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1.
Int J Oral Maxillofac Surg ; 46(5): 621-627, 2017 May.
Article in English | MEDLINE | ID: mdl-28161136

ABSTRACT

Postoperative pain and inflammation after oral surgery is mostly managed using non-steroidal anti-inflammatory drugs (NSAIDs). However, opioids combined with NSAIDs may improve pain management in patients, especially after traumatic oral surgery. Few studies have compared NSAIDs with and without opioid use after oral and maxillofacial surgery. This randomized, double-blind, cross-over study compared the clinical efficacy of either diclofenac (50mg) and codeine (50mg) or diclofenac alone (50mg) for the management of postoperative pain after invasive third molar surgery. Volunteers (n=46) who were scheduled to undergo the removal of symmetrically positioned lower third molars in two separate appointments were included. They reported significantly less postoperative pain at various time points within 24h after surgery and also consumed significantly less rescue medication (paracetamol (acetaminophen)) throughout the study when they took diclofenac combined with codeine than when they took only diclofenac. In conclusion, oral diclofenac with codeine was more effective for managing postoperative pain than diclofenac without codeine. It was expected that patients taking two pain medications after surgery would generally have less pain than when taking only one of the two medications. The prospective cross-over design of the present work makes this study distinct from many others.


Subject(s)
Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Codeine/therapeutic use , Diclofenac/therapeutic use , Molar, Third/surgery , Pain, Postoperative/drug therapy , Tooth, Impacted/surgery , Administration, Oral , Analgesics, Opioid/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Codeine/administration & dosage , Cross-Over Studies , Diclofenac/administration & dosage , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Male , Pain Management , Pain Measurement , Tooth Extraction , Treatment Outcome , Young Adult
2.
J Dent Res ; 94(9 Suppl): 166S-73S, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26202994

ABSTRACT

This double-blind crossover randomized clinical trial compared the efficacy of 2 concentrations of articaine, 2% (A2) and 4% (A4), with 1:200,000 epinephrine, for lower third molar removal. During 2 separate appointments with either A2 or A4, both similarly positioned lower third molars in 46 volunteers were extracted. The following were evaluated: onset and duration of anesthetic action on soft tissues, intraoperative bleeding, hemodynamic parameters, postoperative analgesia, and mouth opening and wound healing during the 7th postoperative day, along with the incidence, type, and severity of adverse reactions. Nearly identical volumes of both anesthetic solutions were used for each appointment: 3.4 ± 0.9 mL ≈ 68 mg of articaine (A2) and 3.3 ± 0.8 mL ≈ 132 mg of articaine (A4). Statistical analysis indicated no differences in onset or duration of anesthetic action on soft tissues or duration of postoperative analgesia evoked by A2 and A4 anesthetic solutions (P > 0.05). The surgeon's rating of intraoperative bleeding was considered minimal throughout all surgery with both anesthetic solutions. While transient changes in blood pressure, heart rate, and oxygen saturation were observed, these factors were clinically insignificant and were uninfluenced by articaine concentration (P > 0.05). No systemic or local adverse reactions were observed in the preoperative and postoperative periods due to A2 or A4, but 1 case of bilateral paresthesia was observed. There were no significant differences between preoperative and postoperative (7th day) values of mouth opening and wound healing whether volunteers received A2 or A4 (P > 0.05). In conclusion, both A2 and A4, administered in equal volumes, were effective and safe during lower third molar surgery, and no significant differences were found between their efficacy and safety (ClinicalTrials.gov NCT02457325).


