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Effect of Erythrina Mulungu on Anxiety During Extraction of Third Molars

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Effect of Erythrina Mulungu on Anxiety During Extraction of Third Molars Med Oral Patol Oral Cir Bucal. 2014 Sep 1;19 (5):e518-24. Erythrina mulungu in dental anxiety control Journal section: Oral Surgery doi:10.4317/medoral.19511 Publication Types: Research http://dx.doi.org/doi:10.4317/medoral.19511 Effect of Erythrina mulungu on anxiety during extraction of third molars Maria-Luisa Silveira-Souto 1, Carla-Rocha São-Mateus 1, Liane-Maciel de Almeida-Souza 1, Francisco-Carlos Groppo 2 1 Department of Dentistry of the Federal University of Sergipe, Aracaju, Sergipe, Brazil 2 Department of Physiological Sciences, Piracicaba Dental School, University of Campinas,Piracicaba, São Paulo, Brazil Correspondence: Claudio Batista Street no number, Cidade Nova Aracaju, Sergipe, Brazil [email protected] Silveira-Souto ML, São-Mateus CR, de Almeida-Souza LM, Groppo FC. Effect of Erythrina mulungu on anxiety during extraction of third molars. Med Oral Patol Oral Cir Bucal. 2014 Sep 1;19 (5):e518-24. http://www.medicinaoral.com/medoralfree01/v19i5/medoralv19i5p518.pdf Received: 27/08/2013 Accepted: 25/12/2013 Article Number: 19511 http://www.medicinaoral.com/ © Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946 eMail: [email protected] Indexed in: Science Citation Index Expanded Journal Citation Reports Index Medicus, MEDLINE, PubMed Scopus, Embase and Emcare Indice Médico Español Abstract Objectives: The aim of the present study was to evaluate the effect of Erythrina mulungu on the control of dental anxiety in patients who had under gone bilateral extraction of asymptomatic, impacted mandibular third molars. Material and Methods: In a randomized, double-blind, crossover study, 30 healthy volunteers (5 men and 25 wom- en, over 18 years of age), received either 500mg of E.mulungu (Mulungu Matusa®) or 500 mg of placebo, p.o., one hour before surgical procedure. The level ofanxiety was assessed through questionnaire sand physical parameters, such as blood pressure, heart rate andoxygen saturation. Data were analyzed by Chi-square test, ANOVA (Tukey test) and Friedman with significance level of 5%. Results: A higher preference (Chi-square, p = 0.0062) for E. mulungu was observed for both genders. Volunteers with higher anxiety levels tended to to prefer E. mulungu. No statistically significant differences were verified in blood pressure (one-way ANOVA, p = 0.1259), heart rate (Friedman, p> 0.05) and oxygen saturation (Friedman, p = 0.7664) among periods and types of treatments. Conclusions: E. mulungu showed an anxiolytic effect without significant changes in physiological parameters. It could be considered as an alternative to control the anxiety in adult patients undergoing mandibular thirdmolars surgery. Key words: Anxiety, Erythrina mulungu, third molar, oral surgery. Introduction in 40-50% of the general population (3). Among dental From the simplest procedure to a more invasive one, such procedures, minor oral surgeries tend to cause a lot of as surgery, anxiety is a common problem faced in the anxiety to patients because they are linked to the pos- dentist office.When these feelings of anxiety and fear oc- sibility of pain. The surgery to remove the third molaris cur due to the prospect of dental treatment, it is known considered the most dreadful for patients, even higher as dental anxiety (1,2). Fear and anxiety about dental than those surgeries performed toremove hard and soft treatment are important clinical problems and they occur tissue from injuries or insertion of implants (4). e518 Med Oral Patol Oral Cir Bucal. 2014 Sep 1;19 (5):e518-24. Erythrina mulungu in dental anxiety control The emotional and psychological states of the patient domized, double-blind, crossover study, 30 volunteered can affect treatment, impair the absorption of drugs, or patients from the Department of Dentistry of the Fe- even cause undesirable physiological changes (2). Thus, deral University of Sergipe (DOD/UFS) were selected, fears, phobias, stressful situations and depression can after diagnosis and indication of bilateral extraction often alter the physiological functions of the body, re- of asymptomatic, impacted mandibular third molars, duce the excitability threshold (making the body feel according to Pell and Gregory classification used by more pain), alter the immune response, and have a nega- Almendros-Marqués, Berini-Aytés & Gay-Escoda (9). tive impact on the trans and postoperative periods (4). This method classifies mandibular third molars into Given the fact that the dentist is routinely in contact 9 different categories based on their vertical position with anxious patients, methods for controlling anxiety (relative tothe cementoenamel junction and the occlusal are used when such condition can alter the performance plane) and their horizontal position (relative to the as- of a safe and quality procedure. Anxiety can be control- cending mandibular ramus). led by both pharmacological and non-pharmacological All participants were informed of both risks and benefits methods. For this, the most used method