This clinical study was conducted in 2020. The study population included patients who applied to a private dental office of a maxillofacial surgeon for the removal of the third mandibular molar with mesioanglular-impacted (class 2B according to the Pell and Gregory classification). The reason for choosing this impaction was associated with its relatively high prevalence in the population (18).
The sample size was estimated at 88 (44 in the intervention group and 44 in the control group) based on the results of a study by Keilani et al. (nineteen). Inclusion criteria: age from 18 to 25 years, the presence of a third mandibular molar with a mesio-angle stroke of class 2B according to the Pell and Gregory classification, the absence of somatic, cardiovascular, pulmonary and liver diseases, as well as known hearing impairment according to the patient's opinion, maximum systolic pressure. Blood pressure 15.9 and maximum diastolic blood pressure 10.9 mm Hg, suffering from unknown mental disorders, having a moderate level of anxiety (determined using the DASS-21 questionnaire) and wishing to participate in the study. Exclusion criteria included taking medication associated with anxiety (anxiety or anxiety) 72 hours before dental treatment and any dental emergencies such as vasovagal syncope and allergies.
To homogenize the anxiety level samples, the DASS-21 questionnaire was first completed by all patients; the study included patients with moderate anxiety. The DASS-21 questionnaire consists of 3 parts, each of which contains 7 questions. A score from 0 to 3 is considered for each question, and the final score for each component is obtained by summing the scores for the relevant questions. Since the DASS-21 is a short form of the original 42-item DASS, the final score for each component was doubled and symptom severity was assessed using the corresponding table (20).
The samples were casually divided into a control group (without music) and two intervention groups (with music) depending on the days of treatment. In the intervention group, soft instrumental music sounded from the moment patients entered the operating room until the end of the operation, when the patient finished and left the room. The type of music in the present study was chosen in accordance with a study by Maleki et al., Who studied the effect of Love Rain music on anxiety reduction in endodontic treatment. The "Rain of Love" CD contains 60–90 minutes of instrumental music. In a study by Maleki et al., This music was rated and selected as relaxing music by a neurologist/neuroscientist, dental specialist and psychiatrist (21).
In the present study, the pain and anxiety levels of patients in both groups were measured using a visual analogue scale (VAS) (22). VAS is a measure with a 10 cm line that ranges from zero to ten, where zero means no pain or anxiety, and ten means most pain or anxiety. The patient determined the intensity of his pain/anxiety on the line. The pain / anxiety intensity was then calculated to a millimeter from zero. This index was used to determine the level of pre- and postoperative anxiety in patients, as well as their postoperative pain (22).
Surgery procedure: First, lidocaine gel was applied. The patient was then anesthetized using 2 cartridges of 2% lidocaine with epinephrine 1: 80,000 and a 27 gauge long needle in the form of inferior alveolar nerve block and long buccal nerve anesthesia. Then, an envelope flap was inserted into the desired place, and after the removal of the bone and the incision of the tooth, the impacted tooth was removed. As a result, the site was sutured up with a 0.3 suture. It should be noted that all surgical interventions were performed by a maxillofacial surgeon.
Data was fed into SPSS version 25. The data were described using mean, standard deviation, and median. Since the pain and anxiety variables were quantitative, the normal distribution was evaluated by the Shapiro-Wilk test. To analyzed the data, Pearson Chi-Square, Mann-Whitney, and repeated measures ANOVA tests were employed with a significance level of less than 0.05.