21 June 2023

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State of anxiety and wisdom tooth extraction

Lara Figini

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Third molar extractions are common procedures in a dental office and often cause anxiety and agitation for the patient. This can also cause alterations in vital signs, triggering associated medical complications that sometimes lead to emergencies during the dental procedure. 

Individual factors, such as genetic factors, can influence an individual's physiological homeostasis during surgical procedures. 

Current literature has shown a direct association between biomarkers and adverse stimuli that determine anxiogenic responses. The genes SLC6A4 (encoding serotonin transport member 6 of solute family 4), DRD2 (encoding dopamine D2 receptor), ANKK1 (encoding ankyrin repeat enzyme and domain kinase-containing 1) and COMT (which encodes the catechol-O-methyltransferase) are associated with alterations of anxiety. Genetic polymorphisms can contribute to individual variations in levels of anxiety with consequent alterations of vital signs generated by adverse stimuli such as dental procedures and oral surgery. 

Genetic polymorphism is the presence, in the population of a species, of several alleles of the same gene with a frequency greater than 1%. This can be due to a mutation, insertion or deletion of long stretches of the sequence of DNA, to the extreme of single nucleotide change, which can change the amino acid product of a single codon.

Materials and methods

In a study published in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology in February 2022, the authors evaluated the association between the genetic polymorphisms of the SLC6A4 (rs1042173 and rs3813034), DRD2 (rs6275 and rs6276), ANKK1 (rs1800497) and COMT (rs174675) genes and the alterations in anxiety levels and vital signs in subjects undergoing third molar extractions.

One hundred and sixty-eight individuals were evaluated in the pre-, intra-, and post-operative periods by monitoring systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and body temperature. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI). Buccal mucosa cells were harvested for genetic evaluation using real-time polymerase chain reaction. Statistical analysis was performed establishing a significance level of 5%.

Results

According to the STAI-Trait psychological inventory, the level of anxiety was found to be associated with rs1800497 (P = .031) and with rs174675 for the STAI-State (P = .007). Considering vital signs, a significant correlation was found between respiratory rate values and rs1042173 (P = .029), rs3813034 (P = .024) and rs6275 (P = .025). Diastolic blood pressure values differed significantly for rs1042173 (P = .042), and body temperature values differed significantly for rs174675 (P = .016).

Conclusions

From the data of this study, it can be concluded that the polymorphisms of the SLC6A4, DRD2, ANKK1 and COMT genes can be associated with alterations in anxiety levels and vital signs in subjects undergoing third molar extractions.

Robson Diego Calixto et al. "Genetic polymorphisms are associated with alterations in anxiety levels and vital signs in patients undergoing third molar extractions." Oral Surg Oral Med Oral Pathol Oral Radiol. February 2022; 133:138-147. https://doi.org/10.1016/j.oooo.2021.05.011