Evaluation of the effects of pregabalin and dexamethasone coadministration on preemptive multimodal analgesia and anxiety in third molar surgeries: a triple-blind randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of pregabalin and dexamethasone coadministration in preemptive analgesia and anxiety control in lower third molar surgery. MATERIALS AND METHODS: A triple-blind, split-mouth clinical trial conducted with patients divided into two groups: control group, receiving placebo and dexamethasone, and test group, receiving pregabalin and dexamethasone preoperatively. The evaluated variables were pain, measured by the Visual Analog Scale (VAS), anxiety assessed through the State-Trait Anxiety Inventory (STAI) questionnaires, hemodynamic parameters [Blood Pressure (BP), Heart Rate (HR), Oxygen Saturation (SpO2)], and sedation assessed by the Ramsay scale. RESULTS: A total of 31 patients were included. The test group exhibited a significant reduction in pain at 2,4,6,8,12,16,24, and 48 h after surgery and in the consumption of rescue analgesics. Anxiety, evaluated by STAI and VAS, showed a significant decrease in the test group (p < 0.001). Additionally, there was a significant decrease in BP at most of the assessed time points (p < 0.05) and a significant reduction in HR at two different time intervals (p = 0.003 and p = 0.009), indicating a positive effect in the test group. There was no significant difference in SpO2 between the groups. Sedation assessment revealed a significant difference at all time points favoring the test group (p < 0.05). There were no significant postoperative adverse effects. CONCLUSIONS: Pregabalin coadministered with dexamethasone demonstrated significant efficacy in controlling postoperative pain and anxiety, as well as a sedative effect. CLINICAL RELEVANCE: The coadministration of pregabalin with dexamethasone may presents potential advantages in both pain modulation and psychological well-being of individuals undergoing third molar surgeries. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (REBEC), No. RBR-378h6t6.

Preoperative Multisensory Room Use in Pediatric Patients With Autism: A Randomized Clinical Trial.

Purpose: To evaluate the impact of multisensory room (MSR) use on preoperative anxiety and postoperative outcomes in children with autism spectrum disorder (ASD) undergoing dental treatment with general anesthesia. Methods: Forty children, ages six to 17 years, with ASD re- quiring general anesthesia for dental treatment, participated in this study. Participants were randomized to either the control group (standard pre- operative waiting room) or intervention group (MSR) for 20 minutes prior to general anesthesia induction. Pre- and post-intervention preoperative anxiety were measured. Following surgery, postoperative emergence delirium was assessed. Short- and long-term postoperative pain and adverse behavioral effects were evaluated six hours, 24 hours, one week, and one month post-surgery. Data analysis employed repeated measures analysis of variance with two groups and either two or four time periods. Results: The sample was predominantly male (62.5 percent) and identified as either White or Black (53 percent) and non-Hispanic (60 percent). Preoperative behavioral anxiety levels increased post-intervention in the control group (P<0.05) and decreased in the MSR group (P<0.001). Following surgery, pain intensity was greater in the control group compared to the MSR group at six hours (P<0.05) and 24 hours (P<0.01), and similar at one and four weeks. Pre- and post-intervention measures of preoperative heart rate, postoperative emergence delirium, and behavioral effects were similar between groups and over time. Conclusion: These findings suggest a novel, nonpharmacologic technique that can be utilized by various health care specialties to reduce preoperative anxiety and improve post- operative outcomes in children with autism spectrum disorder.

Effectiveness of auditory distraction on the management of dental anxiety in patients undergoing tooth extraction at a tertiary care hospital in Islamabad.

