Pharmacological Synergism: A Multimodal Analgesia Approach to Treat Dental Pain / Sinergismo Farmacológico: Un enfoque de analgesia multimodal para el manejo de dolor dental

Abstract Dental pain is usually managed by clinical interventions and pharmacological coadjuvants such as NSAIDs. However, its perception and modulation is mediated by different nociceptive mechanisms and these strategies can be insufficient. The multimodal analgesia refers to the use of 2 or more analgesic drugs that attenuate or blockade different mechanisms of pain, obtaining a greater clinical effect. Within this concept, pharmacological synergism plays a leading role, combining different molecules in lower doses to diminish also side effects. Since there are no standard prescriptions to be use in all the patients, multimodal approaches allow the clinician to make responsible effective combinations, individualizing analgesia as the pathway to success.

Resumen El dolor dental generalmente se trata con intervenciones clínicas y coadyuvantes farmacológicos como los AINEs. Sin embargo, su percepción y modulación está mediada por diferentes mecanismos nociceptivos y estas estrategias pueden ser insuficientes. La analgesia multimodal se refiere al uso de 2 o más fármacos analgésicos que atenúan o bloquean diferentes mecanismos de dolor, obteniendo un mayor efecto clínico. Dentro de este concepto, el sinergismo farmacológico juega un papel importante, combinando diferentes moléculas en dosis más bajas para disminuir también los efectos secundarios. Dado que no hay prescripciones estándar para ser usadas en todos los pacientes, los enfoques multimodales permiten al clínico realizar combinaciones responsables y eficaces, individualizando la analgesia como el camino hacia el éxito.

What do people do before going to the dentist? qualitative study of cultural practices of pain relief in primary care

Objective: to describe and classify the main cultural practices used to relieve orodental pain in people who seek emergency dental care in vulnerable urban and rural areas of central Chile. methodology: a sample of 88 adults residing in urban and rural sectors, who received treatment at primary care emergency dental services in three districts of the central area of Chile was studied using a qualitative descriptive approach of sociocultural epidemiological orientation based on grounded theory. interviews were conducted in the waiting room of the emergency service or at the patient's home. empirical saturation and triangulation of temporal data were protected. results: practices of biomedical origin (self-medication and care received at dental emergency services) and socio-cultural practices were documented. they include the use of chemical products (iodine, phosphorus, battery acid, hydrogen peroxide, gasoline, and alcoholic drinks, among others), herbal infusions (buddleja globosa, aloe vera), mechanical-physical techniques (use of cold or heat, massage); subjects also perform the mechanical manipulation of the area with sharp objects, occasionally extracting the tooth itself. practices occur more frequently at home when the person feels the pain in the affected area, and end on the dental chair with the tooth extraction. conclusions: the coexistence of biomedical practices and alternative cultural strategies was observed. these practices complement each other and make people postpone seeking professional dental care, which may worsen their health condition.

I've got toothache, i need antibiotics: a uk perspective on rational antibiotic prescribing by dentists

Abstract Antibiotics do not cure toothache. This headline message of the United Kingdom's (UK) Dental Antimicrobial Stewardship (AMS) toolkit's posters and leaflets is aimed at patients; clinicians are expected to know this already. Evidence based clinical guidelines exist to set clear standards for good clinical practice yet there are barriers to compliance. The national AMS audit tool is designed for clinicians to review their management of acute dental conditions, including but not limited to the prescription of antibiotics. In this article we aim to help dental teams protect their patients and themselves from adverse events related to antibiotic prescription. It explores the emergent problem of Clostridium difficile, antibiotic resistance and severe sepsis, and considers some of the barriers, which clinicians have suggested, contribute to the unjustified prescription of antibiotics. Dentists must weigh the risks against the benefits before prescribing any antibiotic.

