title: Can ambient orange fragrance reduce patient anxiety during surgical removal of impacted mandibular third molars?
abstract: OBJECTIVE
  To investigate whether ambient orange fragrance, compared with no fragrance, can reduce patient anxiety before and during surgical removal of an impacted mandibular third molar.
  
  
  METHODS
  In the present randomized clinical trial, the patients who required extraction of an impacted mandibular third molar and fulfilled the predetermined criteria were included. A dental anxiety scale (DAS) questionnaire was used to determine the anxiety level of the patients before surgery. Only patients with moderate and high anxiety levels (DAS scale ≥ 9 to ≤ 14) were included. The predictor variable was fragrance exposure. The fragrance group was exposed to orange fragrance, and the control group was exposed to no fragrance. The outcome variables were physiologic measures related to anxiety, including the mean blood pressure, respiratory rate, and pulse rate. The physiologic vital changes were determined before and during the surgical procedure. The data were analyzed using the independent t test, χ(2) test, and Mann-Whitney U test (Statistical Package for Social Sciences, version 16; α = 0.05).
  
  
  RESULTS
  A total of 56 patients fulfilled the inclusion criteria (fragrance group, 19 males and 9 females; no-fragrance group, 12 males and 16 females). Before entering the waiting room, the patients' vital signs were recorded twice. No significant differences were found between the 2 groups. The mean blood pressure, pulse rate, and respiratory rate were significantly lower in the fragrance group during surgery (from sitting in the dental chair to the end of surgery; P < .05).
  
  
  CONCLUSIONS
  The results of our study have shown that orange fragrance is effective in reducing the anxiety related to surgical removal of an impacted mandibular third molar.
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Torabinejad Dental Research Center, Isfahan University of Medical Sciences School of Dentistry, Isfahan, Iran.
authors.forename: Dariush
authors.initials: D
authors.lastname: Hasheminia
authors.affiliation: Dental Student, Dental Students Research Center, Isfahan University of Medical Sciences, School of Dentistry, Isfahan, Iran.
authors.forename: Mahmood Reza
authors.initials: MR
authors.lastname: Kalantar Motamedi
authors.affiliation: General Dentist, Private Office, Isfahan, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Karimi Ahmadabadi
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Zahedan University of Medical Sciences, School of Dentistry, Zahedan, Iran.
authors.forename: Hadi
authors.initials: H
authors.lastname: Hashemzehi
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Torabinejad Dental Research Center, Isfahan University of Medical Sciences, School of Dentistry, Isfahan, Iran. Electronic address: haghighat@dnt.mui.ac.ir.
authors.forename: Abbas
authors.initials: A
authors.lastname: Haghighat
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D032082:Citrus aurantiifolia; D016854:Dental Anxiety / Q000517:prevention & control*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008964:Molar, Third / Q000601:surgery*; D010919:Placebos; D010938:Plant Oils / Q000627:therapeutic use*; D011446:Prospective Studies; D011674:Pulse; D012119:Respiration; D014081:Tooth Extraction / Q000379:methods*; D014095:Tooth, Impacted / Q000601:surgery*; D016896:Treatment Outcome; D055986:Vital Signs; D055815:Young Adult
chemical_list: D010919:Placebos; D010938:Plant Oils; C087245:orange oil