Aromatherapy and dental anxiety

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The prevalence of dental anxiety is reported to be between 54-92% and has been managed using pharmacological and non-pharmacological methods.  The use of essential oils in aromatherapy has been used to improve mood and relieve pain and it has been used to treat anxiety disorders including a number of studies of dental anxiety.

The aim of this review was to evaluate the efficacy of aromatherapy on dental anxiety.

Methods

Searches were conducted in the PubMed, Embase Cochrane Database of Systematic Reviews (CDSR), the Cochrane Central Register of Controlled Trials (CENTRAL) the China National Knowledge Infrastructure (CNKI), ClinicalTrials.gov and the International Clinical Trials Registry Platform, The ProQuest Dissertation Abstracts and Thesis database, The Conference Proceedings Citation Index-Science was searched via Web of Science and OpenGrey databases.  Randomised controlled trials (RCTs) and quasi-randomised controlled clinical trials (CCTs) comparing an aromatherapy approach with a control or other to dental anxiety control (eg music) and published in English or Chinese were considered. Two reviewers screened the studies and extracted data independently. Risk of bias was also assessed independently by two reviewers using the Cochrane risk of bias tool for RCTs, with CCTs being assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) checklist. A narrative synthesis was presented owing to study heterogeneity.

Results

  • 17 studies (11 RCTs, 6 CCTs) involving a total of 2499 patients were included.
  • 11 studies evaluated lavender fagrance, 6 orange odour with apple scent, rose fragrance and Cabe Jawa (Piper retrofraktrum Vahl) being tested in single studies.
  • The overall risk of bias for the 11 RCTs was high or unclear and moderate to serious for the CCTs.
  • No adverse events were reported in any included studies.
  • Compared to the negative control condition, aromatherapy might reduce the anxiety-related physiological parameters and psychometric rating, pain, and mood, alertness, and calmness compared to the negative control condition; and there might be no intergroup difference in such outcomes between aromatherapy and music.
  • The overall certainty of evidence in the current systematic review was rated to be low to very low.

Conclusions

The authors concluded: –

Compared to the negative control condition, aromatherapy is more effective to reduce dental anxiety and has comparable effects on dental anxiety compared to music intervention; however, the certainty of evidence is relatively limited. Further high-quality randomised trials with robust study design and large sample size are warranted to confirm our findings and to confirm the role of aromatherapy in relieving dental anxiety.

Comments

The authors have undertaken a wide database search and included articles in both English and Chinese although there is the possibility that there may be relevant studies in other languages.  While 17 studies have been included there is a concern regarding the levels of bias with few of the RCTs being at low risk of bias for two key domains of random sequence generation and allocation concealment. There were also concerns in relation to the blinding’s of participants, staff and the outcome assessors. Because of the heterogeneity of study designs used the types and timing of outcome measures the variety of procedure undertaken and characteristics of the patients meta-analysis was not possible. So, while findings suggest that aromatherapy may have some benefit in relation to dental anxiety the certainty of the evidence is rated as low to very low using the GRADE assessment approach.  The authors conclusion that further high quality studies are needed to confirm any role for aromatherapy is clearly warranted.

Links

Primary Paper

 Cai H, Xi P, Zhong L, Chen J, Liang X. Efficacy of aromatherapy on dental anxiety: A systematic review of randomised and quasi-randomised controlled trials. Oral Dis. 2020 Apr 8. doi: 10.1111/odi.13346. Epub ahead of print. PMID: 32267044.

Review protocol on PROSPERO

Other references

Dental Elf – 7th Oct 2020

Dental Anxiety: Prevalence in children and adolescents

Dental Elf – 10th Jun 2019

Distraction techniques for managing dental anxiety in children and adolescents

Dental Elf – 12th Jun 2019

Dental fear and anxiety: Is it related to negative oral health beliefs?

 

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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