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Alrehaili R, Alhujaili A, Alharbi S, Alharbi L, Alharbi W, Alkhattabi R, Alkhateeb D, Albisher R, Hakami A, Khalil A. Medications and Orthodontic Tooth Movement: What Accelerates and Diminishes Tooth Movement? Cureus 2024; 16:e61840. [PMID: 38975539 PMCID: PMC11227369 DOI: 10.7759/cureus.61840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
The biological aspect of orthodontic tooth movement is influenced by the magnitude and duration of the applied force. This initiates signaling cascades essential for bone remodeling, which involve activating various cell signaling pathways that enhance the metabolism of the periodontal ligament, leading to localized bone resorption and deposition. This process facilitates tooth movement on the pressure side and promotes healing on the tension side. The remodeling associated with orthodontic tooth movement is an inflammatory reaction involving mediators. Key components in this process include hormones, systemic influences, cyclic adenosine monophosphate, specific cytokines like interleukin 1, colony-stimulating factors, calcium, collagenase, and prostaglandins, all of which are essential for the biological adjustments necessary for tooth movement. Medications that influence molecular pathways critical for the homeostasis of periodontal tissues or that affect changes during orthodontic tooth movement and clastic cell regulation can potentially modulate tooth movement. With the recent increase in prescription medication use, it is essential for clinicians to be aware of medication consumption in prospective patients and understand its potential impact on orthodontic treatment. This review aimed to explore the effects of commonly prescribed medications on the rate of orthodontic tooth movement, thoroughly review the existing evidence on this topic, and identify potential areas for future research.
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Alzubaidi MA, Drummond BK, Wu J, Jones A, Aggarwal VR. Interventions to Reduce Intra-Operative and Post-Operative Pain Associated with Routine Dental Procedures in Children: A Systematic Review and Meta-Analysis. Dent J (Basel) 2024; 12:163. [PMID: 38920864 PMCID: PMC11202832 DOI: 10.3390/dj12060163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE implementing appropriate pharmacological and non-pharmacological interventions to alleviate pain related to routine dental procedures in paediatric patients could enhance children's ability to manage dental care. The aim of this review was to investigate the effectiveness of and provide recommendations for interventions that can be used to reduce intra-operative and post-operative pain associated with routine paediatric dental procedures. METHODS A systematic review of randomised controlled clinical trials (RCT) was conducted. Multiple electronic databases were systematically searched. The Cochrane risk-of-bias tool for RCTs was used to evaluate the quality of the included studies. A meta-analysis was performed to determine the effectiveness of the interventions using the Cohen's d standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes. The GRADE tool was used to assess the certainty of evidence to make recommendations. RESULTS The review included forty-five RCTs comprising 3093 children. Thirty-seven RCTs were included in the meta-analysis, which showed the effectiveness of behavioural interventions (SMD = -0.50, 95% CI -0.83 to -0.18), mechanoreceptor and thermal receptor stimulation (SMD = -1.38, 95% CI -2.02 to -0.73) for intra-operative pain, and pre-emptive oral analgesics (SMD = -0.77, 95% CI -1.21 to -0.33) for reducing post-operative pain in children receiving routine dental care. CONCLUSION The GRADE results for these interventions were strong recommendation (IB) for their use, based on moderate evidence and their benefits far outweighing the harm, and they can be delivered readily with minimal training to reduce the pain experience of paediatric patients.
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Affiliation(s)
- Mohammed A. Alzubaidi
- Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif 21944, Saudi Arabia;
| | - Bernadette K. Drummond
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK; (B.K.D.); (J.W.); (A.J.)
| | - Jianhua Wu
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK; (B.K.D.); (J.W.); (A.J.)
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 4NS, UK
| | - Adam Jones
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK; (B.K.D.); (J.W.); (A.J.)
| | - Vishal R. Aggarwal
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK; (B.K.D.); (J.W.); (A.J.)