OBJECTIVES: The study aimed to assess the effectiveness of anxiety reduction protocol using auditory distraction in alleviating dental anxiety among patients undergoing tooth extraction. MATERIALS AND METHODS: A randomized controlled trial was conducted at the Oral Surgery Department at Islamabad Dental Hospital from July to December 2022, involving 50 patients scheduled for tooth extraction. Participants were randomly divided into two groups: an interventional group, exposed to auditory distraction, and a noninterventional group, without exposure to auditory distraction before the dental extraction. Dental anxiety was measured using the modified dental anxiety scale (MDAS) questionnaire, which scores anxiety levels on a range from 5 (not anxious) to 25 (extremely anxious). Anxiety levels were assessed in the waiting room and just before extraction, and the results were compared across both groups to evaluate the effectiveness of auditory distraction in reducing dental anxiety. RESULTS: The sample size of 50 was randomly and equally allocated to the interventional and noninterventional groups. The study population consisted of 28 (56%) female and 22 (44%) male participants. No significant difference was observed between the anxiety scores of interventional and noninterventional groups at baseline. A significant reduction in anxiety scores was observed in the intervention group during postintervention assessment, while no significant difference was seen in the noninterventional group's anxiety scores. CONCLUSIONS: The study supports the efficacy of anxiety reduction protocol using auditory distraction as a practical tool for reducing dental anxiety among patients undergoing tooth extraction.

Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial.

BACKGROUND: Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. OBJECTIVE: The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. METHODS: This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery. RESULTS: The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05). LIMITATIONS: We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up. CONCLUSIONS: Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.

Does Modifying the Consent Process Based on the Dominant Intelligence Type Reduce Anxiety During 3rd Molar Operations?

PURPOSE: Third molar surgery is one of the most commonly performed operations, usually associated with high anxiety. The purpose of this study was to determine if patients' anxiety would reduce if consent was modified to match their dominant intelligence type (DIT). METHODS AND MATERIALS: A single center, prospective randomized clinical study was conducted in the Maxillofacial Surgery Clinic of Ordu University on patients admitted for lower third molar removal between October 2020 and June 2021. The participants were randomly assigned to a study group where consent was based on DIT or a control group where consent was obtained in the standard fashion. DIT was determined using the multiple intelligence test and was further categorized as visual/spatial, verbal/linguistic, and bodily/kinesthetic. The consent method was the primary and the type of DIT was the secondary predictor variable. The primary and secondary outcome variables were the salivary cortisol level and Modified Dental Anxiety Scale (MDAS) scores measured before and after the consent, and after the operation. Mann-Whitney U, Friedman, Kruskal Wallis, Pearson correlation, and χ2 tests were conducted for statistical analysis. RESULTS: Eighty patients (55 females and 25 males; mean age 23.5 ± 6.2) were included. No significant difference was observed between the study and control groups for the change in cortisol levels and MDAS scores before-after consent (-11.15 ± 62.64; -6.84 ± 32.9) (P = .389), (-0.6 ± 3.46; -0.7 ± 2.49) (P = .832) and before consent-after operation (-39.80 ± 108.2; -39.72 ± 77.04) (P = .987), (-4.31 ± 5.97; -3 ± 4.34) (P = .867). The change in MDAS scores and cortisol levels was not correlated after consent (P = .587, r = 0.62) and operation (P = .406, r = 0.94). CONCLUSION: Providing consent based on DIT is not statistically different than providing consent in the standard fashion. The role of consent strategy in managing anxiety and lack of correlation between salivary cortisol and MDAS requires further investigation.

Should Preoperative Information Before Impacted Third Molar Extraction Be Visual, Verbal, or Both?

