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I.
TITLE
Music Therapy as a Method to Decrease Dental Anxiety/Fear among Extraction
Patients in the University of the Philippines, College of Dentistry (UPCD) Clinic
II.
INTRODUCTION
To many people, music is an important part of their way of life. Common
aphorisms, such as "the harmony of the spheres" and "it is music to my ears", point to
the idea that music is often structured and pleasant to listen to. It is said that music also
relaxes the mind and eases the soul. Research has shown that the power of music has
soothing influence showing significant reductions in stress, pain, anxiety and depression.
Thus, music therapy has been used in health care settings since it helps slow down
patient’s breathing and decrease their blood pressure.
In the dentistry, one of the leading painful and stressful procedures is extraction.
This study will attempt to determine the effectiveness of music therapy in alleviating
dental fear/anxiety of patients undergoing extraction procedures.
III.
OBJECTIVES
General Objective:
This study aims to determine the effect of music therapy on dental fear/anxiety
alleviation in extraction patients in UPCD clinic.
Specific objectives:
1. To gauge the level of dental fear/anxiety among UPCD extraction patients
2. To know if music therapy can decrease dental fear/anxiety in extraction patients
IV.
Ho
Ha
HYPOTHESIS
Music therapy will not affect the anxiety level of extraction patients in UPCD
Clinic.
Music therapy will decrease the anxiety level of extraction patients in UPCD
Clinic.
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V.
REVIEW OF RELATED LITERATURE
According to Wikipedia, music therapy is an interpersonal process wherein music
and all of its aspects—physical, emotional, mental, social, aesthetic, and spiritual— are
used to help patients in improving or maintaining their health.
The healing properties of music have been widely utilized in many different fields
of health sciences. A study about the effects of music therapy on incidence of heart
failure in elderly patients with cerebrovascular disease and dementia found out that
music therapy enhanced parasympathetic activities and decreased congestive heart
failure (Okada, K., et, al. 2009). Another feasibility study suggests music therapy as a
therapeutic approach to critically-ill cancer patients (Magill, L., Levin, T., & Spodek, L.,
2008). In an analysis done, they were able to conclude that listening to music is effective
in reducing procedure time and amount of sedation during colonoscopy and should be
promoted (Tam, W., Wong, E., & Twinn, S., 2008). In the dental field, a study on music
as a stress reliever during dental restorative procedure said that music made a
significant decrease in blood pressure and heart rate of patients undergoing operative
procedures and that music is indeed a stress reliever (Mendoza, 1997).
Dental anxiety and phobia are extremely common. It has been estimated that 9%
to 15% of Americans avoid seeing the dentist because of anxiety and fear. In a survey by
the British Dental Health Foundation, 36% of those who didn't see a dentist regularly
said that fear was the main reason.
A study by Galvez in 1999 stated that in the University of the Philippines, College
of Dentistry, with the rush to complete clinical requirements, clinicians often do not
even regard if their patients have dental anxiety. It is taken for granted until the anxiety
manifests itself and the clinician is caught off guard, or worse, the patient suddenly does
not show up for the appointment. She also stated that prevention of these situations is
necessary for proper dental care to be administered to those seeking treatment as well
as for fulfillment of requirements by the UPCD clinicians.
Since music therapy is said to have properties that can alleviate anxiety on other
fields, it may be beneficial to try the technique in alleviating anxiety in dental extraction.
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VI.
CONCEPTUAL FRAMEWORK
Dental Fear/Anxiety
Music Therapy
Dental Anxiety
Management
Figure 1. Research Structure
Patients seeking dental treatment in UPCD may experience fear/anxiety prior to
or during dental procedures. Emotions created in such situations are uncomfortable so
attempts to alleviate dental fear/anxiety should be made. A promising and costeffective method to do this is music therapy. This method might be a means to control
dental anxiety/fear in the clinic.
VII.
