Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1ß in third molar surgery: a triple-blind, randomized, placebo-controlled study.

This study aimed to evaluate whether pre-emptive analgesia modifies the tissue expression of tumour necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1ß), and whether there is an association with postoperative surgical outcomes. A triple-blind, randomized, placebo-controlled study of patients undergoing mandibular third molar removal was performed. Volunteers were allocated randomly to receive etoricoxib 120 mg, ibuprofen 400 mg, or placebo 1h before surgery. Twenty-four surgical sites per group were required (95% confidence level and 80% statistical power). Pain scores differed significantly between groups (P<0.001). Etoricoxib and ibuprofen reduced pain scores compared to placebo (P<0.05). Pain scores peaked at 4h postoperative in the experimental groups, but at 2h postoperative in the placebo group (P<0.05). A significant reduction in TNF-α concentration from time 0' to time 30' was seen for ibuprofen (P=0.001) and etoricoxib (P=0.016). The ibuprofen group showed a significant reduction in IL-1ß levels from time 0' to time 30' (P=0.038). In conclusion, TNF-α and IL-1ß levels and the inflammatory events in third molar surgery were inversely associated with the degree of cyclooxygenase 2 selectivity of the non-steroidal anti-inflammatory drugs used pre-emptively. Patients given pre-emptive analgesia showed significant reductions in the clinical parameters pain, trismus, and oedema when compared to the placebo group.

Why do children and adolescents neglect dental flossing?

AIM: To identify the variables and actual difficulties related to children and adolescents' non-compliance with dental flossing. METHODS: This cross-sectional study with 36 children and 59 adolescents were selected from dental clinics at the Dental School, University of São Paulo. The percentage of surfaces with disclosed biofilm was used to evaluate general oral hygiene. Participants answered questions concerning dental flossing (difficulties, self-reported motivation, and previous instruction). An examiner observed how the participants flossed their teeth and their possible faults. Univariate and multiple logistic regression analyses were performed and odds ratio values were calculated in order to verify the association between non-compliance (or difficulties) with flossing and possible reasons for that. RESULTS: Similar non-compliance with daily flossing was observed among children and adolescents (p = 0.95). Children's flossing negligence was strongly associated with self-reported laziness in flossing (p = 0.02), and negatively associated with their previous practice by some dentists (p = 0.009). Self-described difficulties in flossing also showed an association with laziness in flossing (p = 0.03). No association was found between negligence of flossing and all variables tested among adolescents (p ≥ 0.05). CONCLUSIONS: Low compliance and difficulties in flossing among children and adolescents seemed to be more related to lack of motivation, although problems concerning manual skills were also observed.

Role of the haem oxygenase/carbon monoxide pathway in Clostridium difficile toxin A-induced enteritis in mice.

Clostridium difficile is the major cause of antibiotic-associated colitis, a disease with significant morbidity and mortality. This study investigated the role of the haem oxygenase-1 (HO-1)/carbon monoxide (CO) pathway in C. difficile toxin A-induced enteritis in mice. The HO substrate haemin, zinc protoporphyrin IX (ZnPP IX), a specific HO-1 inhibitor, dimanganese decacarbonyl (DMDC), a CO donor, or an equivalent volume of their respective vehicles were injected subcutaneously 30 min prior to local challenge with toxin A (25 or 50 µg per ileal loop) or PBS. Intestinal ileal loop weight/length ratios were calculated 3 h later. Ileal tissues were collected for histological analysis and measurement of myeloperoxidase (MPO) activity, tumour necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1ß) production by ELISA and immunohistochemistry for HO-1. Treatment of mice subjected to C. difficile toxin A (TcdA) with haemin or DMDC prevented oedema, mucosal disruption and neutrophil infiltration observed in histological analysis. It also decreased TcdA-induced MPO activity and TNF-α or IL-1ß production. In contrast, the specific HO-1 inhibitor (ZnPP IX) exacerbated all these evaluated parameters. TcdA increased HO-1 expression as seen by immunohistochemistry. These results suggest that the HO-1/CO pathway exerts a protective role in TcdA-induced enteritis and that its pharmacological modulation might be important for the management of C. difficile-associated disease.