The effect of preemptive and/or postoperative ibuprofen therapy for orthodontic pain.

The control of pain during orthodontic treatment is of vital interest to both clinicians and patients. Surprisingly, there has been limited research into the control of orthodontic pain, and there is no standard of care for controlling this discomfort. The purpose of this study was to compare the effectiveness of preemptive ibuprofen therapy, postoperative ibuprofen therapy, and a combination of the 2 therapies. Forty-one orthodontic patients aged 9 years 3 months to 16 years 11 months who were to undergo separator placement were enrolled in this prospective study. Patients were randomly assigned to 1 of 3 experimental conditions: (1) 400 mg ibuprofen taken orally 1 hour before separator placement and 400 mg ibuprofen taken orally 6 hours after the initial dose, (2) 400 mg ibuprofen taken orally 1 hour before separator placement and a lactose capsule taken orally 6 hours after the initial dose, or (3) a lactose capsule taken orally 1 hour before separator placement and 400 mg ibuprofen taken 6 hours after the initial placebo. The results revealed that preemptive ibuprofen therapy significantly decreased pain that was experienced 2 hours after separator placement and at bedtime. Beginning on day 2, there was a trend for patients who had taken both preemptive and postoperative ibuprofen doses to have lower pain scores compared with the other 2 groups. In conclusion, these data indicate that ibuprofen taken 60 minutes before separator placement alleviates pain at 2 hours and at bedtime after treatment. Further study with the use of additional postoperative doses is warranted.

Pain and immunologic response to root canal treatment and subsequent health outcomes.

OBJECTIVE: This study examined the effects of pain and stress associated with a dental procedure, root canal treatment (RCT), on natural killer cell cytotoxicity (NKCC) and the subsequent development of symptoms of upper respiratory illness during the following month. METHODS: Patients (N = 33) were recruited from those scheduled for RCT appointments. Subjects for a non-RCT comparison group (N = 14) were also recruited from dental clinic patients. Peripheral blood was drawn by use of an indwelling catheter three times: just before RCT, 30 minutes after injection of a local anesthetic, and 30 minutes after RCT (a parallel time course was followed for the comparison group.) Blood was assayed for cortisol and NKCC. Subjects completed a health diary in the month after RCT. RESULTS: Patients showed a significant increase in NKCC between baseline and RCT and a significant decrease from RCT to after RCT, whereas the comparison group did not. The NKCC following the RCT was negatively correlated with the pain level during RCT (r = -0.48, p < .01) and pain levels 2 and 6 hours after RCT (r = -0.43, p < .05; r = -0.44 p < .05, respectively). The patient group reported significantly more illness episodes 2 weeks after RCT than the comparison group (Wilcoxon rank sum = 4.78, p = .03). Discriminant function analysis correctly classified 88% of the subjects into the illness category using predictor variables of post-RCT NKCC, stress, and pain levels during RCT (F(3,21) = 8.23, p < .001). CONCLUSIONS: Transitory changes in NKCC associated with pain and stress may be implicated in the development of infectious disease episodes after an acute stressful event.

An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement.

Patients undergoing orthodontic treatment can experience significant levels of pain. This study assessed the effectiveness of preoperative ibuprofen in reducing the incidence and the severity of pain after orthodontic separator placement. Sixty-three adolescent patients (mean age, 13 years) were included in this randomized, double-blind, placebo-controlled, prospective study. Patients were randomly assigned to 1 of 3 experimental conditions: (1) 400 mg of ibuprofen taken orally 1 hour before separator placement and a lactose placebo taken orally immediately after the appointment, (2) a lactose placebo taken orally 1 hour before separator placement and 400 mg of ibuprofen taken orally immediately after the appointment, or (3) a lactose placebo taken orally 1 hour before separator placement and again immediately after the appointment. The patient's level of discomfort was assessed with a visual analog scale at 2, 6, and 24 hours, as well as at 2, 3, and 7 days after placement of the orthodontic separators. An analysis of variance and Duncan's multiple range test revealed that 2 hours after their orthodontic appointment the patients who had taken ibuprofen 1 hour before separator placement had significantly less pain with chewing than did the patients who received either ibuprofen postoperatively or a placebo. Additional measures suggest a trend for less pain for this group of patients. These results support the use of pretreatment ibuprofen for patients requiring analgesics for orthodontic discomfort. Future study of the use of preemptive analgesics in orthodontics is warranted.

Using standardized patients to assess presentation of a dental treatment plan.

