Is serum BDNF level reliable parameter in detecting of dental anxiety before impacted third molar surgery?

BACKGROUND: Brain-derived neurotrophic factor (BDNF) is a factor that implicate in the pathophysiology and treatment of depression and anxiety. The aim of this study was to determine the relationship between dental anxiety and BDNF serum level through impacted third molar surgery. MATERIAL AND METHODS: In this randomized, double-blind, cross-sectional study, the sample included patients who had been admitted for the impacted third molar extraction under local anesthesia between January to November 2020. The primary predictor variable was serum BDNF level and the second predictor variable was dental anxiety scores before and after operation in patients. The primary outcome variable was the correlation between anxiety scores (APAIS, MDAS, STAI, VAS) and serum BDNF level. The sample included 55 patients (22 Male, 33 Female) aged 18 to 42 (24,2+5,55). RESULTS: Comparison of pre-operative scores (APAIS, MDAS, STAI, VAS and BDNF) and post-operative scores were statistically significant (P < .05). Post-operatively, MDAS and VAS scores decreased, while BDNF levels and STAI scores increased compared to the preoperative scores. BDNF was not correlated with APAIS, MDAS, STAI, and VAS preoperatively and postoperatively. CONCLUSIONS: There may be a relationship between serum BDNF level and dental anxiety scale, but, no correlation was found between them.

Evaluation of Vitamin D (25OHD), Bone Alkaline Phosphatase (BALP), Serum Calcium, Serum Phosphorus, Ionized Calcium in Patients with Mandibular Third Molar Impaction. An Observational Study.

The aim of this study was to evaluate the levels of vitamin D (25OHD) and other bone biomarkers in patients with third molar impaction (TMI). Thirty males and 30 females with unilateral or bilateral impacted mandibular third molar, and 15 males and 15 females as a control group (CG) were recruited. Rx-OPT was used to evaluate dental position and Pederson index to measure the difficulty of the intervention. Bone biomarkers were measured through blood venous sample in TMI group and CG. Mann-Whitney test, Pearson's correlation coefficient, linear regression model were used to compare the different parameters in the two groups. 25OHD showed lower values in TMI group than in CG (p < 0.05) with values significantly lower in bilateral impaction (p < 0.05). Pearson's coefficient for 25OHD presented a negative correlation with the Pederson index (ρ = -0.75). Bone alkaline phosphatase (BALP) showed significantly lower dosage in TMI group than CG (p = 0.02), Pearson's coefficient for BALP presented a negative correlation with the Pederson index. Serum calcium, serum phosphorus, ionized calcium levels in TMI and CG groups were similar and Mann-Whitney test did not significantly differ between TMI and CG. TMI could be a sign of vitamin D deficiency and of low BALP levels that should be investigated.

Plasma variations in stress markers: clinical trial of two anesthetics used in regional block in the extraction of impacted inferior third molars.

OBJECTIVES: Was to evaluate the effect of different regional anesthetics (articaine with epinephrine versus prilocaine with felypressin) on stress in the extraction of impacted lower third molars in healthy subjects. STUDY DESIGN: [corrected] A prospective single-blind, split-mouth cross-over randomized study was designed, with a control group. The experimental group consisted of 24 otherwise healthy male volunteers, with two impacted lower third molars which were surgically extracted after inferior alveolar nerve block (regional anesthesia), with a fortnight's interval: the right using 4% articaine with 1:100.000 epinephrine, and the left 3% prilocaine with 1:1.850.000 felypressin. Patients were randomized for the first surgical procedure. To analyze the variation in four stress markers, homovanillic acid, 3-methoxy-4-hydroxyphenylglycol, prolactin and cortisol, 10-mL blood samples were obtained at t = 0, 5, 60, and 120 minutes. The control group consisted of 12 healthy volunteers, who did not undergo either extractions or anesthetic procedures but from whom blood samples were collected and analyzed in the same way. RESULTS: Plasma cortisol increased in the experimental group (multiple range test, P<0.05), the levels being significantly higher in the group receiving 3% prilocaine with 1:1.850,000 felypressin (signed rank test, p<0.0007). There was a significant reduction in homovanillic acid over time in both groups (multiple range test, P<0.05). No significant differences were observed in homovanillic acid, 3-methoxy-4-hydroxyphenylglycol or prolactin concentrations between the experimental and control groups. CONCLUSIONS: The effect of regional anesthesia on stress is lower when 4% articaine with 1:100,000 epinephrine is used in this surgical procedure.

Blockade of peripheral neuronal barrage reduces postoperative pain.

Peripheral afferent neuronal barrage from tissue injury produces central nervous system hyperexcitability which may contribute to increased postoperative pain. Blockade of afferent neuronal barrage has been reported to reduce pain following some, but not all, types of surgery. This study evaluated whether blockade of sensory input with a long-acting local anesthetic reduces postoperative pain after the anesthetic effects have dissipated. Forty-eight patients underwent oral surgery with general anesthesia in a parallel group, double-blind, placebo-controlled study. Subjects randomly received either 0.5% bupivacaine or saline intraoral injections, general anesthesia was induced with propofol, a non-opioid anesthetic, and 2-4 third molars extracted. Subjects were assessed at 24 and 48 h for postoperative pain and analgesic intake. Blood samples were collected at baseline, intraoperatively and at 1-h intervals postoperatively for measurement of beta-endorphin as an index of CNS response to nociceptor input. Plasma beta-endorphin levels increased significantly from baseline to the end of surgery in the saline group in comparison to the bupivacaine group (P < 0.05), indicating effective blockade of nociceptor input into the CNS by the local anesthetic. Pain intensity was not significantly different between groups at 24 h. Pain at 48 h was decreased in the bupivacaine group as measured by category scale and graphic rating scales for pain and unpleasantness (P < 0.05). Additionally, subjects in the bupivacaine group self-administered fewer codeine tablets for unrelieved pain over 24-48 h postoperatively (P < 0.05). These data support previous animal studies demonstrating that blockade of peripheral nociceptive barrage during and immediately after tissue injury results in decreased pain at later time points. The results suggest that blockade of nociceptive input by administration of a long-acting local anesthetic decreases the development of central hyperexcitability, resulting in less pain and analgesic intake.

The effects of diflunisal on bleeding time and platelet aggregation in a multidose study.

Diflunisal, a potent nonsteroidal anti-inflammatory agent, has been confirmed as an effective analgesic in oral surgery. It is generally stated that there is only slight impairment of coagulation at the recommended dosage of diflunisal; however, only a few multidose studies have been conducted, most being single dose studies. This report is of a multidose study of the effects of diflunisal on coagulation in 15 oral surgery patients, being the first such study reported. The results showed that the bleeding time was increased in 53% of the group, but in no case did the increase exceed the upper limit of normal. Additionally, platelet aggregation studies were affected in 38% of patients with increased bleeding time. The overall results substantiate the safety of diflunisal in relation to effect on coagulation, and are directly applicable to postoperative use in oral surgery.