AND \"Music Therapy\"[Mesh] Limits: Meta-Analysis (\"Dental Anxiety\"[Mesh] AND \"Relaxation Therapy\"[Mesh]) AND \"Music Therapy\"[Mesh]
Comments on The Evidence	In this randomized controlled trial the three groups at the beginning of the trial were not equal with the control group having a higher mean age and different male:female ratio than the treated groups. The study was not double blind due to each patient’s awareness of what therapy was being used. While the criteria for a patient to participate was the presence of simple caries, the number of lesions and the locations of each lesion was not stated as constant, therefore the groups were dissimilar to some extent during treatment. Compliance and completion rate were both acceptable. Overall there seems to be a significant reduction in dental anxiety by utilizing the brief relaxation therapy outlined in the article. Due to the size of the sample, there is concern that the validity of music therapy to reduce dental anxiety more than the control may not hold up under further scrutiny. Finally, the severity of the dental anxiety being evaluated may not have been representative of the range of fear levels in a typical clinician’s patient population. Patients that completely avoid the dentist due to fear would theoretically have the highest associated anxiety. This population is not specifically mentioned to be included in this study.
Applicability	With a minimum amount of training a clinician or auxiliary should be able to utilize the basic relaxation and music therapies. The study focused on patients with very mild fear and simple caries but may not be generalizable to patients with more severe conditions. The benefit to the patient includes a more positive experience in the dental clinic and the use of the technique for future treatments. It should be pointed out that no therapy is perfect and a patient should not be led to expect these therapies to eliminate all feelings of anxiety.
Specialty	(General Dentistry) (Behavioral Science)
Keywords	Dental Anxiety, Relaxation Therapy, Music Therapy
ID#	590
Date of submission	04/01/2010
E-mail	stewarttr@livemail.uthscsa.edu
Author	Thomas Stewart
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Robert Klepac, PhD
Faculty mentor e-mail	BOBAPPIC@aol.com
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by David Brockbank, Ryan Fort, Kelsey Parsons (San Antonio, TX) on 01/07/2013 The CAT presented an interesting approach to treating patients with dental anxiety. We would like to see more research studies to increase our confidence in using relaxation therapy in our future dental practices. Until then, it could serve as an additional option for treating patients with dental anxiety.