Inhalarea de metoxifluran reduce anxietatea, dar nu și durerea pacienţilor trataţi de afecţiuni carioase și pulpare: studiu prospectiv randomizat

Abstract

Introducere. Caria dentară și complicațiile ei reprezintă o problemă socială și economică mondială, de aceea măsurile de prevenire și tratament au devenit principala preocupare a stomatolgiei. Frica față de durerea din timpul intervențiilor stomatologice și neîncrederea în metodele de analgezie fac ca pacientul să evite consultul la medicul stomatolog și să se adreseze doar la apariția complicațiilor. De aceea, îndemânarea medicului stomatolog de a asigura o analgezie eficientă în timpul intervenției este o condiție indispensabilă unui tratament calitativ. O terapie solitară antidoloră nu este suficientă 100% în practica dentară, ci doar combinarea mai multor factori are un efect cumulativ pozitiv: pregătirea psihică, sedarea farmacoterapeutică și anestezia loco-regională. În acest context, utilizarea analgezicului inhalator (AI) metoxifluran, ar putea fi o soluție optimă pentru asigurarea confortului în practica medicinei dentare. Material și metode. Studiul a fost efectuat pe un eșantion de 101 pacienți, vârsta medie 29,2 de ani, cu diagnoza de carie dentară, pulpită și defect cuneiform. Pacienții au fost divizați în două grupuri: grupul „metoxifluran” (60 de pacienți), cărora le-a fost administrat AI respectiv și grupul de referință (41 de pacienți), care a primit AL. S-a evaluat comparativ anxietatea și durerea pacientului înainte, în timpul și după tratament cu ajutorul scalei ratei numerice (SRN). Rezultate. O anxietate de ≥5 SRN a fost constatată la 22 (37%) de pacienți din lotul „metoxifluran” și la 16 (39%) – în lotul de referință, ca la sfârșitul tratamentului să fie absentă la 100% dintre pacienții lotului „metoxifluran” și la 95 % dintre cei din lotul de referință. La sondarea intrapulpară, au acuzat durere toți pacienții din grupul „metoxifluran”, fapt care a necesitat trecerea la protocolul alternativ de analgezie, pentru a putea efectua pulpectomia. La pacienții din grupul cu anestezie locală, durerea la sondarea intrapulpară lipsea completamente și a fost posibilă pulpectomia fără a recurge la analgezie de alternativă în toate cazurile. S-a constatat o corelație ușoară dintre anxietate și durere înaintea tratamentului stomatologic (r1 2=0,18 și, respectiv, r2 2=0,22), fapt ce nu s-a mai constatat la sfârșitul tratamentului. Concluzii. Metoxifluranul a demonstrat o acțiune anxiolitică superioară anesteziei locale în tratamentul stomatologic al afecțiunilor carioase și pulpare. Analgezia cu metoxifluran nu a asigurat desinestătător un nivel de analgezie suficient pentru asigurarea confortului pacientului în timpul tratamentului stomatologic al afecțiunilor carioase și pulpare, deseori fiind necesară recurgerea la analgezia de alternativă. S-a constat o corelare ușoară dintre gradul de anxietate și intensitatea durerii până la începerea procedurilor curative stomatologice.