In this new era of relationship-based care, involvement in treatment planning and goal setting is a high priority for patient satisfaction. This study reports on the use of standardized patients (SPs) in training third-year dental students to gather dental, medical, and psychosocial information from patients and to involve the patient in the decision-making process leading to the dental treatment plan. Among the skill areas measured, students were most successful in gathering dental information, with 94 percent of the students obtaining the complete set. Students were least successful in identifying the patient's goals for treatment (81 percent of the students identified the patients' goals). Students were most challenged by discussing sensitive topics with patients such as grief-related depression (25 percent of the students recognized and discussed such topics). It is important that dental schools familiarize students with patient issues and teach them how to talk effectively to patients about personal issues and to incorporate those issues into a discussion of the treatment plan for the patient. Standardized patients can be used effectively toward this end.

Imagery content during nonpharmacologic analgesia in the procedure suite: where your patients would rather be.

RATIONALE AND OBJECTIVES: Imagery as a hypnotic technique can produce analgesia and anxiolysis, but effective use may be restricted to select, highly hypnotizable individuals. This study assessed (a) whether patients not selected for hypnotizability can produce imagery during interventional radiologic procedures and (b) the type of imagery produced. A secondary goal of the study was to familiarize health care providers with a simple, time-efficient technique for imagery. MATERIALS AND METHODS: Fifty-six nonselected patients referred for interventional procedures were guided to a state of self-hypnotic relaxation by a health care provider according to a standardized protocol and script. Patient hypnotizability was assessed according to the Hypnotic Induction Profile test. RESULTS: Patients as a group had average distribution of hypnotizability. The induction script was started in all patients and completed in 53. All patients developed an imagery scenario. Chosen imagery was highly individual, but common trends were nature and travel, family and home, and personal skills. Being with loved ones was an important element of imagery for 14 patients. Thirty-two patients chose passive contemplation, and 24 were action oriented. CONCLUSION: Average patients who present for interventional radiologic procedures and are not preselected for hypnotizability can engage in imagery. Topics chosen are highly individual, thus making prerecorded tapes or provider-directed imagery unlikely to be equally successful.

Immune, stress, and mood markers related to recurrent oral herpes outbreaks.

This was a prospective and longitudinal study designed to compare daily mood states and weekly changes in plasma levels of immune and neuroendocrine markers with recurrent herpes labialis lesion recurrences during a 3-month period among 9 subjects. Results from a paired t test showed that there was a significant decrease in plasma levels of natural killer cells and serum levels of epinephrine from the week before recurrent herpes labialis lesion occurrence (T1,9 = 2.70; p < 0.05) to the week of recrudescence (T1,9 = 2.41; p < 0.05). On the other hand, in the week before recrudescence the number of natural killer cells was 58 units higher than the overall group mean for natural killer cell level (227 units). In the week before outbreak, elevated natural killer cell numbers were associated with a mood of discontentment (r = 0.64; p = 0.05). Elevated levels of epinephrine averaged across the 12 weekly blood draws were significantly correlated with higher scores on affect intensity (r = 0.72; p < 0.05). This study provides new data on the pattern of changes in stress, mood states, and immune and neuroendocrine markers associated with the recurrence of perioral herpes lesions. Putative mechanisms linking neuroendocrine and immune function are discussed.

The patient and the shifting health-care paradigm.

The public's image of the relationship between the health care provider and his or her patients has shifted. This relationship was once seen by the public as being based on trust, compassion, and good will and now is viewed as much more subject to negotiation. The public's perception of dentists and physicians is that they have been seduced by technology, money, and specialization and that they have little time for patients' concerns, wants, and needs. Moreover, there has been a dramatic expansion of patient choice including treatment alternatives and providers. Never before have patients had access to so much information (and misinformation) about treatment, options, materials, and alternatives. All of these factors contribute to a growing discontentment among patients and practitioners. Practice management courses are full of recommendations for shifting the unflattering perception of dentists and physicians to one of more "patient-centeredness." On the other hand, many dentists and physicians are frustrated because for them the patient has always been the center of the caregiving. For many caregivers and patients, it has become far too easy to alternately blame each other, other health care providers, the insurance industry, etc. for being the villain. This paper focuses on what patients want from their dentists. Patients have always assumed that the dentist is competent, reliable, and sincere. What patients also want today is to be involved and educated about their treatment options. Further, they want the dentist to listen, pay attention to their concerns, and to treat them as individuals.

Changes in maternal attitudes toward baby bottle tooth decay.

