Vital Signs and Pain in Anxious Patients Undergoing Lower Third Molar Surgery: A Pilot Split-Mouth Clinical Trial

Kamila Alves Santos¹, Ananda Gomes de Oliveira¹, Fabio Ricardo Loureiro Sato¹, Fernanda Calvo Costa^1*, Rodrigo Dias Nascimento¹, Fernando Vagner Raldi¹, Michelle Bianchi-de Moraes¹

¹Department of Diagnosis and Surgery, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil

*Correspondence author: Fernanda Calvo Costa, Department of Diagnosis and Surgery, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil; E-mail: [email protected]

Citation: Santos KA, et al. Vital Signs and Pain in Anxious Patients Undergoing Lower Third Molar Surgery: A Pilot Split-Mouth Clinical Trial. J Dental Health Oral Res. 2025;6(2):1-8.

Copyright^© 2025 by Santos KA, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Mean and SD values for the variable anxiety as measured by the Corah’s dental anxiety scale. SD = Standard Deviation.

Blood Pressure

In the context of Blood Pressure (BP), the resulting data were subdivided into two groups, namely, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), which were independently evaluated before and after the surgery. Pre-operative SBP for extraction of tooth #48 had a mean value of 98.38 mmHg (SD = 19.50), whereas for extraction of tooth #38 the mean value was 108.38 mmHg (SD = 9.95). With regard to pre-operative DBP, the mean values were 65.25 mmHg (SD = 7.77) and 77.25 mmHg (SD = 18.87), respectively, for teeth #48 and #38. Post-operative SBP had mean values of 111.44 mmHg (SD = 14.09) and 109.56 mmHg (12.65) for teeth #48 and #38, respectively. With regard to the post-operative DBP, the mean values were 67.44 mmHg for extraction of tooth #48 (SD = 9.99) and 67.19 mmHg (SD = 11.81) for extraction of tooth #38. The specific values of each patient in the pre- and post-operative periods are shown in detail in Table 2. Student-t test was used to compare the variation of SBP and DBP before and after each surgical procedure, showing that there were no statistically significant differences in the values of pre-operative and post-operative SBP as well as of post-operative DBP (P = 0.077, P = 0.6948 and P = 0,9488, respectively). However, a statistically significant difference was observed between both surgical procedures (P = 0.025) regarding the pre-operative DBP, in which the first tooth extraction had lower values compared to those of the second one. The values of mean and standard deviation for the variables SBP and DBP before and after the surgical procedures are shown in Table 2.

Table 2: Values of mean and standard deviation for SBP and DBP before and after the surgical procedures. SD: Standard Deviation; SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure.

Heart Rate

Still with regard to vital signs, HR was evaluated in beats per minute (bpm) by using the Student’s t-test and no statistically significant differences between the pre- and post-operative values were found (P = 0.335). In the pre-operative period, the mean values of HR were 79.69 bmp (SD = 9.49) and 83.25 bpm (SD = 11.5) for extractions of teeth #48 and #38, respectively. In the post-operative period, the mean values of HR were 79.39 bmp (SD = 9.71) and 80.75 bpm (SD = 10.10) for extractions of teeth #48 and #38, respectively. The values found before and after the surgical procedures can be seen in Table 3.

Table 3: Values of mean and standard deviation for HR in the pre- and post-operative periods. SD: Standard Deviation; HR: Heart Rate; BPM: Beats Per Minute.

Pain

Student’s t-test was used for comparison of post-operative pain, showing that statistically significant differences were observed between both surgical procedures in the eight post-operative periods. Post-operative pain was intermediately and immediately evaluated after both surgical procedures. Evaluation was initiated every two hours until an 8-hour period and every 24 hours until 72 hours after the surgical procedure. By using a pain analog scale, it was found that pain had the highest mean value within the second hour after extraction of tooth #48 (5.50), followed by that within the first hours (5.38) and within the fourth hour (5.25), whereas the lowest mean value of pain was within the 72 hours after the surgical procedure (3.25). With regard to tooth #38, the higher mean value of pain was 5.06 within 48 hours after the surgery, reaching the lowest mean value (4.06) within the eighth hour. Table 4 shows the relationship between mean and SD of the variable pain for each tooth extracted.

Table 4: Values of mean and standard deviation for pain in the post-operative period. SD: Standard Deviation; H: Hours.

Discussion

According to Okawa, et al., dental treatments are painful and terrifying for the majority of patients [5]. And anxiety and stress can cause systemic complications, in addition to increasing the pain. In view of this, the present study evaluated only anxious patients in two different surgical times in order to verify their influence on vital signs.

No statistically significant differences were found in anxious patients prior to the surgical procedures, although anxiety was slightly lower in the extraction of tooth #38. This result differs from the findings by Alfotawi, et al., Akomolafe, et al., and Selimović, et al., who emphasize that anxiety can significantly decrease after explaining to the patient about the dental procedure [1,13,14]. According to Akomolafe, et al., Gonzalez-Martinez, et al., and Selimovic, et al., and Xu, et al., pain control can be related to the control of the patient’s emotional state, that is, of the anxiety [13-16].

Although Akomolafe, et al., and Selimovic, et al., state that there is a direct relationship between anxiety and pain, the latter refers to inter- and post-operative perceptions involving extractions of third molars associated with anxiety and guidelines to patients [13,14]. The present study was performed with anxious patients only and no statistically significant difference was observed for the variable pain in the post-operative periods. This finding differs from that by Van Wijk, et al., Kain, et al., and Akomolafe, et al., who report that providing patients with more information on surgical procedures and complications also increases significantly the pain control in the post-operative period, meaning that well-informed patients tend to feel less pain [17-19]. In the present study, the pain reported by the patients was mild to moderate, being higher in the second hour (mean of 5.5) and fourth (5.25) after the extraction of tooth #48, despite not being statistically significant, and slightly lower after the extraction of tooth #38. These values were not statistically different, thus also indicating absence of increased levels of pain after both tooth extractions.

Brand HS, et al., state that a simple visit to the dental surgeon can provoke an increase in BP and HR, especially in patients with phobia, anxiety and pain prior to dental procedures [20]. Although the present study was performed with anxious patients, no statistically significant variations were observed in BP and HR. Our finding differs from that by Selimović, et al., who reported increased values of BP and HR in patients to be submitted to third molar extraction, especially those with anxiety [14]. However, Alfotawi, et al., and Ping et al., reported that anxious patients can present with alterations in cardiovascular and hemodynamic functions, including heart beat rate [1,21].

Pre-operative DBP had significant differences, with higher pre-operative values   in the second surgical procedure, that is, extraction of tooth #38. According to Brand HS, et al., it is not clear that there is a significant increase in pre-operative DBP, whereas Selimović, et al., reported an increase in DBP, especially in patients with anxiety [14,20]. On the other hand, the results found for SBP differ from those by Brand HS, et al., as they reported a pre-operative DBP increase, but no significant differences were found in the present study pre- and post-operatively. The values of HR also differ from those reported by the same authors as we found no significant differences before and after the tooth extractions. Even though it is a pilot study, the results can help in the dentist’s clinical conduct when dealing with the third molar removal procedure.

Conclusion

Despite being a pilot study, we can consider the positive factors related to the patient’s previous surgical experience. In the second procedure, although there was no decrease in the parameters of systolic blood pressure, heart rate, or pain assessments analyzed during specific periods, these parameters also did not show an increase, except for diastolic blood pressure, which is an important factor for dentists to consider. However, further studies with a larger sample size should be conducted.

Conflict of Interest

The authors declare no conflict of interest.  

Funding

None.

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