Relaxation Effect of an Audiovisual System on Dental Patients Part 2 Palus-Amplitude

Transcription

1 J. Nihon Univ. Sch. Dent., Vol. 37, No.3, , 1995 Relaxation Effect of an Audiovisual System on Dental Patients Part 2 Palus-Amplitude Yoshinori Satoh1, Eiichi Nagai1, Kouichi Kitamura1, Masahiro Sakamura1, Kennichi Ohki1, Satoru Yokota1, Katsuzo Ohki1, Kazuhiko Hara2, Kazuyoshi Koike2 and Minoru Gotoh2 (Received 23 February and accepted 6 June 1995) Key words: relaxation, audiovisual system, plethysmogram Abstract Dental care services include relaxation of patients to reduce their displeasure at and tension during treatment. For this purpose, it is common to use audio or audiovisual programs, that is, to let them listen to music or watch TV. However, the former utilizes only the auditory sense, and the latter is disadvantageous in that a TV set is a rather large-scale unit. In the present study, we determined the relaxation effect of an audiovisual instrument on dental patients. The instrument, which gives virtual vision, was composed of a lightweight eyeset of the snow goggle type that has a built-in TV screen, with earphone and accessories. The relaxation effect was determined using a polygraph. Introduction The feeling of satisfaction a patient gets with dental care is affected by whether or not he or she is relaxed during dental treatment, as well as other factors such as the skills of dental treatment, services of the paradental staff and informed consent. To eliminate the patient' s anxiety and displeasure at treatment and to attain relaxation, there have been various methods available, such as autogenic training [1], audioanalgesia [2-8], premedication [9], use of the visual and auditory senses with a TV monitor installed on the ceiling of the dental office [10], and use of a bodysonic apparatus[11]. Among these methods, the conventional audiovisual method using a TV set [1 1 is disadvantageous that it requires cumbersome large-scale unit. Recently, Virtual VisionTM, a new audiovisual instrument for relaxation during dental treatment, appeared on the market [12]. This is a small, light instrument of the snow goggle type equipped with an earphone and a built-in TV screen. The earphone can cut off the unpleasant noises associated with dental treatment, achieving a masking effect, and watching pictures on the TV screen makes thepatient relax. In the present study aimed at determining the relaxation effect of this new audiovisual system on patients during dental treatment, we investigated its influence on the activity of sympathetic nerves, an index of relaxation, in terms of pulse-amplitude on a digital plethysmogram. We also carried out a questionnaire survey on the users' impressions of this system. in 1 Department of Removable Partial Denture Prosthodontics, Nihon University School of Dentistry 2 Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry To whom all correspondence should be addressed: Dr. Yoshinori Satoh, Department of Removable Partial Denture Prosthodontics, Nihon University School of Dentistry, Kanda-Surugadai, Chiyoda-ku, Tokyo 101, JAPAN

2 139 Materials and Methods 1. Subjects The subjects were 10 generally healthy male volunteers in their 20s who had no visual or auditory impairment. They were selected randomly from among the students of our dental school who offered their cooperation in this experiment. 2. Methods 1) Devices Virtual VisionTM (V.V.), a new system which makes simultaneous use of sounds and pictures, was used for relaxation (Rel) during dental treatment (Table 1, Fig.1). The relaxation effect was determined by measuring the pulse-amplitude (PA) by plethysmography (PTG), targeting the activity of sympathetic nerves. As dental treatment, each subject underwent scaling of the teeth with a scaler (Table 1). Table 1 Measuring Devices Fig. 1 Virtual Vision 2) Recording of PA PA was recorded twice on two different days in each of the 10 subjects. On the first day of measurement, the subject relaxed for 5 min without using the audiovisual system (Non-V.V.-Rel1) on the chair of a dental unit. During this period, PA was recorded on a pen recorder and a data recorder via the PTG sensor attached to the middle finger of the left hand. The speed of recording on the pen recorder was 2 mm/s. Then, the subject underwent scaling with a scaler for 2 min (Non-V.V.-Scal), while PA was recorded in the same manner. Finally, the subject relaxed for 5 min (Non-V.V.-Rel2), while PA was

