Background: Dental anxiety is a significant and challenging problem in patients seeking dental treatment. During any dental procedure patients often experience severe pre–operative and intra–operative anxiety which makes the procedure more difficult. Anxiety during endodontic therapy often leads to increased pain perceptions and instability of the physiological parameter throughout treatment. Aim: The purpose of this study was to evaluate the influence of music as a nonpharmacologic aid on anxiety, pain perception and physiological parameters (heart rate, systolic blood pressure, and diastolic blood pressure) at three different time period – before, during, and after endodontic treatment. Methods: A total of 100 patients were recruited in the present study. Before starting the endodontic treatment, the interviewer administered the Modified Corah Dental Anxiety Scale (MCDAS) to assess the baseline level of anxiety and Visual Analog Scale (VAS) for pain assessment. Patients were randomly divided into 2 groups: the first one listened to the music during endodontic treatment and the second one did not. Before, during, and after the endodontic procedure, the physiological parameters (i.e. heart rate, systolic and diastolic blood pressure) were recorded. All the data were collected and statistically analyzed. Results: Direct contrasts between patients listening or not listening to music showed that all the measured physiological parameters improved considering the overall period (during and after the root canal therapy) in the group of patients listening to music (P < .05). Conclusion: Within the limitation of the study, music administered to subjects with different levels of anxiety during endodontic treatment significantly decreased pain levels and improved physiological parameters during the endodontic procedures. Clinical Significance: Music and medicine always work together and the soothing effects of sounds and musical frequencies make this union an extraordinary tool of synergistic care. Music therapy can be considered as a valid nonpharmacologic aid to manage anxiety during endodontic treatment.