Dental local anesthesia in Family Health Units: use, pain and associated factors

Cabral, Etenildo Dantas

doi:10.5935/1806-0013.20150051

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Original Articles • Rev. dor 16 (4) • Oct-Dec 2015 • https://doi.org/10.5935/1806-0013.20150051 copy

Dental local anesthesia in Family Health Units: use, pain and associated factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

In spite of the relevance of controlling pain during dental procedures and of the fundamental role of Family Health Units in the Brazilian health system, there are few studies integrating both subjects. So, this study aimed at analyzing some aspects of dental anesthesia in Family Health Units of the city of Caruaru-PE.

METHODS:

We have interviewed 372 adolescent and adult patients from 12 units, in the waiting room or close to it, after dental treatment, using a form with 14 questions. Pain was investigated with a numerical scale of 21 points (0 to 10 with 0.5 intervals).

RESULTS:

Anesthesia was used in 16.1% of procedures. There has been pain during most anesthesias (58.3%), with intensity of 1±1.2, being more frequent when procedures were in the anterior oral region. For non-surgical invasive procedures, anesthesia was more used in adolescents, in procedures in the posterior oral region, when there was previous pain in the treated region and when the dentist asked patients about their preference. Also for these procedures, pain during treatment as a whole was more frequent and more severe when anesthesia was used.

CONCLUSION:

Dental anesthesia is rarely used in these units and pain during anesthesia is frequent, however of low intensity. During non-surgical invasive procedures, its use is associated to some characteristics of patients and treatments, but not to a painless or less painful treatment.

Keywords:
Acute pain; Dental anesthesia; Local anesthesia; Primary health assistance

Procedures to which patients were submitted, in categories	Use of anesthesia for treatment				Total
Procedures to which patients were submitted, in categories	No		Yes
	n	%	n	%	n	%
Noninvasive procedures ^* * clinical evaluation, polishing, sealant, varnish or fluoride application, drug prescription;	92	100.0	0	0	92	100.0
Nonsurgical invasive procedures ^ crown opening, filling/restoration, tartar removal, stitches removal;	220	88.7	28	11.3	248	100.0
Surgical invasive procedures ^* ***** tooth extraction, surgeries and suture.	0	0	32	100.0	32	100.0
Total	312	83.9	60	16.1	372	100.0

Patients and treatment characteristics	Use of anesthesia				p value
Patients and treatment characteristics	No		Yes
	n	%	n	%
Gender					p¹ =0.164
Male	58	93.5	4	6.5
Female	162	87.1	24	12.9
Age group (years)					p²=0.032
12 to 18	26	74.3	9	25.7
19 to 39	130	90.9	13	9.1
40 to 59	64	91.4	6	8.6
Treated dental arch					p¹ =0.200
Upper	93	86.1	15	13.9
Lower	70	87.5	10	12.5
Both	57	95	3	5
Treated oral region					p¹=0.001
Anterior	61	95.3	3	4.7
Posterior	105	81.4	24	18.6
Both	54	98.2	1	1.8
Previous pain in treated region					p³=0.010
No	193	91	19	9
Yes	27	75	9	25
Previous pain in other head region different from the treated					p³=0.481
No	203	89	25	11
Yes	17	85	3	15
Level of dental anxiety^* * According to Corah Dental Anxiety Scale.					p²=0.430
Null	10	90.9	1	9.1
Low	115	91.3	11	8.7
Moderate	70	87.5	10	12.5
Exacerbated	25	80.6	6	19.4
Fear of anesthesia					p¹ =0.125
No	113	91.1	11	8.9
A little	44	93.6	3	6.4
Somewhat	38	84.4	7	15.6
A lot	25	78.1	7	21.9
Check of patients’ preference with regard to anesthesia					p³⁼0.000
No	211	92.1	18	7.9
Yes	9	47.4	10	52.6

Patients and treatment characteristics	Anesthetic pain				p value
	No		Yes
	n	%	n	%
Gender					p¹=0.961
Male	7	41.2	10	58.8
Female	18	41.9	25	58.1
Age group (years)					p¹=0.742
12 to 18	4	33.3	8	66.7
19 to 39	12	41.4	17	58.6
40 to 59	9	47.4	10	52.6
Treated dental arch					p²=0.210
Upper	10	31.3	22	68.7
Lower	12	54.5	10	45.5
Both	3	50	3	50
Treated oral region					p²=0.005
Anterior	1	7.1	13	92.9
Posterior	21	51.2	20	48.8
Both	3	60	2	40
Previous pain in treated region					p¹=0.542
No	16	39.0	25	61.0
Yes	9	47.4	10	52.6
Previous pain in other head region different from the treated					p³=0.634
No	24	42.9	32	57.1
Yes	1	25.0	3	75.0
Level of dental anxiety ^* * According to Corah Dental Anxiety Scale.					p²=0.261
Null	2	100	0	0.0
Low	11	37.9	18	62.1
Moderate	8	38.1	13	61.9
Exacerbated	4	50.0	4	50.0
Fear of anesthesia					p²=0.586
No	13	44.8	16	55.2
A little	3	27.3	8	72.7
Somewhat	4	36.4	7	63.6
A lot	5	55.6	4	44.4
Use of topic anesthesia^ 1 patient did not know whether topical anesthetic was used.					p³=0.102
No	7	63.6	4	36.4
Yes	17	35.4	31	64.6

Use of anesthesia and type of procedure		Pain during treatment				p value^* * Pearson Chi-square test;
		No		Yes
	n	%	n	%
W/o anesthesia	Nonsurgical	122	55.5	98	44.5	0.007^§ § = comparing nonsurgical without anesthesia versus with anesthesia.
	Surgical	-	-	-	-
With anesthesia	Nonsurgical	8	28.6	20	71.4	0.329
	Surgical	13	40.6	19	59.4

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[1] Correspondence to: Etenildo Dantas Cabral, Av. Prof. Moraes Rego, 1235, Cidade Universitária 50670-901 Recife, PE, Brasil. E-mail: etenildo@gmail.com