Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지
DOI QR코드

DOI QR Code

Extraction of mandibular third molars: relationship of preoperative anxiety with body mass index, serum high-sensitivity C-reactive protein levels, and visual analog scale scores and predictors of postoperative complications

  • Eunjee Lee (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong) ;
  • Yu-Jin Jee (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong) ;
  • Jaewoong Jung (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong) ;
  • Mu Hang Lee (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong) ;
  • Sung ok Hong (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong)
  • Received : 2023.05.26
  • Accepted : 2023.06.29
  • Published : 2023.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: Patients undergoing oral surgery exhibit high anxiety, which may elevate their cortisol levels and affect postoperative recovery. Overweight patients are often encountered in the dental clinic due to the increasing prevalence of overweight. We aimed to investigate the relationships between preoperatively assessed body mass index (BMI), serum cortisol and high-sensitivity C-reactive protein (hs-CRP) levels, and visual analog scale (VAS) scores and preoperative anxiety in patients undergoing mandibular third molar (MM3) extraction and to identify predictors of postoperative complications. Patients and Methods: We analyzed 43 patients (age, 20-42 years) undergoing MM3 extraction. At the first visit, patients completed the Modified Dental Anxiety Scale (MDAS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaires. Their BMI and VAS scores were also calculated. The participants underwent blood tests 1 hour before MM3 extraction. On the first postoperative day, the participants' VAS scores and serum hs-CRP levels were reevaluated. Results: We found that BMI was significantly correlated with preoperative VAS scores. Further, BMI and preoperative hs-CRP levels were significantly correlated among women and patients undergoing extractions of fully impacted MM3s. No correlations were found between serum cortisol and other variables. The preoperative MDAS and VAS scores were significantly positively correlated, especially among patients undergoing extractions of fully impacted MM3s. Multiple linear regression showed that BMI and the eruption status of the MM3 were significant predictors of postoperative hsCRP levels and VAS scores, respectively. Conclusion: In MM3 removals, patients with higher BMI showed elevated hs-CRP and higher VAS scores before surgery. Patients with higher anxiety among those undergoing extractions of fully impacted MM3s showed higher preoperative VAS scores. The two main predictors of postoperative complications were BMI and MM3 eruption status.

