OBJECTIVE Endodontic treatment is one of the most fearful procedures among dentistry, and the use of music during the procedure has been evaluated to control patients' anxiety. This systematic review has been conducted to provide a synthesis of the state of knowledge in this field and aimed to answer the following question: "Can music therapy reduce patient's state anxiety during endodontic treatment?". METHODS A search was performed in six electronic databases (PubMed, Cochrane Library, Scopus, Web of Science, EMBASE, and Open Gray) for articles published until April 2022. The eligibility criteria, based on the PICOS strategy, were as follows: (P) patients undergoing endodontic treatment; (I) exposure to music; (C) no music; (O) patients' anxiety; (S) only randomized clinical trials. The risk of bias was analyzed according to the Cochrane Risk of Bias tool for randomized controlled trials (RoB 2). The strength of evidence from the included studies was assessed using the Grading of Assessment, Development, and Assessment Recommendations (GRADE) tool. RESULTS Five eligible studies were retrieved. A low to high risk of bias was verified. Descriptive analysis showed an effect in favor of music intervention, with differences among state anxiety, heart rate and blood pressure. CONCLUSIONS With a very low quality of evidence, dental care professionals may consider playing background music during endodontic treatment since it is a cost-effective and easy alternative to trying to reduce dental anxiety. CONCLUSIONS Five studies were included in this systematic review and showed, with a very low quality of evidence, that music may reduce state anxiety levels on patients during root canal treatment.