The Comparison of Dental Anxiety between Patients Treated with Impacted Third Molar Surgery and Conventional Dental Extraction.

BACKGROUND: The aim of the present study is to compare the dental anxiety levels between two outpatient clinics. METHODS: Two hundred and seventy patients treated in two different clinics of minor oral surgery and dental extraction polyclinic in the Dental Faculty of Eskisehir Osmangazi University were included in the study. The impacted third molar surgery group and conventional dental extraction group consisted of 101 and 169 patients, respectively. The Modified Dental Anxiety Scale (MDAS) and Dental Fear Scale (DFS) were used to measure anxiety levels in patients treated in both clinics. Tests were made in an isolated room preoperatively. The differences in anxiety levels according to education status and gender were also evaluated. RESULTS: The impacted third molar surgery group showed a significant increase in dental anxiety measured with DFS questionnaire (p < 0.05). However, MDAS revealed that there was no difference between anxiety levels between the impacted third molar surgery and conventional dental extraction groups (p > 0.05). There was also no difference in anxiety levels between patients with different education status (p > 0.05). Female patients demonstrated higher levels of anxiety in both MDAS and DFS indexes (p < 0.05). CONCLUSION: Dental anxiety may be higher in patients treated with impacted third molar surgery compared with conventional dental extraction. The education status of patients may not affect dental anxiety. Female patients may show increased levels of dental anxiety in conventional dental and impacted third molar extractions.

Does Viewing a Third Molar Informed Consent Video Decrease Patients' Anxiety?

PURPOSE: Before having impacted third molars removed, patients are frequently asked to view a brief video describing the operation and its benefits and risks. The purpose of this study was to determine whether such information reduces or increases patients' anxiety level. PATIENTS AND METHODS: In this prospective cohort study, 100 patients presenting for consultation regarding removal of their impacted third molars completed a form asking them to grade their anxiety level before and after viewing the informational video as calm, slightly anxious, moderately anxious, or very anxious. RESULTS: Thirty-one percent reported increased anxiety after viewing the video. Only 12% showed a decrease, and in 57%, there was no change (28% were still slightly, moderately, or very anxious). Scoring of the pre- and post-viewing anxiety levels showed a statistically significant increase in anxiety after viewing. CONCLUSIONS: Viewing the video increased or did not reduce the anxiety level in a significant number of patients. Therefore, it is important to complement this video with positive verbal and written reinforcement of such aspects as patient comfort, procedural safety, and adequate pain control.

[Effect of psychological nursing based on relaxation training for the psychological state in patients with impacted third molar removal surgery].

Objective: To discuss the effect of psychological nursing based on relaxation training for the psychological state in patients with impatced third molar removal surgery. Methods: A total of one hundred patients with impacted third molar removal surgery were selected from June 2015 to June 2017 in People's Liberation Army No. 105 hospital. According to the nursing method, all patients were divided into psychological intervention group and the control group, 50 cases in each group, the control group was given routine nursing intervention and the psychological intervention group was given psychological nursing intervention based on relaxation training. Results: The after intervention Corah's modified dental anxiety scale (6.3±1.2), Stouthard dental fear scale (62.9±6.5) scores and heart rate [(76.4±5.2) bpm], systolic blood pressure [(102.5±6.3) mmHg], diastolic blood pressure [(75.3±3.1) mmHg] levels of psychological group were significantly lower than those of the control group. The once removal success rate, intraoperative relaxation sense rate of psychological group were significantly higher than those of the control group, the teeth extraction time of psychological group was significantly lower than that of the control group, the difference was statistically significant (P=0.013, P=0.003). Conclusions: Psychological nursing intervention based on relaxation training can effectively improve the mental state and stress state of patients with impacted third molar removal surgery, which is beneficial to the process of the surgery.

The contemporary management of third molars.

The management of third molars requires a significant assessment and decision process both for the patient and the clinician. The clinician must always identify the indication for third molar surgery, assess the risks of the proposed procedure, and then modify their plan to account for the patient's current and future health, their social and financial setting, and the patient's tolerance of risk. In doing this, the clinician can tailor a solution to meet the individual patient's needs. This decision to remove a third molar is made in the fluid setting of the patient's quality of life and requires regular review. This article gives the clinician the tools, the matrix, and the confidence to guide patients through this process, and outlines some of the pitfalls and common points of bias within the process.

