[Patient satisfaction with procedural sedation in oral and -maxillofacial surgery]. / Patiënttevredenheid met procedurele sedatie in de mka-chirurgie.

Fear of treatment by an oral and maxillofacial (OMF) surgeon or the dentist is a widespread and deep-rooted phenomenon. A patient can be taught to cope with dental phobia by means of psychological, cognitive behavioural therapy, but in cases of invasive oral treatment, such therapy may be insufficiently effective. For these invasive procedures, sedation serves as an alternative treatment option. The department of Oral and Maxillofacial Surgery at the Radboud University Medical Centre in Nijmegen, the Netherlands, offers the possibility to utilise intravenous sedation with midazolam (Dormicum®) and remifentanil (Ultiva®). This results in a reduction in the experience of axiety and pain, which can lead to an anterograde amnesia for the invasive treatment. Procedural sedation and analgesia (PSA) for OMF surgery demonstrate a high level of patient satisfaction, and therefore offer a good alternative treatment to local and general anaesthesia.

Effects of music intervention on anxiety and pain reduction in ambulatory maxillofacial and otorhinolaryngology surgery: a descriptive survey of 27 cases.

PURPOSE: The aim of this study is to determine patients' opinion regarding listening to music before an ambulatory maxillofacial surgery and effects on anxiety and pain reduction. METHODS: This study was conducted on outpatients having a maxillofacial surgery between December 2015 and April 2016 at Poissy/Saint-Germain-en-Laye hospital (France). Patients listened with headphones to an easy-listening music in the operation theater before the first ambulation. A questionnaire including a visual analog scale (VAS) for pain and anxiety was given to participants. The primary endpoint was to determine patients' opinion regarding listening to music before surgery. Secondary endpoints were to determine VAS pain mean, VAS anxiety mean before surgery, VAS anxiety mean after surgery, and if patients wanted to listen to their own playlist. We decided to compare VAS anxiety and pain mean between patients who accepted to listen to music (ALM) and who refused to listen to music (RLM). RESULTS: Nineteen patients ALM and 8 patients RLM to music. 78.9% of patients considered that listening to music before surgery decreased their anxiety. In patients who ALM, the mean (standard deviation, SD) of VAS pain after surgery was 3.42 (1.95), the mean (SD) of VAS anxiety before surgery was 3.1 (2.3), and the mean (SD) of VAS anxiety was 1.21 (0.85). There was a statistically significantly difference of the VAS anxiety mean (SD) before surgery between patients who ALM 3.10 (2.30) and who RLM 6.12 (1.88) (p = 0.005). There was a statistically significantly difference of the VAS anxiety mean (SD) after surgery between patients who ALM 1.21 (0.85) and who RLM 2.62 (1.30) (p = 0.009). Fifty percent of the patients wanted to choose their own music. CONCLUSION: Music seems to reduce anxiety before maxillofacial surgery. An interventional randomized study is needed to demonstrate the positive impact of music on anxiety before maxillofacial surgery.

[Diagnossis and treatment of complicated anterior teeth esthetic defects by combination of whole-process digital esthetic rehabilitation with periodontic surgery].

