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BACKGROUND: Anxiety during oral surgery can impact patient homeostasis, increase the difficulty of the procedure and create additional stress for the surgeon. Furthermore, it has been associated with more intense and prolonged pain during and after dental treatment. OBJECTIVES: The aim of the study is to evaluate the relationship between anxiety, patient characteristics and pain outcomes in oral surgery, as well as to verify the impact of anxiety on patient's perception of pain during and after oral surgery. MATERIAL AND METHODS: This is a prospective observational study. Several variables were evaluated during the course of the oral surgery. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), the Interval Scale of Anxiety Response (ISAR), and Patient SelfRated Anxiety (PAnx) during the procedure. RESULTS: General anxiety measures (STAI) were not associated with specific dental anxiety or external observations of anxiety. Anxiety levels varied according to gender and body mass index (BMI), and were correlated with increased heart rate (HR) (with variability among assessment tools). Odontectomy, ostectomy and an increased volume of anesthesia were associated with higher anxiety levels (with variability among the assessment tools). There was a correlation between pain and anxiety, with anxiety contributing to approx. 12% of the variability in postoperative pain. CONCLUSIONS: Dental anxiety is a complex, multidimensional mental phenomenon characterized by high variability due to the influence of several dynamic factors.

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PURPOSE: The aim of the present investigation was to determine the degree of anxiety and fear in patients treated at the dental school clinics of the Universidade Federal de Pernambuco (Brazil) regarding the different types of treatment offered. MATERIALS AND METHODS: The sample was made up of 400 patients from both genders over 18 years of age treated between July and October 2007. Data collection was carried out through the administration of validated questionnaires by a calibrated researcher. The Modified Dental Anxiety Scale (MDAS) and Gatchel's Scale were used to evaluate the degree of anxiety and fear among the patients. RESULTS: There was a 23.0% prevalence of dental anxiety; 9.5% were very anxious, 13.5% were anxious and 77.0% were not anxious. Women were more anxious than men (20.7% and 11.3%, respectively, P = 0.995). The age group that exhibited the highest prevalence of anxiety was 30 to 39 years (29.3%). Regarding fear, 13.5% felt extreme fear; 30.5% felt moderate fear and 56% felt no fear. Schooling was the only significant socioeconomic factor for both anxiety and fear. In the association between fear and anxiety, 38.9% of the patients with extreme fear were classified as very anxious. CONCLUSION: The majority of individuals were classified as non-anxious and without fear regarding dental procedures.

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En el siguiente artículo se realizará un recorrido posible para pensar el lugar del ¶miedo÷ en la práctica quirúrgica, así como también el lugar de un recurso farmacológico frecuentemente utilizadopara disminuir ¶el dolor÷: ¶la anestesia÷. Desde un abordaje interdisciplinario se interrogarán conceptos teóricos utilizados cotidianamente por odontólogos y cirujanos. El trabajo finaliza con el planteo de un primer tiempo en el protocolo quirúrgico: tiempo de escucha, tiempo de preguntas, tiempo de informar.(AU)

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En el siguiente artículo se realizará un recorrido posible para pensar el lugar del “miedo” en la práctica quirúrgica, así como también el lugar de un recurso farmacológico frecuentemente utilizadopara disminuir “el dolor”: “la anestesia”. Desde un abordaje interdisciplinario se interrogarán conceptos teóricos utilizados cotidianamente por odontólogos y cirujanos. El trabajo finaliza con el planteo de un primer tiempo en el protocolo quirúrgico: tiempo de escucha, tiempo de preguntas, tiempo de informar.

