Comparison of melatonin and music therapy as a preoperative anxiolytic for patients undergoing impacted mandibular third molar extraction: a double-blind randomised controlled trial

Abstract

Dental preoperative anxiety poses significant challenges in healthcare, leading to treatment avoidance and prolonged recovery times. Despite the plethora of pharmacological and psychotherapeutic interventions employed for anxiety management, their relative efficacy remains unclear. This study aims to compare the effectiveness of oral melatonin (6 mg) and music therapy in preoperative anxiety management among patients undergoing surgical extraction of impacted mandibular third molars. A total of 78 patients aged 18–40 years undergoing surgical extraction were selected and randomly assigned into three groups: nil intervention (Group NI) with no intervention, Group ML administered oral melatonin, and Group MT administered 20 min of relaxing music (n = 26). Physiological parameters (pulse rate, blood pressure) and subjective assessments (visual analogue scale for anxiety) were measured on arrival (T1), after the intervention (T2), and after surgical extraction (T3). Salivary cortisol levels, recorded preoperatively and postoperatively, were analysed using ELISA. Results showed significant improvement in physiological parameters for both ML and MT compared with NI (p < 0.05). However, postoperative cortisol levels increased significantly in the NI (0.55 (0.15) - 0.88 (0.32) pmol/ml) and MT groups (from 0.33 (0.15) - 0.62 (0.2) pmol/ml) but decreased in the ML group (from 0.42 (0.19) - 0.3 (0.14) pmol/ml). This indicated a delayed action of melatonin as compared with the immediate impact of music therapy. Understanding the mechanisms and insights obtained can aid in developing advanced anxiety management methods for dental practitioners, thereby enhancing patient care and outcomes in dental practice.