Estudio del miedo en pacientes frente a la extracción del tercer molar / Study of fear in patients facing third molar extraction

El tratamiento odontológico sigue siendo percibido en la actualidad como una experiencia atemorizadora para muchas personas. Se han establecido diversos métodos para tratar de evaluar el temor y ansiedad que refieren las personas cuando deben recibir tra-tamientos bucales. Sin embargo, estos no han sido aplicados adecuadamente como parte de la atención clínica cotidiana. Considerando esto, podría suponer-se que el miedo es uno de los factores desencadenan-tes en la deserción de los tratamientos odontológicos, y las personas asistirían solo en el momento de una urgencia. El objetivo del presente estudio fue analizar el afrontamiento de emociones (miedo) en los pacien-tes que concurren a la consulta para la extracción de un tercer molar en la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA). La metodología que se utilizó fue cuantitativa y cualitativa. El diseño fue exploratorio-descriptivo (AU)

Dental treatment is still perceived today as a frightening experience for many people. Various methods have been established to try to assess the fear and anxiety that people report when they must receive oral treatments, however, these have not been adequately applied as part of daily clinical care. Considering this, it could be assumed that fear is one of the triggering factors in desertion of dental treatments and people would attend only at the time of an emergency. The objective of this study was to analyze the coping with emotions (fear) in patients who attend the consultation for the extraction of a third molar at the Faculty of Dentistry of the University of Buenos Aires (FOUBA). The methodology used was quantitative and qualitative. The design was exploratory-descriptive (AU)

Effect of music at 432 Hz and 440 Hz on dental anxiety and salivary cortisol levels in patients undergoing tooth extraction: a randomized clinical trial

Abstract Objective The aim of this study was to compare the effects of music at 432 Hz, 440 Hz, and no music on the clinical perception of anxiety and salivary cortisol levels in patients undergoing tooth extraction. Methodology A parallel-group randomized clinical trial was conducted. Forty-two patients (average age: 23.8±7.8 years, 27 women) with a moderate level of anxiety were distributed in three groups: use of music for 15 minutes at a frequency of 432 Hz (n=15), at 440 Hz (n=15) and a control group without music (n=12). The CORAH Dental Anxiety Scale and salivary cortisol levels, estimated by the solid phase enzyme-linked immunosorbent assay (ELISA), were measured and compared before and after the music intervention between groups (two-way ANOVA-Tukey p<0.05, RStudio). Results Significantly lower anxiety level values were observed at 432 Hz (8.7±2.67) and 440 Hz (8.4±2.84) compared to the control group (17.2±4.60; p<0.05). The salivary cortisol level at 432 Hz (0.49±0.37 μg/dL) was significantly lower than 440 Hz (1.35±0.69 μg/dL) and the control group (1.59±0.7 μg/dL; p<0.05). Conclusion The use of music significantly decreased clinical anxiety levels, and the frequency of 432 Hz was effective in decreasing salivary cortisol levels before tooth extraction.

Trait vs. state anxiety in different threatening situations / Ansiedade traço versus ansiedade estado em diferentes situações de ameaça

Abstract Objective Anxiety as a uni- or multidimensional construct has been under discussion. The unidimensional approach assumes that there is a general trait anxiety, which predisposes the individuals to increases in state anxiety in various threatening situations. In this case, there should be a correlation between state and trait anxiety in any situation of threat. Therefore, the aim of this study was to investigate the correlation between trait and state anxiety in participants exposed to two different anxiogenic situations: interpersonal threat (Video-Monitored Stroop Test - VMST) and physical threat (third molar extraction - TME). Methods Participants with various levels of trait anxiety (general trait: State-Trait Anxiety Inventory - STAI, Hospital Anxiety and Depression Scale; specific trait: Social Phobia Inventory, Dental Anxiety Scale) had their anxious state evaluated (STAI, self-evaluation of tension level, heart rate, electromyogram activity) before, during and after the VMST or the TME. Results In VMST, trait anxiety correlated to state anxiety (psychological parameters) in all test phases. However, in TME, the only trait measurement that correlated to state anxiety (psychological parameters) was the Dental Anxiety Scale. Conclusion Trait anxiety correlates positively to state anxiety in situations of interpersonal threat, but not of physical threat.

