RU2452366C2 - Method of predicting psychoemotional state of patients at dental examination and possibilities of correction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry. Patient's state is estimated before dental examination by the algorithm of express-diagnostics, presented in the description, and skin-galvanic reaction SGR is measured. If values of express-diagnostics algorithm are lower than 50 points, SGR 40-60, mild degree of psychoemotional stress is diagnosed, no correction is required. If algorithm values are 51-120, SGR 61-70, which testifies to middle degree of psychoemotional stress, and physical discomfort of nervousness or episodic anxiety type is detected, as well as when values of algorithm are 121-260, SGR 61-70, which testifies about severe degree of psychoemotional state, and physical discomfort of mobilisation or fear type are detected, psychotherapeutic correction is performed. If values of express-diagnostics algorithm are higher than 261, SGR 81-100, very severe degree of psychoemotional stress is diagnosed, and in case if physical discomfort of expressed fear or fright type is detected, psychotherapeutic correction with administration of pharmacologic preparations, reducing anxiety level is performed.

EFFECT: method extends arsenal of means for prediction and correction of patient's state at dental examination.

3 tbl, 2 app, 3 ex

Description

The invention relates to medicine, to the section of dentistry, and can be used to assess and correct the psycho-emotional stress of patients at a dental appointment.

According to numerous studies, the prevalence of stomatophobia among patients in dental clinics ranges from 64% to 95% [Ayer W. Psychology in dental practice // St. Petersburg: Peter, 2008. - 234 p .; Grositskaya I.K. Deferred visits to the dentist and their relationship with the personality of the patient // M .: 2002. - 21 p .; Trezubov V.N. Reducing emotional stress in patients at a dental appointment // St. Petersburg, 1994. - 44 p .; Moore R. The contribution of embarrassment to phobic dental anxiety: a qualitative research study // BMC Psychiat. - 2004 .-- Vol.4, N10. - P.22-28]. Underestimation at various stages of the patient's psycho-emotional state can lead to a lack of effectiveness of therapy in general and the development of complications.

There are standard methods for assessing the state of a person: the SMIL test is a standardized multicriteria personality study edited by Sobchik L.N., Eisenck's questionnaire, Kettel's questionnaire (16PF), the SAN test, the Rorschard test, the Lusher test, etc., however, in connection with volume, application of these techniques is possible only in large studies [Alyamovskaya E.N. Psychoprophylaxis in dentistry // New in dentistry. - 2002. - No. 6 (106). - S.12-13].

Among the methods that allow to determine the degree of anxiety of patients, the most often used are: the personal scale for the manifestation of Taylor's anxiety, adapted in Russia T. Nemchin (1983); Spielberg's questionnaire - Hanina (Khanin Yu.L., 1976), which allows one to assess the level of personal and situational anxiety; Hamilton's anxiety scale (Hamilton M., 1959), which allows an objective quantitative assessment of the severity of anxiety and to trace the dynamics of its indicators [Psychology for dentists // pod. ed. N.V. Kudryava. - M .: 2007. - 400 p.]. However, these questionnaires are voluminous, time-consuming, and do not allow the doctor to determine the level of anxiety in a particular stress situation of a dental appointment.

I.Yu. Grinkova, S.E. Zholuyev developed a clinical dental scale for rapid diagnosis of the patient’s psycho-emotional state, based on the identification of the type and severity of the emotional reaction [Grinkova I.Yu. The experience of using the clinical dental scale for rapid diagnosis of the patient’s psycho-emotional state // Clinical Dentistry. - 1999. - No. 3. - S.30-31]. Based on the results of the diagnosis, the question of the need for sedation is resolved. The disadvantages of the method include the assessment of the severity of the patient’s reaction only according to subjective data by the doctor himself.

Boyko V.V. (2003) identified the following types of reactions in patients at a dental appointment: episodic anxiety, excitement, mobilization, fear, fear [Boyko V.V. Physical discomfort at the dental appointment: forms, identification, overcoming // St. Petersburg: Sudarynya, 2003. - 80 pp.]. Forms of physical discomfort differ from each other by the mechanism of occurrence, manifestations and correction methods.

To analyze the patient’s condition, his emotional-volitional and intellectual processes, as an indicator of the activity of the sympathetic-adrenal system and its higher center - the hypothalamic department, a simple and affordable method is used - measuring the skin-galvanic reaction, which is an indicator of involuntary activity of the autonomic nervous system [Ivanova G .G. Assessment of the psychoemotional states of children // Pediatric Dentistry and Prevention. - 2001. - No. 1. - S.53-54]. The method was first used in dentistry by Professor G. Ivanova. in children's practice. We used a comprehensive assessment of physiological parameters: skin-galvanic reaction, blood pressure and heart rate to interpret the patient's condition during dental treatment.

