Exploring the relationship between anxiety, patient characteristics and pain outcomes in oral surgery under local anesthesia: The measurement problem.

Background: Anxiety during oral surgery can impact patient homeostasis, increase the difficulty of the procedure and create additional stress for the surgeon. Furthermore, it has been associated with more intense and prolonged pain during and after dental treatment.
Objectives: The aim of the study is to evaluate the relationship between anxiety, patient characteristics and pain outcomes in oral surgery, as well as to verify the impact of anxiety on patient's perception of pain during and after oral surgery.
Material and Methods: This is a prospective observational study. Several variables were evaluated during the course of the oral surgery. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), the Interval Scale of Anxiety Response (ISAR), and Patient SelfRated Anxiety (PAnx) during the procedure.
Results: General anxiety measures (STAI) were not associated with specific dental anxiety or external observations of anxiety. Anxiety levels varied according to gender and body mass index (BMI), and were correlated with increased heart rate (HR) (with variability among assessment tools). Odontectomy, ostectomy and an increased volume of anesthesia were associated with higher anxiety levels (with variability among the assessment tools). There was a correlation between pain and anxiety, with anxiety contributing to approx. 12% of the variability in postoperative pain.
Conclusions: Dental anxiety is a complex, multidimensional mental phenomenon characterized by high variability due to the influence of several dynamic factors.