Resumo Objetivo A ansiedade como um construto uni ou multidimensional tem estado em discussão. A abordagem unidimensional presume que há uma ansiedade-traço geral, a qual predispõe o indivíduo a aumentar a ansiedade-estado em situações de ameaça. Neste caso, deveria existir uma correlação entre estado e traço ansioso em diferentes situações ameaçadoras. Portanto, o objetivo deste estudo foi avaliar a correlação entre ansiedade-traço e ansiedade-estado em participantes que foram expostos a duas situações ansiogênicas diferentes: ameaça interpessoal (Teste de Stroop Monitorado por Vídeo - TSMV) e ameaça física (exodontia do terceiro molar - ETM). Métodos Participantes com vários níveis de ansiedade-traço (traço geral: Inventário de Ansiedade Traço-Estado - IDATE; Escala Hospitalar de Ansiedade e Depressão; traço específico: Inventário de Fobia Social, Escala de Ansiedade Dental de Corah) tiveram seus estados ansiosos avaliados (IDATE, escala analógica de tensão, frequência cardíaca, eletromiografia) antes, durante e depois do TSMV ou da ETM. Resultados No TSMV, a ansiedade-traço correlacionou-se com a ansiedade-estado (parâmetros psicológicos) em todas as fases do teste. Entretanto, na ETM, a única medida de traço que se correlacionou com a ansiedade-estado (parâmetros psicológicos) foi a Escala de Ansiedade Dental de Corah. Conclusão A ansiedade-traço correlaciona-se positivamente com a ansiedade-estado em situações de ameaça interpessoal, mas não de ameaça física.

Dental anxiety in a sample of West Indian adults / Ansiedad dental en una muestra de adultos de West Indies

AIM: The aim of this study was to investigate the level of dental anxiety and its possible causes among people in Trinidad and Tobago. METHOD: This is a cross-sectional survey of parents and guardians accompanying children who were attending a paediatric dental clinic. Participants completed a questionnaire while in the waiting room, which included the Modified Dental Anxiety Scale (MDAS), age, gender and occupation. An additional item was included which asked participants to rate the anxiety felt on having a tooth extracted. RESULTS: There were 100participants (81% female). Overall, 40% of participants reported moderate to severe anxiety. Twenty-three per cent of participants had moderate anxiety (MDAS 15-18) and 17% had severe anxiety/phobia (MDAS 19-20). Level of anxiety was related to gender (multiple linear regression, p < 0.05). Proportions of participants were very/extremely anxious of having a tooth drilled (48%), local anaesthetic injection (53%) and extraction (52%). Thirty-six per cent of participants had avoided dental treatment in the past because they were too anxious. CONCLUSION: High levels of dental anxiety were found in this sample of Trinidadian adults. The MDAS was able to detect significant elements of that anxiety. The addition of a question on extraction revealed that this procedure may contribute substantially in anxiety toward dental treatment in the Caribbean.

OBJETIVO: El objetivo de este estudio fue investigar el nivel de ansiedad dental y sus posibles causas entre las personas en Trinidad y Tobago. MÉTODO: Éste es un estudio transversal de padres y guardianes que acompañan a los niños que asistían a una clínica dental pediátrica. Los participantes llenaron un cuestionario mientras se hallaban en la sala de espera. El cuestionario incluía la Escala de Ansiedad Dental Modificada (EADM), edad, género y ocupación. Se incluyó un punto adicional que pedía a los participantes que clasificaran la ansiedad que sentían por la extracción de un diente. RESULTADOS: Había 100 participantes (81% hembra). En general, el 40% de los participantes reportó sentir una ansiedad de moderada a severa. El veintitrés por ciento de los participantes tenía una ansiedad moderada (EADM 15-18) y el 17% tenían ansiedad severa/fobia (EADM 19-20). El nivel de ansiedad guardaba relación con el género (regresión logística múltiple p < 0.05). Muchos participantes estaban muy/extremadamente ansiosos por tener un diente bajo la fresa dental (48%), una inyección con anestésico local (53%) y una extracción (52%). Treinta y seis por ciento de los participantes habían evitado el tratamiento dental en el pasado porque se sentían demasiado ansiosos. CONCLUSIÓN: Se encontraron niveles altos de ansiedad dental en esta muestra de adultos trinitenses. La EADM pudo detectar elementos significativos de esa ansiedad. Al añadirse una pregunta sobre extracción, se puso de manifiesto que este procedimiento puede contribuir substancialmente al problema de la ansiedad hacia el tratamiento dental en el Caribe.