OBJECTIVE: To explore a new method of whole-process digital esthetic prosthodontic rehabilitation combined with periodontic surgery for complicated anterior teeth esthetic defects accompanied by soft tissue morphology, to provide an alternative choice for solving this problem under the guidance of three-dimensional (3D) printing digital dental model and surgical guide, thus completing periodontic surgery and digital esthetic rehabilitation of anterior teeth. METHODS: In this study, 12 patients with complicated esthetic problems accompanied by soft tissue morphology in their anterior teeth were included. The dentition and facial images were obtained by intra-oral scanning and three-dimensional (3D) facial scanning and then calibrated. Two esthetic designs and prosthodontic outcome predictions were created by computer aided design /computer aided manufacturing (CAD/CAM) software combined with digital photography, including consideration of white esthetics and comprehensive consideration of pink-white esthetics. The predictive design of prostheses and the facial appearances of the two designs were evaluated by the patients. If the patients chose the design of comprehensive consideration of pink-white esthetics, they would choose whether they would receive periodontic surgery before esthetic rehabilitation. The dentition design cast of those who chose periodontic surgery would be 3D printed for the guide of periodontic surgery accordingly. RESULTS: In light of the two digital designs based on intra-oral scanning, facing scanning and digital photography, the satisfaction rate of the patients was significantly higher for the comprehensive consideration of pink-white esthetic design (P<0.05) and more patients tended to choose priodontic surgery before esthetic rehabilitation. The 3D printed digital dental model and surgical guide provided significant instructions for periodontic surgery, and achieved success transfer from digital design to clinical application. The prostheses were fabricated by CAD/CAM, thus realizing the whole-process digital esthetic rehabilitation. CONCLUSION: The new method for esthetic rehabilitation of complicated anterior teeth esthetic defects accompanied by soft tissue morphology, including patient-involved digital esthetic analysis, design, esthetic outcome prediction, 3D printing surgical guide for periodontic surgery and digital fabrication is a practical technology. This method is useful for improvement of clinical communication efficiency between doctor-patient, doctor-technician and doctors from different departments, and is conducive to multidisciplinary treatment of this complicated anterior teeth esthetic problem.

What attracts people to a career in oral and maxillofacial surgery? A questionnaire survey.

A key aspect of recruiting and retaining the best trainees is identification of the factors that attracted them to OMFS. Although such factors have been examined for medicine in general, we know of no previous study that has looked at those that are specific to OMFS. We distributed a survey online to roughly 1500 people who had registered an interest in OMFS over the past seven years. Personal data, and those about education and employment, were recorded, together with particular factors that drew them to OMFS. Of the 251 trainees who responded, 177 (71%) were interested in a career in OMFS. Differences among sub-groups related to dual qualification, sex, and relationships. Open comments identified the following attractive factors: variety of work, intellectually interesting work, collegiate atmosphere within OMFS, and making a difference to patients. The personalities of those who continued with OMFS training placed high value on achievement, and were more conscientious. The factors identified suggest that the positioning of OMFS as a complex, challenging, and varied hospital-based surgical specialty is key to attracting trainees, and these will be used in future research so that we can move forward from identifying preferences to assessing the relative value placed on those preferences. The data will be useful in the development of strategies to attract new trainees and retain them in the specialty.

What causes trainees to leave oral and maxillofacial surgery? A questionnaire survey.

Understanding what causes trainees to leave OMFS is essential if we are to retain them within the specialty. Although these factors have been defined for medicine, we know of no previous study for OMFS. An online survey was distributed to roughly 1500 people who had registered an interest in OMFS during the past seven years. Personal information and details of education and employment were gathered along with personal factors that attracted them to OMFS. Of 251 trainees who responded, 50 (30%) were no longer interested. Factors that significantly correlated with an interest in OMFS included male sex (p=0.020), dual qualification (p=0.024), and (only for women) being single (p=0.024) and having no dependants (p=0.005). We used qualitative analysis to identify work-life balance, duration of training, and financial implications, as significant factors. Identification of key factors that affect OMFS trainees allows us to develop ways to keep them in the specialty. The predominant factor is work-life balance, and for women this included having children and being married. Financial issues related to the junior doctors' contract and competition ratios to second degrees, are also factors for both sexes. Also important are the "sunk costs" fallacy that causes some trainees to stay in training. This information can be used to help develop higher training, in negotiations of contracts, and to attract and retain future OMFS trainees.

The effect of preoperative suggestions on perioperative dreams and dream recalls after administration of different general anesthetic combinations: a randomized trial in maxillofacial surgery.