The problem of reducing the patient’s emotional stress at the dental appointment is relevant at the present time, since a method for its safe, quick and effective solution has not been developed. In dental practice, for the preliminary preparation of patients, the benzodiazepine tranquilizers were most often used [Karvasarsky B.D. Clinical Psychology // St. Petersburg: Peter, 2004. - 598 p.]. It is known that they have the ability to suppress a sense of fear, anxiety, stop psycho-emotional arousal, have a pronounced sedative and muscle relaxant effect without disturbing proper behavior. A number of authors suggest the combined use of tranquilizers with analgesics [Kiseleva EG Prevention of fear of dental treatment in children // Pediatric Dentistry and Prevention. - 2006. - No. 1-2. - S. 54-61]. However, currently there are data on serious side effects of drugs, the development of withdrawal symptoms. Therefore, the use of tranquilizers and sedatives in dentistry for premedication is limited and impossible without prior consultation with a psychiatrist, which complicates the treatment and lengthens its time [G. Yagudinova Psychophysiological individually-oriented correction of anxiety in dental patients // Ufa: BSU, 2000. - 23 p.].

The search for new methods of sedation in dental practice is being conducted in the direction of using drugs of other groups. S.G. Novikov et al. Propose the use of an antioxidant that has a non-specific antidepressant and anxiolytic effect - methadoxyl [New Aspects of Premedication in Outpatient Dentistry / S.G. Novikova, E.G. Lobanova, S.A. Rabinovich [et al.] / Clinical Dentistry. - 2007. - No. 2. - S. 62-66]. However, when prescribing any drugs, careful consideration of all possible indications and contraindications is necessary, as well as consultation of a specialist with a narrow profile. Therefore, the use of pharmacological correction should be limited only to the most difficult cases.

Psychoprophylaxis has become very common now. Methods of psychological correction of the patient's condition at the dental appointment were developed and adapted by Doctor of Psychology, Professor Boyko V.V. The method is simple, convenient, easy to use, safe. Algorithms of the doctor’s actions for identifying a specific type of physical discomfort are described: excitement, mobilization, episodic anxiety, fear of fear [Appendix 1, Appendix 2].

The disadvantage of these methods is:

- volume, the possibility of use only in large scientific research;

- most of the techniques are poorly adapted to the specific situation of the dental reception;

- the need to spend a significant amount of time to assess the condition of the patient and carry out the correction;

- lack of an integrated approach in the assessment and correction of psycho-emotional stress;

- unidirectional methods, predicting the state without taking into account a complex of factors;

- subjectivity of the assessment according to the observations of the doctor himself;

- the presence of side effects when using drugs or prolonged achievement of the result.

The objective of the study: to propose a method for the comprehensive diagnosis of the psycho-emotional state of a patient at a dental appointment and the possibility of differential correction, devoid of the above disadvantages.

The technical result consists of: a new method for comprehensively assessing the level of the patient’s psychoemotional stress using the express diagnostics algorithm, the values of the skin-galvanic reaction gives the doctor objective information about the patient’s current condition, allows you to determine the need for emotional stress correction, and choose the method of interaction with the patient. The inventive method is simple to implement and does not require expensive equipment.

The technical result is achieved by taking into account the results of measuring the skin-galvanic reaction and the value of the "rapid diagnostic algorithm." The algorithm was developed on the basis of a comprehensive examination of 219 patients who applied to the clinic of the Far Eastern State Medical University “Unistom” for the treatment of dental caries and its complications. All patients underwent a study of dental status, assessment of physiological parameters: skin-galvanic reaction, blood pressure, heart rate, a detailed sociological study. Based on a comparison of the obtained data, an “algorithm for express diagnostics of the degree of severity of emotional stress of patients at the dental appointment” was developed, 158 patients made up the control group — no correction of psychoemotional stress was carried out. 61 people - an experimental group, after a comprehensive examination was carried out psychotherapeutic correction of emotional stress.

Algorithm for rapid diagnosis of the patient's condition before the dental appointment.

Dear Patient! We ask you to answer the proposed questions, evaluate each sign using a scale from 0 to 10 points, circling the desired number: 0 means the complete absence of this sign, 5 - the average severity of the manifestation of this sign, 10 - the maximum manifestation of its severity. In questions 1, 6, 7, choose only one answer; in questions 3, 4 and 5 - one or two answers, in questions 2, 8, 9 any number of answers.

Floor. Husband. Wives Age_year. Profession work experience_year.

