Eur J Oral Sci 2018; 1–7 © 2018 Eur J Oral Sci

DOI: 10.1111/eos.12585 European Journal of

Printed in Singapore. All rights reserved
Oral Sciences

Eun S. Park1,2, Hyeon W. Yim1,3,

Progressive muscle relaxation therapy Kang S. Lee1,3
1
Department of Public Health, Graduate

to relieve dental anxiety: a randomized School of the Catholic University of Korea,

Seoul; 2Department of Dental Hygiene, The
Hyejeon College of Korea, HongSeong-Eup;
controlled trial 3
Department of Preventive Medicine, College
of Medicine, The Catholic University of Korea,
Seoul, Korea

Park ES, Yim HW, Lee KS. Progressive muscle relaxation therapy to relieve dental
anxiety: a randomized controlled trial.
Eur J Oral Sci 2018; 00: 1–7. © 2018 Eur J Oral Sci
Dental anxiety causes patients to refuse or delay treatment, which may exacerbate
oral diseases. The aim of the current randomized controlled trial was to determine
whether progressive muscle relaxation therapy could relieve dental anxiety. The trial
included 68 periodontal patients with dental anxiety scores of ≥13 who were ran-
domly assigned to either an intervention group or a control group (n = 34 per
group). The intervention group was administered progressive muscle relaxation ther-
apy for 20 min and oral health education for 15 min before periodontal treatment Kang Sook Lee, Department of Preventive
Medicine, College of Medicine, The Catholic
once per week for 4 wk. The control group was provided with oral health education
University of Korea, 222 Banpo-daero,
only, for the same duration. Changes in dental anxiety, depression symptoms, blood Seocho-gu, Seoul 137-701, Korea
pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after
the intervention. The intervention group exhibited statistically significantly greater Email: leekangs@catholic.ac.kr
reductions in dental anxiety scores than did the control group at the 4-wk ( 3.82 vs.
0.89) and 3-month ( 4.22 vs. 0.28) assessments. They also exhibited significantly Key words: dental health education;
greater reductions in depression symptoms, systolic and diastolic blood pressure, depression; oral health education;
pulse rate, and salivary cortisol levels at both time-points. Progressive muscle relax- periodontal patients
ation therapy relieves tension and anxiety in dental patients. Accepted for publication October 2018

