Tracking the dropout patients of neoadjuvant chemotherapy with locally advanced oral cavity cancer.

BACKGROUND: Patients with locally advanced oral cavity cancer sometimes stopped treatment after neoadjuvant chemotherapy. There are no guidelines of the management for these patients. Before designing clinical trials, we conducted this study to investigate their characteristics, reasons of dropout, and the follow-up information. METHODS: Medical records were consecutively reviewed of patients with locally advanced oral cavity cancer who underwent neoadjuvant chemotherapy from Jan 2017 to Dec 2019.Variables were compared between patients stopped treating after chemotherapy and completed treatments by student t-test and Chi-square test. Logistic regression model was used to calculate the odd rations of potential predictors of dropout. The dropout patients were followed up for reasons and results of their decision. RESULTS: A total of 171 patients were included with 23 not undergoing surgery after chemotherapy. The odd ratios of age over 65 and single marital status were 3.11 (95%CI: 1.1, 8.7) and 4.935 (95%CI: 1.5, 16.1), respectively, for the dropout. The median survival of patients without surgery was 7.4 months. Believing that chemotherapy would be effective and being afraid of the consequence of surgery were the main reasons of refusing surgery. CONCLUSIONS: The prognosis was poor of these dropout patients. Symptom relief and fear of surgery were the reasons of dropout. Age and marital status affected their decision. Clinical trials are needed to be designed for these patients.

Patient-Reported Quality of Life After Resection With Primary Closure for Oral Tongue Carcinoma.

OBJECTIVES/HYPOTHESIS: For early-stage oral tongue carcinoma and carcinoma in situ (ESOTCCIS), we evaluated patient-reported quality-of-life (QOL) outcomes following resection with primary closure (R-PC). STUDY DESIGN: Retrospective review at an academic cancer center. METHODS: Thirty-nine ESOTCCIS patients (Tis, T1, T2) who underwent R-PC without radiation completed the University of Washington Quality of Life Questionnaire Version 4 (UW-QOL) at least 6 months since R-PC (mean = 2.39 years; range = 0.5-6.7 years). We compared UW-QOL scores for pain, swallowing, chewing, speech, and taste to established normative population scores. Multivariable regression analysis evaluated factors associated with QOL impairment. RESULTS: ESOTCCIS patients who underwent R-PC in comparison to the normative population reported significantly worse mean speech (87.7 vs. 98, P < .001) and taste (85.6 vs. 95, P = .002) scores and no significant differences in mean pain (91.7 vs. 86, P = .96), swallowing (100 vs. 98, P = .98), chewing (97.4 vs. 94, P = .98) scores. For speech and taste, 59% (23/39) reported no postoperative change from baseline, whereas 41% (16/39) and 35.9% (14/39) reported mild impairment, respectively. Overall, postoperative QOL was reported as good, very good, or outstanding by 87.2% (34/39). Higher American Society of Anesthesiologists class, cT1 compared to CIS, and ventral tongue involvement were independently associated with worse speech. Age < 60 years was independently associated with worse taste. CONCLUSIONS: ESOTCCIS patients who undergo R-PC without radiation can expect long-term swallowing, chewing, and pain to be in the normative range. Although a majority of patients can expect to achieve normative speech and taste outcomes, R-PC carries the risks of mild speech and/or taste impairments. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:312-318, 2021.

[Investigation of preoperative anxiety and postoperative quality of life in patients with periodontal mucogingival surgery].