Resumo Antibióticos não curam dor de dente. Tal mensagem, encontrada no título dos panfletos e cartazes da caixa de ferramentas Gerenciamento Antimicrobiano Odontológico (AMS) do Reino Unido, é direcionada aos pacientes; os clínicos já deveriam saber disso. Diretrizes clínicas baseadas em evidência existem para estabelecer padrões claros à boa prática clínica, ainda que existam barreiras para sua observância. A ferramenta AMS para monitoramento nacional é voltada para clínicos revisarem sua conduta frente às condições dentais agudas, inclusive mas não limitada à prescrição de antibióticos. Neste artigo, visa-se colaborar com equipes odontológicas a fim de protegerem a si e a seus pacientes contra situações adversas relacionadas ao uso de antibióticos. Explora-se o problema emergente do Clostridium difficile, resistência bacteriana a antimicrobianos e sepsis severa, além de considerar algumas das barreiras que clínicos têm sugerido como geradoras de prescrições inapropriadas de antibióticos. Os dentistas devem pesar riscos e benefícios antes de prescrever qualquer antibiótico.

Prescripción aplicada al manejo del dolor en odontología y uso adecuado del medicamento / Prescription applied to the management of pain in dentistry and adequate use of the medicinal product

La prescripción en nuestro país tiene normas y parámetros establecidos por ley. La siguiente información es parte de una ardua labor para esclarecer algunos temas y reforzar otros acerca de lo que se puede y como se debe recetar fármacos para el tratamiento del dolor, entendiendo que no solo se puede recetar opioides y Aines, también se puede considerar fármacos con cortico esteroides, antiepilépticos, enzimáticos, antidepresivos, teniendo en cuenta sus indicaciones específicas, interacciones y reacciones adversas. (AU)

The prescription in our country has rules and parameters established by law. The following information is part of an arduous task to clarify some issues and reinforce others about what can and should be prescribed drugs for the treatment of pain, understanding that not only can you prescribe opioids and Aines, you can also consider drugs with corticosteroids steroids, antiepileptics, enzymatic, antidepressants, taking into account their specific indications, interactions and adverse reactions. (AU)

Self-medication in patients seeking care in a dental emergency service

The aims of this work were: To determine what percentage of firsttime patients to the Dental Emergency Department at the School of Dentistry of Buenos Aires University had taken medications to relieve or treat their condition. To determine what percentage of these had used selfmedication, and which were the most frequently taken medicines. To determine whether there is an association between selfmedication and educational level, and between selfmedication and whether the patient has health coverage. This was an observational, crosssectional study which reviewed 567 clinical histories of patients who visited the Dental Emergency Department from March 2015 to September 2016. The following parameters were assessed: sex, age, reason for consultation, medication, dose, interval, duration and indication. Patients' educational level and whether they had health coverage were ascertained. Confidence intervals of 95% were calculated for percentages using the Wilson score method. Inferential analyses were performed using the Chisquare test (ᵪ2). Significance level was set at 5%. Eighty five percent (85%,.n=481) of the patients had taken at least one medication; 77% (n=372) had used selfmedication. The most frequently used medicines were nonsteroid antiinflammatory drugs (61%), antibiotics (34%) and glucocorticoids (2%). No association was found between selfmedication and patients' having health coverage (ᵪ2=13; p=0.08). No significant association was found between educational level and selfmedication (ᵪ2=10; p=0.22). Nevertheless, the lowest percentages of selfmedication were found in subjects with complete university studies (77%; CI95: 60% to 89%), while the highest percentages were found in subjects with incomplete primary education (89%; CI95: 69% to 97%), complete primary education (92%; CI95: 82% to 96%) and incomplete secondary educations (90%; CI95: 84% to 94%).High levels of selfmedication were found in the study population. Although no association was found between educational level and selfmedication behavior, the percentage of selfmedication was higher among patients with lower educational levels. The high level of selfmedication highlights the importance of conducting campaigns to raise awareness about the adequate use of medicines (AU)

