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      Effectiveness of Preoperative Alpha Wave Entrainment in Pediatric Dental Patients: A Randomized Controlled Trial

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          Abstract

          Background

          Pediatric dental anxiety is a significant barrier to effective dental care, necessitating non-pharmacological interventions. Alpha wave entrainment has shown promise in adult studies for reducing procedural anxiety and pain perception, but its effectiveness in pediatric dental settings remains underexplored.

          Objective

          This study aims to evaluate the effectiveness of preoperative alpha wave entrainment in alleviating anxiety in gender-specific participants to the interventions.

          Methods

          We conducted a randomized controlled trial involving 252 pediatric patients (aged 7-12) with cooperative dispositions. Participants were randomly assigned to either an experimental group receiving alpha wave entrainment or a control group receiving conventional behavior management techniques. The experimental intervention involved 10-minute sessions of binaural beats with visual stimulation designed to induce alpha-wave synchronization. Anxiety levels were assessed using physiological measures (heart rate and blood pressure), both pre- and post-interventions.

          Results

          The intervention group demonstrated a significant reduction in heart rate and systolic blood pressure post-intervention compared to the control group. These changes indicate a decrease in anxiety levels, with no significant gender differences in the response to the intervention.

          Conclusion

          Alpha wave entrainment effectively reduces dental anxiety in pediatric patients, with similar efficacy observed across genders. This study supports the incorporation of alpha wave entrainment into pediatric dental practices as a viable alternative to traditional anxiety management techniques.

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          Most cited references28

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          Effect of photic stimulation on human visual cortex lactate and phosphates using 1H and 31P magnetic resonance spectroscopy.

          Previous animal and human studies showed that photic stimulation (PS) increased cerebral blood flow and glucose uptake much more than oxygen consumption, suggesting selective activation of anaerobic glycolysis. In the present studies, image-guided 1H and 31P magnetic resonance spectroscopy (MRS) was used to monitor the changes in lactate and high-energy phosphate concentrations produced by PS of visual cortex in six normal volunteers. PS initially produced a significant rise (to 250% of control, p less than 0.01) in visual cortex lactate during the first 6.4 min of PS, followed by a significant decline (p = 0.01) as PS continued. The PCr/Pi ratios decreased significantly from control values during the first 12.8 min of PS (p less than 0.05), and the pH was slightly increased. The positive P100 deflection of the visual evoked potential recorded between 100 and 172 ms after the strobe was significantly decreased from control at 12.8 min of PS (p less than 0.05). The finding that PS caused decreased PCr/Pi is consistent with the view that increased brain activity stimulated ATPase, causing a rise in ADP that shifted the creatine kinase reaction in the direction of ATP synthesis. The rise in lactate together with an increase in pH suggest that intracellular alkalosis, caused by the shift of creatine kinase, selectively stimulated glycolysis.
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            Brain wave synchronization and entrainment to periodic acoustic stimuli.

            As known, different brainwave frequencies show synchronies related to different perceptual, motor or cognitive states. Brainwaves have also been shown to synchronize with external stimuli with repetition rates of ca. 10-40 Hz. However, not much is known about responses to periodic auditory stimuli with periodicities found in human rhythmic behavior (i.e. 0.5-5 Hz). In an EEG study we compared responses to periodic stimulations (drum sounds and clicks with repetition rates of 1-8 Hz), silence, and random noise. Here we report inter-trial coherence measures taken at the Cz-electrode that show a significant increase in brainwave synchronization following periodic stimulation. Specifically, we found (1) a tonic synchronization response in the delta range with a maximum response at 2 Hz, (2) a phasic response covering the theta range, and (3) an augmented phase synchronization throughout the beta/gamma range (13-44 Hz) produced through increased activity in the lower gamma range and modulated by the stimulus periodicity. Periodic auditory stimulation produces a mixture of evoked and induced, rate-specific and rate-independent increases in stimulus related brainwave synchronization that are likely to affect various cognitive functions. The synchronization responses in the delta range may form part of the neurophysiological processes underlying time coupling between rhythmic sensory input and motor output; the tonic 2 Hz maximum corresponds to the optimal tempo identified in listening, tapping synchronization, and event-interval discrimination experiments. In addition, synchronization effects in the beta and gamma range may contribute to the reported influences of rhythmic entrainment on cognitive functions involved in learning and memory tasks.
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              Analysis of EEG activity in response to binaural beats with different frequencies.

              When two coherent sounds with nearly similar frequencies are presented to each ear respectively with stereo headphones, the brain integrates the two signals and produces a sensation of a third sound called binaural beat (BB). Although earlier studies showed that BB could influence behavior and cognition, common agreement on the mechanism of BB has not been reached yet. In this work, we employed Relative Power (RP), Phase Locking Value (PLV) and Cross-Mutual Information (CMI) to track EEG changes during BB stimulations. EEG signals were acquired from 13 healthy subjects. Five-minute BBs with four different frequencies were tested: delta band (1 Hz), theta band (5 Hz), alpha band (10 Hz) and beta band (20 Hz). We observed RP increase in theta and alpha bands and decrease in beta band during delta and alpha BB stimulations. RP decreased in beta band during theta BB, while RP decreased in theta band during beta BB. However, no clear brainwave entrainment effect was identified. Connectivity changes were detected following the variation of RP during BB stimulations. Our observation supports the hypothesis that BBs could affect functional brain connectivity, suggesting that the mechanism of BB-brain interaction is worth further study.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                12 May 2024
                May 2024
                : 16
                : 5
                : e60154
                Affiliations
                [1 ] Pediatric Dentistry, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
                [2 ] Pedodontics and Preventive Dentistry, SRM Kattankulathur Dental College, Chennai, IND
                [3 ] Endodontics, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
                Author notes
                Article
                10.7759/cureus.60154
                11088951
                38736759
                fe2bd730-95bb-4e7b-be28-5eb161add699
                Copyright © 2024, Shehani A et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 May 2024
                Categories
                Psychology
                Dentistry
                Pediatrics

                audio-visual distraction,binaural beats,non-pharmacological interventions,randomized control trial,dental fear and anxiety,fear and anxiety,vital signs,pediatric preventive dentistry,alpha waves,brainwave entrainment

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