# Thermography as a Method to Detect Dental Anxiety in Oral Surgery
[PERSON]  
1 Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; [EMAIL_ADDRESS] (R.G. ); [EMAIL_ADDRESS] (G.L. ); [EMAIL_ADDRESS] (A.B. ); [EMAIL_ADDRESS] (C.S. ); [EMAIL_ADDRESS] (N.M.M. ); [EMAIL_ADDRESS] (P.S. ); [EMAIL_ADDRESS] (G.M.) [PERSON]  
1 Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; [EMAIL_ADDRESS] (R.G. ); [EMAIL_ADDRESS] (G.L. ); [EMAIL_ADDRESS] (A.B. ); [EMAIL_ADDRESS] (C.S. ); [EMAIL_ADDRESS] (N.M.M. ); [EMAIL_ADDRESS] (P.S. ); [EMAIL_ADDRESS] (G.M.) [PERSON]  
1 Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; [EMAIL_ADDRESS] (R.G. ); [EMAIL_ADDRESS] (G.L. ); [EMAIL_ADDRESS] (A.B. ); [EMAIL_ADDRESS] (C.S. ); nelsonnaro. multiple languages. The advantages of these methods are the disclosure of the degree of anxiety (mildly anxious, moderately anxious, extremely anxious or dental-phobic) but their routine use is very limited because of the lack of time and expertise in their interpretation. Furthermore, self-report questionnaires suffer from a significant bias: they request respondents to be aware of their own anxious states, as well as to be free from social desirability. Therefore, it may happen that the levels of anxiety reported in the answers are not actually those experienced by patients. Objective measurements, instead, involve the assessment of blood pressure, pulse rate, or galvanic skin response [9; 10; 11]. The objective methods are more accurate in the measurement of dental anxiety and they confirm the presence of physiological changes in the body as the result of the stress and anxiety caused by dental procedures. However, even these methods involve some disadvantages: the pulse rate, for example, may be altered as a result of the physical movements of the patient during dental treatment and the galvanic skin response may provide too high a level of sensitivity, giving false positive results. Furthermore, all these methods require a direct contact with the patient's body, which may cause discomfort and distress, so increasing the level of anxiety [9]. Therefore, we have proposed thermal imaging as a new technique for the identification of dental anxiety, a contactless imaging technique widely known in medicine and successfully used in the diagnosis of breast cancer [12], diabetic neuropathy [13] and peripheral vascular disorders [14]. In fact, abnormalities such as malignancies, inflammation, infection and anxiety cause localized increases in temperature shown at thermal imaging as hot spots or as asymmetrical patterns in an infrared thermogram [15]. Even though it is non-specific, infrared thermography is a powerful tool for the detection of problems that affect a patient's physiology [16]. In dentistry, thermography has been used to assess subjects with chronic orterporomandibular joint pain, or inferior alveolar nerve deficits or to monitor changes in bone temperature during the drilling process [17; 18; 19]. To the best of our knowledge, this is the first application of thermal infrared imaging as a method for the identification of dental anxiety in oral surgery. The aim of this study was to ascertain whether facial thermograms can be used as a valid and reliable somatic indicator of dental anxiety.