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Aim The effect of listening to music before tooth extraction on the autonomic nervous system and psychological state remains unclear. This prospective study explored the hypothesis that playing music before the extraction of an impacted mandibular third molar would stabilize patients' autonomic nervous system activity and circulatory dynamics. Methods Thirty‐six patients were randomized into two groups: control and music. Patients in the music group listened to music before tooth extraction. Heart rate variability and circulatory dynamics were recorded during the procedure. The Modified Dental Anxiety Scale and State Trait Anxiety Inventory scale scores were recorded before the procedure, and the latter was used to assess postoperative anxiety scores. Results Sympathetic nervous activity significantly increased in the control group during the administration of local anesthesia, bone removal, and extraction (p < 0.01), although this increase was lower in the music group during the administration of local anesthesia and extraction (p < 0.05). In the music group, the postoperative anxiety score was significantly lower than the preoperative score (p < 0.05). Conclusion Playing music preoperatively may help reduce sympathetic nerve activity during the administration of local anesthesia and tooth extraction.