I. Sensations in the oral cavity before treatment:

Choose one answer:

1) an unpleasant sensation, although there is no pain 0 1 2 3 4 5 6 7 8 9 10 2) I am in pain 0 1 2 3 4 5 6 7 8 9 10

II. Are you experiencing physical pain now:

1) headache 0 1 2 3 4 5 6 7 8 9 10 2) heart pain 0 1 2 3 4 5 6 7 8 9 10 3 very tight muscles 0 1 2 3 4 5 6 7 8 9 10 4) stomach pain 0 1 2 3 4 5 6 7 8 9 10 5) pain in other parts of the body 0 1 2 3 4 5 6 7 8 9 10

III. Your general condition today before treatment:

First, select 1-2 of the most suitable characteristics, and then rate them on a scale:

1) some malaise 0 1 2 3 4 5 6 7 8 9 10 2) bad mood, anxiety 0 1 2 3 4 5 6 7 8 9 10 3) loss of strength, activity 0 1 2 3 4 5 6 7 8 9 10 4) anxiety 0 1 2 3 4 5 6 7 8 9 10 5) depression, depression 0 1 2 3 4 5 6 7 8 9 10

IV. What are you experiencing today with your dentist?

First, select 1-2 of the most suitable characteristics, and then rate them on a scale:

1) some concern 0 1 2 3 4 5 6 7 8 9 10 2) noticeable excitement 0 1 2 3 4 5 6 7 8 9 10 3) severe nervous tension 0 1 2 3 4 5 6 7 8 9 10 4) fear, but I control myself 0 1 2 3 4 5 6 7 8 9 10 5) fear, I can not control myself 0 1 2 3 4 5 6 7 8 9 10

V. What did you experience before (usually the last time) at the dentist's appointment?

First, select 1-2 of the most suitable characteristics, and then rate them on a scale:

1) some concern 0 1 2 3 4 5 6 7 8 9 10 2) noticeable excitement 0 1 2 3 4 5 6 7 8 9 10 3) severe nervous tension 0 1 2 3 4 5 6 7 8 9 10 4) fear, but I control myself 0 1 2 3 4 5 6 7 8 9 10 5) fear, I can not control myself 0 1 2 3 4 5 6 7 8 9 10

VI. Your memories of your first visits to the doctor:

Choose one answer:

1) positive 0 1 2 3 4 5 6 7 8 9 10 2) neutral 0 1 2 3 4 5 6 7 8 9 10 3) negative 0 1 2 3 4 5 6 7 8 9 10 4) sharply negative 0 1 2 3 4 5 6 7 8 9 10

VII. Your attitude to dental treatment now:

Choose one answer:

1) positive 0 1 2 3 4 5 6 7 8 9 10 2) neutral 0 1 2 3 4 5 6 7 8 9 10 3) negative 0 1 2 3 4 5 6 7 8 9 10 4) sharply negative 0 1 2 3 4 5 6 7 8 9 10

Viii. If you are afraid of a dentist, what could cause you to have a fear of dental intervention:

1) fear appeared before coming to the dentist 0 1 2 3 4 5 6 7 8 9 10 2) you previously experienced pain at the doctor’s appointment, discomfort 0 1 2 3 4 5 6 7 8 9 10 3) fear was the result of words or actions of a doctor 0 1 2 3 4 5 6 7 8 9 10 4) fear appeared as a result of complications during or after treatment 0 1 2 3 4 5 6 7 8 9 10 5) You are afraid that during the treatment something can happen 0 1 2 3 4 5 6 7 8 9 10

IX. Do you note the following conditions:

1) constant irritability when dealing with people 0 1 2 3 4 5 6 7 8 9 10 2) loss of interest in life, other people 0 1 2 3 4 5 6 7 8 9 10 3) fear of the future 0 1 2 3 4 5 6 7 8 9 10 4) fear of self-failure 0 1 2 3 4 5 6 7 8 9 10 5) the feeling that no one can be trusted 0 1 2 3 4 5 6 7 8 9 10 6) difficulty making decisions 0 1 2 3 4 5 6 7 8 9 10

An analysis of the data obtained allowed us to conclude that when the value of the rapid diagnostic algorithm is up to 50 points, the values of the skin-galvanic reaction are from 41 to 60 conventional units. diagnose a mild degree of psychoemotional stress, patients may have episodic anxiety, or the absence of physical discomfort, which is registered in 38 patients (17%), no correction is required, or measures aimed at preventing the occurrence of episodic anxiety. When the value of the rapid diagnostic algorithm is from 51 to 120 points, the skin-galvanic reaction is from 61 to 70 conventional units they diagnose an average degree of tension, episodic anxiety was recorded in patients, excitement - 50 people (23%), psychotherapeutic correction is carried out [Appendix 2]. When the value of the rapid diagnostic algorithm is from 121 to 260 points, the skin-galvanic reaction is from 71 to 80 conventional units diagnose a severe degree of tension, mobilization or fear was registered in patients - 98 patients (45%), conduct psychotherapeutic correction. If the value of the rapid diagnostic algorithm is higher than 261 points, the skin-galvanic reaction is from 81 to 100 conventional units. - a very severe degree of psychoemotional stress, expressed forms of fear or fear were recorded in patients - 33 patients (15%), psychotherapeutic correction and consultation of a narrow specialist to prescribe pharmacological preparations are carried out. The scheme for assessing and correcting the psycho-emotional stress of patients at the dental appointment is presented in Table No. 1.

