Scales used to rate adult patients' psycho-emotional status in tooth extraction procedures: a systematic review

Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis

BACKGROUND

This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain.

STUDIES REVIEWED

The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT.

RESULTS

The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001).

PRACTICAL IMPLICATIONS

PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.

Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature

BACKGROUND

It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments.

METHODS

The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations.

RESULTS

Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered.

CONCLUSIONS

this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.

A clinical study of the piezosurgery, high-speed contra-angle handpiece, and the combined application of both for extraction of embedded supernumerary teeth

OBJECTIVES

To compare the effectiveness of three methods: high-speed contra-angle handpiece (HSCAH), piezosurgery, and combined in the extraction of different locations and types of embedded supernumerary teeth.

METHODS

Sixty cases with different locations and different types of embedded supernumerary teeth were randomly divided into three groups for extraction by HSCAH, piezosurgery, and the combination of both, and the intraoperative and postoperative conditions of the three groups were compared and analyzed.

RESULTS

In the extraction of embedded supernumerary teeth in the inverted, horizontal, and root tip positions, the piezosurgery group required significantly longer operative time and reduced intraoperative bleeding compared with the HSCAH and the piezosurgery combined with the HSCAH; it could effectively relieve postoperative pain and facial swelling. In the extraction of oblique, orthodontic, middle, and crown segments of embedded supernumerary teeth, the use of a piezosurgery combined with an HSCAH can effectively reduce the operative time, while the factors of bleeding, postoperative pain, and facial swelling not statistically significant when compared with a piezosurgery. Compared with the HSCAH and combined piezosurgery, piezosurgery can significantly reduce the fear of patients.

CONCLUSION

Piezosurgery is effective in extracting embedded supernumerary teeth in inverted, horizontal, and apical positions, effectively reducing intraoperative and postoperative trauma and shortening the time required for healing. The piezosurgery combined with an HSCAH can effectively reduce intraoperative and postoperative trauma when extracting embedded supernumerary teeth in oblique, orthodontic, middle, and crown positions. piezosurgery is a technique suitable for the treatment of patients with fear.

Effectiveness of Auditory Distraction and Brief Relaxation Therapy in Reducing Anxiety in Dental Patients Undergoing Extraction: A Randomized Controlled Trial

Objective: This study compared the effectiveness of auditory distraction and brief relaxation therapy for reducing anxiety in patients undergoing tooth extraction. Methods: A non-blind, three-armed, randomized control trial was carried out. The targeted study population were patients who needed extraction of a non-restorable and non-mobile molar tooth. Eighty-six patients were recruited; the brief relaxation therapy and auditory distraction groups had 32 participants each, while 10 of the 22 participants in the control group were excluded due to missing data. The Hierarchical Anxiety Questionnaire was used to assess the anxiety level. The Mann–Whitney U or Kruskal–Wallis test was performed to compare means between the groups. The before and after comparisons in each group were carried out using the Wilcoxon Signed-Rank test. The alpha value was set at 0.05, and data were analyzed using SPSS version 24. Results: The mean anxiety score after brief relaxation therapy and auditory distraction had significantly decreased (p < 0.001). Although not significant (p = 0.13), there was a slight increase in the anxiety score of the study participants in the control group just before the extraction procedure. Brief relaxation therapy was significantly effective in reducing anxiety scores in comparison to the control group (MD = 5.87, 95% CI = 2.58, 9.17; p = 0.001), but auditory distraction was not (p = 0.14). Conclusion: Both auditory distraction and brief relaxation therapy were effective in reducing patient anxiety before a dental procedure. Furthermore, it would be interesting to learn if these findings remain consistent for more complex dental procedures, such as surgical removal of an impacted third molar.

The influence of sedation and general anesthesia to patients' psycho-emotional status undergoing wisdom teeth extraction: a pilot clinical trial

Background: Patients usually face negative psycho-emotional status during teeth extraction, therefore sedation and general anesthesia are often selected for wisdom teeth extractions. The aim of this study is to evaluate the difference between sedation and general anesthesia patients' psycho-emotional status and pain, using Universal Scale in Oral Surgery for Psycho-Emotional Rating (USOS), Visual Analogue Scale (VAS) and Modified Corah's Dental Anxiety scale (MDAS). Methods: In the period of 10/21/2019–01/31/2020 a prospective control study was held of adult patients for extraction of four wisdom teeth with sedation or general anesthesia. Patients were evaluated using self-reported questionnaires and physician questionnaire. Results: In total 53 patients were included in study: 43 in the sedation group (SG) and 10 in the general anesthesia group (GAG). Patients' psycho-emotional status was significantly (p < 0.05) more negative in both groups at the day of surgery than before it, but the difference of fear was higher in GAG (p < 0.05). Immediately after surgery GAG (3.80) felt statistically significantly (p < 0.05) more pain than SG (2.60). Conclusion: Sum of USOS, MDAS, dental fear data scores, pulse measurements directly correlated with time, i.e. statistics increased as surgery approached. The pain sensation differences were found only in the assessment immediately after surgery.

