Zhang Zewei, Zhang Yu, Liu Huan, He Feng, Li Guowei, Li Yuan, Zhang Shuyin, Mo Jingzhen, Zhou Hongzhi, Li Chen, Xue Yang
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, Xi'an, China.
Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, China.
BMC Oral Health. 2025 Aug 31;25(1):1387. doi: 10.1186/s12903-025-06734-4.
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.
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.
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.
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.
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.
the registration number is ChiCTR2400086891, dated July 15, 2024.
确定拔牙过程中五个不同时间点的焦虑特征，探讨焦虑与疼痛之间的关系，并确定总体焦虑的预测因素。
对302例接受拔牙的患者进行横断面研究。使用改良牙科焦虑量表（MDAS）在五个时间点评估焦虑水平：拔牙前一晚（T1）、医院等待期（T2）、局部麻醉给药时（T3）、拔牙过程中（T4）和拔牙后（T5）。采用重复测量方差分析、单因素方差分析和Pearson相关分析来评估焦虑水平的时间变化及其与每个评估点的基线特征和疼痛感知的关联；使用卡方检验和二元逻辑回归模型来确定总体焦虑水平的显著预测因素。
该队列（平均年龄31.3±11.4岁；60.3%为女性）在整个拔牙过程中表现出不同的焦虑模式。焦虑水平在T3和T4期间达到峰值，随后术后显著降低（T5；p<0.05）。疼痛（69.5%）和出血（67.9%）是最常报告的诱发焦虑因素。对每个时间点的基线特征与焦虑之间的相关性分析显示，年轻患者（16 - 30岁）在手术过程中焦虑增加幅度小于老年组（p = 0.01）。已婚个体的焦虑缓解比未婚个体更早（p = 0.01）。下颌/双颌拔牙以及较长的手术时间（>10分钟）与术中较高的焦虑相关（p<0.05）。另一方面，预测的疼痛强度与T1 - T4期间的焦虑密切相关（p<0.01），而实际疼痛与T4 - T5期间的焦虑相关（p<0.01）。术后疼痛与T5焦虑的关联最强（p<0.001）。基于总体焦虑水平的危险因素分析发现，女性（OR = 1.76）、失业个体（OR = 3.81）和下颌/双颌拔牙（OR = 2.11 - 2.70）是总体高焦虑的独立预测因素。最后，建立了一个预测模型。基于该模型，一名患有下颌第三磨牙的失业女性患者经历焦虑的估计概率为72%。
牙科焦虑在侵入性手术阶段达到峰值，并受到人口统计学、临床和疼痛预期的影响。确定的危险因素（女性、失业、下颌手术）突出了术前干预的目标。解决疼痛预期并优化患者沟通可能减轻焦虑，特别是在高危人群中。
本研究揭示了拔牙围手术期的焦虑特征。这些见解为临床医生识别和解决焦虑提供了重要证据，最终改善患者护理。此外，这些发现强调了有效疼痛控制在临床实践中制定焦虑管理策略的重要性。
注册号为ChiCTR2400086891，日期为2024年7月15日。
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