Dental anxiety is a complex phenomenon with physical,
mental, and social aspects (1). High levels of dental
anxiety can cause patients to experience stress and
refuse or delay treatment. This damages oral health
and leads to worsening of oral diseases. Dental anxiety
also interferes with successful treatment by causing
increased perceptions of pain after treatment, thereby
delaying optimal recovery (2). The prevalence of dental
anxiety in adult patients is approximately 20% (3), with
5%–7% of patients experiencing extremely high levels
of dental anxiety (4).
SANTUCHI et al. (5) reported relatively high levels of
dental anxiety in periodontal patients, which were asso-
ciated with poor gingival status. Dental anxiety can be
reduced with the use of injected or inhaled sedatives.
However, such drugs entail a risk of side effects, includ-
ing respiratory depression, gastrointestinal disorders,
nausea, vomiting, and allergic reactions. Additionally,
sedatives increase the cost of dental treatment, and the
body takes a long time to absorb injected sedatives, so
they are of limited use in clinical settings. Therefore,
drug-free methods are increasingly being used to ame-
liorate tension and moderate dental anxiety during
treatment (6).
High dental anxiety is associated with oral health
issues and avoidance of dental care, and it can lead
to mental anxiety. In turn, poor oral health is
associated with symptoms of depression. In one previ-
ous study (7), five patients exhibited clinically signifi-
cant symptoms of depression during dental visits, and
antidepressant medication caused reduced saliva pro-
duction, poor oral hygiene, and periodontal disease-
related bacterial infection. Such physiological changes
can lead to periodontal disease as a result of abnor-
mal immune responses (8). Thus, clinicians must be
aware of psychological parameters in patients with
dental anxiety.
Muscle relaxation therapy reduces the activity of the
sympathetic nervous system when stimulated by psy-
chological and physiological responses, resulting in low
heart rate, low respiratory rate, and low blood pres-
sure. In addition, it can effectively regulate the periph-
eral and central nervous systems, thereby lowering
stress, anxiety, and depression levels, and thus is effec-
tive in treating several health problems (9). In previous
studies, Dental Anxiety Scale (DAS) scores were
reported to be significantly lower in a group receiving
progressive muscle relaxation therapy than in the corre-
sponding control group (10), and patients receiving
muscle relaxation therapy reported that the dental anxi-
ety relief persisted during the subsequent dental visit
(11). ARMFIELD et al. (12) also suggested that progres-
sive muscle relaxation therapy enables successful man-
agement of dental anxiety.
2 Park et al.
The purpose of this study was to establish the basis
of dental anxiety mitigation by progressive muscle
relaxation therapy in patients with dental anxiety.
The present randomized controlled trial (Clinical
Research Information Service trial registration number
KCT0001648) investigated whether progressive muscle
relaxation therapy could relieve dental anxiety, and if
so, whether the anxiety-relieving effects of the therapy
lasted for 3 months in periodontal patients. The pri-
mary outcome was relief from dental anxiety 3 months
after commencement of the intervention, and the sec-
ondary outcomes were reductions in dental anxiety,
symptoms of depression, blood pressure, heart rate,
and salivary cortisol concentration, which are consid-
ered indicators of stress (13, 14), at 4 wk and 3 months
after intervention commencement.
Material and methods
Sample size calculation
Dental anxiety was set as the primary evaluation outcome
for calculating sample size. Based on existing research
(15), a two-sided a-value of 0.05, a power of 0.80, and an
effect size of 0.72, a sample size of 31 was originally calcu-
lated as appropriate for intergroup comparison of mean
anxiety scores. Based on an anticipated drop-out rate of
Fig. 1. Flow diagram of subject selection and allocation in accordance with Consolidated Standards of Reporting Trials
(CONSORT) guidelines. DAS, dental anxiety scale.
up to 10%, 35 patients were enrolled in each group to
ensure an adequate final sample size.
Participants
The present study was approved by the Institutional
Review Board of The Catholic University of Korea. The
participants were 70 patients who visited a dental clinic in
Incheon, Republic of Korea, between 4 September 2015
and 30 January 2016 for periodontal treatment. The inclu-
sion criteria were as follows: chronic periodontal disease;
age 30–59 yr; consent to participate after being briefed on
the purpose of the study; a DAS of ≥13 on the Corah den-
tal anxiety scale (16); dental treatment planned for 5 wk
or longer; one or more periodontal pockets ≥4 mm in
depth; the absence of systemic diseases that could affect
periodontal disease; sightedness; literacy; and the ability to
understand the study and answer questions. Two patients
who did not meet the inclusion criteria were excluded: one
had a DAS of <13; and the other was unavailable for the
collection of saliva samples between noon and 4 PM. Thus,
68 patients were ultimately included in this trial.
The patients were randomly assigned to either an inter-
vention group or a control group (n = 34 per group). Two
patients in the intervention group and three in the control
group dropped out after intervention commencement
because they could not visit the clinic at the required time
for personal reasons. Thus, a total of 63 patients com-
pleted the trial (Fig. 1).

