Biomedical subjects
Publications and source records attributed to W P Vallerand.
Patients have the right to expect effective pain control and relief following dental treatment. In recent years, clinical guidelines on pain control have been published and disseminated. This article reviews current concepts of pain and principles of effective pharmacologic pain control. This material was presented as part of the 57th Tennessee Dental Association Postgraduate Dental Seminar.
PURPOSE: Previous studies have shown that perioperative patient education providing coping strategies and/or reasonable expectations regarding the postoperative course can help lessen patient anxiety and decrease pain, complications, and recovery time. This study investigated these effects following extraction of third molars. PATIENTS AND METHODS: Forty patients scheduled to undergo surgical extraction under local anesthetic and intravenous conscious sedation were randomly assigned to one of two groups. Treatment group members were given postoperative instructions that included descriptive information regarding potential sequelae (eg, pain, edema, trismus, nausea) as well as detailed information regarding analgesic use. Control group members were given basic open-ended postoperative wound care instructions. Postoperative pain and satisfaction with pain control were recorded using visual analogue scales. Analgesic consumption was also recorded. Thirty-seven patients completed the protocol. RESULTS: Patients in the treatment group reported significantly less pain during the period from 12 to 18 hours, and at 24 hours postoperatively, but there was no significant difference in analgesic consumption between groups. Patient satisfaction with pain control was significantly greater in the treatment group. CONCLUSION: These results indicate that increasing the quantity of postoperative preparatory information significantly increases pain relief and resultant satisfaction with pain control without increasing analgesic consumption.
The effects of nitrous oxide/oxygen and oral diazepam, administered individually and in combination, on memory and psychomotor coordination were evaluated. Forty healthy adult volunteers (53% male) were randomly assigned to one of four conditions: (1) 100% oxygen and placebo, (2) 50% nitrous oxide/50% oxygen and placebo, (3) 100% oxygen and 20 mg diazepam, or (4) 50% nitrous oxide/50% oxygen and 20 mg diazepam. There was no significant difference between groups with respect to age or weight. Participants' performance was tested in two areas: (1) a visual recall and recognition task and (2) psychomotor coordination as indicated by performance on Trieger's modification of the Bender Gestalt Test. There was no significant difference between the effects of nitrous oxide or diazepam on memory given individually or in combination. Significant differences in psychomotor coordination were seen when comparing groups 2, 3, and 4 with group 1. However, no significant differences existed between groups 2, 3, and 4, indicating that nitrous oxide and diazepam both affect coordination but that their effects are not additive when combined in this manner. The trends in both the memory and psychomotor data suggest diazepam to have a greater effect than nitrous oxide, and the combination to have a greater effect than either agent individually. Further investigation in this area is needed.
Ten fixed human cadaver iliums from elderly persons were studied to compare the amounts of graft material present in the anterior and posterior ilium. Average intracortical volume of surgically accessible marrow space was 15.75 mL for the anterior and 39.24 mL for the posterior ilium. Comparison of marrow volume underlying equal surface areas revealed values of 8.4 mL for the anterior and 14.8 mL for the posterior ilium. The average total volume of compressed cancellous bone obtained was 12.87 mL for the anterior and 30.31 mL for the posterior ilium. The ratio of cortical bone window surface area to resultant immediately accessible graft material was 1:0.49 for the anterior and 1:0.75 for the posterior ilium. These results confirm the greater availability of cancellous bone in the posterior ilium.
Fifty patients diagnosed with TMJ internal derangement, myalgia, and headaches, who had not responded well to nonsurgical management and subsequently underwent TMJ surgery, were retrospectively evaluated. The patients were mailed a survey asking them to evaluate the following symptoms: joint pain, joint noise, facial muscle pain, cervical and shoulder muscle pain, headache frequency and intensity, and overall head and neck pain. The majority of patients reported their symptoms as moderate to severe prior to treatment. In addition to reporting decreases in TMJ pain and noise after surgery, the majority of patients responding also reported decreases in myalgia and headaches. Twenty-two patients managed nonsurgically at the same center were also surveyed. The proportion of patients reporting their symptoms as moderate to severe prior to treatment was lower in this group. Patients reporting decreases in myalgia and headaches were in the minority. The study demonstrates that myalgia and headache symptoms associated with TMJ dysfunction that are poorly responsive to nonsurgical management may improve following TMJ surgery.
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Certain dental procedures being performed routinely can result in nerve damage. The following is a review of some of these surgical procedures coupled with a discussion of ways to avoid, diagnose and manage the nerve injuries associated with them.