PURPOSE: Offering preoperative information is one option to help patients cope with the anxiety associated with oral and maxillofacial surgical procedures. Although this information is commonly delivered verbally, written information, audio recordings, and videos are also recommended. This study aimed to evaluate the effects of different preoperative information techniques on patients' anxiety levels before and after third molar tooth extraction. MATERIALS AND METHODS: A single-blind randomized controlled clinical trial with parallel groups was performed. 92 patients who fulfilled the inclusion criteria were randomly assigned to one of four groups. Group 1 was provided information via a silent video with subtitles. Group 2 was informed via a video with background audio. Group 3 was provided a written information brochure. Group 4, designated as the control group, was informed verbally. The Spielberger state anxiety inventory (STAI-S), dental fear scale (DFS), modified dental anxiety scale (MDAS), and visual analog scale (VAS) were used pre- and postoperatively to evaluate the dental anxiety of patients. The primary predictor variable was the preoperative information method. The primary outcome variables were the scores of STAI-S, DFS, MDAS, and VAS. Gender was also set as a covariate variable. Data analysis was performed with the IBM SPSS Statistics 25.0 software program. Unless otherwise stated, P < .05 was considered statistically significant. RESULTS: A total of 86 patients scheduled for impacted third molar extractions under local anesthesia were included in the study. There was no statistically significant difference among the groups in the mean age (P = .275) or distribution of gender (P = .070). Compared to preoperative values, the postoperative scores of MDAS and VAS were decreased significantly in group 1 (P = .002, P = .003, respectively) and group 3 (P = .007; P = .009, respectively). No statistically significant differences were found between the preoperative and postoperative scores of STAI-S, DFS, MDAS, and VAS in group 2 (P = .300, P = .028, P = .063, P = .038, respectively) and group 4 (P = .127, P = .587, P = .072, P = .016, respectively). CONCLUSIONS: The findings indicate that visual or written material, without audio or oral delivery, substantially reduced the anxiety associated with oral and maxillofacial surgery. Therefore, clinicians should preferentially provide information via written methods to control patients' anxiety before impacted third molar surgery.

Advantages of Sedation With Remimazolam Compared to Midazolam for the Removal of Impacted Tooth in Patients With Dental Anxiety.

PURPOSE: Although midazolam is commonly used to sedate patients with dental anxiety, it has shortcomings that reduce the satisfaction of patients and doctors. The aim of this study was therefore to explore the advantages of remimazolam as a sedative. METHODS: The study design was a prospective randomized controlled trial. Patients with dental anxiety and who were to undergo impacted tooth removal were randomized into remimazolam and midazolam groups. They were sedated with remimazolam or midazolam prior to receiving nerve blocker. The predictor variable was the type of sedative, while the primary outcome variables were the onset time, awakening time, recovery time, and postoperative side effects. Secondary outcome variables were the Modified Dental Anxiety Scale score before and after surgery, patient satisfaction and comfort levels scores, and doctor satisfaction level scores. Other variables included the patient demographics and the operation time. Data were analyzed using the Student's t-test, Mann-Whitney test, χ2 test, and two-way repeated measurement ANOVA test (SPSS Version 25.0). RESULTS: A total of 83 patients were included in this study, with 42 randomized to the remimazolam group and 41 to the midazolam group. There were no significant differences between the two groups in terms of demographic features and operation time. Patients in the remimazolam group had significantly shorter onset time, awakening time, and recovery time compared to those in the midazolam group (each P < .001). Postoperative side effects were more frequent in the midazolam group (P < .001). Following surgery, the Modified Dental Anxiety Scale scores in both groups were significantly lower than prior to surgery (P < .001). Satisfaction levels scores for the patients and doctor were higher in the remimazolam group than in the midazolam group (P < .001). CONCLUSIONS: The use of remimazolam results in faster onset, more rapid recovery, and lower incidence of postoperative side effects compared to midazolam, leading to improved satisfaction for patients and doctors. Remimazolam therefore appears to have several advantages over midazolam for the sedation of patients with dental anxiety associated with the removal of impacted teeth.

Preoperative online intervention to dental anxiety in patients with transcrestal sinus floor elevation.

