1. Introduction
Dental professionals and patients within the dental clinic often encounter a variety of auditory stimuli [
1]. These sounds can yield either unfavorable effects [
2,
3] or positive outcomes, such as the enjoyment of soothing music [
4], or be perceived as disruptive noise. Sound in the dental office originates from both dental and non-dental sources. The first group includes noises generated by dental equipment [
5], which can be reduced by taking appropriate measures. The second group incorporates sounds from within the dental clinic, including interactions between staff and patients, the operation of computers and printers, background music, and television, as well as external sources like traffic and ongoing roadwork sounds [
6,
7]. According to the National Research and Safety Institute, new dental equipment typically generates noise levels that remain below 85 dB(A) [
8], while sound emitted overall within a dental facility falls overall below 80 dB(A), thus falling within the acceptable thresholds established by the World Health Organization [
5,
8]. If these limits are exceeded, or the noise is present for a long time during a patient’s stay in the dental office, then the sound has a negative effect on the patient’s psychology [
6].
Noise, as described in the literature, refers to undesirable and bothersome sounds [
9]. Among dental patients, the most extensively researched consequence of noise is heightened anxiety. In fact, noise-induced fear or anxiety ranks as the third most common reason for avoiding dental appointments [
2]. Patients frequently perceive the dental clinic as an inhospitable and anxiety-inducing place, primarily due to the presence of disruptive and loud noises [
10]. On the other hand, dental healthcare facilities frequently accommodate individuals with dental anxiety and phobias who exhibit heightened sensitivity to both sound and tactile sensations [
11,
12]. Such anxious patients may become uncooperative and pose increased challenges in the management of dental therapies [
2,
11].
Music, on the other hand, offers not only well-being benefits but also numerous advantages in healthcare settings, from community environments to waiting rooms and surgical settings, where it can serve as background music [
6]. Its impact includes mood enhancement, pain and anxiety reduction, improved cardiovascular fitness, mindfulness, and increased social engagement [
13]. Patients can use music as a self-management technique to reduce or control discomfort in these environments [
14]. Also, listening to music provides an effective, nonpharmacologic option for reducing pre-procedural dental anxiety among dental patients [
15]. Music therapy, as a non-invasive and cost-effective intervention, effectively diminishes dental anxiety, thus enhancing the outcomes of medical or dental procedures [
6]. Also, music contributes significantly to relaxation, facilitating concentration, and it proves valuable in (a) reducing anxiety and pain levels [
6], (b) aiding recovery [
4,
16], and (c) promoting commitment to essential preventive care [
17]. Understanding the above-mentioned positive effects of music on patients’ anxiety is then essential for improving the overall patient experience, their well-being, and the well-being of dental professionals working in the area [
18]. It also influences the sustainability of the setting in strategic management and marketing issues [
19]. Thus, several studies have already investigated the potential of music as a non-pharmacological intervention to reduce anxiety levels in patients undergoing dental procedures [
6,
20,
21] by affecting subjective anxiety scales and objective physiological parameters, such as heart rate, blood pressure, and cortisol hormones in patients with moderate dental anxiety during dental procedures [
22]. To add more, a study assessing the effect of music therapy on dental anxiety levels of patients undergoing extractions found that music reduced fear, stress, and anxiety and was a form of meditation and relaxation [
20].
Furthermore, the choice of music genre significantly affects anxiety and pain reduction, as studies indicate these effects are not exclusive to any specific music type [
4]. Interestingly, in a specific study, 58% of respondents favored classical music in the healthcare setting [
23]. Ideally, music in dental settings should align with patients’ personal musical preferences, which are deeply rooted and influential [
6]. Patient preferences and past musical experiences are then crucial factors in the success of any health intervention [
24], including dental procedures. To be effective, though, music should resonate with listeners in terms of culture, genre, mood, and era [
25]. Dental professionals should also be mindful not to elicit excessive emotions or irritation, as music’s evocative nature can impact relaxation for them too [
19]. In a relevant study, it was reported that music is most effective when the musical program is selected by the patient [
26]. In another study, it was found that music chosen by the patient offers the best results in healthcare settings [
27]. But of course, there is a difference between passive music listening, often administered by medical professionals, and active music therapy, where trained music therapists use music creatively to promote and sustain health and well-being [
28]. Finally, it is reported that music therapy programs can benefit people of all ages and abilities, irrespective of their musical background or skill [
6,
29].
