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Sun IG, Chu CH, Lo ECM, Duangthip D. Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis. J Dent 2024; 142:104841. [PMID: 38246307 DOI: 10.1016/j.jdent.2024.104841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE The objective of this review is to determine the global prevalence of dental fear and anxiety (DFA) in early childhood and identify its related factors. METHODS The systematic review utilized three common English-language databases (PubMed, EMBASE, and Web of Science). Two independent researchers performed a systematic search to include observational studies on young children published from 2000 to 2023. They extracted information on prevalence of DFA, assessment tools used, study sites, respondents, and children's dental visit experiences. RESULTS A total of 2,895 studies were identified, and 25 studies met the inclusion criteria for analysis. The pooled prevalence of DFA among 2- to 6- year-old children was estimated to be 30 % (95 % CI=25, 36). Children without dental visit experience (OR=1.37, 95 % CI=1.18, 1.59) and children with caries experiences (OR=1.18, 95 % CI=1.09, 1.27) had higher odds of experiencing DFA compared to those with dental visit experience or caries-free status. The most commonly used assessment tools in the included studies were the Frankl Behaviour Rating Scale (32 %, 8/25), Children's Fear Survey Schedule-Dental Subscale (20 %, 5/25), and Dental Anxiety Question (20 %, 5/25). CONCLUSIONS This systematic review reveals that approximately one-third of young children globally experience DFA. Children who lack dental visit experience or have caries experiences are at increased risk of DFA. Clinicians can use this information to make informed decisions regarding dental care provision for young children. CLINICAL SIGNIFICANCE This study provides comprehensive information on the global prevalence of dental fear and anxiety and its associated factors in early childhood. The findings can assist clinicians in understanding and addressing DFA in their dental care approach for young children. REGISTRATION PROSPERO (CRD42023446464).
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Affiliation(s)
- Ivy Guofang Sun
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Duangporn Duangthip
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China; College of Dentistry, The Ohio State University, Columbus, OH, USA.
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López-Valverde N, López-Valverde A, Macedo de Sousa B, Blanco Rueda JA. Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials. Front Psychiatry 2024; 15:1352817. [PMID: 38463434 PMCID: PMC10920280 DOI: 10.3389/fpsyt.2024.1352817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Stress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments. Methods Studies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes). Results A total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety-stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001). Conclusion Music therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy. Systematic review registration INPLASY, identifier 202312000.
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Affiliation(s)
- Nansi López-Valverde
- Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Antonio López-Valverde
- Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Bruno Macedo de Sousa
- Institute for Occlusion and Orofacial Pain Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - José Antonio Blanco Rueda
- Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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Kvesić AJ, Hrelja M, Lovrić Ž, Šimunović L, Špiljak B, Supina N, Vranić L, Vranić DN. Possible Risk Factors for Dental Fear and Anxiety in Children Who Suffered Traumatic Dental Injury. Dent J (Basel) 2023; 11:190. [PMID: 37623286 PMCID: PMC10453853 DOI: 10.3390/dj11080190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Children who undergo painful experiences such as traumatic dental injury (TDI) during their early years are more likely to be at an increased risk of developing dental fear and anxiety (DFA). The purpose of this study was to identify potential risk factors for DFA of these children. METHODS The study participants were 220 parents/caregivers and their children who experienced TDI. Their socio-demographic backgrounds were investigated with the modified WHO Oral Health Questionnaire for Children that included questions about parents' knowledge and attitudes, while the DFA level was determined using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Simplified Oral Hygiene Index (OHI-S Index) was used to assess oral hygiene status. RESULTS The confirmed risk factors are parental knowledge, female gender, and degree of oral hygiene and pain in the last three months, while age, type of TDI, presence of soft-tissue injury, and number of subjective complaints were not confirmed. The overall model predicted approximately 54% of variance in DFA, R2 = 0.545, F (4.215) = 64.28 p < 0.001. CONCLUSIONS These findings emphasise the importance of addressing pain management, improving oral hygiene, and enhancing parental knowledge to mitigate DFA in children with TDIs.
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Affiliation(s)
| | - Miroslav Hrelja
- Private Dental Office, 10000 Zagreb, Croatia; (A.J.K.); (M.H.); (Ž.L.)
| | - Željka Lovrić
- Private Dental Office, 10000 Zagreb, Croatia; (A.J.K.); (M.H.); (Ž.L.)
| | - Luka Šimunović
- Department of Orthodontics, School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia
| | - Bruno Špiljak
- School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (N.S.); (L.V.)
| | - Nika Supina
- School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (N.S.); (L.V.)
| | - Lara Vranić
- School of Dental Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (N.S.); (L.V.)