SIGNIFICANCE OF THE STUDY
It is known that many people experience some degree of dental fear/anxiety.
They are so apprehensive of dental treatment that they avoid dental care at all cost.
Many will only seek treatment when they have dental emergency already.
Anxious patients may respond to their conditions in different ways. Patient may
have sweaty palms, increased heart rate and blood pressure, difficulty in breathing,
irritability, the need to go to the comfort room frequently, trembling and difficulty in
concentrating. These indications are readily recognizable, thus, should be controlled.
Music as a simple and cost-effective intervention to reduce the anxiety
experienced in limited time periods will have enormous impact on clinical practice
where patients wait and undergo invasive investigations, procedures or surgery.
Since the study will focus on dental extraction, which is considered as a stressful
procedure, the result of the study may lead to a better way of managing patients with
dental fear or at least lessen the degree of fear/ anxiety.
VIII.
DEFINITION OF TERMS
Dental Anxiety/Fear – feeling of apprehension before and/or during any dental
procedure
Music Therapy – use of music as a method for treatment
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IX.
METHODOLOGY
Research Design
An experimental study design will be used since the study involves
determination of the effectiveness of music therapy to dental extraction patients.
Participants
Fifteen patients of the UPCD Clinic indicated for extraction will be the
participants of the study. The following requirements should be met:
1. The patients should be healthy
2. The patients should have no systemic disease;
3. The patients should not be under any kind of medication;
4. The patients should have undergone dental extraction in the past;
5. The patients should have at least two teeth indicated for extraction
The patient’s assent will be required for him/her to be included in the study. In
the event that the patient will not finish the proposed treatment, or he/she decided to
back-out, he/she will then be excluded from the study.
Each participant will be a member of both the experimental and control group.
At least two teeth indicated for extraction for each participant is a very important
requirement since they will be undergoing extraction procedures twice. First extraction
will be done without music (control) while the second one will be done with music
(experimental).
Sampling Design
Random sampling will be done to acquire the participants in the study.
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Plan of Investigation
Screening of
walk-in patients
indicated for
extraction
BPs taken before,
during, and after
procedure
Briefing about
the study and
giving out of
consent forms
Second appointment
Second extraction
procedure
(Experimental Group)
First appointment
First extraction
procedure
(Control Group)
Measuring anxiety
level through
revised Corah’s
Dental Anxiety
Scale
Conventional
extraction
procedure in OS in
UPCD
BPs taken before,
during, and after
procedure
Measuring anxiety
level through
revised Corah’s
Dental Anxiety
Scale
Extraction
procedure done
with music
depending upon
the patient’s
preference
Data Analysis
Figure 2. Procedural Framework
Each of the fifteen participants will sign the consent forms. At the bottom of the
consent forms, there will be a part where they would write the type of music and/or the
songs of their choice. After interview, participants will answer a pre-treatment
questionnaire that will gauge the level of anxiety they are in at that moment. Then,
blood pressure will be taken using digital BP monitor immediately after the patient is
seated at the dental chair. Before and after injection of local anesthesia, BP will be taken
again. Also, BP will be measured after the procedure before the patient is dismissed.
After the dental procedure, they will again answer the post-treatment questionnaire.
At the 2nd appointment, same procedures will be done as the first appointment
except that they will listen to their music of choice once they are inside the OS room.
The music will be playing throughout the procedure.
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Data Management
Table 1. Blood Pressure Records during the First Extraction Procedure
Blood Pressure
Patient
Before
During
After
Table 2. Blood Pressure Records during the Second Extraction Procedure
Blood Pressure
Patient
Before
During
After
Table 3. Difference in Blood Pressure Measurements during the First and Second
Extraction Procedures
Blood Pressure
Patient
Before
During
After
Table 4. Difference in Scores in Pre Treatment and Post Treatment Questionnaire
Pre-Treatment
Post Treatment
Patient
Difference
Score
Score
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Interpretations and Conclusions
Expected findings
Results of the study will reveal if music therapy can indeed be used to decrease
the anxiety level of dental extraction patients. If this is so, then a cost-effective method
of anxiety intervention can be devised that can be suggested to be utilized in the UPCD
Clinic. This will, in turn, help in increasing the number of patient population in the
college who will finish treatment.