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PURPOSE: Oral and oropharyngeal tumor resection may be associated with disfigurement and dysfunctions that affect essential domains of life. This study aimed at assessing the immediate impact of primary surgery on the health-related quality of life for these patients. PATIENTS AND METHODS: Forty-seven patients with squamous cell carcinoma of the lips, oral cavity, or oropharynx, and undergoing treatment in the head and neck surgery center of a large general hospital in the city of São Paulo, Brazil, from October 2005 to September 2006, completed the University of Washington Quality of Life questionnaire pre- and postoperatively (before hospital discharge). A paired t test evaluated differences between assessments; Poisson regression estimated ratios of ratings attributed to each domain (pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder pain, taste, saliva, mood, and anxiety) per patient stratified by sociodemographic, clinical, and behavioral characteristics. RESULTS: The immediate impact of surgery on health-related quality of life corresponded to a 31.1% reduction in the overall rating. The most affected domains were chewing (-73.5%), taste (-61.4%), swallowing (-57.3%), speech (-46.0%), and pain (-42.3%). Anxiety (+65.5%) was the sole domain that improved immediately after surgery. Comparisons involving subgroups of patients indicated that different clinical conditions (regional metastasis, tumor size, and location) were not associated with discrepant health-related quality of life immediately after surgery. CONCLUSIONS: The routine pre- and postoperative assessment of health-related quality of life may contribute to evaluate treatment effectiveness, which would otherwise rely exclusively on assessing end-point results such as survival and tumor relapse. This information is relevant to attenuate the prejudicial impact of surgery on the physical and psychosocial functioning of patients.

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This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, 3rd version), aiming at appraising its ability to identify different patterns of health-related quality of life of patients with oral cancer in Brazil. Patients (N = 100) were interviewed as they were undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital ("Hospital das Clínicas", School of Medicine, University of São Paulo). The results were compared based on categories of socio-demographic and clinical characteristics of the patients. At a one-year follow-up, 20 patients had died, and 24 were considered dropouts. The remaining patients accounted for the longitudinal assessment of modifications in the self report of quality of life. Patients with larger tumours and neoplasms in the posterior part of the mouth presented significantly (p < 0.05) poorer indications of quality of life. Chewing was the poorest rated domain (35.0/100.0), and presented the highest proportion of complaints both at the baseline and at the follow-up assessments. The questionnaire allowed the identification of important contrasts (while comparing clinical characteristics) and similarities (while comparing socio-demographic status) among subsets of respondents, and it can contribute to reduce the impact of treatments and improve subsequent patient management.

O presente estudo realizou teste de campo para uma versão em Português do questionário de qualidade de vida da Universidade de Washington (UW-QOL, 3ª versão), com o intuito de avaliar sua capacidade em descrever padrões diferenciais de qualidade de vida de pacientes com câncer de boca no contexto brasileiro. Foram entrevistados 100 pacientes com carcinoma epidermóide oral no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os resultados foram comparados por características sócio-demográficas e clínicas dos pacientes. Após um ano, 20 pacientes haviam falecido e 24 não foram localizados. A re-entrevista dos demais permitiu o acompanhamento longitudinal de modificações na auto-avaliação de qualidade de vida. Pacientes com tumores maiores e neoplasia na porção posterior da boca apresentaram indicadores de pior qualidade de vida (p < 0.05). Mastigação foi o item com pior avaliação (35,0/100,0) e maior proporção de queixas, tanto na avaliação inicial como no seguimento longitudinal. O questionário permitiu identificar relevantes contrastes (na comparação de características clínicas) e similaridades (na comparação de características sócio-demográficas) entre os grupos de respondentes. Seu uso regular no hospital pode contribuir para reduzir o impacto das aplicações terapêuticas e aprimorar a gestão dos tratamentos.

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This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, 3rd version), aiming at appraising its ability to identify different patterns of health-related quality of life of patients with oral cancer in Brazil. Patients (N = 100) were interviewed as they were undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital ("Hospital das Clínicas", School of Medicine, University of São Paulo). The results were compared based on categories of socio-demographic and clinical characteristics of the patients. At a one-year follow-up, 20 patients had died, and 24 were considered dropouts. The remaining patients accounted for the longitudinal assessment of modifications in the self report of quality of life. Patients with larger tumours and neoplasms in the posterior part of the mouth presented significantly (p < 0.05) poorer indications of quality of life. Chewing was the poorest rated domain (35.0/100.0), and presented the highest proportion of complaints both at the baseline and at the follow-up assessments. The questionnaire allowed the identification of important contrasts (while comparing clinical characteristics) and similarities (while comparing socio-demographic status) among subsets of respondents, and it can contribute to reduce the impact of treatments and improve subsequent patient management.

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