Abstract
Objectives
To assess the feasibility of using short message service text messages to solicit dental patients’ experiences of post-operative dental discomfort and sensitivity (PODDS) and whether responses characterise change in PODDS over time.
Methods
Patients were recruited from clinics following routine dental procedures, such as simple restorations or root surface debridement. They completed a short questionnaire collecting information on socio-economic circumstances, their recent experience of PODDS, the acceptability of receiving text message questions and their telephone number. Participants received a short question by text to their telephone for five consecutive days that asked them to respond with an indication (on a 1 to 10 scale) of their experience of PODDS at that time.
Results
Questionnaires were completed by 34 participants, of whom text message responses were received from an average of 23.4 participants (min 20, max 26) across the five follow-up days. Regression analyses indicated that PODDS decreased over time (β = −0.24, 95% CI −0.36 to −0.12).
Conclusions
Text messaging to solicit PODDS is feasible and can potentially be used to assess the efficacy of treatments designed to minimise or reduce PODDS.
1
Introduction
Dental procedures can result in post-operative discomfort and sensitivity (PODDS). PODDS can contribute to dental anxiety [ ], a loss of psychological well-being and may influence behaviour [ ]. Up to 82% of patients who have undergone treatment are expected to experience at least some post-operative pain or discomfort but the expectation is that this will diminish over time [ ]. The mechanisms responsible for PODDS have been described and include pulpal irritation and an exposed dentine surface [ ].
Despite continuing interest in the causes of and treatments for PODDS [ ], the high prevalence of PODDS in dental patients, and the impact on PODDS on quality of life, there remains no systematic method available to measure and characterise change in PODDS over time. It is known that PODDS has a start point and, for most patients, diminishes and eventually concludes. Yet the nature and duration of PODDS has received little attention. A novel opportunity to investigate the long-term consequences of treatment on PODDS is available through the now ubiquitous mobile telephone. The Short Message Service (SMS), or text message, has already been used successfully in previous studies to interact with participants in order to elicit high frequency (e.g. daily) information over long periods of time [ ]. This low-cost method provides data that can be used to accurately investigate change over time.
The current study aimed to test the feasibility of monitoring PODDS over time in a cohort of dental patients. Feasibility studies, such as this, are designed to identify barriers or other encumbrances that should be addressed before undertaking formal study [ ]. As such, our hypothesis was that patients would respond to text messages consistently over time with secondary hypotheses focused on whether responses have sufficient variance to suggest measures would be sensitive to change over time. We do not speculate on other matters, such as treatment type and PODDS, that might be relevant to a sufficiently powered formal study.
2
Materials and methods
Prior to commencement of the study, ethical approval was gained from North East − Newcastle & North Tyneside 2 Research Ethics Committee (15/NE/0409).
2.1
Participants
Sampling was opportunistic with the intention of recruiting participants who had experienced a diverse range of treatments. Patients attending Cardiff University Dental Hospital for routine dental treatment were approached and provided with an information sheet, written consent form and a questionnaire.
2.2
Inclusion and exclusion criteria
Patients were excluded if they were attending for denture work only or were under 18 years of age. Patients were included if they were willing and able to provide written informed consent.
2.3
Materials
A short questionnaire was constructed that collected patient’s mobile telephone number, acceptability of the study (“Are you happy for us to send you one text message each day for five days in a row?”), times when it would be acceptable for them to receive and respond to text messages, gender, age, tobacco use, qualifications, marital status, and employment status. Questions also sought to characterise any discomfort they had experienced the day before attending the dental hospital and included nature (shooting, stabbing, heavy, sickening, fearful), intensity (none, mild, moderate, severe), frequency of discomfort (“On a scale of 1 to 10 how often did you experience discomfort in your mouth yesterday?”) and intensity of discomfort (“On a scale of 1 to 10 how much discomfort did you experience in your mouth yesterday?”) Questions concerning discomfort were derived from previous studies [ ].
2.4
Procedure
Patients provided written informed consent, completed the questionnaire and then patients’ mobile telephone numbers were entered into an automated text message service. The automated service first sent two single messages “PODDS: Thank you for enrolling in our study at the University Hospital of Wales looking at Post-Operative Dental Discomfort and Sensitivity” and “PODDS: Over the coming days we will send you questions by text message. Please reply to the text message with a number (1 to 10) and nothing else. To leave the study reply to any text with STOP.” The service then sent “PODDS: On a scale of 1 (none) to 10 (worst ever) how much dental discomfort have you experienced in the last 24 hours? Please reply with a number from 1 to 10” to each patient, each day at their preferred time for five consecutive days. The first message was sent the day following attendance. A researcher accessed patients’ notes and recorded the reason for attendance.
2.5
Analytic strategy
Descriptive statistics to determine participant attrition from the study and random effects multiple linear regression to assess any relationship between PODDS and time.
2
Materials and methods
Prior to commencement of the study, ethical approval was gained from North East − Newcastle & North Tyneside 2 Research Ethics Committee (15/NE/0409).
2.1
Participants
Sampling was opportunistic with the intention of recruiting participants who had experienced a diverse range of treatments. Patients attending Cardiff University Dental Hospital for routine dental treatment were approached and provided with an information sheet, written consent form and a questionnaire.
2.2
Inclusion and exclusion criteria
Patients were excluded if they were attending for denture work only or were under 18 years of age. Patients were included if they were willing and able to provide written informed consent.
2.3
Materials
A short questionnaire was constructed that collected patient’s mobile telephone number, acceptability of the study (“Are you happy for us to send you one text message each day for five days in a row?”), times when it would be acceptable for them to receive and respond to text messages, gender, age, tobacco use, qualifications, marital status, and employment status. Questions also sought to characterise any discomfort they had experienced the day before attending the dental hospital and included nature (shooting, stabbing, heavy, sickening, fearful), intensity (none, mild, moderate, severe), frequency of discomfort (“On a scale of 1 to 10 how often did you experience discomfort in your mouth yesterday?”) and intensity of discomfort (“On a scale of 1 to 10 how much discomfort did you experience in your mouth yesterday?”) Questions concerning discomfort were derived from previous studies [ ].
2.4
Procedure
Patients provided written informed consent, completed the questionnaire and then patients’ mobile telephone numbers were entered into an automated text message service. The automated service first sent two single messages “PODDS: Thank you for enrolling in our study at the University Hospital of Wales looking at Post-Operative Dental Discomfort and Sensitivity” and “PODDS: Over the coming days we will send you questions by text message. Please reply to the text message with a number (1 to 10) and nothing else. To leave the study reply to any text with STOP.” The service then sent “PODDS: On a scale of 1 (none) to 10 (worst ever) how much dental discomfort have you experienced in the last 24 hours? Please reply with a number from 1 to 10” to each patient, each day at their preferred time for five consecutive days. The first message was sent the day following attendance. A researcher accessed patients’ notes and recorded the reason for attendance.
2.5
Analytic strategy
Descriptive statistics to determine participant attrition from the study and random effects multiple linear regression to assess any relationship between PODDS and time.
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