{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:55:34Z","timestamp":1785412534115,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016250","name":"Lithuanian University of Health Sciences","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100016250","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/0069bkg23","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Preoperative anxiety is common in adult patients undergoing oral and dentoalveolar surgical procedures under local anesthesia and may impair cooperation, physiological stability, and overall treatment experience. While intravenous sedation and general anesthesia provide effective anxiolysis, they increase anesthetic exposure and recovery demands. Targeted preoperative anxiolysis offers a less invasive strategy to reduce anxiety while preserving responsiveness. However, approaches vary and standardized protocols are lacking. This systematic review evaluated the efficacy and safety of preoperative anxiolytic interventions\u2014including both pharmacological and non-pharmacological strategies\u2014in adult patients undergoing oral surgical procedures under local anesthesia without general anesthesia or deep sedation. Methods: The review adhered to the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261281592). Randomized and quasi-randomized controlled trials published between 2016 and 2026 were identified through structured searches of PubMed\/MEDLINE, ScienceDirect, and Springer Nature Link. Eligible studies included adult patients undergoing oral surgery under local anesthesia and evaluated preoperative anxiolysis using validated instruments such as the Dental Anxiety Scale (DAS), State\u2013Trait Anxiety Inventory (STAI), and Visual Analog Scale for Anxiety (VAS-A). Risk of bias was assessed using the Cochrane RoB 2 tool. Owing to methodological heterogeneity, results were synthesized narratively. Results: Eight trials (n = 617) met the inclusion criteria. Interventions included oral benzodiazepines, melatonin, pregabalin, herbal agents, nitrous oxide, and auriculotherapy. Benzodiazepines consistently reduced anxiety scores (p &lt; 0.05) without significant interagent differences. Pregabalin at a dose of 150 mg significantly lowered STAI-S and VAS-A scores (p &lt; 0.001). Passiflora incarnata was comparable to midazolam and superior to placebo, whereas Erythrina mulungu showed no effect. Melatonin results were inconsistent. Hemodynamics remained stable, and adverse events were mild. Conclusions: Preoperative anxiolysis under local anesthesia effectively reduces anticipatory anxiety in oral surgery, with benzodiazepines demonstrating the most consistent efficacy. Further standardized trials are warranted.<\/jats:p>","DOI":"10.3390\/dj14060327","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:11:01Z","timestamp":1780333861000},"page":"327","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Anxiolysis in Surgical Care Without Sedation or General Anesthesia: A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3300-8030","authenticated-orcid":false,"given":"Inesa","family":"Stonkut\u0117","sequence":"first","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominykas","family":"Afanasjevas","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickevi\u010diaus g. 9, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2749-1495","authenticated-orcid":false,"given":"Audra","family":"Janovskien\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-9626","authenticated-orcid":false,"given":"Dainius","family":"Razukevi\u010dius","sequence":"additional","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9114-7416","authenticated-orcid":false,"given":"\u017dygimantas","family":"Petronis","sequence":"additional","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jcms.2007.03.004","article-title":"Treatment anxiety in oral and maxillofacial surgery. Results of a German multi-centre trial","volume":"35","author":"Hermes","year":"2007","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/j.ijom.2012.06.013","article-title":"What is the most fearful intervention in ambulatory oral surgery? Analysis of an outpatient clinic","volume":"41","author":"Sirin","year":"2012","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.joms.2007.06.662","article-title":"Factors Related to Patients\u2019 Anxiety Before and After Oral Surgery","volume":"66","author":"Muglali","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zhang, Z., Zhang, Y., Liu, H., He, F., Li, G., Li, Y., Zhang, S., Mo, J., Zhou, H., and Li, C. (2025). Patterns and predictors of tooth extraction-related anxiety at sequential perioperative stages. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-06734-4"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100575","DOI":"10.1016\/j.adoms.2025.100575","article-title":"Recent advances in dental local anaesthesia","volume":"19","author":"Khan","year":"2025","journal-title":"Adv. Oral Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1752-248X.2011.01125.x","article-title":"Administration of oral midazolam in surgical dentistry","volume":"4","author":"Parsa","year":"2011","journal-title":"Oral Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10006-024-01326-y","article-title":"Perioperative changes in anxiety and comfort in third molar extraction patients sedated with midazolam","volume":"29","author":"Murakami","year":"2025","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.coms.2021.08.008","article-title":"Update on Medications for Oral Sedation in the Oral and Maxillofacial Surgery Office","volume":"34","author":"Hanna","year":"2022","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"273","DOI":"10.17245\/jdapm.2025.25.4.273","article-title":"Association between preoperative anxiety, intraoperative discomfort, and