Study flow
All participants were briefed on the purposes and methods
of the study before being assigned to one of the two
groups by a third party using random number generation
software. A piece of paper indicating the assigned group
was inserted into a sealed envelope, and participants were
asked to open one of the sealed envelopes in a predeter-
mined order at their first visit. An evaluator performed all
measurements without knowing the group allocation of
any of the participants.
Dental anxiety levels were evaluated using a dental anxi-
ety questionnaire (16), and psychological changes were
assessed using a depression questionnaire (17). Participants
were administered these questionnaires at baseline and at
4 wk and 3 months after intervention commencement. To
evaluate salivary cortisol concentrations, unstimulated sal-
iva samples were collected. Blood pressure and heart rate
were also recorded. All evaluations were performed
between 12 PM and 4 PM (18), and visits were scheduled
according to patient availability. The intervention group
received progressive muscle relaxation therapy and oral
health education once per wk for 4 wk, and the control
group received oral health education only, also once per
week for 4 wk.
When administering progressive muscle relaxation ther-
apy, we adopted a program used to alleviate dental anxi-
ety in patients at a psychiatric department of a university
hospital in South Korea. This intervention program has
been shown to relieve fear and stress (19). Furthermore, it
is easy to learn and practice, requires no special equip-
ment, and can be delivered anywhere at any time. Partici-
pants are advised to wear comfortable clothing and asked
to remove glasses and footwear. They are seated in a
relaxed position on a comfortable chair in a quiet, dimly
lit room and asked to listen to a voice delivered through a
headset playing a recording of a progressive muscle relax-
ation therapy script. During the recording, the patients are
asked to close their eyes, breathe deeply, and imagine
peaceful scenery. They are then asked to progressively
tense and relax different muscle groups throughout their
body—from global to local muscles, including those in the
hands, arms, face, neck, shoulders, abdomen, legs, and
feet. This develops muscle awareness and gives patients
the ability to differentiate between tensed and relaxed mus-
cles (19). Participants in the intervention and control
groups received the same periodontal treatment and oral
health education. In both groups, the education was
administered by a single dental hygienist in a separate den-
tal office.
When conducting the periodontal disease treatment,
clinicians ensured that patients were able to manage their
periodontal health effectively. In addition, patients were
instructed on proper toothbrushing practices in order to
ensure appropriate management of their periodontal
health. Patients in the test group received progressive mus-
cle relaxation therapy for 20 min and oral health educa-
tion for 15 min. Intervention was administered once per
week for a total of 4 wk (i.e. at baseline, and 1, 2, and
3 wk after intervention commencement). Periodontal treat-
ment was performed with scaling once, and root planing
was performed three times. A total of four sessions were
performed once per week. Each week, periodontal treat-
ment was performed after intervention.
During the first week, patients were informed about
proper toothbrush selection, storage and replacement of
toothbrushes, toothbrushing time, and the importance of
PMR therapy to treat dental anxiety 3
toothbrushing. During week 2, a clinical specialist with
over 10 yr of experience explained proper toothbrushing
methods (i.e. the Bass, Rolling, and Watanabe methods)
(20). The patients then practiced these methods on a tooth
model, and their mistakes were identified and corrected
during that process. During week 3, the patients were
informed about interdental care and instructed on the use
of oral hygiene products relevant to their individual peri-
odontal conditions. During week 4, they were again
instructed on methods of toothbrushing and the use of
oral hygiene products.
Evaluations
The primary evaluation was the change in dental anxiety
level at 3 months after starting the intervention, and the
secondary evaluations were the changes in depression, vital
signs, and salivary cortisol levels at 3 months after begin-
ning the intervention. The primary outcome was measured
via the DAS developed by CORAH (16), which is the most
common measure for evaluating dental patient anxiety. It
comprises four questions that describe risky and threaten-
ing situations during dental treatment. Each question is
scored from 1 (not anxious at all) to 5 (terrified); thus, the
total score ranges from 4 to 20. Patients with DAS scores
of ≥13 are deemed to experience dental anxiety. Cron-
bach’s a coefficient for this index in the current study was
0.83.
Symptoms of depression were evaluated using the Beck
Depression Inventory (17), which evaluates clinical symp-
toms of depression and comprises 21 questions, with
responses to each question measured on a 4-point Likert
scale (0–3). The total score ranges from 0 to 63, with
higher scores indicating higher levels of depression. The
associated Cronbach’s a coefficient in the current study
was 0.91.
Patients were prohibited from consuming food and caf-
feine, smoking, and brushing their teeth for 1 h before sal-
iva collection. Saliva samples were collected between 12 PM
and 4 PM (18). Patients were instructed to rest in a com-
fortable position, without speaking, for 5 min before saliva
was collected. To avoid mixing saliva with food residue or
blood, patients were asked to gargle with cold water
before collection. Once the mouth was thus naturally
moistened, patients were asked to spit into polypropylene
specimen containers. Saliva samples containing blood were
excluded.
The saliva samples (2 ml) were stored at 20°C and
transported to the testing laboratory while frozen, before
analysis. The samples were evaluated using a high-sensitiv-
ity salivary cortisol ELISA (Salimetrics LLC, State Col-
lege, PA, USA) (21).
Blood pressure was measured using an automated blood
pressure monitor (MX3; Omron, Tokyo, Japan). Patients
were prohibited from consuming caffeinated food, under-
going intensive exercise, and smoking for 1 h before mea-
surements were made. During measurements, patients were
instructed to rest for at least 10 min, and then blood pres-
sure was measured 3 min later and again 5 min after the
first measurement. The average value of the two measure-
ments was used for analysis. If the margin of error was
≥10 mmHg, the measurement was repeated and the aver-
age of the two values with the smallest margin of error
was used for analysis (22).
Periodontal status was measured at the initial examina-
tion. A gingival index is the most commonly utilized
4 Park et al.

