Key Takeaways & Executive Findings
- •• Preoperative dental anxiety significantly prolongs mandibular third molar extraction time, with each 1-point increase in DAS-TMS adding 1.1 minutes. • The relationship between dental anxiety and operation time is nonlinear, with a threshold effect observed at a DAS-TMS score of 14.47. • High anxiety prevalence (32.4% anxious, 8.8% highly anxious) underscores the need for routine anxiety screening in oral surgery. • Managing preoperative anxiety could reduce surgical time and potentially improve postoperative outcomes.
Abstract
BACKGROUND: Patients undergoing mandibular third molar extraction show significantly higher dental anxiety levels than those receiving other dental procedures. Preoperative anxiety not only prolongs operation time but also worsens postoperative complications. OBJECTIVE: To investigate the relationship between preoperative dental anxiety and the time of mandibular third molar extraction. METHODS: A cross-sectional observational study was designed for the patient's extraction of mandibular third molar in the outpatient clinic of Department of Stomatology of Aerospace Center Hospital. The Modified Dental Anxiety Scale for Third Molar Surgery (MDAS-TMS) was used to evaluate the preoperative anxiety status. Demographic characteristics, surgical and radiographic features of the patients were recorded. The main outcome indicator was the duration of surgery. Multivariable linear regression models were developed to analyze their influences, and a restricted cubic spline function was used to evaluate their potential nonlinear associations. RESULTS AND CONCLUSION: A total of 216 patients (71 men and 145 women) were included in the study. The mean DAS-TMS score was 10.4, 32.4% were mildly anxious, and 8.8% were highly anxious. For each 1-unit increase in the DAS-TMS after multivariate adjustment, operation time increased by 1.1 minutes (β=1.10, P < 0.001, 95%CI: 0.76-1.49). Restricted cubic spline analysis revealed evidence of a nonlinear association (P for nonlinearity=0.013). The results indicate that preoperative dental anxiety has a significant impact on the duration of mandibular third molar extraction.
1. Introduction
Impacted mandibular third molar extraction is one of the most common dentoalveolar surgeries in oral and maxillofacial surgery [1], and the accompanying dental anxiety has attracted increasing attention. Dental anxiety is defined as a specific fear response induced by dental treatment-related stimuli, manifesting as a composite state of psychological tension and physiological stress [2-3]. Epidemiological surveys show that anxiety levels in third molar extraction patients are significantly higher than in routine dental treatments, with the highest levels observed during mandibular third molar extraction [4-5]. Studies have shown that preoperative dental anxiety can lead to delayed or avoided dental treatment [6], reducing patient compliance and oral health-related quality of life [7-10].
Currently, the assessment of dental anxiety mainly relies on standardized psychometric tools, including the classic Dental Anxiety Scale (DAS) [2], the Modified Dental Anxiety Scale (MDAS) [11-12], the Index of Dental Anxiety and Fear (IDAF-4C), and the State-Trait Anxiety Inventory (STAI) [13-14]. This study selected the Dental Anxiety Scale for Third Molar Surgery (DAS-TMS), developed based on the modified dental anxiety scale and applicable to third molar extraction, to assess preoperative dental anxiety levels in the study population. Its clinical validity has been verified in the Chinese population [15].
Recent studies have found that preoperative anxiety can activate the body's stress response and prolong postoperative recovery [16-18]. Some studies have shown that preoperative anxiety affects the difficulty of mandibular third molar extraction [19]. As an objective indicator of surgical difficulty, operation time is positively correlated with the incidence of postoperative complications [20]. Therefore, it is speculated that preoperative dental anxiety may be related to operation time. Some studies have evaluated the relationship between dental anxiety and mandibular third molar surgery time [5,20-21]. However, due to residual confounding and possible reverse causation, the direct independent effect of preoperative dental anxiety on operation time remains unclear, and the generalizability and extrapolation of the conclusions need further verification. In addition, whether there is a nonlinear association between the two remains to be studied. Therefore, this study aimed to use DAS-TMS to analyze the association between preoperative dental anxiety and the time of mandibular third molar extraction, in order to provide guidance for clinical dental practice.
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Li Lei, Bai Xiaolong, Li Jiaye, Wang Weili (2026). Association between preoperative dental anxiety and the time of mandibular third molar extraction. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21573
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Frequently Asked Questions
What is the main finding of the study on dental anxiety and third molar extraction time?
The study found that preoperative dental anxiety significantly prolongs the duration of mandibular third molar extraction. Each 1-point increase in the DAS-TMS score was associated with a 1.1-minute increase in operation time, after adjusting for confounders.
How was dental anxiety measured in the study?
Dental anxiety was measured using the Dental Anxiety Scale for Third Molar Surgery (DAS-TMS), a modified version of the dental anxiety scale specifically developed for third molar extraction patients. It has been validated in the Chinese population.
Was the relationship between dental anxiety and operation time linear?
No, the relationship was nonlinear. Restricted cubic spline analysis revealed a nonlinear association, with a threshold effect at a DAS-TMS score of 14.47, beyond which operation time significantly increased.
What are the clinical implications of this study?
The findings suggest that screening for preoperative dental anxiety and implementing anxiety-reduction strategies could help shorten surgical time and potentially improve patient outcomes. This is particularly relevant for patients undergoing mandibular third molar extraction.
What type of study design was used?
The study used a cross-sectional observational design, collecting data from 216 patients who underwent mandibular third molar extraction at the Department of Stomatology of Aerospace Center Hospital between January and December 2022.
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