This study aimed to compare changes in dental and state anxiety across four assessment stages between patients undergoing same-session and scheduled mandibular third molar surgery and to explore whether Big Five personality traits moderated these changes.

This observational study included 69 patients (same-session, n = 36; scheduled surgery, n = 33), with surgical timing determined by patient preference. Before the surgical timing decision (T0), participants completed STAI-Trait, TIPI, MDAS, and STAI-State. MDAS and STAI-State assessments were repeated after the decision (T1), immediately before local anaesthesia (T2), and immediately after surgery (T3). Baseline-adjusted generalised estimating equations evaluated group × time effects across the three post-decision assessments (T1–T3); primary contrasts were Holm-adjusted and personality analyses were exploratory with false-discovery-rate adjustment.

No statistically significant differences in baseline characteristics were detected between the groups. Adjusted group × time interactions were significant for MDAS (Wald χ²(2) = 17.39; Holm p < 0.001) and STAI-State (χ²(2) = 11.16; Holm p = 0.004). The key between-group change contrasts were MDAS T3 − T2 (β = −1.52; Holm p < 0.001) and STAI-State T2 − T1 (β = −5.21; Holm p = 0.003), with both indicating greater decreases or smaller increases in the same-session group. Exploratory agreeableness moderation of STAI-State trajectories survived FDR correction (χ²(2) = 10.70; q = 0.048).

Surgical pathways were associated with different perioperative anxiety trajectories, with the most pronounced between-group differences occurring at different assessment intervals for dental and state anxiety. Personality moderation was exploratory; nonrandomised group selection precludes causal attribution.