OBJECTIVE: Dental anxiety (DA) is a frequent and widespread phenomenon worldwide. There are few studies that have discussed the preoperative intervention of dental anxiety. The aim of this study was to explore the clinical efficacy of an online intervention to improve understanding and reduce dental anxiety in patients with transcrestal sinus floor elevation (TSFE) and to explore the correlation between patients' understanding and dental anxiety, pain perception, and satisfaction. METHOD AND MATERIALS: This prospective randomized controlled trial enrolled patients who underwent TSFE and simultaneous implant placement. Patients were randomly allocated to the preoperative online intervention group (test group) and the non-online intervention group (control group). Two patient interview topic guide questionnaires were utilized to assess the extent and source of patients' understanding of the treatment process after a consultation at the hospital (T1) and prior to the surgery (T2). The preoperative dental anxiety was also assessed using the modified Corah dental anxiety scale (MDAS) at T1 and T2. All patients used the visual analog scale to describe their pain perception and satisfaction with the treatment process immediately after surgery (T3). A correlation analysis was performed to analyze the interrelationship between patient understanding, dental anxiety, pain perception, and satisfaction. RESULTS: At T1, both groups were homogenous in their knowledge of the TSFE procedure and preoperative dental anxiety. At T2, the test group showed a better understanding of the TSFE procedure and lower preoperative dental anxiety than that of T1 and the control group at T2. Pain perception was significantly lower in the test group than in the control group at T3. Patients in the test group expressed significantly greater satisfaction with the treatment process than the control test group. There was a negative correlation between patients' understanding and preoperative dental anxiety. A positive correlation between preoperative dental anxiety and pain perception was found with a significant difference. Patients' satisfaction was positively correlated with understanding and negatively correlated with pain perception. CONCLUSIONS: Preoperative online intervention effectively increased patients' understanding of the treatment process. This resulted in decreased preoperative dental anxiety, decreased pain perception, and greater postoperative satisfaction from patients who underwent TSFE. CLINICAL RELEVANCE: Online medical care can be considered as an auxiliary tool to improve the effect of implant surgery.

Influence of active versus passive parental presence on the behavior of preschoolers with different intelligence levels in the dental operatory: a randomized controlled clinical trial.

BACKGROUND: Dental fear and anxiety still pose the most common factors proposed for the child's negative behavior in the dental operatory. Intelligence has an impact on the children's communication, feelings, and responsiveness to dental situations. The benefits of parental presence on reinforcing the child's behavior during dental treatment are still debatable. This study aimed to assess the effect of parental active versus parental passive presence techniques on the overall behavior of preschool children with different intelligence levels. METHODS: This randomized controlled trial was conducted from December 2017 to August 2019. It recruited 150 healthy children, 3-6-year-old, with no history of previous dental pain/treatment, and intelligence quotient level of 70- ≤ 110 stratified into 3 equal groups (high, average, low). In the first visit, each IQ group was randomly divided into test (PAP) and control (PPP) groups. In the second visit, dental fear was assessed before preventive intervention, the test groups were then managed using parental active presence technique, while the control groups were managed using parental passive presence technique. The overall behavior was assessed at the end of the visit. Data was analyzed using Chi-square test and logistic regression analysis. RESULTS: The parental active presence technique had significant effect on children with high and low intelligence quotients. There were significantly higher odds of positive behavior in high than low intelligence quotient children, (OR 4.08, 95% CI 1.43, 11.67, P = 0.01). The parental active presence technique had significantly higher odds of positive behavior than the parental passive presence technique, (OR 4.08, 95% CI 1.71, 9.76, P = 0.002). CONCLUSIONS: The parental active presence technique had positively influenced the children's overall behavior irrespective of their intelligence levels. This trial was retrospectively registered, trial identifier number: NCT04580316, 8/11/2020.

Effect of Heartfulness Meditation on Anxiety and Perceived Pain in Patients Undergoing Impacted Third Molar Surgery.

