Do Antimicrobial Photodynamic Therapy and Low-Level Laser Therapy Minimize Postoperative Pain and Edema After Molar Extraction?

Assessment of Patient Characteristics Influencing the Analgesic Effects of Ibuprofen Gargle After Mandibular Third Molar Extractions

Introduction In our previous work, we investigated the analgesic effects of ibuprofen gargle after mandibular third molar extractions. However, a subsequent detailed review of individual patient data revealed variations in postoperative pain reduction among patients. Consequently, the present study was designed to conduct post-hoc subanalyses that identified factors contributing to variation in the analgesic response to ibuprofen gargle after third molar extractions. Materials and methods This study involved thirty-five Japanese patients from a prior randomized, double-blind, placebo-controlled, crossover study, which focused on the analgesic effects of ibuprofen gargle after mandibular third molar extractions. Participants were categorized as responders (n = 13) and non-responders (n = 22) based on the within-subject difference (ibuprofen-placebo, IP) of visual analog scale (VAS) changes. Baseline characteristics were compared, along with variables, such as age, sex, the reason for extraction, extraction site, Pell Gregory (space and depth) classification, Winter's classification, surgeon's experience, and surgery time. Baseline characteristics predicting responder status were examined using multivariate logistic regression. Results In the univariate analysis, variables such as age, sex, and baseline VAS scores with p-values <0.2 were evaluated using a stepwise approach. This analysis identified age (per -10 years) with an odds ratio of 4.163 (95% confidence interval (CI): 1.170-31.952, p = 0.0233) and sex (female) with an odds ratio of 9.977 (95% CI: 1.336-208.256, p = 0.0213) as significant predictors of responder status. Conclusions In young and female patients, ibuprofen gargle decreased postoperative pain after mandibular third molar extractions.

Efficacy and safety of ibuprofen gargle for postoperative pain after mandibular third molar extraction: A phase II, placebo-controlled, double-blind, randomized crossover trial

OBJECTIVE

This study was designed to evaluate the postoperative efficacy and safety of using an ibuprofen gargle as a pain management strategy for patients who have undergone mandibular third molar extraction. We also ensured that the quality of treatment was not compromised throughout the study.

MATERIAL AND METHODS

Patients were randomized in a 1:1 ratio into two groups: the ibuprofen-placebo (IP) group and the placebo-ibuprofen (PI) group. On postoperative Day (POD) 1, the IP group initiated ibuprofen administration, while the PI group started taking placebo. On POD 2, the IP group switched to using placebo, whereas the PI group switched to ibuprofen. From PODs 3-5, both groups were prescribed ibuprofen gargle. The primary endpoint was within-subject visual analog scale (VAS) score before and 5 min after the first use of the ibuprofen or placebo gargle on PODs 1 and 2 (ΔVAS5_ibuprofen  - ΔVAS5_placebo ). The incidence and severity of adverse events were assessed using the Common Terminology Criteria for Adverse Events version 5.0 and a subjective rating scale.

RESULTS

This study enrolled 40 patients. The within-subject VAS5 of the IP and PI groups were 1.25 ± 12.0 and -5.26 ± 8.93 mm, respectively. The treatment effect of ibuprofen gargle was -2.01 ± 10.62 mm (p = .246). None of the patients in each group presented with serious adverse events or clinically significant complications (including dry sockets) after extraction. Transient adverse events, such as throat tingling and oral discomfort (grade 1), were observed in each group.

CONCLUSION

Ibuprofen gargle was safe but did not provide significant pain relief when used after mandibular third molar extraction.

The efficacy of low-level laser therapy for the healing of second-degree burn wounds on lower limbs of glucocorticoid-dependent patients

This study was designed to investigate the effect of 630 ~ 650-nm red light on treating second-degree burns on lower limbs of glucocorticoid-dependent patients. Sixty-two glucocorticoid-dependent patients with the second-degree burns on lower limbs were divided into the control group (n = 25) and the observation group (n = 37) according to the treatment sequence and the patients' willingness. The patients in both groups were conventionally treated with 1% sulfadiazine silver cream dressing, with the only difference that the observation group received an additional 630-650-nm red light irradiation for 20 min before dressing. Each group was observed for 21 days, and observation ended if the wound healing was terminated. The wound healing rates, wound secretions, marginal response, and pain/itching levels were monitored and assessed. Compared with the control group, the observation group showed higher wound healing rate, fewer wound secretions, and more relief in marginal response. Clinical observation showed that 630-650-nm red light could effectively reduce wound purulent drainage/discharge, relieve the marginal response as well as pain, and promote wound healing.

Do Antimicrobial Photodynamic Therapy and Low-Level Laser Therapy Influence Oral Health-Related Quality of Life After Molar Extraction?

PURPOSE

Most individuals experience significant deterioration in their oral health-related quality of life (OHRQoL) in the first few days after tooth extraction. This study aimed to evaluate the impact of antimicrobial photodynamic therapy (aPDT) and low-level laser therapy (LLLT) protocols on OHRQoL after extraction of lower molars.

