When Pain Shapes Dental Anxiety: A Cross-Sectional Mediation Study in Patients Requiring Endodontic Treatment

Objective: This study aimed to evaluate the associations between dental anxiety-fear, state-trait anxiety, and pain in patients requiring endodontic treatment and to explore the role of preoperative pain intensity in these associations. Methods: This cross-sectional study included 253 adults scheduled for endodontic treatment. Sociodemographic characteristics and relevant clinical data were recorded. Pain intensity and psychological variables were assessed using the Numerical Rating Scale (NRS), Modified Dental Anxiety Scale (MDAS), Dental Fear Survey (DFS), and the State Anxiety and Trait Anxiety subscales of the State-Trait Anxiety Inventory (STAI-S and STAI-T). Associations were analyzed using group comparison tests and correlation analyses, and mediation analyses were performed using Hayes' PROCESS macro-4. Results: Significant correlations were found among all psychological parameters (p < 0.05). The observed associations were consistent with a potential partial mediating role of pain in the relationship between state-trait anxiety and dental anxiety. Higher anxiety levels were present in patients with anterior teeth requiring either primary treatment or retreatment compared with posterior teeth (p < 0.05). Conclusions: Preoperative pain may contribute to the association patterns identified between dental anxiety and state-trait anxiety. Further studies with larger sample sizes and adjusted analytical models are needed to better clarify these relationships.