Background: Dental anxiety frequently deters individuals from seeking timely dental care, with extraction procedures often perceived as highly distressing. While general dental anxiety has been studied, few investigations have specifically assessed changes in anxiety before and after dental extraction, particularly among Indian patients and in relation to clinical predictors. Methods: This prospective study enrolled 100 patients (50 males, 50 females; mean age 43.57 ± 13.90 years) scheduled for extraction under local anesthesia. Anxiety was measured using the Dental Fear Survey (DFS) immediately before and after extraction. Additional clinical and psychological parameters�including previous dental experience, pain expectation and experience (VAS), waiting time, use of sedation, and extraction complexity�were documented. Statistical analyses included paired t-tests for pre- and post-extraction DFS scores and correlations with clinical variables. Results tables clearly indicate non-significant (ns) or not analyzed (N/A) parameters. Results: Mean DFS scores decreased significantly post-extraction (61.72 ± 20.24 to 55.08 ± 19.82; mean reduction 6.64 points, �10.8 decrease, p = 0.001), indicating a clinically meaningful decline in anxiety levels. Both genders exhibited reduced anxiety, though females reported slightly higher post-extraction scores. Significant correlations were observed between DFS scores and traumatic dental experience, pain expectation, actual pain experienced, and waiting time (pre-extraction only). Importantly, no significant association was found between DFS scores and extraction complexity or use of sedation, underscoring this as a key finding of the study. Conclusion: Dental extraction under local anesthesia results in immediate anxiety reduction, with gender-related nuances. This study emphasizes the value of perioperative anxiety assessment and identifies predictors that can inform targeted interventions and improvements to current clinical protocols. All results presented correspond strictly to parameters measured and analyzed in this study. © 2025 Elsevier B.V., All rights reserved.