PURPOSE: Oral-maxillofacial surgical procedures like impacted third molar surgery (ITMS) may lead to increased perioperative anxiety and pain perception in patients. Psychological interventions like meditation have been shown to decrease acute anxiety levels in individuals. The purpose of this study was to investigate the effect of heartfulness (HFN) meditation during ITMS. We hypothesized that heartfulness meditation would reduce the intraoperative anxiety and pain perception in patients undergoing ITMS procedures. PATIENTS AND METHODS: The prospective interventional study included 60 participants. They were randomly assigned to heartfulness meditation group (26 participants) and control group (34 participants). The heartfulness meditation group was given meditation before their ITMS procedure. Perioperative anxiety and pain perception were assessed using the Spielberger State - Triat Anxiety Inventory (STAI - T, STAI - S), Modified Dental Anxiety Scale (MDAS) and Numerical Rating Scale (NRS). Descriptive statistics such as frequency, percentage, mean and standard deviation were used to describe the data. Inferential statistics such as Chi-square test, Unpaired T test and Pearson correlation were used to analyze the data. RESULTS: The heartfulness meditation group reported less intraoperative anxiety (STAI - S) compared to the control group which was statistically significant (P < 0.002). There was a positive correlation between triat and situational anxiety levels of the participants. There was no significant difference between the groups in relation to dental anxiety and intraoperative pain perception. CONCLUSION: A single session of heartfulness meditation was effective in reducing the intraoperative anxiety levels in impacted third molar surgery. However, its effectiveness in reducing dental anxiety and pain perception was not significant.

Effect of opaque eye coverage on anxiety in candidates for surgical removal of impacted third molars: a randomized clinical trial.

OBJECTIVE: To assess the effects of opaque eye coverage on anxiety in candidates for surgical removal of impacted third molars. STUDY DESIGN: This randomized clinical trial was conducted in candidates for surgical extraction of bilateral, vertical, class IC impacted maxillary third molars or bilateral, mesioangular class IC impacted mandibular third molars. Patients with moderate anxiety (dental anxiety scale range, 9-14) were selected. Surgical extraction of the bilateral third molars was performed in 2 separate visits with and without covering the eyes using surgical drapes. Pulse rate (PR), systolic and diastolic blood pressure (BP), and respiratory rate (RR) were measured immediately after surgery. Moreover, after surgery, the patients were asked to rate their dental anxiety on a visual analog scale (VAS) from 0 to 10. The collected data were used for statistical analysis. RESULTS: Sixty patients with a mean age of 21.31 years participated in the study. PR, systolic BP, RR, and VAS were significantly higher with eye coverage (P < .001). Diastolic BP was not significantly different between the 2 surgical sessions (with or without eye coverage) (P = .157). CONCLUSION: In patients with moderate dental anxiety, covering the eyes during surgical extraction of third molars may contribute to the increase of dental anxiety.

Binaural beats or 432 Hz music? which method is more effective for reducing preoperative dental anxiety?

BACKGROUND: The aim of this prospective clinical study was to investigate the effectiveness of binaural beats and music at a frequency of 432 Hz and compare which method is more effective for reducing preoperative dental anxiety in impacted third molar surgery. MATERIAL AND METHODS: Ninety patients were randomly selected to the binaural beats group, music group and control group. Visual analog scale used to evaluate dental anxiety before the local anesthesia in the first measurement. Local anesthesia was applied to the all patients. Patients in the music group listened to 432 Hz tuned music using earphones for 10 minutes. Patients in the binaural beats group listened to binaural beats using earphones (for the right ear, 220 Hz and for the left ear 210 Hz) for 10 minutes. No special treatment was applied to the patients in control group. In the second measurement, dental anxiety was measured again in all three groups. For analysis of differences between three groups was used One way Anova and Kruskal Wallis test. RESULTS: Twenty seven male and 53 female patients included the study. In the first measurement, the same level of anxiety was recorded in all three groups. (p=0.811) There was a significant decrease in anxiety in both the binaural beats and music group in the second measurement. (p<0.001). CONCLUSIONS: Binaural beats and 432 Hz tuned music are a valid non pharmacological adjuvant to reduce dental anxiety in impacted third molar surgery. They have a positive effect to reduce the dental anxiety.

