Ambient odors of orange and lavender reduce anxiety and
improve mood in a dental office
*, G. Marwinski
, S. Lehr
, P. Johren
, L. Deecke
University Clinic of Neurology, Medical University of Vienna, Austria
Department of Medical Statistics, Medical University of Vienna, Austria
Private Office, Bochum, Germany
University Witten/Herdecke, Germany
Received 27 April 2005; received in revised form 27 May 2005; accepted 24 June 2005
The goal of this study was to investigate the impact of the essential oils of orange and lavender on anxiety, mood, alertness and
calmness in dental patients. Two hundred patients between the ages of 18 and 77 years (half women, half men) were assigned to one
of four independent groups. While waiting for dental procedures patients were either stimulated with ambient odor of orange or
ambient odor of lavender. These conditions were compared to a music condition and a control condition (no odor, no music). Anxiety,
mood, alertness and calmness were assessed while patients waited for dental treatment. Statistical analyses revealed that compared to
control condition both ambient odors of orange and lavender reduced anxiety and improved mood in patients waiting for dental
treatment. These findings support the previous opinion that odors are capable of altering emotional states and may indicate that the use
of odors is helpful in reducing anxiety in dental patients.
D2005 Elsevier Inc. All rights reserved.
Keywords: Essential oil of orange; Essential oil of lavender; Anxiety; Mood; Aromatherapy
Odors have long been known to be capable of altering
the emotional state of humans. Physiological and psycho-
logical effects of essential oils have been acknowledged
in folk medicine and aromatherapy for a long time .
Citrus and lavender fragrances have been particularly
attributed with mood enhancing properties by aromathera-
In a previous ambient odor study using orange odor
in a waiting room of a dentist’s office, we found
reduced anxiety and improved mood in female but not in
male patients waiting for dental treatment . Early
studies demonstrated the sedative nature of lavender [4,5]
and in two recent studies [6,7] lavender was shown to
improve mood in young subjects; however, no data for
the clinical setting in a dental office is available for
Given the potential of essential oils of altering psycho-
logical states, the goals of the present study were to tackle
the important question whether the effect of reducing
anxiety and improving mood in a dental office is specific
to orange oil or if it can be extended to lavender odor. A
second goal was to investigate whether stimuli from other
modalities, music for example, have the same effect. For
this purpose we set up an experimental trial taking place in
the waiting room of a dental office. The setting of a dentist’s
waiting room was chosen because previous evidence
suggested dental experience to be associated with fear and
0031-9384/$ - see front matter D2005 Elsevier Inc. All rights reserved.
* Corresponding author. Neurologische Universita¨tsklinik, Allgemeines
Krankenhaus, Wa¨hringergu¨ rtel 18-20, A-1097 Wien, Austria. Tel.: +43 1
40400 3109; fax: +43 1 40400 3141.
E-mail address: email@example.com (J. Lehrner).
Physiology & Behavior 86 (2005) 92 – 95
2. Materials and methods
2.1. Subjects, experimental design and statistical analyses
We included 200 patients between the ages of 18 and
77 years in our study. All subjects gave informed consent
for a protocol according to the Helsinki Declaration.
Patients were told the purpose of the study was to
determine the association between pain and mood. After
the experiment, each patient was debriefed about the true
nature of the study by the dentist and subsequently
provided informed consent. The participants were assigned
either to a control group with no odor and no music, or to
a music group, or to an orange odor group, or to a
lavender odor group, respectively. Patients were selected
consecutively in order to control different dental proce-
dures (regular check-up, dental hygiene, dental drilling,
tooth pulling, pain). First we tested the no odor study
group, followed by the music group, then the orange odor
study group, and finally the lavender odor study group.
Testing started November 2003 and ended in January
2004. As patients were assigned sequentially to the
experimental conditions, we assumed that age, pain, nasal
disease status, etc. were comparable across conditions.
However, due to the season of the year, it was likely that
the patient sample contained patients with nasal disease. In
order to control for nasal disease status, we screened the
patient sample by means of self report for allergies and
common cold. The four study groups did not differ
regarding frequency of self reported allergies (v
p> 0.05) and self reported comm on cold (v
test, p> 0.05),
respectively. See Table 1 for details.
Upon arriving, patients were registered and then were
handed the questionnaires to be filled-in while waiting
for treatment. Importantly, answering the questionnaires
was entirely self-paced and dependent only on the speed
of patients. We did not measure fill-in time but in no
case was it longer than 20 minutes. First, they completed
a questionnaire asking for demographic data. The mean
age of patients was comparable between the four groups
as indicated by analysis of variance ( F(3,194) = 1.27,
p= 0.293). See Table 1.
