Does a Patient’s Psychological Profile Influence Pain Experienced by Wisdom Teeth Removal?

An interesting article titled “Does Psychological Profile Influence Third Molar Extraction and Postoperative Pain?” appears in the 2017 edition of the Journal of Oral and Maxillofacial Surgery written by Gonzalez-Martinez et al. (vol. 75, pp. 484-490). The article explores if psychological distress is associated with higher levels of dental anxiety and pain following wisdom teeth surgery.

Dental anxiety has been shown in studies to be present in 3% to 20% of the population and oral surgery has been shown to provoke the most anxiety. The authors feel that detecting dental anxiety early is essential and one tool for evaluating the psychological profile of an individual is the Symptom Checklist 90 (SCL-90). The authors devised a triple blinded study for patients having wisdom teeth extracted (surgeon, anesthetist, and patient). Patients presented at the University Hospital Casa de Salud of Valencia in Spain and answered a 90 item questionnaire for the Symptom Checklist 90 Revised (SCL-90-R) that measured psychological distress on a scale of 0 to 4. After completing the questionnaire the patients had complete blood and coagulation tests performed. Right before the surgery, the preoperative state of anxiety was recorded by asking patients to rate their level of anxiety on a scale from 0 to 10. The patients were given local anesthesia (4% articaine with 1:100,000 epinephrine) and intravenous sedation (midazolam 0.05 mg/kg, fentanyl 1 mg/kg, continuous infusion of 1% propofol) while having wisdom teeth removed. The patients were monitored during surgery to record both systolic and diastolic blood pressure and heart rate at different times. Pain experienced after surgery was monitored for seven days where the degree of pain was measured using a visual analog scale (VAS). Seven days after the extractions the patients were monitored to evaluate the healing of the surgical area.

feedback face survey - Does a Patient's Psychological Profile Influence Pain Experienced by Wisdom Teeth Removal?
This image is from Pixabay and has a PIxabay license

A total of 62 patients were used in the assessments. The authors performed a Kolmogorov-Smirnov test on the collected data but due to non-normality performed non parametric tests to assess statistical significance. Patients were divided into 3 groups: no psychological morbidity – mentally healthy (38 patients), psychological disorder (16 patients), and psychopathology (8 patients). The authors used the Pell and Gregory classification and Winter classification to grade the position of wisdom teeth but no statistical significant differences were found between groups. The authors found that twenty-hour hours surgery, there were not statistical differences between the 3 groups regarding postoperative pain. However among all 3 groups there was a significant decrease pain from the first to the fourth day after surgery. In the week after surgery, there was a positive significant difference, indicating less pain in patients without psychological disorders and in patients with psychological distress, but there was not a reduction in pain in patients with psychopathology disorders. The authors found a statistically significant difference of pain amongst those with different psychological profiles, on the sixth and seventh days after surgery. The authors also found the state of anxiety was significantly related to patients affected by psychological disorders or psychopathology when compared to patients without any mental disorders.

The authors state:

“One of the most important contributions of our study is evidence regarding the influence of psychological profile in conjunction with postoperative recovery in oral surgery.”

Thus the authors feel their study showed that patients with psychological distress present with higher levels of dental anxiety and postoperative pain. They feel the SCL-90-R used in their study to assess the psychological profile can be completed by patients within 15 minutes and can allow for doctors to quickly obtain information about the possibility of mental illness in their patients. One way to help with mental illness is to consider counseling and if you have a family, then family counseling, see for example Such counseling could allow addressing sources of stress which as shown in this study could lead to less pain after having wisdom teeth removed.

Leave a Comment