Discussion
Anxiety, anxiety, pain, dizziness, amnesia
CORTEX
Anxiety develops when patients are subjected to stressful situations, such as medical interventions [In general, there is no difference between the study's findings and those of other studies [On the other hand, the study's findings contradict the results of Muzzarelli et al. [Lavandula angustifolia (lavender essential oil), the main constituents of which are linalool and linalyl acetate, was used in our study to stimulate olfaction in patients. Linalool stimulates serotonin secretion in the brain, which acts as a sedative and improves the patient's mood. Linalyl acetate, on the other hand, is a narcotic that helps patients to control their behaviors. Both components act as anxiolytic, and thus lavender oil reduces anxiety in the patients [Understanding the physiology of emotional responses to different stimuli, as well as how the anxiety develops in humans, could aid in explaining the findings of our study. Olfaction, like any other sensory stimuli, affects the limbic system in the brain, which regulates emotional changes either positive or negative [If the odors are anxious, the amygdala stimulates the hypothalamus, which stimulates the pituitary gland, which stimulates the adrenal gland to secrete stress hormones (adrenaline, noradrenaline, catecholamines, and corticosteroids). Stress hormones are responsible for the fight-or-flight response, which protects the body from anxious stimuli. Cortisol also makes the patient more alert and sensitive to stimulation. If the stimulus is chronic and persistent, anxiety will develop as a result of the constant release of stress hormones, resulting in negative behavioral and emotional responses. Anxiety is also experienced as a result of sustained cortisol secretion, which inhibits serotonin secretion. [On the other hand, the pleasant sent activates olfactory receptor cells connected to the olfactory bulb, which then sends signals to the amygdala and olfactory cortex. These activities cause the amygdala to initiate good memories, resulting in the release of anxiolytic neurotransmitters such as endorphins and serotonin, which improve mood and produce sedation. Furthermore, the pleasant sent reduces anxiety by inhibiting stress hormone secretion [In terms of pain perception, the study's findings revealed that olfaction aromatherapy significantly reduces the intensity of pain and eliminates the need for postoperative analgesics, as also reported by Moss et al. [Regarding hemodynamic changes, the inhalation of the olfactory aromatherapy was significantly improving all the vital signs, except DBP. The same finding was also reported by Stanley et al., [The clinical importance of our study is that, up to our knowledge, it is the first study that predict to what extent the olfactory aromatherapy affects anxiety and pain perception during dental settings. Furthermore, because of the study's design and intervention, the findings could be generalized. Moreover, the findings of this study may encourage dentists to consider using lavender oil aromatherapy as a simple complementary therapy in dental settings to reduce dental anxiety and pain and avoid the risks of anxiolytic drugs. Those drugs have drawbacks, such as abuse/dependence liability, amnesia, clinical effect delay, sedation, and dizziness, all of which affect clinical adherence. Also, olfactory aromatherapy is a simple, inexpensive, non-invasive technique with few side effects, can be used to manage anxiety and pain in medical settings.The study has some limitations, such as a small sample size, and the patients were treated by a variety of dentists who took different approaches to their patients' behavior and attitudes. Furthermore, the results of the study were obtained via a questionnaire, which had drawbacks. It has been demonstrated that the patient's mode influences his or her responses to questions. Despite this, our study has many strengths, such as the absence of confounders such as age, gender, and time lapse. Its preferred random control trial design, as well as the fact that it is a single institutional study.