Child behaviour during dental care under nitrous oxide sedation: a cohort study using two different gas distribution systems.

PURPOSE: Conscious sedation by inhalation of a mixture of nitrous oxide and oxygen (CS) is a technique used in dental care for anxious, handicapped or uncooperative patients. The very special objective of this cohort study is to compare the behaviour of young patients during dental care under CS in two hospitals using different gas distribution systems. METHODS: Young patients were divided into four categories: young child (YC), phobic anxiety (PA), mental disorder (MD), occasional indication (OI). Differences in behaviour scale at various time points according to the sedation system used were established and compared using Mann-Whitney tests. RESULTS: This study showed that there is no difference in behaviour during dental care in YC after sedation. In PA, a significant difference in behaviour is only observed during local anaesthesia (p = 0.024). CONCLUSION: No significant differences detected in children's behaviour under conscious sedation using different gas administration systems. The delicate stage of local anaesthesia in PA patients can be facilitated with repeated sessions of dental care under conscious sedation.

Avaliação e manejo da ansiedade e fobia odontológica: a psicologia na formação do cirurgião-dentista / Evaluation and management of anxiety and dental fear: psychology in the formation of the dentist

Dental fear and anxiety arise from several factors, among them, exposure to previous traumatic experiences with needles, injections and instruments that can cause discomfort. Anxious patients tend to reschedule appointments, avoid treatments and are only available for visits at the dentist when painful symptoms appear, so delayed treatment tends to be more invasive and cause even more emotional damage to the patient, consequently aggravate this feeling and, in turn, create a vicious cycle in which avoiding treatment only makes the oral health condition even worse. It is up to professionals of Dentistry to identify anxiety in patients and make use of resources to manage this anxiety in order to enable an effective dental treatment with less emotional damage to the patient. The aim of this study is to evaluate, by means of a integrative literature review, the importance of the study of Psychology by the dental professional and to expose the techniques for coping with dental anxiety, based on scientific evidences.

O medo e a ansiedade odontológica surgem por diversos fatores, entre eles, a exposição à experiências traumáticas anteriores com envolvimento de agulhas, injeções e instrumentos que possam causar incômodo. Os pacientes ansiosos tendem a adiar consultas, evitam os tratamentos odontológicos e só se dispõe às visitas ao dentista quando aparecem sintomas dolorosos, logo o tratamento tardio tende a ser mais invasivo causando ainda mais prejuízo emocional ao paciente, consequente agravo a tal sentimento e, por sua vez, origina um ciclo vicioso no qual evitar o tratamento agrava ainda mais a condição de saúde bucal. Cabe aos profissionais da Odontologia identificar a ansiedade nos pacientes e fazer uso de recursos de manejo dessa ansiedade de modo a possibilitar um tratamento odontológico eficaz e com menor prejuízo emocional ao paciente. Com este estudo pretende-se avaliar por meio de uma revisão integrativa de literatura, a importância do estudo da Psicologia pelo profissional da Odontologia e expor algumas técnicas de enfrentamento da ansiedade odontológica, com base em evidências científicas.

Effect of an Informative Video on Anxiety and Hemodynamic Parameters in Patients Requiring Mandibular Third Molar Extraction: A Randomized Clinical Trial.