How Patients Percept Their Recovery Following Impacted Mandibular Third Molar Coronectomy.

OBJECTIVES: To compare the quality of life (QOL), side effects, risks, and complications following mandibular third molar coronectomy compared with conventional third molar extraction. METHODS: Sixty-nine patients referred for extraction of impacted mandibular third molars were prospectively studied. The decision to perform coronectomy was made according to radiological data indicative of a risk for inferior alveolar nerve injury. The patients were asked to fill out a questionnaire on their QOL during the first postoperative week, and the surgeon was asked to fill out a questionnaire on these patients' demographic, clinical, and radiological details as well as surgery-related data. The study participants were followed up for at least 1 year postoperatively. RESULTS: Thirty-four of the 69 patients underwent coronectomy (study group) and 35 underwent full extraction (control group(. There was no group difference in QOL scores during the first postoperative week. There was no patient of nerve injury in either group. No complications were found in the postoperative period. Two patients of coronectomy necessitate residual tooth removal prior to planned orthodontic treatment. CONCLUSIONS: These patients' QOL are similar to those for patients following total extraction. No difference in side effects following procedure was found between coronectomy and total extraction. CLINICAL RELEVANCE: Coronectomy of impacted mandibular third molars may be offered instead of total extraction in patients presenting radiological characteristics of root proximity to the inferior alveolar nerve.

Effect of malocclusion severity on oral health-related quality of life and food intake ability in a Korean population.

INTRODUCTION: The aim of this study was to evaluate the effect of malocclusion severity on oral health-related quality of life and food intake ability in adult patients, controlling for sex, age, and the type of dental clinic visited. METHODS: The sample consisted of 472 Korean patients (156 male, 316 female) with a mean age of 21.1 (SD, 8.6) years in a dental hospital and a private clinic. The correlations between the Korean version of the Oral Health Impact Profile-14 (OHIP-14K), subjective food intake ability (FIA) for 5 key foods, and Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) were investigated. RESULTS: The mean IOTN-DHC and OHIP-14K scores were significantly higher for the dental hospital patients than for the private clinic patients (IOTN-DHC, P <0.001; OHIP-14K, P <0.05). Malocclusion severity was significantly higher in male than in female subjects (P <0.001). Older patients perceived their oral health-related quality of life more negatively than did the teens (P <0.001). As the severity of the malocclusion increased, oral health-related quality of life and masticatory function worsened (OHIP-14K, P <0.001; FIA, P <0.05). CONCLUSIONS: As the severity of the malocclusion and the age of the patients increased, oral health-related quality of life and masticatory function relatively deteriorated. This finding provides evidence that severe malocclusions are associated with lower quality of life and less masticatory efficiency in older patients.

Psychological impact of third molar surgery: a 1-month prospective study.

PURPOSE: To prospectively examine the psychological impact of surgical third molar removal, and to identify possible psychological risk factors for the development of dental anxiety and symptoms of psychological trauma. MATERIALS AND METHODS: Patients (N = 71) scheduled for surgical mandibular third molar removal were assessed regarding operative and psychological variables immediately postoperatively and at 1-week and 1-month follow-up. RESULTS: The emotional impact of the surgical procedure appeared to be modest. Only a small proportion of respondents reported a significant increase in dental anxiety or posttraumatic stress (4.3%) at 1-month follow-up. CONCLUSIONS: The results suggest that surgical removal of a third molar by use of local anesthesia, without sedation or general anesthesia, has minimal impact on the development of dental anxiety or symptoms of psychological trauma. Replication of the findings in samples with higher preoperative anxiety levels and with other types of surgical procedures is warranted.

Knowledge may not be the best target for strategies to influence evidence-based practice: using psychological models to understand RCT effects.

BACKGROUND: Interventions to enhance the implementation of evidence-based practice have a varied success rate. This may be due to a lack of understanding of the mechanism by which interventions achieve results. PURPOSE: Use psychological models to further an understanding of trial effects by piggy-backing on a randomised controlled trial testing 2 interventions (Audit & Feedback and Computer-aided Learning) in relation to evidence-based third molar management. METHOD: All participants of the parent trial (64 General Dental Practitioners across Scotland), regardless of intervention group, were invited to complete a questionnaire assessing knowledge and predictive measures from Theory of Planned Behaviour and Social Cognitive Theory. The main outcome was evidence-based extracting behaviour derived from patient records. RESULTS: Neither intervention significantly influenced behaviour in the parent trial. This study revealed that the interventions did enhance knowledge, but knowledge did not predict extraction behaviour. However, the interventions did not influence variables that did predict extraction behaviour (attitude, perceived behavioural control, self-efficacy). Results suggest both interventions failed because neither influenced possible mediating beliefs for the target behavior. CONCLUSION: Using psychology models elucidated intervention effects and allowed the identification of factors associated with evidence based practice, providing the basis for improving future intervention design.

