Avaliação da eficacia de dois protocolos farmacologicos de controle da ansiedade em um centro de especialidades odontologicas (CEO) / Evaluation of the efficacy of two pharmacologic protocols of anxiety control in a dental specialities center




The importance of anxiety control is well established in the literature, but little is published about its application in public health facilities. The aim of this study was to compare two pharmacologic anxiety control protocols in a public health facility. Hundred and three ASA II subjects (controlled chronic diseases and patients with special needs) from the public dental service of Vassouras, RJ, were submitted to maxillary tooth extraction under the following conditions: 1. Midazolam (sedated with 7.5mg midazolam p.o. 30 min before dental treatment), 2. N2O/O2 (sedated with nitrous oxide/oxygen during dental treatment), and 3. (treated without pharmacologic sedation). The systolic and diastolic blood pressures, respiratory and heart rates and oxygen saturation were evaluated before, during and after dental treatment. The anxiety level was evaluated before each treatment; the perceptions about the dental treatment (anxiety and pain control) by the subject and the dentist who performed the treatment were evaluated at the end of each dental treatment. The volume of local anesthetic, cost and time for the procedures in each session were also evaluated. The subjects and dentists were asked what was the preferred session. The results were submitted to Chi-square, Friedman, Mann-Whitney and Kruskal-Wallis according to the parameter studied (α = 0.05). Less anesthetic volumes and lower values of systolic and diastolic pressures, and respiratory and heart rates were observed in the sessions with pharmacologic sedation (p<0.05). The volunteers presented lower (p<0.0001) anxiety levels (self evaluation and evaluation by dentist) in the sessions with pharmacologic sedation. The N2O/O2 sedation was preferred by most of the dentists (88%) and volunteers (75%). Less time (p<0.05) was expended in the midazolam session with no difference between the two other sessions (p>0.05). The cost of midazolam sedation was lower than that of N2O/O2 sedation. Both pharmacologic sedation protocols were able to reduce the anxiety of the volunteers with a better control of the cardiovascular parameters during the sessions than the observed in the session without pharmacologic sedation. Due to the lower cost and less treatment time offered by midazolam sedation this can be advantageous in public health service. The inhalation sedation with N2O/O2 could be used in public health facilities for medium complexity dental treatment. Public health dental professional should be qualified to offer anxiety control especially to medically compromised patients.


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