Stress Factors Induced by Patient and Young Clinicien During Endodontic Treatment
Condition: Endodontic Treatment
Study type: Observational [Patient Registry]

Summary: 
      The aim of this pilot study is to examine the patient's induced stress and the young
      dentist's induced stress, during endodontic treatment. This study is carried out using
      physiologic (cortisol measurement, arterial pressure and heart rate) and psychological data
      (VAS visual analog scale of stress, pain and discomfort, CORAH and HAD Scales) collected from
      patients of Brest University Dental Hospital at various stages of root canal treatment. The
      endodontic treatment is carried out under the usual standards and practices.
    

Detailed description: 
      Thirty patients and students are involved. All adult patients referred to the dental
      department for initial endodontic treatment are given the option of taking part, excluding
      those presenting cardiovascular disease or mental, psychiatric, or neuronal disease. Patients
      taking antihypertensive treatment, anxiolytics, sedatives, or neuroleptic drugs are also
      excluded from the study. Thirty dental students will conduct endodontic treatments according
      to the regular local procedures. No patient receives any sedative premedication.

      The indicators of stress are monitored at 6 steps of endodontic treatment:

      T1: preoperative rest; T2: local anaesthesia (4% articaïne hydrochloride with 1:200 000
      epinephrine). T3: rubber-dam set-up T4: root canal instrumentation T5: root canal filling T6:
      postoperative rest

      The main study criteria is the variation of stress:

      At the 6 steps of the treatment and at the next visit for the final restoration, both
      subjects (patient and student) are asked to use a visual analog scale (VAS) to score the
      level of stress specifically induced by the endodontic treatment. The VAS is a 10-cm scale
      without graduation on which subjects are asked to score the specific level of stress
      experienced from 0 (not stressed at all) to 10 (worst stress imaginable). The VAS of stress
      has proven to be a valid tool that is highly sensitive to change.

      Other study criteria:

      - CORAH and HAD Scales At the beginning of the treatment (T1), the patient is asked to
      complete a French version of the Corah Dental Anxiety scale (DAS). This questionnaire
      consists of 4 parts: the results lead to the assessment of dental anxiety.

      At the beginning of the treatment (T1), patients and students are asked to complete the
      Hospital Anxiety and Depression Scale (HAD Scale) which is presented as a reliable instrument
      for assessing clinically significant anxiety and depression in patients.

        -  Cardiovascular Parameters For each subject, the physiological indicators of stress (ie,
           heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) are
           monitored during each of the 6 steps.

        -  Cortisol Measurements A correlation between salivary cortisol level and stress in dental
           procedure was noticed .

      Salivary samples are collected during each of the 6 steps of endodontic treatment which are
      then stored at -20° before being sent to the laboratory to test cortisol levels .

        -  Discomfort and Pain Experienced During Treatment Dental anxiety was found to have a
           direct relationship with pain perception (). Patients were asked to report the levels of
           discomfort and pain experienced during the 6 steps using the VAS and at the next visit
           for the final restoration.

        -  Patient and student preferences After the completion of each scale patients will have to
           report whether they thought that they would have experienced as much pain, stress, or
           discomfort if they had received premedication before treatment.

      When the treatment is complete the students are asked to report:

        1. his/her level of satisfaction with the course of treatment,

        2. whether he/she felt awkward faced with the patient's manifestations of stress,
           discomfort, or pain during the session

        3. whether he/she would have preferred that the patient had received sedative medication
           before the endodontic treatment.

      The main aim of the study is to examine the patient's induced stress during endodontic
      treatment in order to offer customised solutions to lessen stress. The other aims are to
      evaluate the young dentist's induced stress, to examine and compare the patient's induced
      stress and the young dentist's induced stress, and to evaluate the patient's pain and
      discomfort during endodontic treatment.

      The results of this observational study are to be used as a reference for future
      interventional studies to reduce stress during endodontic treatment. Techniques such as
      relaxation, hypnosis, acupuncture, distraction, music therapy, positive reinforcement,
      stop-signalling, and exposure-based treatments, "tell-show-do" are some solutions which could
      be initiated at the dentistry department of CHRU Brest.
    

Intervention name(s): Endodontic treatment; VAS of stress; CORAH scale; HAD Scale; Cardiovascular Parameters; Cortisol Measurements; Discomfort and Pain Experienced During Treatment; Patient's preferences.; student preferences.
Intervention type(s): Procedure; Other; Other; Other; Other; Other; Other; Other; Other
Intervention description(s): Endodontic treatment or root canal therapy is a sequence of treatment for the infected pulp of a tooth which results in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion.; The VAS is a 10-cm scale without graduation on which subjects are asked to score the specific level of stress experienced from 0 (not stressed at all) to 10 (worst stress imaginable); At the beginning of the treatment (T1), the patient is asked to complete a French version of the Corah Dental Anxiety scale (DAS).; At the beginning of the treatment (T1), patients and students are asked to complete the Hospital Anxiety and Depression Scale (HAD Scale) which is presented as a reliable instrument for assessing clinically significant anxiety and depression.; For each subject, the physiological indicators of stress (ie, heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) are monitored during each of the 6 steps.; Salivary samples are collected during each of the 6 steps of endodontic treatment which are then stored at -20° before being sent to the laboratory to test cortisol levels .; Patients were asked to report the levels of discomfort and pain experienced during the 6 steps using the VAS and at the next visit for the final restoration.; After the completion of each treatment patients will have to report whether they thought that they would have experienced as much pain, stress, or discomfort if they had received premedication before treatment.; When the treatment is complete the students are asked to report:
his/her level of satisfaction with the course of treatment,
whether he/she felt awkward faced with the patient's manifestations of stress, discomfort, or pain during the session
whether he/she would have preferred that the patient had received sedative medication before the endodontic treatment.
Intervention MeSH terms: Hydrocortisone
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        30 patients and students were needed.
      
Biospecimen description: 
      Salivary samples are collected during endodontic treatment to measure cortisol production
      during endodontic treatment. Cortisol is a hormone secreted from the adrenal cortex and
      dispersed to all body fluids (urine, serum, or saliva). A correlation between salivary
      cortisol levels and stress in dental procedure is noticed.
    
Keywords: Induced stress, dental anxiety, endodontic treatment, salivary cortisol, cardiovascular parameters, pain, discomfort.