METHODS

The investigators designed a double-blind, randomized controlled clinical trial study. Patients with indications for lower molar extraction were included in the study and randomized into four groups: control group, antimicrobial photodynamic therapy group, LLLT group (LLLT.G), and aPDT and LLLT group (aPDT + LLLT.G).The Oral Health Impact Profile (OHIP-14) questionnaire was used through an interview with the participants before the extraction (T0 - baseline) and on the 7th (T1) and 30th (T2) days after extraction. Other variables were age, sex, ethnicity, decayed-missing-filled teeth (DMFT) and tooth types. Appropriate univariate and bivariate statistics were computed, and statistical significance was set at a value P < .05.

RESULTS

The sample was composed of 40 patients with a mean age of 41.25 ± 13.97 and 25 (62.5%) were women. The mean OHIP-14 scores were significantly different in the intervals at T0 versus T1 and T0 versus T2 for all domains (P < .001), demonstrating a positive impact on the OHRQoL. The total scores indicated a significant improvement in the OHRQoL in the aPDT (7.10, standard deviation 4.18, P = .043), LLLT (6.40, SD 5.87, P = .025), and aPDT + LLLT (5.30, SD 3.59, P = .012) groups compared to that in the control group (12.90, SD 6.64) at T1. Patients undergoing extraction of lower mandibular molars with aPDT + LLLT had the lowest mean OHIP-14 total score at T1 (5.30) and T2 (0.70).

CONCLUSION

The aPDT and LLLT protocols had a positive impact on the participants' OHRQoL. These procedures can be applied in everyday surgical practice.

Effectiveness of low power laser in reducing postoperative signs and symptoms after third molar surgery: a triple-blind clinical trial

The objective of this research was to evaluate the effectiveness of using LPL (Low power laser) to reduce pain, edema, and trismus after impacted lower third molar extraction. A split-mouth randomized triple-blind clinical trial was conducted at the Federal University of Ceará. For inclusion criteria, it was necessary that the patient presented a clear indication for removal of both lower third molars, in addition to both molars being in similar positions. The third molars (38 and 48) were randomly allocated to the test group that received the LPL application protocol, and to the placebo group that received a simulation of the protocol, making a total sample of 44 surgeries. Patients in the test group used an average of 50% of the amount of analgesics that was used by the placebo group, however, there was a statistically significant difference only on days four and five. Regarding trismus, the test group presented wide mouth openings, both at 48 hours and at 7 days after surgery compared to the placebo group, but without a statistically significant difference. For edema, we noted an equilibrium between the test group and the placebo group, but no measurement obtained a statistically significant difference. The use of LPL presented better pain and trismus indicators after complex extractions. The use of LPL is thus indicated as a complementary therapy to reduce postoperative discomfort caused by complex tooth extractions.

Effect Of Low-Level Laser Therapy On Inflammatory Sequеlae Of Impacted Mandibular Third Molar Surgery: A Single-Blind, Placebo-Controlled, Randomized Clinical Trial

Objective — Postoperative pain, facial swelling, and limitation of mouth opening are common sequеlae of lower third molar surgery. The objective of the study was to evaluate the effect of Low- level laser irradiation in controlling these sequеlae. Material and Methods — This randomized, single-blinded, split-mouth pilot study was carried out at the department of oral and maxillofacial surgery, university affiliated hospital, Erbil, Iraq. The study was conducted on 20 patients (13 males and 7 females), with a mean age of 26.3±7.4 years, who needed surgical removal of symmetrical bilateral impacted lower third molars. In each patient, one side was treated by low level laser and the other side was control. Laser irradiation was performed by postoperative single intraoral application of 940 nm laser beam at four points. Pain, trismus, and facial swelling were evaluated at the first, third, and seventh postoperative days. The data were analyzed using Mann–Whitney U test and unpaired t -test. Results — As compared to the control sides, low- level laser irradiated sides showed a significant reduction in visual analogue pain scales (VAS) during the first three postoperative days (P<0.05). The VAS scores of the laser treated sides were 4.46, 4.00, and 3.35 as compared to 6.58, 5.82, and 5.17 for the control sides. The swelling, and trismus were significantly reduced on the first and third postoperative days in the laser treated sides, as compared to the control sides (P<0.05). The facial measurements during the first and third postoperative days were 108.72 mm and 114.77 mm in the laser sides and 113.57 mm and 118.43 mm in the control sides. The degree of mouth opening during the first and third postoperative days were 33.48 mm and 30.37 mm in the laser sides and 27.93 mm and 25.58 mm in the control sides Conclusions — Single intraoral application of low- level laser is effective in reducing pain, swelling and trismus after mandibular third molar surgery. Therefore, it can be used as an adjuvant in controlling postoperative complications after lower third molar surgery.

