J Dent Anesth Pain Med.  2017 Jun;17(2):105-111. 10.17245/jdapm.2017.17.2.105.

Hemodynamic changes and pain perception-related anxiety after experiencing an impacted-tooth removal: clinical practice outcome

• Raocharernporn S
• Boonsiriseth K
• Khanijou M
• Wongsirichat N

• KMID: 2384471
• DOI: http://doi.org/10.17245/jdapm.2017.17.2.105

Abstract

BACKGROUND
Dental fear is usually associated with hemodynamic changes. Fear of pain during the surgical removal of a lower impacted third molar might cause patients anxiety, thereby leading to avoidance of any future dental therapy. This study aimed to determine the effect of experiencing a surgical impacted-tooth removal on the pain perception-related anxiety and hemodynamic status.
METHODS
Twenty-seven healthy patients aged 15-30 years (mean age, 24 years), for whom surgical removal of bilateral lower third molars was advised, were included. This prospective, randomized, controlled, split-mouth study involved operations on both sides of the mandibular arch, with a 1-month washout period in between. Blood pressure and heart rate were measured before the surgical procedure, during and after the injection, preoperatively, and postoperatively. Pain perception was evaluated using a 100-mm visual analog scale during the injection, preoperatively, and postoperatively after the numbness disappeared. Differences in the blood pressure, heart rate, and pain perception between the two appointments were analyzed using the paired t-test. For all statistical analyses, SPSS version 11.5 was used.
RESULTS
The mean pain perception values during the injection and preoperatively showed no significant differences between the two appointments (P > 0.05); however, significant differences in the blood pressure and heart rate were noted before the surgical procedure; preoperatively, the blood pressure alone showed a significant difference (P < 0.05).
CONCLUSIONS
There was a significant decrease in the blood pressure and heart rate preoperatively; hence, experiencing a surgical impacted-tooth removal can reduce the subsequent preoperative anxiety in healthy patients.

Keyword

Anxiety; Hemodynamics; Pain; Surgery; Third Molar; Visual Analog Scale

MeSH Terms

Anxiety*
Appointments and Schedules
Blood Pressure
Dental Anxiety
Heart Rate
Hemodynamics*
Humans
Hypesthesia
Molar, Third
Pain Perception
Prospective Studies
Visual Analog Scale

Figure

• 

  Fig. 1 Gender-wise distribution of patients who underwent lower third molar surgery is shown.

• 

  Fig. 2 Angulations of the lower third molar impaction in patients included in this study are shown.

• 

  Fig. 3 Distribution of the levels of the lower third molars in patients included in this study are presented.

• 

  Fig. 4 Operation times for the first and second lower third molar operations are shown.

• 

  Fig. 5 Number of patients with postoperative complications are shown.

Reference

1. Gatchel RJ, Ingersoll BD, Bowman L, Robertson MC, Walker C. The prevalence of dental fear and avoidance: a recent survey study. J Am Dent Assoc. 1983; 107:609–610. PMID: 6579095.

2. Kaufman E, Epstein JB, Naveh E, Gorsky M, Gross A, Cohen G. A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections. Anesth Prog. 2005; 52:122–127. PMID: 16596910.

3. Nusstein J, Steinkruger G, Reader A, Beck M, Weaver J. The effects of a 2-stage injection technique on inferior alveolar nerve block injection pain. Anesth Prog. 2006; 53:126–130. PMID: 17177591.

4. Liau FL, Kok SH, Lee JJ, Kuo RC, Hwang CR, Yang PJ, et al. Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105:16–26. Epub 2007 Jul 25. PMID: 17656135.

5. Jensen MP, Chen C, Brugger AM. Interpretation of Visual Analog Scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003; 4:407–414. PMID: 14622683.

6. Luyk NH, Beck FM, Weaver JM. A visual analogue scale in the assessment of dental anxiety. Anesth Prog. 1988; 35:121–123. PMID: 3166350.

7. Okawa K, Ichinohe T, Kaneko Y. Anxiety may enhance pain during dental treatment. Bull Tokyo Dent Coll. 2005; 46:51–58. PMID: 16598181.

8. Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety. Community Dental Health. 1996; 13:86–92. PMID: 8763138.

9. Edmunds R, Buchanan H. Cognitive vulnerability and the aetiology and maintenance of dental anxiety. Community Dent Oral Epidemiol. 2011; 40:17–25. PMID: 21895734.

