| Objective Currently,the extraction of mandibular impacted molars is one of the most common surgeries in oral surgical clinic.However,There are many patients with dental anxiety who feel nervous,afraid,showing irritability,palpitation and shortness of breath or even escape from the treatment about oral therapy especially tooth extraction.The patients’ nervousness,anxiety,do not cooperate with the doctor’s treatment make the therapy difficult,also the patient is suffering psychologically.Nitrous oxide inhalation is a safe and effective sedative technology,it can improve the pain threshold,reduce pain,and reduce or eliminate anxiety,so that patients achieve relaxation,comfort,cooperation.And the high speed air turbine handpiece as the most commonly used extraction device,it has gained basic popularity.This paper evaluates the application of inhaled nitrous oxide and handpiece in the extraction of mandibular impacted molar in dental anxiety patients.Methods 120 cases with impacted mandibular wisdom tooth extraction treated during the period from July 2015 to October 2016 in Anhui Stomatologic Hospital were selected.Inclusion criteria:(1)According to the American Society of Anesthesiology(ASA)score,all patients were grade I(health,in addition to local lesions without systemic disease);(2)Patients have dental anxiety symptoms,manifested as fear of the diagnosis and treatment process,tension,escape and so on.;(3)The root development of the mandibular impacted molar is completed,middle or low impaction,mesial tilting;(4)There was no loosening and no inclination of the mandibular second molar,no effect to the extraction process;(5)No history of drug allergy;(6)No mental disorder,no communication barriers,can correctly determine the intensity of pain;(7)No extraction contraindication,the patients were informed and agreed to participate in the experiment and signed informed consent.120 cases randomly divided into three groups:A(40% N2O+local anesthesia),B(60% N2O+local anesthesia),C(control group,local anesthesia).The changes of heart rate and oxygen saturation in the extraction process were recorded.The pain level and sedation effects were analyzed with visual analogue scale(VAS)and Ramsay scale.After the operation,the parameters were statistically analysed.Results 1.Results of biological indexes:The variance analysis of repeated measurement data showed that there was no significant difference in HR and Sp O2 between group A and group B at three time points(P>0.05),There were significant difference in HR and Sp O2 between group C and group A、B at three time points(P<0.05).2.Results of sedation degree: There was no significant difference in Ramsay scores between group A and group B in local anesthesia(P>0.05),but the degree of sedation in group B was higher than that in group A。There were significant difference in Ramsay scores between group C and group A、B at local anesthesia(P<0.05).The Ramsay scores of the three groups were significantly different at the time of extraction(P <0.05).3.Results of pain degree: The VSA scores of the three groups were significantly different in local anesthesia(P<0.05),There was no significant difference in VAS score between group A and group B when extraction(P>0.05),but the degree of analgesia in group B was better than that in group A.There were significant difference in VAS scores between group C and group A、B at the time of extraction(P<0.05).Therefore,nitrous oxide inhalation group showed much less changes in heart rate and blood pressure;much lower VAS pain score and Ramsay score than local anesthesia group.There were significant difference between them(P < 0.05).It has statistical significance.Conclusion Nitrous oxide inhalation is effective in alleviating dental anxiety and it has a good sedative and analgesic effects during impacted wisdom tooth extraction.Thus it worth wide clinical use. |
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