Patterns and predictors of tooth extraction-related anxiety at sequential perioperative stages

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OBJECTIVE: To determine the characteristics of anxiety at five different points during tooth extraction, explore the relationship between anxiety and pain, and identify predictors of overall anxiety. METHODS: A cross-sectional study was conducted among 302 patients undergoing tooth extraction. Anxiety levels were evaluated using a modified dental anxiety scale (MDAS) at five time points: pre-extraction night (T1), hospital waiting period (T2), local anesthesia administration (T3), extraction procedure (T4), and post-extraction (T5). Repeated-measures ANOVA, one-way ANOVA and Pearson correlation analysis were employed to evaluate temporal variations in anxiety levels and their associations with baseline characteristics and pain perception at each assessment point; Chi-square tests and binary logistic regression modeling were used to identify significant predictors of overall anxiety levels. RESULTS: The cohort (mean age 31.3 ± 11.4 years; 60.3% female) demonstrated distinct anxiety patterns throughout the extraction process. Anxiety levels peaked during T3 and T4, followed by a significant post-operative reduction (T5; p < 0.05). Pain (69.5%) and bleeding (67.9%) emerged as the most frequently reported anxiety-inducing factors. Analysis of the correlation between baseline characteristics and anxiety at each time point revealed that younger patients (16-30 years) had smaller anxiety increases during procedures vs. older groups (p = 0.01). Married individuals showed earlier anxiety reduction than unmarried (p = 0.01). Mandibular/bimaxillary extractions and longer durations (> 10 min) correlated with higher intraoperative anxiety (p < 0.05). On the other hand, predicted pain intensity strongly correlated with anxiety at T1-T4 (p < 0.01), while actual pain linked to T4-T5 anxiety (p < 0.01). Postoperative pain showed the strongest association with T5 anxiety (p < 0.001). Risk factor analysis based on overall anxiety levels found that females (OR = 1.76), unemployed individuals (OR = 3.81), and mandibular/bimaxillary extractions (OR = 2.11-2.70) were independent predictors of high overall anxiety. Finally, a prediction model was established. Based on this model, a female unemployed patient with a mandibular third molar had an estimated 72% probability of experiencing anxiety. CONCLUSIONS: Dental anxiety peaks during invasive procedural phases and is influenced by demographic, clinical, and pain anticipation. The identified risk factors (female, unemployment, mandibular procedures) highlight targets for preoperative interventions. Addressing pain expectations and optimizing patient communication may mitigate anxiety, particularly in high-risk groups. CLINICAL RELEVANCE: This study reveals the anxiety characteristics during the perioperative period of tooth extraction. These insights offer essential evidence for clinicians to identify and address anxiety, ultimately enhancing patient care. Additionally, these findings highlight the importance of effective pain control in developing anxiety management strategies in clinical practice. TRIAL REGISTRATION: the registration number is ChiCTR2400086891, dated July 15, 2024.

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