Patients' Experience of Pain and Discomfort - Assignment Example

Patients' Experience of Pain and Discomfort during Instrumentation in the Diagnosis and Non-Surgical Treatment of Periodontitis: Periodontitis or Periodontal infection usually implicates a two-fold risk in affected individuals. The dysfunction of the gums or the gingival area originates due to the hardening of the accumulated plaque below the gum-line into tartar, which entices bacterial infection. This is associated with swelling, redness and bleeding symptoms that are minor manifestations at the onset of early Periodontitis and it ultimately leads to the loss of teeth due to progressive destruction of the softer tissues and bones supporting them. (Mayo Clinic, 1998 - 2008) In spite of its severity the condition is treatable by both surgical and non-surgical methods. Non surgical diagnosis and treatment involve scaling to remove the accumulated tartar, root planning to smooth the loosened gum tissues for preventing further tartar accumulation and probing the pocket depths to thoroughly clean the bacterial colonies in the sub-gingival layer, that is, the gaps between the root and the gum tissues. This review attempts to provide a critical analysis of the paper presented by Daniel van Steenberghe, Peter Garmyn, Lut Geers, Elke Hendrickx, Marina Marechal, Karin Huizar, Ann Kristofferson, Karin Meyer-Rosberg, and Guy Vandenhoven on the basis of a multi-centered investigation in order to understand the extent of pain in fixed numbers of both first timers and recall patients during instrument based diagnosis and routine non-surgical treatment of the condition. The importance of the investigation not only lies in the common occurrence of the disease affecting a major part of the adult population in the United States of America, but also in its two-fold risk, including an imminent damage of the oral area and its association with much more severe physiologic conditions, like cardiac arrest, stroke, atherosclerosis and increased blood glucose levels. (Journal of American Dental Association, 2000) The study analyzed the findings obtained from a survey carried out on the experiences involving pain and discomfort of two different groups of patients during diagnosis and treatment with non-surgical periodontal instrumentation. The principal objective of the analysis was to run a trial test for establishing the hypothesis indicating the existence of discomfort during periodontal diagnosis based on observations from earlier rudimentary investigations. Another important aim of the study was to compare and contrast the discomforting experience for patients under instrumentation for diagnosis both in hospital environment and in clinics during private practice. The secondary objective of the investigation was to standardize and corroborate a set of earlier formulated survey questionnaires for assessing the past experience of patients with previous diagnostic sessions of scaling and pocket depth probing by periodontists that can be used for future assays on patient responses after administration of topical anesthetics during treatment. A nested case controlled analysis was performed with the two groups of individuals, one composed of first timers for non-surgical treatment and diagnosis and the other being the recall patients who had earlier undergone primary SRP (Scaling and Root Planning) and probes for PD (Pocket Depth). The first timers who constituted the primary study group formed the basis of the investigation and were subjected to either PD or SRP or both. They were compared with recall patients constituting the comparison group, who were subjected to cohorts being exposed to either PD or SRP, thereby together constituting the control group. The best part of this longitudinal study population was the formation of the nested control group to minimize the recall bias, which is the misleading influence due to the memory of past treatments on the experiences of the individuals from the recall group. The longitudinal analysis was performed with both the respondents and the non respondents in the study and the comparison group. The data was collected for analysis based on repeated observations for the SRP or PD inflicted pain and discomfort at three different instances over a fixed period of time. The first survey was conducted before the sessions using the standard set of questionnaires to assess the previous experiences of patients with instrumentation during periodontal diagnosis and treatment, the second assay consisted of recorded experiences of pain and discomforts with the patients undergoing the primary session and the final survey was conducted four hours after the instrumentation and diagnosis in order to assess extent of postoperative distress and pain in patients who have undergone the treatment. Cohorts were formed out of both study and recall groups based on the extent of anesthesia administered and mode of its administration, either by topically or by injection. Though 90% the patients in the primary SRP sessions and 2% of the recall patients received anesthetics, none of the PD patients received so. This control was arranged to compare and record the influence of anesthesia on the pain experienced during periodontal instrumentation. The initial findings support the use of anesthetics as the patients experienced moderate to extreme pain during PD, conducted without anesthesia in both present and recall sessions. However, the assay conducted with SRP for both the primary and the recall group of patients was not so distinctly defined. Pain and discomfort were registered during the primary SRP sessions even with the use of anesthetics that supported similar observations from earlier studies. The observation that a lesser or equal percentage of patients undergoing primary and SRP reported pain compared to the postoperative patients fails to correlate with the supporting evidences. In fact the limited extent of postoperative pain can be due to various unaccounted mediating factors, like, dispositional pessimism from the earlier visits, decreased inflammation of the gingival area in the previously treated group, or even, due to surgical manipulation of gingival tissues. In case of Periodontitis, soft tissue surgery is usually painless compared to the surgery of rigid osseous tissues. The extent of pain and discomfort associated with the present SRP was found to be more pronounced for first timers compared to the patients in the recall group. Due to the limitation of the investigation with respect to the lack of enough control groups for comparison and cross analysis, several untested possibilities like, reduced depth of probing during second visits, less prolonged recall sessions and psychological familiarity of accustomed recall patients, together cloud the actual reason behind this observation. Whatever be the case the scope of the study is profound as the findings do hint upon the existence of acute discomfort with non-surgical periodontal treatment and indicate the dire effects of anesthetic injections on the pain itself. The investigation rightfully establishes the requirement of apparently painless alternative topical anesthetics for future diagnostic purposes. References: 1. "Periodontitis", 1998 - 2008, Mayo Clinic, retrieved from: http://www.mayoclinic.com/health/periodontitis/DS00369 on November 21, 2008 2. Drisko, Connie, H., "Trends in Surgical and Nonsurgical Periodontal Treatment", 2000, Journal of the American Dental Association, retrieved from: http://www.ada.org/prof/resources/pubs/jada/reports/suppl_21century_07.pdf on November 21, 2008 Read More