Generalizations and extrapolations of results
Results will be generalizable to the target population. Results may be
extrapolated to the Filipino population since students from UPCD come from different
geographical groups in the Philippines.
X.
ETHICAL CONSIDERATIONS
Consent forms will be filled out prior to the procedure to serve as proof that the
patient agreed to be a part of the study. Confidentiality of the identity of the
participants will be ensured since those forms will be under the safekeeping of the
proponents of the study.
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XI.
TIME TABLE
ACTIVITY
Administrative
Preparation
Social
Preparation
Feasibility
Study
Data
Collection
Data
Processing
Data Analysis
Writing of
Results
1st
October
2nd 3rd
4th
1st
November
2nd 3rd 4th
1st
December
2nd 3rd 4th
1st
January
2nd 3rd
4th
1st
February
2nd 3rd
4th
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XII. PERSONNEL AND FACILITIES
The study will be conducted in the Oral Surgery Room in the UPCD Clinic. Due to
time constraint, we will ask assistance from some classmates. They will be oriented first
about our study before helping us with the extraction procedures. A digital BP monitor
will be provided. Computers will be used for internet researches and the preparation
and writing of the research (i.e.: research proposal, survey questionnaire, and final
paper). A biostatistician will be asked to help us with our data analysis.
XIII. BUDGET
Personnel
Biostatistician
Honoraria and Tokens
Digital BP Monitor
Batteries
Office supplies
Bond Paper
P 200.00/ream x 2
Printer Ink
P 600.00/cartridge x 1
Stapler/Wires
Photocopying
Informed Consent
Survey Forms
Final Paper
Presentation of Results
Invitations
Refreshments
Binding
Contingency Fund
TOTAL
P 2, 500.00
P 1,000.00
P 1,500.00
P 2, 500.00
P 500.00
P 1, 050.00
P 400.00
P 600.00
P 50.00
P
270.00
P 20.00
P 50.00
P 200.00
P 1, 900.00
P 500.00
P 700.00
P 700.00
P 2, 000.00
P10, 720.00
XIV. WORKS CITED
Okada, Kaoru. , et al. “Effects of music therapy on autonomic nervous system activity,
incidence of heart failure events, and plasma cytokine and catecholamine levels
in elderly patients with cerebrovascular disease and dementia”. International
Heart Journal. 50.1 (2009): 95-110. PubMed. Web. 07 Oct. 2009
Magill, Lucanne, Levin, Tomer, and Lesley Spodek. “One-Session Music Therapy and CBT
for Critically Ill Cancer Patients”. Psychiatric Services. 59.10 (Oct 2008): 12161217. PubMed. Web. 07 Oct. 2009
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Tam, Wilson, Wong, Eliza, and Sheila Twinn. “Effect of music on procedure time and
sedation during colonoscopy: A meta-analysis”. World Journal of
Gastroenterology. 14.34 (Sept 2008): 5336-5343. PubMed. Web. 07 Oct. 2009
Mendoza, Mari-Sophia. “Music as a Stress Reliever during Dental Restorative
Procedures”. Unpublished Seminar Paper (DDM). University of the Philippines.
1997.
Sevilla, M. L. and Singson, M. P. “A Study of the Most Common Causes of Fear, Anxiety,
and Phobias Related to Dental Treatment”. Unpublished Seminar Paper (DDM).
University of the Philippines. 1982.
Galvez, Rica. “A Descriptive Study on the Determinants of Dental Anxiety and Coping
Modes among Patients in UPCD”. Unpublished Seminar Paper (DDM). University
of the Philippines. 1999
XV. PROPONENT’S BIODATA