Efficacy of ibuprofen gargle for postoperative pain after mandibular third molar extraction: protocol for a phase II, placebo-controlled, double-blind, randomized crossover trial

Background

Extraction of mandibular third molars is one of the most commonly performed oral surgical procedures, and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management. Oral NSAIDs are associated with adverse events such as gastrointestinal disorders, renal and hepatic dysfunction, and platelet dysfunction. Topical analgesics have been proposed as alternatives to oral and injectable medications to safely improve postoperative pain relief. We will conduct a single-center, placebo-controlled, double-blind, randomized crossover trial to assess the pain-relieving effect of an ibuprofen-containing gargle in patients undergoing extraction of mandibular third molars when compared with a placebo gargle.

Objective

This will be the first clinical study to compare the efficacy of an ibuprofen gargle with that of a placebo for relieving postoperative pain in addition to loxoprofen after mandibular third molar extraction.

Methods

This study will be performed at Kobe University Hospital. Participants (N=40) will be randomized equally to 1 of 2 groups. The ibuprofen-placebo group will receive an ibuprofen gargle on postoperative day (POD) 1 and a placebo gargle on POD 2. The placebo-ibuprofen group will receive a placebo gargle on POD 1 and an ibuprofen gargle on POD 2. Both groups will receive ibuprofen gargles on PODs 3-5 at least once daily. The primary objective is to estimate the within-subject difference on a visual analog scale (VAS) before and 5 minutes after using the ibuprofen or placebo gargle on PODs 1 and 2. The secondary objectives are to estimate the within-subject differences in ΔVAS before and 15 minutes after using the ibuprofen or placebo gargle on PODs 1 and 2, ΔVAS before and 5 or 15 minutes after using the ibuprofen gargle on PODs 3-5, overall efficacy (self-completion, 5 scales) on PODs 1-5, daily frequency of use (ibuprofen or placebo gargle and analgesics) on PODs 1-7, and the occurrence of adverse events.

Results

The Certified Review Board of Kobe University approved the study. The intervention was implemented in May 2021. For the primary analysis, we will calculate the mean and SD of ΔVAS₅ on PODs 1 and 2 and the within-study difference in ΔVAS₅. The treatment effect will be estimated by dividing the mean ΔVAS₅ in the within-subject difference by 2 and calculating the P value using an unpaired t test. For the secondary analysis, we will calculate the mean and SD of ΔVAS₁₅ on PODs 1 and 2 and the within-study difference in ΔVAS₁₅. The treatment effect will be estimated as in the primary analysis.

Conclusions

This trial will provide exploratory evidence of the efficacy and safety of an ibuprofen gargle for pain reduction after mandibular third molar extraction.

Trial Registration

Japan Registry of Clinical Trials jRCTs051210022; https://tinyurl.com/39ej23zu

International Registered Report Identifier (IRRID)

DERR1-10.2196/35533

Effect of photobiomodulation on post-operative symptoms in teeth with asymptomatic apical periodontitis treated with foraminal enlargement: A randomized clinical trial

AIM

To assess the efficacy of photobiomodulation in reducing post-operative symptoms and use of analgesics in teeth with asymptomatic apical periodontitis treated with foraminal enlargement in a single visit.

METHODOLOGY

This prospective double-blind, controlled, superiority, randomized clinical trial enrolled 70 patients requiring root canal treatment of one single-rooted tooth with asymptomatic apical periodontitis. The participants were randomized into one of the following two groups: 35 patients in the control group (C.G) - root canal treatment with foraminal enlargement, without any additional treatment and 35 patients in the photobiomodulation group (PBM.G) - root canal treatment with foraminal enlargement associated with photobiomodulation (antimicrobial photodynamic therapy and low-level laser therapy). The outcome variables were post-operative pain, tenderness, oedema and the use of analgesics. Pain intensity was measured using a visual analogue scale (recorded every day for 7 days, then the 14th and 30th days after root canal treatment). Facial oedema was assessed subjectively by two independent evaluators using photographs taken by one of the researchers at 48 h, 72 h and 7 days after the procedures. Data were tabulated and analysed using the Mann-Whitney U, Chi-Square, Fisher`s Exact, Student T and Ordinal Logistic Regression by Generalized Estimating Equations tests in SPSS software.

RESULTS

There were no significant differences in post-operative pain and tenderness between the groups at any observation period (p > .05). Photobiomodulation (beta = -0.77 / p = .01), time (beta = -0.23 / p < .01), and male gender (beta = -1.20 / p < .01) were associated with decreased post-operative pain. Only time (beta: -0.10; p < .01) and male gender (beta: -1.04; p < .01) were associated with decreased tenderness. For oedema and use of analgesics, there was no difference between the groups (p > .05).

CONCLUSIONS

Photobiomodulation had no significant effect on post-operative pain, tenderness, oedema and the use of analgesics after root canal treatment with foraminal enlargement, in single-rooted teeth treated in a single visit. Register of Clinical Trials: NCT03704857. Research Ethics Committee: no 2.353.996 / CAAE 74185417.9.0000.5626.