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Pimenta RP, Takahashi CM, Barberato-Filho S, McClung DCF, Moraes FDS, de Souza IM, Bergamaschi CDC. Preemptive use of anti-inflammatories and analgesics in oral surgery: a review of systematic reviews. Front Pharmacol 2024; 14:1303382. [PMID: 38328575 PMCID: PMC10847331 DOI: 10.3389/fphar.2023.1303382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
Objectives: This review of systematic reviews evaluated the effectiveness and safety of the preemptive use of anti-inflammatory and analgesic drugs in the management of postoperative pain, edema, and trismus in oral surgery. Materials and methods: The databases searched included the Cochrane Library, MEDLINE, EMBASE, Epistemonikos, Scopus, Web of Science, and Virtual Health Library, up to March 2023. Pairs of reviewers independently selected the studies, extracted the data, and rated their methodological quality using the AMSTAR-2 tool. Results: All of the 19 studies reviewed had at least two critical methodological flaws. Third molar surgery was the most common procedure (n = 15) and the oral route the most frequent approach (n = 14). The use of betamethasone (10, 20, and 60 mg), dexamethasone (4 and 8 mg), methylprednisolone (16, 20, 40, 60, 80, and 125 mg), and prednisolone (10 and 20 mg) by different routes and likewise of celecoxib (200 mg), diclofenac (25, 30, 50, 75, and 100 mg), etoricoxib (120 mg), ibuprofen (400 and 600 mg), ketorolac (30 mg), meloxicam (7.5, 10, and 15 mg), nimesulide (100 mg), and rofecoxib (50 mg) administered by oral, intramuscular, and intravenous routes were found to reduce pain, edema, and trismus in patients undergoing third molar surgery. Data on adverse effects were poorly reported. Conclusion: Further randomized clinical trials should be conducted to confirm these findings, given the wide variety of drugs, doses, and routes of administration used.
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Affiliation(s)
- Régis Penha Pimenta
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Silvio Barberato-Filho
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Fabio da Silva Moraes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Pessano S, Gloeck NR, Tancredi L, Ringsten M, Hohlfeld A, Ebrahim S, Albertella M, Kredo T, Bruschettini M. Ibuprofen for acute postoperative pain in children. Cochrane Database Syst Rev 2024; 1:CD015432. [PMID: 38180091 PMCID: PMC10767793 DOI: 10.1002/14651858.cd015432.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Children often require pain management following surgery to avoid suffering. Effective pain management has consequences for healing time and quality of life. Ibuprofen, a frequently used non-steroidal anti-inflammatory drug (NSAID) administered to children, is used to treat pain and inflammation in the postoperative period. OBJECTIVES 1) To assess the efficacy and safety of ibuprofen (any dose) for acute postoperative pain management in children compared with placebo or other active comparators. 2) To compare ibuprofen administered at different doses, routes (e.g. oral, intravenous, etc.), or strategies (e.g. as needed versus as scheduled). SEARCH METHODS We used standard Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, CINAHL and trials registries in August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 17 years and younger, treated for acute postoperative or postprocedural pain, that compared ibuprofen to placebo or any active comparator. We included RCTs that compared different administration routes, doses of ibuprofen and schedules. DATA COLLECTION AND ANALYSIS We adhered to standard Cochrane methods for data collection and analysis. Our primary outcomes were pain relief reported by the child, pain intensity reported by the child, adverse events, and serious adverse events. We present results using risk ratios (RR) and standardised mean differences (SMD), with the associated confidence intervals (CI). We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 43 RCTs that enroled 4265 children (3935 children included in this review). We rated the overall risk of bias at the study level as high or unclear for 37 studies that had one or several unclear or high risk of bias judgements across the domains. We judged six studies as having a low risk of bias across all domains. Ibuprofen versus placebo (35 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen probably reduces child-reported pain intensity less than two hours postintervention compared to placebo (SMD -1.12, 95% CI -1.39 to -0.86; 3 studies, 259 children; moderate-certainty evidence). Ibuprofen may reduce child-reported pain intensity, two hours to less than 24 hours postintervention (SMD -1.01, 95% CI -1.24 to -0.78; 5 studies, 345 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events compared to placebo (RR 0.79, 95% CI 0.51 to 1.23; 5 studies, 384 children; low-certainty evidence). Ibuprofen versus paracetamol (21 