PURPOSE: The purpose was to determine the effect of watching an informative video about mandibular third molar (M3M) removal on patient anxiety and hemodynamic parameters. PATIENTS AND METHODS: A randomized controlled clinical trial was carried out in healthy patients (aged between 18 and 40 years) requiring M3M extraction under local anesthesia. Patients with previous tooth extractions, psychiatric disorders, or cardiac problems or patients undergoing anxiolytic or antidepressant drug treatment were excluded. Participants were randomized into 2 groups according to whether they watched an informative video about the surgical procedure (video group) or not (control group). The primary outcome variable was the difference between groups regarding patient anxiety assessed with the State-Trait Anxiety Inventory (STAI) and the Modified Dental Anxiety Scale (MDAS). The secondary outcome variables were hemodynamic parameters recorded during different moments of the surgical procedure. Descriptive, bivariate, and multivariate analyses were performed, and a repeated-measures mixed model was generated. Statistical significance was considered for P < .05. RESULTS: Fifty patients referred for M3M extraction met the inclusion criteria. The final data analysis was based on 47 patients: 25 from the video group and 22 controls. The bivariate analysis showed the video group to have a significant decrease in anxiety as measured by the MDAS (P = .006; 95% confidence interval [CI], -4.1 to -0.7) and STAI-State (P = .003; 95% CI, -13.7 to -0.7). A significantly lower heart rate was likewise found in the video group (χ2 = 4.30, df = 1, P = .038). The linear regression analysis adjusting for the STAI-Trait also showed lower dental anxiety measured by the MDAS in the video group (P = .023; 95% CI, 0.32 to 4.14). CONCLUSIONS: Providing preoperative information through an informative video about M3M removal significantly reduces patient anxiety and heart rate during the surgical procedure.

Conscious sedation for the management of dental anxiety in third molar extraction surgery: a systematic review.

BACKGROUND: Dental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps. METHODS: A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Seventeen RCTs with a total of 1788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo. CONCLUSIONS: This review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design.

Conscious Sedation in Dentistry.

Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.

Effect of Lavender Oil Inhalation on Reducing Presurgical Anxiety in Orthognathic Surgery Patients.

PURPOSE: We hypothesized that lavender oil inhalation, before orthognathic surgery, would have an anxiolytic effect on patients. MATERIALS AND METHODS: We executed a single-blinded, randomized, prospective study. The study comprised 90 patients (43 men and 47 women) scheduled to undergo orthognathic surgery (bilateral sagittal split, Le Fort I, and bimaxillary osteotomies). The patients were exposed to different concentrations of lavender oil diffusions in 120 mL of water during a 1-hour period before surgery (group 1, 0.1-mL oil diffusion; group 2, 0.3-mL oil diffusion; and group 3, no oil). The predictor variable was the State-Trait Anxiety Inventory (STAI). The STAI-2 was used to assess trait anxiety scores, and the STAI-1 was used to assess state anxiety scores at the time of admittance (STAI-1-A) and after 1 hour, before operating room transfer (STAI-1-OR). We performed a χ2 analysis for categorical variables, 1-way analysis of variance for continuous variables, and paired-samples t test for patients' state and trait anxiety levels. The P value was set at .05. RESULTS: No significant differences were found between groups concerning gender, age, working status, educational background, and surgical operation to be performed. When the demographic data and STAI scores were compared, the STAI-2 scores of patients in group 3 aged between 18 and 30 years and high school graduates were significantly higher. The mean trait anxiety scores were significantly higher in group 2 than in group 1. The STAI-1-OR scores in all 3 groups were significantly higher than the STAI-1-A scores. However, no statistically significant difference was found between the groups. CONCLUSIONS: The results of this study suggested that 1 hour of presurgical inhalation of 0.1-mL and 0.3-mL lavender oil diffusions in 120 mL of water did not have an anxiolytic effect on patients undergoing orthognathic surgery. Future studies will focus on different concentrations, different inhalation times, and higher study samples.

