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Chapter 232those who routinely visit them for preventive care.27 Students who had never received dental injections had higher anxiety scores for these injections than students who had previously experienced them.28 Also, the type of anesthetic injection is related to more anxiety. In a recent review article, the specific type of anesthetic injection affected patient anxiety, with patients who required specific block type local anesthesia reporting significantly higher anxiety immediately after the procedure than those who had infiltration anesthesia.29In our study, higher anxiety scores were associated with more pain during the local anesthesia and high pain during a previous injection was also associated with more pain during the injection. We also found this in our earlier study, more negative experiences with injections were related to more anticipated and experienced anxiety and pain.In our study, pre-operative anxiety was more severe in women than in men. Similarly, Yusa et al. found higher STAI-state scores on day 2 in women than in men.30 There was no significant difference in the anxiety scores of subjects who had impacted vs non-impacted tooth removal, suggesting that the extraction itself caused anxiety for the patients, irrespective of the condition of the removed tooth and extraction procedure. Women generally have higher anxiety about dental treatment than men.19 Other studies performed in different countries have shown that women, in general, report higher anxiety than men.27,31 There was no significant difference between the experienced pain mean scores from males vs. females in the present study. This is in contrast with most studies that reported women and men report different amounts of pain in the orofacial region. Women responded to a pulp tester at a lower level than men, suggesting a lower pain threshold.32 The luteinizing hormone may desensitize the opioid receptor, increasing pain sensitivity in women during ovulatory and luteal phases.33,34 However, although women showed a lower pain threshold, the phases of the menstrual cycle and the use of oral contraceptives did not affect injection discomfort or local anesthetic efficacy and duration.32 Hapidou & de Catanzaro found there is a significantly higher pain threshold during the follicular phase (days 8-14) compared with the luteal phase (day 15-21).35 In the present study, the same outcome was found, but data from only eight female patients were used in this analysis. Thus, the limited number of patients and the lack of information about the use of