method for gauging gingival inflammation while evaluating Table 1

periodontal status. In the present study, the gingival
Baseline characteristics of the study participants
indices of the buccal, lingual, mesial, and distal surfaces of
six teeth were scored on a 4-point scale ranging from 0 to Study group
3 points (23).
Using a Williams probe (Hu-Friedy, Chicago, IL, USA), Intervention Control
Variable (n = 34) (n = 34)
periodontal pocket depth (PPD) was measured in millimeters
from the gingival ridge to the bottom of the pocket at the fol- Age (yr) 42.4  10.0 43.2  9.9
lowing six sites around each tooth, except the third molar: Sex
the mesiobuccal, midbuccal, distobuccal, distolingual, midlin- Male 9 (26) 8 (24)
gual, and mesiolingual sites. The largest PPD value measured Female 25 (74) 26 (76)
for each site, for each tooth, was recorded, and the mean Education level
value of all teeth was used for the analysis (24). ≤Middle school 3 (9) 5 (15)
Gingival bleeding on probing (BOP) with a periodontal High school 13 (38) 16 (47)
probe is considered a sign of gingivitis. In the present ≥College 18 (53) 13 (38)
study, the six sites around each tooth for which PPD was Income (1000 won)
measured were checked for bleeding 10–30 s after probing. <1000 3 (9) 2 (6)
Bleeding on probing was recorded for each tooth as either 1000–2999 22 (65) 19 (56)
absent (0) or present (1), if even only one site showed ≥3000 9 (26) 13 (38)
bleeding. The number of teeth with gingival bleeding was Clinical parameters
calculated as a percentage of the total dentition to yield a Gingival index 1.3  0.6 1.4  0.5
BOP percentage (25). Probing pocket depth (mm) 2.7  0.5 2.7  0.4
Percantage of teeth with 32.0  6.9 32.5  6.4
bleeding on probing
Data analysis Psychological parameters
Dental anxiety scale 13.7  1.1 13.5  0.9
Data analysis was performed using SAS version 9.4 (SAS Beck depression inventory 31.2  8.5 29.7  6.3
Institute, Cary, NC, USA). Summary statistics are pre- Systolic blood pressure 126.6  16.3 120.5  9.6
sented as number (%) for categorical variables and as (mmHg)
mean  SD for continuous variables. Baseline character- Diastolic blood pressure 79.9  10.4 77.4  6.3
istics, as well as the patients’ clinical and psychological (mmHg)
parameters, were compared using the Wilcoxon rank-sum Pulse rate (times min 1) 78.1  13.5 72.6  10.0
test, the chi-square test, or Fisher’s exact test. Baseline Salivary cortisol level (ng ml 1) 2.6  2.1 2.3  1.4
data were compared with data obtained at 4 wk and Data are presented as n (%) or mean  SD.
3 months after intervention commencement using the The P-values of significant differences between the groups were
paired t-test or Wilcoxon signed-rank test. To confirm the determined using the chi-square test, Fisher’s exact test, the Stu-
efficacy of the therapy, time-dependent changes in the two dent’s t-test, or the Wilcoxon rank-sum test.
groups were compared using analysis of covariance. All
participants registered in this randomized clinical trial
were analyzed using the intention-to-treat (ITT) method. 3 months after intervention commencement. Four
In cases of missing data, the last observation carried for- weeks after intervention commencement, the decrease
ward (LOCF) method was utilized. All values of P <0.05 in dental anxiety was significantly greater in the inter-
were considered statistically significant. vention group than in the control group ( 3.8 vs.
0.9; P < 0.001). Three months after commencement
of the intervention, the decrease in dental anxiety was
Results still significantly greater in the intervention group than
in the control group ( 4.2 vs. 0.3; P < 0.001). These
As shown in Table 1, there was no significant difference results indicate that in both groups, dental anxiety had
in the mean age between the intervention group lessened 4 wk after intervention commencement and
(42.4 yr) and the control group (43.2 yr). The overall that the effects of muscle relaxation therapy lasted for
proportion of women in the study was 73%, and there at least 3 months.
were no significant differences in education level or As shown in Fig. 2, the decrease in depression symp-
income between the two groups. toms was significantly greater in the intervention group
At baseline, there were no significant differences in than in the control group ( 1.3 vs. +0.5; P < 0.001) at
the level of gingivitis, PPD, or BOP between the two the 4 wk assessment, and 3 months after commence-
groups, and there were no significant differences in the ment of the intervention, the decrease was still signifi-
psychological parameters (dental anxiety or symptoms cantly greater in the intervention group than in the
of depression) or physiological parameters (diastolic control group ( 2.2 vs. +1.0; P < 0.001).
blood pressure, heart rate, or salivary cortisol levels) The decrease in systolic blood pressure 4 wk after
between the two groups, with the exception of systolic intervention commencement was significantly greater in
blood pressure, which was significantly higher in the the intervention group than in the control group
intervention group. ( 11.0 vs. +3.2; P < 0.001), and 3 months after com-
As shown in Table 2, in the intervention group, the mencement of the intervention, the decrease was still
mean DAS score decreased from 13.7  0.2 at baseline significantly greater in the intervention group than in
to 9.9  0.2 and 9.6  0.2, respectively, at 4 wk and the control group ( 11.9 vs. +4.5; P < 0.001).
 PMR therapy to treat dental anxiety 5

