Psychological factors and perceptions of pain associated with dental treatment

Abstract

Although pain during dental treatment has been identified as playing a major role in the onset of dental anxiety and is a major concern of patients when seeking dental care, there have been very few studies of the prevalence of pain during dental treatment and the factors associated with patients' perceptions of pain. This study used data from a longitudinal population-based study to assess the proportion of dental attenders who experienced pain while having dental treatment and the psychological characteristics which predisposed them to experience pain. Of 1422 subjects who completed questionnaires at baseline and five-year follow-up, 96.4% had visited a dentist over the observation period. Two fifths, 42.5%, reported having pain during treatment and one-fifth, 19.1%, had pain that was moderate to severe in intensity. Reports of pain were associated with the types of treatment received, and a number of baseline sociodemographic and psychological factors. In a logistic regression analysis predicting the probability of pain, a variable documenting the number of types of invasive treatment received (restorations, extractions, crowns/bridges, root canal therapy and periodontal treatment/surgery) had the strongest independent effect. Pain was also more likely to be reported by those with previous painful experiences and those who were anxious about dental treatment, expected treatment to be painful and felt that they had little control over the treatment process. Pain was less likely to be reported by those who said they were unwilling to accept or tolerate pain. Younger subjects and those with higher levels of education were more likely to report pain than older subjects and those with a lower educational level. These results indicate that pain is as much a cognitive and emotional construct as a physiological experience. They also have implications for dentists' behaviour when providing dental care.

Avaliação do grau de ansiedade dos pacientes antes de cirurgias orais menores

“…No que se refere à relação idade e ansiedade, os resultados são bastante diversificados na literatura. Alguns estudos relacionam uma maior ansiedade em pacientes jovens e adultos, em relação aos idosos 13 , estando relacionados com autores que afirmam que a ansiedade diminui com o passar dos anos 19 , enquanto outros demonstram que há uma maior ansiedade em pacientes idosos em relação aos mais jovens, sendo esta justificada por experiências traumáticas no tempo em que eram jovens 20 . No presente estudo, não houve correlação (teste de correlação de Spearman, p>0,05) entre idade dos voluntários e os valores de ansiedade, apresentando resultados semelhantes a diversos autores que afirmam que fatores sociodemográficos, como idade, não apresentam relação nenhuma com os níveis de ansiedade [9][10][11] .…”

“…Existem estudos indicando que os níveis de ansiedade são mais altos entre indivíduos com mais de 24 anos de idade 12 . Tratamentos odontológicos invasivos -como restaurações, extrações, procedimento protético de coroas/pontes, tratamento endodôntico e tratamento periodontal/cirurgia -foram associados com maior probabilidade de sentir dor durante o procedimento odontológico 13 . Entre os procedimentos odontológicos, a injeção anestésica é um dos principais fatores na produção de fobia e ansiedade durante o tratamento.…”

“…Tem sido relatado que a punção com a agulha anestésica e os procedimentos clínicos mais invasivos, como cirurgias orais, são os procedimentos mais estressantes 8 . Estudos evidenciaram uma relação positiva entre ansiedade e dor relativas ao tratamento odontológico 13,14 e que, quando somado ao fato de os procedimentos relatados na literatura como maiores geradores de ansiedade serem as injeções anestésicas e as cirurgias orais menores, como a exodontia 15,16 , reforça-se a possibilidade de a anestesia estar entre os procedimentos mais dolorosos, bem como permite supor que as cirurgias orais menores, como a exodontia, estejam entre os procedimentos invasivos mais dolorosos. Apesar de a escala de CORAH (1969) ter embasamento científico como questionário para avaliação da ansiedade, foi realizado um teste-piloto com 20% da amostra total para avaliar se havia um entendimento do paciente perante o questionamento do operador.…”

Management of fear and anxiety in the dental clinic: a review

“…While pain is cued by a physiological process it also has a strong cognitive component, and people with dental anxiety can have both exaggerated pain expectancies and pain perceptions. [19][20][21] Clinicians need to be aware that managing patient pain is not the same as managing patients' anxiety and fear. First, the actual act of administering local anaesthesia by intraoral injection is, for many anxious people, one of the most stressful and fearevoking aspects of the dental experience.…”

Psychological intervention in acute dental pain: review

“…Maggirias and Locker 5 found that patients with high scores on the Pain Tolerance Scale (PTS) were less likely to report painful dental experiences; those patients have previously agreed with the statement 'I would be angry if I felt pain during dental treatment' and disagreed with the statement 'If I am in pain I just put up with it', suggesting that patients may either interpret sensations and experiences as something other than pain or those patients are more successful at conveying concerns regarding pain to dentists. Dentists may then modify their clinical and interpersonal approach to minimise the possibility of pain or the perception of pain.…”