Does a Brochure Reduce Dental Anxiety in Patients Undergoing Third Molar Extraction? A Randomized Clinical Trial

Dental anxiety frequently compromises patient cooperation and outcomes during third molar (3M) extraction prompting the use of nonpharmacological strategies such as detailed written information. Evidence on reducing preoperative anxiety remains inconsistent warranting further randomized studies.

The study purpose was to measure and compare anxiety levels, hemodynamic parameters, and postintervention satisfaction between combined verbal and written information versus verbal information alone among patients undergoing 3M removal.

A randomized, single-blind clinical trial involved patients attending the Master of Medicine, Surgery, and Oral Implantology at the University of Barcelona for 3M extraction between 2022 and 2025. Exclusion criteria included systemic diseases, psychiatric medication (anxiolytic/antidepressants), pregnancy, inability to complete questionnaires, non-3M extraction, or prior 3M extractions within 1 year.

The primary predictor was the type of preoperative intervention, with participants randomized to receive either combined verbal and written information about the treatment procedure or verbal information alone.

Primary outcome was anxiety measured using State-Anxiety Inventory and Modified Dental Anxiety Scale at baseline, presurgery, postsurgery, and follow-up. Secondary outcomes were hemodynamic parameters and questionnaire-based satisfaction level, assessed across procedural stages.

These included age, sex, reason for extraction, lower molar extracted, Winter and Gregory and Pell classifications, and baseline anxiety.

Categorical variables were assessed using χ² or Fisher's exact tests. Continuous variables were measured using independent t-test or Mann-Whitney U tests. The primary significance level was set at α = 5%.

The study sample consisted of 75 participants with a mean age 25.73 (6.64) years and 40 (53.33%) women. Combined verbal and written information did not significantly reduce preoperative anxiety compared to verbal information alone, as measured by the State-Anxiety Inventory (median 38.00 [range 25 to 61] vs 38.00 [25 to 66]; P = .3) and Modified Dental Anxiety Scale (median 10.00 [range 5 to 18] vs 9.00 [5 to 20]; P = .5). No other measures reached statistical significance, including hemodynamic parameters (P = .2) and patient satisfaction (P = .2).

Combined verbal and written information did not significantly reduce preoperative anxiety or change hemodynamic parameters and patient satisfaction compared to verbal information alone in patients undergoing 3M extraction.