Short-Term Association between Anxiety, Self-Medication and Subjective Postoperative Clinical Signs in Norwegian Patients Following Surgical Removal of Third Molar Teeth

Thursday, October 10, 2013
Lasse A. Skoglund CandOdont, DiplSed&PainContr, DSci, Section of Dental Pharmacology and Pharmacotherapy, Faculty of Dentistry, ICD, University of Oslo, Oslo, Norway
Ellen C. Vigen MOdont, DiplSed&PainControl, Section of Dental Pharmacology and Pharmacotherapy, Faculty of Dentistry, ICD, University of Oslo, Oslo, Norway
Olaug Egeland CandOdont, Department of Maxillofacial Surgery, Oslo University Hospital (Ullevaal), Oslo, Norway
Gaute Lyngstad CandOdont, Section of Dental Pharmacology and Pharmacotherapy, Faculty of Dentistry, ICD, University of Oslo, Oslo, Norway
Per Skjelbred PhD, MD, CandOdont, Department of Maxillofacial Surgery, Oslo University Hospital (Ullevaal), Oslo, Norway
Anders Skoglund BSc, Section of Dental Pharmacology and Pharmacotherapy, University of Oslo, Oslo, Norway

Statement of problem: Gender moderates the pain experience where females report more pain than males. Less is known about the association between anxiety, gender and postoperative swelling.

Purpose: This pilot trial investigated if gender could influence the association between preoperative dental anxiety, postoperative analgesic tablet consumption, pain and swelling in Norwegian patients during the immediate 6 hour postoperative period following third molar surgery.

Materials and Methods: Twenty-seven (15 females/12 males) consecutive Norwegian patients of ASA class I-II participated. Mean ages (SD) females/males were 29.5 (7.4)/32.7 (10.7) years, heights were 168.6 (5.4)/179.9 (6.0) cm, and weights were 59.3 (7.2)/ 80.7 (12.2) kg. A third molar with at least one previous history of acute pericoronitis were removed using a buccal envelope flap and local anesthetic (lidocaine 2% + adrenalin 1:80 000) only. Patient consent and Norwegian Ethical Committee approval was obtained. The patients scored their level of dental anxiety on Corah's Dental Anxiety Scale (CDAS) just prior to surgery and their subjective pain intensity (PI) every hour up to 6 hours after completing surgery on a 0-10 numerical rating scale (NRS). Preoperative swelling scores were also scored on a 0-10 NRS and subtracted from postoperative swelling scores at 6 hours to calculate swelling. The patients had access to OTC analgesics ad libitum restricted only by the maximum daily dose regimen specific of each drug. Every tablet intake including type and dose during the observation period was noted.

Data analysis: Mean group data including specifics of the surgical procedures were calculated. Sum PI was calculated by adding hourly PIs and swelling by subtracting preoperative from postoperative swelling assessments. Differences between data were analyzed by the Independent Samples T-Test, and Pearson's correlation coefficients were computed with the Bivariate Correlations Test (IBM© SPSS© Statistics release 20.0.0). The level of 2-tailed statistical significance was P<0.05 and equal variances were not assumed for group data.

Results: Mean (SD) females/males time of the day when surgery ended was 12:49 (2:05)/11:41 (2:18) hours. The corresponding volumes of local anesthetic were 2.7 (0.27)/3.2 (0.5) ml. Times used for obtaining effect of local anesthetic were 2.2 (1.3)/4.5 (4.1) min, and times used for surgery were 16:32 (8:39)/15:05 (5:35) minuses. Females and males differed with respect to height and weight (P=0.000), and volume of local anesthetic used (P=0.029). The numerical difference in time for local anesthetic effect was not statistically significant (P=0.88). Preoperative CDAS scores were 8.5 (3.3)/7.4 (2.6), numbers of tablets taken 0-6 hrs. 1.7 (1.0)/ 1.9 (1.4), sum PI 0-6 hrs16.6 (10.3)/16.7 (10.6), and swelling scores at 6 hours 4.3 (2.9)/ 1.7 (1.8). None of these numerical differences were statistically significant except for difference in subjective swelling at 6 hours, P=0.008. Correlation analyses for both genders together showed a statistically significant correlation between anxiety and number of tablets taken 0-6 hours r=0.39, P=0.044. Analyses of correlations within the male group showed statistically significant correlations regarding CDAS score and number of tablets, r=0.622, P=0.031, and the sum PI r=0.746, P=0.005, and swelling at 6 hours r=0.690, P=0.013. No correlations with CDAS were found in the female group.

Conclusion: In spite of the low CDAS scores and the limited number of patients this pilot trial suggests different associations between males and females with respect to preoperative dental anxiety status and postoperative self-medication of analgesic drugs, pain experience and swelling during the immediate 6 hour period following third molar surgery.

 

References:

Corah NL, Pantera RE. Controlled study of psychological stress in a dental procedure. J Dent Res 1968;47:154-7.

Vaughn F, Wichowski H, Bosworth G. Does preoperative anxiety level predict postoperative pain? AORN J 2007;85:589-604.

 

 

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