Next they were asked about their current pain using an
11-point Likert scale ranging from 0 (no pain at all) to 10
(unbearable pain). Analysis of variance, for degree of
toothache, detected no statistical difference between groups
(F(3,184) = 0.74, p= 0.534) indicating that all four groups
were comparable in terms of pain rating. See Table 1.
Patients were next given a German version of the State-
Trait Anxiety Inventory (STAI)  a self report measure
with demonstrated reliability and validity for assessing trait
and state anxiety. High scores indicate high self-perceived
Subsequently, they were given the Mehrdimensionale
Befindlichkeitsfragebogen (MDBF)  for assessment of
current mood, alertness and calmness. Patients had to
answer questions on 5-point Likert scales regarding mood,
alertness and calmness. Scale reliability (Cronbach’s a)is
above 0.9 for all three scales. Higher scores indicate more
positive mood, high level of alertness and high level of
Ambient odors of orange and lavender were diffused
separately in the waiting room through an electrical
dispenser in both odor groups whereas in the control group
and the music group no odor was in the air. The dispenser
was hidden from the patients view and the system of Voitino
Air100 (Krailling, Germany) with constant intermediate
concentration was used. The odors were set free from 7:30
a.m. to 6:30 p.m. The waiting room was 16 m
the change from orange to lavender the odor delivery system
was thoroughly cleaned according to standard procedures of
the odor delivering system.
The natural essential oils of citrus sinensis and lavender
supplied by Primavera (Sulzberg, Germany) were used. The
main components of the essential oil of orange was
determined by gas chromatography to be limonene 95.3%
and myrcene 1.88%, all other components were below 1%.
The main components of the essential oil of lavender was
determined by gas chromatography to be linalylacetate
34.8%, linaloole 30.6%, occimene-cis 5.9%, occimene-
trans 3.5%, terpinene-4ol 5.4, lavandulylacetate 3.4%,
caryophyllen 4.8%, all other components were below 1%.
The gas chromatography data were provided by the delivery
For the music condition, the compact disk of ‘‘Cafe´ del
Mar — Music from Ibiza’’ was used throughout the study.
This particular music is considered up lifting and cheerful,
reminding people of vacations and good times. The music
was played through the speakers of the dental office in the
waiting room situated on the ceiling of the room. The
loudness of the music remained constant throughout the
In order to compare the variable state anxiety between
the four ‘‘groups’’ an analysis of covariance with the fixed
Mean, standard deviation, range of scores and frequency for each variable
over experimental groups
odor (N= 48)
40.4T13.3 41.0 T13.7 41.9 T14.7 40.2 T12.4
19 – 77 23 – 74 23 – 74 21 – 70
6.3T3.1 6.4 T3.2 6.8 T3.2 6.6 T3.5
0–10 0–10 0–10 0–10
26/25 25/24 23/25 24/26
34/13 38/6 38/6 42/5
36/10 30/14 33/13 37/8
Group effect p> 0.05.
test, p> 0.05.
test, p> 0.05.
J. Lehrner et al. / Physiology & Behavior 86 (2005) 92– 95 93
factors ‘‘group’’ (4 levels: control/music/orange odor/laven-
der odor), ‘‘gender’’ and the covariates age and trait anxiety
was performed. The interaction between ‘‘gender’’ and
‘‘group’’ was also included in the model in order to test
whether differences between the groups depend on gender
because a gender effect for orange odor was found in our
previous study. Post hoc comparisons between group means
were performed by the method of Tukey– Kramer. A p-
value < 0.05 was considered to indicate statistical signifi-
cance. A similar analysis was carried out for the variables
mood, alertness and calmness, except that trait anxiety was
not included as covariate. Calculations were performed
using the SAS software system V8.2 (SAS Institute Inc.,
2002, Cary, NC).
Tab l e 2 gives the means, standard deviations and range of
scores of the raw data for each variable over experimental
The analysis of covariance for the dependent variable of
state anxiety detected a statistical group effect ( F(3,163) =
3.1, p= 0.028); however, no significant interaction between
group and gender ( p= 0.740) was observed. Post hoc analysis
using Tukey– Kramer multiple comparisons revealed a
statistical group difference between the control group and
the orange group ( p= 0.049) and between the control group
and the lavender group ( p= 0.039). No statistical significant
group difference was found between control group and music
group ( p= 0.371), and furthermore, no other group differ-
ences were significant.