Subject(s)
Anesthetics, Local/administration & dosage , Carticaine/administration & dosage , Molar, Third/surgery , Tooth Extraction/methods , Adolescent , Adult , Anesthesia, Dental/methods , Anesthetics, Local/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Blood Loss, Surgical , Blood Pressure/physiology , Carticaine/adverse effects , Cross-Over Studies , Double-Blind Method , Female , Follow-Up Studies , Heart Rate/physiology , Humans , Male , Mandible/surgery , Nerve Block/methods , Oxygen/blood , Pain, Postoperative/prevention & control , Piroxicam/therapeutic use , Safety , Tooth, Impacted/surgery , Treatment Outcome , Wound Healing/physiology , Young Adult
3.
Horm Metab Res ; 46(7): 484-9, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24710698

ABSTRACT

This study investigated how proteins of the insulin signaling cascade could modulate insulin resistance after dexamethasone (Dexa) treatment and aerobic training. Rats were distributed into 4 groups: sedentary control (SC), sedentary+Dexa (SD), trained control (TC), and trained+Dexa (TD), and underwent aerobic training for 70 days or remained sedentary. Dexa was administered during the last 10 days (1 mg · kg(-1) per day i. p.). After 70 days, an intraperitoneal glucose tolerance test (ipGTT) was performed. Protein levels of IRS-1, AKT, and PKC-α in the tibialis anterior (TA) muscle were identified using Western blots. Dexa treatment increased blood glucose and the area under the curve (AUC) of ipGTT. Training attenuated the hyperglycemia and the AUC induced by Dexa. Dexa reduced IRS-1 (- 16%) and AKT (- 43%) protein level with no changes in PKC-α levels. Moreover, these effects on IRS-1 and AKT protein level were prevented in trained animals. These results show for the first time that aerobic exercise prevented reductions of IRS-1 and AKT level induced by Dexa in the TA muscle, suggesting that aerobic exercise is a good strategy to prevent Dexa-induced peripheral insulin resistance.


Subject(s)
Dexamethasone/pharmacology , Insulin Resistance , Physical Conditioning, Animal , Animals , Blood Glucose/metabolism , Blotting, Western , Body Weight/drug effects , Glucose Tolerance Test , Insulin Receptor Substrate Proteins/metabolism , Muscles/drug effects , Muscles/metabolism , Organ Size/drug effects , Phosphorylation/drug effects , Rats , Rats, Wistar
4.
Oral Dis ; 17(6): 572-6, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21332606

ABSTRACT

BACKGROUND: Fanconi's anemia (FA) is a rare recessive genetic disorder characterized by bone marrow failure, developmental and congenital abnormalities, which frequently evolves to aplastic anemia and neoplasias, primarily acute leukemia and head-neck carcinomas. Risk of malignancies increases after hematopoietic stem cell transplantation (HSCT), and the role of human papillomavirus (HPV) in FA carcinogenesis have been proposed. OBJECTIVE: To investigate prevalence of oral HPV in FA patients without oral malignant lesions. MATERIALS AND METHODS: After oral examination, 76 subjects without detectable oral malignant lesions were included and classified in four groups: 20 FA submitted to HSCT (I), 22 FA not submitted to HSCT (II), 18 severe aplastic anemia (SAA) submitted to HSCT (III) and 16 healthy subjects (IV). Liquid-based cytology sampling, HPV screening by polymerase chain reaction and genotyping by reverse hybridization were performed. RESULTS: The HPV detection rates were: group I 35%, group II 27.3%, group III 38% and group IV 6.25%. Prevalence of high risk HPV types, mainly HPV16, was detected. Compared with control group, suggestions for increased likelihood of being HPV infected in SAA (OR = 9.55, 95% CI: 1.01-125.41) and FA patients submitted to HSCT (OR = 8.08, 0.83-72.29) emerged. CONCLUSION: Patients without oral malignant lesions submitted to HSCT, have high prevalence of oral HPV. HPV screening and close follow up should be considered in these patients.