PURPOSE: To evaluate preoperative anxiety and postoperative quality of life in patients with periodontal mucogingival surgery, and provide a theoretical basis for preventing preoperative anxiety and improving postoperative quality of life in mucogingival surgery. METHODS: According to the inclusion and exclusion criteria, 26 patients with mucogingival surgery were randomly selected, including 13 cases undergoing free gingival graft and 13 cases undergoing subepithelial connective tissue graft. All patients were asked to answer the following questionnaires which included self-rating anxiety scale (SAS), modified dental anxiety scale (MDAS), pain evaluation using visual pain scale (VAS), clinical performance evaluation (swelling, bleeding, nausea, oral odor), and oral function evaluation (chewing, speaking, sleeping, working). Data analysis was performed using SPSS 18.0 software package. RESULTS: The preoperative SAS score was 44.33±11.99, 4 patients had anxiety, accounting for 15.38%. The preoperative MDSA score was 9.85±2.41, 4 patients had anxiety, accounting for 15.38%. The VAS values at 1 day, 3 days, 5 days, 7 days, and 10 days after surgery were moderate pain (4.54±1.32), mild pain (3.31±1.31), mild pain (2.00±1.14), and painless( 0.70±0.72), painless (0.08±0.27). The VAS values at 1 day, 3 days, and 5 days after FGG were greater than those after CTG (P<0.05).The most common discomforts after mucogingival surgery were swelling, bleeding, disturbance in chewing and speech. Swelling, disturbance in chewing and speech persisted until 7 days after surgery, and bleeding continued until 5 days after surgery. The postoperative discomfort of FGG was significantly higher than that of CTG. CONCLUSIONS: Four had preoperative anxiety prior to mucogingival surgery. The main clinical symptoms after surgery were moderate to mild pain, swelling, bleeding, disturbance in chewing and speech within 1-7 days after surgery. The effect of CTG on the quality of life of patients was significantly less than that of FGG.

Assessment of the effect of parental presence in dental operatory on the behavior of children aged 4-7 years.

BACKGROUND: Child presents a unique challenge to accept a dental treatment, and such a challenge gets modified by the presence or the absence of a parent in the operatory. Many dentists have reportedly and controversially used parental separation anxiety as a tool to control behavior of an uncooperative child and also to deliver quality dental treatment in young children. But is the parental separation beneficial for dentist to gain child cooperation? AIMS AND OBJECTIVES: The objective is to evaluate the influence of parental presence or absence in the operating room on child's behavior during dental procedure on children of 4 years and above. MATERIALS AND METHODS: The study was carried out on 30 children of 4-7 years of age group, 16 (4-6 years) preschoolers, and 14 (6-7 years) early schoolers. Two consecutive restorative procedures were carried out. On a first visit, parents were present and on a second visit, separation of parents was done. Behavior rating was done by commonly used Frankel's Behavior Rating Scale. RESULTS: Chi-square test was performed for the statistical analysis. There was no significant difference found in the child's behavior by the presence or absence of parents in the perception of dental treatment in the dental operatory. In contrast to that there was a significant increase in cooperative behavior of some children due to other factors influencing the behavior of the child with a Chi-square value = 35.296, P < 0.001. CONCLUSION: Parents can be excluded from the dental operatory to eliminate many behavior-related problems during the course of treatment.

Does giving brief information keep patients calm during different oral surgical procedures?

OBJECTIVES: Dental anxiety may play a central role in the oral health status and treatment outcomes of oral surgical procedures. The study aimed to investigate the effect that brief written information has over patients undergoing oral surgical procedures and to evaluate factors that may cause anxiety. METHOD AND MATERIALS: A prospective study was performed on 38 mandibular third molar surgery patients (mean age 26.74 ± 6.44 years) and 56 implant surgery patients (mean age 49.13 ± 15.11 years). Each group was divided into two subgroups, and written information, explaining what they could expect and details about the procedure, was provided to study groups. The Spielberger State-Trait Anxiety Inventory was used to measure state (STAI-S) and trait anxiety (STAI-T). The visual analog scale (VAS) was used for pain scores preoperatively and on days 1, 3, 5, and 7. Demographic data and intraoperative behaviors of patients were recorded. RESULTS: All groups had similar anxiety scores at baseline. Preoperative STAI-S and VAS scores were similar between study and control groups (P > .05). Study groups showed significantly lower mean intraoperative anxiety levels (P < .05). The implant group had a significantly lower VAS score (P < .05). STAI-T and preoperative STAI-S were not related to VAS. Postoperative STAI-S and VAS and recuperation were correlated (P < .05). Women showed significantly higher anxiety and VAS scores. CONCLUSION: The patients who received written information did not report lower anxiety scores. However, improved patient cooperation could be achieved with this method. Different surgical procedures may cause anxiety for different reasons.

How did we do? An investigation into the suitability of patient questionnaires (PREMs and PROMs) in three primary care oral surgery practices.

