Effect of Alpha Binaural Beat Music on Pain After Orthodontic Separator Placement

This study is a prospective, parallel-arm, randomized controlled clinical trial to be conducted at the Department of Dentistry and Oral Health Sciences, Aga Khan University Hospital, Karachi, Pakistan. The study aims to evaluate the effectiveness of alpha-frequency binaural beat auditory stimulation in reducing orthodontic pain and anxiety associated with orthodontic separator placement.

Orthodontic separators are routinely used during the initial stages of fixed orthodontic treatment to create interproximal space for orthodontic band placement. Although considered a routine orthodontic procedure, separator placement frequently causes discomfort and pain that may negatively affect patient motivation, treatment acceptance, compliance, and overall orthodontic experience. Psychological factors, particularly anxiety, have also been shown to influence pain perception and may contribute to variations in pain responses among orthodontic patients. Consequently, there is growing interest in safe and effective non-pharmacological approaches that may improve patient comfort while avoiding the potential adverse effects associated with analgesic medications.

Binaural beats are an auditory phenomenon produced when two slightly different sound frequencies are presented separately to each ear, resulting in the perception of a third frequency corresponding to the difference between the two tones. Alpha-frequency binaural beats, typically ranging between 8 and 13 Hz, have been associated with relaxation, reduced psychological stress, and decreased anxiety. Previous studies have suggested potential beneficial effects of binaural beats on pain perception and emotional responses; however, evidence regarding their effectiveness following orthodontic separator placement remains limited.

Orthodontically treatment-naïve participants aged 15 to 30 years with permanent dentition, mild crowding (≤3 mm arch length discrepancy), good periodontal health, and a requirement for fixed orthodontic treatment will be screened for eligibility and recruited following informed consent procedures. To minimize potential confounding factors and standardize the painful stimulus across participants, all subjects will require bilateral maxillary first molar banding and placement of four elastomeric separators, consisting of one mesial and one distal separator around each maxillary first molar (two separators per side). Participants will be randomly allocated in a 1:1 ratio to either an intervention group or a control group.

The intervention group will receive alpha-frequency binaural beat stimulation through stereo headphones. The auditory stimulus will be generated by presenting a 285-Hz carrier frequency to one ear and a 296-Hz carrier frequency to the opposite ear, resulting in the perception of an 11-Hz alpha-frequency binaural beat. Participants will listen to a standardized audio track for five minutes at designated assessment intervals. Participants allocated to the control group will undergo an equivalent five-minute quiet resting period without auditory stimulation.

Orthodontic pain intensity will be assessed using the Visual Analogue Scale for Pain (VAS-P), while anxiety levels will be assessed using the Visual Analogue Scale for Anxiety (VAS-A). Outcome assessments will be performed before separator placement, during separator placement, and at 6, 24, and 48 hours following the procedure. Analgesic consumption during the observation period will also be recorded.

The primary objective of the study is to evaluate the effect of alpha-frequency binaural beat music on orthodontic pain intensity 24 hours after separator placement. Secondary objectives include evaluating orthodontic pain intensity at 6 and 48 hours, anxiety levels, and analgesic consumption during the observation period. The findings of this study may provide evidence regarding a simple, inexpensive, safe, and non-pharmacological adjunct that could improve patient comfort, reduce procedure-related anxiety, and enhance the overall orthodontic treatment experience during the initial stages of orthodontic care.

Inclusion criteria

• Patients aged 15-30 years.
• Permanent dentition.
• Mild crowding (≤3 mm arch length discrepancy).
• Good periodontal health.
• Requirement for fixed orthodontic treatment.
• Requirement for bilateral maxillary first molar banding.
• Requirement for placement of four elastomeric separators, consisting of one separator mesial and one separator distal to each maxillary first molar.
• Ability to understand study instructions and complete study assessments.
• Willingness to use stereo headphones.
• Provision of written informed consent.

Exclusion criteria

• Previous fixed orthodontic treatment.
• Congenital or acquired hearing impairment.
• Use of hearing aids or assistive listening devices.
• History of tinnitus, hyperacusis, or sound sensitivity.
• Active ear infection.
• Recent upper respiratory tract infection associated with ear symptoms.
• Neurological disorders.
• Psychiatric disorders requiring treatment, including anxiety and depressive disorders.
• Current use of analgesics, anti-inflammatory medications, antidepressants, anxiolytics, antipsychotics, or sedatives.
• Chronic pain disorders.
• Active periodontal disease or significant gingival inflammation.
• Active dental pain, pulpal pathology, or oral infection.
• Inability or unwillingness to use stereo headphones.
• Inability to understand study instructions or complete study assessments.