REVIEW ARTICLE

https://doi.org/10.5005/jp-journals-10015-2578
World Journal of Dentistry
Volume 16 | Issue 1 | Year 2025

Effectiveness of Binaural Beats in Reduction of Anxiety among Children Undergoing Dental Treatment: A Systematic Review

Snehal S Kumthekar¹ https://orcid.org/0009-0009-4797-0016, Shivayogi M Hugar² https://orcid.org/0000-0003-3657-6709, Varunika V Sahai³ https://orcid.org/0009-0004-4986-9521, Bhuvanesh N Bhusari⁴ https://orcid.org/0000-0002-6619-3090, Niraj Gokhale⁵ https://orcid.org/0000-0003-4975-5167, Aishwarya A Patil⁶ https://orcid.org/0009-0000-3086-9872

^1–6Department of Pediatric and Preventive Dentistry, KLE Academy of Higher Education and Research, Vishwanath Katti Institute of Dental Sciences and Hospital, Belagavi, Karnataka, India

Corresponding Author: Shivayogi M Hugar, Department of Pediatric and Preventive Dentistry, KLE Academy of Higher Education and Research, Vishwanath Katti Institute of Dental Sciences and Hospital, Belagavi, Karnataka, India, Phone: +91 9986436448, e-mail: dr.hugarsm@gmail.com

Received: 11 January 2025; Accepted: 13 February 2025; Published on: 13 March 2025

ABSTRACT

Aim: To evaluate the effectiveness of binaural beats in minimizing anxiety among children undergoing dental treatment.

Background: Music therapy, binaural auditory beats in particular, provides significant anxiety relief by exposing each ear to slightly different frequencies, creating a perceived third frequency. Research shows that these beats influence brainwave patterns, promoting relaxation and concentration.

Review results: The review included randomized and nonrandomized trials comparing binaural beats with other music distraction aids in the reduction of anxiety among children undergoing dental treatment. Studies were quality-assessed and categorized as low, some concerns, or high. The search strategy initially identified 4,730 articles. Following a screening of titles and abstracts, 204 articles were shortlisted for full-text evaluation. In the end, only three articles met the eligibility criteria for inclusion in the systematic review.

Conclusion: Binaural auditory beats have demonstrated significant effectiveness in alleviating anxiety in children during dental procedures, owing to their capacity to synchronize brainwaves. The adoption of noninvasive, nonpharmacological psychotherapeutic approaches to reduce patient anxiety needs to be endorsed in dental environments.

Clinical significance: Binaural beats provide a noninvasive, cost-effective, and safe method to reduce dental anxiety, improving patient comfort, treatment efficiency, and overall satisfaction. This approach minimizes the need for pharmacological interventions, making it accessible and beneficial for widespread use in dental and other medical settings. By consolidating evidence, the review supports the adoption of binaural beats as an evidence-based tool for anxiety management.

Keywords: Anxiety, Binaural beats, Children, Dentistry

How to cite this article: Kumthekar SS, Hugar SM, Sahai VV, et al. Effectiveness of Binaural Beats in Reduction of Anxiety among Children Undergoing Dental Treatment: A Systematic Review. World J Dent 2025;16(1):74–79.

Source of support: Nil

Conflict of interest: None

INTRODUCTION

“The medicine of the future will be music and sound.” This statement by Edgar Cayce signifies the use of music in health sciences. In a child, the contributing factors for noncompliance or troublesome behavior during dental treatment encompass factors such as fear, momentary stress, previous aversive or grim dental procedures, insufficient preparatory measures for the procedure, and the impact of parental influences. Anxiety among patients due to unrealistic pain perception of certain customary procedures is more probable in dentistry than in any other field of health sciences. It is not only concerned with fear of pain or invasive procedures, but also the confrontation with unfamiliar people and environment and the experience of loss of control. Dentistry, as a branch, has an environment and knowledge that can stimulate the natural fear responses even in the adult population.¹

Apprehension and distress related to dentistry and oral treatments are prominent traits that lead to the evasion of dental services. Unease tied to the idea of seeing a dentist for check-ups and dental operations is known as dental apprehension.²

