The Use of a Respiratory Rate Biofeedback Device to Reduce Dental Anxiety: An Exploratory Investigation
Abstract
Anxiety experienced by individuals visiting the dental office to receive treatment is common. Evidence has shown biofeedback to be a useful modality of treatment for numerous maladies associated with anxiety. The purpose of the current pilot study was to investigate the use of a novel biofeedback device (RESPeRATE™) to reduce patients' pre-operative general anxiety levels and consequently reduce the pain associated with dental injections. Eighty-one subjects participated in this study, forty in the experimental group and forty-one in the control group. Subjects in the experimental group used the biofeedback technique, while those in the control group were not exposed to any biofeedback. All subjects filled out a pre-injection anxiety survey, then received an inferior alveolar injection of local anesthetic. Post-injection, both groups were given an anxiety survey and asked to respond to four questions regarding the injection experience using a Visual Analog Scale (VAS). With the use of the respiratory rate biofeedback device, there was a significant reduction of negative feelings regarding the overall injection experience, as measured by a VAS. Our findings demonstrate that this novel biofeedback technique may be helpful in the amelioration of dental anxiety, and may help produce a more pleasant overall experience for the patient.
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A novel biofeedback device was effective in reducing dental anxiety and negative feelings associated with dental injections in a pilot study.
“The results demonstrated the effectiveness of the biofeedback device in reducing dental anxiety and negative feelings associated with dental injections [22].”
From Novel non-pharmacological strategies for managing dentophobia in adult patients - literature review (2024) · cites this paper as [22]
Cites
Practical Nonparametric Statistics
Groggel, D. J., & Conover, W. J. (2000) · Technometrics · doi:10.2307/1271101 · Cited by 11,071 · see citing works
A critical review of visual analogue scales in the measurement of clinical phenomena
Wewers, M. E., & Lowe, N. K. (1990) · Research in Nursing & Health · doi:10.1002/nur.4770130405 · Cited by 2,580 · cited 1× · see citing works
“Visual analog scales have been described as useful for measuring a variety of subjective phenomena, with applications of the method well documented in the pain and mood research literature ( Wewers and Lowe 1990 ).”
MethodReliability of the Visual Analog Scale for Measurement of Acute Pain
Bijur, P. E., Silver, W. G., & Gallagher, E. J. (2001) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2001.tb01132.x · Cited by 2,091 · see citing works
Bodily Changes in Pain, Hunger, Fear, and Rage.
Washburn, M. F., & Cannon, W. B. (1917) · The Journal of Philosophy Psychology and Scientific Methods · doi:10.2307/2013624 · Cited by 1,912 · see citing works
Practical Nonparametric Statistics (2nd ed).
Groeneveld, R. A., & Conover, W. J. (1981) · Journal of the American Statistical Association · doi:10.2307/2287607 · Cited by 1,869 · see citing works
Analysis of Ordinal Categorical Data.
Tsutakawa, R. K., & Agresti, A. (1985) · Journal of the American Statistical Association · doi:10.2307/2288509 · Cited by 1,644 · see citing works
Analysis of Ordinal Categorical Data
Agresti, A. (2010) · Wiley Series in Probability and Statistics · doi:10.1002/9780470594001 · Cited by 1,620 · see citing works
Practical Nonparametric Statistics
Bhapkar, V. P., & Conover, W. J. (1972) · Technometrics · doi:10.2307/1267149 · Cited by 1,422 · see citing works
Bodily Changes in Pain, Hunger, Fear and Rage
Cannon, W. B. (1929) · Southern Medical Journal · doi:10.1097/00007611-192909000-00037 · Cited by 1,359 · see citing works
Development of a Dental Anxiety Scale
Corah, N. L. (1969) · Journal of Dental Research · doi:10.1177/00220345690480041801 · Cited by 1,299 · see citing works
Assessment of a dental anxiety scale
Corah, N. L., Gale, E. N., & Illig, S. J. (1978) · The Journal of the American Dental Association · doi:10.14219/jada.archive.1978.0394 · Cited by 779 · see citing works
(1987) · Oral Surgery Oral Medicine Oral Pathology · doi:10.1016/0030-4220(87)90383-5 · Cited by 705 · see citing works
A Comparison of Pain Rating Scales by Sampling From Clinical Trial Data
Breivik, E. K., Björnsson, G. A., & Skovlund, E. (2000) · Clinical Journal of Pain · doi:10.1097/00002508-200003000-00005 · Cited by 681 · see citing works
Jacobson, A. (1988) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/0889-5406(88)90461-1 · Cited by 670 · see citing works
Practical Nonparametric Statistics, 3rd Ed.