BACKGROUND: Images evoked immediately before the induction of anesthesia with the help of suggestions may influence dreaming during anesthesia.The aim of the study was to assess the incidence of evoked dreams and dream recalls by employing suggestions before induction of anesthesia while administering different general anesthetic combinations. METHODS: This is a single center, prospective randomized including 270 adult patients scheduled for maxillofacial surgical interventions. Patients were assigned to control, suggestion and dreamfilm groups according to the psychological method used. According to the anesthetic protocol there were also three subgroups: etomidate & sevoflurane, propofol & sevoflurane, propofol & propofol groups. Primary outcome measure was the incidence of postoperative dreams in the non-intervention group and in the three groups receiving different psychological interventions. Secondary endpoint was to test the effect of perioperative suggestions and dreamfilm-formation training on the occurrance of dreams and recallable dreams in different general anesthesiological techniques. RESULTS: Dream incidence rates measured in the control group did not differ significantly (etomidate & sevoflurane: 40%, propofol & sevoflurane: 26%, propofol & propofol: 39%). A significant increase could be observed in the incidence rate of dreams between the control and suggestion groups in the propofol & sevoflurane (26%-52%) group (p = 0.023). There was a significant difference in the incidence of dreams between the control and dreamfilm subgroup in the propofol & sevoflurane (26% vs. 57%), and in the propofol & propofol group (39% vs.70%) (p = 0.010, and p = 0.009, respectively). Similar to this, there was a significant difference in dream incidence between the dreamfilm and the suggestion subgroups (44% vs. 70%) in the propofol & propofol group (p = 0.019). Propofol as an induction agent contributed most to dream formation and recalls (χ2-test p value: 0.005). The content of images and dreams evoked using suggestions showed great agreement using all three anesthetic protocols. CONCLUSION: The psychological method influenced dreaming during anesthesia. The increase of the incidence rate of dreams was dependent on the anesthetic agent used, especially the induction agent. The study was registered in ClinicalTrials.gov. Identifier: NCT01839201.

Reputation of Oral and Maxillofacial Surgery in the UK: the patients' perspective.

Our intention is to shed theoretical and practical light on the professional reputation of Oral and Maxillofacial Surgery (OMFS) in the UK by drawing on theories from management literature, particularly concerning reputation. Since professional reputation is socially constructed by stakeholders, we used interpretivist methods to conduct a qualitative study of patients (stakeholders) to gain an insight into their view of the profession. Findings from our focus groups highlighted the importance of "soft-wired skills" and showed a perception - reality gap in the interaction between patients and doctors. They also highlighted the importance of consistency, relational coordination, mechanisms to enable transparent feedback, and professional processes of governance. To help understand how best to manage the reputation of the specialty, we also explored how this is affected by the media and the Internet.

The role of hypnotherapy in dentistry.

Dental fear is a universal phenomenon justifying the increasing relevance of psychology and the behavioural sciences to dental training and clinical practice. Pharmacological sedation has been used more and more over the past two decades, in order to relieve dental anxiety and phobia and let the patient face oral surgery safely. Hypnosis is a still underused but powerful non-pharmacological tool in dentistry. It provides an effective sedation whilst maintaining patient collaboration, but it also may help patients recovering from dental anxiety and phobia as well as those with a severe gag reflex. While pharmacological sedation affords a temporary respite and helps the patient to cope with a single procedure, hypnosis can effectively allow for both an excellent sedation in a physiological way and the treatment of patients' anxiety, or substantially decrease the doses used for sedative and analgesic drugs when these are needed.

Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children.

OBJECTIVE: To investigate the effects of sociodemographic factors and maternal anxiety levels on behaviour in children undergoing surgery. METHODS: This study included children aged 3-12 years who were scheduled for surgery, and their respective mothers. Each mother completed a questionnaire concerning sociodemographic and economic characteristics. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) form Tx-1, following transfer of the child to the operating room. An anaesthesiologist rated preoperative anxiety in each child using the Frankl Behaviour Rating Scale (FBRS) and Venham Picture Test (VPT). RESULTS: One hundred children (mean ± SD age 7 ± 2.7 years) who received dental (47%), plastic (39%) or urological (14%) surgery, and 100 mothers (mean ± SD age 34 ± 6.6 years) were included. A statistically significant difference between maternal STAI Tx-1 scores and children's VPT scores was revealed. There was no significant difference between maternal STAI Tx-1 scores and children's FBRS scores. Maternal education level and socioeconomic status had no effect on FBRS, VPT and STAI Tx-1 scores. CONCLUSION: Maternal knowledge and experience of anaesthesia, and high levels of maternal anxiety, may be related to increased anxiety in children undergoing surgery.