Psychodiagnostics as a Mandatory Element of Patient Protocols in Dentistry

Objectives:

This study aims at performing psychodiagnostics of the patients` condition with removable and fixed dentures both before and after dental treatment.

Materials and Methods:

The first group included 200 patients with fixed-type dentures, and the second group consisted of 200 patients with removable dental devices. The control group included 200 patients with healthy teeth. All patients were subjected to Fere’s skin-galvanic reaction procedure. Patients also filled out the Dental Status Questionnaire and were then tested following the Spielberger-Hanin Scale. For a comparison of differences, a two-sample t-test for independent samples was used. The Pearson correlation between features was calculated considering their distribution as normal.

Results:

In the control group, the hemispheric activity index increased 1.1 times after treatment. In Group 2, following the dental status questionnaire, the index of hemispheric activity increased 1.3 times in males with a positive emotional mood (P ≤ 0.01). A 2.2-fold and 2.1-fold (P ≤ 0.01) increase was observed among female and male patients with a negative emotional mood in Group 2, respectively. After the treatment, the hemispheric activity index in Group 1 increased by 1.1 times for males with a positive mood (P ≤ 0.01) and by 1.2 times for male and female patients with a negative mood (P ≤ 0.05). Direct correlation was recorded between the increase in the number of scores and emotional mood among males and females from Group 1 (0.72 and 0.73, respectively). After the survey, a correlation was established between the values of the hemispheric activity index and the increase in scores among males (0.82) and females (0.81). There was also a connection between the increase in scores and the level of personal anxiety in both male (0.57) and female (0.66) patients, as well as between the increase in scores and the level of reactive anxiety (0.56 and 0.57, respectively).

Conclusions:

Changes in the hemispheric activity index were shown to be related to the patient’s dental condition questionnaire. Besides, there is a relationship with the type of dental service. The practical application of this study implies that more reliable information about the patient’s satisfaction with the quality of dental care provided can be obtained using not only standard psychodiagnostic methods but also questionnaires on the patient’s dental status. Once the survey is completed and the data obtained analyzed, it is possible to define the correct strategy to restore the patient’s physical and mental health after dental treatment.

Clinical treatment and medication in decreasing the development of major depression caused by spinal fracture

Background

Chronic pain and limited activities of daily living after spinal fracture may induce the occurrence of major depression (MD); however, risk factors regarding medications, surgical intervention, and severity of fracture are unclear. We aimed to analyze risk factors of MD development after spinal fracture.

Methods

This was a retrospective database study, using the health care database of the Taiwan government. We included 11,225 patients with new spinal fracture (study group), and 33,675 matched patients without fracture (comparison group). We respectively reviewed data of each participant for 3 years to assess the development of MD. The Cox proportional hazards model was used to determine the prevalence of MD, after adjusting for patient demographics, medications, surgical interventions, spinal cord involvement, and postfracture comorbidities.

Results

In total, 187 fracture patients (1.7%) and 281 nonfracture patients (0.8%) developed new-onset MD (hazard ratio [HR]:1.96, (95% confidence interval [CI]: 1.63–2.36)). Spinal cord involvement (HR: 2.96, 95% CI: 2.54–3.42) and postfracture comorbidities (HR: 3.51, 95% CI: 2.86–3.97) obviously increased the risk of MD.

Conclusions

Patients with spinal fracture (spinal cord involvement and postfracture comorbidities) were more likely to develop MD. Early surgical interventions (vertebroplasty) and medications (narcotics) may decrease the risk of MD.

Single-channel electroencephalography and its associations with anxiety and pain during oral surgery: a preliminary report

Background

This study aimed to assess the course of anxiety and pain during lower third molar (LTMo) surgery and explore the role of mobile and single-channel electroencephalography under clinical and surgical conditions.

Methods

The State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), and Interval Scale of Anxiety Response (ISAR) were used. The patient self-rated anxiety (PSA), the pain felt during and after surgery, EEG, heart rate (HR), and blood pressure (BP) were assessed.

Results

The Attention (ATT) and Meditation (MED) algorithms and indicators evaluated in this study showed several associations. ATT showed interactions and an association with STAI-S, pain during surgery, PSA level, HR, and surgical duration. MED showed an interaction and association with DAS, STAI-S, and pain due to anesthesia. Preclinical anxiety parameters may influence clinical perceptions and biological parameters during LTMo surgeries. High STAI-Trait and PSA scores were associated with postoperative pain, whereas high STAI-State scores were associated with more pain during anesthesia and surgery, as well as DAS, which was also associated with patient interference during surgery due to anxiety.

