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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 131-134

Effect of aromatherapy on dental patient anxiety: A randomized controlled trial


1 Department of Public Health Dentistry, Nanded Rural Dental College and Research Center, Nanded, Maharashtra, India
2 Department of Public Health Dentistry, Mamata Dental College, Khammam, Telangana, India
3 Department of Public Health Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
4 Department of Public Health Dentistry, Saint Joseph Dental College, Eluru, Andhra Pradesh, India

Date of Web Publication10-Jun-2016

Correspondence Address:
M Venkataramana
Department of Public Health Dentistry, Nanded Rural Dental College and Research Center, Nanded, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.183805

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  Abstract 


Introduction: Dental anxiety is a common and potentially distressing problem, both for the patients and for dental practitioners. It is considered to be the main barrier and affects the working lives of dental professional potentially compromising their performance. Aim: To know the effect of aromatherapy in the reduction of dental anxiety and to compare the anxiety levels of dental patients with the control group. Materials and Methods: A randomized controlled trial design was used. Of 40 dental clinics in Khammam town, 10 dental clinics were selected by simple random sampling method. A total of 100 patients attending the dental clinic for the first time were included in the study. Ambient odor of lavender was maintained with a candle warmer. A questionnaire comprising demographic information, smoking status, Modified dental anxiety scale (Humphries et al. in 1995), was given to the patients when they were waiting in the waiting room. Student's t-test and ANOVA test were used for data analysis. The level of significance was set at 0.05. Results: Considerable decrease in anxiety scores in 3 age groups was observed. A statistically significant (P = 0.002) decrease with age in mean anxiety score. A significant difference in anxiety scores of lavender group, a significant decrease of anxiety scores with an increase of age. Conclusion: Lavender decreased the current anxiety scores of patients effectively.

Keywords: Aromatherapy, dental anxiety, Humphries Scale


How to cite this article:
Venkataramana M, Pratap K, Padma M, Kalyan S, Reddy A A, Sandhya P. Effect of aromatherapy on dental patient anxiety: A randomized controlled trial. J Indian Assoc Public Health Dent 2016;14:131-4

How to cite this URL:
Venkataramana M, Pratap K, Padma M, Kalyan S, Reddy A A, Sandhya P. Effect of aromatherapy on dental patient anxiety: A randomized controlled trial. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 May 25];14:131-4. Available from: http://www.jiaphd.org/text.asp?2016/14/2/131/183805




  Introduction Top


Dental procedures frequently evoke considerable degrees of anxiety,[1],[2],[3],[4] especially when preceded by anxious waiting in the dental clinic and lack of information on the dental procedures.[5] Dental anxiety has been defined as an “abnormal fear or dread of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures” and can have physiological, cognitive, and behavioral consequence.[6],[7] The prevalence of dental anxiety in a representative sample of Australians was 14.9%.[8] In a survey of 300 German residents, the rate of dental anxiety was 11%.[9]

Dental anxiety also affects the working lives of dental professionals. Dealing with anxious patients leads to increased tension that may potentially compromise performance. Increased time per visit may be required. Managing dental anxiety has been suggested as one of the most difficult tasks for dental practitioners.[10],[11],[12] Anxiety usually managed by both pharmacologically and nonpharmacological methods. One common way of managing anxiety in the dental surgery is through conscious sedation or general anesthesia.[6] Pharmacologic management of anxiety can significantly improve patient outcomes; however, it is associated with some risks require additional equipment and cannot be applied to the patients with allergies and other medications.[13] Different side effects such as fatigue, confusion, and restlessness are evident.

A remarkable increase in the use of complementary and alternative medicine (CAM) around the globe is evidenced.[14] Aromatherapy is a commonly used CAM and one of the nonpharmacological strategies that has long been regarded as a popular means of treatment for anxiety. It involves the therapeutic use of essential, aromatic oils with excitation of the olfactory system, to induce relaxation, and thus quell certain anxiety symptoms.[14],[15] Aromatherapy is claimed to be beneficial to the mental, psychologic, spiritual, and social aspects. With respect to safety, it is reported that that aromatherapy is relatively free of adverse effects compared with conventional drugs.[14],[16]

Lavender (Lavandula angustifolia and Lavandula stoechas, from the Labiatae family) is a plant with an anxiolytic and relaxing aroma. Main components of lavender are linalool, a sedative agent which affects gamma-amino butyric acid receptors in the central nervous system and linalyl acetate a narcotic agent.[17] Previous studies confirmed the positive effects of lavender on examination anxiety.[18],[19] There have been very few studies evaluating the effect of lavender on dental anxiety. Hence, this study conducted with an aim to know the effect of aromatherapy on dental patient anxiety.


