Abstract
Objective Dental anxiety is a significant barrier for patients seeking oral healthcare and can be influenced by biological, psychological, and demographic factors. This study aimed to investigate how different phases of the menstrual cycle affect dental anxiety in women immediately before undergoing root canal treatment, using both psychometric scales and physiological indicators. Gender-based comparisons were also included for contextual understanding. Methods An analytical cross-sectional study was conducted with 259 participants (aged 18-50 years, 191 women) requiring root canal treatment. Women were categorized into menstrual, proliferative, and secretory phases based on self-reported cycle data. The Severity of anxiety were assessed using the Modified Dental Anxiety Scale (MDAS) and the State-Trait Anxiety Inventory (STAI), alongside physiological measures such as blood pressure and oxygen saturation. In addition to Kruskal-Wallis and Chi-squared tests, multiple linear regression analyses were performed to adjust for potential confounders, including age, education, preoperative pain, and physiological parameters. Results Women in the menstrual and secretory phases reported significantly higher MDAS and STAI-T scores compared to men (p < 0.001). Regarding the STAI-S, scores in all three menstrual phases were significantly higher than those of men (p = 0.001). Multiple regression analysis confirmed that these associations remained significant after adjustment for potential confounders, while age, education, preoperative pain, and physiological parameters showed no significant effects. Physiological parameters, including blood pressure and oxygen saturation, showed no significant variations across groups (p > 0.05). A strong positive correlation was observed between MDAS and both STAI-S and STAI-T scores. Conclusion Women in the menstrual and secretory phases reported higher levels of dental anxiety compared to men, but no significant differences were observed in physiological markers. These findings suggest that estrogen reduction during certain phases of the menstrual cycle may increase anxiety and highlight the potential clinical value of individualized anxiety management during these phases.