Laserpuntura no controle de dor e ansiedade em cirurgias de terceiros molares

Abstract

Tooth extraction is a dental procedure that involves trauma to bones and soft tissues. The severity of the intervention, the location of the dental units, the tissue texture, the degree of bone destruction, and the patient’s level of anxiety are variables that influence the presence or absence of postoperative effects. Low-level laser therapy (LLLT) has been clinically used to control pain and anxiety, providing an attenuation of possible undesirable clinical outcomes. This controlled, double-blind, randomized crossover clinical study included 32 volunteer patients who underwent two surgical procedures: Protocol A consisted of placebo laser acupuncture and conventional pharmacological therapy, with dexamethasone 8 mg (one tablet) every 8 hours, followed by one (1) tablet of midazolam administered 30 minutes before surgery for anxiety control. For Protocol B, systemic laser acupuncture was performed at predefined points for pain and anxiety control, applied 24 hours before the procedure, along with placebo dexamethasone (one starch tablet) every 8 hours, combined with placebo midazolam (one starch tablet) 30 minutes before surgery. Additionally, paracetamol 750 mg was prescribed as rescue medication for analgesia. Data were initially tabulated in Microsoft Excel (version 2015) and subsequently analyzed using the BioEstat software (version 5.3). Pain data analysis revealed no statistically significant differences (paired t-test, p = 0.44) between the midazolam group (37.4 ± 17.2) and the laser acupuncture group (36.2 ± 12.6 min). For laser acupuncture, there was a significant reduction in pain (Friedman test and BKY) at 48 h (p = 0.0050) and at 72 h (p < 0.0001) compared to pain measured at 24 h, with no statistically significant differences (p = 0.07) between 48 h and 72 h. The comparison between the two protocols revealed lower pain for laser acupuncture at 24 h (p = 0.0083) and 48 h (p = 0.0026), with no statistically significant differences between the protocols at 72 h (p = 0.08). Analgesic tablet consumption was lower at 48 h (Friedman test and BKY, p = 0.0083) and 72 h (p < 0.0001) compared to 24 h in the laser acupuncture group, with no statistically significant differences (p = 0.05) between 48 h and 72 h. For midazolam, consumption was lower at 48 h (p = 0.0275) and 72 h (p < 0.0001) compared to 24 h, and also lower at 72 h than at 48 h (p = 0.0122). These findings conclude that systemic laser acupuncture represents an effective alternative for pain and anxiety control in third molar extraction procedures.