Objective To observe the effect of cognitive behavioral therapy (CBT) on dental anxiety (DA) in patients with impacted mandibular third molars (IMTM). Methods From January 2019 to December 2020, a total of 80 patients with dental anxiety scale (DAS) scores were ≥15 points at the initial diagnosis of IMTM extracted in the hospital were selected. According to the bottom of the visit ID card, the patients were divided into two groups, the odd number was the control group, and the double number was the experimental group, with 40 patients in each group. The control group was given routine nursing intervention and the experimental group was given CBT for behavior management. The DAS, Dental Fear Scale (DFS),Visual Analog Pain Scale (VAS),HOUPT Behavior Scale, and Frankl classification of clinical behavior were used to evaluate the dental anxiety, pain level, treatment completion, and intraoperative cooperation of the two groups of patients. The vital signs such as heart rate (HR),systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation (SpO2), and the operation time were recorded. The complete indexes were recorded at the initial visit (T1), before surgery (T2), local anesthesia (T3), during operation (T4), six hours after surgery (T5), seven days after surgery (T6) and ninety days after surgery (T7). Results The differences of the DAS scores, DFS scores, anticipated VAS pain scores, HR,SBP,DBP,SpO2 at T1 and the Intraoperative VAS pain scores at T4 were not significant between the two groups (P>0. 05). The DAS scores and DFS scores of the experimental group were significantly lower than those of the control group at T2 and T7. The HR,SBP,DBP and anticipated VAS pain scores of the experimental group were significantly lower than those of the control group at T2. The local anesthesia VAS scores at T3,postoperative VAS pain scores at T5,and postoperative analgesic needs of the experimental group were significantly lower than those of the control group. The HOUPT Scale scores and the Frankl Scale scores at T4 of the experimental group were significantly better than those of the control group,and the operation time of the experimental group was significantly shorter than that of the control group,with statistical significance (P<0. 05). Conclusion CBT is a pragmatic and effective method of facilitating dental treatment in patients who suffer from high level of DA. [ABSTRACT FROM AUTHOR]