The selection of music types in diverse healthcare settings, including dental offices, is moreover contingent upon several factors, notably personal preferences, age, emotional associations, familiarity, and the overall dental office atmosphere and culture. Individuals exhibit unique musical tastes shaped by personal experiences, emotions, and cultural backgrounds, with certain types eliciting positive emotions or inducing relaxation [
30]. Age also plays a pivotal role, as music preferences often vary among different generations; younger patients may gravitate towards contemporary genres, while older patients may lean towards classical or folk music [
31,
32]. Music’s ability to evoke emotions and establish a specific atmosphere is crucial in dental settings, where choosing music that promotes relaxation and reduces anxiety contributes to a more comfortable environment for patients [
6]. The element of familiarity is significant, with patients often preferring music they know well, fostering a sense of comfort and security rooted in personal experiences or cultural backgrounds [
33]. Moreover, the dental office atmosphere itself can influence preferences, with instrumental or soothing-tempo music being preferable, contributing to a calm and focused ambiance during appointments [
6]. It seems that recognizing and accommodating these diverse music preferences based on various factors can significantly enhance the overall comfort and relaxation of dental patients.
The principal objective of this study was to investigate the current sound preferences of dental patients before and during dental treatment, encompassing ambient sounds like background music, staff–patient interactions, operation of dental equipment, and other environmental noises. Additionally, the research aimed to identify and understand noise obstacles within dental offices, considering both dental and non-dental sources while also evaluating the psychological impact of varying noise levels on patients during their dental appointments. Additionally, the investigation assessed the impact of music on anxiety reduction and analyzed the influence of music on patient outcomes, encompassing anxiety levels, pain reduction, and overall satisfaction. It also aimed to compare the effectiveness of patient-selected music versus music administered by dental professionals in reducing anxiety. Overall, we aimed to offer valuable insights into optimizing eco-soundscapes in dental offices, ultimately contributing to the improvement of the overall experience and well-being of dental patients. Τhe basic research questions of this study were then the following: (1) What are the preferences of patients relative to noise and music playing in the dental clinic, in terms of music type, music source, and types of noise that are perceived as unpleasant within the environment of a dental clinic? (2) What are the preferences of dental clinic visitors relative to the volume of music listening in their everyday lives? (3) How do disturbances and feelings of anxiety due to noise in the environment of the dental clinic relate to the demographic variables of patients? (4) How do disturbances and feelings of anxiety due to noise in the environment of the dental clinic relate to music and noise preferences? (5) What are the significant predictors of disturbances and feelings of anxiety due to noise in the environment of the dental clinic?
3. Results
A total of 134 questionnaires were completed, 55 from the department of dentistry and 79 from the four private practices over a 3-month period, from September 2023 to November 2023.
Table 2 presents the demographic and clinical profile of the study’s sample (N = 134). Females slightly outnumbered males (56.7% vs. 43.3%). Participants were mainly aged 20–30 years (24.6%) and 51–60 years (23.9%), with fewer over 60 years (12.7%). Educational backgrounds varied: 42.5% had secondary education, 17.9% had post-secondary education, and 39.6% held university degrees. Most attended private dental clinics with over two seats (32.1%). Therapy duration was evenly distributed across ranges: 1–3 months (20.9%), 4–8 months (26.9%), 9–12 months (26.9%), and 12 months or more (25.4%). Few reported hearing loss (4.5%). Noise sensitivity varied: somewhat sensitive (56.7%), not sensitive (25.4%), and sensitive/very sensitive (17.9%). Overall health status was moderate to good (M = 3.84, SD = 0.95). Perceived noise disturbance from patients/staff (M = 2.11, SD = 1.62) and machines (M = 2.28, SD = 0.92) was low in dental clinics.
Participants waiting for dental appointments preferred relaxing instrumental music (42.5%), foreign pop (30.6%), or classical music (15.7%). In the waiting room, they wanted random radio music (35.1%), their own playlist (29.9%), TV shows (20.1%), or news (16.4%). They would be irritated by impersonal staff treatment (44%), disrespectful behavior (41.8%), hearing other patients in pain (41.8%), staff communication issues (37.3%), or complaints from others (30.6%), but only 12.7% by the lack of music in the clinic. Overall,
Figure 2 shows data referring to the first research question of this study.