| | - Dubravka Negovetić Vranić
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia;
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Galdino FF, Dos Santos Falcão PC, Rezende Costa L, Bendo CB, da Silva Fidalgo TK. Development and validation of a questionnaire on the feelings of undergraduate dental students regarding child dental care. J Dent Educ 2023. [PMID: 36929657 DOI: 10.1002/jdd.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES This study aimed to develop and test a questionnaire's validity and reliability to evaluate undergraduate dental students' feelings regarding child dental care. METHODS The questionnaire was developed using a focus group of 10 undergraduate dental students. This questionnaire was then structured and applied digitally via Google Forms to 90 dental students aged 22.95 years (±0.89) who had already completed or were enrolled in a pediatric dentistry discipline. The test-retest was conducted with 15 students. Descriptive analysis, exploratory factorial analysis (EFA), and intraclass correlation coefficient were performed to evaluate the test-retest reliability, Cronbach's alpha (α) to measure the internal consistency, and Mann-Whitney test was used to determine the discriminant validity (p < 0.05). RESULTS The final version of the questionnaire concerning the feelings of dental students when faced with pediatric dental treatment comprised three items, which evaluated anxiety, fear, and insecurity. The visual analog scale was used to evaluate the answer for each item. The questionnaire resulted in a total score that varied from 0 to 10. The higher the score on the questionnaire, the greater the negative feelings regarding pediatric dental treatment. The results of the EFA were satisfactory (Bartlett's sphericity = 0.001; Kayser-Meyer-Olkin measure = 0.725). The EFA extracted a single dimension with an eigenvalue of 2.4 and a total explained variance of 80%. The internal consistency of the questionnaire was satisfactory (α = 0.877), and the test-retest reliability was good (intraclass correlation coefficient = 0.691). Students who felt confident about carrying out invasive procedures in children demonstrated more positive feelings related to the pediatric dental treatment (average = 3.50 ± 2.73) than those who did not feel such confidence (average = 5.00 ± 2.35; p = 0.007). CONCLUSIONS The unidimensional questionnaire proposed by this study is valid and reliable in evaluating the feelings of undergraduate dental students regarding child dental care.
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Affiliation(s)
- Fabíola Fontes Galdino
- Department of Preventive and Community Dentistry, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | | | - Luciane Rezende Costa
- Department of Pediatric Dentistry, School of Dentistry, Goias Federal University, Goiânia, GO, Brazil
| | - Cristiane Baccin Bendo
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Tatiana Kelly da Silva Fidalgo
- Department of Preventive and Community Dentistry, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
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Vanhée T, Dadoun F, Vanden Abbeele A, Bottenberg P, Jacquet W, Loeb I. A Parental Behavior Scale in Pediatric Dentistry: The Development of an Observational Scale. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020249. [PMID: 36832378 PMCID: PMC9954998 DOI: 10.3390/children10020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023]
Abstract
Children's treatment means a triangular relationship between the child, practitioner, and parent, with specific interactions influencing the procedure. The objective was to create and validate a hetero-rating scale of parental behavior and verify the correlation between child and parental behavior during pediatric dentistry sessions. Treatment sessions were recorded and evaluated, including 60 children representing three age groups. Two raters interpreted the resulting video clips using the modified Venham scale for children and the new hetero-rating scale for parents. They analyzed the videos twice and attributed scores at different time points of the appointment. The correlation between parental behavior upon entrance and the children's behavioral at the dental office in the treatment stage was significantly positive in both raters (Kendall Tau: 0.20-0.30). Furthermore, a panel of 20 dental practitioners scored a randomized selection of five recordings per age group. The level of agreement between the two experts was higher than that between the 20 clinicians. Venham types of scale involving multiple aspects can be used in research, but their application in dental practice requires further development. The link between parental anxiety and child anxiety is confirmed, but further research is required to incorporate specific aspects of treatment and parental behavior.
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Affiliation(s)
- Tania Vanhée
- Department of Dentistry, Faculty of Medicine, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Surgical Clinical Sciences CHIR-ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Correspondence:
| | - Farah Dadoun
- Department of Dentistry, Faculty of Medicine, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Astrid Vanden Abbeele
- Department of Dentistry, Faculty of Medicine, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Peter Bottenberg
- Department of Dentistry, Faculty of Medicine, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Surgical Clinical Sciences CHIR-ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Wolfgang Jacquet
- Department of Surgical Clinical Sciences CHIR-ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Isabelle Loeb
- Department of Stomatology and Maxillo-Facial Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium
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Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042380. [PMID: 35206566 PMCID: PMC8872083 DOI: 10.3390/ijerph19042380] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 01/28/2023]
Abstract
Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.
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Affiliation(s)
- Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (W.G.); (N.H.)
