Anxiety and Hemodynamic Changes in Third Molar Extraction After Patient Education

Ummugulsum Coskun

Status: Completed

Conditions: Tooth Impacted; Tooth Extraction; Dental Anxiety; Molar, Third; Hemodynamic

Treatments: Procedure: Surgical extraction of impacted mandibular third molar; Other: Detailed Verbal Preoperative Information; Other: Basic Preoperative Information; Device: Multiparameter patient monitor; Other: Visual Preoperative Information (2D Animation); Drug: Articaine 4% with epinephrine 1:100,000

Study type: Interventional

Funder types: Other

Identifiers

NCT07018115

2015/30

Details and patient eligibility

About

This randomized clinical trial investigates the effect of different preoperative patient information strategies on anxiety levels and hemodynamic responses during third molar extraction. Ninety-seven patients were assigned to control, verbal information, or visual (animation) information groups. Anxiety was measured using the Modified Dental Anxiety Scale (MDAS) and State-Trait Anxiety Inventory (STAI), while heart rate, blood pressure, oxygen saturation, and pain were recorded. The study aims to assess whether educational interventions can reduce anxiety and improve patient comfort during oral surgery.

Full description

This prospective, randomized clinical trial was designed to evaluate the effect of different preoperative patient information strategies on anxiety levels, hemodynamic responses, and pain perception during the surgical extraction of impacted mandibular third molars. Third molar extraction is a common procedure in oral and maxillofacial surgery, often associated with elevated patient anxiety, which can negatively affect both psychological well-being and physiological parameters such as heart rate and blood pressure.

In this study, 97 patients requiring surgical removal of a single impacted mandibular third molar were recruited and randomly assigned into one of three groups:

1. Control group - provided with a brief, basic explanation of the surgical procedure;
2. Verbal information group - provided with a detailed, non-technical verbal explanation covering the anesthesia, surgical steps, and post-operative care;
3. Visual information group - provided with the same verbal explanation plus an educational 2D animation illustrating the surgical process.

The anxiety levels of participants were measured using two validated scales: the Modified Dental Anxiety Scale (MDAS) and the State-Trait Anxiety Inventory (STAI), both before and after surgery. Physiological measurements, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SaO₂), were recorded at five standardized time points: before surgery, after information delivery and before anesthesia, after anesthesia, during tooth extraction, and in the postoperative period. Pain levels were assessed during the procedure using a Visual Analog Scale (VAS).

All surgeries were conducted under local anesthesia by experienced oral surgeons, following a standardized surgical protocol to minimize operator-related variability. The study also considered demographic and clinical variables, such as patient age, sex, education level, and the depth of impaction of the third molar, as potential factors influencing anxiety and physiological responses.

The study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, and received approval from the university's ethics committee (approval number 2015/30). The primary hypothesis was that providing patients with detailed verbal or visual information would reduce preoperative anxiety compared to basic explanations, and that visual tools might offer additional benefits by enhancing patient understanding and comfort.

The results demonstrated that while anxiety scores generally decreased postoperatively across all groups, the visual (animation) information group showed significantly better oxygen saturation levels during extraction and in the postoperative period, suggesting a positive physiological impact. However, no significant differences were found between groups regarding pain scores or overall surgical duration.

These findings highlight the importance of preoperative patient education and suggest that incorporating visual educational tools, such as animations, may improve physiological stability and patient experience during oral surgical procedures. Further research is warranted to refine these strategies and explore their long-term benefits in various dental and surgical contexts.

Enrollment: 97 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Age ≥ 18 years
• Requiring surgical removal of a impacted mandibular third molar
• Ability to read and complete the questionnaires
• Willingness to participate in the study

Exclusion criteria

• Age < 18 years
• History of systemic disease contraindicating surgery
• Poor oral hygiene
• Current pericoronitis or acute infection around the third molar
• Pregnancy

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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97 participants in 3 patient groups

Control Group

Other group

Description:

Participants receive only a basic, brief explanation of the surgical procedure without additional detailed verbal or visual information.

Treatment:

Drug: Articaine 4% with epinephrine 1:100,000

Device: Multiparameter patient monitor

Other: Basic Preoperative Information

Procedure: Surgical extraction of impacted mandibular third molar

Verbal Information Group

Experimental group

Description:

Participants receive a comprehensive verbal explanation of the surgical procedure, covering all key steps such as anesthesia, incision, bone removal, tooth sectioning, and suturing, delivered in clear, non-technical language to optimize patient understanding.

Treatment:

Drug: Articaine 4% with epinephrine 1:100,000

Device: Multiparameter patient monitor

Procedure: Surgical extraction of impacted mandibular third molar

Other: Detailed Verbal Preoperative Information

Visual Information Group

Experimental group

Description:

Participants receive the same detailed verbal explanation as the verbal information group, supplemented with a 2D animated video illustrating the surgical procedure

Treatment:

Drug: Articaine 4% with epinephrine 1:100,000

Other: Visual Preoperative Information (2D Animation)

Device: Multiparameter patient monitor

Procedure: Surgical extraction of impacted mandibular third molar