The implementation of the invention was carried out in the dental clinic of the Far Eastern State Medical University "Unistom." When the patient contacted, an express diagnosis of the condition before the dental appointment was carried out according to the algorithm we developed for measuring the skin-galvanic reaction (RAG) (type 2003-M device included in the state register of measuring instruments). Based on the obtained values of the rapid diagnostic algorithm and RAG data, the doctor determines the degree of psychoemotional stress in this patient [Table 1]. According to the scheme for assessing and correcting the emotional stress of patients at the dental appointment [Table 1], the type of physical discomfort in the patient is identified, for clarification, an algorithm for recognizing the type of physical discomfort at the dental appointment, developed by the doctor of pedagogical sciences, professor V.V. Boyko, is used ( 2003) [Appendix 1]. Based on the data obtained, a psychotherapeutic correction of emotional stress is carried out [Table 1], based on an algorithm for blocking physical discomfort developed and adapted for dental admission by a doctor of pedagogical sciences, professor Boyko V.V. [Appendix 2].

Principles of correction of emotional stress of patients at the dental appointment.

1. Determining the severity of emotional stress according to the algorithm of express diagnostics and the values of the skin-galvanic reaction. Evaluation criteria for the rapid diagnostic algorithm:

up to 50 points - a slight degree of psychoemotional stress; from 51 to 120 points - the average severity of psycho-emotional stress; from 121 to 260 points - a severe degree of severity of psycho-emotional stress; above 261 points - a very severe degree of severity of psycho-emotional stress.

Criteria for assessing the values of the skin-galvanic reaction (used device type 2003-M, included in the state register of measuring instruments): up to 40 conventional units - low psycho-emotional arousal; from 41 to 60 conventional units - The normal state of the nervous system; from 61 to 70 conventional units - moderate excitation of the nervous system;

from 71 to 80 conventional units - strong excitement of the nervous system;

81 conventional units and above - extreme excitement of the nervous system.

2. Determining the type of physical discomfort according to the scheme for assessing and correcting emotional stress [Table 1] and the recognition algorithm for the type of physical discomfort [Appendix 1].

3. Correction of emotional stress of patients at the dental appointment [Table 1, Appendix 2].

In order to evaluate the results of the study, we compared the changes in the recorded parameters in the patients of the experimental and control groups, presented in table No. 2, according to which there are differences in the values of the skin-galvanic reaction, heart rate, personal data in patients of the compared groups. The degree of severity of nervous system excitation (as assessed by RAG) after dental treatment in patients with acute pain syndrome in the control group was 76 conventional units, and in the experimental group - 61 conventional units (p <0.05). Among the “planned” patients, the differences are as follows: in the RAG control group, 73 conventional units in the experimental - 58 conventional units (p <0.05). In addition, in patients who underwent correction, after taking the heart rate and self-esteem data (questionnaire) were lower compared with patients in the control group.

Evaluation of the effectiveness of the results of the measures taken was carried out by calculating the difference in the values of physiological parameters and the questionnaire data of patients before and after dental admission, the results are presented in table No. 3, according to which it is seen that the greatest decrease was revealed in the values of the skin-galvanic reaction in patients who treated with acute pain syndrome (22.1 points). Statistically significant differences are observed in the values of all the indicators presented, except for blood pressure, which can be explained by the participation of young somatically healthy patients in the study. Thus, the excitation of the nervous system, according to the galvanic skin reaction, undergoes the largest fluctuations, and blood pressure indicators are more stable. The calculation of differences in the decrease in physiological parameters between the patients of the experimental and control groups revealed that the greatest reduction in the values with significant differences in the indicators was noted for the galvanic skin reaction, in patients with acute pain syndrome - 60%, in planned patients - 45%. The reduction in heart rate was 32%, the severity of psychoemotional arousal, according to the survey (sociological study) - 20%. Therefore, a galvanic-skin reaction is the most labile indicator, reflecting the tone of the autonomic nervous system, the level of emotional stress of a person. Thus, the study obtained high medical efficiency of the psychotherapeutic correction of patients at the dental appointment, which amounted to 45% in planned patients and 60% in patients who came with acute pain due to a reduction in the value of the skin-galvanic reaction.