Introduction With the expansion of oral surgery services into the primary care sector there is a need to monitor the quality of the care provided. The Guide for Commissioning Oral Surgery and Oral Medicine proposed a set of questions to be used as patient related experience and outcome measures (PREMs and PROMs).Aim The British Association of Oral Surgeons (BAOS) primary care group (which includes the authors) were tasked by the Chief Dental Officer for England to test the suitability of these PREMs and PROMs.Method The questions as published in the commissioning guide were piloted in primary care oral surgery practices and patient feedback was sought. The authors then proposed and implemented an amended series of questions that they felt would be more practical as generic templates for oral surgery services.Results Our data demonstrates that the revised questions have produced data that is easy to interpret and attracted a greater number of feedback comments from patients.Discussion and conclusion The revised questionnaires incorporate the NHS Friends and Family Test as the collection of this data is normally a contractual requirement for providers of NHS services. They also use questions from other validated healthcare satisfaction survey tools. The use of Likert scales provides a richer data set which makes the interpretation of data easier and highlights areas for improvement. It is important to note that the data provided by PREMs and PROMs is subject to a number of biases and should be used for local quality improvement and longitudinal analysis of outcome data rather than comparison between providers.

Donor site morbidity and quality of life after microvascular head and neck reconstruction with free fibula and deep-circumflex iliac artery flaps.

PURPOSE: Bone defects after resective tumor surgeries often require the use of microvascular reanastomized bone grafts for reconstruction. The decision as to which specific flap is most suitable for the particular patient is dependent on various factors. The aspects donor site morbidity and quality of life are rarely taken into account in this connection. The aim of this study was to analyze whether these factors, in the future, should influence the choice of donor site. MATERIAL AND METHODS: In this study, the donor sites of 46 patients with respect to deep-circumflex iliac artery (DCIA) and fibula flaps were analyzed using subjective and objective parameters. The primary outcome was postoperative pain measured by VAS. Postoperative complication evaluations as well as 2 orthopedic scores were implemented (American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Harris Hip Score) and the patients' quality of life was assessed using the 36-Item Short Form (SF-36) questionnaire to quantify donor site impairment. RESULTS: Postoperative pain was rated with a mean value of 42.4 mm (SD 34.8) for the DCIA group and 36.9 mm (SD 37.1) for the fibula group (p = 0.617). After a mean period of 13.72 months, pain was rated with a mean value of 15.3 mm (SD 21.7) for DCIA and 13.3 mm (SD 22.6 mm) for the fibula (p = 0.763). Persistent pain, however, was recorded only in 11.11% of DCIA patients and 5.26% of fibula patients. Furthermore pain intensity was higher in the DCIA group. A changed gait pattern was observed in 59.26% of DCIA patients and 21.05% of fibula patients. DCIA patients required walking aids for walking and stair climbing more often. Looking at the results of the 2 orthopedic scores, fibula patients showed slightly better results. Concerning quality of life, patients after reconstructive surgery with DCIA flaps showed slight better results than patients in the fibula group. CONCLUSIONS: Taking the results of this study into account, the outcome in terms of pain, morbidity and quality of life did not show a significant superiority of any donor site.

Fibula Jaw in a Day: State of the Art in Maxillofacial Reconstruction.

Microvascular free tissue transfer has been one of the greatest milestones in reconstruction of the mandible and maxilla after tumor ablative surgery. Although fibula free flap reconstruction allows for immediate bony reconstruction, dental rehabilitation usually requires 6 to 12 months before it is completed. This can have a serious psychological impact on patients because they go without teeth during this timeframe. The "jaw-in-a-day" procedure was previously described by a group at New York University Medical Center. It allowed for tumor removal and full jaw reconstruction and dental rehabilitation in 1 surgery. This report describes 3 patients treated with this novel technique and adds to the 4 cases previously reported in the literature. To their knowledge, the authors are the second group to report on this technique. A series of photographs and videos are referenced in this article to illustrate the different steps used in this procedure.

Modified Dental Anxiety Scale: validation of the Italian version.

AIM: Anxiety is a relevant problem in dental practice. The Modified Dental Anxiety Scale (MDAS) is a brief, simple questionnaire consisting of five questions with a total score ranging from 5 to 25, the Italian version of which is not available yet. The aim of the study was to provide an Italian version of the MDAS and check its reliability in oral surgery, which is a major cause of dental anxiety due to the expected perception of pain and suffering. METHODS: The Italian version of the test was administered to 230 patients (98 male and 132 female patients, ages 14-88 years) undergoing oral surgery. Further recorded data were: American Society of Anaesthesiologists physical status classification (ASA-PS), frequency of visiting the dentist and any previous distressing experiences in dental or medical setting. RESULTS: The internal consistency of the test was high, with a Cronbach's alpha=0.92. The MDAS score was significantly higher in females (P<0.0001) and in patients with previous distressing experiences in medical and/or dental settings (P<0.0001); the correlation with age (P=0.01) and frequency on visiting the dentist (P=0.02) were also significant. CONCLUSIONS: The patients' selection (oral surgery only) may be a limit of the study, which might not provide an estimation of anxiety prevalence in the general dental population; however our result agree with those of studies performed in other Countries in the generic population, suggesting the absence of major differences with respect to the surgical setting and show the reliability and manageability of the Italian version of MDAS.