Miedo al tratamiento odontológico en escolares mexicanos / Dental fear among Mexican schoolchildren

RESUMEN Introducción: El miedo al tratamiento odontológico es una reacción emocional que se presenta en niños con una connotación especial. Puede influir en la conducta del niño durante el tiempo de la consulta e intervenir en la efectividad del tratamiento. El abordaje de sus características y de sus diferentes niveles de manifestación es importante para dimensionar este fenómeno psicológico y trazar estrategias futuras. Objetivo: Caracterizar el miedo al tratamiento odontológico en niños escolares mexicanos. Métodos: Se realizó una investigación descriptiva, observacional de corte transversal en 163 niños escolares de 6 a 12 años de edad de una escuela de Monterrey, México, en el período comprendido entre febrero y mayo del 2017. Se les aplicó la escala Dental Subscale of the Children's Fear Survey Schedule para determinar los niveles de miedo. Se asumieron para la investigación las variables sexo, edad y niveles de miedo. El análisis de los datos estadísticos se realizó mediante el programa SPSS versión 19.0 Resultados: Se destacó el miedo moderado con 45,4 por ciento y el componente asfixiarme de la escala con el 52,1 por ciento. Las "inyecciones" y que "un extraño me toque" constituyeron los ítems más relacionados con mucho miedo con un 42,7 por ciento y 47,9 por ciento, respectivamente. Se presentó la categoría mucho miedo solo a los 8 y 11 años de edad con 15,3 por ciento y 9,3 por ciento, respectivamente, así como el sexo femenino con el 48,4 por ciento. Conclusiones: El miedo al tratamiento odontológico en niños escolares mexicanos se manifiesta en niveles moderados, con una predilección a temer más a la asfixia durante el tratamiento dental. Edades tempranas de escolaridad, con ligero predominio en el sexo femenino, constituyeron las características más relacionadas con este fenómeno psicológico(AU)

ABSTRACT Introduction: Dental fear is an emotional reaction occurring in children with a special connotation. It may influence the behavior of child patients during consultation and affect the effectiveness of treatment. Addressing its characteristics and its various forms of manifestation is important to gain insight into this psychological phenomenon and devise future strategies. Objective: Characterize dental fear among Mexican schoolchildren. Methods: A cross-sectional observational descriptive study was conducted of 163 schoolchildren aged 6-12 years from a school in Monterrey, Mexico, from February to May 2017. The Dental Subscale of the Children's Fear Survey Schedule was applied to determine fear levels. The variables analyzed in the study were sex, age and fear levels. Analysis of statistical data was performed with the software SPSS version 19.0. Results: The scale components moderate fear (45.4 percent) and fear of suffocation (52.1 percent) stood out among the results obtained. Injections and being touched by a stranger were the items most commonly related to great fear, with 42.7 percent and 47.9 percent, respectively. The great fear category was present only at 8 and 11 years of age, with 15.3 percent and 9.3 percent, respectively, and in the female sex with 48.4 percent. Conclusions: Dental fear is moderate among Mexican schoolchildren, with a prevalence of fear of suffocation during dental care. Early school ages and a predominance of the female sex were the features most commonly related to this psychological phenomenon(AU)

Acupuncture on anxiety and inflammatory events following surgery of mandibular third molars: a split-mouth, randomized, triple-blind clinical trial.

The aim of this study was to compare the effects of acupuncture and placebo acupuncture on the control of pain, oedema, and trismus following the extraction of third molars and on the control of preoperative anxiety. Sixteen patients (mean age 22.5±3.45years) each underwent four acupuncture sessions, one prior to each surgery and the others at 24, 48, and 72hours after each surgery (left and right tooth). Oedema was determined using measurements of the face and trismus was determined by maximum mouth opening at baseline and at 24, 48, 72hours and 7days following surgery. Postoperative pain was evaluated by the patients using a visual analogue scale (VAS) at 24, 48, and 72hours following surgery. Anxiety was evaluated using the State-Trait Anxiety Inventory and a VAS at baseline and before and after acupuncture prior to surgery. The statistical analysis was performed using the paired t-test and Wilcoxon test. Acupuncture showed a better performance in the control of oedema at 48hours (P=0.026), 72hours (P=0.046), and 7days (P=0.040) when compared to placebo. There was no statistically significant difference between the acupuncture and placebo groups in the control of pain, trismus, or anxiety.