Los objetivos del presente trabajo fueron: Determinar qué porcentaje de pacientes que concurrió por primera vez al Servicio de Urgencias de la Facultad de Odontología de la Universidad de Buenos Aires consumió medicamentos para aliviar o tratar su dolencia. Determinar qué porcentaje de pacientes fueron automedicados, y cuáles fueron los medica mentos más utilizados. Determinar si existe relación entre la automedicación y el nivel de estudio y entre la automedicación y la presencia de cobertura médica. Se realizó un estudio observacional y transversal. Se relevaron 567 historias clínicas de pacientes que concurrieron entre marzo 2015 y septiembre 2016 y se valoraron los siguientes parámetros: sexo, edad, origen de la consulta, medicación, dosis, intervalo, duración, e indicación. Se indagó el nivel educacional alcanzado y la existencia de cobertura médica. Se calcularon intervalos de confianza al 95% para porcentajes mediante el método score de Wilson. Se realizaron análisis inferenciales mediante la prueba Chicuadrado (ᵪ2). Se fijó un nivel de significación del 5%. El 85% (n=481) de los pacientes había consumido al menos un medicamento. El 77% (n=372) de los pacientes estaba autome dicado. Los medicamentos más utilizados fueron antiinflamatorios no esteoroideos (61%), antibióticos (34%) y glucocorticoides (2%). No se encontró asociación entre la automedicación y la presencia de cobertura médica (ᵪ2=13; p=0,08). No se encontró asociación significativa entre el nivel de estudios y la automedicación (ᵪ2=10; p=0,22). Sin embargo, los sujetos con estudio universitario completo presentaron el menor porcentaje de automedicación (77%; IC95: 60% a 89%), mientras que los mayores porcentajes se encontraron en sujetos con primario incompleto (89%; IC95: 69% a 97%), primario completo (92%; IC95: 82% a 96%) y secundario incompleto (90%; IC95: 84% a 94%). Se encontraron niveles elevados de automedicación en la población estudiada. Si bien no se observó asociación entre nivel educativo y la conducta de automedicación, fue mayor el porcentaje de automedicación en pacientes con menor nivel educativo. La alta presencia de automedicación refuerza la importancia de realizar campañas de concientización sobre el consumo adecuado de medicamentos (AU)

Alternativas de uso y eficacia analgésica en el dolor de origen dental en un servicio de urgencias de atención primaria / Alternatives for the use and analgesic efficacy in dental pain in a primary care emergency department

El propósito de esta investigación fue conocer las características del dolor de origen dental (DOD) urgente en un Servicio de Urgencias de Atención Primaria, las preferencias terapéuticas de los médicos de Urgencias y su eficacia clínica. Para ello se realizó un cuestionario a 114 médicos de Urgencias, analizando la frecuencia y alternativas analgésicas más usadas en el DOD. Se seleccionaron las cuatro más prevalentes: Metamizol, Diclofenaco, Metamizol+Diclofenaco y Metilprednisolona, y fueron las que recibieron, en ensayo simple ciego, los cuatro grupos formados aleatoriamente de una muestra de 300 pacientes. Registramos mediante Escala Visual Numérica (EVN) la intensidad del dolor inicial, dolor percibido a las 12 y 24 h tras tratamiento, grado de mejoría, tiempo de mejora percibida y analgesia de rescate. Los cuatro grupos se compararon estadísticamente utilizando el test de Chi Cuadrado y el test ANOVA. Entre otros datos, hemos conocido las características del DOD urgente en la población seleccionada, hayando resultados estadísticamente significativos en las valoraciones medias en la EVN tras el tatamiento, más bajos en los tratados con Metilprednisolona y más altos con Diclofenaco. De igual forma, se observó un mayor porcentaje de mejoría clínica notable en el grupo tratado con Metilprednisolona, seguido de Metamizol+Diclofenaco, y en el extremo opuesto, un porcentaje mayor sin mejoría con Diclofenaco, que además fue el de mayor uso de analgesia de rescate.

The purpose of this research was to know the characteristics of dental origin pain (DOP) in an Emergency Department of Primary Care, the therapeutic preferences of emergency physicians and clinical efficacy. A questionnaire was submitted to 114 emergency physicians by reporting the frequency and analgesic alternatives most used in the DOP. We selected the four most prevalent: Metamizole, Diclofenac, Diclofenac and Metamizole + Methylprednisolone, received in a single-blind trial. The four groups were selected randomly from a sample of 300 patients. We recorded by Visual Numeric Scale (VNS) the initial pain intensity, perceived pain at 12 and 24 h after treatment, the degree of improvement, the time improvement was perceived, and the analgesia relief. The four groups were compared statistically using the chi-square test and ANOVA test. Among other data, the characteristics of the urgent DOP were studied in the selected population, noting statistically significant results in average ratings on VNS following treatment, lower in those treated with methylprednisolone and higher with diclofenac. Similarly, a higher percentage of significant clinical improvements was recorded in the group treated with methylprednisolone group, followed by Metamizole + Diclofenac, and at the opposite end, a higher percentage without improvement with diclofenac, in which the highest use of analgesia relief was also observed.

