If a patient with a known heart condition develops arrhythmia during treatment, treatment should be immediately discontinued and supplementary oxygen administration should be provided. It is important to talk to your cardiologist about the possibility of undergoing dental treatment and to inform your dentist if you are taking anticoagulants, as these medications can cause excessive bleeding during some oral surgery procedures. Ask your dentist if oxygen and nitroglycerin are available in case of a medical emergency during your office visit. In conventional TENS, the delivery of impulses is usually continuous, but the same effect can also be achieved by emitting the pulses in “bursts” or “trains”, which some authors have called pulsed TENS or in bursts.
Thorsen and Lumsden (2) reported an interesting case of trigeminal neuralgia in a 36-year-old man, who showed immediate and prolonged remission of symptoms when an intense TENS discharge occurred accidentally. Safe and effective dental treatment for these patients requires close medical and dental coordination, an understanding of the possible dangers during dental treatment, knowledge of the drugs used in the treatment of cardiovascular diseases, and the possible adverse effects of drugs commonly used in periodontal practice. Harvey and Elliott (1 in 1995) discovered that TENS is effective in reducing pain during tooth decay preparation in pediatric patients. In a double-blind study, of the 20 patients who needed class 1 amalgam restorations on their first permanent mandibular molars, they treated 10 patients with TENS and 10 patients without using TENS.
They found a statistically greater increase in saliva production in patients who used active devices than in patients with placebo. They discovered that “patients' fear is the most important factor preventing the effective use of TENS and factors such as the depth of preparation of the cavity or the group of teeth are not significant. Over the years, research has demonstrated how periodontal disease, in the form of an infection in the mouth, can contribute to many general health conditions, such as diabetes, heart disease and stroke. In fact, one of the types of bacteria that are often associated with periodontal disease may also play a role in strokes.
In pediatric patients, TENS has been used effectively to control pain during various procedures, such as the placement of pit and fissure sealants, the preparation of cavities, minor extractions and endodontic procedures. The theory of pain control, proposed by Melzack and Wall (in 1965), is the most popular theory to explain the mechanism of action of TENS. Quanstrom and Milgrom (2) in 1989 combined TENS with nitrous oxide and oxygen in 309 patients and compared it with TENS alone in 62 patients to verify the effectiveness of pain control during restorative procedures without using local anesthesia. William Stenberg (2) reported in 1994 on the use of TENS to control pain during cavity preparation in a 24-year-old patient susceptible to malignant hyperthermia and obtained favorable results.
Because patients are generally unaware of the type of pacemaker they are using, it is recommended not to use TENS in these patients. TENS has also been used in combination with nitrous oxide and oxygen or diazepam to achieve analgesic during dental treatment.
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