Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jan;105(1):16-26. doi: 10.1016/j.tripleo.2007.03.015. Epub 2007 Jul 25.


Objective: The present study evaluated whether dental patient anxiety has an effect on the cardiovascular response to the delivery of anesthetic to achieve mandibular anesthesia.

Study design: One hundred eighty adult patients scheduled to receive routine dental extraction under local anesthesia were enrolled in this prospective study. Anxiety was measured at 15 minutes before local anesthetic delivery using Corah's Dental Anxiety Scale (Corah's DAS). Anesthetic was delivered using a standard technique for mandibular nerve block with the same dose (2 cartridges) given to all patients. Cardiovascular response data including blood pressure, heart rate, O(2) saturation, and electrocardiographic changes were measured at 5 time points from 5 minutes before to 15 minutes after the administration of anesthetic.

Results: The mean anxiety scale score before administration of anesthetic was 9.3 (SD +/- 2.5) with a range from 4 to 20. Women had a significantly higher mean dental anxiety level than men (P < .05). Younger age was associated with a higher anxiety scale score. Severe preoperative anxiety (Corah's DAS >12) was associated with significantly increased heart rate during administration of anesthetic. Patients with severe anxiety also had a significantly greater increase in heart rate during anesthetic administration (P < .001). Younger age was associated with increased likelihood of high dental anxiety and associated cardiovascular response to dental anesthesia (P = .001). Pain on injection was also associated with increased heart rate during anesthetic administration.

Conclusion: This study showed that Corah's dental anxiety scale is a useful tool for estimating the impact of anxiety on the heart rate during local anesthetic delivery to achieve mandibular block for dental extraction. Younger patients undergoing tooth extraction were more likely to have high anxiety levels, and younger patients with high anxiety were more likely to report a traumatic dental history. High anxiety, younger age, and traumatic dental history were correlated with greater increases in heart rate during the administration of local dental anesthesia.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anesthetics, Local / pharmacology*
  • Cardiovascular System / drug effects*
  • Dental Anxiety / diagnosis
  • Dental Anxiety / physiopathology*
  • Epidemiologic Methods
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Male
  • Mandibular Nerve / drug effects
  • Middle Aged
  • Nerve Block
  • Sex Factors
  • Tooth Extraction / psychology*


  • Anesthetics, Local