Several studies have shown that a significant number of parents whose children have baby bottle tooth decay (BBTD) admit prior knowledge regarding the harmful effects of putting their children to bed with a bottle. The Elaboration Likelihood Model of Persuasion (ELM) offers a theoretical framework for better understanding why knowledge and attitude are often not predictive of behavior. The goal of this study was to use the ELM to analyze the manner in which information about BBTD is evaluated. One hundred twenty low-income women (either pregnant or with a child younger than 7 months of age) at a WIC clinic were randomly assigned to three groups: 1) 5-min audiotaped persuasive message about BBTD; 2) same audiotaped message with overheard audience response affirming the message; and 3) no intervention control group. Knowledge and attitudes about BBTD were measured before and after the experimental intervention. Participants hearing the audiotaped message also were asked to rate the expertise of the messenger and the quality of the message. Both groups hearing a taped message about BBTD showed a significant positive change in attitude and knowledge when compared with the control group (P < 0.05). No significant difference was found between the attitude and knowledge of those who heard an audiotaped message accompanied by an audience response compared with those who heard the audiotaped message alone. No significant difference between the ratings of message quality or messenger expertise by group was found. It was concluded that the participants in this study processed the BBTD message primarily through the central route, that is, by careful evaluation of the issue-relevant information contained in the persuasive message.

Contributors to dentists' job satisfaction and quality of life.

Every career has the potential for producing personal satisfaction and dissatisfaction, and much of that assessment is dependent on what an individual values in life. The purpose of this study was to identify factors that contribute to dentists' job satisfaction and the overall quality of their lives. Multiple regression analysis was performed to find the best set of predictor variables. After controlling for age, sex, and length of time in practice, the combination of variables that best predicted overall job satisfaction was income, respect, and patient relations (R2 = 57%). The combination of variables that best predicted overall quality of life, after again controlling for age, sex, and length of time in practice were income, professional time, and personal time (R2 = 83%). Although over half of the dentists surveyed are satisfied with their career, they are dissatisfied with their level of stress, professional environment (threat of malpractice litigation), and amount of personal time. Implications and recommendations are discussed.

Knowledge of male and female midwestern college students about baby bottle tooth decay.

The purpose of this bellwether study was to establish the level of knowledge a group of young men and women college students had about baby bottle tooth decay (BBTD) and the associated risk factors. The results show that knowledge about BBTD is very limited even among a well-educated group of young adults. Overall 39% of the respondents had heard of BBTD whereas 87% had heard of sudden infant death syndrome (SIDS). Thirty-two percent thought BBTD was a fictional (vs. "real" or "unsure") health problem, while 3% of the respondents thought SIDS was a fictional health problem. Knowledge about overall risk factors for oral disease was greater than that for BBTD. Further, these subjects report that if they believed that adopting a certain feeding practice would reduce the risk of tooth decay for their babies, they would be likely to adopt it. Men and women significantly differed on the age at which a child should first see a dentist (chi sq = 19.56, df = 5, P < 0.01). Forty-five percent of the men selected either when the first tooth erupts or between 6-18 months as the time a child should first be seen by a dentist. Only 11% of the women thought a child should be seen that early. Forty-five percent of the women students selected 2-3 years as the earliest age at which a child should be seen by a dentist. Implications of this research are discussed.

Anticipatory stress reduction among chronic pain patients.

Stress has long been viewed as a contributor to the pain experienced by chronic pain patients. The purpose of this research was to study the relationship between anticipated and experienced stress and anticipated and experienced pain levels among three patient groups: chronic pain patients, patients about to receive molar extraction (acute pain group), and a no-pain comparison group. Results showed that chronic pain patients anticipated significantly more stress than did an acute pain or a non-pain comparison patient group but reported non-significant differences in the actual level of stress experienced. A secondary purpose of this study was to examine cognitive factors, such as perceived daily hassles, which may contribute to this increased anticipatory stress. Results showed that there was consistency among the chronic pain patients as to the types of anticipated stressors, which were similar to those previously reported by chronic headache sufferers. The chronic pain group had significantly higher scores than the two remaining groups on the stress they anticipated from hassles related both to practical considerations (F2.45 = 3.5, p < 0.05) and to health (F2.45 = 9.37, p < 0.001). Strategies the dentist can use in combination with dental therapy to reduce cognitive-based anticipatory stress as well as strategies for collaboration with the patient and a mental health therapist are discussed.

Sensory focus as therapeutic treatments for acute pain.