Características postquirúrgicas dento-buco-maxilo-faciales de niños con hendidura de labio y paladar / Features postsurgical dento-coof maxillofacial of children with cleft lip and palate

La Hendidura de Labio y/o Paladar (HLP) es la anomalía congénita más común que afecta a la raza humana. Es de etiología multifactorial. Determinar las características bucales de niños con HLP post-quirúrgicas que acudieron al Centro de Investigación y atención a pacientes con mal formaciones Craneofaciales y Prótesis Maxilo Facial (CIAPA), durante el año 2013. La muestra estuvo formada por 25 niños venezolanos, entre 6 y 9 años con cirugía de HLP realizada, que acudieron por primera vez a recibir tratamiento odontológico. Se realizo un análisis descriptivo y transversal. El instrumento de evaluación constó de dos partes, un cuestionario de 12 preguntas a la madre para establecer variables sociodemográficas, antecedentes personales y familiares relacionados con HLP. Se realizó un examen bucal a los niños, para determinar sus características dento-buco-maxilo-faciales Del total de la muestra estudiada (25) 84% de las madres en edades entre 20 y 35 años de edad, 70% no termino la educación básica, 95% eran amas de casa, el 50% refirió que su embarazo fue deseado, 20% reportó antecedentes familiares de HLP, 75% de la madres rechazaron al niño/a al nacer,100% presento alguna alteración en las estructuras dento-buco-palatina-maxilar, ambos géneros estaban afectados casi en la misma proporción Lo más trascendente en el tratamiento de esta malformación es el manejo interdisciplinario por un grupo de especialistas entrenados en el tema con una gran interaccio?n en la toma de decisiones de manera individual en cual debe estar el odontopediatra.

The cleft lip and/or palate (HLP) is the most common birth defect that affects the human race .is multifactorial etiology. To determine the characteristics of children with oral HLP post-surgical who came to the Center of Research and care for patients with craniofacial and evil formations Maxillo Facial prosthesis (CIAPA), during the year 2013. The sample was formed by 25 Venezuelan children, between 6 and 9 years with HLP surgery performed, who came for the first time to receive dental treatment. A descriptive and cross-sectional analysis was conducted. The evaluation instrument consisted of two parts, a questionnaire of 12 questions to the mother to establish socio-demographic variables, personal and family history related to HLP. An oral examination was carried out to children, for dento-buco-maxilo-facial characteristics Of the total study sample (25) 84% of the mothers were between 20 and 35 years of months,70% did not finish the basic education, 95% were homemakers, 50% stated that her pregnancy was unwanted, 20% reported family history of HLP, 75% of the mothers refused to child at birth, 100% present some alteration in the dento-buco-palatine-maxillary structures both genders were affected almost in the same proportion. The most transcendent in the treatment of this malformation is the interdisciplinary management by a group of specialists trained in the subject with great interaction in decision-making individually in which must be the pediatric dentist.

Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation.

BACKGROUND: Anxiety is a relevant but still underscored perioperative problem. The Visual Analogue Scale for Anxiety (VAS-A) seems to be effective, fast and manageable, but has not been fully validated yet. The aim of this study is to validate VAS-A comparing it to, Corah's Dental Anxiety Scale (CDAS) Spielberger's State Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). METHODS: One hundred consecutive patients (38 males and 62 females, median age 49 years) submitted to oral surgery filled out the VAS-A, CDAS, STAI forms Y1 and Y2, and BDI at preoperative examination; the order of administration of tests was randomized. RESULTS: VAS-A score was significantly correlated to CDAS (P<0.0001), STAI-Y1 (P<0.0001), STAI-Y2 (P<0.002) but not to BDI (P=0.18). ROC curve analysis suggested VAS-A equal to 46 mm as threshold for anxiety when using STAI Y1 equal to 40 as reference cutoff. CONCLUSION: Our study confirms that VAS-A is a reliable indicator of preoperative anxiety and may detect patients with depressive symptoms also. Values of VAS-A around 50 mm are a reliable threshold for a clinically meaningful level of preoperative anxiety.