3 140 recorded in the same manner. On the second day of measurement, PA was recorded similarly, using the Virtual VisionTM audiovisual system. Specifically, following 5 min of relaxation without using V.V., the subject, wearing V.V. with sounds and pictures played back, relaxed for 5 min (V.V.-Rel1), underwent scaling with a scaler for 2 min (V.V.-Scal), and relaxed for another 5 min (V.V.-Rel2). PA was recorded throughout this period. 3) Assessment of the relaxation effect For each subject, the pulse magnitude was measured at 1-min intervals to obtain PAvalues. Namely, five PA values were obtained at 1-min intervals for each of Non-V.V.-Rel1,Non-V.V.- Rel2, V.V.-Rel1 and V.V.-Rel2 and two PA values at 1-min intervals for each of Non-V.V.-Scal and V.V.-Scal. Using the mean of the five PA values of Non-V.V.-Rel1 as the standard, the percentages of PA values for V.V.-Rel1,V.V.-Scal and V.V.-Rel2 relative to the standard value were calculated. 4) Questionnaire All subjects were asked six questions, shown in Table 2, about the effect of V.V., to obtain their subjective assessment. Table 2 Questionnaire 1. PTG Results The means and standard deviations of PA values for Non-V.V.-Rel1, -Scale and -Rel2, and V.V.-Rel1, 10 subjects, with Non-V.V.Rel1 used as the standard, are shown in Table 3 and Fia.2. Data for a subject who showed a marked relaxation effect (Subject A) are shown in Table 4 and Fig.3, and those of another subject who showed hardly any such effect (Subject B) are shown in Table 5 and Fig.4.

4 141 Fig. 2 Pulse-amplitude obtained by PTG in 10 subjects Fig. 3 Pulse-amplitude obtained by PTG (subjects A) Fig. 4 Pulse-amplitude obtained by PTG (subjects B) Table 3 Pulse-amplitude obtained by PTG in 10 subjects

5 142 Table 4 Pulse-amplitude obtained by PTG (Subject A) Table 5 Pulse-amplitude obtained by PTG (Subject B) 2. Questionnaire The results of the questionnaire are shown in Table 6. Discussion 1. Measurement of relaxation Anxiety and displeasure are known to enhance the activity of autonomic nerves, particularly sympathetic nerves [ ]. Since such enhancement affects PA, blood pressure, heart beat, etc., sympathetic nervous activity can be assessed through measurement of these parameters as indices [1.10]. In the present study, we focused on PA as an index of sympathetic nervous activity becasuse this can be obtained easily by measuring the amplitude of the waves recorded on the pen recorder. 2. Assessment of relaxation effect The percentage of PA values in 10 subjects, obtained with the values for Non-V.V.-Rel1 set as 100%, are shown in Tables 3-5 and Figs.2-4. As shown in Table 3 and Fig.2, the results for 10 subjects showed a slight decrease in PA (93-90%) \ or a slight increase in sympathetic nervous activity \during V.V.-Rel2, a rapid decrease in PA (56-57%) \ or a rapid increase in nervous activity \ during V.V.-Scal, and restoration of PA to near the V.V.-Rel1 level

