Short-term Association Between Anxiety, Self-Medication and Subjective Postoperative Clinical Signs in Norwegian Patients Following Surgical Removal of Third Molar Teeth

Abstract

Statement of Problem:Gender moderates pain experience where females had a lower pain threshold and were less tolerant to pain thanmales. Less is known about postoperative self-medication and swelling. Purpose: The purpose of this pilot trial was to investigate if gender could influence the association between preoperative dental anxiety, postoperative analgesic tablet consumption and pain in Norwegian patients during a 7 day period following third molar surgery. Materials and Methods: Twenty-seven (15 females/ 12 males) consecutive Norwegian patients of ASA class I-II participated. Mean ages (SD) females/males were 29.5 (7.4)/32.7 (10.7) years, heights were 168.6 (5.4)/ 179.9 (6.0) cm, and weights were 59.3 (7.2)/80.7 (12.2) kg. A single third molar with at least one previous history of acute pericoronitis was removed using a buccal envelope flap and local anesthesia (lidocaine 2% + adrenalin 1:80 000) only. Patient consent and Norwegian Ethical Committee approval was obtained prior to trial. The patients scored their level of dental anxiety on Corah’s Dental Anxiety Scale (CDAS) just prior to surgery, and their subjective pain intensity (PI) every hour up to 12 hours after completing surgery, including the exact time patients took analgesic drugs for the first time on a 0-10 numerical rating scale (NRS). PI was scored at 8:00, 12:00, 16:00 and 20:00 hours every day for 6 days after the day of surgery. The patients had access to OTC analgesics ad libitum restricted only by the maximum daily dose regimen specific of each drug. Every tablet intake including type and dose during the observation period was noted. Data Analysis: Mean group data including specifics of the surgical procedures were calculated. Differences between data were analyzed by the Independent Samples T-Test, and Pearson’s correlation coefficients were computedwith theBivariateCorrelationsTest (IBMÂ SPSSÂ Statistics release 20.0.0). The level of 2-tailed statistical significance was P<0.05, and equal variances were not assumed for group data. Results: Mean (SD) females/males time of the day when surgery ended was 12:49 (2:05)/11:41 (2:18) hours. The corresponding volumes of local anesthetic were 2.7 (0.27)/3.2 (0.5) ml. Times used for obtaining effect of local anesthetic were 2.2 (1.3)/4.5 (4.1) min, and times used for surgery were 16:32 (8:39)/15:05 (5:35) min:sec. Females and males differed with respect to height and weight (P=0.000), and volume of local anesthetic used (P=0.029). The numerical difference in time for local anesthetic effect was not statistically significant (P=0.88). CDAS scores were 8.5 (3.3)/7.4 (2.6), times to first drug intake 2:50 (2:26)/3:35 (2:02) hrs:min, PI at the first drug intake 4.8 (2.9)/4.7 (2.1), sum tablets over