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen likely reduces child-reported pain intensity less than two hours postintervention compared to paracetamol (SMD -0.42, 95% CI -0.82 to -0.02; 2 studies, 100 children; moderate-certainty evidence). Ibuprofen may slightly reduce child-reported pain intensity two hours to 24 hours postintervention (SMD -0.21, 95% CI -0.40 to -0.02; 6 studies, 422 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events (0 events in each group; 1 study, 44 children; low-certainty evidence). Ibuprofen versus morphine (1 RCT) No studies reported pain relief or pain intensity reported by the child or a third party, or serious adverse events. Ibuprofen likely results in a reduction in adverse events compared to morphine (RR 0.58, 95% CI 0.40 to 0.83; risk difference (RD) -0.25, 95% CI -0.40 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 4; 1 study, 154 children; moderate-certainty evidence). Ibuprofen versus ketorolac (1 RCT) No studies reported pain relief or pain intensity reported by the child, or serious adverse events. Ibuprofen may result in a reduction in adverse events compared to ketorolac (RR 0.51, 95% CI 0.27 to 0.96; RD -0.29, 95% CI -0.53 to -0.04; NNTB 4; 1 study, 59 children; low-certainty evidence). AUTHORS' CONCLUSIONS Despite identifying 43 RCTs, we remain uncertain about the effect of ibuprofen compared to placebo or active comparators for some critical outcomes and in the comparisons between different doses, schedules and routes for ibuprofen administration. This is largely due to poor reporting on important outcomes such as serious adverse events, and poor study conduct or reporting that reduced our confidence in the results, along with small underpowered studies. Compared to placebo, ibuprofen likely results in pain reduction less than two hours postintervention, however, the efficacy might be lower at two hours to 24 hours. Compared to paracetamol, ibuprofen likely results in pain reduction up to 24 hours postintervention. We could not explore if there was a different effect in different kinds of surgeries or procedures. Ibuprofen likely results in a reduction in adverse events compared to morphine, and in little to no difference in bleeding when compared to paracetamol. We remain mostly uncertain about the safety of ibuprofen compared to other drugs.
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Affiliation(s)
- Sara Pessano
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Natasha R Gloeck
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Luca Tancredi
- Geriatrie, Hessing Stiftung, Augsburg, Germany
- Medical School, Regiomed, Coburg, Germany
| | - Martin Ringsten
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ameer Hohlfeld
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sumayyah Ebrahim
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Yu Z, Xiong Y, Fan M, Li J, Liang K. Metronidazole and Ketoprofen-Loaded Mesoporous Magnesium Carbonate for Rapid Treatment of Acute Periodontitis In Vitro. ACS OMEGA 2023; 8:25441-25452. [PMID: 37483201 PMCID: PMC10357566 DOI: 10.1021/acsomega.3c02968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Abstract
In the clinical pharmacological treatment of acute periodontitis, local periodontal administration is expected to be preferable to systemic administration. However, the action of the active medicine component is hindered and diminished by the limitation of drug solubility, which does not provide timely relief of the enormous pain being suffered by patients. This study aimed to develop a mesoporous magnesium carbonate (MMC) medicine loading system consisting of MMC, metronidazole (MET), and ketoprofen (KET), which was noted as MET-KET@MMC. A solvent evaporation process was utilized to load MET and KET in MMC. Scanning electron microscopy, nitrogen sorption, thermogravimetric analysis, and X-ray diffraction were performed on the MET-KET@MMC. The rapid drug release properties were also investigated through the drug release curve. The rapid antiseptic property against Porphyromonas gingivalis (P. gingivalis) and the rapid anti-inflammatory property (within 1 min) were analyzed in vitro. The cytotoxicity of MET-KET@MMC was tested in direct contact with human gingival cells and human oral keratinocytes. Crystallizations of MET and KET were completely suppressed in MMC. As compared to crystalline MET and KET, MMC induced higher apparent solubility and rapid drug release, resulting in 8.76 times and 3.43 times higher release percentages of the drugs, respectively. Over 70.11% of MET and 85.97% of KET were released from MMC within 1 min, resisting bacteria and reducing inflammation. MET-KET@MMC nanoparticles enhanced the solubility of drugs and possess rapid antimicrobial and anti-inflammatory properties. The MET-KET@MMC is a promising candidate for the pharmacotherapy of acute periodontitis with drugs, highlighting a significant clinical potential of MMC-based immediate drug release systems.