Table 3 presents data on the use of music players and related behaviors and answers to the second research question of this study. Participants primarily used radios (49.3%), headphones (41.0%), and smartphones (35.1%) for music. Most preferred moderate volume (44.0%), with significant portions liking high (29.9%) or low volumes (15.7%). Few listened at very high (8.2%) or very low volumes (1.5%). Only one person annoyed others with loud music. Speaking volumes in noisy environments were mostly moderate (36.6%) or high (35.1%). Perception of external sounds varied from bad (5.2%) to excellent (2.2%), with moderate (25.4%) and good (26.1%) being common. Daily music player usage ranged from 1–2 h (28.4%) to 0–30 min (22.4%). Continuous usage was mostly 0–30 min (32.8%) or 30–60 min (28.4%) per day. Live concert attendance was typically 1–2 times per year (46.3%), with 32.1% never attending.
Table 4 shows that female gender correlated with noise sensitivity (r = 0.220,
p < 0.05) and poorer health (r = −0.176,
p < 0.05). Private clinic visits were associated with younger age (r = −0.355,
p < 0.01), higher education (r = 0.374,
p < 0.01), and poorer health (r = −0.237,
p < 0.01). Private clinic patients reported more noise disturbance (r = 0.235,
p < 0.01) and less anxiety due to clinic mobility (r = −0.215,
p < 0.05). Older age correlated with higher noise sensitivity (r = 0.194,
p < 0.05), while lower education correlated with more noise from machines (r = −0.185,
p < 0.05). Noise sensitivity was linked to more disturbance from machines (r = 0.438,
p < 0.01), anxiety due to clinic mobility (r = 0.427,
p < 0.01), and ambient noise (r = 0.399,
p < 0.01).
Table 4 presents data answering the third research question of this study.
Since no significant associations were detected between music preferences in the dental clinic and feelings of anxiety (see
Table 5), regression analyses were performed only for the outcome variables of perceived health status and noise disturbance from people and machines. Regression analysis at this stage was used exploratorily, aiming to detect the most substantial associations between music preferences and the outcome variables. In this context, better health status was linked to visiting university dental clinics (β = 0.300,
p = 0.005), younger age (β = 0.300,
p = 0.034), clearer perception of external sounds while using music players (β = 0.190,
p = 0.039), avoiding smartphone music use (β = −0.370,
p < 0.001), and disliking Greek folk songs (β = −0.200,
p = 0.030). Noise disturbance from machines was associated with younger age (β = −0.270,
p = 0.015), lower education (β = −0.210,
p = 0.035), higher noise sensitivity (β = 0.190,
p = 0.027), and increased anxiety due to ambient noise (β = 0.510,
p = 0.027). Additionally, disturbance from patients or staff was related to private clinic visits (β = 0.240,
p = 0.018), specific playlist preferences (β = 0.310,
p = 0.012), absence of music (β = 0.280,
p = 0.016), and smartphone music use (β = 0.230,
p = 0.029).
Table 6 presents data answering the fifth research question of this study. Ιt specifically highlights significant predictors of perceived health status and noise disturbance. Better health was associated with visiting university dental clinics (β = 0.300,
p = 0.005), younger age (β = 0.300,
p = 0.034), and clearer perception of external sounds while using music players (β = 0.190,
p = 0.039). However, poorer health correlated with liking Greek folk songs (β = −0.200,
p = 0.030) and using smartphones for music (β = −0.370,
p < 0.001). Noise disturbance from machines was predicted by younger age (β = −0.270,
p = 0.015), lower education (β = −0.210,
p = 0.035), higher noise sensitivity (β = 0.190,
p = 0.027), and anxiety due to ambient noise (β = 0.510,
p = 0.027). Similarly, noise disturbance from patients or staff was associated with private clinic visits (β = 0.240,
p = 0.018), specific playlist preferences (β = 0.310,
p = 0.012), absence of music (β = 0.280,
p = 0.016), and smartphone music use (β = 0.230,
p = 0.029).