Oral Sphere

BACKGROUND

Pediatric dentistry is especially worrying about dental anxiety and perception of pain, which can severely complicate the process and have an adverse effect on the overall experience of small patients ^[1]. These may cause dental visits to be traumatic resulting in the avoidance of dental care required, a phenomenon that may worsen oral health. The effective control of dental anxiety and pain will be essential in providing children with trauma-free and effective dental treatment that will result in positive experiences and sustainable dental health. Anxiety and pain are usually relieved with help of traditional pharmacological interventions including sedatives and analgesics ^[2]. Nevertheless, these approaches have side effects such as drowsiness, nausea and adverse drug reactions. Moreover, they might need a closer level of focus on the procedures, and are not as suitable to the daily pediatric dental check-up. Consequently, interest in non-pharmacological interventions, which are safe, easy, and have a few side effects, has been increasing. These options offer a good prospect of dental anxiety and pain management without medications ^[3].

The issue of aromatherapy as an adjunctive treatment with essential oils has been a promising treatment in a number of medical settings, and dentistry is not an exception. Oils such as lavender and orange are of interest with respect to the possibility of alleviating anxiety and decreasing the perception of pain ^[4]. Lavender essential oil, extracted out of Lavandula angustifolia is famous because of its anxiolytic and calming effects. It has already been widely studied due to its effectiveness in anxiety reduction both in a clinical and non-clinical setting. It is also believed that Lavender has its effects by acting upon the central nervous system via the olfactory pathway resulting in a decrease in the activity of the sympathetic nervous system ^[5]. This has the effect of causing a calming effect that may help in the alleviation of the anticipatory stress that goes with dental procedures and is therefore used especially in the management of dental anxiety among pediatric patients ^[6].

Another essential oil that may have some benefits in anxiety reduction and mood improvement is orange essential oil, which is obtained by extraction of Citrus sinensis. Orange essential oil is known to have uplifting and stress-relieving effects on people, and it has been proved to provide a feeling of well-being and relaxation ^[7]. The sweet and recognizable odor of orange may be utilized to calm the children with fear and it is a useful medication in dentistry among the kids. The soothing properties of orange oil can be utilized in a dental environment where children can be especially susceptible to increased fear and anxiety, thereby enhancing the mood and general experience of a child in the dental setting ^[8].

The use of the essential oils in pediatric dentistry especially in dental extractions under local anesthesia is a new method of controlling dental anxiety and pain. Dental extractions are also considered to be the most feared ones in children and the anxiety that is involved can worsen the pain perception and this will make the experience more difficult and traumatic ^[9]. Including aromatherapy as a part of dental care procedure, there is a chance to make the situation less frightening and more favorable to children, which would allow reducing their fear and increase their cooperation throughout the procedures ^[10],^[11]. This may result in improved results, not only in the success of the treatment but also in the future feelings of the child towards dental treatment.

Therefore, this study is important to assess the effectiveness of lavender and orange essential oils in reducing dental anxiety and pain perception in pediatric patients undergoing tooth extractions. Understanding the potential benefits of these essential oils could contribute to the development of alternative, non-drug-based methods for managing dental anxiety and discomfort, ultimately enhancing pediatric dental treatment practices.

MATERIALS AND METHODS

RESULTS

The study included 90 participants, with 57.8% (n=52) being female and 42.2% (n=38) male. The age range was 7 to 12 years, with a mean age of 8.76 ± 1.376 years. The mean ages for children in the lavender oil, orange oil, and control groups were 8.8 ± 1.45, 8.7 ± 1.3, and 8.77 ± 1.4 years, respectively. There were no statistically significant differences in the mean age or gender distribution between the groups (p=0.961, >0.05), indicating that the demographic characteristics were consistent across the study groups.

A statistically significant difference (p<0.001) was observed in pulse rate and anxiety levels, as measured by the Face Image Scale, across the different time intervals in all three groups Table 1. To explore the statistical significance of these differences between pulse rate and anxiety levels at various intervals, pairwise comparisons were conducted for each group Table 2.

