Presurgical Illustration and Psychological Stress in Mandibular Third Molar Surgery

Psychological stress is a common factor accompanied with surgeries in most situations, and mandibular third molar (Wisdom tooth (WT)) surgery couldn't be an exception. Saliva was proven as a valid carrier that could be used to track the levels of cortisol representing the degree of patient's provoked stress. Patient orientation and presurgical diagrammatic illustration of the steps of WT surgery are very important aspects for patient preparation, yet, may be potential stress triggers as well.

This study aims to figure out if patients are exposed to illustrations that shows the mandibular third molar surgery before having the surgery would aggravate their stress or may relieve it considering orientation and relative absence of fear of unknown.

Inclusion criteria

• Healthy patients (American Society of Anesthesiologists Class I),
• Patients demanding extraction of their mandibular third molar,
• Mandibular third molars requiring flap raising, bone removal, coronal and radicular sectioning (Modified Parant Scale Class IV),
• Patients accepting their saliva sampling prior to and after surgery.

Exclusion criteria

• Acutely painful mandibular third molars on clinical examination,
• Pericoronal and/or active periapical and/or active periodontal pathologies on clinical and radiographic examinations,
• Patients using steroids,
• Psychiatric patients,
• Smokers,
• Pregnant patients, and/or those observing their menstruation,
• Patients with conditions of altered cortisol secretion (such as Addison's disease, Cushing's syndrome, and congenital adrenal hyperplasia),
• Patients with altered secretion of saliva (such as due to using atropine, calcium channel blockers, antidepressants, antihistamines, Sjogren's syndrome, and radiotherapy).
• Patients who are overtly anxious about dental treatment (scoring >19 on the Modified Dental Anxiety Scale).