Conclusions

The findings suggest that single-channel EEG is promising for evaluating brain responses associated with systemic reactions related to anxiety, surgical stress, and pain during oral surgery.

Correlation between preoperative pressure pain assessments and anxiety and postoperative pain in impacted lower third molar surgery

Objectives

The aim of this study was to evaluate correlations between anxiety and preoperative pressure pain assessments and postoperative pain and analgesic requirements in impacted lower third molar tooth surgery.

Materials and Methods

This prospective study enrolled 60 patients who underwent impacted lower third molar surgery. The preoperative State-Trait Anxiety Inventory-I (STAI-I), pressure pain threshold, and pressure pain tolerance scores were measured. At 2, 4, 6, 12, and 24 hours, and at 6 days following surgery, the patients scored their pain on the visual analogue scale and recorded their analgesic drug usage. The data were evaluated, and the results were statistically analyzed.

Results

Of the 60 patients, 38 were female. Mean age was 24.62±7.42 years. The study found no relationship between preoperative pressure pain assessments and postoperative pain (P>0.05). There was also no relationship observed between preoperative STAI-I scores and postoperative pain (P>0.05). However, there was a positive correlation between operation time and total medication taken (P<0.05).

Conclusion

Preoperative pressure pain threshold, pressure pain tolerance, and anxiety level had no significant effects on postoperative pain and analgesic requirements in impacted lower third molar surgery.

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

(1) Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. (2) Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: “virtual reality”, “distraction systems”, “dental anxiety” and “pain”. Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used and in standard care situations. (3) Results: 32 studies were identified, of which 8 met the inclusion criteria. The effect of VR in children was significant, both for anxiety (standardized mean difference (SMD) = −1.75) and pain (SMD = −1.46). (4) Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: “virtual reality”, “distraction systems”, “dental anxiety” and “pain”. Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used, and in standard care situations. Results: 31 studies were identified, of which 14 met the inclusion criteria. Pain levels were evaluated in four studies (n = 4), anxiety levels in three (n = 3) and anxiety and pain together in seven (n = 7). Our meta-analysis was based on ten studies (n = 10). The effect of VR was studied mainly in the pediatric population (for pain SMD = −0.82). In the adult population, only two studies (not significant) were considered. Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.

Using the natural environment to address the psychosocial impact of neurological disability: A systematic review

Engaging with the natural environment contributes to favourable psychosocial health outcomes. A systematic review of research published before June 2017 was conducted to establish how engaging with natural environments impact the psychosocial health of people with a neurological disability. Identified studies included populations with dementia (n=14), brain injury (n=2), and stroke (n=2). Evidence suggests that engaging with gardens, and gardening, can favourably impact the emotional and social health of people with dementia and, an explanatory theoretical model is proposed. Considerable research gaps exist and further research investigating the psychosocial impact of engaging with natural environments for people with different neurological conditions (for example spinal cord injury or stroke) is warranted.

Validation of Universal Scale in Oral Surgery (USOS) for Patient's Psycho-emotional Status Rating

Objectives

There aren’t any objective methods that may help in standard evaluation of oral surgery patient’s psycho-emotional status. Without any standardized evaluation, two main problems appear: heterogeneity between studies and ineffective patient’s evaluation. Therefore, Universal Scale in Oral Surgery (USOS) for patient’s psycho-emotional status rating has previously been proposed by authors. The aim of present study is to assess the clinical effectivity and validate the Universal Scale in Oral Surgery in case of outpatient tooth extraction for adult healthy patients.

Material and Methods

Clinical trial to validate the USOS for patient’s psycho-emotional status rating was performed. In total 90 patients, that came for outpatient dental extraction to Lithuanian University of Health Sciences Oral and Maxillofacial Surgery Department ambulatory, were enrolled in clinical trial. Patients filled self-reported questionnaires before the procedure. Operating surgeon rated USOS for patient’s psycho-emotional status rating doctor’s part questionnaire after the procedure. 4 - 6 weeks later all patients were asked to fill USOS for patient’s psycho-emotional status rating questionnaire retrospectively.

Results

According to the statistical analysis, the final composition of USOS for patient’s psycho-emotional status rating that would fit to reliability coefficient should be composed from 6 patient part questions and 3 general doctor part questions.

Conclusions

Universal Scale in Oral Surgery for patient’s psycho-emotional status rating is a novel, doctor and patient rated scale which is suitable for clinical and scientific usage.