Observational studyBMC oral health2026
Anxiety levels during the first clinical tooth extraction experience among fourth-year dental students: a cross-sectional observational study.
Observational study in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND/
objectivesThe first clinical tooth extraction represents a pivotal and anxiety-provoking milestone in dental undergraduate education. The assessment of anxiety at this specific moment has important implications for curriculum design, student well-being, and patient safety. This study aimed to measure and characterise state and trait anxiety levels among fourth-year dental students performing tooth extraction on real patients for the first time.
methodsA cross-sectional single-centre observational study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Nevşehir Hacı Bektaş Veli University, Turkey. All 74 fourth-year dental students (49 female, 25 male) participating in the first compulsory clinical extraction session were invited to complete the State-Trait Anxiety Inventory (STAI). State anxiety (STAI-S) was assessed immediately before the extraction procedure; trait anxiety (STAI-T) was assessed during a regular, non-clinical lecture session. Descriptive statistics, a one-sample t-test, a paired-samples t-test, Pearson correlation analysis, and effect size calculations (Cohen's d, 95% CIs) were performed.
resultsThe mean STAI-S score immediately preceding the first extraction was 53.54 ± 6.17 (range 38-66), which was significantly higher than the theoretical midpoint of 50 (t = 4.937, df = 73, p < 0.001, Cohen's d = 0.574). The mean STAI-T score was 40.16 ± 6.22 (range 28-51), consistent with commonly reported normative ranges for non-clinical adult populations. State anxiety scores were significantly higher than trait anxiety scores (paired t = 21.339, p < 0.001, Cohen's d = 2.181). A moderate positive correlation was found between state and trait anxiety (r = 0.621, p < 0.001). Most students (81.1%) showed moderate state anxiety; 17.6% showed high state anxiety. No statistically significant gender difference was found in either STAI-S or STAI-T scores (p = 0.441 and p = 0.939, respectively).
conclusionFourth-year dental students experience significantly elevated situational anxiety immediately prior to their first real-patient tooth extraction, suggesting that the observed elevation was predominantly related to the situational demands of the clinical encounter. These findings support the potential value of structured psychological preparation and progressive clinical exposure in undergraduate dental curricula to optimise both student welfare and patient care outcomes.
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