Evaluation of Anxiety, Pain, and Hemodynamic Changes during Surgical Removal of Lower Third Molar under Local Anesthesia

[Anxiety level and physiological response to invasive dental treatments. a longitudinal study]

Objective

To determine the relationship between the level of anxiety and the physiological response to invasive dental treatments.

Materials and methods

A convenience sample of 180 patients was formed (73 men and 107 women) ≥18 years (range: 18-58) undergoing treatment with local anesthetics from three private dental offices in the city of Lima. Measurements were made before, during and after treatment on anxiety according to the IDARE questionnaire of 40 questions (20 trait and 20 state) and their physiological response was evaluated according to oxygen saturation (OS), pulse and blood pressure (BP) measured. with digital pulse oximeter and blood pressure monitor. The Friedman and Spearman correlation tests were used, working with a value of P<0.05.

Results

Most patients had a medium level of anxiety before dental treatment (state 49.4% and trait 55.6%). OS, pulse and BP increased after application of the anesthetic and decreased at the end of treatment, with significant differences (P<0.05). Anxiety scores were significantly correlated only with pulse (state: r=0.238-0.564; trait: r=0.174-0.323) and BP (state: r=0.429-0.699; trait: r=0.312-0.465) (P<0.05).

Conclusion

State-trait anxiety had a positive relationship with the physiological dimensions of blood pressure and pulse before dental treatment with local anesthetics.

Effect of Visual Exposure versus Obstruction upon Patient's Quantitative and Qualitative Stress Parameters Changes during Minor Oral Surgery

OBJECTIVES

 Dental anxiety is ultimately related to the fear of pain, more evidently seen in surgical dental procedures. This study aimed at comparing the stress parameter differences between patients undergoing minor oral surgery (MOS) with their eyes covered (closed) versus uncovered (open) at our center.

MATERIALS AND METHODS

 Twenty-three MOS patients were draped with eyes covered, while another 23 MOS patients were draped with eyes uncovered. Stress parameters such as systolic and diastolic blood pressures (DBP), mean arterial pressure (MAP), heart rate, random blood glucose, and Spielberger State-Trait Anxiety Inventory (STAI)-6 questionnaire score were recorded accordingly in the different intervals; then statistically analyzed later.

RESULTS

 Closed eyes patients had significantly lower mean DBP and MAP (73.91 ± 6.80/88.94 ± 6.88 mm Hg) as compared with open eyes patients intraoperatively. Though significant only in the postoperative phase, the closed eyes group had a relatively lower mean heart pulse rate than the open eyes group in all surgical intervals. Postoperatively, closed eyes patients had lower mean blood glucose level as compared with open eyes group. STAI mean score revealed a higher psychological stress for closed eyes patients versus open eyes patients.

CONCLUSION

 Closed eyes patients displayed lower quantifiable physiological stress level as compared with patients undergoing MOS draped with eyes uncovered. However, in qualitative psychological context, closed eyes draped MOS patients responded poorly as compared with opened eyes draped patients under similar surgical stress.

Dental anxiety, cardiovascular changes and patient preconceptions toward implants and root canal treatments: An observational study

Background

There is little information about dental anxiety and the patient's vital signs during dental procedures. This study evaluates and compare patient anxiety levels and cardiovascular changes before and during root canal treatment (RCT) and single-tooth implant procedures.

Material and Methods

Preoperative data and pre-treatment considerations were recorded. HR and SpO2 were monitored during treatment procedures at five points. Data were analyzed accordingly using Mann Whitney or X2 tests. 80 patients met the inclusion criteria.

Results

Anxiety and fear scores were strongly correlated (p< 0.001). Both treatments resulted in low levels of dental anxiety and fear. Patients with a prior dental bad experience presented higher anxiety scores in the implant treatment group (p< 0.05). Implant treatment was considered a more time-consuming and more painful procedure than root canal treatment (p< 0.05). No significant relation was found between the level of anxiety with HR and SpO2.