Dental apprehension evolves from many factors, suggesting that a singular therapeutic approach is not sufficient for its management. Throughout time, dental practitioners have adopted diverse strategies to lessen dental unease and improve patient calmness. Generally, dental apprehension possibly is addressed through nonmedical approaches, medication-based treatments, or integration of both, depending upon the severity of apprehension, the proficiency of the dentist, and the clinical context.³

Studies have shown that carefully selected music can impact neural patterns, inducing total tranquility and reducing discomfort and apprehension. Melodic interruption, a nonintrusive method, involves patients listening to soothing music during tense dental procedures. This approach is thought to lower neuroendocrine and sympathetic nervous system activity by promoting relaxation and diverting attention. Its efficacy has been observed in dental patients of all ages, including children and adults.⁴^,⁵

In the field of music intervention, binaural auditory beats have emerged as a noteworthy way to alleviate stress. Binaural beats entail exposure to separate frequencies in both ears, leading to the perception of a third frequency—the binaural beat. This acoustic occurrence is investigated for its potential to influence neural rhythms and induce a relaxed state and concentration. To achieve a relaxed state, a binaural tone with a frequency corresponding to alpha brainwaves (8–12 Hz) can be effective.⁶

Binaural beats have been shown to modify functional connectivity in the auditory cortex and significantly influence brainwave entrainment. This alpha wave stimulation may promote the release of endorphins, potentially resulting in a clinical relaxation effect in children.⁷

While literature highlights the application of binaural beats for anxiety reduction in children undergoing dental treatment, there is a lack of comprehensive review on their effectiveness. Hence, this study aims to fill this gap by being the first to analyze the impact of binaural beats on alleviating anxiety among children undergoing dental treatment.

Focused Question

Are binaural beats effective in alleviating anxiety among children undergoing dental treatment?

PICOST Format

P (Population): Pediatric patients undergoing dental treatment (3–12 years).

I (Intervention): Binaural beats.

C (Comparison): Other music distraction aids (white noise and monaural beats).

O (Outcome): Anxiety evaluation.

S (Study design): Randomized control trials, quasi-controlled trials and control clinical trial.

T (Time frame): Data collection from 1st January 2004 to 31st March 2024.

Objective

To evaluate the effectiveness of binaural beats in the alleviation of anxiety among children undergoing dental treatment.

METHODOLOGY

Protocol and Registration

This systematic review is registered with PROSPERO, the international prospective register of systematic reviews, funded by the National Institute for Health Research and managed by the Centre for Reviews and Dissemination (CRD), an academic department at the University of York. The registration number for this review is CRD42024503167, which can be accessed at https://www.crd.york.ac.uk/prospero/#recordDetails=CRD42024503167.⁸

Inclusion Criteria

The study must be conducted in a clinical context.
The study design which includes randomized controlled trials, quasi-randomized trials, or controlled clinical trials.
The study population of pediatric patients who are undergoing dental treatment.
A study evaluating an anxiety.
Study published from 1st January 2004 to 31st March 2024.
Studies written in English or in other languages provided they can be translated into English.

Exclusion Criteria

Articles are categorized as in vitro studies or review articles.
Studies involving children with special healthcare needs or other medical conditions.

Search Strategy

The search strategy for searching articles was the music distraction method used (i.e., binaural beats or monaural beats or 432 Hz or pink noise or music or Indian classical music or Hindustani music or 440 Hz or white noise) AND anxiety AND children AND dentistry.

For example:

Binaural beats AND anxiety AND children AND dentistry.
Monaural beats AND anxiety AND children AND dentistry.

In total, eight search strategies were formed with different music distraction methods used (i.e., binaural beats or monaural beats or 432 Hz or pink noise or music or Indian classical music or Hindustani music or 440 Hz or white noise) AND anxiety AND children AND dentistry (Table 1).