Medical hypnosis as a tool to acclimatize children to noninvasive positive pressure ventilation: a pilot study.

BACKGROUND: Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV. METHODS: Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. RESULTS: Hypnosis was performed in nine children aged 2 to 15 years. Seven children had a high level of anticipatory anxiety because of a tracheotomy since birth (n=2), a history of maxillofacial surgery (n=2), severe dyspnea because of lung disease (n=2), and morbid obesity and depression (n=1), and two children with obstructive sleep apnea failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children to obtain a progressive psychocorporal relaxation. All patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (>6 h) NPPV acceptance. The 6-month compliance with NPPV was excellent, with a median use of 7.5 h per night. CONCLUSION: Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures.

Low burnout risk and high engagement levels among oral and maxillofacial surgeons.

Little is known about the well-being of oral and maxillofacial surgeons. The aim of this study was to measure the levels of burnout risk and the demanding work aspects of Dutch oral and maxillofacial surgeons, as well as the levels of positive work engagement and stimulating aspects of the work environment. The Maslach Burnout Inventory, Dutch version (UBOS), and inventories on positive engagement, work demands, and stimulating aspects of work, were sent to all 179 Dutch oral and maxillofacial surgeons currently in clinical practices. With a 70% response, UBOS mean scores on Emotional Exhaustion and Depersonalization appeared lower, and on Personal Accomplishment appeared higher, when compared with relevant reference scores. Engagement scores appeared to be relatively high. Mean scores on the work demands subscales were all well below the scale midpoint, whereas work resources were all well above. Dutch oral and maxillofacial surgeons showed relatively favorable burnout and engagement levels. The aspects of the work environment that best explain differences in burnout are 'Practice demands and organization' and 'Lack of variation and perspective in work'. Differences in engagement are best explained by 'Variety in work' and 'Positive effect upon patients'. It is remarkable that all work demands show relatively low levels and all stimulating work aspects show relatively high levels.

Serum testosterone levels in surgeons during major head and neck cancer surgery: a suppositional study.

Serum testosterone levels are known to have diurnal variation and to decrease by up to 2% per year after the age of 40. They can also be affected by stress and aggressive behaviour as well as various medical conditions. Although studies have investigated the role of mood and stress, none has specifically evaluated the effect of operative procedures on surgeons testosterone levels, particularly those in our own specialty, one that has historically been associated with perceived 'high testosterone' levels. We devised a suppositional study, particularly pertinent for publication at the beginning of April. This was a prospective randomised study of five male consultant maxillofacial surgeons (including two with male pattern baldness) and assayed serum testosterone levels at rest, during, and after a series of major ablative and reconstructive procedures. The resting testosterone levels were found to be similar in all surgeons (220 ± 120.9 mcg/ml). During major head and neck procedures, a statistically significant increase in serum testosterone was found (up to a maximum concentration of 1062.50 mcg/ml). Multivariate analysis revealed that the likely predictors of increasing serum testosterone were: size and extent of tumour and complexity, and type of microvascular reconstruction (all P<0.001). The long-term effects of chronically raised serum testosterone warrant further investigation but recent evidence has found that it may be cerebro-protective against conditions including Alzheimer's syndrome.

Psychological care for maxillofacial trauma patients: a preliminary survey of oral and maxillofacial surgeons.