Dor em urgência odontológica: uso de anti-inflamatórios, corticoides e analgésicos em casos de pulpite aguda irreversível / Pain in dental emergency: anti inflammatory use, steroids and painkillers in cases of irreversible acute pulpitis

O objetivo deste estudo foi avaliar o uso do cetorolaco de trometamina 10mg sublingual 30 minutos antes do procedimento de biopulpectomia em pacientes com pulpite irreversível com relação à dor antes do procedimento e nas 48 horas subsequentes, a quantidade de medicação consumida no pós-operatório e tempo esperado para sua utilização. Também foi avaliada a influência da anestesia intrapulpar, o uso da automedicação analgésica antes da procura pelo atendimento e diferença entre gêneros sobre os níveis de dor pré e pós-operatória. Propôs-se avaliar também a necessidade da presença do antibiótico na medicação intracanal, comparando o Otosporin® com hidrocortisona. Participaram da pesquisa 608 pacientes que procuraram o Setor de Urgência Odontológica da Faculdade de Odontologia de Bauru ou o Setor Odontológico do Pronto Socorro Central da Prefeitura Municipal de Bauru, sendo que 34 completaram de forma adequada o protocolo previsto. Foram divididos em 4 grupos que receberam cetorolaco ou placebo como medicação pré-operatória e Otosporin® ou hidrocortisona como medicação intracanal. Foram anotados os valores de intensidade de dor, em uma escala visual analógica, antes da medicação pré-operatória, antes do atendimento, após o atendimento, 1, 2, 4, 12, 24, 48 horas após e quando houve necessidade de medicação pós-operatória para alívio da dor. Também foi anotado se o paciente havia se automedicado e qual a droga utilizada, se houve necessidade de anestesia intrapulpar, a quantidade de medicação consumida pelo paciente no pós-operatório e o tempo esperado para seu consumo. Dos resultados observou-se que os pacientes que receberam cetorolaco como medicação pré-operatória tiveram uma redução significativa da dor em 30 minutos, quando comparado ao placebo. Foi observado que o tempo necessário para a ingestão de medicamentos pós-operatórios não demonstrou diferença significativa entre os grupos, assim como na quantidade de medicação ingerida. O tempo decorrido entre a primeira e a última dose de medicação pós-operatória também não demonstrou diferença estatística. Com relação a anestesia intrapulpar, 78% dos pacientes necessitaram desta técnica, mas devido ao pequeno tamanho da amostra obtida, não foi possível correlacionar o seu uso com a utilização da medicação pós-operatória. Para os pacientes que se automedicaram previamente, não houve diferença significativa em relação à dor inicial. Quando os gêneros foram comparados, não foi possível observar uma diferença estatística significante entre eles com relação aos parâmetros estudados. Também foram descritos no trabalho os motivos de não inclusão dos 574 pacientes que foram abordados durante a realização deste estudo. Com base nos resultados, conclui-se que o cetorolaco diminuiu expressivamente o nível de dor durante a espera pelo atendimento, porém com relação ao tempo esperado pelo paciente para tomar a primeira dose de medicação pós-operatória, a última dose, a quantidade de comprimidos e a frequência de ingestão não demonstrou a mesma diferença. Também não houve diferença no nível de dor inicial entre os pacientes que se automedicaram e os que não fizeram uso dessa prática. Devido ao pequeno número da amostra, não foi possível encontrar uma correlação entre o uso da técnica anestésica intrapulpar e medicação pós-operatória, sugerindo mais estudos futuros.(AU)