**Table 1:** Table showing search strategies used and articles in search
Search strategies	Articles in search
	PubMed	Google Scholar	Proquest	Science Direct	Cochrane Central
Binaural beats AND monaural beats AND anxiety AND children AND dentistry	01	114	206	03	01
Binaural beats AND 432 Hz AND anxiety AND children AND dentistry	00	44	01	00	00
Binaural beats AND pink noise AND anxiety AND children AND dentistry	00	199	606	02	00
Binaural beats AND music AND anxiety AND children AND dentistry	01	632	723	05	01
Binaural beats AND Indian classical music AND anxiety AND children AND dentistry	01	179	572	01	00
Binaural beats AND Hindustani music AND anxiety AND children AND dentistry	00	187	18	00	00
Binaural beats AND 440 Hz AND anxiety AND children AND dentistry	00	37	00	00	00
Binaural beats AND white music AND anxiety AND children AND dentistry	00	472	722	02	00
Total	03	1,864	2,848	13	02

Data were retrieved from databases including PubMed, Google Scholar, Science Direct, ProQuest, and Cochrane Central, covering the period from 1st January 2004 to 31st March 2024. Web searches were done from August to October 2024. Citation lists were examined to locate relevant studies. Physical searches were carried out to access full-text studies when electronic access was unavailable.

Study Selection

One reviewer (SK) separately examined titles and abstracts identified from the search process, ensuring they met inclusion criteria. Complete texts of all shortlisted studies were then acquired and thoroughly reviewed to determine their eligibility. In cases of uncertainty about a study’s inclusion, the issue was resolved through discussion with the second author (SMH). The calculated kappa score for agreement was found to be 0.79, which indicates moderate reliability. For articles considered for meta-analysis, quality assessment was conducted independently by SK and subsequently cross-verified by two other authors (SMH and VS). These steps ensured the systematic integration of studies into the systematic review. In studies we included in the systematic review, we did not find any with similar control groups and parameters. As a result, we were unable to perform a meta-analysis. All excluded studies were documented, along with the specific reasons for their exclusion (Fig. 1).

Fig. 1: PRISMA 2020 flow diagram depicting the process of selection and exclusion of articles at each step

RESULTS

A total of 4,730 articles were identified after the search. Upon screening for duplicates, 459 articles were found to be duplicates. After reviewing titles and abstracts, 4,067 studies were omitted as they did not correspond with the aims of the systematic review. The enduring 204 studies were sought for retrieval, but 166 could not be obtained, leading to their exclusion. In total, 38 studies were examined for complete text, and 35 were excluded for the following reasons: 2 articles had different study designs, 12 were in languages other than English, 2 did not include applicable comparison groups, and 19 had study populations older than 15 years. Ultimately, three studies were selected, qualitatively analyzed, and included in the review. In our systematic review, none of the included studies had comparable control groups or parameters. Consequently, a meta-analysis was not feasible.

Study Characteristics

This process followed a standardized outline. Study characteristics, including the author’s name, year of publication, sample size, age-group, study design, intervention group, comparator group, any additional groups evaluated, method of outcome assessment, and the author’s conclusions, were systematically tabulated for selected studies (Table 2).

**Table 2:** Table showing qualitative analysis of the studies selected for the systematic review
Sl. no.	Authors and year	Study design	Blinding	Age-group (years)	Control group (N)	Test group (N)	Other groups evaluated (N)	Method of assessment		Authors conclusion
								Objective	Subjective
1	Singh et al., 2020	Non RCT	No blinding	3–10	–	Binaural auditory beats	–	Pulse oximeter	Visual facial anxiety scale	Binaural beats can be used effectively as a noninvasive treatment modality to reduce anxiety in apprehensive pediatric patients
2	Bhusari et al., 2023	RCT	Double blinded	6–12	No music	Binaural auditory beats	Monaural beats	Pulse oximeter	Venham’s picture test	Binaural auditory beat was found to be most effective followed by monaural beat compared to control group
3	Padawe et al., 2023	RCT	Double blinded	3–10	White noise	Binaural auditory beats	–	Pulse oximeter	Venham’s picture test	Binaural beats are definitely effective in the reduction of dental anxiety due to their brainwave entrainment capability

