Background. Dental anxiety is a significant cause of poor dental health. Because patients often prefer nonpharmacological interventions, the clinical effectiveness of clearly structured approaches is of particular interest. Methods. This prospective randomized controlled study compares a brief relaxation method (BR) with music distraction (MD) and with a con- trol group (C). The authors randomly assigned 90 patients with dental anxiety to BR, MD or C groups. They assessed the outcomes by means of the state anxiety subscale of the State-Trait Anxiety Inventory. Results. Both BR and MD reduced dental anxiety significantly. In con- trast, patients in the C group did not exhibit a significant change in their anxiety level. BR was significantly superior to MD. Stratification according to the patient’s general level of dental anxiety revealed that BR also was particularly effective in highly anxious subjects, whereas MD did not have a clinically relevant effect on these subjects. Conclusions. BR appears to be a safe, economically sound and effec- tive nonpharmacological approach to the short-term reduction of dental anxiety. Additional investigations are needed to validate these findings in a larger clinical trial and to determine the long-term effects of this intervention. Clinical Implications. Relaxation techniques are a pragmatic, effec- tive and cost-saving method of facilitating dental treatment in anxious patients. Key Words. Dental anxiety; complementary medicine; randomized controlled clinical trials. JADA 2008;139(3):317-324. D ental anxiety is a signifi- cant problem for patients and dental care pro- viders. Patients who have dental anxiety tend to avoid necessary treatment, and once in the dental chair, they often are difficult to treat. Misdiagnosis may even result from a dentist- patient relationship that is domi- nated by severe anxiety. 1 Avoidance of dental treatment owing to anxiety is common and appears to be associated strongly with significant deterioration of oral and dental health, 2 leading to a vicious cycle of cumulative anxiety and increasing avoidance. 3 Enkling and colleagues 4 conducted a demo- graphic survey and found that 11 percent of a German community sample experienced dental anxiety. While a survey of Norwegian sub- jects reported a prevalence of dental anxiety below 10 percent, 5 other studies have reported that the prevalence of high levels of dental anxiety ranged between 4 percent 6,7 and more than 20 percent. 6,8 Dental anxiety levels tend to be higher in ABSTRACT Dr. Lahmann is a senior physician, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Langerstrasse 3, Munich 81675, Germany, e-mail “lahmann@tum.de”. Address reprint requests to Dr. Lahmann. Dr. Schoen is a dentist in a dental clinic, Munich, Germany. Dr. Henningsen is a professor, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Germany. Dr. Ronel is a ward physician, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Germany. Dr. Muehlbacher is a senior physician, Department of Psychiatry 1, private medical university, Salzburg, Austria. Dr. Loew is a professor, Department of Psychosomatic Medicine, University Hospital of Regensburg, Germany. Dr. Tritt is a lecturer, Department of Psychosomatic Medicine, University Hospital of Regensburg, Germany. Dr. Nickel is a professor, Department of Psychosomatic Medicine and Psychotherapy, Medical University of Graz, Austria. Dr. Doering is a professor, Psychosomatics in Dentistry, Department of Prosthodontics, and a professor, Department of Psychosomatics and Psychotherapy, University of Münster, Germany. Brief relaxation versus music distraction in the treatment of dental anxiety A randomized controlled clinical trial Claas Lahmann, MD; Rainer Schoen, DMD; Peter Henningsen, MD; Joram Ronel, MD; Moritz Muehlbacher, MD; Thomas Loew, MD; Karin Tritt, PhD; Marius Nickel, MD; Stephan Doering, MD R E S E A R C H JADA, Vol. 139 http://jada.ada.org March 2008 317 Copyright © 2008 American Dental Association. All rights reserved.