The dependent variables of mood, alertness and calmness
were analyzed in subsequent analyses of covariance with the
fixed factors ‘‘group’’ (4 levels: control/music/orange odor/
lavender odor), gender and the covariate age. For the measure
of mood there was a significant effect of group ( F(3,165)=
3.1, p= 0.030) and no significant group by gender interaction
(p= 0.103). Post hoc analys is using Tukey – Kramer multi-
ple comparisons revealed a significant group difference
between the control group and the orange group
(p= 0.046) and between the control group and the lavender
group ( p= 0.046). No statistical significant group differ-
ence was found between control group and music group
(p= 0.339), and furthermore, no other group differences
were significant. Statistical analysis of the dependent
measure alertness showed no statistically significant main
effect of group ( F(3,165) = 2.2, p= 0.097) nor significant
group by gender interaction ( p=0.166). For the measure of
calmness there was a significant group effect ( F(3,165) = 4.5,
p= 0.004), however, no signifi cant group x gender inter-
action ( p= 0.332) was obtained. Post hoc analysis using
Tukey–Kramer multiple comparisons revealed a borderline
significant group difference between the control group and
the orange group ( p= 0. 061) and a significant group differ-
ence between the control group and the lavender group
(p= 0.016). No statistical significant group difference was
found between control group and music group ( p=0.355),
and furthermore, no other group differences were significant.
It is widely believed that odors have the power to
influence emotional states in humans. We tested this
hypothesis in a controlled experimental study taking
advantage of the highly emotional situation in a dentist’s
waiting room. While waiting for their dental procedures
patients were stimulated either with ambient odor of orange
or ambient odor of lavender. These conditions were
compared to a music condition and a control condition
(no odor, no music). We found that patients who were
exposed to orange odor or lavender odor had a lower level
of state anxiety, a more positive mood, and a higher level of
calmness compared to the patients in the control condition.
The results of this study confirmed the previous notion of
sedative properties of the natural essential oil of orange in a
clinical setting and extended it to the essential oil of
lavender. We further found that exposure to music in a
dentist’s waiting room has an intermediate effect. This
finding is consistent with a growing body of evidence
showing that odors are capable of changing emotional states
in humans. Several prior studies reported that ambient odors
of orange  and lavender [4 – 7] can influence anxiety and
mood in humans. Our study extended this evidence to the
clinical setting in a dental office.
The mode of action of ambient odors in inducing
emotional changes is currently unknown. Recent work
suggests that some essential oils possess pharmacological
properties that may be responsible for the emotional effects
reported in this study. For instance, lavender has been
demonstrated to act postsynaptically, and it is suggested that
it modulates the activity of cyclic adenosine monophosphate
(cAMP). A reduction in cAMP activity is associated with
sedation, a causal relationship that has been established for
Mean, standard deviation and range of scores for each variable over
43.3T13.4 38.1 T10.8 35.7 T10.1 38.1T11.3
24 – 79 23 – 68 20– 69 20 – 65
27.9T7.4 31.2 T4.9 31.7T6.1 30.5 T7.6
9 – 40 20 – 40 13– 40 8 – 47
25.6T6.3 28.2 T7.0 28.5T5.8 27.1 T7.2
14 – 37 14 – 40 18– 40 8 – 38
25.1T8.0 28.2 T6.4 30.1T6.5 28.7 T7.9
8 – 40 17 – 40 10– 40 9 – 40
Group effect p< 0.05.
Interaction of sexgroup p> 0.05.
Group effect p> 0.05 and sex group interaction p> 0.05.
J. Lehrner et al. / Physiology & Behavior 86 (2005) 92– 9594
the effects of cannabis . Transdermal administration of
()-linalool, one of the main constituents of essential
lavender oil, lowered physiological arousal level by means
of autonomic deactivation  without affecting mood
ratings. After experimentally reducing olfactory function in
rats, inhalation of cedrol, a major component of cedarwood
oil, still had marked sedative effects suggesting that the
mechanism of action is via a pathway other than the
olfactory system . On the other hand it is well known
that olfactory processing is directly linked to the limbic
system including the amygdala and that emotional changes
are induced by means of olfactory stimulation as evidenced
by neuroimaging studies . Further research is needed to
resolve this question.
In conclusion, our study supports the traditional use of
essential oils in altering emotional states. It also demon-
strated that essential oils, used as ambient odors, might be
helpful to reduce anxiety and improve mood in dental
offices. Future studies should also take up suggestions 
to investigate effects of odorant mixtures, as well as those of
single odor molecules and effects of natural odor mixtures
compared to synthetic products.
We would like to thank Arinya Eller for proof-reading
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