Association between dental anxiety and intraoperative pain during root canal treatment: a cross-sectional study

Aim: To investigate whether dental anxiety influences the intraoperative pain felt by patients during root canal treatment.

Methodology: In a cross-sectional design, 180 patients (90 men and 90 women) were included. Pre-operative anxiety levels were assessed using the short-form Dental Anxiety Inventory (S-DAI). Pain during root canal treatment was evaluated using a 10-cm visual analogue scale (VAS) that ranked the level of pain between 'Absence of pain' and 'Unbearable pain'. The minimal sample size was determined using the software of the National Center for Advancing Translational Sciences (NIH, UK). Multivariate logistic regression analysis was used to identify relationships between variables.

Results: Mean pain level during root canal treatment was 2.2 ± 2.1. The mean anxiety S-DAI score was 27.2 ± 12.5. Fifty percent of men had mild anxiety levels, while in 70% of women anxiety was moderate or high (P = 0.017). Anxiety correlated positively with intraoperative pain (R = 0.406). Multivariate logistic regression analysis revealed that anxiety was significantly associated with intraoperative pain felt by patients (OR = 4.0; 95% C.I. = 1.7-9.3; P = 0.001).

Conclusions: Anxious patients were more than twice as likely to feel moderate or intense intraoperative pain during root canal treatment. To know the patient´s degree of anxiety could help the dentist to decide whether to use anxiolytic premedication and/or supplemental local anaesthesia to assure better control of pain during root canal treatment.