A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers.

A double-blind trial of amlexanox (C16H14N2O4) was carried out in 32 patients with recurrent oral aphthous ulcerations. During the treatment period, which lasted for 3 days, patients received either placebo topical paste or 5% amlexanox paste. The paste was applied by the investigator twice per day for 3 days and once on the fourth day. Efficacy was assessed by the following parameters: 1) pain measured by the patients marking a 15-cm line between poles connoting no pain versus severe pain; 2) erythema evaluated by the investigator on a four-point scale ranging from none to strong; 3) size determined by investigator measurement of the perpendicular dimensions of the ulcer; and 4) an investigator's improvement scale consisting of six rank-ordered points from -1 for worsening of the ulcer with respect to previously described criteria to +4 when the ulcer had healed completely. All evaluations were based on a comparison with the day 1 visit of the patient. Outcomes for patients receiving the active ingredient were superior on all four criteria of effectiveness. Group differences for all criteria but pain reduction were statistically significant (P < .05). No side effects were reported. It was concluded that amlexanox is effective in reducing aphthous ulcer erythema, pain, and lesional size.

Reversal of central benzodiazepine effects by intravenous flumazenil.

The purpose of this study was to determine the efficacy of flumazenil in safely expediting patient recovery from benzodiazepine sedation. This double-blind, randomized, placebo-controlled study involved 30 patients who received conscious sedation induced by intravenous midazolam given for a dental surgical procedure. Patients who received flumazenil were rated significantly more alert than were placebo-treated patients at 5 and 15 min following test drug administration. They also had significantly superior scores on the digital symbol substitution test and on tests in a comprehensive modified neurological examination 5 min after receiving flumazenil. Group differences were not as impressive on recall and recognition tests. However, flumazenil patients scored somewhat more favorably than the placebo group patients in identifying simple objects they had been shown during the observation period following surgery. Flumazenil appears to be a promising drug for reversing midazolam conscious sedation.

A double-blind single-dose evaluation of the relative analgesic efficacy and safety of carprofen in the treatment of postoperative pain after oral surgery.

A clinical study to evaluate the analgesic efficacy of carprofen was conducted at the University of Colorado School of Dentistry. In a 6-month period, 248 patients underwent the surgical removal of wisdom teeth for analysis of postoperative pain relief.

A report of two smokeless tobacco surveys and associated intervention strategies among Utah adolescents.

Smokeless tobacco is an increasingly popular substance, especially among male adolescents. We determined the prevalence of smokeless tobacco use and evaluated selected factors associated with it among 8,902 students in grades 7 through 12 in the Davis County, Utah, School District. The students responded anonymously in their classrooms to a 16-item self-reporting questionnaire. Results indicated that smokeless tobacco usage was predominately a male phenomenon in all grades and schools, as illustrated by prevalence rates "within the past week" for junior high school students (male: 15.0%; female: 1.1%). Modal responses regarding users' source of supply revealed "friends" as the leading source for junior high students (43.1%) and direct purchase for senior high students (62.2%). Peer usage or nonusage of smokeless tobacco was found to be directly and proportionately correlated with smokeless tobacco users' participation in the school activity designated "sports" for both junior high (39%) and senior high school students (36.2%). Subsequently, clinical evaluation of high school male athletes was undertaken. To our surprise, the rate of lesion detection among members of this group, previously judged to be the subjects most likely to use smokeless tobacco, fell far short of the anticipated rate. We believe the reason for the low rate may be the result of numerous efforts to educate students and coaches, the reinforcement of existing tobacco use policies by the Davis County School District, and the reiteration to smokeless tobacco vendors of the terms of the Utah laws relative to smokeless tobacco sales. This health-endangering behavior deserves a concerted educational thrust by health professional, parents, and teachers, with emphasis on prevention.

A comparison of the use of smokeless tobacco in rural and urban teenagers.

This paper compared the use of smokeless tobacco and its effects in rural and urban teenagers. A random sample of 445 subjects from rural Colorado were examined: 82.9 percent of the total sample were Caucasian, and 94.6 percent of those who used smokeless tobacco were Caucasian. This percentage supports the findings of an earlier urban study that the habit is predominantly one of male Caucasians. The average age of the users was 16.7 years, slightly older than in the urban study. Of the rural users, 62.5 percent had lesions of the oral tissues, compared with 48.7 percent lesional incidence in urban users. In both studies, those subjects with lesions had longer daily contact with smokeless tobacco, as well as a longer history of use than those without lesions. These are numerical averages that reflect great individual variations in susceptibility. The average duration of use for rural and urban users with lesions was almost the same; the development of lesions appears to be related to the length of daily exposure, which, on the average, was greater among rural users than urban users. Additionally, more than twice as many degree 3 lesions were found among users in the rural study. The habituating effects of nicotine and the influence of this substance on the future tobacco-usage patterns of youngsters who presently use smokeless tobacco are areas of concern. It is hoped that additional research will further delineate the scope of this current health problem.

Communication in patient management as seen in a patient with multiple sclerosis.

A case report has been presented showing the possible psychological impact of a debilitating disease, such as multiple sclerosis, on a patient. Medical and dental evaluations had determined that it was necessary to delay making dentures until oral conditions improved. As this did not satisfy the patient's immediate objectives of treatment, he chose not to follow the proposed treatment plan. Instead he searched to find someone who would give him what he wanted. Dentists must evaluate the patient's objectives in relation to the physical criteria for treatment and should not compromise standards of care to accommodate the patient's demands.