Methods used in adult dental extraction patients to improve psychoemotional status: systematic review

Dental anxiety is a common problem that may negatively affect patients undergoing tooth extraction procedures. Non-pharmacological interventions have been proposed as supportive strategies to reduce anxiety and improve patient comfort.

The aim of this systematic review was to analyze and summarize non-pharmacological methods used to improve psychoemotional status in adult patients undergoing tooth extraction procedures.

Methods

A systematic literature search was conducted in PubMed (MEDLINE) for studies published between 18 September 2014 and 18 September 2024. A supplementary search was also conducted in ScienceDirect on 18 September 2024, using an adapted keyword strategy and the publication year filter (2014–2024), to reduce the risk of retrieval bias. Randomized controlled trials involving adult patients undergoing dental extraction procedures and evaluating non-pharmacological interventions for anxiety reduction were included. Studies involving pharmacological sedation, non-extraction procedures, or lacking psychoemotional outcomes were excluded.

Results

The PubMed search identified 3692 records. After screening and eligibility assessment according to predefined criteria, 25 randomized controlled trials were included in the qualitative synthesis. The most commonly investigated interventions included music therapy, virtual reality, aromatherapy, guided relaxation techniques, informational interventions, and acupuncture-based methods. Anxiety outcomes were measured using validated scales such as the Modified Dental Anxiety Scale (MDAS), State-Trait Anxiety Inventory (STAI), Visual Analogue Scale (VAS), and Amsterdam Preoperative Anxiety and Information Scale (APAIS), as well as physiological parameters including heart rate, blood pressure, and salivary cortisol. Most studies reported reductions in anxiety indicators following non-pharmacological interventions.

Conclusion

Non-pharmacological interventions may contribute to reducing anxiety in patients undergoing tooth extraction procedures. However, heterogeneity among interventions and outcome measures limits direct comparison across studies. Further well-designed randomized controlled trials are needed to strengthen the evidence base.