Miedo a la intervención quirúrgica: posibles intervenciones no quirúrgicas / Fear of surgery: possible non-surgical interventions

En el siguiente artículo se realizará un recorrido posible para pensar el lugar del “miedo” en la práctica quirúrgica, así como también el lugar de un recurso farmacológico frecuentemente utilizadopara disminuir “el dolor”: “la anestesia”. Desde un abordaje interdisciplinario se interrogarán conceptos teóricos utilizados cotidianamente por odontólogos y cirujanos. El trabajo finaliza con el planteo de un primer tiempo en el protocolo quirúrgico: tiempo de escucha, tiempo de preguntas, tiempo de informar.

Self-assessment of facial form oral function and psychosocial function before and after orthognathic surgery: a retrospective study.

Orthognathic surgery is a well-accepted treatment for patients with skeletal discrepancies. The primary motivation of many patients who seek orthognathic surgery is esthetics and not for correction of functional disability. The treatment is incomplete if the surgeon attempts to correct the physical deformity alone without adequate understanding and regard for the emotional framework. The purpose of this study is aimed at patient's self-perceptions of facial form oral function and psychosocial function before and after orthognathic surgery. Fifty patients were included in the study, of which 21 were used as control. Twenty-two questions were asked to evaluate the problem in all four areas as mentioned earlier. Each question takes a score from one to five. In group I, the internal consistency of each scale indicates moderate to high internal reliability, ranging from alpha = 0.71 for general health to alpha = 0.88 for psychosocial problem. In group II, except for functional problems, the internal consistency of each scale has moderate to high reliability. The psychological wellbeing of an orthognathic surgery patient is enhanced by careful preoperative counseling regarding the expected surgical treatment objectives, the operative course, and the expected postoperative sequelae. Patients who undergo orthognathic surgery readily accept the changes in their postoperative appearance and are satisfied with achieved results.

[Assessment of the rate of fear in different dental processes in Kerman dental school, 2007]

Fear from dentistry procedures is one of the most prevalent conditions which can influence patient-dentist relationships. The aim of this study was to assess the rate of fear from different dental procedures in patients referred to the dental school of Kerman university. In this cross-sectional study, the rate of fear from different dental procedures in 386 patients referred to the dental school of Kerman University was assessed with the visual analogue scale by a questionnaire. Data were analyzed by t and ANOVA tests. The results of this study showed that from 386 patients referred, 74 [19%] patients had low to moderate fear, 261[67.8%] patients had moderate to severe fear and 51[13.2%] patients had extreme fear. Most of the patients feared from surgery, root canal therapy, extraction and observing the syringe. The analysis of data showed that there was a significant relationship between fear, sex and previous unpleasant experiences. Women had more fear than men [P=0.012], and those who had unpleasant experiences feared more than those who did not [P=0.03]. Fear decreased as the number of visits to the dentist increased [P=0.021]. In spite of the differences in the rate of fear, dental procedures which cause the fear were the same in the patients

Evaluation of the quality of life of patients with oral cancer in Brazil

This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, 3rd version), aiming at appraising its ability to identify different patterns of health-related quality of life of patients with oral cancer in Brazil. Patients (N = 100) were interviewed as they were undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital ("Hospital das Clínicas", School of Medicine, University of São Paulo). The results were compared based on categories of socio-demographic and clinical characteristics of the patients. At a one-year follow-up, 20 patients had died, and 24 were considered dropouts. The remaining patients accounted for the longitudinal assessment of modifications in the self report of quality of life. Patients with larger tumours and neoplasms in the posterior part of the mouth presented significantly (p < 0.05) poorer indications of quality of life. Chewing was the poorest rated domain (35.0/100.0), and presented the highest proportion of complaints both at the baseline and at the follow-up assessments. The questionnaire allowed the identification of important contrasts (while comparing clinical characteristics) and similarities (while comparing socio-demographic status) among subsets of respondents, and it can contribute to reduce the impact of treatments and improve subsequent patient management.

O presente estudo realizou teste de campo para uma versão em Português do questionário de qualidade de vida da Universidade de Washington (UW-QOL, 3ª versão), com o intuito de avaliar sua capacidade em descrever padrões diferenciais de qualidade de vida de pacientes com câncer de boca no contexto brasileiro. Foram entrevistados 100 pacientes com carcinoma epidermóide oral no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os resultados foram comparados por características sócio-demográficas e clínicas dos pacientes. Após um ano, 20 pacientes haviam falecido e 24 não foram localizados. A re-entrevista dos demais permitiu o acompanhamento longitudinal de modificações na auto-avaliação de qualidade de vida. Pacientes com tumores maiores e neoplasia na porção posterior da boca apresentaram indicadores de pior qualidade de vida (p < 0.05). Mastigação foi o item com pior avaliação (35,0/100,0) e maior proporção de queixas, tanto na avaliação inicial como no seguimento longitudinal. O questionário permitiu identificar relevantes contrastes (na comparação de características clínicas) e similaridades (na comparação de características sócio-demográficas) entre os grupos de respondentes. Seu uso regular no hospital pode contribuir para reduzir o impacto das aplicações terapêuticas e aprimorar a gestão dos tratamentos.