Keywords

References

  1. Agras S, Sylvester D, Oliveau D. The epidemiology of common fears and phobia. Compr Psychiatry 1969;10:151-6. https://doi.org/10.1016/0010-440x(69)90022-4
  2. Tanidir AN, Atac MS, Karacelebi E. Information given by multimedia: influence on anxiety about extraction of impacted wisdom teeth. Br J Oral Maxillofac Surg 2016;54:652-7. https://doi.org/10.1016/j.bjoms.2016.03.026
  3. Earl P. Patients' anxieties with third molar surgery. Br J Oral Maxillofac Surg 1994;32:293-7. https://doi.org/10.1016/0266-4356(94)90049-3
  4. Kazancioglu HO, Tek M, Ezirganli S, Demirtas N. Does watching a video on third molar surgery increase patients' anxiety level? Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:272-7. https://doi.org/10.1016/j.oooo.2014.10.012
  5. Sbirkova T, Мassaldjieva R, Neychev D, Raycheva R. Anxiety and changes in physiological parameters during surgical procedures for removal of impacted mandibular third molars in young adults. J Int Dent Med Res 2021;14:221-7.
  6. Xu JL, Xia R. Influence factors of dental anxiety in patients with impacted third molar extractions and its correlation with postoperative pain: a prospective study. Med Oral Patol Oral Cir Bucal 2020;25:e714-9. https://doi.org/10.4317/medoral.23293
  7. George JM, Scott DS, Turner SP, Gregg JM. The effects of psychological factors and physical trauma on recovery from oral surgery. J Behav Med 1980;3:291-310. https://doi.org/10.1007/bf00845053
  8. Vallerand WP, Vallerand AH, Heft M. The effects of postoperative preparatory information on the clinical course following third molar extraction. J Oral Maxillofac Surg 1994;52:1165-70; discussion 1170-1. https://doi.org/10.1016/0278-2391(94)90536-3
  9. Gao Q, Mok HP, Zhang HY, Qiu HL, Liu J, Chen ZR, et al. Inflammatory indicator levels in patients undergoing aortic valve replacement via median sternotomy with preoperative anxiety and postoperative complications: a prospective cohort study. J Int Med Res 2021;49:300060520977417. https://doi.org/10.1177/0300060520977417
  10. Litt MD. A model of pain and anxiety associated with acute stressors: distress in dental procedures. Behav Res Ther 1996;34:459-76. https://doi.org/10.1016/0005-7967(96)00015-0
  11. Benjamins C, Asscheman H, Schuurs AH. Increased salivary cortisol in severe dental anxiety. Psychophysiology 1992;29:302-5. https://doi.org/10.1111/j.1469-8986.1992.tb01703.x
  12. Krueger TH, Heller HW, Hauffa BP, Haake P, Exton MS, Schedlowski M. The dental anxiety scale and effects of dental fear on salivary cortisol. Percept Mot Skills 2005;100:109-17. https://doi.org/10.2466/pms.100.1.109-117
  13. Yfanti K, Kitraki E, Emmanouil D, Pandis N, Papagiannoulis L. Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study. Stress 2014;17:296-304. https://doi.org/10.3109/10253890.2014.918602
  14. Preiss K, Brennan L, Clarke D. A systematic review of variables associated with the relationship between obesity and depression. Obes Rev 2013;14:906-18. https://doi.org/10.1111/obr.12052
  15. Lykouras L, Michopoulos J. Anxiety disorders and obesity. Psychiatriki 2011;22:307-13.
  16. Tayefi M, Shafiee M, Kazemi-Bajestani SMR, Esmaeili H, Darroudi S, Khakpouri S, et al. Depression and anxiety both associate with serum level of hs-CRP: a gender-stratified analysis in a population-based study. Psychoneuroendocrinology 2017;81:63-9. https://doi.org/10.1016/j.psyneuen.2017.02.035
  17. Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health 2009;9:20. https://doi.org/10.1186/1472-6831-9-20
  18. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 1996;82:445-51. https://doi.org/10.1097/00000539-199603000-00002
  19. Shin WJ, Kim YC, Yeom JH, Cho SY, Lee DH, Kim DW. The validity of Amsterdam Preoperative Anxiety Information Scale in the assessment of the preoperative anxiety - compared with hospital anxiety depression scale and visual analogue scale -. Korean J Anesthesiol 1999;37:179-87. https://doi.org/10.4097/kjae.1999.37.2.179
  20. Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: a prospective study. Clin J Pain 2005;21:439-45. https://doi.org/10.1097/01.ajp.0000135236.12705.2d
  21. Zhao G, Ford ES, Dhingra S, Li C, Strine TW, Mokdad AH. Depression and anxiety among US adults: associations with body mass index. Int J Obes (Lond) 2009;33:257-66. https://doi.org/10.1038/ijo.2008.268
  22. Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. Int J Obes (Lond) 2010;34:407-19. https://doi.org/10.1038/ijo.2009.252
  23. Barry D, Pietrzak RH, Petry NM. Gender differences in associations between body mass index and DSM-IV mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Ann Epidemiol 2008;18:458-66. https://doi.org/10.1016/j.annepidem.2007.12.009
  24. Scott KM, McGee MA, Wells JE, Oakley Browne MA. Obesity and mental disorders in the adult general population. J Psychosom Res 2008;64:97-105. https://doi.org/10.1016/j.jpsychores.2007.09.006
  25. Bankier B, Barajas J, Martinez-Rumayor A, Januzzi JL. Association between C-reactive protein and generalized anxiety disorder in stable coronary heart disease patients. Eur Heart J 2008;29:2212-7. https://doi.org/10.1093/eurheartj/ehn326
  26. Kim T, Ganocy SJ, Antonelli M, Einstadter D, Ballou S. Association of CRP with BMI in males and females. Arthritis Rheumatol 2017;69(Suppl 10):1954.
  27. Kandemir S, Oksan T, Alpoz AR, Ergezer G, Kabalak T. Salivary cortisol levels in children during dental treatment. J Marmara Univ Dent Fac 1997;2:639-42.
  28. Selimuzzaman SM, Begum N, Islam N, Begum S. Effects of surgical stress on serum cortisol level: a comparative study between elective and emergency surgery. J Bangladesh Soc Physiol 2007;2:28-33. https://doi.org/10.3329/jbsp.v2i0.981
  29. Manso Platero FJ, Calatayud Sierra J, Carrillo Baracaldo JS, Barberia Leache E, Zaragoza Rubira JR. [Anxiety, inflammation and duration of operation: is there a relationship?] Av Odontoestomatol 1989;5:31-4. Spanish.
  30. Ozalp G, Sarioglu R, Tuncel G, Aslan K, Kadiogullari N. Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand 2003;47:26-9. https://doi.org/10.1034/j.1399-6576.2003.470105.x
  31. Feeney SL. The relationship between pain and negative affect in older adults: anxiety as a predictor of pain. J Anxiety Disord 2004;18:733-44. https://doi.org/10.1016/j.janxdis.2001.04.001
  32. Martinez-Urrutia A. Anxiety and pain in surgical patients. J Consult Clin Psychol 1975;43:437-42. https://doi.org/10.1037/h0076898
  33. Kain ZN, Sevarino FB, Rinder C, Pincus S, Alexander GM, Ivy M, et al. Preoperative anxiolysis and postoperative recovery in women undergoing abdominal hysterectomy. Anesthesiology 2001;94:415-22. https://doi.org/10.1097/00000542-200103000-00009
  34. Kalkman JC, Visser K, Moen J, Bonsel JG, Grobbee ED, Moons MKG. Preoperative prediction of severe postoperative pain. Pain 2003;105:415-23. https://doi.org/10.1016/s0304-3959(03)00252-5
  35. Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997;85:808-16. https://doi.org/10.1097/00000539-199710000-00017
  36. Duskova M, Vasakova J, Duskova J, Kaiferova J, Broukal Z, Starka L. The role of stress hormones in dental management behavior problems. Physiol Res 2017;66(Suppl 3):S317-22. https://doi.org/10.33549/physiolres.933718
  37. Brand HS. Anxiety and cortisol excretion correlate prior to dental treatment. Int Dent J 1999;49:330-6. https://doi.org/10.1111/j.1875-595x.1999.tb00533.x