Conclusions

No significant relation was found between the level of dental anxiety with HR and SpO2. Single-implant treatment was pre-considered to be a more time-consuming and more painful procedure when compared with a RCT. HR was higher at the initial stages and decreased as both procedures finished. Key words:Dental anxiety, endodontics, dental implants, oximetry, heart rate.

Cardiovascular Response of Aged Outpatients With Systemic Diseases During Tooth Extraction: A Single-Center Retrospective Observational Study

Background

Aged people are maintaining many natural teeth due to improved oral health. However, compromised general health and poor oral hygiene habits at earlier ages resulted in poor status of preserved teeth. Therefore, tooth extraction is required in many aged people. More knowledge is needed because there are many risk factors during the surgery in frail aged adults. The aim of this study was to evaluate the cardiovascular response of such a population during tooth extraction and analyze risk factors to provide clinical guidance.

Methods

A retrospective study was performed on aged patients with systemic diseases who underwent tooth extraction. Data regarding demographic profiles and cardiovascular parameters of heart rate and blood pressure were collected preoperative, when local anesthesia was administered, at the beginning of tooth extraction, 5 min after tooth extraction, and postoperative. The effects of risk factors, including age, sex, and systemic diseases on these parameters were analyzed with a multilevel model.

Results

Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of aged patients increased significantly when performing local anesthesia and tooth extraction. During the operation, the older patients (β = 2.011, P = 0.005) and the diabetics (β = 3.902, P < 0.0001) were associated with higher SBP, while those with more tooth extractions exhibited higher HR (β = 0.893, P = 0.007). Women patients showed both significantly elevated HR (β = 1.687, P < 0.0001) and SBP (β = 2.268, P < 0.0001). However, for coronary artery disease patients, HR (β = −2.747, P < 0.0001) and blood pressure [SBP (β = −4.094, P < 0.0001) and DBP (β = −0.87, P = 0.016)] were markedly lower than those of patients without a diagnosis of coronary artery disease.

Conclusion

Cardiovascular response of aged outpatients with systemic diseases during tooth extraction is quite significant. Age, sex, systemic diseases, and the number of tooth extraction could be risk factors closely associated with cardiovascular response. The findings might provide safety guidance for dentists on tooth extraction in this population.

Variation in Hemodynamic Characteristics during Periodontal Crown-Lengthening Surgical Procedure: An Uncontrolled Cohort Study

(1) Background: The purpose of this prospective study was to determine the changes in primary hemodynamic parameters and oxygen saturation in systemically healthy patients during the surgical procedure involving crown lengthening. (2) Methods: A total of 44 patients who required a crown-lengthening procedure in a single tooth in the maxillary arch were included in this study. Heart rate (HR), blood pressure (BP) and oxygen saturation (SpO₂) were measured in all the subjects at three different intervals: before injecting the anesthetic (T1), after the anesthetic injection (T2) and after the procedure (T3). Descriptive statistics were computed, and observations were recorded as mean and standard deviation (SD). Analysis of variance (ANOVA) was used to compare the mean observation within parameters at different time intervals. (3) Results: All primary hemodynamic parameters were increased in the T2 phase over T1 and decreased in the T3 phase over T2. However, SpO₂ decreased in both the T2 and T3 phases compared to the initial T1 phase. No significant differences were observed among the primary hemodynamic variables. However, SpO₂ showed a significant difference (p = 0.013) among the T1, T2 and T3 phases. (4) Conclusions: Further study with larger sample size is required in order to analyze the accurate hemodynamic alterations.

Assessment of Dental Anxiety and Hemodynamic Changes during Different Dental Procedures: A Report from Eastern Saudi Arabia

OBJECTIVES

 This study aimed to investigate hemodynamic changes in healthy adult patients during different dental procedures and evaluate whether these changes were associated with patients' dental anxiety.