The aim of this study was to evaluate the use of ketorolac tromethamine (10mg sublingual taken 30 minutes before pulpectomy in patients with irreversible pulpitis) in pain reduction immediately before the procedure and the 48 subsequent hours, postoperative consumption of analgesic drugs and time for its use. The influence of intrapulpal anesthesia, the use of analgesic self-medication prior to the demand for care and gender difference on the levels of pre- and postoperative pain was also evaluated. It was also proposed assess the need for antibiotic presence in the intracanal medicament, comparing Otosporin® with hydrocortisone. A total of 608 patients who presented to Dental Urgency Sector from Dental School of Bauru (USP) or Emergency Dental Sector from Bauru City Hall were invited to participate, and 34 completed properly planned protocol. They were distributed in 4 groups that received either ketorolac or placebo as preoperative medication and Otosporin® or hydrocortisone as intracanal medication. The rates of pain intensity were recorded by means of a visual analogue scale before pretreatment medication, immediately before the appointment, 1, 2, 4, 12, 24, 48 hours after the appointment, and when there was taken post medication for postoperative pain relief. It was also recorded if the patient had self medicated and which the drug used and, if there was need intrapulpal anesthesia, amount of ketorolac and rescue medication (paracetamol 750mg) consumed by the patient postoperative time and the waitng time for consumption. The results showed that patients receiving Ketorolac as preoperative medication had a significant reduction of pain in 30 minutes compared to placebo. It was observed that the time required for the intake of postoperative drug showed no significant difference between groups, as well as the amount of medication intake. The time elapsed between the first and last dose of postoperative medication also showed no statistical difference. Concerning intrapulpal anesthesia, 78% of patients required for this technique, but because of the small sample size obtained it was impossible to correlate their use with the use of postoperative medication. For patients who practiced self medication previously, there was no significant difference with respect to initial pain. When genders were compared, it was not possible to observe a statistically significant difference between them regarding the parameters studied. Were also described in the study the reasons of non-inclusion of 574 patients that were addressed during this study. Based on the results, it is concluded that ketorolac significantly decreased the level of pain during the waiting time, but with respect to the time length for the patient to take the first dose of postoperative medication, the last dose, the number of tablets and taken frequency did not show the same difference. There was no difference in the initial level of pain among patients who practiced self medication and those who did not use this practice. Due to the small sample size, it was not possible to find a correlation between the use of the anesthetic technique intrapulpal and postoperative medication, suggesting more future studies.(AU)

Influencia de la temperatura de la lidocaína 2 por ciento con epinefrina 1: 80.000 sobre el dolor por inyección e inicio de acción en el bloqueo del nervio dentario inferior / Effect of themperature of lidocaine 2 per cent with epinephrine 1: 80.000 on pain from injection and onset of action in inferior alveolar nerve block

La colocación de anestesia local genera un dolor manifestado por los pacientes, pues antes de que el anestésico inicie su efecto, ingresa a la mucosa a una temperatura inferior a la corporal y produce un estímulo doloroso. El objetivo de este estudio fue determinar la influencia de la temperatura de la lidocaína al 2 por ciento con epinefrina 1:80,000 sobre el dolor por inyección e inicio de acción. Material y métodos: Se realizó un estudio ciego en 38 pacientes sometidos a dos aplicaciones de lidocaína 2 por ciento con epinefrina 1:80,000 a temperatura de 37o C y temperatura ambiente. Resultados: Según la escala visual análoga, se obtuvieron para la administración de anestesia a 37o C valores de 6.63 ± 5.037 mm, y para la administración a temperatura ambiental, valores de 12.870 ± 12.001 mm (p < 0.05). Según la escala de respuesta verbal, se encontró que para la administración de anestesia a 37o C, el 100 por ciento manifestó un dolor menor a lo esperado¼, mientras que en la administración a temperatura ambiente, sólo 61 por ciento manifestó olor menor de lo esperado¼ (p < 0.05). En relación con el tiempo de inicio de acción, se encontró que la administración de anestesia a 37o C presentó un valor de 201.66 ± 85.336 segundos, mientras que para la administración a temperatura ambiente, se presentó un valor de 286.66 ± 84.292 segundos (p < 0.05). Conclusión: La administración del anestésico local a 37o C produce menor intensidad de dolor y menor tiempo de inicio de acción en compa-ración con la administración de anestésico local a temperatura ambiente.