[Elaboration of health care quality criteria in maxillofacial surgery].

Criteria of quality of care in oral and maxillofacial surgery should reflect not only the quality of the repair functions of chewing, swallowing, breathing, speech, and should take into account the psycho-emotional condition of the patient; satisfaction of its appearance, quality cosmetic fill configuration of the face, tooth defects, smiles; adaptation to implants and dentures; their quality, the conditions and possibilities of their use. The application of the provisions of the international classification of functioning, disability and health in oral and maxillofacial surgery, is a condition that will allow to unify the approaches to the development of quality criteria of this type of medical care.

Early and late operation of cleft lip and intelligence quotient and psychosocial development in 3-7 years.

BACKGROUND: Early and late operations of the cleft lip represent exposure to general anesthesia during the first year of life. The early exposure to the anesthetics may influence long term neurological outcome. Timing of the operation may also influence the quality of life as babies with early repair might be accepted better by their families. AIMS: The aim of the study was to compare outcomes between two groups of patients operated on for the cleft lip in the first year of life. STUDY DESIGN: Observational cohort study. SUBJECTS: Early repair group included patients operated on in the first eight days of life and late repair group those operated on between 3 and 10 months. OUTCOME MEASURES: Intelligence quotient (IQ) and psychosocial development of children who were operated on for cleft lip were compared at the age of 3-7 years. RESULTS: No differences were found between early (n=15) and late (n=17) repair group in terms of IQ. In both IQ was within the normal range: 100.00 (SD 13.867), 98.76 (SD 10.109), respectively. Significantly better results in physical functioning (P=0.042) and self-esteem (P=0.014) concepts in early repair group were found. CONCLUSIONS: We compared outcomes of two groups of patients operated on for cleft lip in the first year of life. The earlier anesthesia did not show a negative impact on intelligence quotient in 3-7 years compared to later anesthesia. The earlier repair of the cleft lip showed a significant positive impact on psychosocial development in 2 out of 13 concepts tested.

Correlation between Surgeon's experience, surgery complexity and the alteration of stress related physiological parameters.

INTRODUCTION: In the present work we analyzed the hormonal (salivary Cortisol; sC), immune (salivary Immunoglobulin A; sIgA) and cardiovascular (Heart rate, HR, and systolic blood pressure, SBP) responses induced by stress conditions in oral surgeons, randomly recruited according to their expertise level. MATERIALS AND METHODS: Each surgeon performed three different surgical procedures with increasing degrees of technical difficulty and under time-limited conditions, to assess whether these variants may influence the risks of stress-induced secondary hypertension among the involved health professionals. sC and sIgA samples and cardiovascular function measurements were taken up before, during, and two hours after every surgery. Salivary samples and cardiovascular measurements were taken also during non-surgical days, as baseline controls. RESULTS: We observed that more experienced surgeons showed a higher stress management ability compared to those with less experience or, generally, younger, which are more exposed to the risks of developing secondary hypertension. Nevertheless, indipendently of sex and experience, oral surgeons are constantly exposed to high risks of developing stress-related diseases. CONCLUSIONS: On the basis of the issues addressed and the results obtained, we have highlighted the importance of the investigated stress biomarkers to monitor and to prevent stress-related pathologies among oral surgeons. This approach is aimed to emphasize the significance of these specific stress-biomarkers, which represent a powerful instrument to evaluate stress levels in oral surgeons, and that may help to reduce the most severe life-threatening risks to which they are daily exposed. In conclusion, final goal of this study is to suggest an useful guideline to monitor the stress levels of oral and maxillofacial surgeons in order to improve their quality of life, which is inevitably reflected on the quality of the performances provided and, finally, to prevent possible mistakes in their daily activities.