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Affiliation(s)
- Zhaohan Yu
- State
Key Laboratory of Oral Diseases, National Clinical Research Center
for Oral Diseases, Department of Cariology and Endodontics, West China
Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yan Xiong
- Orthopedic
Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Menglin Fan
- State
Key Laboratory of Oral Diseases, National Clinical Research Center
for Oral Diseases, Department of Cariology and Endodontics, West China
Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jiyao Li
- State
Key Laboratory of Oral Diseases, National Clinical Research Center
for Oral Diseases, Department of Cariology and Endodontics, West China
Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Kunneng Liang
- State
Key Laboratory of Oral Diseases, National Clinical Research Center
for Oral Diseases, Department of Cariology and Endodontics, West China
Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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6
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Alshami AA, Alhamed SA, Almahri JR, AlSaggabi FA, Alshahrani AS. Effect of pre-operative administration of ibuprofen in children undergoing extraction for reducing post-operative pain: a double-blind randomised controlled clinical trial. Br Dent J 2021:10.1038/s41415-021-2959-2. [PMID: 33986479 DOI: 10.1038/s41415-021-2959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022]
Abstract
Introduction Administration of non-steroidal anti-inflammatory drugs (NSAIDs) before tooth extraction may reduce post-surgical pain, but there is a lack of research.Aims To compare pain and anxiety in paediatric tooth extraction patients receiving a pre-operative NSAID vs placebo.Design Randomised, double-blind, placebo-controlled clinical trial.Setting Princess Nourah bint Abdulrahman University's dental clinic in Riyadh, Saudi Arabia.Materials and methods Eligible paediatric tooth extraction patients were randomised to group A, which received NSAID pre-operatively, or group B, which received the placebo.Interventions A research coordinator measured participants before extraction, and then 3 hours and 24 hours post-extraction.Main outcome methods The Wong-Baker FACES scale and the Modified Child Dental Anxiety Scale (faces).Results There were 56 participants (28 in each group). Pain and anxiety scores were not statistically significantly different between the two groups before or 24 hours post-extraction. However, group A had significantly lower pain (-1.3151, p = 0.0063) and anxiety scores (-0.6071, p = 0.0081) compared to group B three hours post-extraction.Discussion Pre-operative administration of NSAIDs in paediatric dental patients was associated with significantly lower post-extraction pain and anxiety.Conclusions Clinicians should consider making NSAID administration before paediatric tooth extraction part of their clinical protocol.
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Affiliation(s)
- Abeer Ali Alshami
- Preventive Dental Sciences Department, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Sanaa Aidroos Alhamed
- Diagnostic science department, Faculty of dentistry, King Abdulaziz University, Saudi Arabia
| | - Jawaher Radhi Almahri
- Dental Intern, Princess Nourah bint Abdulrahman University, Airport Road, King Khalid International Airport, Riyadh, 84428, Saudi Arabia
| | - Fouz Abdulaziz AlSaggabi
- Dental Intern, Princess Nourah bint Abdulrahman University, Airport Road, King Khalid International Airport, Riyadh, 84428, Saudi Arabia
| | - Arwa Safar Alshahrani
- Dental Intern, Princess Nourah bint Abdulrahman University, Airport Road, King Khalid International Airport, Riyadh, 84428, Saudi Arabia
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Baillargeau C, Lopez-Cazaux S, Charles H, Ordureau A, Dajean-Trutaud S, Prud'homme T, Hyon I, Soueidan A, Alliot-Licht B, Renard E. Post-operative discomforts in children after extraction of primary teeth. Clin Exp Dent Res 2020; 6:650-658. [PMID: 32830447 PMCID: PMC7745079 DOI: 10.1002/cre2.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives This prospective observational study aimed to evaluate discomfort after extraction of deciduous teeth under local anesthesia. The primary objective was to describe the prevalence of post‐extraction pain (PEP), post‐extraction bleeding (PEB), post‐extraction biting injury (PEBI), and analgesic usage in children. The secondary objective was to define whether it is possible to determine a profile of patients or a type of extraction procedure predictive to PEP, administration of analgesics, PEB, or PEBI. Methods One hundred and twenty‐five children, aged 3–13 years, with indications of at least one deciduous tooth extraction, were included. Immediately after extraction, information concerning the patient and the extraction were collected. Eighteen to 32 hr after extraction, parents were called by phone to request reports concerning the onset and intensity of PEP assessed using the Wong‐Baker Faces (WBF) scale, the administration of paracetamol (acetaminophen) to their children, and the appearance of PEB and/or PEBI. Results Of the children, 37.3% reported PEP (WBF ≥2), but 23.3% of these children did not receive any analgesic drugs to help relieve pain. Pain appeared before 3 hr after extraction in 69% of the children. Higher incidences of PEP and usage of analgesics were found both in the group of children with unfavorable socioeconomic level compared to favorable level and in the group with pre‐operative pain compared to no pre‐operative pain (p < .05). Conclusions About a third of the children reported pain after extraction, but the instructions for pain relief were not followed by all parents. The socioeconomic level of the young patient and the pain felt during the extraction were important predictors of discomfort. Therefore, our study could help the dentist to provide information on predicted post‐operative discomfort and to allow suitable care depending on the patient's profile or procedure.