  Materials and Methods Top


A randomized controlled trial was conducted on an age group of 18–60 years old outpatients of the selected dental clinics in Khammam town, Telangana state with another group of outpatients of the dental clinics in the same geographic area as controls. Ethical clearance was obtained from of Institution Ethical Committee. Permission was obtained from practitioners of private dental clinics, and informed consent was taken from the patients before the start of the study.

Of 40 dental clinics, 10 dental clinics in Khammam town were selected by simple random sampling method [Figure 1]. Randomly five dental clinics were allotted into the lavender group and other five for the control group. The study was carried out on 100 subjects and patients attending dental clinics for the first time were included. Patients with respiratory allergies were excluded. In each group, 50 subjects were participated with no loss on follow-up.
Figure 1: Consort diagram of the study

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Ambient odor of lavender essential oil was maintained through a candle warmer. The candle warmer comprised a lower compartment with an aroma free candle and an upper compartment containing water, either with lavender conditioned or without lavender oil. The oil was diffused via candle warmer. The same candle warmer was used in the control condition. However, lavender oil was replaced by plain water, applied in a similar manner. In both cases, the candles used were aroma free.

Patients were asked to fill the questionnaire after waiting for 15 min in respected waiting rooms. Questionnaire was translated to local Telugu language and reliability was checked by test-retest method among 10 participants who completed the questionnaire with 2 weeks apart. Questionnaire was administered in both English and Telugu languages. Questionnaire consists of demographic information on age, gender, and smoking status. Dental anxiety was measured by the Modified Dental Anxiety Scale given by Humphris et al. in 1995.[20] This five-item questionnaire is measured on a Likert scale from 1 to 5 with higher scores indicating higher anxiety. Collected data were analyzed using SPSS version 18.0 (SPSS, Chicago, IL, USA). Student's t-test and ANOVA test were used for data analysis. Level of significance was set at 0.05.


  Results Top


The mean age of subjects in lavender group and control group were 37 (standard deviation [SD]-14) years and 33 (SD-9) years, respectively. In control group, 27 males and 23 females and in lavender group 31 were males, and 19 were females. There was significant difference in the anxiety scores between lavender and control groups (P = 0.001) [Table 1]. The patients were divided into three age groups (15–24 years, 25–34 years, 35 years, and above), there was a considerable decrease in anxiety scores in 3 age groups. A statistically significant (P = 0.002) decrease with age in mean anxiety score [Table 2]. Female population had much-decreased anxiety levels in lavender conditioned group [Table 3].
Table 1: Comparison of lavender and control groups with respect to anxiety scores

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Table 2: Comparison of three age groups with anxiety scores in lavender, control

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Table 3: Comparison of male and female with respect to anxiety scores by t-test in each group

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  Discussion Top


It is widely believed that odors have the power to influence emotional states in humans.[21],[22],[23] Here, dentist waiting room which is always a highly anxious place for patients is taken in the study.

Patients exposed to lavender essential oil had lower level of anxiety, and confirmed the previous notion of sedative properties of natural essential oils and extended its use in dental settings.[22],[24]

The mode of action of essential oils in inducing emotional changes is currently unknown. For instance, lavender essential has been demonstrated to act postsynaptically, and it is suggested that it modulate the activity of cyclic adenosine monophosphate (c AMP). A reduction in c AMP activity is associated with sedation.[6]

Anxiety scores significantly decreased for lavender group with an increase in age and it was unchanged in control group. This study findings were similar to the study conducted by Akbay Oba et al.[25] and Edwards and Fillingim [26] Females showed significant decrease in anxiety levels than males in both groups consistent with the studies conducted by Toet et al.[27] and Marchand and Arsenault.[28]

This study provides evidence in favor of the use of lavender scent in dental settings as a low cost, simple intervention for alleviating dental patient anxiety and supports the traditional use of essential oils in altering emotional states. Lavender is an effective means of reducing current anxiety levels and should be perceived as a means of “on-the-spot” reduction of anxiety.

As we did not include a control odor, the lavender scent might have simply masked odors in the dental surgery that patients associate with dentistry. Since the study was conducted on small sample, future work should consider including a control odor condition in replicating this study on a larger scale.


