Effects of Passiflora incarnata on salivary biomarkers and anxiety in patients undergoing third molar extraction surgery

This study aimed to evaluate the effectiveness of Passiflora incarnata in controlling anxiety during impacted third molar extractions, in comparison to Midazolam and placebo. Thirty healthy patients (aged 16–35) indicated for impacted third molar extraction were randomly assigned to three groups (n = 10): placebo (PLA), Midazolam (MID), and Passiflora incarnata (PAS). Medications were administered 30 min prior to surgery. Anxiety was assessed using the Corah Dental Anxiety Scale, Modified Dental Anxiety Scale (MDAS), and Hospital Anxiety and Depression Scale (HAD). Physiological parameters (heart rate, blood pressure, and oxygen saturation) were recorded pre-, intra- (at specific surgical stages), and postoperatively. Saliva samples were collected pre- and post-surgery under standardized conditions to avoid blood contamination and analyzed for cortisol (via chemiluminescence assay, expressed in µg/dl), α-amylase activity (using a spectrophotometric method, expressed in U/L), and total protein content (via BCA assay, expressed in g/L). Questionnaires were administered before and after surgery to minimize medication influence. Statistical analysis was performed using SigmaPlot 12.0, with data subjected to normality testing, two-way ANOVA, and post-hoc Holm-Sidak tests at a 5% significance level. No significant differences were observed between groups regarding anxiety scores or most physiological measures (p > 0.05). Diastolic blood pressure was higher in the PAS group (p < 0.05). Salivary cortisol levels in the PAS and MID groups were significantly lower than in PLA postoperatively (p < 0.05), with no differences between PAS and MID (p > 0.05). These findings suggest that Passiflora incarnata is a safe and effective alternative for reducing biochemical stress markers during oral surgery, despite similar effects on subjective anxiety measures.