Background Abundant evidence from human and animal studies indicates that the sympathetic response during mental stress preferentially involves the heart. Acute or chronic stress can lead to cardiovascular disease, including hypertension and cardiac arrhythmias. Stressors in dental practice are numerous, including drill noise, sight of a needle and pain. Numerous studies indicate that many adults suffer from dental fear or dental anxiety, and many develop dental phobia. Fear, anxiety or phobia are associated with increases in heart rate, changes in systolic blood pressure, and decreased oxygen saturation. This combination of factors poses challenges for the cardiovascular system and may explain why severe cardiac perturbations are observed in some patients receiving dental treatment. Aim We review the central sympathetic pathways and mechanisms involved in the cardiovascular response to mental stress in the context of dental practice. Methods and results Through a comprehensive literature review we present a functional model that illustrates how dental stressors result in autonomic cardiovascular changes. The focus is on medullary and supramedullary regions mediating sympathetic output during stressful situations as well as for integrating the somatosympathetic reflex, the active reflex that controls blood pressure during painful stimulation. Conclusion Concurrent activation of specific groups of sympathetic premotor neurones by both mental stress and nociceptive afferent input may underlie the abnormal cardiac sympathetic output triggered by dental stressors, potentially contributing to the initiation of cardiac arrhythmias.
Felice et al. (2026) studied this question.