An interesting article titled “Comparative Evaluation of Efficacy of Oral Diazepam and Buspirone in Reducing Anxiety and Discomfort in Mandibular Third Molar Surgery- In Vivo Study,” by Mitra et al. appears in the Indian Journal of Public Health Research & Development (vol.10, no. 3, Mar. 2019, pp. 182-186). The article seeks to compare the effectiveness of diazepam and buspirone in reducing anxiety and discomfort in lower wisdom teeth removal.
The authors were motivated to perform the study because dental anxiety has been reported to range from roughly 4% to 21%. Even more alarming is that up to nearly 50% of patients who have high anxiety have missed a dental appointment at one point. While non medication treatment options exist such as behavioral modification and hypnosis and guided relaxation, some patients may really only respond to medications. Benzodiazepines are the most commonly used oral sedative drugs that are classified as hypnotics of which diazepam belongs. Buspirone is considered an azapirone and does not have hypnotic, anticonvulsant and muscle relaxant properties. Previously evidence shows that buspirone has limited potential for abuse and dependance and does not impair cognitive function.
In the study 28 patients in Pune, India, were included as part of the double blind split mouth study and divided equally into two groups. Group A patients were prescribed 5m of diazepam and group B were prescribed 10 mg of buspirone before the surgery. Perioperative anxiety was rated with 1 indicating no fear and 10 indicating extreme fear. All patients were given a painkiller and antibiotics as part of the discharge procedure. All patients were reviewed after seven days to remove any stitches. After 3 weeks the groups were crossed and the sequence of tables were reversed.
For the group given diazepam, the authors found that preoperatively, 30 minutes after receiving medication, during extraction, and post operatively the anxiety scale was 4.64 ± 1.28, 4.17 ± 0.98, 4.32 ± 1.36 and 3.85 ± 1.92 respectively. The authors found no statistically significant reduction in anxiety from preoperatively until post operatively for the diazepam group. For the group given buspirone, the authors found that that preoperatively, 30 minutes after receiving medication, during extraction, and post operatively the anxiety scale was 4.92 ± 1.84, 3.96 ± 1.5, 3.39 ± 2.02 and 2.67 ± 1.67 respectively. The authors found a statistically significant reduction in anxiety from preoperatively until post operatively for the buspirone group. The authors also found a stastically signficant difference between the comfort level of those given buspirone compared to diazepam, with 78% of the busipirone group being comfortable and 44.8% of the diazepam group being comfortable.
The authors state:
The use of oral anxiolysis is [a] better alternative to parental sedation for the patients who are sufficiently anxious regarding needle and oral surgical procedures. This finding is conferred by [a] study conducted by Dionne… where oral benzodiazepine[‘s] relatively fast onset, short elimination half-life, and minimal respiratory and cardiovascular effects make it desirable for outpatient use compared with other sedatives that have less favorable pharmacodynamic and pharmacokinetic properties.
The authors believed that buspirone is a safe medication for helping a patient to cope with anxiety. In their study such a reduction in anxiety was achieved within 30 minutes after taking buspirone in those patients who were having lower impacted wisdom teeth extracted. The authors do point out that one flaw with their study was the distribution of the anxiety levels of patients used in the study. In the present study most of the patients were of either mild or moderate anxiety to start the study but a better study would have included more patients with severe anxiety to start. Even so the results seem to indicate that buspirone might be a drug to consider to take prior to having wisdom teeth extracted if you suffer from dental anxiety.