In the lavender essential oil group, pairwise comparisons revealed statistically significant or highly significant differences (p<0.01, 0.05) between most time intervals, except for PR EXT - PR BI, FIS EXT - FIS LA, and FLACC EXT - FLACC LA, where no significant differences were found (p>0.05). Similarly, in the orange essential oil group, significant differences were seen between most time intervals (p<0.01, 0.05), except for PR LA - PR BI, FIS EXT - FIS LA, FLACC EXT - FLACC LA, and Wong Pain Rating EXT - Wong Pain Rating LA, where differences were not statistically significant (p>0.05). In the control group, significant differences were noted.

DISCUSSION

The research problem addressed in this study was the efficacy of lavender and orange essential oils in alleviating dental phobia and perception of pain in children undergoing dental surgeries. The findings suggest that both orange and lavender essential oils had a significant effect on anxiety and pain, and in both cases, the impact of lavender was stronger. Such results are in line with other studies on the anxiolytic and analgesic properties of these essential oils, which indicates that they could be a useful tool in pediatric dentistry ^[12].

Kritsidima et al. (2010) ^[13] showed the soothing properties of lavender essential oil in dental patients stating that there was a decrease in anxiety levels during dental procedures. This is consistent with our results in which lavender essential oil was found to have a significant effect of reducing anxiety following inhalation and during the procedure. Likewise, S PK et al et al. (2019) ^[14] found that the lavender aromatherapy worked well in reducing the level of anxiety among dental patients, which is similar to our study as it revealed a similar decrease in anxiety at various time points.

In its turn, orange essential oil, though least researched, also demonstrated considerable effects as far as the reduction of anxiety is concerned. In their study, Abdalhai R et al. (2025) ^[15] established that orange essential oil reduced anxiety and improved the mood of dental patients as was the case in our research. According to our results, the orange essential oil possesses potential to be used as an adjunct treatment to manage dental anxiety in children.

Moreover, pain perception was also reduced significantly especially in the lavender group. This is in line with the results of You J et al. (2024) ^[16], who argued that lavender essential oil decreased pain perception during medical procedures. It was also shown by Ghaderi et al. (2020) ^[17] that the lavender oil might become an efficient tool in managing pains in dental pediatric practice. In our research, the perception of pain was lesser when using lavender oil as compared to the orange oil, which is in line with these past studies, as lavender has a greater analgesic effect.

Höferl M et al. (2016) ^[18] and K Sazawa et al. (2022) ^[19] also helped to understand the physiological effects of essential oils by demonstrating that these oils could decrease physiological indicators of stress, including pulse rate. Similar findings were obtained in our study as the pulse rate and anxiety levels reduced significantly in the lavender essential oil group and orange essential oil group as compared to the control group. This supports the notion that essential oils do not only work to decrease subjective sensations of anxiety but also to influence physiological reactions to stress.

Finally, the study results are consistent with other studies indicating that lavender and orange essential oils can be used as non-pharmacological methods of treatment of dental anxiety and dental pain perceptions among children ^[20],^[21]. The use of these oils in pediatric dental practice might enhance patient experience and increase cooperation and decrease the trauma that dental procedures cause. Further research needs to be done in order to perfect these techniques and to assess their relevance in various age groups and dental procedures.

LIMITATIONS

Although the study results were promising, limitations have to be taken into account. The sample was also small and the research was carried out at one institution thus limiting the external validity of the results. Also, the subjectivity of the measures, which is based on the self-reports and the ratings of the observers, may create some biases that may affect the validity of the measurements of the anxiety and the perception of pain. Further studies are needed to reinforce these results, and future studies should include multi-centre studies with larger sample sizes to determine the long-term outcomes of aromatherapy in dental care of children.

CONCLUSION

Irrespective of the limitations, the result of this study indicated that both lavender and orange essential oils had a significant effect on reducing anxiety and pain compared to the control group, though the effects of the former were stronger. These findings highlight the possibility of aromatherapy as a useful non-pharmacological intervention in the dental care of children. Aromatherapy is a simple, harmless and effective way to make the children dental experience enjoyable through the establishment of a relaxing environment which would help diminish fear and anxiety during the procedure. This may improve patient cooperation and result in improved treatment outcomes. Topical application of lavender and orange essential oils is an encouraging method to treating dental phobia and pain among children, leading to the provision of more efficient and trauma-free treatment. More research using larger populations and a more varied scope of dental procedures are suggested to verify such results and explore the broader implication of aromatherapy in paediatric dentistry.