Risk of Bias

The risk of bias for each study is presented visually using a figure, with studies categorized as ”some concerns” (yellow) or ”low risk” (green) of bias, based on the Risk-of-Bias Visualization (ROBVIS) tool. In Singh et al.’s⁹ study, the overall risk of bias indicated some concerns, primarily due to issues arising from the randomization process. In contrast, the Bhusari et al.’s¹⁰ and Padawe et al.’s¹¹ study demonstrated low risk of bias across all domains examined. Studies were assessed in five domains: randomization process, deviation from intended interventions, missing outcome data, measurement of the outcome, and bias in selection of the reported result. A summary of risk of bias for each individual study, along with assessments of bias for each domain, is provided (Figs 2 and 3).

Fig. 2: Graph showing summary of risk of bias: review authors’ judgments about each risk of bias item for each included study

Fig. 3: Graph showing risk of bias: review authors’ judgments about each risk of bias item presented as percentages across all included studies

DISCUSSION

Dental fear (DF) is a significant issue in pediatric dentistry, affecting approximately 20% of children. Both pharmacological and nonpharmacological interventions are valuable tools in managing and treating children experiencing DF.¹² Dental fear and anxiety (DFA) encompass the intense negative emotions linked with dental procedures, regardless of whether they meet the criteria for diagnosing dental phobia. Meanwhile, dental behavior management problems are determined by the dentist’s clinical observations and expertise. Dental anxiety is a multifaceted and intricate phenomenon. Various factors identified in the literature contribute to its development, such as individual personality traits, fear of pain, previous traumatic dental encounters, and the impact of family members or peers who experience dental anxiety, which can provoke fear in a child.¹³

The role of music in easing stress has been recognized in many health and psychological sectors. Integrating music into the clinic in dentistry has been shown to be effective in reducing stress and increasing patient comfort. Music can make people feel at peace, change the perception of external stress, and regulate emotional responses, making it useful for managing esteem anxiety. In the realm of music therapy, binaural auditory beats have gained attention as a potential method for reducing anxiety. Originating in the 19th century, binaural beats entail the presentation of subtly different frequencies to each ear, resulting in the perception of a third frequency, that is, “binaural beat.” Researchers have investigated this auditory phenomenon for its potential to influence brainwave activity and induce states of calmness and concentration.⁴^,⁵

The effectiveness of reducing anxiety through binaural auditory beats lies in the fact that audio incorporating these beats induces variation in brainwave activity. This alteration is prompted by the frequency of the binaural beats, leading to synchronization of brain activity, known as the frequency tracking response. By stimulating the reticular-thalamic activating system, sustained binaural beat frequencies reverberate across the brain through frequency-tracking response (FTR), thereby influencing arousal levels.¹⁴

The study conducted by Särkämö et al. examined how binaural and monaural beat stimulation affects attention and working memory in individuals with varying emotional levels. The results indicated no significant differences in performance on attention and working memory tasks under white noise, monaural beats, and binaural beats conditions. The study suggests that both binaural and monaural beats may similarly influence attention processing.¹⁵ A systematic review conducted in the year 2021 concluded that binaural beat stimulation has the potential to influence brain oscillatory activity, though the evidence remains inconclusive. However, our systematic review concludes that binaural beats can effectively calm the patient and thus help in the reduction of anxiety while undergoing dental treatment. Some studies indicate that binaural beats can entrain brain waves, bringing about improvements in mental functions such as concentration, retention, and relaxation. However, other studies report minimal or no significant effects, suggesting that the impact of binaural beats may vary depending on individual differences or experimental conditions.¹⁶

The systematic review conducted by Gori et al. in 2021 examines the effectiveness of music therapy in reducing anxiety during dental procedures, which concluded that music is a helpful tool for managing stress, with patients reporting improved relaxation and comfort during treatments. This systematic review focuses specifically on music as a therapeutic intervention to reduce anxiety during dental procedures, exploring its effectiveness across various patient groups, while our systematic review on binaural beats narrows the focus to a specific auditory intervention, examining its impact on anxiety reduction in children undergoing dental treatment.¹⁷

