Assessment of pre and postoperative anxiety in patients undergoing ambulatory oral surgery in primary care

To analyze the pre- and postoperative anxiety level in patients undergoing ambulatory oral surgery (AOS) in a primary healthcare center (PHC). Prospective and descriptive clinical study on 45 patients who underwent AOS procedures in the dental clinic of a public PHC of Spain between April and September 2015. Anxiety analysis was carried out with pre- and postoperative anxiety-state (STAI-S), anxiety-trait (STAI-T) and dental anxiety (MDAS) questionnaires. A descriptive, inferential and binary logistic regression analysis were performed for the variables age, sex, educational level, previous experience of oral treatment, type of oral surgery, degree of third molar impaction, surgical time, intraoperative complications, postoperative complications, and pain score with a visual analogue scale (VAS). The majority were female (57.8%) with a mean age of 33.5+9.6 years. The most frequent procedure was the lower third molar removal (82.2%). The mean pain score on the VAS was 1.6+1.8. The incidence of complications was low (7.8%). There was a statistically significant association between post- and preoperative anxiety (r=0.56, p<0.001) and a correlation between pain score and postoperative anxiety (Rho= -0.35, p=0.02). The likelihood of postoperative anxiety was related to preoperative anxiety (OR=1.3, p=0.03). AOS in a HPC is safe and should be more encouraged in the public primary care. The emotional impact on users was relatively low, highlighting that the preoperative anxiety levels were higher than the postoperative ones. Psychological factors related to pre- and postoperative anxiety should be considered in the AOS carried out in PC

Impact of the coronavirus pandemic on maxillofacial trauma:a retrospective study in southern Spain

The coronavirus pandemic has impacted health systems worldwide, with Spain being one of the most affected countries. However, little is known about the extent to which the effects of staying home, social distancing, and quarantine measures have influenced the epidemiology of patients with maxillofacial trauma. The aim of this study was to analyze the impact of the coronavirus pandemic on the incidence, demographic patterns, and characteristics of maxillofacial fractures in the largest hospital in southern Spain. Data from patients who underwent surgery for maxillofacial fractures during the first year of the pandemic between 16 March 2020 and 14 March 2021 (pandemic group) were retrospectively compared with a control group during the equivalent period of the previous year (pre-pandemic group). The incidence was compared by weeks and by lockdown periods of the population. Demographic information, aetioloy, fracture characteristics, treatment performed, and days of preoperative stay were evaluated. Descriptive and bivariate statistics were calculated (p<0.05). During the first year of the pandemic, there was a 35.2% reduction in maxillofacial fractures (n=59) compared to the pre-pandemic year (n=91, p=0.040). A significant drop was detected during the total home lockdown period of the population (p=0.028). In the pandemic group, there was a reduction in fractures due to interpersonal aggressions, an increase in panfacial fractures, a significant increase in other non-facial injuries associated with polytrauma (p=0.037), a higher number of open reduction procedures with internal fixation, and a significantly longer mean preoperative stay (p=0.016). The first pandemic year was associated with a decline in the frequency of maxillofacial trauma and a change in the pattern and characteristics of fractures. Inter-annual epidemiological knowledge of maxillofacial fractures may be useful for more efficient planning of resource allocation and surgical practice strategy during future coronavirus outbreaks and population lockdowns

Validation of the Spanish version of the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire

The Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHC-OHRQOL-Q) is an instrument designed specifically for parents and caregivers of patients with special needs that has not yet been applied in Spain. The aim of this study was to adapt it to Spanish and evaluate its reliability and validity in patients with intellectual disability (ID) treated under general anesthesia. The study was conducted in two different stages: a) cross-cultural adaptation of the original questionnaire, and b) cross-sectional study on 100 parents and caregivers who completed the piloted FHC-OHRQOL-Q. The patients were examined according to the WHO methodology. Dental treatments performed were recorded. Statistical tests were used to evaluate reliability (internal consistency) and validity (content, criterion, construct and discriminant) of the instrument. The mean age was 24 years (range=4-71 years). The most frequent causes of ID were psychomotor retardation (25%) and cerebral palsy (24%). The items most frequently answered by parents and caregivers were eating and nutrition problems (80%) and bad breath/taste (57%). Reliability (Cronbach?s alpha coefficient) was considered excellent (alpha=0.80-0.95). The analysis of the factorial validity yielded similar results to the original questionnaire. The high response rate of items (>96%) allowed content validity. Criterion validity was confirmed by a significant correlation with questions on oral health and oral well-being. Discriminant validity was demonstrated by the significant association of ?21.5 years of age with worse oral symptoms (p=0.034) and parental concerns (p=0.005), DMFT index ?3 with daily life problems (p=0.02), ?4 decayed teeth with daily life problems (p=0.001), and >2 dental extractions with oral symptoms (p=0.000), daily life problems (p=0.002) and parent´s perceptions (p=0.043). The FHC-OHRQOL-Q in Spanish is a reliable and valid instrument to apply in clinical practice to evaluate the impact of OHRQOL in mostly adult patients with ID, accessible to Spanish-speaking parents and caregivers

