Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: a prospective study

Abstract

Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p = 0.04), and in the MDAS between before and immediately after extraction (p = 0.02), and between immediately after and 7 days after extraction (p = <0.001). The DFS also differed between before and immediately after extraction (p = 0.002), and between immediately and 7 days after extraction (p < 0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.

Introduction

The most widely accepted concept of anxiety involves a complex pattern of behaviour associated with physiological activation that occurs in response to internal (cognitive and somatic) and external (environmental) stimuli, which patients may experience before or during dental treatment, or both.1, 2, 3, 4, 5, 6, 7 Fear and anxiety in dentistry is usually associated with poor oral health, poor oral health-related quality of life, and compromised psychosocial health, including low self-esteem and reduced morale.8, 9, 10 McGrath and Bedi¹¹ reported that people with the wost oral health-related quality of life were most commonly among those with high levels of dental anxiety. Schuller et al.,¹² stated that, compared with people who had little dental fear, people with a great deal of dental fear had more decayed tooth surfaces, decayed teeth, and missing teeth and fewer filled and sound teeth.¹³ Hägglin et al.,⁸ also noted that severe dental anxiety was associated with more missing teeth.Dental anxiety is a complex phenomenon affected by several variables.14, 15, 16, 17, 18 Pain is often cited as both an aetiological and a maintaining factor in patients’ dental anxiety.¹⁹ However, not all patients who experience pain during dental procedures develop disabling dental anxiety,20, 21 and not all patients whose overestimation of dental pain is unconfirmed necessarily reduce their recall of past pain or prediction of future pain. Patients’ anxiety may be affected by age, sex, educational standard, and personality. Some studies have reported that people of lower socioeconomic status and with less education have more anxiety, whereas others have reported more dental anxiety in those with better education.14, 15, 22, 23, 24, 25

Our hypothesis was that oral surgery is highly stressful for the patient, that the patient's state of anxiety fluctuates over time, and that studies that have set out to establish qualitative dimensions of fear and anxiety based on assessing patients’ memories have tended to have equivocal findings. Dental anxiety can be assessed successfully with simple self-reported scales. In the present study our objective was to evaluate the degree of anxiety and fear of dental extraction before and immediately after the procedure, and 7 days later, using Spielberger's State-Trait Anxiety Inventor (STAI) (Spanish version), the Modified Dental Anxiety Scale (MDAS), and the Dental Fear Survey (DFS).