Introduction. Dental caries and its complications represent a social and economic issue worldwide, thus its prevention and treatment have become one of the main concerns of dentistry. Fear of pain during dental procedures and the distrust towards classic analgesic solution lead to a tendency of avoiding dental visits and the patients seek the doctors consult only when complications arise. Therefore, the skill of the dentist in providing an effective analgesia during the dental inprocedures is a prerequisite for quality treatment. A single pain therapy will not suffice in dental practice, but only by combining several factors, there will be achieved a cumulative positive effect: mental preparedness, pharmacotherapeutic sedation and loco-regional anesthesia. In this context, the use of the analgesic inhaler (AI) – methoxyflurane may be an optimal solution for ensuring comfort in the practice of dentistry. Material and methods. The study was conducted on a sample of 101 patients, with a mean age of 29.2 years, with a diagnosis of dental caries, pulp diseases and wedge-shaped defect. Patients were divided into two groups: “methoxyflurane” group (60 patients) and the reference group (41 patients) who received local anesthesia. There was made a comparative analysis between the the levels of pain and anxiety before, during and after treatment with the help of the numeric rating scale (NRS). Results. An anxiety level of ≥5 NRS was observed in 22 (37%) patients in the “methoxyflurane” group and in 16 patients (39%) from the reference group, afterwards (at the end of treatment) being absent in 100% of patients in the “methoxyflurane” group and in 95% of those from the reference group. At intrapulpal probing, all the patients from the “methoxyflurane” group have complained of pain, which required using alternative analgesic protocols, in order to be able to execute pulpectomy. For patients from the “local anesthesia” group, there was no pain at intrapulpal probing and thus pulpectomy has been possible without resorting to alternative analgesia in all the clinical cases. We found a weak correlation between anxiety and pain levels before dental treatment (r1 2=0,18 and respectively r2 2=0,22), which has not been observed at the end of treatment. Conclusions. Methoxyflurane has shown an anxiolytic effect that is superior to its potential effect of local anesthesia in the dental treatment of caries and diseases of pulp. Methoxyfluraneinduced analgesia did not provide a sufficient analgesic effect by itself in order to be able of ensuring the patient’s comfort during dental treatment of caries and pulpal diseases, often requiring the use of an alternative analgesia solution. There was observed a weak correlation between the degree of anxiety and pain intensity before the start of dental therapeutic procedures.

Introduction. Dental caries and its complications represent a social and economic issue worldwide, thus its prevention and treatment have become one of the main concerns of dentistry. Fear of pain during dental procedures and the distrust towards classic analgesic solution lead to a tendency of avoiding dental visits and the patients seek the doctors consult only when complications arise. Therefore, the skill of the dentist in providing an effective analgesia during the dental inprocedures is a prerequisite for quality treatment. A single pain therapy will not suffice in dental practice, but only by combining several factors, there will be achieved a cumulative positive effect: mental preparedness, pharmacotherapeutic sedation and loco-regional anesthesia. In this context, the use of the analgesic inhaler (AI) – methoxyflurane may be an optimal solution for ensuring comfort in the practice of dentistry. Material and methods. The study was conducted on a sample of 101 patients, with a mean age of 29.2 years, with a diagnosis of dental caries, pulp diseases and wedge-shaped defect. Patients were divided into two groups: “methoxyflurane” group (60 patients) and the reference group (41 patients) who received local anesthesia. There was made a comparative analysis between the the levels of pain and anxiety before, during and after treatment with the help of the numeric rating scale (NRS). Results. An anxiety level of ≥5 NRS was observed in 22 (37%) patients in the “methoxyflurane” group and in 16 patients (39%) from the reference group, afterwards (at the end of treatment) being absent in 100% of patients in the “methoxyflurane” group and in 95% of those from the reference group. At intrapulpal probing, all the patients from the “methoxyflurane” group have complained of pain, which required using alternative analgesic protocols, in order to be able to execute pulpectomy. For patients from the “local anesthesia” group, there was no pain at intrapulpal probing and thus pulpectomy has been possible without resorting to alternative analgesia in all the clinical cases. We found a weak correlation between anxiety and pain levels before dental treatment (r1 2=0,18 and respectively r2 2=0,22), which has not been observed at the end of treatment. Conclusions. Methoxyflurane has shown an anxiolytic effect that is superior to its potential effect of local anesthesia in the dental treatment of caries and diseases of pulp. Methoxyfluraneinduced analgesia did not provide a sufficient analgesic effect by itself in order to be able of ensuring the patient’s comfort during dental treatment of caries and pulpal diseases, often requiring the use of an alternative analgesia solution. There was observed a weak correlation between the degree of anxiety and pain intensity before the start of dental therapeutic procedures.