Objective: Considerable emphasis has been placed on the fear that patients undergoing oral surgery have of the local anesthetic injection. However, other potential factors such as fear of pain during the operation, fear of the operation itself, and fear of postoperative pain are often not considered. The purpose of this study was to determine how patients rank their fear of these four factors. Such information can be helpful in improving patient management. Method and materials: Patients 18 years of age and older presenting to the Oral Surgery Clinic of the Virginia Commonwealth University School of Dentistry for tooth extraction were asked to complete a brief questionnaire ranking their fear of the four previously noted factors, as well as to include their age, gender, and level of education. Results: One hundred patients (52 females and 48 males), ranging in age from 18 to 93 years, completed the survey. Sixty-one had a high school education, 22 had some college education, and 17 had a college degree or higher. Twenty-five ranked pain from the local anesthetic as their greatest fear, 26 ranked pain during the operation as their greatest fear, 18 ranked the operation as their greatest fear, and 31 ranked fear of postoperative pain the highest. There were some significant differences in the rankings between females and males. Conclusions: The results of this study show that patients have fear of pain during and after the procedure as well as of the local anesthetic injection. To maximize patient comfort, how all these factors will be properly managed needs to be discussed preoperatively. Keywords: anesthesia, fear, gender, oral surgery, pain