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14 July 2021

Driving after oral surgery: is it possible?

Giulia Palandrani


Awareness of a potential negative impact on driving ability following surgical interventions is crucial for patient safety.
One of the key factors influencing driving ability Key  is the Total Brake Response Time ( TBRT ). The term “reaction time” is defined as the time a subject needs to respond to a stimulus with an appropriate movement . To safely drive a car, it is essential to be able to stop the vehicle at any moment. The TBRT corresponds to the time from perception of a stimulus to application of a certain force on the brake pedal.
There are many factors potentially influencing the TBRT e.g., the driver’s age and sex, cognitive ability, fatigue, stress, alcohol, and drug abuse.

The aim of this study was to prospectively evaluate the TBRT in patients scheduled for Oral surgery in local anesthesia by use of a driving simulator. The study was designed to detect potential differences in TBRT before and after oral surgery as well as at the time of the removal of sutures (ROS) about 7–10 days later.  To further validate the results, outcomes were compared to a control group of volunteers not scheduled for any surgical procedure. 


Materials and methods 

Patients with a minimum age of at least 18 years and possession of a valid driving license were included. Patients with neurological diseases were excluded. Participants were asked to indicate their nervousness preoperatively regarding the imminent surgical procedure (“yes” versus “no”). Postoperatively, patients were asked whether they experienced considerable stress during surgery or not (“yes” versus “no”). Potential differences between the respective groups were analyzed using the t test.
A group of 67 volunteers had undergone identical assessment procedures employing the same driving simulator. The TBRT outcomes of the study group at time of ROS (t3) were evaluated against the corresponding results of the comparison group. 

For all assessments, a driving simulator corresponding to validated devices described in the international literature was used. It features two lights, a green and a red one. The red lamp is directed towards the driver and serves as the stimulus to prompt the driver’s response.  The aim was to exert full pressure on the brake pedal as quickly as possible on perception of the red light flashing. Following detailed instructions, participants could familiarize themselves with the mode of action in three test runs.

Following the test runs, the actual assessments took place. In total, three series of assessments at different points in time (t1, t2, t3) were done each of which comprised 10 measurements. Assessments were performed 15–30 min before surgery (t1),  15 min post surgery (t2), and at the time of ROS which usually took place about 7–10 days postoperatively (t3). All assessments were done by the same investigator.

For statistical comparison and further validation of our results, the study patients’ TBRT outcomes were compared to data of a group of 67 volunteers (29 women, 38 men).


Results and discussion

Thirty-seven (50.7%) out of the initial 73 participants were women and 36 (49.3%) were men. The median age was 28 years with an interquartile range (IQR) of 23–42 years. The youngest participant was 18 years old and the oldest one was 74 years of age. Comparing the TBRT between t1 and t2, a significant difference was noted (t = − 4.944, p < 0.001). The mean TBRT was significantly lower at t1 (612 ms) compared to t2 (657 ms). Comparing outcomes between t1 and t3, the t test showed a significant difference too (t = 7.454, p < 0.001). The mean TBRT was significantly lower at t3 (537 ms) compared to t1 (612 ms). Comparing results between t2 and t3, the t test also revealed a significant difference (t = 11.971, p < 0.001). Comparison of results between the study group at t3 and the control group including the 67 volunteers using the t test did not show any statistically significant difference (t = 1.316, p = 0.191). TBRT in women was significantly longer at all evaluation points in time.
There are various possible explanations for the influence of Oral surgery on TBRT . The local anesthetic could play a role. Influencing factors could include emotional stress, postoperative pain, exhaustion after surgery, negative impact of lying flat with open mouth for a relatively long time, or a combination thereof. 


Conclusions
The results of this study support the conclusion that every surgeon performing dentoalveolar procedures should explain to patients undergoing such interventions that it is strongly recommended not to drive any vehicle immediately after the operation. Patients should be made aware of the presumed increased risk of causing an accident and the potential medical and legal consequences. 


For additional information:  Is it safe to drive after oral surgery? Is it safe to drive after oral surgery?


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