Predictors of pain associated with routine procedures performed in general dental practice.

OBJECTIVES: The objective of the study was to investigate factors that influence pain intensities associated with routine dental procedures. METHOD: Four hundred and fifty-one dental patients self-reported pain experienced during the procedure immediately after undergoing a variety of common dental interventions and 1 day after the completion of the procedure. Pain character was measured using the McGill short-form pain questionnaire and intensity using a numerical rating (NRS) scale. Information was collected on a number of factors that could influence pain: dental anxiety was measured using the Corah Dental Anxiety Scale to categorize patients into four domains (fearless, some unease, nervous and very anxious). Dentists provided information regarding the type(s) of procedure and use of local anaesthetic (LA). RESULTS: Seventy-five percent of patients (339/451) reported no pain during their procedure when the data were collected immediately postoperatively (NRS score = 0). Univariate analyses showed that dental anxiety, LA use and type of procedure (extractions) were significant (P < 0.05) predictors of reported intra-operative pain. However, when these factors were combined in a multivariate model, the strongest predictor of pain was dental anxiety [odds ratio (OR) = 4.98 (95% CI 1.42-17.44)] and LA use [OR = 2.79 (95% CI 1.39-5.61)]. Although the strongest predictor of postoperative pain on the next day was pain reported during the procedure [OR = 5.85 (95% CI 2.71-12.64)], LA remained a significant predictor of pain the day after the procedure [OR = 3.16 (95% CI 1.02-9.81)]. CONCLUSIONS: Dentists need to assess their patients both preoperatively for dental anxiety and intra-operatively for signs of suboptimal local anaesthesia so as to effectively align patient management and clinical techniques to control dental anxiety and produce adequate anaesthesia.

Patients' knowledge of risk factors for dental disease. A pilot service evaluation in a general dental practice.

UNLABELLED: The major dental diseases, including erosion, caries and periodontal disease, are preventable, and the Department of Health has produced guidelines in a 'Prevention Toolkit' to aid prevention of these diseases in primary care. AIM: To investigate patients' knowledge of the key themes in the Prevention Toolkit and to compare their knowledge of the different dental diseases. METHODS: Patients attending a general dental practice in North West England were asked to complete a questionnaire while they waited to see their dentist. The questionnaire had been piloted for readability, relevance of questions, and ease of use. It included nine true/false questions on key prevention messages. Data from the respondents were used to assess whether there were differences in knowledge by age or gender and between the types of dental diseases. Results were analysed using chi-square tests. RESULTS: 105 patients completed the questionnaire. Of the 420 questions relating to periodontal diseases, 322 (77%) were answered correctly and 196 (47%) of the 420 questions on caries were answered correctly; however, only 32 (31%) of the 105 questions relating to erosion were answered correctly. There were significantly lower levels of knowledge of caries (P<0.01) compared with periodontal diseases. Worryingly, 47 (45%) of 105 respondents stated incorrectly that brushing teeth immediately after consuming a 'fizzy' drink would protect the teeth. CONCLUSION: The results of this pilot service evaluation indicate that in the practice concerned, more needs to be done to promote disease prevention at the primary care level. The current questionnaire could form a valuable tool to audit and reinforce patients' knowledge, although it needs further development and validation. Longitudinal evaluation of the questionnaire, linking it with disease outcome measures, has the potential to indicate whether change in knowledge translates into behavioural change.

Influence of torpor on cardiac expression of genes involved in the circadian clock and protein turnover in the Siberian hamster (Phodopus sungorus).

The Siberian hamster exhibits the key winter adaptive strategy of daily torpor, during which metabolism and heart rate are slowed for a few hours and body temperature declines by up to 20 degrees C, allowing substantial energetic savings. Previous studies of hibernators in which temperature drops by >30 degrees C for many days to weeks have revealed decreased transcription and translation during hypometabolism and identified several key physiological pathways involved. Here we used a cDNA microarray to define cardiac transcript changes over the course of a daily torpor bout and return to normothermia, and we show that, in common with hibernators, a relatively small proportion of the transcriptome (<5%) exhibited altered expression over a torpor bout. Pathways exhibiting significantly altered gene expression included transcriptional regulation, RNA stability and translational control, globin regulation, and cardiomyocyte function. Remarkably, gene representatives of the entire ubiquitylation pathway were significantly altered over the torpor bout, implying a key role for cardiac protein turnover and translation during a low-temperature torpor bout. The circadian clock maintained rhythmic transcription during torpor. Quantitative PCR profiling of heart, liver, and lung and in situ hybridization studies of clock genes in the hypothalamic circadian clock in the suprachiasmatic nucleus revealed that many circadian regulated transcripts exhibited synchronous alteration in expression during arousal. Our data highlight the potential importance of genes involved in protein turnover as part of the adaptive strategy of low-temperature torpor in a seasonal mammal.