Table 2
Comparison of dental anxiety levels at 4 weeks and 3 months post-intervention

Study group
Variable Intervention (n = 34) Control (n = 34) P-value

DAS score at baseline 13.7  0.2 13.5  0.2

DAS score at 4 wk 9.9  0.2 12.6  0.2
DAS score at 3 months 9.6  0.2 13.2  0.3
Change in DAS at 3 months* 4.2 ( 4.6 to 3.8) 0.3 ( 0.7 to 0.1) <0.001
Change in DAS at 4 wk† 3.8 ( 4.1 to 3.5) 0.9 ( 1.2 to 0.6) <0.001

Values are given as mean  SD or mean difference (95% CI).

The P-values of significant differences between the groups were determined using the chi-square test, Fisher’s exact test, the Student’s t-
test, or the Wilcoxon rank-sum test.DAS, dental anxiety scale.Statistical analysis was performed by analysis of covariance, adjusted in
accordance with the baseline value of each parameter. The P-values of significant differences in parameters between baseline and 4 wk or
3 months post-intervention were determined using the paired t-test or Wilcoxon signed-rank test.
*Primary outcome.
†
Secondary outcome.
DAS, dental anxiety scale.

Fig. 2. Comparisons of depression levels (A), systolic (B) and diastolic (C) blood pressure, pulse rate (D), and salivary cortisol
levels (E) in the intervention and control groups at 4 wk and 3 months after the intervention. f/u, follow up.

