Electrodermal activity during dental procedures: effects of procedure type, age, and audiovisual interventions

Dental anxiety affects roughly 15% of the general population, yet the relative contribution of procedure type, patient age, and distraction interventions to objective autonomic arousal during dental treatment remains poorly characterised. This study investigated the effects of these three factors on electrodermal activity (EDA) in a clinical dental setting. Skin conductance was continuously recorded in 65 adult patients (age 18-29: n=23; 30-55: n=19; ≥56: n=23) undergoing dental procedures under local anaesthesia at a walk-in dental clinic. Patients were randomly assigned to audiovisual intervention (n=30) or control (n=35), and EDA was measured with a wrist-worn sensor and analyzed in STATISTICA 13.0 using nonparametric tests. Extractions produced significantly elevated mean EDA (mean (M)=10.85 μS, standard deviation (SD)=5.00) compared with non-extraction procedures (M=5.20 μS, SD=5.60; Z=4.25, P<0.001, η²=0.28). Older patients (≥56 years: median (Mdn)=2.49 µS) showed lower EDA than middle-aged patients (30-55 years: Mdn=7.81 µS; H=7.96, P=0.019, η²=0.09), consistent with physiological aging and stress resilience. Procedure duration did not correlate with EDA (r(s)=0.15, P=0.23). Anti-stress ball users showed elevated EDA during extractions (Mdn=13.12 vs. 8.60 μS, Z=-2.22, P=0.026), most plausibly attributable to bilateral hand immobilisation imposed by the study protocol. Among non-extraction procedures, augmented reality glasses (AR) were associated with the lowest median EDA (Mdn=2.35 μS, n=12), followed by music glasses (Mdn=2.73 µS, n=4) and headphones (Mdn=4.01 µS, n=3), though group differences were non-significant (H=1.42, P=0.49). Autonomic arousal was more strongly determined by procedure invasiveness (η2=0.28) than by patient age (η²=0.09), with the invasiveness effect driven primarily by the extraction subgroup. AR glasses were well tolerated and associated with the lowest EDA in non-extraction procedures, warranting evaluation in an adequately powered trial. Adequately powered randomised controlled trials restricted to single procedure types and incorporating validated anxiety scales are required before clinical recommendations can be made.