This study examined the hypothesis that instructing patients to focus on their sensations (sensory focus) during root canal therapy reduces painful response. Before dental treatment, patients were randomly assigned to one of four audiotaped conditions: sensory focus with and without procedural information, procedural information, or no-intervention. Patients were categorized as to how much control they desired and felt. The "high desire for control/low felt control" subgroup's sensory pain intensity scores in the sensory focus condition were significantly lower than the "high desire for control/low felt control" subgroup's sensory intensity scores in the no-intervention comparison condition. This was true immediately after treatment (F(1,303) = 13.37; p < or = .001) and 1 week after treatment (F(1,303) = 14.30; p < or = .001). Immediately after treatment, the high desire for control/low felt control subgroup in the sensory/procedural condition was significantly lower on sensory pain intensity scores than the high desire/low felt subgroup in the no-intervention condition (F(1,303) = 3.75; p < or = .001). This difference was not observed on the 1-week recall of pain. Adding procedural information to the instructions to focus on sensation did not increase the pain-reducing effects. Results extend prior findings that sensory focus significantly reduces sensory pain intensity only among patients who are classified as having a high desire for control and low perceived control. These results are congruent with theoretical arguments that coping preferences moderate the reaction of patients to various therapeutic strategies.

Differences in judgments of persuasive argument quality by three population groups in Iowa.

OBJECTIVES: This study describes a method for studying the perceived persuasiveness of rationales for adopting preventive health behaviors. METHODS: Using the Elaboration Likelihood Model, we surveyed 156 individuals as to the level of persuasiveness that each of several categories of reason presented in adopting target "prevention" behaviors such as eliminating the use of smokeless tobacco or seeking regular dental care. RESULTS: Significant differences between what the public reported as persuasive reasons and those selected by future dental practitioners were found. Patients saw potential cost savings, elimination of future pain, and being told by an authority person to adopt a behavior as highly persuasive reasons to adopt a target behavior. Nonwhite patients gave significantly higher scores than did white patients to arguments centering on social/aesthetic appeal. On the negative side, episodic care seekers felt significantly more strongly than regular care seekers that their practicing dental prevention activities (e.g., regular checkups, brushing, and flossing) benefited someone other than themselves (dental profession and dental manufacturers). CONCLUSIONS: Results of this study suggest that one way to improve persuasive public health preventive messages is to consider whether the fundamental arguments on which preventive health campaigns are built have broad patient appeal.

Perception of oral health needs by Southeast Iowa non-dental health care providers.

The purposes of this dental study were to identify, among non-dental health care providers and administrators, (1) those reasons assessed to be most persuasive in adopting selected dental preventive practices, (2) barriers perceived to be present for their clients to obtain dental services, and (3) practices which would make dental services more available to their clients. A nine-item dental care/attitude survey was completed by 82% (n = 68) of the health care and social services providers/administrators attending one of the United Way of East Central Iowa group meetings. The results of this survey indicated that, for these respondents, the most persuasive reasons for adopting preventive dental practice behaviors were based on susceptibility to disease and social and esthetic benefits. Further, the results of this survey showed that female respondents gave significantly higher scores than males to the importance of social benefits (self-worth and employment marketability), health benefits, and the importance that authority figures (dentists and physicians) placed on the behavior. Fifty-one percent of the respondents knew of patients who had problems obtaining dental services. The main reasons given for clients' access problems were the lack of money, the lack of insurance, and the lack of transportation.

Common misconceptions about oral health in the older adult: nursing practices.

A survey of nurses, director-supervisors, and nursing home health aides who provide home care in Iowa showed that many misconceptions exist about what constitutes appropriate oral and dental care practices for the older adult. Despite differences in formal education among these nursing personnel, several misunderstandings about dental problems among older adults were common to all three employment groups. These misconceptions represented a broad range of topics from the characteristics of oral cancer lesions to the appropriate use of denture adhesives; two dealt specifically with the recognition of potential oral cancer lesions. This paper describes attitudes and misinformation held by the respondents, and suggests ways to correct these fallacies through in-service training programs.

Desired control and felt control as mediators of stress in a dental setting.

Control-related variables have clearly affected stress responses in previous research (Thompson, 1981). Prior work, however, has primarily emphasized the amount of control that subjects perceive they have. In the three studies reported here, we examined the added predictive utility of assessing subjects' desire for control. Data from all three studies indicate that subjects who have a high desire for control coupled with a low feeling of control are characterized by particularly high degrees of dental distress. These results were found both in settings where patients anticipated immediate dental treatment and where treatment was not imminent. In addition, the results indicate that this "at risk" group reported greater distress before and immediately after actual dental treatment. Furthermore, they remembered their dental treatment as being more aversive 1 week after treatment. The practical implications and theoretical significance of these data are considered.