Effect of binaural beats and isochronic tones on anxiety during mandibular third molar surgery

Objective: Dental procedures, particularly the surgical extraction of impacted mandibular third molars, can lead to high levels of anxiety in patients, which may negatively affect patient cooperation. In recent years, acoustic neurostimulation techniques, emerging as alternatives to traditional music therapy, have gained attention for their potential to reduce anxiety through brainwave entrainment (BWE). This study aims to comparatively evaluate the effects of two common forms of auditory stimulation—binaural beats (BB) and isochronic tones (IT)—on dental anxiety during the extraction of impacted mandibular third molars using both subjective anxiety scales and objective physiological parameters. Materials and Methods: This randomized controlled trial included 90 patients scheduled for impacted mandibular third molar extraction. Participants were randomly assigned to one of three groups: binaural beats (BB), isochronic tones (IT), or control. During the procedure, patients in the BB and IT groups listened to auditory stimuli via headphones, while the control group received no auditory input. Anxiety levels were assessed before and after the procedure using the Modified Dental Anxiety Scale (MDAS), Dental Fear Scale (DFS), State Anxiety Inventory (STAI-S), and Visual Analog Scales (VAS-anxiety) for anxiety and pain. Physiological parameters (heart rate, respiratory rate, systolic and diastolic blood pressure, and oxygen saturation) were recorded at eight predefined stages of the operation. Results: In the BB and IT groups, statistically significant reductions in respiratory rate and heart rate were observed after the 5-minute preoperative listening period and in the postoperative phase, whereas the control group showed increases between the anesthesia and extraction stages. Systolic blood pressure was lower in the BB group during the incision stage, and respiratory rate was lower in the IT group during anesthesia compared to other groups (p<0.05). Postoperative DFS scores significantly decreased in both the BB and IT groups (p<0.05). Although STAI-S, MDAS, and VAS-anxiety scores decreased in all groups, no significant differences were found between them (p>0.05). In the postoperative satisfaction survey, 78.3% of participants indicated they would prefer to receive the same auditory stimulation again. Conclusion: The findings suggest that auditory stimulation techniques such as binaural beats and isochronic tones may be effective in reducing dental anxiety during the surgical extraction of impacted third molars. These methods offer innovative, non-pharmacological support strategies for clinical dental practice. Future research should investigate underlying neurophysiological mechanisms using objective markers such as electroencephalography (EEG) and focus on developing standardized application protocols.