[Psychological aspects of orthognathic surgery]. / Psychologische aspecten van een kaakstandcorrectie.

Corrective jaw surgery, for patients with malocclusion and dysgnathia, is primarily performed to rehabilitate oral functions. However, the patients' motivation for orthognathic surgery often seems to be influenced as well by the desire for aesthetic correction of a facial anomaly. Preoperative screening for psychiatric problems such as body dysmorphic disorder is requisite. The majority of orthognathic patients experience a negative influence of their appearance on their psychosocial well-being. In addition, the hope for aesthetic improvement is not seldom an important incentive for visiting an oral and maxillofacial surgeon. In the literature, in addition to a positive effect of corrective jaw surgery on the patient's perceived appearance, an associated improvement in quality of life is described. Correction of a disharmonious face is at least as important to patients as oral function recovery.

Long-term functional outcomes and quality of life after oncologic surgery and microvascular reconstruction in patients with oral or oropharyngeal cancer.

CONCLUSIONS: Surgery for oral or oropharyngeal cancer with free-flap reconstruction is associated with moderate but persistent functional and quality of life (QoL) problems. Patient age, tumor stage, tumor site, and radiotherapy were the main predictors of functional outcome. OBJECTIVES: To evaluate long-term functional outcomes and QoL, and to determine their predictive factors in patients with oral or oropharyngeal cancer after oncologic surgery and free-flap reconstruction. METHODS: Patients who underwent surgery with free-flap reconstruction for oral or oropharyngeal cancer between 2000 and 2009 who were alive at least 1 year after therapy were included in this study. Patients completed the Voice Handicap Index (VHI-10) questionnaire and the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30 and H&N35. Swallowing was evaluated using the Dysphagia Outcome and Severity Scale (DOSS) and by flexible fiberoptic laryngoscopy. RESULTS: Sixty-four patients were included in the study. VHI-10 mean score was 11.2 ± 9 and its predictive factors were T stage (p = 0.005) and tumor involvement of the tongue base (p = 0.01). The mean DOSS score was 4 ± 0.8. Age (p = 0.008), gender (p = 0.04), and radiotherapy (p = 0.001) were the main predictive factors of the DOSS score.

Do patients fear undergoing general anesthesia for oral surgery?

Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.

Do cleft lip and palate patients opt for secondary corrective surgery of upper lip and nose, frequently?

PURPOSE: This prospective study was aimed at assessing cleft lip and palate (CLP) patients' opinions and attitudes towards their upper lip and nose and the number of secondary corrective surgical interventions electively undertaken to upper lip and nose that were carried out during a 2 year follow-up period. MATERIALS AND METHODS: During a 2 year follow-up period CLP outpatients were recruited for the study who attended follow-up examinations at a cleft lip and palate craniofacial center and received a recommendation for secondary corrective facial surgery. The participants filled in a questionnaire that included questions regarding the patients' opinions and attitudes towards appearance of lip and nose and need for secondary corrective facial surgery. During an additional interval of 2 years the rate of patients who underwent secondary corrective surgery to lip and nose was documented. RESULTS: Out of 362 CLP patients 37 (mean age 13.6 ± 7.6 years) received a recommendation for secondary corrective surgery to upper lip and/or nose. 22 patients (mean age 12.6 ± 6.3 years) filled in the questionnaire (response rate of 62.1%). The satisfaction with the overall facial appearance following the first corrective operation was statistically significantly better than the satisfaction with the nose (p = .016). The satisfaction with facial symmetry (5.6 ± 2.0) did not differ statistically significantly from the overall satisfaction with the facial appearance (6.2 ± 1.8; p = .093). Significantly fewer patients (n = 9) opted for corrective surgery compared to the number of patients who got the recommendation to have secondary corrective surgery done (n = 22, p < .0005). CONCLUSIONS: The findings of the present study may reflect a high overall patient satisfaction with the primary treatment outcome following surgery for CLP. Perceived patient need for secondary operation for the lip/nose may be as low as 5%.

Quality of life in oral cancer patients-effects of tongue resection and sociocultural aspects.

