EXPRESSION OF MARKERS OF EMOTIONAL-PAIN STRESS AFTER REMOVAL OF IMPACTED LOWER THIRD MOLARS IN PATIENTS WITH DIFFERENT INDIVIDUAL PSYCHOLOGICAL FEATURES
DOI:
https://doi.org/10.11603/2415-8798.2019.2.10262Keywords:
retention of the lower third molars, postoperative inflammatory reaction, neuroticism, anxiety, prostaglandin E2, cortisolAbstract
After removal of impacted lower third molars in patients there are pathophysiological changes in the organism, inflammatory (immune) reactions induced by an operating trauma. Acute inflammatory reaction in the maxillofacial area is accompanied by pain syndrome, edema of soft facial tissues, trismus, sensory disorders of the functions of the lower alveolar and/or lingual nerves. The appearance of the above clinical symptoms of damage of the tissues of the maxillofacial area often causes them psycho-emotional stress, reactive anxiety. Their severity depends on the individual-typological characteristics of each patient. The fundamental psychological feature of personality is neuroticism.
The aim of the study – to learn the expression of markers of emotional-pain stress (reactive anxiety and content of cortisol and prostaglandin E2 in oral liquid) in patients with different individual psychological features (neuroticism) after removal of impacted lower third molars.
Materials and Methods. In 30 patients aged 18–30 years (16 men, 14 women), atypical removal of the retained third molars was performed according to orthodontic indications (high surgery complication level according to Pederson scale). The level of neuroticism in patients was evaluated by their testing according to G. Eysenck's method. The postoperative reaction of the patients was evaluated for the severity of the pain syndrome, the swelling of the facial soft tissues, the degree of inflammatory-muscular contracture of the masticatory muscles according to H. Eysenck method, for a qualitative assessment of the pain, we used the McGill pain questionnaire. The degree of damage of the lower alveolar nerve was detected by measuring the electrical excitation of the pulp of the fang on the corresponding side of the mandible and the electrical potentials of the facial skin in the projection of the mental aperture. The determination of cortisol and prostaglandin E2 in the oral liquid of patients was performed in the preoperative period and for 1st and 5th days of the postoperative period by the method of ELISA. In order to determine the probability and correlation strength, Pearson correlation coefficient (χ2) was determined.
Results and Discussion. It was found that patients, regardless of their level of neuroticism, in assessing the nature of acute pain, according to the McGill questionnaire, descriptors from the sensory scale prevail. In addition, patients with expressed level of neuroticism to characterize the pain sensation were also selected by descriptors from the affective scale. An increase in the content of prostaglandin E2 in the oral liquid was detected as inflammatory changes develop. Significant decrease of local clinical manifestations of acute inflammatory response directly correlated (χ2 = 26.53, р < 0.001) with a significant decrease in the oral liquid content of this biochemical marker of inflammatory response. The content of cortisol in the oral liquid of the patients was influenced not only by the severity of acute inflammatory reaction and the intensity of pain, but also by psycho-emotional factor.
Conclusions. After removal of impacted lower third molars in the majority of patients with manifestations of neuroticism under the influence of severe acute inflammation and nociceptive pain appears psycho-emotional stress (reactive anxiety). Patients regardless of their level of neuroticism in assessing nociceptive pain predominate descriptors of sensory questionnaire McGill, to characterize neuropathic pain patients with high levels of neuroticism also use descriptors of affective scale. The level of prostaglandin E2 and cortisol in the oral liquid of patients depends on the severity of the acute inflammation and intensity of the pain syndrome in them. The level of cortisol in the oral liquid is also influenced by the level of neuroticism in patients.
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