INTRODUCTION: Psychological morbidities are major complications following maxillofacial injuries. The aim of this study was to assess self-evaluation of oral and maxillofacial surgeons on posttraumatic psychological care. METHODS: Using a cross-sectional study design, we enrolled a sample of surgeons in 261 oral and maxillofacial surgery (OMFS) departments in the United States, United Kingdom and France. A self-administered e-mail questionnaire was used to evaluate knowledge, attitude and practice of the surgeons regarding psychological problems in maxillofacial injury patients, and their collaboration with psychological personnel. Appropriate descriptive and univariate statistics were computed, and P<0.05 was considered statistically significant. RESULTS: The response rate was 28.1% (112 of 398), but we included only 100 respondents from 107 OMS units. 60% of the surgeons disclosed a moderate or high level of relevant knowledge. Only 28 OMS departments (26.2%) had intra-service psychological staff (commonly in France [P<0.05]), and five surgeons revealed considerable deficits in access to psychological care. Frequent reasons for patient referral to psychological staff were depression, body dysmorphic disorder, posttraumatic stress disorder, suicidal idea, anxiety and behavioural changes. Eighty-eight surgeons linked patient's non-compliance with changes or difficulties in practice, and 58 surgeons experienced it already. CONCLUSIONS: Despite several limitations, the results of this study suggest that oral and maxillofacial surgeons have a great interest and experience in posttraumatic psychological problems. Psychological professionals in charge will improve surgical care quality. Well-designed studies with larger sample size are desirable to confirm our results. Ethical issues of maxillofacial trauma care are also discussed.

Knowledge, attitude and practices of Indian dental surgeons towards tobacco control: advances towards prevention.

AIMS AND METHODS: We assessed the knowledge, attitude and practices of dental surgeons in the city of Bangalore, Karnataka, concerning use of tobacco in their patients. A self-administered questionnaire was administered to all dental surgeons prior to a sensitization program on nicotine dependence. RESULTS: The dental surgeons who responded (n=100) reported a need for increasing sensitization on the issue of tobacco especially among health professionals. Only 33% knew that nicotine is the most addictive drug and knowledge was poor about pharmacological as well as non pharmacological methods of treatment of nicotine dependence. Only 52% asked all their patients about tobacco use. However, almost all dental surgeons agreed that there should be a ban on public use of tobacco. IMPLICATIONS: The results of this study call for sensitizing health professionals on a larger scale on the issue of tobacco use and its treatment.

Occupational stress in oral and maxillofacial surgeons: tendencies, traits, and triggers.

Health professionals are subject to higher levels of stress than the average worker. Little has been written on these subjects, specifically in oral and maxillofacial surgeons. Anecdotally, dentists have been singled out as the health care professionals more likely to be subjected to severe stress, burnout, failed marriages, depression, substance abuse, and commit suicide. However, with oral and maxillofacial surgery being a particularly high-stress specialty of dentistry, a study of the dental literature regarding stress may be relevant. This article explores the myths and realities of stress and burnout in oral and maxillofacial surgeons and the coping skills, both adaptive and maladaptive used by practitioners to deal with their stress. This article also offers some practical suggestions for improving both the mental and physical health of oral and maxillofacial surgeons.

[Burn-out and engagement among oral surgeons]. / Burn-out en bevlogenheid bij kaakchirurgen.

The aim of this study was to measure Dutch oral surgeons' levels of burn-out risk and the contributing role of demanding working conditions. In addition, the extent of work engagement was considered, and which stimulating working conditions contributed to it. All 179 Dutch oral surgeons registered in the Dutch Dental Association's files received a questionnaire by means of which burn-out, work engagement and both demanding and stimulating aspects from the work environment could be measured. Based upon a 70% response, it can be concluded that Dutch oral surgeons have a relatively low risk of burn-out and a high degree of engagement. Demanding working conditions which explain the differences in the risk of burn-out are: 'Pressure of work and clinic organization', and 'Lack of variation and perspective in work'. Differences in enthusiasm were best explained by 'Variety in work', and 'Positive effect upon patients'. It is remarkable that the mean for all demanding aspects of work is relatively low and the mean for all stimulating aspects is relatively high.