MATERIALS AND METHODS

 A convenience sample of 119 patients of both genders undergoing routine dental care participated in the study. Participants responded to the Arabic version of the modified dental anxiety scale (MDAS) and a self-structured questionnaire. Each patient had their blood pressure, heart rate, and oxygen saturation measured at three points: before, during, and after the dental procedure using an electronic sphygmomanometer. MDAS scores were categorized into no anxiety, mild, moderate or severe anxiety, while readings of heart rate and blood pressure were categorized into no change, increased or decreased and either "no change" or "increased" for oxygen saturation. Chi-square test was used to investigate the association between the study variables and a p value of < 0.05 was considered statistically significant. SPSS version 20 was used in the analysis.

RESULTS

 Mean ( ± standard deviation [SD]) of MDAS was 11.12 ( ±  3.9) an indicative of moderate dental anxiety. No changes in blood pressure, heart rate, or in oxygen saturation were observed on 39.5%, 54.6% and 97.5% among the study participants, respectively. Half of the participants avoided dental care, with dental anxiety being the main reason for that (26.1%). Pattern of dental visits was significantly associated with MDAS scores (p = 0.042). There were significant changes in blood pressure (p = 0.0003), heart rate (p = 0.01) but not in oxygen saturation (p = 0.33). Changes in blood pressure, heart rate, and oxygen saturation were not associated with dental anxiety p = 0.15, 0.10, and 0.99, respectively.

CONCLUSION

 The results of this study indicate that the type of dental procedure may cause dental anxiety and cause hemodynamic changes. Therefore, close monitoring of patients with dental anxiety during the treatment is advised.

Thermography as a Method to Detect Dental Anxiety in Oral Surgery

(1) Background: the aim of this study was to evaluate if dental anxiety can be measured objectively using thermal infrared imaging. (2) Methods: Patients referred to the Department of Oral Surgery of the University of Naples Federico II and requiring dental extractions were consecutively enrolled in the study. Face thermal distribution images of the patients were acquired before and during their first clinical examination using infrared thermal cameras. The data were analyzed in relation to five regions of interest (ROI) of the patient’s face (nose, ear, forehead, zygoma, chin). The differences in the temperatures assessed between the two measurements for each ROI were evaluated by using paired T-test. The Pearson correlation and linear regression were performed to evaluate the association between differences in temperatures and Modified Dental Anxiety Scale (MDAS) questionnaire score, age, and gender; (3) results: sixty participants were enrolled in the study (28 males and 32 females; mean age 57.4 year-old; age range 18–80 year-old). Only for nose and ear zone there was a statistically significant difference between measurements at baseline and visit. Correlation between the thermal imaging measurements and the scores of the MDAS questionnaire was found for nose and ear, but not for all of the other regions. (4) Conclusions: the study demonstrated a potential use of thermal infrared imaging to measure dental anxiety.

Changes in Blood Pressure and Pulse Rate of Patients without Systemic Diseases Following the Injection of 2% Lidocaine Plus Epinephrine 1:80000 in an Inferior Alveolar Nerve Block - A Prospective Study

Introduction

An inferior alveolar nerve block is dental anesthesia produced by the local injection of lidocaine plus epinephrine; however, its administration could cause cardiovascular side effects. We aimed to assess the changes in blood pressure and pulse rate following the injection of 2% lidocaine with epinephrine 1:80000 for an inferior alveolar nerve block.

Materials and Methods

Seventy-one patients without any systemic disease were enrolled in this study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate were measured using an automatic digital blood pressure monitor in four stages as follows: at the rest time (Stage 1), prior to injection (Stage 2), immediately after injection (Stage 3), and 10 min after the administration of anesthetic agents (Stage 4). All injections and measurements were carried out by a single operator to minimize the variability.

Results

SBP and DBP in all stages were within the normal range (lower than 130 and 80 mmHg, respectively), and none of the patients showed evidence of arterial hypertension. Although the pulse rate increased significantly at Stages 2, 3, and 4 compared with Stage 1 (P < 0.05), no evidence of bradycardia or tachycardia was seen.

Discussion

Local anesthesia with 2% lidocaine plus epinephrine 1:80000 for an inferior alveolar nerve block would be safe for patients without any systemic diseases.