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Affiliation(s)
- Claire Baillargeau
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.,Université de Nantes UFR d'Odontologie, Nantes, France
| | - Serena Lopez-Cazaux
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.,Université de Nantes UFR d'Odontologie, Nantes, France
| | - Hugo Charles
- Centre Hospitalier Universitaire de Nantes, Direction de la recherche, Service de méthodologie, Nantes, France
| | - Aline Ordureau
- Centre Hospitalier Universitaire de Nantes, Direction de la recherche, Service de méthodologie, Nantes, France
| | - Sylvie Dajean-Trutaud
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.,Université de Nantes UFR d'Odontologie, Nantes, France
| | - Tony Prud'homme
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.,Université de Nantes UFR d'Odontologie, Nantes, France
| | - Isabelle Hyon
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France
| | - Assem Soueidan
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.,Université de Nantes UFR d'Odontologie, Nantes, France
| | - Brigitte Alliot-Licht
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.,Université de Nantes UFR d'Odontologie, Nantes, France
| | - Emmanuelle Renard
- Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.,Université de Nantes UFR d'Odontologie, Nantes, France
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8
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Berlin H, Vall M, Bergenäs E, Ridell K, Brogårdh-Roth S, Lager E, List T, Davidson T, Klingberg G. Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review. PLoS One 2019; 14:e0227027. [PMID: 31891621 PMCID: PMC6938383 DOI: 10.1371/journal.pone.0227027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
Background There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. Aim To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3–19 years. Design A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. Results 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. Conclusions There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.
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Affiliation(s)
- Henrik Berlin
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
- Health Technology Assessment—Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
- * E-mail:
| | - Martina Vall
- Malmö University Library, Malmö University, Malmö, Sweden
| | | | - Karin Ridell
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Susanne Brogårdh-Roth
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Elisabeth Lager
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Thomas Davidson
- Health Technology Assessment—Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Gunilla Klingberg
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
- Health Technology Assessment—Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
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9
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Zhou S, Zou H, Chen G, Huang G. Synthesis and Biological Activities of Chemical Drugs for the Treatment of Rheumatoid Arthritis. Top Curr Chem (Cham) 2019; 377:28. [DOI: 10.1007/s41061-019-0252-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022]
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10
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Schuh CMAP, Benso B, Aguayo S. Potential Novel Strategies for the Treatment of Dental Pulp-Derived Pain: Pharmacological Approaches and Beyond. Front Pharmacol 2019; 10:1068. [PMID: 31620000 PMCID: PMC6759635 DOI: 10.3389/fphar.2019.01068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022] Open
Abstract
The diagnosis and management of pain is an everyday occurrence in dentistry, and its effective control is essential to ensure the wellbeing of patients. Most tooth-associated pain originates from the dental pulp, a highly vascularized and innervated tissue, which is encased within mineralized dentin. It plays a crucial role in the sensing of stimuli from the local environment, such as infections (i.e. dental caries) and traumatic injury, leading to a local inflammatory response and subsequently to an increase in intra-pulp pressure, activating nerve endings. However, thermal, chemical, and mechanical stimuli also have the ability to generate dental pulp pain, which presents mechanisms highly specific to this tissue and which have to be considered in pain management. Traditionally, the management of dental pulp pain has mostly been pharmacological, using non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, or restorative (i.e. removal of dental caries), or a combination of both. Both research areas continuously present novel and creative approaches. This includes the modulation of thermo-sensitive transient receptor potential cation channels (TRP) by newly designed drugs in pharmacological research, as well as the use of novel biomaterials, stem cells, exosomes and physical stimulation to obtain pulp regeneration in regenerative medicine. Therefore, the aim of this review is to present an up-to-date account of causes underlying dental pain, novel treatments involving the control of pain and inflammation and the induction of pulp regeneration, as well as insights in pain in dentistry from the physiological, pharmacological, regenerative and clinical perspectives.