The advantage of the proposed method are:

- Speed, objectivity of diagnosis. Software has been developed to accelerate the receipt of the result of the express diagnostic algorithm

- Security, no need for expensive special equipment

- Accessibility, convenience for the doctor and patient

- No side effects

- Easy to implement

- Improving the medical effectiveness of treatment and preventive measures

- Reducing the risk of emergency reactions

- Improving patient comfort

- Saving the time of the doctor and patient due to the possibility of carrying out a larger volume of necessary manipulations in one visit, as a result of normalization of the patient's psycho-emotional state

- Establishing a trusting relationship between doctor and patient

Example 1. Patient D., 27 years old, turned to the clinic of therapeutic dentistry with complaints of acute spontaneous pain in the tooth of the upper jaw on the right, worse in the evening and when eating.

Anamnesis: according to the patient, the tooth is disturbed for 5 days. I took analgesics on my own up to 5 tablets per day. 2 days ago I went to the dental clinic at the place of residence, where they could not “anesthetize” the tooth. The patient refused dental intervention. Objective data: the face is symmetrical, the skin is clean, regional lymph nodes are not enlarged. Dental status corresponds to the identified pathology. KPU = 13 - high level of caries intensity; comprehensive hygiene index J.C. Green, J.R. Vermillion (OHI-S) = 3.0 - satisfactory oral hygiene. After examination, carrying out additional research methods, the patient was given a dental diagnosis: tooth 1.6 - chronic fibrous pulpitis in the acute stage. Code ICD K04.0. The values of physiological parameters: blood pressure 130/85 mm Hg - increased normal, heart rate of 94 beats per minute - tachycardia.

The patient is tense, looking for eye contact with the staff, expresses concern about the painfulness of the treatment, the professionalism of the doctor, and the health of the equipment. Informs the doctor that anesthesia does not work on him.

The results of assessing the severity of emotional stress according to the rapid diagnostic algorithm: 194 points - a severe degree. The value of the skin-galvanic reaction was 80 conventional units - strong excitation of the nervous system. According to the scheme for assessing and correcting emotional stress of patients at the dental appointment [Table 1], the patient revealed a severe degree of psychoemotional stress, therefore, a possible type of physical discomfort is mobilization or fear. Based on the patient’s behavior, taking into account the signs described in the algorithm for recognizing the type of physical discomfort at the dental appointment [Appendix 1], the patient is diagnosed with fear.

A psychotherapeutic correction of fear was carried out, aimed at recognizing the naturalness of experiences, designating a measure of manifestation of fear, identifying the causes of fear, demonstrating its failure [Appendix 2]. In this case, the reason for the fear of dental intervention was the patient's conviction that there was no effect from anesthesia and a high degree of toxicity of the drugs. Specific reasons for insolvency are given. In case of fear, the entire correction is aimed at constantly turning to the patient’s consciousness.

After the correction, the patient externally became calmer, expressed a desire to “try” to begin treatment. The values of physiological parameters after correction: skin-galvanic reaction of 70 conventional units - moderate excitation, blood pressure 125/85 mm Hg - normal values, heart rate 86 beats. in minutes - a high norm. The patient underwent dental treatment of the revealed pathology according to the treatment standards.

After administration, the patient's condition is good. RAG = 65 conventional units - moderate excitation, blood pressure 125/80 mm Hg - normal value, heart rate 84 beats per min - high norm. The patient signed up for the next visit.

Example 2

Patient K., 38 years old, turned to the clinic of therapeutic dentistry with complaints of acute spontaneous pain in the tooth of the upper jaw on the right, aggravated by chewing, swelling of the cheek on the right.

Anamnesis: according to the patient, the tooth bothers him for a week, was previously ill several times, did not seek dental care in connection with the horror (according to the wording of the patient himself), which he experiences in relation to the dentist. I took analgesics on my own up to 8 tablets per day, tried to be treated with folk remedies. Asymmetry of the face appeared a day ago. Objective data: the face is asymmetric, due to swelling of the upper jaw on the right, zygomatic and infraorbital regions, submandibular regional lymph nodes on the right up to 1 cm, on the left up to 0.8 cm, mobile, slightly painful on palpation. Dental status corresponds to the identified pathology. KPU = 16 - high level of caries intensity; hygiene index J.C. Green, J.R. Vermillion (OHI-S) = 5.0 - poor.

After examination, carrying out additional research methods, the patient was given a dental diagnosis: tooth 1.5 - chronic granulating periodontitis in the acute stage. Code ICD K04.5. The values of physiological parameters: blood pressure 130/85 mm Hg - normal, heart rate 98 beats per minute - tachycardia.

