Perceived Need for Local Anesthesia: METHODS

In: Dental treatment

25 Mar 2010

Subjects were 163 Anglo-Americans from Seattle, WA (n = 112) and Columbus, OH (n = 51), 195 Mandarin Chinese from Taipei, Taiwan (n = 140) and mainland China (n = 55) and 167 Scandinavians (n = 112 Danes from Arhus, Denmark and n = 55 Swedes from Go-teborg and Linkoping, Sweden); a total of 129 dentists and 396 patients. The pool of subjects was drawn from public and private dental clinics in about equal proportions, with the exception of American clinics because in the US most are private practices. These particular ethnic groups were chosen because pilot data about them indicated wide variation in use of anesthetics. Recruited subjects were age and gender matched to isolate the cultural variables by recruiting equally from each of four sample segments: men 44 yr or younger, men 45 yr or older, women 44 yr or younger, and women 45 yr or older. Ethnic groups were also approximately matched by occupations of informants across groups (eg, clerks, policemen, teachers, clergy, etc.).

Semistructured qualitative interviews of 51 Anglo-Americans, 31 Mandarin Chinese, 23 Danish, and 17 Swedish dentists (audiotaped) were used to determine: (a) the relative frequency of the use or nonuse of anesthetic for similar tooth drilling in adults, (b) the reasons for nonuse of anesthetic as reported by these dentists about their adult patients, and (c) the distribution of reasons reported by dentists for why some patients were not using anesthetic. All interviewed dentists had local anesthesia available and were experienced with its use. The following questions were included: ”What percentage of your patients do not take anesthetic for routine dental work such as mesial or distal occlusal fillings?” and “Of those who don’t use anesthetic, what reasons do they give, and how are these distributed by approximate percentage?” In another part of the interview, dentists were also asked “What do you say to a patient just before you give an anesthetic injection?” Unstructured follow-up questions were also employed to encourage details in answers to these questions, such as “Could you tell me more about ‘such-and-such’?” In addition to asking dentists about patients, patients and dentists were asked directly, “Do you usually use local anesthetic for tooth drilling?” If patients required addi tional explanation, it was described as “more than a small filling.” 

To more efficiently investigate the patterns of qualitative statements made, a computer software program was also employed. It aided the systematic coding of categories and the development of an understanding of these categories as ethnic themes using a custom-fitted indexing system for all the verbatim transcriptions of audiotaped interviews.

Although the study aim was the discovery and description of important psychosocial variables about perceptions of pain and the need for anesthetic, the two following general hypotheses guided comparisons across ethnic groups: (a) there are ethnic differences in the use of local anesthesia for tooth drilling and (b) the reasons for nonuse of local anesthesia differ by ethnicity.

Percentages volunteered by dentists about their patients are presented as median scores, because they were ordinal estimates, whereas actual patient and dentist reports are in true percentages. In some cases, to determine the likelihood of occurrence of comparable phenomena across groups, bivariate odds ratios (OR) with confidence intervals at 95% were calculated with Chi-square (Yates’ correction) or Fisher’s exact tests for significance at P = 0.05. discount drugs canda

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.