Borror, C. M. (2001) · Journal of Quality Technology · doi:10.1080/00224065.2001.11980074 · Cited by 588 · see citing works
Thanawala, V., & Bedforth, N. M. (2013) · British Journal of Anaesthesia · doi:10.1093/bja/aet047 · Cited by 515 · see citing works
Reliability and validity of a visual analog scale for acute abdominal pain in the ED
Gallagher, E. J., Bijur, P. E., Latimer, C. T., & Silver, W. G. (2002) · The American Journal of Emergency Medicine · doi:10.1053/ajem.2002.33778 · Cited by 454 · see citing works
The prevalence and practice management consequences of dental fear in a major US city
Milgrom, P., Fiset, L. O., Melnick, S. L., & Weinstein, P. (1988) · The Journal of the American Dental Association · doi:10.14219/jada.archive.1988.0030 · Cited by 407 · see citing works
International Dental Federation (2021) · International Dental Journal · doi:10.1002/(issn)1875-595x · Cited by 402 · see citing works
Interactions Between Respiration and Circulation
Daly, M. D. B. (1986) · Comprehensive physiology · doi:10.1002/cphy.cp030216 · Cited by 234 · see citing works
Breathing-control lowers blood pressure
Grossman, E., Grossman, A., Schein, M. H., Zimlichman, R., & Gavish, B. (2001) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001147 · Cited by 234 · see citing works
Oosterink, F. M. D., de Jongh, A., & Aartman, I. H. A. (2008) · European Journal Of Oral Sciences · doi:10.1111/j.1600-0722.2007.00500.x · Cited by 205 · see citing works
Reiner, R. (2008) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-007-9046-6 · Cited by 186 · see citing works
Sedative music reduces anxiety and pain during chair rest after open-heart surgery
Voss, J. A., Good, M., Yates, B., Baun, M. M., Thompson, A., & Hertzog, M. (2004) · Pain · doi:10.1016/j.pain.2004.08.020 · Cited by 185 · see citing works
Appraisal of dental anxiety and fear questionnaires: a review
Schuurs, A. H. B., & Hoogstraten, J. (1993) · Community Dentistry and Oral Epidemiology · doi:10.1111/j.1600-0528.1993.tb01095.x · Cited by 179 · see citing works
Sedation: A guide to patient management
(1987) · Oral Surgery Oral Medicine Oral Pathology · doi:10.1016/0030-4220(87)90244-1 · Cited by 178 · see citing works
Schein, M. H., Gavish, B., Herz, M., Rosner-Kahana, D., Naveh, P., Knishkowy, B., Zlotnikov, E., BEN-ZVI, N., & Melmed, R. N. (2001) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001148 · Cited by 168 · see citing works
Biopharmaceutical Considerations in Subcutaneous and Intramuscular Drug Administration
Ballard, B. E. (1968) · Journal of Pharmaceutical Sciences · doi:10.1002/jps.2600570301 · Cited by 136 · see citing works
Dental phobic patients' view of dental anxiety and experiences in dental care: a qualitative study
Abrahamsson, K. H., Berggren, U., Hallberg, L. R. ‐., & Carlsson, S. G. (2002) · Scandinavian Journal of Caring Sciences · doi:10.1046/j.1471-6712.2002.00083.x · Cited by 126 · see citing works
The effects of slow breathing on affective responses to pain stimuli: an experimental study
Zautra, A. J., Fasman, R., Davis, M. C., & Craig, A. D. (. (2010) · Pain · doi:10.1016/j.pain.2009.10.001 · Cited by 126 · see citing works
Elliott, W. J., Izzo, J. L., White, W. B., Rosing, D. R., Snyder, C. S., Alter, A., Gavish, B., & Black, H. R. (2004) · Journal of Clinical Hypertension · doi:10.1111/j.1524-6175.2004.03553.x · Cited by 114 · see citing works
Pellino, T. A., Gordon, D. B., Engelke, Z. K., Busse, K. L., Collins, M. A., Silver, C. E., & Norcross, N. J. (2005) · Orthopaedic Nursing · doi:10.1097/00006416-200505000-00005 · Cited by 104 · see citing works
Analgesic Efficacy and Safety of an Intraoral Lidocaine Patch
Hersh, E. V., Houpt, M. I., Cooper, S. A., Feldman, R. S., WOLFF, M. S., & Levin, L. M. (1996) · The Journal of the American Dental Association · doi:10.14219/jada.archive.1996.0098 · Cited by 102 · see citing works
Anesthesia and Sedation in the Dental Office
(1985) · JAMA · doi:10.1001/jama.1985.03360080085036 · Cited by 89 · see citing works
Nonpharmacologic treatment of hypertension by respiratory exercise in the home setting
Meles, E. (2004) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2003.12.009 · Cited by 82 · see citing works
Effects of paced respiration on anxiety reduction in a clinical population
Clark, M. E., & Hirschman, R. (1990) · Biofeedback and Self-Regulation · doi:10.1007/bf01011109 · Cited by 80 · see citing works
An evaluation of dental pain using Visual Analogue Scales and the McGill Pain Questionnaire
Seymour, R. A., Charlton, J. E., & Phillips, M. E. (1983) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/0278-2391(83)90017-4 · Cited by 75 · see citing works
Dental fears in general practice: new guidelines for assessment and treatment.
