Association Between Dental Anxiety and Pain Perception in Patients Receiving Dental Implants: An Observational Study

OBJECTIVE: Previous studies have identified an association between dental anxiety and pain perception; however, the nature of this relationship in the context of oral implant surgery, particularly with respect to pain perception across multiple time points, remains unclear. This study aimed to examine the association between dental anxiety and peak pain perception following oral implant surgery. METHODS: We conducted a prospective observational study involving 332 patients undergoing oral implant surgery. Pain perception was evaluated using a Visual Analogue Scale at five time points: preoperatively (T0), intraoperatively (T1), and at 6 h (T2), 24 h (T3), and 7 days postoperatively (T4). Dental anxiety was assessed with the Modified Dental Anxiety Scale. Logistic regression analysis was conducted to investigate the association between dental anxiety and peak pain perception. A generalized additive model was used to identify nonlinear associations, and a segmented logistic regression model was employed to identify break points. RESULTS: The mean score for pain perception increased from 0.26 ± 0.87 at T0 to 4.36 ± 1.70 at T2, then gradually decreased to 2.55 ± 1.34 at T3 and 0.55 ± 0.80 at T4, where T2 was the time point of peak pain intensity. Logistic regression analysis revealed that the odds ratio (OR) for the association between dental anxiety and pain perception was 1.38 (95% CI: 1.26, 1.53), indicating a 38% increase in the likelihood of pain perception for each one-unit increase in dental anxiety score. A nonlinear relationship was observed, with a break point identified at a dental anxiety score of 14.01. Below this threshold, the odds of pain perception increased substantially with increasing anxiety (OR = 1.51, 95% CI: 1.34, 1.69; p < 0.001). However, beyond this point, the level of anxiety was not associated with pain perception risk (OR = 0.91, 95% CI: 0.76, 1.07; p > 0.05). CONCLUSION: A nonlinear relationship was observed between dental anxiety and pain perception following oral implant surgery. Even at subclinical levels, elevated anxiety was associated with an increased likelihood of pain perception. These findings highlight the importance of early identification and management of dental anxiety to improve postoperative pain control. Further research is warranted to evaluate the clinical utility of integrating anxiety assessment into preoperative care.