The decrease in diastolic blood pressure 4 wk after
intervention commencement was significantly greater in
the intervention group than in the control group ( 6.5
vs. +1.7; P < 0.001), and 3 months after commence-
ment of the intervention, the decrease was still
significantly greater in the intervention group than in
the control group ( 7.4 vs. +0.5; P < 0.001).
The decrease in pulse rate 4 wk after intervention
commencement was significantly greater in the interven-
tion group than in the control group ( 6.7 vs. +2.2;
6 Park et al.
P < 0.001), and 3 months after commencement of the
intervention, the decrease was still significantly greater
in the intervention group than in the control group
( 7.3 vs. +0.1; P = 0.002).
The decrease in salivary cortisol levels 4 wk after
intervention commencement was significantly greater
in the intervention group than in the control group
( 1.0 vs. 0.1; P = 0.007), and 3 months after com-
mencement of the intervention, the decrease was still
significantly greater in the intervention group than in
the control group ( 1.0 vs. +0.3; P = 0.002).
These results indicate that in both groups, dental
anxiety, depression symptoms, systolic blood pressure,
diastolic blood pressure, pulse rate, and salivary corti-
sol levels had become reduced 4 wk after intervention
commencement and that the effects of muscle relax-
ation therapy lasted for at least 3 months.
Discussion
The present study examined the effects of progressive
muscle relaxation therapy on periodontal patients’ den-
tal anxiety relief maintenance at 4 wk and 3 months
after intervention, and clearly demonstrated an associa-
tion between progressive muscle relaxation therapy and
the relief of dental anxiety. This result is consistent
with that of a previous study which reported a signifi-
cant decrease in anxiety in fracture patients who
received progressive muscle relaxation therapy every
morning and afternoon during hospitalization (13). The
findings are also concordant with those of another
study in which there was a significant reduction in anxi-
ety in patients with cancer who received therapy for
10 wk (26).
Patients in the control group who did not receive
progressive muscle relaxation therapy also experienced
a temporary decrease in dental anxiety at 4 wk post-
intervention. However, at 3 months post-intervention,
dental anxiety levels in the control group had increased
again; by contrast, patients in the intervention group
continued to experience dental anxiety relief, which
indicated the effectiveness of progressive muscle relax-
ation therapy. The effects of therapy were observed to
have lasted until 3 months post-intervention. On the
basis of these findings, it may be concluded that pro-
gressive muscle relaxation therapy administered on a
long-term basis under constant monitoring to ensure
moderation produces long-lasting positive effects. We
have found that the progressive muscle relaxation
response can facilitate stress relief in patients with den-
tal anxiety. The DAS is an objective, reliable, and vali-
dated measure that is widely used in adult dental
anxiety research worldwide. It evaluates dental anxiety
using specific questions about the respondent’s dental
situation. The original study conducted by CORAH (16)
demonstrated that the internal consistency of the dental
anxiety questions was high (standardized Cronbach’s
a = 0.86), and therefore the scale can be considered as
accurate. Psychological and pharmacological interven-
tions are effective in reducing dental anxiety. However,
studies have shown (27) that pharmacological interven-
tion results in risk factors and adverse effects; notably,
persistent dental anxiety relief has been found only
from psychological interventions. Therefore, it is neces-
sary to use psychological intervention to alleviate den-
tal anxiety.
The intervention group also exhibited reductions in
symptoms of depression 4 wk and 3 months after start-
ing the intervention, which is consistent with the results
of a previous study in which patients with atopic der-
matitis exhibited a significant decrease in depression
symptoms 1 month after receiving muscle relaxation
therapy twice daily for 4 wk (28). These results suggest
that progressive muscle relaxation therapy effectively
alleviates depression stemming from dental anxiety.
The authors of another study argued that depression
symptoms are strongly associated with dental anxiety
and that they have a stronger effect on particular types
of anxiety (7).
In patients who are extremely afraid of dental treat-
ment, symptoms of depression are caused by a combi-
nation of subjective stress from past experiences and a
negative emotional state. Participants treated using pro-
gressive muscle relaxation therapy appear to experience
a positive emotional state repeatedly, which reduces
dental anxiety, stabilizes patient behavior, and conse-
quently ameliorates depression symptoms. Therefore, to
reduce patients’ dental anxiety, dentists should be
mindful of various psychological factors, particularly
symptoms of depression.
The intervention group in the present study exhibited
a clinically significant decrease in salivary cortisol
levels. This is concordant with a previous study in
which patients with breast cancer exhibited lower corti-
sol levels after being administered therapy once per
week for 10 wk, whereas a control group that did not
receive relaxation therapy exhibited an increase in corti-
sol levels (29). In the present study, because the two
groups had similar gingival states and demographic
characteristics, neither of these factors could have
affected the variables evaluated. Therefore, progressive
muscle relaxation therapy can effectively reduce stress
and it appears to alleviate dental anxiety and help
patients feel relaxed and calm, leading to decreased cor-
tisol levels.
There was a low drop-out rate in the present study
(2.9%), and the LOCF method was used in cases of
missing data, for ITT analysis. Nevertheless, outcomes
did not differ between the ITT analyses with and with-
out the missing variables, perhaps because the study
used randomized allocation to prevent undue influence
by a third confounding factor and to minimize preju-
dice or bias, ensuring an objective and scientific
approach toward evaluating the effect of progressive
muscle relaxation therapy on dental anxiety.
The present study had several limitations. Because
the participants were enrolled from a single dental
clinic, the generalizability of the intervention group,
and consequently the external validity of the findings,
may be limited. Psychological parameters, including
dental anxiety, were evaluated using self-reported

questionnaires and may therefore have been subjective.
However, physiological indicators of anxiety, such as
blood pressure, heart rate, and salivary cortisol levels,
were objective. Studies involving longer follow-up peri-
ods are required to determine the duration of the
effects of progressive muscle relaxation therapy.
In the present study, the administration of progres-
sive muscle relaxation therapy over four sessions by a
dental hygienist effectively alleviated dental anxiety in
periodontal patients for at least 3 months after the
intervention. Progressive muscle relaxation therapy can
be used to relieve dental anxiety and stress in periodon-
tal patients.
Acknowledgements – We are grateful to the survey respondents
and wish to acknowledge the study assistants for their help with
patient interviews.
Conflict of interests – The authors have no conflict of interests to
declare.
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