The placement of local anesthesia causes pain in patients due to the fact that before the anesthetic takes effect, it fi rst enters the mucosa at a temperature that is below body temperature, which results in a pain stimulus. The aim of this study was to determine the extent to which the temperature of lidocaine 2% with epinephrine 1:80,000 affects the pain caused by an injection and the onset of action. Material and methods:We performed a blind study involving 38 patients who received two applications of lidocaine 2% with epinephrine 1:80,000, one at 37 oC and the other at room temperature. Results: Based on the visual analog scale, administering anesthesia at 37 oC produced values of 6.63 ± 5.037 mm, and at room temperature, values of 12.870 ± 12.001 mm (p < 0.05). On the verbal response scale, administering anesthesia at 37 oC resulted in 100% expressing ®less than expected¼ pain, while the administration at room temperature resulted in only 61% expressing ®less than expected¼ pain (p < 0.05). In terms of time to onset of action, it was found that administering anesthesia at 37 oC produced a value of 201.66 ± 85.336 seconds, whereas at room temperature, the value was 286.66 ± 84.292 seconds (p < 0.05). Conclusion: Administering the local anesthetic at 37 oC produces a lower pain intensity and shorter onset of action compared to doing so at room temperature.

The influence of desensitizing dentifrices on pain induced by in-office bleaching

The purpose of this study was to evaluate whether the use of desensitizing dentifrices used 15 days prior to and after in-office tooth bleaching could eliminate or reduce tooth sensitivity. After institutional review board approval and informed consent, 45 subjects were selected and divided into 3 groups according to the dentifrice selected: Colgate Total (CT), Colgate Sensitive Pro-Relief (CS) or Sensodyne ProNamel (SP). The subjects used toothpaste and a toothbrush provided to them for 15 days prior to bleaching. They were then submitted to two in-office bleaching sessions (Whiteness HP Blue Calcium). Their tooth sensitivity was assessed using the Visual Analog Scale (VAS) for a week after each session. Their tooth shade alteration was measured with a Vitapan Classical shade guide to determine if the dentifrices could influence the effectiveness of the bleaching agent. The data were submitted to Wilcoxon, Kruskal-Wallis and Mann-Whitney tests (α = 0.05). The use of desensitizing dentifrices did not affect the bleaching efficacy. In regard to tooth sensitivity, there was a statistically significant difference between the results of the Control Group and Group T2 after the first session (p = 0.048). There was no statistically significant difference in the results for the other groups after the first session. In regard to the second session, there was no statistically significant difference in the results for all the groups. The use of a desensitizing dentifrice containing nitrate potassium reduced tooth sensitivity during the bleaching regimen. Dentifrices containing arginine and calcium carbonate did not reduce tooth sensitivity. Color change was not influenced by the dentifrices used.

Lumiracoxib for acute postoperative dental pain: a systematic review of randomized clinical trials / Lumiracoxibe para dor dental aguda e pós-operatória: uma revisão sistemática de ensaios clínicos randomizados

CONTEXT AND OBJECTIVE: Lumiracoxib is an anti-inflammatory drug that has been used to treat acute dental pain, mainly in postsurgical settings, in which the greatest levels of pain and discomfort are experienced during the first 24 hours. This study aimed to assess the efficacy and safety of lumiracoxib for treating acute postsurgical dental pain. DESIGN AND SETTING: Systematic review developed at the Brazilian Cochrane Centre, Universidade Federal de São Paulo. METHODS: An electronic search was conducted in the PubMed, Cochrane Library, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SciELO (Scientific Electronic Library Online) and Embase databases. A manual search was also performed. Only randomized controlled trials were included, and these were selected and assessed by two researchers with regard to the risk of bias. RESULTS: Three clinical trials with 921 participants were included. Lumiracoxib 400 mg produced onset of analgesia in a shorter time than shown by lumiracoxib 100 mg, celecoxib 200 mg and ibuprofen 400 mg. There was no difference between lumiracoxib 400 mg and rofecoxib 50 mg. In two studies, the mean time taken to attain onset of analgesia for the placebo was not estimated because the number of participants who reached onset was too small. CONCLUSION: There is evidence with a moderate risk of bias that recommends the use of lumiracoxib for acute postoperative dental pain. However, the adverse effects are not completely known. Given that lumiracoxib is currently available in only three countries, further studies are likely to be rare and discouraged.