Subject(s)
Alphapapillomavirus/classification , Fanconi Anemia/complications , Mouth Diseases/virology , Papillomavirus Infections/complications , Adolescent , Adult , Anemia, Aplastic/therapy , Child , Child, Preschool , DNA, Viral/analysis , Fanconi Anemia/therapy , Female , Follow-Up Studies , Genotyping Techniques , Hematopoietic Stem Cell Transplantation , Human papillomavirus 16/isolation & purification , Human papillomavirus 18/isolation & purification , Human papillomavirus 6/isolation & purification , Humans , Male , Middle Aged , Polymerase Chain Reaction , Young Adult
5.
Int J Oral Maxillofac Surg ; 40(3): 292-7, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21144709

ABSTRACT

In this study, 53 patients received piroxicam, administered orally or sublingually, after undergoing removal of symmetrically positioned lower third molars, during two separate appointments. This study used a randomized, blind, cross-over protocol. Objective and subjective parameters were recorded for comparison of postoperative results for 7 days after surgery. Patients treated with oral or sublingual piroxicam reported low postoperative pain scores. The patients who received piroxicam orally took a similar average amount of analgesic rescue medication compared with patients who received piroxicam sublingually (p>0.05). Patients exhibited similar values for mouth opening measured just before surgery and immediately following suture removal 7 days later (p>0.05), and showed no significant differences between routes of piroxicam administration for swelling control during the second or seventh postoperative days (p>0.05). In summary, pain, trismus and swelling after lower third molar extraction, independent of surgical difficulty, could be controlled by piroxicam 20mg administered orally or sublingually and no significant differences were observed between the route of delivery used in this study.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Molar, Third/surgery , Pain, Postoperative/drug therapy , Piroxicam/administration & dosage , Tooth Extraction , Acetaminophen/therapeutic use , Administration, Oral , Administration, Sublingual , Analgesics, Non-Narcotic/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Cross-Over Studies , Edema/drug therapy , Female , Follow-Up Studies , Humans , Male , Mandible/surgery , Osteotomy , Postoperative Complications/drug therapy , Range of Motion, Articular/physiology , Single-Blind Method , Time Factors , Treatment Outcome , Trismus/drug therapy , Young Adult
6.
J Periodontol ; 80(1): 130-9, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19228099

ABSTRACT

BACKGROUND: The systemic renin-angiotensin system (RAS) promotes the plasmatic production of angiotensin (Ang) II, which acts through interaction with specific receptors. There is growing evidence that local systems in various tissues and organs are capable of generating angiotensins independently of circulating RAS. The aims of this study were to investigate the expression and localization of RAS components in rat gingival tissue and evaluate the in vitro production of Ang II and other peptides catalyzed by rat gingival tissue homogenates incubated with different Ang II precursors. METHODS: Reverse transcription-polymerase chain reaction assessed mRNA expression. Immunohistochemical analysis aimed to detect and localize renin. A standardized fluorimetric method with tripeptide hippuryl-histidyl-leucine was used to measure tissue angiotensin-converting enzyme (ACE) activity, whereas high performance liquid chromatography showed products formed after the incubation of tissue homogenates with Ang I or tetradecapeptide renin substrate (TDP). RESULTS: mRNA for renin, angiotensinogen, ACE, and Ang II receptors (AT(1a), AT(1b), and AT(2)) was detected in gingival tissue; cultured gingival fibroblasts expressed renin, angiotensinogen, and AT(1a) receptor. Renin was present in the vascular endothelium and was intensely expressed in the epithelial basal layer of periodontally affected gingival tissue. ACE activity was detected (4.95 +/- 0.89 nmol histidyl-leucine/g/minute). When Ang I was used as substrate, Ang 1-9 (0.576 +/- 0.128 nmol/mg/minute), Ang II (0.066 +/- 0.008 nmol/mg/minute), and Ang 1-7 (0.111 +/- 0.017 nmol/mg/minute) were formed, whereas these same peptides (0.139 +/- 0.031, 0.206 +/- 0.046, and 0.039 +/- 0.007 nmol/mg/minute, respectively) and Ang I (0.973 +/- 0.139 nmol/mg/minute) were formed when TDP was the substrate. CONCLUSION: Local RAS exists in rat gingival tissue and is capable of generating Ang II and other vasoactive peptides in vitro.


