Factors determining tooth extraction anxiety and fear in adult dental patients: a systematic review

The aim of this study was to review previous studies and to identify reliable factors determining anxiety in adult patients undergoing tooth extraction procedures. An electronic literature search was conducted of the MEDLINE, ScienceDirect, SpringerLink, and Wiley Online Library databases covering the period January 2005 to May 2015. Sequential screening was performed at the title/abstract and full-text level. The review included all human prospective and retrospective follow-up studies and clinical trials, cohort studies, case-control studies, and case series that demonstrated at least one factor determining tooth extraction anxiety and/or fear and used specific scales for measurement. The search identified 16 articles meeting the inclusion criteria. Factors related to tooth extraction in patients were assessed: propensity to anxiety (P < 0.05), pain experience or expectations (P < 0.05), level of disturbance during the procedure (P < 0.001), difficulty of the procedure (P = 0.034), marital status (P = 0.003), social class (P = 0.012), and type of local anaesthesia (P = 0.008). Using a video as the method of providing information (P < 0.05) and having had a previous negative dental experience (P < 0.05) led to an increase in patient anxiety level. Due to disagreements between studies, further investigations into the other factors are required to clarify the results. However, the absence of a single and appropriate scale that includes both the patient's evaluation and that of the doctor, hinders the rating of patient anxiety.