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Affiliation(s)
- Christina M. A. P. Schuh
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Bruna Benso
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Department of Physiology, Faculty of Medicine, Universidad Austral de Chile, Millennium Nucleus of Ion Channels Associated Diseases (MiNICAD), Valdivia, Chile
| | - Sebastian Aguayo
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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11
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Preemptive Analgesia by Paracetamol, Ibuprofen or Placebo in Pediatric Dental Care: A Randomized Controlled Study. J Clin Pediatr Dent 2019; 43:51-55. [PMID: 30289371 DOI: 10.17796/1053-4625-43.1.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare postoperative pain among children who received an oral dose of paracetamol, ibuprofen or a placebo, prior to tooth extractions. STUDY DESIGN Thirty minutes prior to dental treatment, children received a liquid dosage, fruit flavored and orange colored, of paracetamol, ibuprofen, or a placebo. Data accessed included children's dental history, their behavior, and their feeling of pain or anxiety according to Wong-Baker FACES: before treatment, following local anesthesia, and following treatment. Parents were interviewed by telephone regarding their children's need for a postoperative analgesia (paracetamol or ibuprofen), and their feeling of pain at four and 24 hours posttreatment. RESULTS Parents reported administering paracetamol or nurofen following the dental procedure to 9/43 (21%), 2/33 (6%) and 12/29 (41%) of the children in the preemptive paracetamol, ibuprofen, and placebo groups, respectively. For the 3 groups, mean pain assessment were similar: around the middle of the Wong-Baker FACES scale at baseline, slightly higher following local anesthesia, and low (pain-free) at four and 24 hours postoperative. CONCLUSION Children who received paracetamol or ibuprofen prior to tooth extractions were less likely to need an analgesic following treatment, compared to children who received a placebo.
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12
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Berlin H, List T, Ridell K, Davidson T, Toft D, Klingberg G. Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars. Eur Arch Paediatr Dent 2019; 20:545-555. [PMID: 30963511 DOI: 10.1007/s40368-019-00425-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions. METHODS 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. RESULTS The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI ≥ 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. CONCLUSIONS The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.
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Affiliation(s)
- H Berlin
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden.
| | - T List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - K Ridell
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
| | - T Davidson
- Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - D Toft
- Colosseum Smile Dental Group, Malmö, Sweden
| | - G Klingberg
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
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13
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Petkovic J, Trawin J, Dewidar O, Yoganathan M, Tugwell P, Welch V. Sex/gender reporting and analysis in Campbell and Cochrane systematic reviews: a cross-sectional methods study. Syst Rev 2018; 7:113. [PMID: 30068380 PMCID: PMC6090880 DOI: 10.1186/s13643-018-0778-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/17/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The importance of sex and gender considerations in research is being increasingly recognized. Evidence indicates that sex and gender can influence intervention effectiveness. We assessed the extent to which sex/gender is reported and analyzed in Campbell and Cochrane systematic reviews. METHODS We screened all the systematic reviews in the Campbell Library (n = 137) and a sample of systematic reviews from 2016 to 2017 in the Cochrane Library (n = 674). We documented the frequency of sex/gender terms used in each section of the reviews. RESULTS We excluded 5 Cochrane reviews because they were withdrawn or published and updated within the same time period as well as 4 Campbell reviews and 114 Cochrane reviews which only included studies focused on a single sex. Our analysis includes 133 Campbell reviews and 555 Cochrane reviews. We assessed reporting of sex/gender considerations for each section of the systematic review (Abstract, Background, Methods, Results, Discussion). In the methods section, 83% of Cochrane reviews (95% CI 80-86%) and 51% of Campbell reviews (95% CI 42-59%) reported on sex/gender. In the results section, less than 30% of reviews reported on sex/gender. Of these, 37% (95% CI 29-45%) of Campbell and 75% (95% CI 68-82%) of Cochrane reviews provided a descriptive report of sex/gender and 63% (95% CI 55-71%) of Campbell reviews and 25% (95% CI 18-32%) of Cochrane reviews reported analytic approaches for exploring sex/gender, such as subgroup analyses, exploring heterogeneity, or presenting disaggregated data by sex/gender. CONCLUSION Our study indicates that sex/gender reporting in Campbell and Cochrane reviews is inadequate.