Subject(s)
Gingiva/metabolism , Renin-Angiotensin System/physiology , Angiotensinogen/analysis , Angiotensins/analysis , Animals , Cells, Cultured , Chromatography, High Pressure Liquid , Endothelium, Vascular/metabolism , Epithelium/metabolism , Fibroblasts/metabolism , Fluorometry , Gingiva/cytology , Immunohistochemistry , Male , Oligopeptides/metabolism , Peptidyl-Dipeptidase A/analysis , Periodontitis/metabolism , Periodontitis/pathology , RNA, Messenger/analysis , Rats , Rats, Wistar , Receptor, Angiotensin, Type 1/analysis , Receptor, Angiotensin, Type 2/analysis , Renin/analysis , Reverse Transcriptase Polymerase Chain Reaction
7.
Braz J Med Biol Res ; 40(8): 1133-40, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17665051

ABSTRACT

We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 +/- 4.36 and 93.12 +/- 3.70% of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 +/- 91.21 and 461.54 +/- 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 +/- 1.84 and 8.46 +/- 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 +/- 1.61 and 2.23 +/- 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.


Subject(s)
Cyclooxygenase Inhibitors/therapeutic use , Edema/drug therapy , Isoxazoles/therapeutic use , Molar, Third/surgery , Pain, Postoperative/drug therapy , Piroxicam/therapeutic use , Sulfonamides/therapeutic use , Trismus/drug therapy , Adult , Double-Blind Method , Female , Humans , Male , Tooth Extraction , Treatment Outcome
8.
Rev. bras. pesqui. méd. biol ; Braz. j. med. biol. res;40(8): 1133-1140, Aug. 2007. tab, graf
Article in English | LILACS | ID: lil-456809

ABSTRACT

We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 ± 4.36 and 93.12 ± 3.70 percent of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 ± 91.21 and 461.54 ± 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 ± 1.84 and 8.46 ± 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 ± 1.61 and 2.23 ± 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.


Subject(s)
Adult , Female , Humans , Male , Cyclooxygenase Inhibitors/therapeutic use , Edema/drug therapy , Isoxazoles/therapeutic use , Molar, Third/surgery , Pain, Postoperative/drug therapy , Piroxicam/therapeutic use , Sulfonamides/therapeutic use , Trismus/drug therapy , Double-Blind Method , Tooth Extraction , Treatment Outcome
9.
Int J Oral Maxillofac Surg ; 36(1): 26-31, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17112703

ABSTRACT

Fifty patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Meloxicam 7.5 or 15 mg was once daily administered in a double-blind, randomized and crossover manner after the surgery for 4 days. Objective and subjective parameters were recorded for comparison of postoperative courses. Patients treated with 7.5mg meloxicam who underwent osteotomy reported higher pain scores at 1.5, 3, 4, 10, 12 and 16 h (P<0.05) and ingested a greater amount of rescue analgesic medication (P<0.05) than those who did not require osteotomy. A higher percentage of patients who underwent osteotomy medicated with 7.5mg meloxicam needed rescue medication as compared to those who did not require osteotomy (P<0.05). There was a similar mouth opening at suture removal compared with preoperative values for both doses (P>0.05). There were no significant differences concerning swelling observed on the 2nd or 7th postoperative days in comparison with baseline (P>0.05) between the two doses. Pain, trismus and swelling after lower third molar removal not requiring osteotomy can be successfully controlled by a dose regimen of 7.5mg meloxicam once daily. For more aggressive extractions 15 mg meloxicam is advisable.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Molar, Third/surgery , Pain, Postoperative/prevention & control , Thiazines/administration & dosage , Thiazoles/administration & dosage , Tooth Extraction , Administration, Oral , Adult , Analysis of Variance , Cross-Over Studies , Dose-Response Relationship, Drug , Double-Blind Method , Edema/prevention & control , Female , Humans , Male , Meloxicam , Osteotomy , Range of Motion, Articular , Statistics, Nonparametric , Tooth Extraction/adverse effects , Tooth, Impacted/surgery , Trismus/prevention & control
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