Oral health-related quality of life after dental treatment in patients with intellectual disability

The influence of dental treatment on oral health-related quality of life (OHRQOL) has rarely been evaluated in patients with intellectual disability (ID) through validated questionnaires. The aim of this study was to estimate the changes on OHRQOL in patients with ID after the implementation of an institutional dental treatment program under general anesthesia using the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHCOHRQOL-Q). A prospective longitudinal study was conducted on 85 patients (mean age=24.85 years) classified according to DSM-V whose parents/caregivers completed the FHC-OHRQOL-Q. We analyzed the changes in the questionnaire?s overall score and its dimensions from pre-treatment to 12-months of follow-up, considering effect sizes and minimal important differences estimated by the standard measurement error. The impact of clinical and therapeutic factors was evaluated using univariate and multiple linear regression analysis (p<0.05). Significant improvement of OHRQOL was found after dental treatment in oral symptoms (p0.001), daily life problems (p=0.018), parent?s perceptions (p=0.013) and FHCOHRQOL-Q´s overall score (p=0.001). OHRQOL changes exhibited an intermediate magnitude (0.38-0.21) as estimated by effect sizes. Changes in oral symptoms showed positive correlation with DMFT index (r=0.375, p=0.002), decayed teeth (r=0.244, p=0.036), dental extractions (r=0.424, p<0.001) and number of treatments (r=0.255, p=0.019). The improvement was greater in patients with 4 decayed teeth (p=0.049) and undergoing 2 dental extractions (p=0.002). Multiple regression analysis demonstrated that dental extractions (p<0.001) and DMFT index (p=0.028) were significantly related to oral symptom improvement. Dental treatment under general anesthesia showed a positive effect on the overall FHC-OHRQOL-Q score and most of its dimensions. At 12-months of follow-up, the improvement of oral symptoms was significantly associated with DMFT index, decayed teeth, dental extractions and number of treatments. In our clinical setting, the implementation of a dental treatment program enhanced the OHRQOL of patients with ID

La artroscopia en el daño interno de la ATM: resultados clínicos de un estudio prospectivo

The tempormandibular joint dysfunction syndrome (TMJD) syndrome has a multifactorial etiology. Patients are considered operative candidates when nonsurgical therapy fails to adequately control symptoms. Our objective is to demonstrate the efficacy of arthroscopic lysis and lavage treatment for a homogeneous group of patients diagnosed of TMJD according to clinical-radiographic parameters. Design. This article reports a prospective study of 22 articulations (13 patients) diagnosed of internal derangement of TMJ and treated with lysis and lavage arthroscopy from February 1996 to April 2001. Before and after treatment as well as during the follow-up (range: 12-63 months, mean: 27 months), the following parameters were considered: pain, MIO, protrusive and laterotrusive mobility, noises, and MRI. Results. We performed a descriptive statistical study of continuous variables, comparing the pre- and postsurgery values with Wilcoxon and Mc Nemar tests, demonstrating a significant improvement during follow-up. Mann Whitney U Test was used for comparing pain and MIO between early and advanced stages, demonstrating a significantly greater improvement for early stages. The MRI results at one year of follow-up supports improvement in 27% (II-III Wilkes stages). According to Murakami criteria we obtained 23% excellent outcome, and 77% favorable outcome. Conclusions. Joint lysis and lavage is a useful and effectiveness method for treatment of internal derangement for early stages as well as for late stages, improving pain, MIO, protrusive and laterotrusive movements, and noises significantly. The improvement of MIO with arthroscopic lysis and lavage is greater for early stages.El síndrome disfunción témporomandibular (SDTM) es un cuadro clínico multifactorial, ante el cual se preconiza un tratamiento escalonado en función de su gravedad. Nuestro objetivo es valorar la eficacia del tratamiento artroscópico mediante lisis y lavado en un grupo homogéneo de pacientes diagnosticados de SDTM según parámetros clínicoradiológicos. Diseño del estudio. Realizamos un estudio prospectivo de 22 articulaciones (13 pacientes), con el diagnóstico de daño articular interno, tratadas mediante lisis y lavado artroscópico entre febrero de 1996 y abril de 2001. Antes y después del tratamiento, así como durante el seguimiento (rango: 12-63 meses, media: 27 meses) se valoraron el dolor, MAO, movilidad en protrusiva y laterotrusiva, ruidos, y RM. Resultados. Realizamos un estudio estadístico descriptivo de las variables continuas, comparando los valores pre y posquirúrgicos con el test de Wilcoxon y Mc Nemar demostrando mejoría significativa a lo largo del seguimiento. Con el test de la U de Man Whitney se comparó el dolor y la MAO entre los estadios tempranos y tardíos de la enfermedad, siendo la mejoría significativamente mayor para los estadios tempranos. Los hallazgos radiológicos de la RM al año mejoraron en el 27% (estadios II-III de Wilkes). Según los criterios de Murakami obtuvimos una tasa de éxito del 23%, y resultado satisfactorio en el 77%. Conclusiones. El lavado y lisis articular es una técnica útil y efectiva para el SDTM, tanto en los estadíos tempranos como tardíos de la enfermedad, mejorando significativamente el dolor, MAO, protrusión, laterotrusión y los ruidos articulares. La mejoría de la apertura interincisal con la lisis y lavado artrocópico es mayor en los estadíos tempranos de la enfermedad

