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British Journal of Healthcare and Medical Research - Vol. 11, No. 6

Publication Date: December 25, 2024

DOI:10.14738/bjhmr.116.18057.

De Romero, B. C., Paba, J. L., Ramirez, C. D., & Tellez, D. A. D. (2024). Assessment of Anxiety and Hemodynamic Changes Pre and

Post-Oral Implant Surgery. British Journal of Healthcare and Medical Research, Vol - 11(6). 326-334.

Services for Science and Education – United Kingdom

Assessment of Anxiety and Hemodynamic Changes Pre and Post- Oral Implant Surgery

Beatriz Cepeda De Romero

National University of Colombia and

UNICIEO University Foundation

Juliana Lobo Paba

Universidad Santo Tomás de Colombia and

UNICIEO University Foundation in Colombia

Cristian Diaz Ramirez

Colombian Dental College and

UNICIEO University Foundation in Colombia

Diego Alejandro Diaz Tellez

Colombian Dental College, and

UNICIEO University Foundation in Colombia

ABSTRACT

Dental anxiety is the fifth most common cause of anxiety. Patient anxiety is

observed in situations involving anesthetic injections, use of rotary instruments.

Local anesthetics are used in conjunction with vasoconstrictors, to prolong their

action at the applied site and prevent dissemination to the bloodstream and the

presence of multisystemic adverse reactions. Method: Clinical, observational,

analytical research longitudinal cohort with minimal risk. It shows 40 patients with

voluntary participation, over 18 years of age, healthy use of articaine 4% with

epinephrine 1:100,000. Pre-anesthesia: assessment of the degree of anxiety using

the Modified Corah Dental Anxiety Scale. Blood pressure and heart rate in three

stages: pre-anesthesia, 10 minutes post-anesthesia and at the end of the surgical

procedure using a digital blood pressure monitor (SCANMED)® and the percentage

of oxygen saturation with oximeter (OMRON).® Results: Mean age 56.7 ± 13.1 years,

women 26 (65%), men 14 (35%); no pre-existing diseases (60%),. Surgical time (2

hours and 15 minutes). The most commonly used type of surgery is of medium

complejidad. In the three times evaluated by the Cochrane Q test, there was a

significant difference in the values of systolic pressure (P=0.001), diastolic pressure

(P=0.037), Heart rate variations (P=0.660). and moderate anxiety 16 (40%) were

present using the Modified Corah Dental Anxiety Scale. Conclusion: Older adults

with dental implant surgery presented mild or moderate anxiety, without

significant changes in blood pressure and oxygen saturation, 10 minutes after the

administration of local anesthesia and at the end of the surgical procedure.

Keywords: Anxiety, Heart rate, Blood pressure.

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327

De Romero, B. C., Paba, J. L., Ramirez, C. D., & Tellez, D. A. D. (2024). Assessment of Anxiety and Hemodynamic Changes Pre and Post-Oral Implant

Surgery. British Journal of Healthcare and Medical Research, Vol - 11(6). 326-334.

URL: http://dx.doi.org/10.14738/bjhmr.116.18057.

INTRODUCCIÓN

Oral dental implant surgery is an effective and predictable modality used for patients with the

need to rehabilitate their oral health; including in some cases previous surgical techniques such

as guided bone regeneration, maxillary sinus elevation and grafting, lateralization of the

inferior dental nerve, among other specific surgeries in the case of each individual and their

needs. These techniques can produce hemodynamic and perceptual changes in patients before,

during, and after the surgical procedure; which may or may not be related to the local anesthetic

[1].

To control pain during oral surgical procedures, the use of anesthetics is essential. Due to their

mechanism of action, they reversibly inhibit the entry of sodium ions into all cell membranes,

blocking the excitation of sensory receptors and nerve conduction of myelinated and

unmyelinated nerve fibers, so that sensory information does not reach the cerebral sensory

cortex. The most commonly used are lidocaine, mepivacaine, and articaine [2].

Local anesthetics are used in conjunction with vasoconstrictors, to delay the absorption of the

drug, thus prolonging its action at the applied site (infiltrative or truncular) and prevent

dissemination to the bloodstream to prevent the presence of multisystem adverse reactions

(RAM). The most commonly used vasoconstrictors are epinephrine (adrenaline) and

norepinephrine (noradrenaline). Vasoconstrictors act on the alpha-adrenergic receptors of

vascular smooth muscle, causing vasoconstriction of the arterioles and venules of the local

microcirculation and can sometimes cause hemodynamic alterations [3]. On the other hand, it

is known that pain during dental treatment can trigger the release of endogenous

catecholamines, which in turn can lead to hemodynamic changes, such as increases in blood

pressure and heart rate, and can even lead to arrhythmias [4].

