ENOMOTO, K; (2012) Psychological factors associated with pain 24 hours post-tooth extraction. Doctoral thesis , UCL (University College London).

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Abstract

Background: There is a considerable variation in dental patients’ post-operative pain experience and analgesic requirements following identical surgical procedures. This has been related to a variety of psychological factors. Pain is one of the most commonly cited factors that is strongly associated with dental fear. Surgical removal of a third molar, the most common procedure in oral surgery and generally associated with dread, has received limited research attention. It is, therefore, essential to understand factors likely to influence the pain experience of patients in such a stressful setting. Such an understanding will not only help patients cope with fear and pain, but also will assist clinicians create a less stressful environment. This study investigated psychological factors predicting heightened pain perception in tooth extraction: dental anxiety; dental control; pain catastrophizing; expectation of pain; social desirability (defensiveness); trait anxiety and monitor-blunter style coping. Methods: The sample consisted of 306 participants (144 male and 162 female aged between 18 and 62 years with the mean age of 31.82) who were referred by their local dental practitioners for the surgical removal of tooth/teeth under local anaesthetic at the unit of Oral and Maxillofacial surgery at UCL Eastman Dental Institute. The tooth/teeth which needed extraction were not limited to the third molars. The variables were measured at four different time points: on recruitment (baseline: T0), before (T1), after (T2) and the following day (T3) of the dental surgery. The variables assessed were: dental anxiety; dental control; pain catastrophizing; social desirability; trait anxiety; monitor-blunter style coping; sensory intensity of pain, affective quality of pain, state anxiety and mood states. After the surgery, the dental surgeons rated the complexity of the surgical procedure and the perception of their patients’ distress levels. 7 Results: It was found that pain 24 hours post-tooth extraction was best predicted by the levels of expected sensory pain together with post-surgery state anxiety, trait anxiety and expected affective pain. Expected sensory pain, in turn, was predicted by dental anxiety, monitoring and felt (perceived) control (i.e., the dental pain predictors). Moreover, dental anxiety was found to be a precursor to all the dental pain predictors. Furthermore, pain catastrophizing did not make to the primary dental pain predictors. Nevertheless, it contributed to heightened levels of trait anxiety and expected affective pain which sequentially helped to intensify perception of dental pain. In addition, it was revealed that dental surgeons underevaluated their patients’ treatment pain.

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