Psychological and Pupillo-Algometrical Monitoring of Dental Patients during Their Antistress Therapy

Abstract

The purpose of the study was to investigate the psychological status and pain sensitivity by the pupillometric method in dental patients during preoperative antistress drug therapy. Materials and methods. In 100 patients, during their initial examination, signs of psychological stress were detected in them in social conditions during the last month before surgical interventions, using the PSM-25 scale of Lemoureux-Tessier-Fillion. The level of anxiety and depressive symptoms were determined using the Hospital Anxiety and Depression Scale. Pain sensitivity in patients was studied by measuring the reaction of the pupil of the eye to the action of an algogenic mechanical factor using the developed proprietary technique of digital pupillometry. Depending on the applied schemes of antistress drug therapy, patients were divided into two clinical groups. The control group included 50 people with different levels of psychological stress. During premedication, they were given Gidazepam for sedation. The main group included 50 patients who were under psychological stress. At the stage of preoperative preparation (for 7 days), they were prescribed a course of antistress therapy: enterally the drug “Antistress” (which contains L-tryptophan) and endonasally – dalargin solution. Results and discussion. Psychological stress acquired by patients in social conditions is a favorable background for the appearance of clinical manifestations of anxiety and depression before the start of operations. The use of Gidazepam by stress-labile dental patients of the control group during premedication made it possible to provide antistressor protection only in 8 cases. These patients had a moderate level of psychological stress. The results of psychological testing and pupillo-algometry confirm the need to use alternative medication schemes of antistressor protection for emotionally labile dental patients during their preparation for planned surgical interventions. In patients of the main group with an average level of psychological stress before surgical interventions, antistressor protection was achieved in 100% of cases. The effectiveness of the applied medicinal scheme was statistically significant in comparison with the standard scheme of treatment of psychoemotional tension used by patients of the control group – χ2 - 15.771 (р<0.001). Preoperative antistress therapy was not sufficiently effective for only 16.7% of patients in the main group with a high level of psychological stress. When comparing the results of stress-protective therapy with those of patients in the control group, statistically significant differences were also found – χ2 - 16.875 (р<0.001). Conclusion. In dental patients who are in a state of chronic psychological stress, psychoemotional tension (reactive anxiety) increases and pain sensitivity increases before the start of planned surgical interventions, which is confirmed by psychological tests and digital pupillo-algometry. One-time use of Gidazepam by stress-sensitive patients during premedication is not effective enough to normalize their psycho-emotional state. Prescribing a course of drug antistress therapy (L-tryptophan and dalargin) to dental patients diagnosed with chronic psychological stress allows to statistically reliably normalize their psychoemotional state and reduce pain sensitivity before the start of surgical interventions