Assessment of pre and postoperative anxiety in patients undergoing ambulatory oral surgery in primary care

Background: To analyze the pre- and postoperative anxiety level in patients undergoing ambulatory oral surgery (AOS) in a primary healthcare center (PHC). Material and Methods: Prospective and descriptive clinical study on 45 patients who underwent AOS procedures in the dental clinic of a public PHC of Spain between April and September 2015. Anxiety analysis was carried out with pre- and postoperative anxiety-state (STAI-S), anxiety-trait (STAI-T) and dental anxiety (MDAS) questionnaires. A descriptive, inferential and binary logistic regression analysis were performed for the variables age, sex, educational level, previous experience of oral treatment, type of oral surgery, degree of third molar impaction, surgical time, intraoperative complications, postoperative complications, and pain score with a visual analogue scale (VAS). Results: The majority were female (57.8%) with a mean age of 33.5±9.6 years. The most frequent procedure was the lower third molar removal (82.2%). The mean pain score on the VAS was 1.6±1.8. The incidence of complications was low (7.8%). There was a statistically significant association between post- and preoperative anxiety (r=0.56, p<0.001) and a correlation between pain score and postoperative anxiety (Rho= -0.35, p=0.02). The likelihood of postoperative anxiety was related to preoperative anxiety (OR=1.3, p=0.03). Conclusions: AOS in a PHC is safe and should be more encouraged in the public primary care. The emotional impact on users was relatively low, highlighting that the preoperative anxiety levels were higher than the postoperative ones. Psychological factors related to pre- and postoperative anxiety should be considered in the AOS carried out in PC (AU)

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Telemedicine as an effective tool for the management of temporomandibular joint disorders.

PURPOSE: To evaluate the effectiveness of a store-and-forward telemedicine system (SFTMS) as an optimal method for the selection, diagnosis and treatment of patients with TMJ disorders (TMJD) referred from primary care sites to the Maxillofacial Surgery Unit (hospital-based). MATERIALS AND METHODS: A multicenter, analytical, quasi-experimental, non-randomized clinical study of a SFTMS aimed towards the management of patients with TMJD was conducted at the Oral and Maxillofacial Surgery Unit of the Virgen Macarena University Hospital (Seville, Spain) and 10 primary care areas of the North area of Seville located between 15 and 180 km from the hospital. The study was carried out between January 2008 and February 2010 including a non-random sample consisting of all patients with TMJD treated at primary care sites during the study period. We describe the development and effectiveness of this method based on the rates of diagnosis of myofascial syndrome and/or internal deragement Wilkes Stages I-II-III, internal deragement Wilkes Stages IV-V, other arthropathies, resolved teleconsultations, second teleconsultations, referrals to hospital, mean treatment delay, lost hours working/patient and complaints. The same variables were also described for the TMJD conventional consultation system at hospital (standard system). Descriptive statistics (frequency tables, means and medians, and dispersion measures), T-Student test was used to compare the differences in the average quantitative variables (time) and Chi2 test was used to compare the differences in the average qualitative variables. RESULTS: Over a 24-month period, 710 patients with TMJD were assisted at hospital by conventional consultation from 1-1-2008 to 2-25-2010, of which 587 (82.7%) were women and 123 (17.3%) were men with a mean age of 41.08 years. The mean time elapsed until treatment onset was 78.6 days, with a mean cost of 32 lost working hours per patient. In this period, 342 patients with TMJD were assisted by teleconsultation, of which 276 (80.7%) were women and 66 (19.2%) were men with a mean age of 38.3 years. Only 35 (10%) patients presented some other TMJ pathology that required maxillofacial surgery. The remaining 307 (89.7%) received non-surgical treatment in the primary care center (high resolutive consultations) in a mean time of 2.3 days (p<0.05), and a mean cost of 16 lost working hours/patient (p<0.05). CONCLUSIONS: Telemedicine allows a correct diagnosis and an adequate treatment for the majority of TMJD from primary care sites and shortens the delay in treatment onset, preventing displacement and unnecessary costs for these patients.