The systematic review on auditory distraction techniques focused on various auditory distraction methods, including music, white noise, and nature sounds, to manage dental anxiety. The findings suggest that auditory distractions are effective in lowering anxiety, though the effectiveness varies depending on the type of auditory stimulus and the patient’s characteristics. Our study focuses specifically on binaural beats as a targeted auditory intervention, while this review examines a broader range of auditory techniques, such as music and sound therapies, and their effectiveness across various patient groups.¹⁸

The study done by Peterson et al. in 2019 explores how binaural and monaural beat stimulation affect cognitive functioning in individuals with different emotional levels. The findings suggest that both types of beat stimulation can influence cognitive performance, but the effects may vary depending on the individual’s emotional state.¹⁹

The review on 2019 assessed the use of music therapy in pediatric dentistry, focusing on its ability to reduce preprocedural anxiety in children. It concluded that music therapy is an effective and enjoyable method for calming anxious pediatric patients, particularly when used before and during dental treatments. Our systematic review concentrates on binaural beats, whereas this review discusses music therapy as a tool for anxiety reduction. Both reviews underline the positive effects on children undergoing dental treatments, though they assess different auditory approaches.²⁰

The results of our systematic review concluded that binaural auditory beats are effective in reducing anxiety in this context, consistent with the findings of Jadhav in the year 2024.²¹

The summary of the effectiveness of music distraction aids mentioned in this systematic review in the reduction of anxiety among children undergoing dental treatment is compiled in Table 3.

**Table 3:** Table showing effectiveness of music distraction aids in reduction of anxiety among children undergoing dental treatment
SI. no.	Author	Music distraction aids	Outcomes		Conclusion
			Reduction in physiological parameters of anxiety	Reduction in anxiety rating scales
1.	Singh et al.	Binaural beats	↓↓	↓↓	Binaural beats were effective
2.	Bhusari et al.	Binaural beats	↓↓	↓↓	Binaural beats were effective followed by monaural beats compared to no music
		Monaural beats	↓	↓
		No music	–	–
3.	Padawe et al.	Binaural beats	↓↓	↓↓	Binaural beats were effective
3.	Padawe et al.	White noise	↓	↓	Binaural beats were effective

↓, effective in anxiety reduction; ↓↓, more effective in anxiety reduction

The study had some limitations. We might have considered studies investigating the impact of binaural auditory beats on pain reduction during dental procedures. We were unable to include studies that could not be translated into English. Additionally, we could have included research exploring their effects on various medical conditions. Moreover, this study did not cover the use of binaural auditory beats in managing mood and behavior in dental settings. Furthermore, recommending further well-designed randomized controlled clinical trials with larger participant groups is advisable. Future research could investigate how various frequencies of binaural beats and frequency modulation impact anxiety reduction in children undergoing dental treatment. Such studies might offer valuable insights into enhancing auditory interventions for anxiety relief, potentially resulting in more effective and personalized therapeutic methods.

CONCLUSION

This study highlights the impact of binaural auditory beats and other music distraction aids in alleviating anxiety in children undergoing dental treatment. Hence, this study has concluded that binaural auditory beats are proven to be most effective in alleviating anxiety in children undergoing dental treatment due to their brainwave entrainment capability.

Clinical Significance

Binaural beats provide a noninvasive, cost-effective, and safe method to reduce dental anxiety, improving patient comfort, treatment efficiency, and overall satisfaction. This approach minimizes the need for pharmacological interventions, making it accessible and beneficial for widespread use in dental and other medical settings. By consolidating evidence, the review supports the adoption of binaural beats as an evidence-based tool for anxiety management.

ORCID

Snehal S Kumthekar https://orcid.org/0009-0009-4797-0016

Shivayogi M Hugar https://orcid.org/0000-0003-3657-6709

Varunika V Sahai https://orcid.org/0009-0004-4986-9521

Bhuvanesh N Bhusari https://orcid.org/0000-0002-6619-3090

Niraj Gokhale https://orcid.org/0000-0003-4975-5167

Aishwarya A Patil https://orcid.org/0009-0000-3086-9872

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