CONTEXTO E OBJETIVO: O lumiracoxibe é um anti-inflamatório que tem sido utilizado no tratamento de dor dental aguda, principalmente no cenário pós-cirúrgico, no qual níveis mais elevados de dor e desconforto são sentidos durante as primeiras 24 horas. Este estudo teve por objetivo avaliar a eficácia e a segurança do lumiracoxibe no tratamento da dor dental aguda e pós-operatória. TIPO DE ESTUDO E LOCAL: Revisão sistemática desenvolvida no Centro Cochrane do Brasil, Universidade Federal de São Paulo. MÉTODOS: Foi realizada busca eletrônica nas bases de dados PubMed, Cochrane Library, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SciELO (Scientific Electronic Library Online) e Embase. Também foi realizada busca manual. Apenas ensaios clínicos randomizados foram incluídos e foram selecionados e avaliados por dois pesquisadores quanto ao risco de viés. RESULTADOS: Foram incluídos três ensaios clínicos com 921 participantes. O lumiracoxibe 400 mg mostrou menor tempo de início de analgesia que o lumiracoxibe 100 mg, celecoxibe 200 mg e ibuprofeno de 400 mg. Não houve diferença entre lumiracoxibe 400 mg e rofecoxibe 50 mg. Em dois estudos o tempo médio de início de analgesia para o placebo não foi estimado, pois o número de participantes que a alcançou foi pequeno. CONCLUSÃO: Há evidências, com moderado risco de viés, que recomendam o uso de lumiracoxibe para a dor dental aguda e pós-operatória. No entanto, os efeitos adversos não são completamente conhecidos. Considerando que o lumiracoxibe está disponível em apenas três países, provavelmente a realização de pesquisas futuras será rara e desestimulada.

Analgesic effect of clove essential oil in mice

Results obtained from literature reviews and human studies have shown the analgesic effects of clove plant in toothache. The present work was undertaken in order to investigate the possible analgesic effect of clove oil in mice. Fifty mice were divided into 5 groups: 1] Saline; 2] Essential oil [Ess] 2%, 3] Ess 5%, 4] Ess10% and 5] Ess 20%. The hot plate test [55+/-0.2[degree]C; Cut-off 60 sec] was performed as a base record 15 min before injection of drugs [Saline or 2, 5, 10 and 20% concentrations of Essential oil] and consequently repeated every 15 minutes after injection. Repeated measures ANOVA test showed that maximal percent effect [MPE] in animal groups treated by 5, 10 and 20% essential oil was significantly higher than saline group. Comparison between 4 treated groups showed that MPE in 10% essential group was higher than 2 and 5% groups however; there was no significant difference between 10% and 20% groups. The result of present study showed that clove essential oil has analgesic effect inmice using hot plate test. More investigations are needed to elucidate the exact mechanism

Evaluation of the effect of locally administered amitriptyline gel as adjunct to local anesthetics in irreversible pulpitis pain.

BACKGROUND: Amitriptyline is one of the most common tricyclic antidepressants, which binds to pain sensory nerve fibers close to the sodium channel; hence, it could interact to some degree with receptors of local anesthetics. This study was designed to assess the additional analgesic effects of 2% Amitriptyline local gel administration in irreversible pulpitis pain of the molars. MATERIALS AND METHODS: This study was a randomized, double-blind clinical trial that was performed on 56 consented adult patients who did not receive enough analgesia after a lidocaine nerve block for their tooth pulpitis pain. Patients were treated with 0.2 ml of either 2% amitriptyline or placebo, which was directly injected into their mandibular molar pulp chamber after they had received two routine lidocaine injections. Patients were asked to score their pain as a mark on a 10-cm Visual Analogue Scale (VAS) at different timepoints: 0 (just before gel administration), 1, 3, 5, 7, and 9 minutes after the treatments. RESULTS: There was a 92.5% decrease in VAS scores of patients 9 minutes after amitriptyline administration compared to Time 0, while in the placebo group this difference was only 13.5%. Further, in the amitriptyline group, the VAS score at all timepoints was statistically different from Time 0 (P < 0.01). The overall pain reduction and its trend was significantly higher in the amitriptyline group compared with the placebo group (P < 0.001). CONCLUSION: Inter-pulp space administration of amitriptyline 2% gel for completing analgesia in irreversible pulpitis pain could be effective and useful as a conjunctive therapy to injections of local anesthetics.