10. Kleinknecht RA, Thornlike RM, McGlynn FD, Harkavy J. Factor analysis of the dental fear survey with cross-validation. J Am Dent Assoc. 1984; 108:59–61. PMID: 6582116.

11. Reiss S, Rolf AP, David MG, Richard JM. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986; 24:1–8. PMID: 3947307.

12. Klages U, Ulusoy O, Kianifard S, Wehrbein H. Dental trait anxiety and pain sensitivity as predictors of expected and experienced pain in stressful dental procedures. Eur J Oral Sci. 2004; 112:477–483. PMID: 15560829.

13. Kim YK, Kim SM, Myoung H. Musical intervention reduces patients’ anxiety in surgical extraction of an impacted mandibular third molar. J Oral Maxillofac Surg. 2011; 69:1036–1045. PMID: 20708320.

14. Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. Ambul Pediatr. 2008; 8:117–128. PMID: 18355741.

15. Mobilio N, Gremigni P, Pramstraller M, Vecchiatini R, Calura G, Catapano S. Explaining pain after lower third molar extraction by preoperative pain assessment. J Oral Maxillofac Surg. 2011; 69:2731–2738. PMID: 21835529.

16. Baum C, Huber C, Schneider R, Lautenbacher S. Prediction of experimental pain sensitivity by attention to pain-related stimuli in healthy individuals. Percept Mot Skills. 2011; 112:926–946. PMID: 21853779.

17. Alemany-Martínez A, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Hemodynamic changes during the surgical removal of lower third molars. J Oral Maxillofac Surg. 2008; 66:453–461. PMID: 18280377.

18. Rivat C, Becker C, Blugeot A, Zeau B, Mauborgne A, Pohl M, et al. Chronic stress induces transient spinal neuroinflammation, triggering sensory hypersensitivity and long-lasting anxiety-induced hyperalgesia. Pain. 2010; 150:358–368. PMID: 20573451.

19. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998; 86:102–106. PMID: 9428860.

20. Frabetti L, Checchi L, Finelli K. Cardiovascular effects of local anesthesia with epinephrine in periodontal treatment. Quintessence Int. 1992; 23:19–24. PMID: 1631266.

21. de Morais HH, de Santana Santos T, da Costa Araújo FA, de Freitas Xavier RL, Vajgel A, de Holanda Vasconcellos RJ. Hemodynamic changes comparing 2% lidocaine and 4% articaine with epinephrine 1: 100,000 in lower third molar surgery. J Craniofac Surg. 2012; 23:1204–1211. PMID: 22801130.

22. Ping B, Kiattavorncharoen S, Saengsirinavin C, Im P, Durward C, Wongsirichat N. The efficacy of an elevated concentration of lidocaine HCl in impacted lower third molar surgery. J Dent Anesth Pain Med. 2015; 15:69–76.

23. Lasemi E, Sezavar M, Habibi L, Hemmat S, Sarkarat F, Nematollahi Z. Articaine (4%) with epinephrine (1:100,000 or 1:200,000) in inferior alveolar nerve block: Effects on the vital signs and onset, and duration of anesthesia. J Dent Anesth Pain Med. 2015; 15:201–205.

24. Ping B, Kiattavorncharoen S, Durward C, Im P, Saengsirinavin C, Wongsirichat N. Hemodynamic changes associated with a novel concentration of lidocaine HCl for impacted lower third molar surgery. J Dent Anesth Pain Med. 2015; 15:121–128.

25. Kämmerer PW, Palarie V, Daubländer M, Bicer C, Shabazfar N, Brüllmann D, et al. Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: double-blind randomized clinical trial of anesthetic efficacy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113:495–499. PMID: 22676931.

26. Vasconcellos RJ, Vasconcelos BC, Genú PR. Influence of local anesthethics with adrenalina 1:100.000 in basic vital constants during third molar surgery. Med Oral Patol Oral Cir Bucal. 2008; 13:E431–E437. PMID: 18587307.

27. Carrera I, Mestre R, Berini L, Gay-Escoda C. Alterations in monitored vita constants induced by various local anesthetics in combination with different vasoconstrictors in the surgical removal of lower third molars. Bull Group Int Rech Sci Stomatol Odontol. 2000; 42:1–10. PMID: 11799734.

28. Fernieini EM, Bennett JD, Silverman DG, Halaszynski TM. Hemodynamic assessment of local anesthetic administration by laser Doppler flowmetry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91:526–530. PMID: 11346729.