Milgrom, P., & Weinstein, P. M. (1993) · PubMed · Cited by 74 · see citing works
Psychometric properties of the modified dental anxiety scale: an independent replication.
Newton, T., & Edwards, J. C. (2005) · PubMed · Cited by 70 · see citing works
A clinical comparison of pain perception to the Wand and a traditional syringe
Saloum, F. S., Baumgartner, J. C., Marshall, G., & Tinkle, J. S. (2000) · Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology · doi:10.1067/moe.2000.106333 · Cited by 66 · see citing works
Sedation: A guide to patient management
(1985) · Oral Surgery Oral Medicine Oral Pathology · doi:10.1016/0030-4220(85)90277-4 · Cited by 55 · see citing works
Some characteristics of regular and irregular attenders for dental check‐ups
Liddell, A., & May, B. (1984) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1984.tb00622.x · Cited by 53 · see citing works
Oral Health Care Utilization by US Rural Residents, National Health Interview Survey 1999
Vargas, C. M., Dye, B. A., & Hayes, K. L. (2003) · Journal of Public Health Dentistry · doi:10.1111/j.1752-7325.2003.tb03493.x · Cited by 53 · see citing works
Comparison of a controlled injection pressure system with a conventional technique
Goodell, G. G., Gallagher, F. J., & Nicoll, B. K. (2000) · Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology · doi:10.1067/moe.2000.107365 · Cited by 44 · see citing works
Fear of routine dental treatment in adults: Its nature and management
Lindsay, S., & Jackson, C. (1993) · Psychology and Health · doi:10.1080/08870449308403174 · Cited by 41 · see citing works
The Psychodynamics of Dental Anxiety and Dental Phobia
Rubin, J. G., Slovin, M., & Krochak, M. (1988) · Dental Clinics of North America · doi:10.1016/s0011-8532(22)00299-3 · Cited by 40 · see citing works
Psychology and Dentistry: Mental Health Aspects of Patient Care
Ayer, W. A. (2005) · Medical Entomology and Zoology · Cited by 39 · see citing works
Using a precision-metered injection system to minimize dental injection anxiety.
Krochak, M., & Friedman, N. (1998) · PubMed · Cited by 38 · see citing works
Pathways to full mouth extraction
Bouma, J., Uitenbroek, D. G., Westert, G. P., Schaub, R. M. H., & van de Poel, F. (1987) · Community Dentistry And Oral Epidemiology · doi:10.1111/j.1600-0528.1987.tb01739.x · Cited by 38 · see citing works
Arun, C. P. (2004) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1296.016 · Cited by 29 · see citing works
The pressures created by inferior alveolar injections
Rood, J. P. (1978) · BDJ · doi:10.1038/sj.bdj.4804079 · Cited by 24 · see citing works
Pain Response after Psychological Preparation for Repeated Periodontal Surgery
Croog, S. H., Baume, R. M., & Nalbandian, J. (1994) · The Journal of the American Dental Association · doi:10.14219/jada.archive.1994.0171 · Cited by 20 · see citing works
Characteristics of dentally successful and dentally unsuccessful adults
Nutall, N. M. (1984) · Community Dentistry And Oral Epidemiology · doi:10.1111/j.1600-0528.1984.tb01441.x · Cited by 16 · see citing works
The effect of warming local anesthetic solutions prior to injection.