- Correspondence:
| | | | - Willa Giffin
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (W.G.); (N.H.)
| | - Natasha Hikita
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (W.G.); (N.H.)
| | - José C. Polido
- Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA;
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Krekmanova L, Sotirianou M, Sabel N. Young patients' self-reported fear compared to professionals' assessments during invasive and non-invasive dental visits: a prospective, longitudinal study. Eur Arch Paediatr Dent 2022; 23:309-315. [PMID: 35020180 PMCID: PMC8994721 DOI: 10.1007/s40368-021-00685-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
Purpose The main purpose was to study young patients’ self-reports on dental fear over a 5-year period, prospectively. Also, to compare these to professionals’ proxy reports for dental fear during invasive and non-invasive dental visits. The research question was, to what extent the self-reports and dental professionals’ proxy reports are congruent, and if there were patient age-dependent differences. Methods 3134 patients from 11 public dental clinics, representing urban and rural areas, were invited. Four age cohorts were formed: 3, 7, 11, and 15 years of age and followed between the years 2008 and 2012. Dental examinations (non-invasive) and restorative treatments + extractions (invasive) were registered. During the treatments, self-reports regarding fear and professional proxy reports were registered: Not afraid at all = 0, little nervous = 1, quite afraid = 2, very scared = 3, terrified = 4. Results 2363 patients completed the cohort periods (51% girls and 49% boys). In all, 9708 dental examinations, restorations and extractions were performed. The fear prevalence increased with the invasiveness of the dental procedure; 7–56%. For dental examinations and restorations, fear declined with ascending age. The highest fear prevalence was reported for dental extractions. Younger children reported fear more frequently than older children, p < 0.001. Frequent inconsistencies between self-reports and proxy reports were observed among the younger children (16%) compared to the older children (8%), p < 0.001. Conclusion Non-congruence was observed for self-reports and proxy reports regarding all age cohorts.
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Affiliation(s)
- L Krekmanova
- Department of Pediatric Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Clinic of Pedodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden.
| | - M Sotirianou
- Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - N Sabel
- Department of Pediatric Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinic of Pedodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
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Kuroiwa K, Harano N, Shigeyama-Tada Y, Ono K, Watanabe S. Effects of inhalation sedation with nitrous oxide on intraoral senses. PEDIATRIC DENTAL JOURNAL 2021. [DOI: 10.1016/j.pdj.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Behavior of Children during Dental Care with Rubber Dam Isolation: A Randomized Controlled Study. Dent J (Basel) 2021; 9:dj9080089. [PMID: 34436001 PMCID: PMC8393898 DOI: 10.3390/dj9080089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The establishment of the dental dam improves dentist working conditions and patient protection. The purpose of this study was to analyze the behavior of the child during dental care with or without a dam. METHODS In this interventional randomized study, 51 patients are divided into two groups, one with a rubber dam and the other with cotton roll isolation. Their behavior was observed during the treatment of temporary molars. The duration of the treatment, the patient's feeling with a visual analogue scale (VAS), the behavior (B) of the child measured with a hetero-evaluation scale (modified Venham scale) and the cardiac frequency (CF) were measured. RESULTS The group treated with a rubber dam has a significant decrease in the various stress parameters that have been identified (B, p value = 0.034; CF, p value = 0.015). Subgroups of patients with and without nitrous oxide sedation were compared and similar results were obtained. CONCLUSIONS Isolation with a rubber dam reduces child's stress during dental care. Although it is slightly more time-consuming and training is necessary for a quick and effective placement, it allows dentists to perform dental care in the best possible conditions, while reducing dental anxiety in young patients.
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Herbal medicines as anxiolytics prior to third molar surgical extraction. A randomized controlled clinical trial. Clin Oral Investig 2020; 25:1579-1586. [PMID: 32951121 DOI: 10.1007/s00784-020-03468-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/21/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aimed to compare the effects of Passiflora incarnata, Erythrina mulungu, and midazolam in controlling anxiety in patients undergoing mandibular third molar extraction. METHODS The volunteers underwent extraction of their third mandibular molars in a randomized, placebo-controlled, triple-blind, and parallel clinical trial. Passiflora incarnata (500 mg), Erythrina mulungu (500 mg), or midazolam (15 mg) was orally administered 60 min before the surgery. The anxiety level of participants was evaluated using questionnaires and measurements of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2). RESULTS A total of 200 volunteers were included in this clinical trial. Considering each procedure independently, no significant differences (p > 0.05) in BP, HR, and SpO2 were observed among the protocols. CONCLUSIONS Passiflora incarnata showed a similar effect to midazolam but differed from placebo and mulungu, which were unable to control anxiety in this situation. Therefore, the results suggest that Passiflora configures an herbal medicine with an anxiolytic effect, adequate to use in third molar extractions. CLINICAL RELEVANCE The use of Passiflora incarnata may be an alternative to benzodiazepines for controlling anxiety in patients scheduled for oral surgery under local anesthesia. TRIAL REGISTRATION ClinicalTrials.gov : ANSI-388.427.
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