postoperative pain across different dental extraction types: A prospective observational study","volume":"25","author":"Soto","year":"2025","journal-title":"J. Dent. Anesth. Pain Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Giordano, F., Giglio, M., Sorrentino, I., Dell\u2019olio, F., Lorusso, P., Massaro, M., Tempesta, A., Limongelli, L., Selicato, L., and Favia, G. (2023). Effect of Preoperative Music Therapy Versus Intravenous Midazolam on Anxiety, Sedation and Stress in Stomatology Surgery: A Randomized Controlled Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093215"},{"key":"ref_11","first-page":"1579","article-title":"Herbal medicines as anxiolytics prior to third molar surgical extraction. A randomized controlled clinical trial","volume":"25","author":"Amorim","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2258.e1","DOI":"10.1016\/j.joms.2019.06.001","article-title":"Comparison of Three Anxiety Management Protocols for Extraction of Third Molars With the Use of Midazolam, Diazepam, and Nitrous Oxide: A Randomized Clinical Trial","volume":"77","author":"Barbier","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1016\/j.joms.2019.02.045","article-title":"Should Melatonin Be Used as an Alternative Sedative and Anxiolytic Agent in Mandibular Third Molar Surgery?","volume":"77","author":"Torun","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Valverde, N., L\u00f3pez-Valverde, A., de Sousa, B.M., and Rueda, J.A.B. (2024). Efficacy of music therapy on stress and anxiety prior to dental treatment: A systematic review and meta-analysis of randomized clinical trials. Front. Psychiatry, 15.","DOI":"10.3389\/fpsyt.2024.1352817"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00784-024-05700-8","article-title":"Evaluation of the effects of pregabalin and dexamethasone coadministration on preemptive multimodal analgesia and anxiety in third molar surgeries: A triple-blind randomized clinical trial","volume":"28","author":"Diniz","year":"2024","journal-title":"Clin. Oral Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s12663-018-1096-1","article-title":"Comparative Study Between Oral Lorazepam and Diazepam as Sedation in Oral and Maxillofacial Surgery","volume":"18","author":"Sharma","year":"2019","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_18","first-page":"e77651","article-title":"Evaluating the Anxiolytic Efficacy of Oral Alprazolam in Modulating Vital Parameters During Minor Oral Surgical Procedures: A Quasi-experimental Study","volume":"17","author":"Mulla","year":"2025","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s00784-025-06649-y","article-title":"Preoperative 15 mg of melatonin for surgical discomfort, pain, edema and trismus in mandibular third molar surgery: A randomized double-blind placebo-controlled clinical trial","volume":"29","author":"Ruppel","year":"2025","journal-title":"Clin. Oral Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.ijom.2018.10.014","article-title":"Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction","volume":"48","author":"Dellovo","year":"2019","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_22","first-page":"e68023","article-title":"Strategical Ways for Dental Anxiety Management Prior to Third Molar Extraction","volume":"16","author":"Alshehri","year":"2024","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1111\/anae.16187","article-title":"Airway and respiratory complications during anaesthesia and associated with peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists","volume":"79","author":"Cook","year":"2023","journal-title":"Anaesthesia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"273","DOI":"10.17245\/jdapm.2016.16.4.273","article-title":"Postoperative nausea and vomiting after general anesthesia for oral and maxillofacial surgery","volume":"16","author":"Apipan","year":"2016","journal-title":"J. Dent. Anesth. Pain Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/acem.12875","article-title":"Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis","volume":"23","author":"Bellolio","year":"2016","journal-title":"Acad. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1051\/mbcb\/2024020","article-title":"Retrospective study on patient comfort and post-operative condition associated with intravenous sedation versus general anesthesia for third molar extraction in ambulatory surgery in a state hospital","volume":"30","author":"Bratiloveanu","year":"2024","journal-title":"J. Oral Med. Oral Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1051\/mbcb\/2022023","article-title":"The influence of sedation and general anesthesia to patients\u2019 psycho-emotional status undergoing wisdom teeth extraction: A pilot clinical trial","volume":"28","author":"Petronis","year":"2022","journal-title":"J. Oral Med. Oral Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"102891","DOI":"10.1016\/j.janxdis.2024.102891","article-title":"Interventions to reduce adult state anxiety, dental trait anxiety, and dental phobia: A systematic review and meta-analyses of randomized controlled trials","volume":"105","author":"Steenen","year":"2024","journal-title":"J. Anxiety Disord."},{"key":"ref_29","first-page":"e379","article-title":"Relationship between preoperative anxiety and postoperative satisfaction in dental implant surgery with intravenous conscious sedation","volume":"15","year":"2010","journal-title":"Med. Oral Patol. Oral Y Cir. Bucal"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/6\/327\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:23:40Z","timestamp":1780460620000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/6\/327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["dj14060327"],"URL":"https:\/\/doi.org\/10.3390\/dj14060327","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}