Study On Influence Of Dental Anxiety On Patients' Pain Experience During Orthodontic Treatment

Objective:Pain and discomfort after placement of the appliance arecommon experiences among orthodontic patients. It has been reported thatfear of pain is a key factor in discouraging patients from seekingorthodontic treatment. Further, Patel V had found that a small butsignificant proportion of patients (8%) discontinued treatment because ofthe pain experienced in the early stages of appliance therapy. Pain during orthodontic treatment is not only one kind ofphysiological feeling,but also links with the psychological factor that mightaffect the degree of pain.It is a quite important question fordiscussion.However, only a limited number of studies have specificallyinvestigated this subject. Methods: Sixty-five patients attending the Orthodontic Department atthe Affiliated Stomatological Hospital of CQUMS were admitted to thestudy on the basis that they were willing to participate and satisfied thefollowing criteria.Informed and witnessed consent was obtained frompatients, parents/guardian. A randomized clinical trial was performed to compare the nature,prevalence, intensity, and duration of pain related to the use of fixedappliances. 65 subjects participated in the study, the pain response beingassessed by each of the visual analogue scales, the questionnaires. Each of 65 patients was asked to complete a questionnaire modifiedfrom dental anxiety scale (DAS) before orthodontic treatment, and tocomplete a table with VAS score of pain after placement of the applianceeveryday in one month. The same verbal instructions and questionnaireswere given to each one:One month later,each patient must finish a tableabout intensity and time of pain. 1. Daily record of pain/discomfort. This measured by means of 10cmvisual analogue scales (VAS) and MPQ,the pain at four periods during each24 hours; at 09:00, 13:00, 17:00, and 21:00 hours over 15 days. 2. No tablet consumption. Statistical analysis: All responses from the questionnaires were stored,coded, and analyzed with the SAS 6.12 package. Standard methods ofanalysis were used including one-way analysis of variance and multiplestepwise regression analysis. Associations between continuous variableswere evaluated by the Spearman rank correlations. The levels of statistical significance employed in all tests were 0.05:P<0.05,statistically significant; P<0.01, statistically highly significant;P<0.001, statistically very highly significant. Results: 30.77% of all had DAS scores≥11 indicating obviouslydental anxiety.Scores were significantly higher in such cases as:who hadlower extent of pain endurance and who was in tense mood on thatday(P<0.01). The pain response was found to be highly and consistently subjective,not related to sex, or social class; however, a statistically significantassociation was found between the age and the duration of pain(P<0.05). There was statistical significance in VAS score of pain between thetwo groups(catastrophizer and non- catastrophizer)(P<0.01),while nostatistical significance in duration of pain(P>0.05). Conclusion: The results of this study imply that patient attitude maypredict the amount of discomfort occurring during treatment, which in turn,may predict patient acceptance of appliance and treatment on the whole andhis/her compliance. Therefore,cure and nurse staff should take necessarymeasures to provide patients with psychological therapy and nursingguidiance before orthodontic treatment.