Dental Anxiety, Fear, and Root Canal Treatment Monitoring of Heart Rate and Oxygen Saturation in Patients Treated during the Coronavirus Disease 2019 Pandemic: An Observational Clinical Study

Introduction

The present study aimed to evaluate anxiety in patients and to monitor their heart rate (HR) and blood oxygenation (SpO₂) before, during, and after a root canal treatment (RCT) during the state of alarm in 2 different periods of strict and partial confinement.

Methods

The patients who required a primary RCT were selected. Demographic, preoperative, and postoperative variables were registered, including perceived dental anxiety, fear, HR, and SpO₂. Spearman correlation, chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for frequency distribution and variable interaction, and Wilcoxon and Mann-Whitney tests were used to compare HR and SpO₂ between groups and different treatment points.

Results

Ninety-six patients were included. The median Modified Dental Anxiety Scale scores were 8 (interquartile range [IQR], 6–9.25) and 6 (IQR, 5.5–8) in patients treated during the strict and partial confinement periods. The median fear scores were 2 (IQR, 0–5) and 3 (IQR, 1–5), respectively. Having a previous dental bad experience resulted in higher dental anxiety and fear (P < .05). HR was increased in patients with higher MDAS and fear scores and in those treated during the strict confinement (P < .05). In treatment time points T6 (x-ray taking), and T7 (post-treatment), HR decreased compared with the other evaluated treatment time points (P < .05). No clinical differences were found regarding SpO₂.

Conclusions

Self-perception on dental anxiety and fear was similar to other studies in a nonpandemic context. Patients with higher levels of dental anxiety and those treated in the strict confinement period presented an elevated HR. However, it can be stated that RCT performed by endodontists does not result in a significant alteration in patients.

Patient's pre-operative dental anxiety is related to diastolic blood pressure and the need for post-surgical analgesia

In order to study the relationship of the patient’s anxiety level from Corah’s Dental Anxiety Scale (DAS) vs different physiological parameters: pre and post-operative blood pressure, and pre and post-operative heart rates, and subsequently, relate the results to the patient’s post-operative anti-inflammatory analgesic need, 185 patients requiring a simple dental extraction were recruited. They filled out the DAS in the waiting room prior to their procedure and once in the examination room, their preoperative blood pressure and heart rate was measured. Once the dental extraction had been completed, their blood pressure and heart rate were measured again. Before leaving the clinic, the patient was given an analgesic form in which they had to indicate whether or not they had required analgesia after the procedure. Diastolic blood pressure (DBP) showed statistically significant differences between pre-operative and post-operative (P = 0.001). DAS was related with pre-operative diastolic blood pressure (pre-DBP) (P = 0.001) and post-operative diastolic blood pressure (post-DBP) as well as pre-operative heart rate (pre-HR) (P = 0.027) and post-operative heart rate (post-HR) (P = 0.013). Patients with high levels of DAS tend to take more Ibuprofen 400 mg (P = 0.038). The different levels of anxiety will determine what type of anti-inflammatory analgesia the patient will take, if necessary.

Do state-trait anxiety and previous unpleasant dental experiences predict the need for sedation in women having third molar surgery?

The aim of this study was to examine the need for sedation in women who had or had not had a previous unpleasant dental experience, and to assess possible contributory factors. The sample size required was estimated at 312 subjects. Healthy women listed for the surgical removal of third molars were asked to complete a questionnaire regarding their health, clinical and personal experience, past dental experience, result of the Indicator of Sedation Need (IOSN) scale, and of the Spielberger's State-Trait Anxiety Inventory. The participants were categorised before analysis by the nature of their previous dental experience. The number of participants who required sedation, their mean IOSN score, and the mean degree of state anxiety were significantly higher in the unpleasant experience group. The younger the patient at the time of the experience, the worse the state-anxiety (r=-0.25). The odds that sedation would be needed were 2.24 times higher in the same group. The final model correctly predicted the need for sedation in 75.3% of the cases. Healthy women having third molar surgery who had had a previous upsetting dental experience were more likely to need sedation and had worse state-anxiety than those who had not.