Blood pressure is directly controlled by the Sympathetic Nervous System (SNS) and the

Parasympathetic Nervous System (PNS). Stress stimulates the predominance of the SNS,

causing an increase in blood pressure and heart rate and inducing the contraction of peripheral

blood vessels; it can also cause variations in respiratory rate, which is proportional to

alterations in oxygen saturation or carbon dioxide levels in the blood, triggering hemodynamic

changes and, in some cases, perceptual changes of the senses [2].

Dental anxiety is the fifth most common cause of anxiety. It is an emotional state due to a

threatening stimulus that may not be identifiable. A known or perceived reaction to danger or

threat is fear. Both dental anxiety and stress elicit physical, cognitive, emotional, and behavioral

responses in an individual; however, anxiety or the traumatic dental experience can generate

exaggerated production of catecholamines; which can also produce hemodynamic and

metabolic changes [2]. In addition to these factors, the dental experience of friends or relatives

and congenital aspects determine anxiety or fear of dental treatment among patients [4].

Patient anxiety is observed in situations involving anesthetic injections, use of rotary

instruments, and/or tooth extractions [5]. As dental experience determines this anxiety, the

gender in which anxiety is most predominant is in women due to the hormonal change that

women present at different stages of their lives [6]. Metabolic and hemodynamic changes are

also correlated with changes in auditory perception during extensive dental or medical

procedures [7].

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British Journal of Healthcare and Medical Research (BJHMR) Vol 11, Issue 06, December-2024

Services for Science and Education – United Kingdom

Fukayama et al., (2006) stated that certain heme modulator drugs and local anesthetics (LA)

used in dental surgical procedures could cause vascular variations. Along with surgical

procedures, additional factors such as anxiety and stress can also contribute to hemodynamic

changes. Several studies have hypothesized that patients' anxiety toward dental procedures

plays an important role in hemodynamic disturbances. In addition, the complex appearance of

dental instruments and procedures, such as the introduction of injections of local anesthetics,

the use of rotary instruments, and surgical forceps, could increase patient anxiety [8].

For all of the above, it is important during surgical or invasive dental procedures to monitor

vital signs such as blood pressure (mm Hg), heart rate (c/sec) and pulse oximetry (SpO2), which

allows professionals to detect potential risks: pre-surgery, post-surgery and make an early

diagnosis of complications [9]. It is also of great importance It should be clarified that the

population that shows the greatest need for oral surgery are the elderly, and in this population

the variation of normality in blood pressure, heart rate, oxygen saturation and auditory

perception is more frequent. Therefore, it is necessary for the health professional to control

vital signs and the patient's general condition to avoid adverse effects [10]. It is considered

necessary to perform a vital signs protocol in order to prevent complications in the intra- and

postoperative dental period, as well as to improve the dental experience of each patient [11].

These physiological responses may more frequently affect patients who are systemically

compromised by drug and disease interactions, which implies a meticulous vital signs protocol

[12]. It is important to evaluate anxiety in the presence of dental implants or procedures that

involve the use of needles, rotary instruments, or extractions, using the Modified Corah Dental

Anxiety Scale (MDAS) and its effects on heart rate, artery pressure, and oxygen saturation

values to prevent adverse effects in patients [13-14].

Matsumura et al., (1998) The objective of the study was to determine changes in blood pressure

and heart rate during tooth extraction. The study included 40 patients between 19 and 74 years

of age, who underwent tooth extraction. It was observed that changes in hemodynamic status

occur with alterations in blood pressure and heart rate during dental surgical procedures,

without significant changes in oxygen saturation, which indicates that there is no significant

hypoxic threat to the patient. On the other hand, it was found that middle-aged patients

experienced greater increases in blood pressure during dental surgery than younger

individuals [15].

Silvestre et al. (2001), the aim of the study was to analyze the degree of anxiety in patients who

underwent the extraction of a molar, to assess the degree of anxiety using Hamilton's anxiety t- test and the changes in systolic and diastolic blood pressure in three groups of patients

according to the type of anesthesia GROUP 1 (2% lidocaine with epinephrine 1:80,000 ppm),

GROUP 2 (3% Mepivacaine with 1:80,000 ppm epinephrine) and GROUP 3 (3% Mepivacaine

without vasoconstrictor) and assessment of the degree of Anxiety. The results showed that the

mean of the initial values of the degree of Anxiety was 5.04 and at the end of it was 3.44.

Variations in blood pressure and heart rate did not present statistically significant figures in

the three groups of patients. They concluded that whether or not to use a vasoconstrictor with

the local anesthetic solution has no effect on blood pressure in normotensive patients, although

some increase in systolic blood pressure (SBP) was observed at the time of tooth extraction and

at the end of the procedure. This was attributed to increased patient anxiety during tooth

extraction [16].