Anxiety before dental surgery under local anesthesia: reducing the items on state anxiety in the State-Trait Anxiety Inventory-form X

Effectiveness of precooling with ethyl chloride versus honey in alleviating intra-oral injection pain in adult patients: A randomized controlled trial

Objective:

The objective of the study was to assess and compare the effectiveness of precooling with ethyl chloride versus honey in alleviating the pain of dental injection.

Methods:

About 90 patients were recruited for this randomized controlled trial. In each of the following three groups, 30 patients were allocated: Group 1, precooling with ethyl chloride; Group 2, honey; and Group 3, control. The pain score of patients in each group was measured after injecting the dental local anesthesia using a visual analog scale. Paired t-test and multiple linear regression tests were used for statistical analysis. A p value of ⩽0.05 was considered to be as significant.

Results:

The mean pain scores of participants residing in different groups were as follows: Group 1: 2.83 ± 1.46, Group 2: 4.33 ± 1.62, and Group 3: 7.80. After administrating ethyl chloride, the majority of the 18 (60%) patients reported to suffer from “mild pain.” Furthermore, in patients who were given honey in Group 2, most of the 21 (70%) patients reported suffering from “moderate pain.” In Group 3 (control) where no anesthetic modality was used, the majority of the 25 (83.33%) patients experienced “severe pain.” A significant difference was noted among the pain scores of three groups ( p = 0.001).

Conclusion:

The administration of local anesthetic is part of almost all dental procedures. Precooling with ethyl chloride resulted in a greater reduction in pain scores than honey upon administration of local anesthesia injection.

Self‐reported factors for improving patient's dental care: A pilot study

Objectives

Patient‐centered approach can offer valuable information in improving dental care, but literature is scarce. This study aimed to evaluate self‐reported factors beneficial for attendance in dental care.

Material and Methods

Survey data were collected during the summer of 2020 comprising both structured questionnaires and an open question on factors considered beneficial for dental attendance. Voluntary patients over 15 years of age (n = 196, 98%) agreed to fill the questionnaires, and n = 112 of them (57%) also gave open commentary in an urgent dental care clinic, City of Oulu, Finland, comprising the study population. Dental fear was assessed by Modified Dental Anxiety Scale (MDAS) sum scores (min 5, max 25). All utterances (n = 181) on an open question were evaluated by inductive content analysis to create sub‐ and main categories. Covid‐19 pandemic case counts in Finland were low at the time of the survey, but their effect on seeking dental care was asked. The distribution of patients was evaluated by cross‐tabulation, considering their age, gender, and dental fear status; the significance level was p < .05.

Results

Females dominated slightly the study population (57%). The mean age of the respondents was 44 years. Half (50%) had moderate (MDAS score 10−18), and 10% had severe dental fear (≥19). The open responses could be categorized into four main categories. The largest main category by patient count concerned factors related to personnel (29%), followed by the patient (28%) and treatment (25%) related, and administrative factors (19%). Males chose factors falling into categories of administration and treatment while females chose patient and personnel‐related factors (p = .048). Compared to the rest, fearful persons (MDAS > 9) reported more often factors related to personnel and treatment (p = .03). Of all participants, 17% reported seeking less dental care during the pandemic.

Conclusions

Patients value dental personnel and treatment‐related factors, specifically those with fear.

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.

The Association Between Coffee Consumption and Local Anesthesia Failure: Social Beliefs and Scientific Evidence

Introduction In our clinical practice, we have encountered patients who reported the failure of local anesthesia due to excessive coffee consumption and required higher-than-normal doses of local anesthesia. Therefore, our study aimed to assess the awareness and knowledge of coffee consumption, its effect on local anesthesia, and the available scientific evidence among the public, patients, and clinicians in dental practice.  Material and Methods A cross-sectional survey with two sets of questionnaires was designed based on the Likert scale. A 5-point scale was used to assess agreement and frequency. Yes/no and open-ended questions were used for the assessment. Questionnaires were distributed among the clinicians, patients, and the public. Data were analyzed with descriptive linear statistics. Results Of the 430 responses provided by patients and the general public, more than 40% believed that the local anesthetic failure was caused by excessive coffee consumption. Among the 235 responses provided by the clinicians, 65% of the clinicians reported encountering patients with local anesthesia failure and believed it could be due to excessive coffee consumption. However, only 9% of the clinicians were aware of scientific evidence regarding the effect of coffee consumption on local anesthesia failure.  Conclusion Surprisingly, the majority of clinicians believed that caffeine had an effect on the reduction of local anesthesia; however, only a few of them had scientific knowledge. The available scientific evidence relates that caffeine can influence cognitive performance by increasing alertness, as well as sleep deprivation causing stress and anxiety, which partially explains the local anesthetic failure among coffee consumers. Therefore, a stress reduction protocol should be a routine daily practice for a dentist to reduce the failure rate of local anesthesia.