Diastolic Changes In BP

Population Study The total number of patients in the 18-45 group was 57 (29.8%). However, the largest sample group with 128 patients (69.2%) was the 46-90 age group. The total number of patients with at least one feature (moderate, severe or high) of dental anxiety was 111. This is 60% more than the 40% who were not diagnosed by the DAS. Patients who had to have analgesia were also present in a total of103 (55.7%), which is an equal split of analgesic options (paracetamol at 27.6% versus Ibuprofen at 28.1%). The anaesthesia used was: articaine was given to 46 men, and lidocaine to the remaining half. Anaesthesia was administered to the females in the same way. 49.7% were given articaine, and 50.3% had lidocaine. (Table 1).

However, Table 2 shows that the population averaged 55.9 years old and had 1.6 carpules. We have these figures for preoperative physiological variables. They are: systolic (144.9) mmHg, diastolic (77.7mmHg), HR (75.1 beats/minute--bpm) in comparison with the postoperative variables (systolic (145.4 mmHg), diastolic (77.7mmHg), y HR (75.3 beats/minute--bpm).

Spearman's rho index shows the connection between pre-operative physio parameters and postoperative physiological variables. The strongest relationships are those that exist between identical variables (pre-operative systolic BP; pre-operative & post-operative diastolic BP; and pre-operative & post-operative HR). These were found in patients before and after intervention. Pre-operative and perioperative systolic BP were 0.913, 0.866 and 0.865 respectively. It is clear that physiological variables are related before and after the extraction.

The next step was to determine if there were any differences between the pre- and post-operation. The Student's test for paired samples is used to determine this. Data was found normal (p-value >0.05 in Kolmogorov–Smirnov test), and homoscedastic at (P-value =0.05 in Levene test). Data from Table 3 show statistically significant differences in diastolic BP only (P value=0.001). The diastolic BP (measures the force of the heart against the artery walls during each beat) is statistically significant. This could indicate a variation in patient's physiological condition.

Study of the relation between physiological parameters, DAS Cohen’s f and DAS Cohen’s b was done to determine the relationship between anxiety levels and various physiological variables. The DAS Cohen’s f indicated that each variable had a significant effect with values greater than 0.8.

A significant level of difference was found between the averages for systolic BP, HR and heart rate before and after extraction. This is in comparison to levels of anxiety in DAS. Analyzing the significance level was done using the Kruskal–Wallis nonparametric test. The results can be seen in the Figs. The results are shown in Figs. Despite these differences, there were no statistically significant numbers for the pre-operative systolic BP value (P = 0.613) or postoperative systolic BP values (P = 0.810).

Relationship between pre-operative and post-operative systolic blood pressure in regards to the DAS (n = 185). Pre-operative measures are represented by dark colours, while post-operative measures represent each level of anxiety.

Relationship between pre-operative and post-operative diastolic blood pressure in regards to the DAS (n = 185). Pre-operative measures are represented by dark colours, while post-operative measures represent each level of anxiety.

Relationship between post-operative and pre-operative heart beats in regard to the DAS (n =185). Pre-operative measures are represented by dark colours, while post-operative measures represent each level of anxiety.

The average P-values of previous systolic BP for four different levels is 0.613. However, for each of these levels of anxiety the average P-value post-operative systolic BP was 0.810. These results do not prove statistically significant. They also indicate that there is no correlation between the systolic BP measured and those obtained using the DAS (Fig. 1).

The P-value of the diastolic BP values for each level of anxiety was 0.011. The P-value for the average diastolic BP post-operatively was 0.004. This is statistically significant. It indicates that there's a correlation between diastolic BP and values obtained by the DAS. 2).

The P-value of the HR averages from the prior levels was 0.027. The post-operative average HR for these four levels of anxiety was 0.013. These results are statistically significant. They also explain the correlation between DAS and HR (Fig. 3).

Relationship between anxiety level, post-operative painkillers and use of anaesthesia. Pearson's Chi-squared Test was used to evaluate this relationship. These were two qualitative categorical variables.

Table 4 shows that the variables were connected by a P-value. The Table 4 table also shows the patient data for each category. As an example, 40/74% of people with anxiety levels 1 and 4 did not use paracetamol or medication. Frequency differences between anxiety levels 2 or 4 were not significant. Paracetamol was used at the lowest rate by patients with anxiety levels 3 and 36 (6/36). The results show that people with anxiety levels below 3 tend not to use paracetamol, but if medication is required, they prefer paracetamol 65 mg.

The Z (normal distribution), test was performed to examine the variances in percentages. Table 4 shows the numbers in parenthesis. It is clear that the Z test can be used to assess the effect of different anxiety levels on the intake of Ibuprofen. The results show that those with higher anxiety levels (high or severe) are more likely to choose ibuprofen 400mg as their first medicine. This is to avoid future pains which may never occur after simple extractions.

Pearson's Chi-squared test was used to examine the relationship between anaesthesia (articaine or lidocaine), and anesthesia needed for pain relief after intervention. A P-value of 0.948 was found, which means that they aren't connected.

Additional parameters were studied concerning the extraction times. Other factors that did not impact the final results are the periodontal condition of the tooth and need to take antibiotics before extraction.

The KruskalWallis test was used to determine the statistical correlation between the possible levels of periodontal involvement for a tooth. It was done on independent samples and a significant of P = 0.01 0.05 (Table 5). As expected, this indicates that the most severe periodontal involvement directly affects the extraction time.

We also tested for the necessity of prior antibiotic use and the effect it has on extraction time using the Mann-Whitney U Test for separate samples (Table 5). The significance level was P = 0.77 >0.05. This non-statistically significant result reinforces the notion that extraction times are equal for patients who need drug-antibiotic treatment before extraction.

Finaly, in order to evaluate how different levels of anxiety affected the extraction time, we used the Kruskal–Wallis test for independent samples. (Table 5). The extraction time is not statistically different between anxiety levels.