Perioperative Propranolol Against Dental Anxiety: A Randomized Controlled Trial

Abstract

BackgroundPromising results from a trauma reactivation study on post-traumatic stress disorder suggest that propranolol is capable of attenuating symptoms of traumatically induced mental disorders by blocking memory reconsolidation.MethodsA randomized, parallel, placebo-controlled, quadruple-blind trial was designed to determine the effectiveness of perioperative propranolol during exposure to dental extractions in reducing dental anxiety in patients with dental anxiety or dental phobia. Between November 2014 and December 2018, 52 patients with high levels of fear in anticipation of dental extractions who were referred to a department of oral and maxillofacial surgery for at least two tooth and/or molar removals with 1 month in between were included. On the first visit participants received either 120 mg of perioperative oral propranolol (n = 19) or placebo (n = 17), and a core fear memory was reactivated 1 h preoperatively. The primary outcome was change in severity of dental anxiety from baseline to 1-month follow-up, as indexed by the short version of the dental anxiety inventory (S-DAI). Secondary outcome measures were change in intra-operative state anxiety and specific phobia diagnoses.ResultsLinear mixed model (LMM) yielded no statistically significant difference in change of dental trait anxiety from baseline to 1-month follow-up between propranolol and placebo groups (Cohen's d = 0.23). S-DAI scores decreased in both study arms from baseline to follow-up (propranolol arm: from 32.1 [SD = 7.3] to 29.1 [SD = 8.8]; placebo arm: from 31.6 [SD = 7.5] to 27.1 [SD = 6.5]). Also, administering propranolol was not associated with a significant difference in change of intra-operative state anxiety or phobia diagnoses between groups over time.ConclusionsThe results do not concur with earlier findings regarding post-traumatic stress disorder, and suggest that individuals with traumatically induced fears or phobias do not benefit from the application of perioperative propranolol.

Response to: “Updated and rectified meta-analysis shows no effect of propranolol versus placebo on traumatic memory reconsolidation disruption”

“…But even more problematic, we found Addiction-related disorders Jobes et al 11 Lonergan et al 12 Pachas et al 13 Xue et al 14 Zhao et al 9 Elsey et al 19 Roullet et al 20 moderate Roullet et al 20 severe Soeter et al 21 Steenen et al References for two additional studies. 8,9 Letters J Psychiatry Neurosci 2022;47(5)…”

“…Steenen and colleagues 1 re-analyzed our data by excluding a number of studies that they deemed had high risk of bias (retaining only 4), adding to these the 3 unpublished studies mentioned above. They also included 2 studies published after our paper was completed and accepted for publication (see Steenen and colleagues 8 and Elsey and Kindt 9 ). Exactly how they concluded that this set of studies had low risk of bias is not specified.…”

Updated and rectified meta-analysis shows no effect of propranolol versus placebo on traumatic memory reconsolidation disruption

“…We found that, if their pooled analysis of clinical studies had been restricted to low-risk-of-bias RCTs into psychotrauma-related symptomatology, 56 the pooled analysis would have shown that propranolol was not statistically significantly superior to placebo (Figure 1). Moreover, if the pooled analysis is supplemented with missed and new trials, 6,79,10 the 95 % confidence interval of the pooled mean difference is even wider (Figure 2).…”