The patient is tense, detached, distrustful, removes the body and turns away when the doctor says. He cannot explain the reason for his condition. He claims that the doctor’s assurances about the painlessness of the treatment do not affect him. The value of the skin-galvanic reaction 85 srvc - extreme arousal. The degree of emotional stress according to the rapid diagnostic algorithm of 298 points is a very severe degree of severity.

According to the evaluation and correction scheme [Table 1], the patient revealed a very severe degree of psychoemotional stress. Possible types of physical discomfort are expressed fear or fear. Considering the patient’s behavior, the patient is identified by the algorithm of recognition of the type of physical discomfort [Appendix 1].

Conducted psychotherapeutic correction of fear. The patient’s technique of relaxation in a state of fear was chosen — involuntary catharsis — the patient’s prompting to respond to fear and use up emotional energy, which leads to relaxation. The method is achieved by asking the patient to describe in detail and show their experiences at the dentist. The participation of a doctor is mandatory [Appendix 2]. After the patient used up his emotions, he relaxed, felt the sympathy of the doctor, and dental treatment was started. The values of physiological parameters after correction: skin-galvanic reaction of 75 conventional units - strong excitation, blood pressure 125/80 mm Hg - normal values, heart rate 90 beats. in minutes - a high norm.

The patient underwent dental treatment of the revealed pathology according to the treatment standards. After administration, the patient's condition is good. RAG = 70 conventional units - moderate excitation, blood pressure 120/80 mm Hg - normal value, heart rate 84 beats per min - high norm. The patient expressed a desire to continue treatment, signed up for a repeat visit.

Example 3

Patient I., 33 years old, came to the clinic of therapeutic dentistry with complaints of aching pain in the tooth of the upper jaw on the left, aggravated by taking cold, sweet. Anamnesis: according to the patient, the tooth periodically bothered for six months.

Objective data: the face is symmetrical, regional lymph nodes are not enlarged. Dental status corresponds to the identified pathology. KPU = 11 - the average level of intensity of caries; Hygiene Index J.C. Green, J.R. Vermillion (OHI-S) = 3.2 - poor. The values of physiological parameters before dental treatment: blood pressure 125/85 mm Hg - normal value, heart rate 92 beats per minute - tachycardia.

The patient is tense, movements are constrained, her eyes are fixed, periodically fixed on the actions and manipulations of the doctor. The breath is shallow. The patient is silent, responds in monosyllables, after a long pause, with delays responds to requests.

After examination, carrying out additional research methods, the patient was given a dental diagnosis: tooth 2.6. - chronic fibrous pulpitis in remission. K04.0.

Values of the dermal-galvanic reaction 75 conventional units - strong excitement. The value of the rapid diagnostic algorithm is 130 points - a severe degree of stress. Based on the data obtained, according to the scheme for assessing and correcting stress [Table 1], the patient revealed a severe degree of psychoemotional stress. A possible type of physical discomfort is mobilization or fear. Given the patient’s behavior, according to the recognition algorithm of the type of physical discomfort at the dental appointment [Appendix 1], mobilization is diagnosed. A psychotherapeutic correction was carried out, aimed at constant contact with the patient, informing that his experiences were taken into account, explanations about the causes, time and duration of possible discomfort during dental procedures [Appendix 2]. After the correction, the condition improved, the patient externally became more relaxed, calm, speech informative.

The values of physiological parameters after the correction: skin-galvanic reaction of 70 conventional units - moderate excitation, blood pressure 125/80 mm Hg - normal values, heart rate 84 beats. in minutes - a high norm. The patient underwent dental treatment of the revealed pathology according to the treatment standards. After taking the condition is good. RAG = 70 conventional units - moderate excitation, blood pressure 120/80 mm Hg - normal value, heart rate 80 beats per min - normal. The patient thanked for the attentive attitude and painless treatment.

Table number 1 The scheme of assessment and correction of emotional stress of patients at the dental appointment The degree of psychoemotion
voltage Express Diagnostics Values
Ki (points) Values of the skin-galvanic reaction (conventional units) Type of emotional reaction Correction principles Easy up to 50 from 40 to 60 Lack of discomfort at the reception, occasional alarm is possible Correction does not require warning alert Average 51 to 120 61 to 70 Episodic anxiety, excitement Conducting psychotherapeutic correction Heavy 121 to 260 from 71 to 80 Mobilization, fear Conducting psychotherapeutic correction Very heavy above 261 81 to 100 Expressed fear, fear Conducting psychotherapeutic correction. Consultation of narrow specialists with the aim of prescribing pharmacological drugs that reduce stress