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Affiliation(s)
- Jennifer Petkovic
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada.
| | - Jessica Trawin
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
| | - Omar Dewidar
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
| | - Manosila Yoganathan
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
| | - Peter Tugwell
- Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Mailbox 201B, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, K1Y 4E9, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, K1H 8M5, Canada
| | - Vivian Welch
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
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14
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Kharouba J, Hawash N, Peretz B, Blumer S, Srour Y, Nassar M, Sabbah M, Safadi A, Khorev A, Somri M. Effect of intravenous paracetamol as pre-emptive compared to preventive analgesia in a pediatric dental setting: a prospective randomized study. Int J Paediatr Dent 2018; 28:83-91. [PMID: 28618198 DOI: 10.1111/ipd.12311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Efficacy of pre-emptive analgesia compared to preventive regimen, managing postoperative pain is still controversial. AIM Evaluating the efficacy of intravenous (IV) paracetamol as pre-emptive analgesia compared to preventive post-treatment administration in pediatric dental setting. DESIGN In a prospective trial, 60 noncooperative children of ASA I, II aged 3-10 years who underwent dental rehabilitation under general anesthesia were randomly divided into two groups. Pre-emptive group (n = 30) received 15 mg/kg of IV paracetamol before the start of treatment. Preventive group (n = 30) received 15 mg/kg of paracetamol at the end of treatment. Analgesic efficacy was measured by visual analog scale of faces (VASOF), percentage of children received postoperative analgesia. RESULTS The VASOF results in the pre-emptive group were significantly lower compared to the preventive group at 4, 8, 12, and 24 h (0.0146, 0.0188, 0.0085, and 0.0001, respectively). Less children in the pre-emptive group received supplemental fentanyl postoperatively compared to the preventive group (27.6%, 58.6%, respectively, P = 0.0170). Time to first rescue dose of fentanyl postoperatively in the pre-emptive group was later than in the preventive group (P = 0.0432). CONCLUSIONS Administration of IV paracetamol pre-emptively provides lower pain scores, and a decreased percentage of children required pain relief and less amount of postoperative opioids, compared to preventive administration.
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Affiliation(s)
- Johny Kharouba
- Department of Pediatric Dentistry, Faculty of Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nasir Hawash
- Anaesthesia Department, Bnai Zion Medical Center, Haifa, Israel
| | - Benjamin Peretz
- Department of Pediatric Dentistry, Faculty of Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigalit Blumer
- Department of Pediatric Dentistry, Faculty of Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yara Srour
- Anaesthesia Department, Bnai Zion Medical Center, Haifa, Israel
| | - Marry Nassar
- Anaesthesia Department and Paediatric Anaesthesia Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Mulham Sabbah
- Anaesthesia Department, Bnai Zion Medical Center, Haifa, Israel
| | - Anan Safadi
- Anaesthesia Department, Bnai Zion Medical Center, Haifa, Israel
| | - Alexey Khorev
- Anaesthesia Department, Bnai Zion Medical Center, Haifa, Israel
| | - Mostafa Somri
- Anaesthesia Department and Paediatric Anaesthesia Unit, Bnai Zion Medical Center, Haifa, Israel.,The Bruce & Ruth Rappaport, Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
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15
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Monk AB, Harrison JE, Worthington HV, Teague A. Pharmacological interventions for pain relief during orthodontic treatment. Cochrane Database Syst Rev 2017; 11:CD003976. [PMID: 29182798 PMCID: PMC6486038 DOI: 10.1002/14651858.cd003976.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pain is a common side effect of orthodontic treatment. It increases in proportion to the amount of force applied to the teeth, and the type of orthodontic appliance used can affect the intensity of the pain. Pain during orthodontic treatment has been shown to be the most common reason for people wanting to discontinue treatment, and has been ranked as the worst aspect of treatment. Although pharmacological methods of pain relief have been investigated, there remains some uncertainty among orthodontists about which painkillers are most suitable and whether pre-emptive analgesia is beneficial. We conducted this Cochrane Review to assess and summarize the international evidence relating to the effectiveness of analgesics for preventing this unwanted side effect associated with orthodontic treatment. OBJECTIVES The objectives of this review are to determine:- the effectiveness of drug interventions for pain relief during orthodontic treatment; and- whether there is a difference in the analgesic effect provided by different types, forms and doses of analgesia taken during orthodontic treatment. