ATTACHMENT C

EXAMPLES AND STUDIES OF THERAPEUTIC VALUE OF MUSIC IN DENTAL SURGERIES.

1.	European Court of Justice 

The European Court of Justice has recently ruled that dental practices that play background music in their surgeries for free do not have to pay royalties on the music played.  The Court was clear that dentists are not making any profits from the playing of music and are playing the music to a limited audience (their patients) so no royalties are due to musicians or songwriters. 

(Societa` Consortile Fonografici (SCF) v Marco Del Corso (Case C-135/10) 15 March 2012- http://curia.europa.eu/juris/document/document.jsf?text=&docid=120443&pageIndex=0&doclang=en&mode=doc&dir=&occ=first&part=1&cid=132980 )

See also related decision: 

Phonographic Performance (Ireland) Ltd v Ireland and another (Case C-162/10), Court of Justice of the European Union (ECJ), 15 March 2012: 
http://curia.europa.eu/juris/document/document.jsf?text=&docid=120461&pageIndex=0&doclang=EN&mode=doc&dir=&occ=first&part=1&cid=132963 

2.	Musical Intervention Reduces Patients’ Anxiety in Surgical Extraction of an Impacted Mandibular Third Molar.
Yu-Kyoung Kim, PhD, Soung-Min Kim, PhD, DDS,† and Hoon Myoung, PhD, DDS  Ref: J Oral Maxillofacial Surgery 69:1036-1045, 2011

This study looked at patients undergoing impacted mandibular third molar (IMTM) extraction.  Such patients often have severe perioperative anxiety, which may lead to increased perceptions of pain and vital sign instability throughout surgery. Intraoperational musical interventions have been used during operations to decrease patient anxiety levels.  The anxiolytic effects of musical intervention during surgical extraction of an IMTM were examined.  The hypothesis that musical intervention would have positive effects on patients' vital signs, anxiety levels, and perceptions of pain was examined.

The results of the study demonstrated that vital signs changed significantly throughout surgery according to the stage of the procedure.  For both groups, vital signs increased from baseline and reached peak values at the time of the initial incision and then decreased quickly and plateaued within normal limits.  There were no significant differences between groups in blood pressure; however, the music-treated group showed a significantly smaller change in heart rate than the control group.  The music-treated group reported significantly less intraoperative anxiety than the nonmusic-treated control group when controlling for preoperative anxiety levels (F = 4.226, P < .05).
It concluded that these results support the hypothesis that the use of patient-chosen music during surgical extraction of an IMTM significantly lowers patient intraoperative anxiety levels.

3.	Randomised controlled trial of music on state anxiety and physiological indices in patients undergoing root canal treatment
Hui-Ling Lai, Ming-Jay Hwang, Chia-Jung Chen, Kuei-Fen Chang, Tai-Chu Peng and Fwu-Mei Chang, Ref: Journal of Clinical Nursing (2008), 17, 2654–2660. 

The purpose of this randomised investigator-blind controlled trial is to examine the effects of music on the state anxiety and physiological indices among patients undergoing root canal treatment. Subjects in the music group listened to selected sedative music using headphones throughout the root canal treatment procedure.  The control group subjects worn headphones but without the music.  Using a repeated measures design with a single pre-test and five post-tests, the subjects’ heart rate, blood pressure and finger temperature were measured before the study and every 10 minutes until the end of the root canal treatment procedure.  Anxiety was measured before the study and at the end of the treatment procedure.

The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics, except for gender.  However, the subjects in the music group showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group.  The effect size for state anxiety and finger temperature was 0·34 and 0·14 respectively.  The findings provide evidence for nurses and dentists that the use of soothing music for anxiety reduction in patients undergoing root canal treatment procedures is supported by research findings.

4.	Music and Auditory Distraction Reduce Pain: Emotional or Attentional Effects?

Nicolas Silvestrini, PhD1, Vale´rie Piguet, MD2, Christine Cedraschi, PhD2, and Marcel R. Zentner, PhD1,3, Ref: Music and Medicine 2011 3: 264 originally published online 4 August 2011.  

This study investigated the impact of pleasant and unpleasant classical music on experimental pain, compared to silence and to an auditory attention task.  The purpose of this study was to answer the question: Is it possible to eliminate the stress connected with a visit to a dental office by music?  This study also sought to assess whether music influences dental patients’ tension, behaviour and treatability and whether these effects depend on sex, age, kind of dental treatment or the level of patient’s dental anxiety.

The evidence indicated that both music and the auditory attention task have a pain-reducing effect on pain ratings and pain tolerance but not on the nociceptive flexion reflex.  These results suggest that both positive emotions induced by the pleasant music and attention — especially selective attention — elicited by the attention task had a beneficial effect on pain ratings and pain tolerance.

5.	Does music during dental treatment make a difference?

Iwona Olszewska DDS, Maciej Ýarow DDS, PhD. Ref: The 81st General Session of the International Association for Dental Research (June 25-28, 2003) Poster 2726

Patients who were listening to music during the dental treatment showed lower level of tension, better treatability and better adjustment to all kinds of treatment.  Especially among patients with medium and high levels of anxiety music had a significant influence on their fear and comfort during the dental visit.  Music also had the biggest influence on better adjustment to dental treatment among patients with high and medium levels of anxiety.  The differences in tension levels among patients undergoing various kinds of treatments by music were not statistically significant.  However the influence of music on patient’s relaxation in all age and sex groups was not statistically significant.  Music was concluded to be a very useful tool in making the dental treatment more pleasant for the patient.

6.	Is there a role for music in reducing anxiety in plastic surgery minor operations?

H Sadideen, A Parikh, T Dobbs, A Pay, PS Critchley . Oxford University Hospitals NHS Trust,    UK, Ann R Coll Surg Engl  2012; 94: 152–154 

This study concluded that music appears to reduce intra-operative anxiety in awake patients in both the elective and trauma plastic surgical setting.  Easy listening music and chart classics appear to be suitable genres according to patients. 

7.	Extraction of a Grossly Decayed Tooth Without Local Anesthesia But With Audio
Analgesia: A Case Report 

Manish Bhagania and Anirudha Agnihotryl.  Ref:Music and Medicine 2011 3: NP.

Extraction of a tooth of a 28-year-old female patient was performed without local anaesthesia and with music.  This case report showed that music can induce analgesia during uncomplicated extraction of the lower left second premolar with prior application of a small amount of topical anaesthetic over gingiva.