Assessing oral health-related quality of life in general dental practice in Scotland: validation of the OHIP-14.

OBJECTIVES: To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice. METHODS: Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals. RESULTS: A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients. CONCLUSIONS: The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.

Patients' perceptions of recovery after exposure of impacted teeth with a closed-eruption technique.

This prospective study evaluated patients' perceptions of recovery after surgical exposure of impacted teeth treated with a closed-eruption surgical-orthodontic technique. Twenty-nine patients (16 female, 13 male; mean age, 16 +/- 2.8 years) were given a health-related quality of life questionnaire to be completed each postoperative day (POD) for 7 days. The questionnaire was designed to assess the patient's perception of recovery: pain, oral function, general activity, and other parameters. The impact of possible predictor variables, such as age, sex, length of surgical procedure, tooth location, height of impaction, and need for bone removal were assessed. Severe pain (27.6%, 13.8%, 3.4%) and consumption of analgesics (76%, 41%, 17%) declined gradually over the first 3 PODs. Improvement in oral function and other symptoms was evident by PODs 3 and 4. Absence from school outweighed interference in daily activity by 3 days (POD 6 vs POD 3). Buccolingual tooth location was the most significant predictor variable, with results showing a delayed recovery for patients with buccally impacted teeth. The most striking difference was reported with regard to swelling (P <.0001), followed by mouth opening (P =.008) and speech (P =.05). When the surgical procedure lasted 30 minutes or longer, there was prolonged recovery from pain (P =.01). This study provides information to patients and clinicians on postoperative recovery after surgical exposure of impacted teeth by the closed-eruption surgical-orthodontic technique.

Patients' perceptions of recovery after surgical exposure of impacted maxillary teeth treated with an open-eruption surgical-orthodontic technique.

This study assessed patient perceptions of immediate post-operative recovery after the surgical exposure of impacted maxillary teeth with an open-eruption technique. Thirty patients (24 females and six males) underwent surgical exposure of 39 impacted maxillary teeth using this technique. After surgery the patients were contacted by telephone daily for 7 days, to complete a health-related quality of life (HRQOL) questionnaire, which assessed their perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. Severe pain was reported by 30 per cent of the patients in the first post-operative day (POD 1), which declined to 6.7 per cent by POD 6. Consumption of analgesics declined gradually over the post-operative days (POD 1: 80 per cent, POD 7: 20 per cent). Difficulty in eating required 5 days to reach minimal levels; enjoying everyday food, 2.5 days; school attendance, limitations in daily routine, swallowing, and speech, 2 days each; swelling, bad taste/smell, 1.5 days each; within 1 day all other measures attained minimal levels. The need for bone removal during the exposure resulted in delayed recovery with regard to the ability to eat. In general, females reported delayed recovery for pain. The present data may serve as basic guidelines against which future studies which assess post-operative management of patients after surgical exposure of impacted teeth by an open-eruption technique may be compared.

Analgesic effect of an aspirin-codeine-butalbital-caffeine combination and an acetaminophen-codeine combination in postoperative oral surgery pain.

The efficacy of an aspirin-caffeine-codeine-butalbital combination was compared to an acetaminophen-codeine combination and placebo in outpatients who had moderate or severe pain after the surgical removal of impacted third molars. Using a self-rating record, patients rated their pain, relief, anxiety and relaxation hourly for up to 6 hours after medicating. Each active medication was significantly superior to placebo for measures of analgesia and relaxation. Although the butalbital-containing combination provided consistently greater analgesia, the differences between active medications were not statistically significant. The acetaminophen-codeine combination significantly reduced anxiety; however, the butalbital containing combination did not. The results of this study suggest that female patients may have greater efficacy than male patients. All adverse effects were transitory and consistent with the known pharmacologic profiles of the study medications or the backup analgesic.