BACKGROUND: The aims of this study were to evaluate postoperative quality of life in patients who have had resections of tongue cancer and reconstruction by flaps and to collect information about their sociocultural situation. METHODS: In this cross-sectional study, patients with primary tongue cancer treated with total and subtotal tongue resection in the First Affiliated Hospital of Zhengzhou University, between July 2008 and October 2011, were included. Quality of life was assessed by the 14-item Oral Health Impact Profile and the Medical Outcomes Study-Short Form 36 questionnaires 12 months postoperatively. Furthermore, a questionnaire about the sociocultural background of the patients was applied. RESULTS: Forty-six of the 62 questionnaires were returned (74.19%). In the Medical Outcomes Study-Short Form 36, the best-scoring domain was bodily pain, whereas the lowest scores were for social functioning and vitality. In the 14-item Oral Health Impact Profile, the lowest-scoring domain was psychological disability, followed by psychological discomfort and social disability. CONCLUSIONS: The postoperative quality of life in our patients was significantly influenced by tongue resection. This should be considered for surgical planning. The sociocultural data showed a rather low education level and life standard level for the majority of the patients.

Recalling the threat: dental anxiety in patients waiting for dental surgery.

OBJECTIVE: The tendency of patients with high levels of anxiety to easily recall threatening stimuli has not been examined in relation to dental anxiety. The current study was aimed to examine the effect of pre-treatment anxiety levels and of information given prior to dentistry surgical procedures on free recall of threatening words. METHODS: Forty-two subjects attending a private dental clinic were recruited. While awaiting root-canal treatment or tooth extraction, patients were asked to proofread a list of 32 words, which contained mental and physical threat-related words, as well as positive and neutral words. only half of the subjects received information on the forthcoming surgical procedure. Pre-treatment anxiety levels using the dental anxiety Scale (daS) and word recall were evaluated. RESULTS: Only subjects with high dental anxiety (above median score) recalled more mental and physical threat related words, than positive words. Moreover, the dental anxiety score as a continuous variable predicted the mean number of mental threat-related words recalled. no significant differences were noted between those who did or did not receive information prior to the surgical procedures, on the recall of the four types of words. CONCLUSIONS: Similar to other anxiety disorders, patients with dental anxiety display a tendency for free recall of threatening stimuli presented to them before a threatening event. Preliminary information given prior to dentistry surgical procedures does not decrease anxiety. Suggestions for intervention in the dentist's clinic are given.

Salivary cortisol, salivary alpha amylase, and the dental anxiety scale.

The aim of this study was to investigate the correlation between dental anxiety, salivary cortisol, and salivary alpha amylase (sAA) levels. Furthermore, the aim was to look into individual differences such as age, race, gender, any existing pain, or traumatic dental experience and their effect on dental anxiety. This study followed a cross-sectional design and included a convenience sample of 46. Every patient was asked to complete the Dental Anxiety Scale (DAS) and a basic demographic/dental history questionnaire. A saliva sample, utilizing the method of passive drooling, was then collected in 2-mL cryovials. Samples were analyzed for salivary cortisol and sAA levels by Salimetrics. Significant associations were observed between DAS scores and presence of pain and history of traumatic dental experience. However, no significant correlations were observed between DAS, cortisol, and sAA levels. Our study reconfirms that dental anxiety is associated with presence of pain and a history of traumatic dental experience. On the other hand, our study was the first to our knowledge to test the correlation between the DAS and sAA; nevertheless, our results failed to show any significant correlation between dental anxiety, cortisol, and sAA levels.

What is the most fearful intervention in ambulatory oral surgery? Analysis of an outpatient clinic.

The aim of this study was to evaluate the levels of fear and anxiety in patients undergoing different types of minor oral surgery procedures by using conventional rating scales adjusted to the population characteristics. A demographic form and translated versions of the Modified Dental Anxiety Scale (MDAS) and Dental Fear Survey (DFS) were completed by 500 patients having hard or soft tissue pathologies, third molar removal, implant placement, tooth extraction procedures and 200 non-clinical participants. MDAS and DFS were highly correlated (r = 0.79; P < 0.05). The structural properties of the MDAS were similar to the original, but the DFS required substantive changes to achieve comparable measurement properties. Anxiety levels decreased with age and were greater in females, those with higher education and following a previous unpleasant experience (P < 0.05 for all). The third molar group scored higher than most of the surgical categories in both questionnaires (P < 0.05 for each). DFS showed they tended to avoid surgical procedures and were more susceptible to environmental and chair-side effects (P<0.05 for all). Regarding oral surgery, third molar patients should be targeted to increase overall comfort of the treatment. Assessments should be adjusted to cultural differences.