Rogers, K. B., Fielding, A. F., & Markiewicz, S. W. (1990) · PubMed · Cited by 16 · see citing works
Moore, R., & Birn, H. (1990) · PubMed · Cited by 14 · see citing works
Flagged first, then by citations
1 of the 57 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Giggins, O. M., Persson, U., & Caulfield, B. (2013) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-10-60 · Cited by 760 · see citing works
Strategies to manage patients with dental anxiety and dental phobia: literature review
Appukuttan, D. (2016) · Clinical, Cosmetic and Investigational Dentistry · doi:10.2147/ccide.s63626 · Cited by 616 · see citing works
Management of fear and anxiety in the dental clinic: a review
Armfield, J., & Heaton, L. (2013) · Australian Dental Journal · doi:10.1111/adj.12118 · Cited by 585 · see citing works
The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise
Nicolò, A., Massaroni, C., Schena, E., & Sacchetti, M. (2020) · Sensors · doi:10.3390/s20216396 · Cited by 451 · see citing works
Breathing Practices for Treatment of Psychiatric and Stress-Related Medical Conditions
Brown, R. P., Gerbarg, P. L., & Muench, F. J. (2013) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2013.01.001 · Cited by 201 · see citing works
Biofeedback for Everyday Stress Management: A Systematic Review
Yu, B., Funk, M., Hu, J., Wang, Q., & Feijs, L. M. G. (2018) · Frontiers in ICT · doi:10.3389/fict.2018.00023 · Cited by 185 · see citing works
Hoffmann, B., Erwood, K., Ncomanzi, S., Fischer, V, O'Brien, D., & Lee, A. (2022) · Australian Dental Journal · doi:10.1111/adj.12926 · Cited by 111 · see citing works
Peak High-Frequency HRV and Peak Alpha Frequency Higher in PTSD
Wahbeh, H., & Oken, B. (2012) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-012-9208-z · Cited by 110 · see citing works
Development and Pilot Test of a Virtual Reality Respiratory Biofeedback Approach
Blum, J., Rockstroh, C., & Göritz, A. S. (2020) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-020-09468-x · Cited by 60 · see citing works
Mental health disorders and their impact on cardiovascular health disparities
Vaccarino, V., Prescott, E., Shah, A. J., Bremner, J. D., Raggi, P., Dobilienė, O., Gale, C. P., & Bugiardini, R. (2025) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2025.101373 · Cited by 42 · see citing works
Lu, C. Y., Zhang, Y. Y., Xiang, B., Peng, S., Gu, M., & Wong, H. M. (2022) · Odontology · doi:10.1007/s10266-022-00711-x · Cited by 37 · see citing works
Szulczewski, M. T. (2021) · Neuromodulation Technology at the Neural Interface · doi:10.1111/ner.13458 · Cited by 33 · see citing works
Biofeedback no tratamento de transtornos relacionados ao estresse e à ansiedade: uma revisão crítica
Lantyer, A. D. S., Viana, M. D. B., & Padovani, R. D. C. (2013) · Psico-USF · doi:10.1590/s1413-82712013000100014 · Cited by 22 · see citing works
CalmWear: A Smart Tactile Sensory Stimulation Clothing
Göncü-Berk, G., Zhang, R., & Yilmaz, C. (2021) · International Symposium on Wearable Computers · doi:10.1145/3460421.3478829 · Cited by 21 · see citing works
Dedeepya, P., Nuvvula, S., Kamatham, R., & Nirmala, S. (2013) · European Archives of Paediatric Dentistry · doi:10.1007/s40368-013-0070-3 · Cited by 21 · see citing works
Levi, M., Bossù, M., Luzzi, V., Semprini, F., Salaris, A., Ottaviani, C., Violani, C., & Polimeni, A. (2022) · International Journal of Paediatric Dentistry · doi:10.1111/ipd.12958 · Cited by 17 · see citing works
Cebalo, N., Vranić, D. N., & Kes, V. B. (2020) · Acta Stomatologica Croatica · doi:10.15644/asc54/4/8 · Cited by 14 · see citing works
Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study
Ovadia‐Blechman, Z., Tarrasch, R., Velicki, M., & Gal, H. C. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.678098 · Cited by 14 · see citing works
Ansari, A. S., Joshi, S. S., Mazumdar, S., & Ansari, S. (2016) · Contemporary Clinical Dentistry · doi:10.4103/0976-237x.194125 · Cited by 9 · see citing works