Table number 2 Comparative characteristics of recorded indicators in patients of the experimental and control groups Indicators control group experienced group Patients with acute pain Patients without pain Patients with acute pain Patients without pain Application Form 73.28 ± 3.47 24.74 ± 1.99 71.57 ± 2.58 23.97 ± 1.78 Application form after admission 29.15 ± 1.8 * 11.35 ± 0.91 18.03 ± 1.3 7.08 ± 0.8 & RAG before admission (conventional) 85.11 ± 0.93 81.21 ± 0.96 83.5 ± 0.57 72.16 ± 0.67 RAG after treatment 76.22 ± 0.74 * 73.2 ± 0.86 61.4 ± 0.67 57.59 ± 0.61 & GARDEN before administration (mmHg) 131.25 ± 0.79 127.05 ± 0.75 128.83 ± 0.52 125.03 ± 0.88 DBP before admission 86.88 ± 0.59 83.14 ± 0.68 85.83 ± 0.59 82.65 ± 0.5 GARDEN after administration 124.75 ± 0.47 122.56 ± 0.59 122.67 ± 0.62 120.03 ± 0.54 DBP after administration 82.19 ± 0.41 80.64 ± 0.49 80.33 ± 0.58 79.42 ± 0.65 Heart rate before administration (bpm) 94.95 ± 0.66 89.19 ± 0.79 92.07 ± 0.48 84.16 ± 0.39 Heart rate after taking 86.74 ± 0.56 * 82.45 ± 0.72 80.0 ± 0.81 74.06 ± 0.72 & Note: *, & - statistically significant differences are calculated between the control and experimental groups depending on the severity of pain (p <0.05). The most significant differences are highlighted in bold.

Table number 3 Evaluation of the effectiveness of the results of the correction of patients at the dental appointment by the difference in indicators Indicators control group experienced group Patients with acute pain Patients without pain Patients with acute pain Patients without pain Profile, points 44.13 ± 2.57 * 13.39 ± 1.31 53.54 ± 3.01 16.89 ± 1.23 & RAG (conventional units) 8.89 ± 0.83 * 8.01 ± 0.79 22.1 ± 0.52 14.57 ± 0.9 & GARDEN 6.5 ± 0.79 4.49 ± 0.81 6.16 ± 0.75 5 ± 0.87 DBP 4.69 ± 0.77 2.5 ± 0.51 5.5 ± 0.81 3.23 ± 0.64 Heart rate 8.21 ± 0.35 * 6.74 ± 0.49 12.07 ± 0.32 10.1 ± 0.31 & Note: * and & - statistically significant differences are calculated in relation to the control group of patients depending on the severity of pain (p <0.05).

Annex 1.

Recognition algorithm of the type of psychoemotional reaction at the dental appointment

1. Occasional anxiety

Signs: the patient was calm, relaxed, and suddenly froze, alert, began to actively monitor the situation, then again a state of relative rest.

Reasons: the doctor did not prepare the patient for a specific unpleasant sensation; a precursor of unpleasant sensations came into view of the patient; a situation arose in the work that the patient perceives as abnormal, threatening his health.

2. Excitement

Signs: increased micromotion: frequent blinking, tremor of the fingers, twitching of the shoulders, head movements in search of a comfortable position, distracted gaze, intermittent or slowed breathing, possible increased speech activity, comments about the situation in the office or the doctor’s actions.

Reasons: the patient was not prepared for specific sensations; was prepared for the procedure, but tired of immobility, keep his mouth open; the assistant does a poor job of his duties: untimely removes saliva, tightens his lip, etc .; the doctor awkwardly manipulates; uses obscure terms.

3. Mobilization

Signs: the muscles of the body are strained for a long time, the arms and legs are motionless, the head is fixed, the gaze is almost motionless, it answers in monosyllables, it reacts with delays.

Reasons: the patient was not prepared for the upcoming sensations, memories of discomfort in the past.

4. Fear

Signs: the patient is ready to explain how and when the fear appeared, does not close, makes eye contact with the staff, shows an interest in information, tries to tell everything, relies on the help of staff in overcoming an uncomfortable state.

Forms of manifestation: verbally, non-verbally, openly, veiled:

- verbal form: asks questions, comments on the situation, makes comments, which contain concerns about a particular occasion,

- non-verbal form: facial expressions, looks, body movements testify to fear, the patient controls emotional stress, is sensually gullible.

Reasons: trace reaction, negative attitude to treatment, ignorance of modern methods of pain relief, emotional lability, neurotic status of a person, expectation of pain, discomfort. Children's behavior - the patient needs custody, shifts responsibility for making decisions to others; childhood memory was formed during the first visits to the dentist; imitation by another - the child has learned the model of parental behavior, prejudices - erroneous ideas about the nature of dental treatment; staff error.

5. Fear

Signs: verbal form: a manifestation of fear involving speech, the patient is not able to cope with strong emotions, his thinking is blocked, he cannot convince himself of the groundlessness of his experiences, he does not perceive the arguments of others;

non-verbal form: recognized by behavioral signs: slow motion, dilated pupils, pallor, grimace of horror, speech difficulties, excessive tension of the limbs.

