Anxiety related to non-surgical root canal treatment: systematic review and meta-analysis

Objectives: Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical change. Dental anxiety has been associated with pain and care avoidance. Anxiety is common with more invasive treatments including nonsurgical root canal treatment (NSRCT). The very words “root canal” appear to be deeply embedded in societal consciousness; they are a commonly used idiom for something menacing or to be dreaded. Better understanding of dental anxiety may prevent treatment avoidance. The purpose of this study was to conduct a systematic review of anxiety associated with NSRCT.
Methods: Inclusion/exclusion criteria were used for defined searches in MEDLINE and Cochrane Library, and PsycINFO. Title lists were scanned and abstracts read to determine utility; articles meeting inclusion criteria were analyzed for heterogeneity; data was extracted, summarized and compiled into a table of evidence, and meta-analysis performed where possible.
Results: Defined searching produced 927 titles; 31 articles were included, mostly representing modern populations from countries with high or very high human development indices. Major sources of heterogeneity included differing study aims, outcome measures, differences in clinical setting, study geographic location, differences in operator type, and variations in patient selection or sample size. Meta-analysis of 16 papers, including 1565 subjects, gave a pre-treatment anxiety rating of 39 (SD=9) on a normalized 100 point scale. Meta-analysis of 4 papers, including 232 subjects, gave a post-treatment anxiety rating of 27 (SD=5) on a normalized 100 point scale, representing a 31 % reduction. A L’Abbe plot showed that anxiety decreased following NSRCT in each of the included 5 studies. Limited data indicated that gender, age and prior NSRCT experience influenced NSRCT associated anxiety. NSRCT associated anxiety was ranked high among dental treatments, often close to oral surgery.
Conclusions: Anxiety associated with NSRCT was generally moderate. Anxiety decreased following NSRCT.