Does Third Molar Surgery Alter Cardiac Parameters? A Retrospective Study

Alper Sindel, Mehmet Ali Altay, Nelli Yıldırımyan, Öznur Özalp


Objective: To investigate perioperative changes in the cardiac parameters of anxiety, which are blood pressure and heart rate, in patients undergoing surgical extraction of third molars. Material and Methods: Patients who reported anxiety before scheduled procedures were monitored for cardiac parameters before, during and after the surgery. The obtained data were analyzed to determine if there is a certain pattern of change within these values in systemically healthy patients. Alterations in selected parameters with regard to duration and difficulty of operation were also studied. IBM SPSS Statistics was used for data analysis. Repeated-measures of analysis of variance (ANOVA), paired samples t-test and Kruskal-Wallis tests were applied and a significance level of 5% was assessed. Results: Difficulty was categorized as minimally, moderately or very difficult in 9, 28 and 3 patients respectively. Mean operation time was 36.18 minutes with a range of 8 to 91 minutes. Operation time showed no variations with different levels of difficulty (p = 0.268). No statistical differences in any of the parameters listed above could be identified. Conclusion: Despite the common belief that dental procedures initiate anxiety, this study reveals that physiological parameters of anxiety show no significant changes over the course of third molar surgery, likewise difficulty and duration of surgery do not cause noteworthy changes in these parameters.


Dental Anxiety; Blood Pressure; Heart Rate; Molar, Third.

Full Text:



Elliott M, Coventry A. Critical care: the eight vital signs of patient monitoring. Br J Nurs 2012; 21(10):621-5. doi:10.12968/bjon.2012.21.10.621.

Joseph VS. Vital signs and resuscitation. Georgetown: Landes Bioscience, 2003.

Vingerhoets G. Perioperative anxiety and depression in open-heart surgery. Psychosomatics 1998; 39(1):30-7.

Simon AE, Steptoe A, Wardle J. Socioeconomic status differences in coping with a stressful medical procedure. Psychosom Med 2005; 67(2):270-6. doi: 10.1097/01.psy.0000155665.55439.53.

Hollander M, Schortinghuis J, Vissink A. Changes in heart rate during third molar surgery. Int J Oral Maxillofac Surg 2016; 45(12):1652-7. doi: 10.1016/j.ijom.2016.08.004.

Alemany-Martínez A, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Hemodynamic changes during the surgical removal of lower third molars. J Oral Maxillofac Surg 2008; 66(3):453-61. doi: 10.1016/j.joms.2007.06.634.

Tolas AG, Pflug AE, Halter JB. Arterial plasma epinephrine concentrations and hemodynamic responses after dental injection of local anesthetic with epinephrine. J Am Dent Assoc 1982; 104(1):41-3.

Pell GJ, Gregory B. Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest 1933; 39:330-8.

Winter GB. Principles of exodontia as applied to the impacted mandibular third molar. American Medical Book Company, 1926.

Armfield JM. A comparison of three continuous scales used to determine the prevalence of clinically significant dental fear. Community Dent Oral Epidemiol 2011; 39(6):554-63. doi:10.1111/j.1600-0528.2011.00628.x.

Armfield JM. What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance. Community Dent Oral Epidemiol 2013; 41(3):279-87. doi: 10.1111/cdoe.12005.

Liau FL, Kok S-H, Lee J-J, Kuo R-C, Hwang C-R, Yang P-J, Lin CP, Kuo YS, Chang HH. Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105(1):16-26. doi: 10.1016/j.tripleo.2007.03.015.

Berggren U, Meynert G. Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc 1984; 109(2):247-51.

Sanadhya Y, Sanadhya S, Jalihal S, Nagarajappa R, Ramesh G, Tak M. Hemodynamic, ventilator, and ECG changes in pediatric patients undergoing extraction. J Indian Soc Pedod Prev Dent 2013; 31(1):10-6. doi: 10.4103/0970-4388.112393.

Brand HS, Gortzak RA, Palmer-Bouva CC, Abraham RE, Abraham-Inpijn L. Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment. Int Dent J 1995; 45(1):45-8.

Gungormus M, Buyukkurt M. The evaluation of the changes in blood pressure and pulse rate of hypertensive patients during tooth extraction. Acta Med Austriaca 2002; 30(5):127-9.

Cheraskin E, Prasertsuntarasai T. Use of epinephrine with local anesthesia in hypertensive patients. IV. Effect of tooth extraction on blood pressure and pulse rate. J Am Dent Assoc 1959; 58(1):61-8.

Nichols C. Dentistry and hypertension. J Am Dent Assoc 1997; 128(11):1557-62.

Beck FM, Weaver JM. Blood pressure and heart rate responses to anticipated high-stress dental treatment. J Dent Res 1981; 60(1):26-9. doi: 10.1177/00220345810600010501.

Hall JE, Guyton AC. Textbook of medical physiology. Elsevier Inc., 2006.

Paramaesvaran M, Kingon A. Alterations in blood pressure and pulse rate in exodontia patients. Aust Dent J 1994; 39(5):282-6.

Jacofsky MD, Santos MT, Khemlani-Patel S, Neziroglu F. Biological explanations of anxiety disorders. [Accessed 26 Apr 2017]. Available from:

Steimer T. The biology of fear-and anxiety-related behaviors. Dialogues Clin Neurosci 2002; 4(3):231-49.

Matsumura K, Miura K, Takata Y, Kurokawa H, Kajiyama M, Abe I, et al. Changes in blood pressure and heart rate variability during dental surgery. Am J Hypertens 1998; 11(11):1376-80.


PBOCI is a member of CrossRef and all the content of its journals are linked by DOIs through CrossRef.