A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients.

Pain is not the sole reason for fear of dentistry. Anxiety or the fear of unknown during dental treatment is a major factor and it has been the major concern for dentists for a long time. Therefore, the main aim of this study was to evaluate and compare the two distraction techniques, viz, audio distraction and audiovisual distraction, in management of anxious pediatric dental patients. Sixty children aged between 4-8 years were divided into three groups. Each child had four dental visits--screening visit, prophylaxis visit, cavity preparation and restoration visit, and extraction visit. Child's anxiety level in each visit was assessed using a combination of four measures: Venham's picture test, Venham's rating of clinical anxiety, pulse rate, and oxygen saturation. The values obtained were tabulated and subjected to statistical analysis. It was concluded that audiovisual distraction technique was more effective in managing anxious pediatric dental patient as compared to audio distraction technique.

Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss

Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76 percent at the time and 35 to 87 percent after extraction). From 72.5 percent patients who expressed intention of immediate replacement of edentulous spaces, only 8.1 percent had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.

Estudos de autopercepção têm demonstrado que a ausência de dentes pode resultar em impactos estéticos, funcionais, psicológicos e sociais, embora nem todos os indivíduos demandam por tratamento protético imediato após a perda dentária. O objetivo do estudo foi avaliar a percepção de pacientes submetidos a exodontia em relação a fatores associados à perda e ao tratamento protético, no momento e após a perda dos dentes. Uma amostra de conveniência de 211 pacientes consecutivos foi avaliada quanto à condição clínica, autopercepção dos impactos orais e necessidade de tratamento, por meio de exame clínico e questionário, no momento e após 3 meses da exodontia. A percepção de impactos da perda dentária foi alta (21-76 por cento no momento e 35-87 por cento após a exodontia). Dos 72,5 por cento pacientes que relataram pretender a reposição protética imediata apenas 8,1 por cento realizaram o tratamento. A motivação financeira foi relatada como o maior impedimento para o tratamento. A análise univariada mostrou associação entre reposição imediata e localização anterior da perda (p=0,00) e extensão do espaço desdentado (p=0,01), entre localização da perda e limitação funcional percebida (p=0,03). O incômodo com a aparência foi relacionado à localização da perda no arco superior (p=0,02), o desejo por tratamento protético foi relacionado à extensão do espaço desdentado (p=0,05). Na maioria dos aspectos avaliados a percepção de problemas associados à perda foi maior no sexo feminino. Conclui-se que, embora a necessidade percebida de tratamento protético seja alta, fatores clínicos e sócio-econômicos são determinantes para a realização do tratamento.

Razões das perdas dentárias nas cidades de Maceió e Recife, Brasil / Tooth loss reasons in Maceió and Recife, Brazil

Com o objetivo de identificar as razões das perdas dentárias nas cidades de Maceipo e recife, Brasil, foram realizados dois estudos transversais que inclíram 466 indivíduos em Maceió e 404 em Recife, adultos e de ambos os sexos. Todos os participantes assinaram termo de consentimento, e antes do exame clínico, responderam um formulário com informações sobre as variáveis sócio-econômica e demográficas. O registro de CPO-D foi obtido de cada paciente assim como a razão da perda dental. Os dados sócio-econômicos foram obtidos para verificar quais os fatores interferiram na razão da perda dental. Os resultados mostraram que nas duas cidades a maioria das extrações foram devido a cárie (63,3 por cento- Maceió e 70,3 por cento- Recife), seguida pela perda por doença periodontal (13,1 por cento- Maceió e 15,1 por cento- Recife). Em Maceió houve significância estatística entre as razões para a extração e idade, tipo de dente (anterior ou posterior), nível educacional, renda familiar (p<0,001) e índice CPO-D (P=0,002). Em Recife os resultados mostraram associação significante da razão da perda com a idade, nível educacional, CPO-D e tipo de dente (p<0,001). Nas duas cidades a principal razão da perda dentária foi a cárie, seguida pela extração por doença periodontal