Disguised forms of fear: anosognosia: denies the need for dental intervention; escapism: avoids visits to the doctor; crowding out: switching to something more important than cure; euphoria: simulated optimism; exaggeration of impressions: fear is disguised as criticism of dentistry; aggression: anger, rudeness, manifested with a reduced level of culture.

Appendix 2

Algorithm for blocking psychoemotional reactions at a dental appointment

The general algorithm for blocking psychoemotional reactions:

1) to recognize the dominant type of reaction: to see the signs of a given reaction, to take into account the psychological need that causes this reaction;

2) “adjust” to the patient: signal the acceptance of the characteristics of his response, carry out “stroking”;

3) to act adequately: for irrational patients, apply the appropriate form of suggestion, for rational patients use argumentation.

Algorithm of exposure to a patient in a state of episodic anxiety, excitement,

mobilization: before treatment, it is necessary to agree with the patient about the signal “something is disturbing”

1) make it clear to the patient that his experiences have been noted: “Is something bothering you?”, “I see. You are uncomfortable. ” 2) if possible, give a pause for relaxation: “rest”, “relax”. 3) if it is impossible to interrupt the actions, explain that the situation is normal, give comments on the nature and duration.

The algorithm of psychotherapeutic effect on the patient in case of fear: 1. “Accept” the patient: recognize the naturalness of the experience of fear, express sympathy (it is appropriate to note that you understand that the state of fear is uncomfortable), show the positive role of fear (it indicates the mobilization of the body), to express my approval to the patient “it’s good that you said about your condition, I will try to help you”;

2. Designate the measure of fear “yes, but ...”: fear should not harm, one must be able to be afraid. Paragraphs 1 and 2 can be presented in the phrase: “I understand your condition well. It happens that patients are anxious at the dentist. This is a natural defensive reaction. However, it should not interfere with the treatment. Do you agree?";

3. To identify the cause of the fear, usually the patient himself specifies the reason, if not, ask the questions: “What, in your opinion, could cause you to have a fear of dental intervention?”, “Fear arose before coming to the dentist?”, “Perhaps at the appointment Did you feel pain, discomfort? ”,“ Fear was the result of the words or actions of the doctor? ”,“ Fear appeared as a result of treatment - did you have complications, did you have to redo the work? ” After the first positive answer, you can no longer ask questions;

4. “Mirror” the identified cause: give the patient feedback: you heard the reason, briefly formulated, took note, give the necessary explanations, will be taken into account in the treatment process;

5. Show the insolvency of the cause: to find the "defect" of the cause - chance, prescription, unfounded; give arguments. 2 types of arguments: from a person: examples of the behavior of patients, or their own impressions or colleagues. From facts: links to scientific data, experiments, historical information.

Forms of manifestation of fear: verbal: fear manifests itself with the participation of speech. Nonverbal: recognized by behavioral characteristics.

Algorithm for overcoming fear: the main task is to induce the patient to use up emotional charge before treatment, deprive fear of energy support. 1. Join: recognize the naturalness of fear, express sympathy, show the positive role of fear in life. 2. Designate the measure of fear: “yes but ..”, fear should not harm health, interfere with treatment, one should not be afraid of a doctor. 3. A specific method of suggestion or relaxation (catharsis, regulation of respiration, switching attention, methods of confrontation, “switching” of fear).

Claims (1)

A method for correcting a patient’s condition at a dental appointment, taking into account the assessment of his psychoemotional state, which assesses the patient’s condition before the dental appointment using the express diagnostic algorithm described in the description and the value of the skin-galvanic reaction in arbitrary units, based on which the degree of psychoemotional stress and type of physical discomfort, and according to the results obtained, a correction is carried out; when the values of the rapid diagnostic algorithm up to 50 points, skin-galvanic reaction from 40 to 60 srvc. units they diagnose a mild degree of emotional stress, correction is not required; with the values of the algorithm from 51 to 120 points, the skin-galvanic reaction from 61 to 70 conv. units, which indicates an average degree of psychoemotional stress and the identification of physical discomfort such as excitement or episodic anxiety, or with algorithm values from 121 to 260 points, a galvanic skin reaction from 71 to 80 conv. units, which indicates a severe degree of psychoemotional stress, and the identification of physical discomfort such as mobilization or fear, conduct a psychotherapeutic correction; with the values of the rapid diagnostic algorithm above 261 points, a skin-galvanic reaction from 81 to 100 conv. units they diagnose a very severe degree of psychoemotional stress and, if a physical discomfort of the type is detected, expressed fear or fear, conduct a psychotherapeutic correction with the use of pharmacological drugs that reduce the level of anxiety.