Effect of virtual reality and music therapy on anxiety and perioperative pain in surgical extraction of impacted third molars.

BACKGROUND: The objective of this study was to evaluate the effect of virtual reality (VR) and music therapy on anxiety and perioperative pain in patients undergoing extraction of impacted third molars. METHODS: A total of 275 patients who had to undergo surgery for third-molar extraction participated in a randomized controlled trial and were divided into 3 parallel groups: music therapy intervention (n = 91), VR intervention (n = 93), and control (n = 91). The Spielberger State-Trait Anxiety Inventory and the visual analog scale of pain intensity were used as measurements in this study. RESULTS: Patients in the music therapy and VR groups showed a greater reduction in anxiety level scores after third-molar extraction surgery (reduction in total anxiety in music group: 15.12; 95% CI, 13.16 to 17.08; Rosenthal r, 1.61; P < .001; reduction in total anxiety in VR group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P < .001; reduction in total anxiety in control group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P < .001). The intensity of pain after the intervention was lower in patients in the music therapy group than patients in the control group (P = .04). After the intervention, the music therapy and VR groups presented a significant decrease in systolic blood pressure (P < .05), diastolic blood pressure (P < .05), and heart rate (P < .05) compared with the control group. CONCLUSIONS: These findings suggest that the use of music therapy and VR during third-molar extraction surgery reduces anxiety and improves the patient's physiological parameters. PRACTICAL IMPLICATIONS: Implementation of these interventions (noninvasive, nonpharmacologic, economic) in the field of oral and maxillofacial surgery and dentistry could improve procedures performed under local anesthesia, improving the clinical experience of patients. This clinical trial was registered with the Australian New Zealand Clinical Trials Registry. The registration number is ACTRN12622000384752.

Comparative Study between the Combination of Dexamethasone and Bupivacaine for Third Molar Surgery Postoperative Pain: A Triple-Blind, Randomized Clinical Trial.

Objectives: To compare the possible benefits of the combination of dexamethasone-bupivacaine with articaine-epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine-epinephrine and submucosal reinforcement with 0.8 mg dexamethasone-5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine-epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients' scores on the VAS as well as their consumption of analgesic drugs after surgery.

A comparative study between traditional fixation with miniplates and modified lag screws for the treatment of mandibular fractures.

OBJECTIVES: The objective of this study is to investigate two internal fixation surgical techniques for mandibular fractures in order to compare modified lag screw techniques with standard miniplates. MATERIALS AND METHODS: This is an observational prospective study. Three hundred eighteen patients were operated on for mandibular fractures. The patients were divided into two groups according to the type of surgical technique used: modified lag screws (155 patients) and traditional miniplates (163 patients). Analyses were made of sociodemographic and preoperative variables, the parameters related to the fracture type and postoperative data. RESULTS: There were no differences between the two groups regarding their sociodemographic characteristics. The modified lag screws were primarily used with double fractures, while conventional miniplates were more often used with simple fractures. The number of complications was higher with the miniplate technique. The unfavorable fractures had an OR of 5.75 due to postoperative complications; double fractures had an OR of 8.87 and simple fractures an OR of 19.53, which, in both cases, were lower with conventional miniplates than with modified lag screws. CONCLUSION: Modified lag screws provide a rigid fixation system that is as secure as miniplates, but with greater compression between the fragments, less postsurgical gap, faster ossification, and fewer postoperative complications. CLINICAL RELEVANCE: The modified screw technique is a safe tool that does not require any specific osteosynthesis materials not found in a basic traumatology kit and has a lower cost, due to the reduced amount of material used.

Tratamiento con enjuagues de ketaminaketamina asociado o no a fentanilo transmucoso en el dolor oncológico orofacial resistente a opiáceos mayores / Treatment with ketamine mouthwashes with and without transmucosal fentanyl in major opiate-resistant orofacial cancer pain

Objetivo: Evaluar la efectividad de los enjuagues de ketamina asociados o no a fentanilo transmucoso en una serie de diversos dolores orofaciales de etiología neoplásica de difícil control analgésico. Material y métodos: Estudio prospectivo de 20 pacientes, con 8 pacientes que recibieron enjuagues de ketamina (40 mg = 4 ml), 8 pacientes que recibieron ketamina asociada a citrato de fentanilo por vía transmucosa oral a dosis de 200 mcg y 4 pacientes con opiáceos sistémicos para el dolor orofacial y mucositis refractaria. Resultados: Un total de16 de los 20 pacientes tenían dolor orofacial o mucositis refractaria al tratamiento con lidocaína y opiáceos. La tasa de éxito del empleo de enjuagues de ketamina fue del 50% (8/16 pacientes). La asociación ketamina y fentanilo transmucoso obtuvo una tasa de éxito del 94,1% (15/16 pacientes). Los efectos adversos se asocian al uso de la ketamina; todos los efectos secundarios fueron transitorios y desaparecieron cuando se suspendieron los enjuagues con ketamina. Conclusión: Los enjuagues de ketamina son una opción eficaz para el tratamiento del dolor orofacial secundario al cáncer. En caso de presencia de episodios de dolor irruptivo recurrente, la asociación de ketamina en enjuague bucal y citrato de fentanilo oral transmucoso puede ser una opción viable en dolor refractario a otros tratamientos (AU)

Purpose: The objective of this study was to determine if an oral ketamine mouth wash and expectorant, that may or may not rinse transmucosal fentanyl, was a safe and effective method to alleviate a series of various difficult to control orofacial pain of cancer origin. Material and methods: A prospective review was made of the medical charts of 20 patients, finding 8 patients who received ketamine mouthwash (40 mg = 4 ml), 8 patients who received ketamine mouthwash and oral transmucosal fentanyl citrate 200 mcg, and 4 patients with systemic opioids for refractory orofacial and mucositis pain. Results: Of the 20 patients, 16 had orofacial or mucositis pain refractory to a mixture of lidocaine and opioids. The effectiveness of ketamine mouthwash was 50% (8/16 patients). The combination of ketamine and/or fentanyl transmucosal had an analgesic efficacy of 94.1% (15/16 patients). The adverse effects were associated with the ketamine mouthwash; all side effects were transient and subsided when the ketamine mouthwash was stopped. Conclusion: Ketamine mouthwash for orofacial pain due to cancer may be an effective treatment option. In cases of reported episodes of breakthrough pain, the combination of a ketamine mouthwash and oral transmucosal fentanyl citrate may be a viable treatment option in refractory mucositis pain (AU)

Hospital dental practice in special patients

Dental patients with special needs are people with different systemic diseases, multiple disorders or severe physical and/or mental disabilities. A Medline search was made, yielding a total of 29 articles that served as the basis for this study, which offers a brief description of the dental intervention protocols in medically compromised patients. Dental treatment in patients with special needs, whether presenting medical problems or disabilities, is sometimes complex. For this reason the hospital should be regarded as the ideal setting for the care of these individuals. Before starting any dental intervention, a correct patient evaluation is needed, based on a correct anamnesis, medical records and interconsultation reports, and with due assessment of the medical risks involved. The hospital setting offers the advantage of access to electronic medical records and to data referred to any complementary tests that may have been made, and we moreover have the possibility of performing treatments under general anesthesia. In this context, ambulatory major surgery is the best approach when considering general anesthesia in patients of this kind