La artroscopia en el daño interno de la ATM: resultados clínicos de un estudio prospectivo

The tempormandibular joint dysfunction syndrome (TMJD) syndrome has a multifactorial etiology. Patients are considered operative candidates when nonsurgical therapy fails to adequately control symptoms. Our objective is to demonstrate the efficacy of arthroscopic lysis and lavage treatment for a homogeneous group of patients diagnosed of TMJD according to clinical-radiographic parameters. Design. This article reports a prospective study of 22 articulations (13 patients) diagnosed of internal derangement of TMJ and treated with lysis and lavage arthroscopy from February 1996 to April 2001. Before and after treatment as well as during the follow-up (range: 12-63 months, mean: 27 months), the following parameters were considered: pain, MIO, protrusive and laterotrusive mobility, noises, and MRI. Results. We performed a descriptive statistical study of continuous variables, comparing the pre- and postsurgery values with Wilcoxon and Mc Nemar tests, demonstrating a significant improvement during follow-up. Mann Whitney U Test was used for comparing pain and MIO between early and advanced stages, demonstrating a significantly greater improvement for early stages. The MRI results at one year of follow-up supports improvement in 27% (II-III Wilkes stages). According to Murakami criteria we obtained 23% excellent outcome, and 77% favorable outcome. Conclusions. Joint lysis and lavage is a useful and effectiveness method for treatment of internal derangement for early stages as well as for late stages, improving pain, MIO, protrusive and laterotrusive movements, and noises significantly. The improvement of MIO with arthroscopic lysis and lavage is greater for early stages.El síndrome disfunción témporomandibular (SDTM) es un cuadro clínico multifactorial, ante el cual se preconiza un tratamiento escalonado en función de su gravedad. Nuestro objetivo es valorar la eficacia del tratamiento artroscópico mediante lisis y lavado en un grupo homogéneo de pacientes diagnosticados de SDTM según parámetros clínicoradiológicos. Diseño del estudio. Realizamos un estudio prospectivo de 22 articulaciones (13 pacientes), con el diagnóstico de daño articular interno, tratadas mediante lisis y lavado artroscópico entre febrero de 1996 y abril de 2001. Antes y después del tratamiento, así como durante el seguimiento (rango: 12-63 meses, media: 27 meses) se valoraron el dolor, MAO, movilidad en protrusiva y laterotrusiva, ruidos, y RM. Resultados. Realizamos un estudio estadístico descriptivo de las variables continuas, comparando los valores pre y posquirúrgicos con el test de Wilcoxon y Mc Nemar demostrando mejoría significativa a lo largo del seguimiento. Con el test de la U de Man Whitney se comparó el dolor y la MAO entre los estadios tempranos y tardíos de la enfermedad, siendo la mejoría significativamente mayor para los estadios tempranos. Los hallazgos radiológicos de la RM al año mejoraron en el 27% (estadios II-III de Wilkes). Según los criterios de Murakami obtuvimos una tasa de éxito del 23%, y resultado satisfactorio en el 77%. Conclusiones. El lavado y lisis articular es una técnica útil y efectiva para el SDTM, tanto en los estadíos tempranos como tardíos de la enfermedad, mejorando significativamente el dolor, MAO, protrusión, laterotrusión y los ruidos articulares. La mejoría de la apertura interincisal con la lisis y lavado artrocópico es mayor en los estadíos tempranos de la enfermedad