Uses of turmeric in dentistry: an update.

Turmeric has been used for thousands of years as a dye, a flavoring, and a medicinal herb. In India, it has been used traditionally as a remedy for stomach and liver ailments, as well as topically to heal sores. Ancient Indian medicine has touted turmeric as an herb with the ability to provide glow and luster to the skin as well as vigor and vitality to the entire body. Since turmeric has antimicrobial, antioxidant, astringent, and other useful properties, it is quite useful in Dentistry also. The objective of this article is to highlight various uses of turmeric in the dental field along with its use in medical problems.

[ study on efficacy of NSAIDS in controlling pain caused by orthodontic treatment]

Considering the pain as one of the most significant reasons for patients avoiding orthodontic treatments, the topic of pain control appears to be of prime importance for both clinicians and patients. This study was aimed at determining the efficacy of commonly used non-steroidal anti- inflammatory drugs [NSAIDs] in controlling pain following orthodontic procedures. This was a double-blind clinical trial performed on a total of 75 patients, randomly divided into 5 groups following the placement of their initial arch wires. The members of each group received one of the 5 different treatments [Ibuprofen 400 mg, Naproxen 250 mg, Mefenamic acid 250 mg, Aspirin 325mg, and starch as placebo]. After receiving 2 doses of drugs [one hour before and six hours after bonding] the patients indicated the severity of their pain on a 100mm horizontal line [VAS] during mastication, biting, fitting on anterior and posterior teeth in different specified times. Statistical analyses were carried out based on ANOVA and t-test. The pain increased soon after the placement of the arch wire and reached its peak in 24 hours. In all cases, the least pain was reported following the administration of Ibuprofen and the most after taking placebo. Although all NSAIDs were more or less effective in controlling pain, ibuprofen was found to be relatively of higher efficacy in decreasing the pain

Manejo clínico-farmacológico del dolor dental / Clinical and pharmacological management of toothache

En la práctica odontológica es frecuente el tratamiento farmacológico con analgésicos para mitigar el dolor en pacientes que han sido sometidos a algún procedimiento odontológico mayor, con el fin de prevenir o disminuir el dolor provocado con el procedimiento. Sin embargo, a la fecha no se puede hablar de un manejo estandarizado para todo tipo de pacientes y la investigación en la búsqueda del mejor tratamiento farmacológico es continua. Se presentan en esta revisión los aspectos fundamentales del dolor, las características del dolor dental, los diferentes fármacos y estrategias de manejo del dolor que se han utilizado en diferentes estudios clínicos y algunas recomendaciones.

Efecto del cromoglicato de sodio intracanal en la prevención de las agudizaciones endodónticas intercitas en pacientes atópicos / Effect of intracanal sodium cromoglycate for the prevention of interappointment endodontic flare-ups in allergic patients

Las investigaciones anteriores han reportado mayor incidencia de agudizaciones endodónticas intercitas en pacientes alérgicos, debido a una reacción de hipersensibilidad inmediata. El propósito del presente estudio fue evaluar la eficacia del cromoglicato de sodio intracanal para prevenir las exacerbaciones en estos pacientes. En un estudio a doble ciego, se seleccionaron 30 pacientes atópicos que requerían tratamiento endodóntico en piezas vitales sin procesos infecciosos: 15 fueron medicados en forma intracanal con cromoglicato de sodio y 15 con solución salina, luego de la primera sesión. Los pacientes valoraron el grado de dolor como: ausente, leve, moderado y severo, registrándolo a las 8, 24 y 48 horas postoperatorias. Se observó una menor incidencia de dolor estadísticamente significativa en los casos medicados con cromoglicato de sodio comparado con la solución salina a las 8 horas (X2=16.20536, df=1;p=0.01683) y una diferencia estadísticamente significativa a favor del cromoglicato de sodio a las 24 horas