Rational thinking as a mediator of the relationship between mindfulness and dental anxiety
Yao, J., Carciofo, R., & Pan, L. (2023) · Scientific Reports · doi:10.1038/s41598-023-28879-4 · Cited by 8 · see citing works
Mousavi, S. A., Nasiri, F., Kashani, M. S. A., Ghazalgoo, A., Iranmanesh, P., & Shahbazi, S. (2025) · Clinical and Experimental Dental Research · doi:10.1002/cre2.70156 · Cited by 6 · see citing works
Setiawan, A. S. (2014) · Dental Journal (Majalah Kedokteran Gigi) · doi:10.20473/j.djmkg.v47.i2.p87-91 · Cited by 3 · see citing works
Novel non-pharmacological strategies for managing dentophobia in adult patients - literature review
Los, A., Fiegler-Rudol, J., Tysiąc-Miśta, M., & Tanasiewicz, M. (2024) · Wiadomości Lekarskie · doi:10.36740/wlek202408112 · Cited by 2 · see citing works
Zeitoun, S. I., Khalil, A., Wahba, N. A., & Sayed, M. (2021) · Alexandria Dental Journal · doi:10.21608/adjalexu.2020.25911.1054 · Cited by 2 · see citing works
Herath, S. S., Kusumi, A., Note, Y., Nakamura, E., Nozawa, A., & Nomura, S. (2017) · Artificial Life and Robotics · doi:10.1007/s10015-017-0402-1 · Cited by 2 · see citing works
Wawrzyniak, A., Sadowska, N., Pawlak-Mojsiewicz, M., Walczuk, N., Masłyk, D., Barczyk, I., Skomro, P., Sroczyk-Jaszczyńska, M., Kijak, K., Gronwald, H., et al. (2026) · Public health reviews · doi:10.3389/phrs.2026.1609316 · Cited by 1 · see citing works
Oyekunle, O. M., Fulton, J., & Hayes, C. (2016) · Journal of Community & Public Health Nursing · doi:10.4172/2471-9846.1000146 · Cited by 1 · see citing works
Forbes, E., Clover, K. A., Baker, A., McCarter, K. L., Oultram, S., Kumar, M., WRATTEN, C. R., Tieu, M. T., Nixon, J. L., & Britton, B. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-062467 · Cited by 1 · see citing works
Can Pulse Rate Variability be Used to Monitor Compliance with a Breath Pacer?
Sokolovskiy, S., Arroyo, D., & Hansma, P. K. (2024) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-023-09617-y · Cited by 1 · see citing works
Complementary and Alternative Medicine
Goupil, S., & Goupil, M. T. (2019) · Springer eBooks · doi:10.1007/978-3-319-91361-2_5
Herath, S. S., HAYAKAWA, K., SAKAI, O., SEKIYA, R., & Nomura, S. (2019) · International Journal of Affective Engineering · doi:10.5057/ijae.ijae-d-18-00037
The Use of a Respiratory Biofeedback Instrument in Managing Fear and Anxiety in Clinical Practice
Wong, N. S. M., Yeung, A. W. K., McGrath, C. P. J., & Leung, Y. Y. (2025) · International Dental Journal · doi:10.1016/j.identj.2025.100882
Endodontik Tedavilerde Dental Anksiyete
Çakır, H., & Kiraz, G. (2025) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.3813.c701
Bansal, N., Mehra, P., Loshali, A., Rehan, H. S., & Debnath, E. M. (2026) · Journal of Maxillofacial and Oral Surgery · doi:10.1007/s12663-025-02892-8
- Authors
- Morarend, Q. A., Spector, M. L., Dawson, D. V., Clark, S. H., & Holmes, D. C.
- Affiliations
- University of Iowa (US)
- Corresponding author
- Spector, Michael L.
- ORCID
- Holmes, David C.
- Venue
- Applied Psychophysiology and Biofeedback
- Published
- 2011-03-02
- Volume
- 36
- Issue
- 2
- Pages
- 63-70
- ISSN
- 0363-3586 (ISSN-L)
- 1090-0586
- 1573-3270
- OpenAlex
- W1965460385
- Cited by
- 33
- References
- 57
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 3 · 2014: 1 · 2013: 5 · 2012: 1
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Applied Psychophysiology and Biofeedback (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Music Therapy and Health
- Keywords
- dental anxiety, preoperative anxiety, local anesthetic injection pain, anxiety reduction, patient experience
- MeSH terms
- Adult, Aged, Biofeedback, Psychology, Female, Humans, Male, Middle Aged, Pilot Projects, Dental Anxiety, Treatment Outcome, Respiratory Rate
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