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16-02-2012 | General practice | Article

Patient anxiety is a predictor of self-reported pain during routine dental visits


Free abstract

MedWire News: Patients with "dental anxiety" are significantly more likely to report experiencing pain during routine procedures, research shows.

In addition, the use of local anesthetic and the type of procedure, namely extractions, were also significant predictors of pain.

"Contrary to popular belief, the majority of commonly provided dental treatments are not painful, as 75% of participants reported no pain during the procedure," report Vishal Aggarwal (University of Manchester, UK) and colleagues.

Writing in Community Dentistry and Oral Epidemiology, the researchers concede that patients, historically, perceive dental procedures as "painful and uncomfortable."

Negative emotions, including anxiety, have been previously shown to influence pain perception and remain a significant barrier in patients accessing dental care.

Aggarwal and colleagues attempted to identify factors that influence pain intensity among 451 dental patients undergoing routine procedures. The participants, 45% of whom received local anesthetic, rated the intensity and character of the pain experienced once the procedure was completed.

Fifteen patients (3.4%) reported being very anxious prior to visiting the dentist, with women slightly more anxious than men.

In total, 339 patients reported experiencing no pain at all during the procedure. The self-reported pain in the remaining 25% of patients was typically described as tenderness. Sharp and shooting pain was reported in 12.5% and 7.0% of patients, respectively.

Patients having an extraction were significantly more likely to experience pain compared with those undergoing routine examinations or scaling (odds ratio [OR]=3.31). Very anxious patients were also significantly more likely to experience pain than those without anxiety (OR=5.20). Local anesthetic use was also a significant predictor of pain (OR=2.27).

In a multivariate model, the strongest predictors of self-reported pain were dental anxiety (OR=4.98) and local anesthetic use (OR=2.79).

The association between self-reported pain and high levels of anxiety is an expected finding and has been observed in other studies, according to Aggarwal and colleagues. They note, however, that the prevalence of severe anxiety in this study was significantly lower than that observed in other trials.

To improve patient care, dentists need to assess their patients preoperatively for anxiety about the procedures and to "use appropriate patient management techniques based on the outcomes of the assessment," they conclude.

By MedWire Reporters

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