Does Audio-Visual Information Affect Anxiety and Perceived Pain Levels in Mini-Screw Application?–A Study in South Indian Population

Akriti Tiwari^* and Sarvana Dinesh SP

^*Correspondence: Akriti Tiwari, Department of Orthodontics and Dentofacial Orthopaedics, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India, Email:

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Introduction

During dental procedures, increased anxiety levels in patients are a major problem faced by clinicians. Anxious patients are more likely to be uncooperative while carrying out dental procedures which may frustrate the clinician leading to delay in the procedures [1]. Anxiety is a complex emotion that could be due to dental fear, socioeconomic status, parental dental anxiety, etc. [2].

There are various self-assessment questionnaires to assess anxiety. STAI (Self-trait anxiety inventory) is a form of questionnaire which measures trait anxiety and state anxiety [3]. Trait anxiety is a temporary emotion felt by a person. It is an emotion felt in the time of fear and danger whereas state anxiety is permanent throughout a person’s life and is based on its personality characteristic [4]. The sum of these two scales amount to total anxiety [5].

Mini-screw anchorage has become an essential part of orthodontic treatment plans, nowadays [6]. The placement of mini-screws requires a minor surgical procedure which could cause an unacceptable amount of pain but at the same time it can cause anxiety to the patient. If the patient is informed prior about the procedure, it can cause less anxiety and make them more co-operative towards the procedure.

The root cause of pre-operative anxiety could be due to a patient's concern about his/her general health, uncertainty about the procedure, type of surgery, postoperative discomfort and pain [7]. Providing information to the patient regarding the procedure allows the patient to be more aware of it and this in turn, could reduce anxiety and stress. Information provided to the patient could be either verbally or audio-visually, or a combination of both. A study conducted by Stephens R et al. reported that patients who were informed about the procedure verbally followed by audio-visual depiction added up to being more advantageous [8]. However, a study reported that delivering combined multimedia and verbal information was insufficient to reduce anxiety levels and stress among the patients.

This knowledge was instrumental for us to study the audio-visual information affecting anxiety and perceived pain levels in mini-screw application–A study in the South Indian population.

Methods

Study design

This is a prospective controlled trial evaluating the anxiety levels of patients who were informed about the procedure either verbally or audio-visually before miniscrew placement. The study consisted of 10 subjects within the age group of 22-30 years (6 males and 4 females).

Inclusion criteria

Subjects who were undergoing fixed orthodontic treatment and required mini-screw placement based on need for additional anchorage.

Exclusion criteria

Subjects who were not willing to participate in the study.

Sampling

Participants were allocated into two groups, group A (n=5) and control group B (n=5). Group A consisted of subjects who were informed about the procedure audiovisually and Group B consisted of subjects who were verbally informed about the procedure.

Procedure

The procedure was performed in the influence of infiltrative local anaesthesia with less than one quarter of the cartridge. The sterile implant with the help of screwdriver was placed in the posterior buccal region. Self-drilling miniscrews (8 mm length, 1.5 mm diameter, SK surgicals) were placed following the guidelines recommended with no incision or soft tissue removal from the attached gingiva prior to insertion. Following the insertion, patients were instructed to maintain good oral hygiene to prevent failure of the implant.

The audio-visual information was provided with the help of a video that was taken from external sources depicting the placement of mini-screws. The video depicted the placement of mini-screws on a typhodont. The script for the verbal information was as follows.

“First, local anaesthetic will be injected. After the Injection, mini-screw of 8mm in length and 1.5mm in diameter will be inserted with a screwdriver” [9].

The audio-visual as well as verbal information about the procedure was provided by the same researcher (AT). The anxiety level was measured with the help of Spielberg STAI just before the placement of mini-screw. State anxiety scale (STAI-S) consists of 20 questions enquiring how the patient feels at that moment of the insertion with respondents rating anxiety level from one (1) (not at all) to four (4) (very much so). The trait anxiety scale (STAI-T) also consists of 20 questions assessing their anxiety level from rating one (almost never) to four (almost always) [10].