6 143 (84-92%) \or reversal of the enhanced activity \during V.V.-Rel2. In these 10 subjects, the sympathetic nervous activity was rather enhanced even with the use of a V.V. because of anxiety and tension prior to dental treatment. During scaling, the nervous activity was enhanced greatly both with and without the use of V.V., though the enhancement was slightly less in the former than in the latter case. After scaling, the subject tended to return to a relaxed state (the percentage of PA approximating 100%) more rapidly with V.V. than without (Table 3). Among the 10 subjects, one (Subject A) showed a markedly higher relaxation effect (Table 4), and another (Subject B) showed a lower effect (Table 5), with the use of V.V. in comparison with the mean effect shown in Table 3. Thus the results of the present study, expressed as mean values among 10 subjects, suggest that this new audiovisual system is effective for relaxation during dental treatment. It is also suggested that there is individual variation in the relaxation effect, some subjects showing a marked effect and others showing a low effect. The results of the questionnaire revealed that this instrument provided relaxation in 80% of the subjects and relief from anxiety in 50%, and that 70% of them desired to use it again for future dental treatment. This indicates that it is necessary for the dentist to give consideration to the patient' s relaxation during dental treatment. This study only covered changes in PA in 10 subjects. Therefore, it is desirable to analyze various other parameters such as blood pressure, heart rate and respiratory rate in a greater number of subjects to comprehensively evaluate this new audiovisual system. The subjects of the present study underwent scaling as the test dental treatment. Detailed examination of the effects of this system during other types of dental treatment or prolonged dental treatment is also necessary in the future. Conclusions To determine how the use of a new audiovisual system (Virtual Visionm) during dental treatment affects relaxation through its masking effect, we measured PA in 10 subjects while providing sounds and pictures via this instrument, and asked them about their impressions using questionnaires. The results were as follows: 1). The PA value for relaxation prior to dental treatment was lower with the use of the audiovisual system than without it. However, after the beginning of dental treatment and during the second relaxation period, the PA value was higher with the audiovisual system than without it, suggesting its benefit. 2). The results of the questionnaire indicated that the use of this audiovisual system during dental treatment would lessen the patients' anxiety and help them relax. References [1] Koike, K.: Effect of autogenic training on the activity of sympathetic nerves, -Plethysmography, heart rate and microvibration measures-, Nihon Univ. Dent. J., 64, , 1990 (in Japanese) [2] Hatano, K., Oyama, T., Kogure, I., Ohkura, I. and Spintge, R.: Anxiolytic effect of music on dental treatment, 'Part 1 Subjective and objective evaluation, J. Japanese Dent. Soc. Anesthesiol., , 1983(in Japanese) [3] Koike, K.,Miura, T., Ikezima, M., Hagiwara, Y.,Yagi, T.,Yosida, M., Matsuura, N., Ohsawa, I., Isomura, A., Okabe, H., Gotoh, M. and Sugiura, M.: The effect of audioanalgesia against dental procedure (Part 1) sympathetic nerve activity, Nihon Univ. Dent. J., 63, , 1989 (in Japanese) [4] Gardner, W.J. and Licklider, J.C.R.: Auditory analgesia in dental operation, J.A.D.A., 59, , 1959 [5] Davis, H.,Cox, J.R. and Gloring, A.:Minimum requirments for apparatus for "Auditory analgesia", J.A.D.A., 63, , 1961

7 144 [6] Tsuchiya, T., Hozawa, S., Waki, N. and Kurosu, K.: Effectiveness of audioanalgesia in dental procedure (I) \Questionnaire and observation of external behavior in children, Aichi Gakuin J. Dent.Sci., 13, 62-76, 1975(in Japanese) [7] Tsuchiya, T., Hozawa, S., Yoshioka, T., Waki, N. and Kurosu, K.: Effectiveness of audioanalgesia in dental procedure(ii) \ Observation of internal behavior of children by polygraph (four channels), Jpn. J. Pedodont.,13, , 1975 (in Japanese) [8] Tsuchiya, T., Hozawa, S., Watanabe, T., Fukuta, O. and Kurosu, K.: Effectiveness of audioanalgesia in dental procedure(iii) \ Observation of children' s internal behavior in tooth drilling by polygraph (eight channel), Aichi Gakuin J. Dent.Sci., 13, , 1976 (in Japanese) [9] Koike, K., Okabe, H,. Yagi, T., Miyata, Y., Gotoh, M. and Sugiura, M.: The effect of the premedication of adrenergic beta-receptor blockade(part 1), Nihon Univ. Dent. J., 59,93-97,1985(in Japanese) [10] Tojo, H., Kanamori, K., Tanaka, N., Amamiya, H., Amamiya, J.,Ozeki, H., Ushiyama, T.,Ishii, Y.,Narita, Y.and Uchida, Y.: Analysis of the pulse wave rhythm in patient of dental phobia, Jpn. J. Psychosomatic Dent. 4, 33-40,1989 (in Japanese) [11] Tsuchiya,T., Yamada,Y. and Kurosu K.: Effectiveness of bodysonic apparatus in dental treatment, Jpn. J. Psychosomatic Dent., 7, 71-83, 1992 (in Japanese) [12] Satoh,Y., Toyoma, H.,Uchida, K.,Ohyama, T., Wang Lu, Kitamura, K., Maejima, K., Ohtani, K.,Ohki, K., Fukase, Y., Nishiyama, M., Horiuchi, K., Yamanaka, R., Tomita, A. and Ema, S.: Relaxation effect of an audiovisual system on dental patients- Part 1 An audiovisual system, Jpn. Soc. Dent. Pract., 29, , 1994 (in Japanese)

8 145 Table 6 Questionnaire 1. Have you ever recieived dental treatment? Did the treatment hurt? 2. How did you feel wearning this instrument? 3. Were you relaxed with the pictures and music provided by this instrument? 4. Did it ease your anxiety about dental treatment? 5. Did today's treatment hurt? 6. Do you want to use this instrument again in future dental treatment?