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: the Cochrane Oral Health Trials Register (to 19 June 2017), the Cochrane Central Register of Controlled Trials (CENTRAL;the Cochrane Library 2016, Issue 7), MEDLINE Ovid (1946 to 19 June 2017), Embase Ovid (1980 to 19 June 2017) and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 19 June 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched on the 19 June 2017 for ongoing studies. We placed no restrictions on language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomized controlled trials (RCTs) relating to pain control during orthodontic treatment. Pain could be measured on a visual analogue scale (VAS), numerical rating scale (NRS) or categorical scale. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results, agreed the studies to be included and extracted information from the included studies regarding methods, participants, interventions, outcomes, harms and results. We planned to resolve any discrepancies or disagreements through discussion. We used the Cochrane 'Risk of bias' tool to assess the risk of bias in the studies. MAIN RESULTS We identified 32 relevant RCTs, which included 3110 participants aged 9 to 34 years, 2348 of whom we were able to include in our analyses. Seventeen of the studies had more than two arms. We were able to use data from 12 trials in meta-analyses that compared analgesics versus control (no treatment or a placebo); nine that compared non-steroidal anti-inflammatories (NSAIDs) versus paracetamol; and two that compared pre-emptive versus post-treatment ibuprofen for pain control following orthodontic treatment. One study provided data for the comparison of NSAIDs versus local anaesthetic.We found moderate-quality evidence that analgesics effectively reduced pain following orthodontic treatment when compared to no treatment or a placebo at 2 hours (mean difference (MD) -11.66 mm on a 0 to 100 mm VAS, 95% confidence interval (CI) -16.15 to -7.17; 10 studies, 685 participants), 6 hours (MD -24.27 mm on a VAS, 95% CI -31.44 to -17.11; 9 studies, 535 participants) and 24 hours (MD -21.19 mm on a VAS, 95% CI -28.31 to -14.06; 12 studies, 1012 participants).We did not find any evidence of a difference in efficacy between NSAID and paracetamol at 2, 6 or 24 hours (at 24 hours: MD -0.51, 95% CI -8.93 to 7.92; 9 studies, 734 participants; low-quality evidence).Very low-quality evidence suggested pre-emptive ibuprofen gave better pain relief at 2 hours than ibuprofen taken post treatment (MD -11.30, 95% CI -16.27 to -6.33; one study, 41 participants), however, the difference was no longer significant at 6 or 24 hours.A single study of 48 participants compared topical NSAIDs versus local anaesthetic and showed no evidence of a difference in the effectiveness of the interventions (very low-quality evidence).Use of rescue analgesia was poorly reported. The very low-quality evidence did not show evidence of a difference between participants taking ibuprofen and participants taking paracetamol (relative risk (RR) 1.5, 95% CI 0.6 to 3.6). Nor did we find evidence of a difference between groups in likelihood of requiring rescue analgesia when ibuprofen was taken pre-emptively compared to after treatment (RR 0.8, 95% CI 0.3 to 1.9).Adverse effects were identified in one study, with one participant developing a rash that required treatment with antihistamines. This was provisionally diagnosed as a hypersensitivity to paracetamol. AUTHORS' CONCLUSIONS Analgesics are more effective at reducing pain following orthodontic treatment than placebo or no treatment. Low-quality evidence did not show a difference in effectiveness between systemic NSAIDs compared with paracetamol, or topical NSAIDs compared with local anaesthetic. More high-quality research is needed to investigate these comparisons, and to evaluate pre-emptive versus post-treatment administration of analgesics.
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Affiliation(s)
- Aoife B Monk
- Liverpool University Dental HospitalOrthodontic DepartmentPembroke PlaceLiverpoolUKL3 5PS
| | - Jayne E Harrison
- Liverpool University Dental HospitalOrthodontic DepartmentPembroke PlaceLiverpoolUKL3 5PS
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Annabel Teague
- University Hospital WaterfordOrthodontic DepartmentDunmore RoadWaterfordIrelandX91 ER8E
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