Statistical analysis

After the collection of data from the subjects, the data was analysed. Descriptive statistics using percentages was carried out to evaluate the response of the subjects to Spielberger state-trait anxiety inventory questionnaire concerning their anxiety level during placement of miniimplants. Student’s t-test was performed to evaluate the difference of anxiety scores in different groups and Independent t-test was performed to evaluate the difference of anxiety scores in between genders. These analyses were carried out using IBM SPSS statistical software (Version 23.0).

Results

The completed questionnaire was collected from 10 patients over a period of two weeks from March 2019 to April 2019 and analysed. Table 1 represents the mean, standard deviation of anxiety scores in control group and study group. It also represents the student’s t-test and there was a statistically non-significant difference of anxiety scores observed (p>0.05). Table 2 represents the mean and standard deviation of anxiety scores in different genders. It represents an independent t-test and it was found to be a statistically non-significant difference of the anxiety scores in different genders. Figure 1 represents the percentage of anxiety level in subjects. It was observed that the anxiety level was higher in patients (54.4 %) who were informed about the procedure verbally than the ones who were given an audio-visual depiction of it (46.6%).

Table 1: valuation of anxiety scores in different groups.

Table 2: Evaluation of anxiety scores in different genders.

Figure 1: Percentage of anxiety level in subjects

Discussions

Mini-screw placement is a simple procedure but at the same time it can be a little invasive, making the patient anxious. It was hypothesized that audio-visual depiction of the procedure would reduce the anxiety levels in patients. To record this, STAI-S and STAI-T were taken. In the present study it was observed that the subjects who were verbally informed about the procedure were more anxious as compared to those who were shown an audiovisual depiction of it. Therefore, this result satisfies our hypothesis.

It was observed that 54.4% of the subjects were anxious after verbal information of the procedure than those who were audio-visually informed about it. According to a study conducted by Stephens R et al. reported that patients who were informed about the procedure verbally followed by audio-visual depiction added up to being more advantageous but unlike our study these subjects were informed about the procedure both, verbally and audio-visually [8]. Study conducted by Prabhat Chaudhari et al. reported that there is a positive correlation between dental anxiety and pain associated with mini-screw placement [11].

Another study conducted by Berra Calik Koseler et al. reported the association between anxiety level and miniscrew placement; audio-visual methods caused more anxiety in patients which doesn’t satisfy our hypothesis [9]. Sari et al. reported that anxiety level was reduced in patients who were undergoing treatment since last year but the present study was short-term [12].

Meta-analysis reported on dental anxiety by Kvale et al. concluded that patients undergoing behavioural intervention for dental fear can be expected to report on significant reduction in their fear [13]. It is indicated that increasing the quantity of postoperative preparatory information will increase pain relief.

In the present study it was observed that there was statistically non-significant difference observed of the anxiety scores in different genders and this finding was in agreement with the study conducted by Koseler et al. where in there was no statistically significant difference in the anxiety scores between the male and female patients in either groups [9]. Similarly, a study reported that sex did not significantly affect anxiety.

In contrast to the findings of our study, Prabhat et al reported that females are more anxious as compared to males but they measured anxiety using Corah’s dental anxiety scale which consisted of four questions to assess dental anxiety and the other was the dental fear survey (DFS), which consisted of 20 questions unlike our study where we used STAI questionnaire [11]. Similarly, Hakki et al reported that females had significantly higher levels of anxiety as compared to males [11,14].

Small sample size is the limitation of this study. Future scope of this study indicates that preoperative information will reduce the anxiety in patients and they will be more cooperative for the treatment.

Conclusion

From the study conducted, it was evident that subjects who were shown video depiction of the Orthodontic mini-screw placement procedure were less anxious than the ones who were verbally informed about it. The same strategy can be implemented in other minor surgical procedures too to make the patients co-operate better.

Source of Funding

Nil.

Conflict of Interest

Nil.

Authors Contribution

AT contributed with study designing, data collection, data evaluation, manuscript typing and revision of manuscript. SD contributed with study designing, data evaluation, manuscript typing and revision of manuscript. AT and SD contributed for data evaluation and manuscript revision.

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