Evaluation of pain perception during orthodontic debonding of metallic brackets with four different techniques.

OBJECTIVE: The aim of this study was to evaluate patients' pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different. MATERIAL AND METHODS: One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients' levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal-Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05. RESULTS: Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group. CONCLUSIONS: Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.

Evaluation of pain perception during orthodontic debonding of metallic brackets with four different techniques

Abstract Objective The aim of this study was to evaluate patients' pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different. Material and Methods One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients' levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal-Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05. Results Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group. Conclusions Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.

Non-linear indices of heart rate variability during endodontic treatment.

Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.

Non-linear indices of heart rate variability during endodontic treatment

Abstract Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.

Salivary biomarkers, vital signs and behaviour of pre-school children during their first dental visit.

AIM: Anxiety may influence dental treatment unfavourably, thus evaluation of the psychophysiological reactions of the child may reduce its negative effects. This study aimed to evaluate and correlate the levels of cortisol and alpha-amylase, vital signs and behaviour of children during their first dental visit. METHODS: Study sample consisted of 32 children (11 male and 21 female patients) aged between 4 and 6 years, who would go to the dentist for the first time, with no pain or chronic illness, and without the use of medication. Three saliva samples were collected: before, immediately after and 20 minutes after the dental procedure (dental prophylaxis). STATISTICS: Data were analysed using Student's t test and Pearson's correlation test (p = 0.05). RESULTS: In the comparison of the levels of alpha-amylase, the heart rate and blood pressure were higher after the dental visit and the levels of salivary cortisol were significantly higher before. There was no statistically significant difference in the correlation between the Frankl Behaviour Rating Scale and the levels of cortisol and alpha-amylase, but the results showed that the levels of these two salivary biomarkers increased gradually as the child had a less cooperative behaviour. CONCLUSION The sample revealed that the first dental visit generated anxiety, which was manifested through physiological and behavioural alterations.

Cardiovascular responses to different stages of restorative dental treatment unaffected by local anaesthetic type.

BACKGROUND: The aim of this study was to evaluate the cardiovascular effects of maxillary infiltration using 2% lidocaine with 1:100,000 adrenaline, 4% articaine with 1:200,000 adrenaline, and 4% articaine with 1:100,000 adrenaline in different stages during restorative dental procedures. METHODS: Twenty healthy patients randomly received 1.8 mL of the three local anaesthetics. Systolic blood pressure, average blood pressure, diastolic blood pressure, and heart rate were evaluated by the oscillometric and photoplethysmograph methods in seven stages during the appointment. RESULTS: Statistical analysis by ANOVA and Tukey tests of cardiovascular parameters did not show significant differences between the anaesthetic associations. There were significant differences for the parameters among different clinical stages. CONCLUSIONS: The variation of cardiovascular parameters was similar for lidocaine and articaine with both adrenaline concentrations and showed no advantage of one drug over the other. Cardiovascular parameters were influenced by the stages of the dental procedures, which showed the effect of anxiety during restorative dental treatment.

Changes in blood pressure in children undergoing psychological treatment before dental procedures.

Different dental procedures in children undergoing treatment can induce changes in blood pressure. These changes will be minimized if psychological treatment is applied prior to any procedure. The objective of this study was to determine changes in blood pressure (systolic-diastolic) in children undergoing psychological treatment before dental procedures. The population studied consisted of 100 children and adolescents, ages 6 to 15 years. The patients were assigned to two groups at random, i.e. with or without psychological treatment before dental procedures. Behavior management was carried out applying the tell-show-do technique of conduct handling. The systolic and diastolic blood pressures were measured prior to the initiation of the treatment, during drilling, restoring, and before dismissing the patient. The no-psychological treatment group exhibited significant differences in diastolic and systolic blood pressures during the dental procedure whereas the psychological treatment group evidenced no significant differences in blood pressure. No correlation was found between the alterations of blood pressure and the type of dental treatment performed. The application of the tell-show-do method would have an effect on the blood pressure in patients undergoing dental procedures.

ESTUDIO DE LA ANSIEDAD Y EL MIEDO EN EL PACIENTE ODONTOLOGICO

La ansiedad refleja en función de la frecuencia cardiaca en los pacientes antes de la exploración dental es significativamente mayor que durante y después del tratamiento. Todo esto demuestra la importancia de los primeros momentos de la relación dentista-enfermo. La ansiedad valorada a través de la frecuencia cardiaca en las mujeres, es mayor que en los varones en los tres momentos de la exploración. Los varones registran valores mayores de la tensión arterial sistólica con respecto a las mujeres, en los momentos de la anestesia local y de la cirugía; por lo que podemos considerar a los hombres como personas de mayor riesgo a sufrir accidentes cerebrovasculares y cardiovasculares