Page 33 - Demo

Anxiety and pain related to mandibular block injections312The aim of this study was to determine if there was a difference in the physiological responses between patients with low pain scores (<7 NRS) and patients with high pain scores (7-10 NRS). There was a significant increase in sweat secretion and a significant decrease in RSP between the relax-phase and the oral injection. There was also a significant positive relationship between experienced anxiety and HR in phase 4. Patients with higher scores for experienced anxiety had a higher HR during the injection. However, there was no significant difference in the physiological response between patients who had scores <7 and ≥7 for experienced pain. This could possibly be explained by the small group of patients in the higher pain group. There were only eight patients with scores ≥7 for experienced pain. One could postulate that physiologic responses are mainly caused by the vasoconstrictor in the local anesthetic. Vasoconstrictors, principally adrenalin, contribute to successful local anesthetic by increasing the depth and duration of analgesia and providing hemostasis. Furthermore, by concentrating the local anesthetic agent at the infiltration site, the vasoconstrictor decreases the risk for systemic side effects of the local anesthetic. The hemodynamics during local anesthesia are greatly affected by pain and anxiety and slightly by the vasoconstrictor.19 The hemodynamic effects of epinephrine-containing local anesthetics are considered small. Several authors found only a small increase in HR and a small reduction in mean arterial blood pressure after a single local anesthetic injection containing epinephrine.20-22 Several studies demonstrated that the cardiovascular effect of administration of dental anesthetic is mainly influenced by anxiety and is most significantly manifested by an increase in HR.19,24,25 Larger amounts of epinephrine-containing local anesthetics, however, result in an increased HR, stroke volume, and cardiac index in a dosedependent fashion with no significant changes in blood pressure.26In the present study, the mean expected pain score was significantly higher than the experienced pain score. This was also found in an earlier study by our research group where the experienced mean pain intensity as a result of a mandibular injection was 2.4, which is slightly lower than the pain intensity of 3.4 found in the present study.11 The relationship between the intensity of dental anxiety and the treatment experience is controversial. Dental anxiety is greatest among people who had never visited a dentist and lowest among