  Conclusion Top


Inhalation aromatherapy had positive effects on reducing anxiety in patient before the surgery which is recommended as a new and easy alternative to reduce anxiety in the patients before treatment. Lavender decreased the current anxiety scores of patients effectively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Stabholz A, Peretz B. Dental anxiety among patients prior to different dental treatments. Int Dent J 1999;49:90-4.  Back to cited text no. 1
    
2.
Bodner E, Iancu I. Recalling the threat: Dental anxiety in patients waiting for dental surgery. Isr J Psychiatry Relat Sci 2013;50:61-6.  Back to cited text no. 2
    
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Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: A systematic review. J Endod 2011;37:429-38.  Back to cited text no. 3
    
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Fox C, Newton JT. A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children. Community Dent Oral Epidemiol 2006;34:455-9.  Back to cited text no. 5
    
6.
Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental patient anxiety levels: A cluster randomised-controlled trial. Community Dent Oral Epidemiol 2010;38:83-7.  Back to cited text no. 6
    
7.
Locker D. An Introduction to Behavioural Science and Dentistry. London: Tavistock Routledge; 1989. p. 145-60.  Back to cited text no. 7
    
8.
Thomson WM, Stewart JF, Carter KD, Spencer AJ. Dental anxiety among Australians. Int Dent J 1996;46:320-4.  Back to cited text no. 8
    
9.
Enkling N, Marwinski G, Jöhren P. Dental anxiety in a representative sample of residents of a large German city. Clin Oral Investig 2006;10:84-91.  Back to cited text no. 9
    
10.
Humphris G, Ling MS. Behavioural Sciences for Dentistry. Edinburgh: Churchill Livingstone; 2000. p. 71-85.  Back to cited text no. 10
    
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Kleinknecht RA, Klepac RK, Alexander LD. Origins and characteristics of fear of dentistry. J Am Dent Assoc 1973;86:842-8.  Back to cited text no. 11
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12.
Kent GG, Blinkhorn AS. The Psychology of Dental Care. 2nd ed. Oxford: Wright; 1991. p. 55-98.  Back to cited text no. 12
    
13.
Coulthard P. Conscious sedation guidance. Evid Based Dent 2006;7:90-1.  Back to cited text no. 13
    
14.
Lee YL, Wu Y, Tsang HW, Leung AY, Cheung WM. A systematic review on the anxiolytic effects of aromatherapy in people with anxiety symptoms. J Altern Complement Med 2011;17:101-8.  Back to cited text no. 14
    
15.
Kite SM, Maher EJ, Anderson K, Young T, Young J, Wood J, et al. Development of an aromatherapy service at a cancer centre. Palliat Med 1998;12:171-80.  Back to cited text no. 15
    
16.
Perry N, Perry E. Aromatherapy in the management of psychiatric disorders: Clinical and neuropharmacological perspectives. CNS Drugs 2006;20:257-80.  Back to cited text no. 16
    
17.
Perry R, Terry R, Watson LK, Ernst E. Is lavender an anxiolytic drug? A systematic review of randomised clinical trials. Phytomedicine 2012;19:825-35.  Back to cited text no. 17
    
18.
Re L, Barocci S, Sonnino S, Mencarelli A, Vivani C, Paolucci G, et al. Linalool modifies the nicotinic receptor-ion channel kinetics at the mouse neuromuscular junction. Pharmacol Res 2000;42:177-82.  Back to cited text no. 18
    
19.
Kutlu AK, Yılmaz E, Çeçen D. Effects of aroma inhalation on examination anxiety. Teach Learn Nurs 2008;3:125-30.  Back to cited text no. 19
    
20.
Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: Validation and United Kingdom norms. Community Dent Health 1995;12:143-50.  Back to cited text no. 20
    
21.
Burnett KM, Solterbeck LA, Strapp CM. Scent and mood state following an anxiety-provoking task. Psychol Rep 2004;95:707-22.  Back to cited text no. 21
    
22.
Lis-Balchin M, Hart S. Studies on the mode of action of the essential oil of lavender (Lavandula angustifolia P. Miller). Phytother Res 1999;13:540-2.  Back to cited text no. 22
    
23.
Robins JL. The science and art of aromatherapy. J Holist Nurs 1999;17:5-17.  Back to cited text no. 23
    
24.
Lehrner J, Marwinski G, Lehr S, Johren P, Deecke L. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiol Behav 2005;86:92-5.  Back to cited text no. 24
    
25.
Akbay Oba A, Dülgergil CT, Sönmez IS. Prevalence of dental anxiety in 7- to 11-year-old children and its relationship to dental caries. Med Princ Pract 2009;18:453-7.  Back to cited text no. 25
    
26.
Edwards RR, Fillingim RB. Age-associated differences in responses to noxious stimuli. J Gerontol A Biol Sci Med Sci 2001;56:M180-5.  Back to cited text no. 26
    
27.
Toet A, Smeets MA, van Dijk E, Dijkstra D, van den Reijen L. Effects of pleasant ambient fragrances on dental fear: Comparing apples and oranges. Chemosens Percept 2010;3:182-9.  Back to cited text no. 27
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28.
Marchand S, Arsenault P. Odors modulate pain perception: A gender-specific effect. Physiol Behav 2002;76:251-6.  Back to cited text no. 28
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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