is the verbali- of the study, and signed an informed consent. Exclusion zation one, where the dentist should be able to under- criteria were: patients under the age of 18; any general stand, guide, soothe and comfort the patient regarding health problem based on the medical history and physi- the procedures to be performed.When this is not enough, cal examination; history of use of any medication within pharmacological methods are used, such as anxioly- 15 days before the beginning of the research; history of tics, which act reducing anxiety. Benzodiazepines are hypersensitivity to drugs, substances or materials used the most commonly used anxiolytics (5). However, they in this experiment; pregnancy or lactation; history of have important side effects. Patients using benzodi- pericoronitis. azepines can not go unaccompanied to a consultation, The study participants randomly received either Mu- drive or operate machinery duringtreatment. lungu Matusa® 500 mg (two capsules of 250 mg each) Because of the difficulties with the use of this group of or placebo (starch, two capsules), orally one hour be- drugs, one may resort to the use of herbal medicines. fore the start of surgical procedures, at either the first or These are substances obtained from plants, which can second intervention (right or left side). It is noteworthy be used as handmade medicines in the form of teas, so- that both the placebo and the capsule of Erytrina mu- lutions orpills (6). lungu were absolutely equal in size and shape. The drug Erythrina mulungu, a Southern Brazilian native plant was given to the patient by the first researcher, coded as which produces alkaloids and steroids, is a herbal medi- “Protocol 1” or “Protocol 2”. Both protocols were only cine known for its good control of anxiety. Popularly identified at the end of the experiment. Randomization known asmulungu (7), Erythrina mulungu is a medium- was done with Random Number Generator Pro 2.15 sized tree found in tropical regions and itsbark and seed software and it was established that 15 patients received have been used in folk medicine due to their anticon- “Protocol 1” and 15 patients received “Protocol 2” in vulsant, analgesic, sedative, hypnotic and hypotensive the first surgery.Therefore, everyone involved in the re- properties (8). search, volunteers, surgeon and researcher, had no prior Studies in mice and rats show that water-alcoholic ex- knowledge of pharmacological treatments thatwere be- tracts of E. mulungu are central nervous system depres- ing used (double-blind study). sants, they alter the responses related to anxiety, but In order to avoid the pain and swelling after surgery, they do not affect motor coordination (6-8). Although a single dose of intramuscular dexamethasone (8mg), the benefits of anxiolytic effects of the E. mulungu can 30 minutes before surgery, was administered. Before be applied to the dental clinic for anxiety reduction the surgery, oral antisepsis was performed by vigor- without presenting the constraints of benzodiazepines, ous rinsing, for one minute, with an aqueous solution of there is a dearth of research on the use of this plant for chlorhexidinedigluconate (0.12%). In the extra-oral an- the control of dental anxiety. Thus, this study aimed to tiseptisis, an alcoholic solution of polyvinylpyrrolidone- assess the efficacy ofE. mulungu in controlling anxiety iodine (PVP-I) 10% was used. during dental procedure. Local anesthesia was performed using the Vazirani- Akinosi mandibular nerve block technique, according Material and Methods to Haas (10), which consists of positioning the needle The study was submitted for review and approval to tip in the pterygomandibular space. For this blockade, the University Hospital Research Ethics Committee one cartridge (1.8 ml) of 2% lidocaine with 1:100,000 of of the Federal University of Sergipeby the protocol epinephrine was used. The needle was insertedinto the CEP 401/2011 and CAAE number 0366.0.107.000-11- tissue in the distobuccal vestibule opposite thesecond ,in a meeting held on 07/12/2011, and consort number or third mandibular molar just medial to the coronoid NCT01948622. In this research, characterized as a ran- notch until bone was contacted and 0.25 mL of artic- e519 Med Oral Patol Oral Cir Bucal. 2014 Sep 1;19 (5):e518-24. Erythrina mulungu in dental anxiety control aine (4%) with 1:100,000 of epinephrine was released, -Phase III - return visit: after each surgical procedure, only then the buccal nerve was anesthetized, according the volunteers received a self assessment form, to be to Reed et al. (11). answered in the days following the surgery. They were Surgical procedures occurred in two sessions, one for supposed to answer if they were tranquil, moderately each side of the hemi-jaw. Extractions of impacted anxious or very anxious. And also if they rememberede mandibular third molars were done by the operator, a very thing from the surgery, the majority of events,some maxillofacial surgeon from the DOD/UFS. The surgi- particular time, almost nothing or nothing at all, with cal technique used was performed according to Jansma the purpose of expressing the presence or absence of et al.
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