1
|
Rosa A, Pujia AM, Arcuri C. Investigation of alveolar osteitis and the effectiveness of laser treatment: a unified Meta-analysis and review of the literature. BMC Oral Health 2024; 24:700. [PMID: 38886713 PMCID: PMC11184811 DOI: 10.1186/s12903-024-04461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Post-tooth extraction, dry socket is a frequently encountered complication, causing substantial pain and hindering the healing process. Conventional approaches to manage this condition have traditionally involved the use of antiseptic dressings to diminish bacterial presence and facilitate healing. This study aims to assess the efficacy of laser therapy in the symptomatic treatment of alveolitis. METHODS A literature search was conducted on PubMed, Embase, Scopus, Google Scholar, Web of Science, focusing on publications from 1998 to 31/01/2024 using relevant keywords. The combination of "laser" and "dry socket" was executed through the boolean connection AND. RESULTS At the conclusion of the study, a total of 50 studies were identified across the three search engines, with only three selected for the current systematic study and meta-analysis. The meta-analysis indicated that laser treatment proves effective in addressing alveolitis compared to Alvogyl. However, the correlation between the two was not highly significant. CONCLUSION These findings suggest that laser therapy may serve as a viable alternative to traditional treatments for dry socket. This minimally invasive procedure has the potential to alleviate pain and promote healing with fewer associated side effects."
Collapse
Affiliation(s)
- Alessio Rosa
- Department of Chemical Science and Technologies, Dentistry, University of Tor Vergata, Rome, 00133, Italy.
| | - Alberto Maria Pujia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, 00133, Italy
| | - Claudio Arcuri
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
| |
Collapse
|
2
|
Yousef MSM, El Dakrory UAER, ELhadidi YN, El Abedin MDZ. The Effect of Intra-socket Vitamin E Application on the Reduction in Postoperative Pain and Reduction in Incidence of Dry Socket in Female Patients: A Randomized Controlled Trial. J Maxillofac Oral Surg 2024; 23:545-551. [PMID: 38911421 PMCID: PMC11190123 DOI: 10.1007/s12663-023-02076-2] [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: 05/11/2023] [Accepted: 11/14/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction Blum defined dry socket as the presence of postoperative pain in and around the extraction site that worsens 1-3 days after the extraction. Methods 90 female patients seeking extraction of a single tooth in the lower posterior region were divided randomly into 45 patients who received vitamin E inside the socket after extraction (study group) and 45 patients who did not receive vitamin E after extraction (control group). Results After 3 days, there was a decrease in pain levels in the study group compared to the control group. Only 7 patients out of 45 (16%) suffered from pain compared to 17 patients out of 45 (38%) in the control group. So, the improvement in pain was statistically significant P = 0.02. After 7 days, there was a decrease in wound healing levels in the study group compared to the control group. Only 8 patients out of 45 (17%) had poor wound healing compared to 7 patients out of 45 (16%) in the control group. However, the improvement in wound healing was not statistically significant P = 0.8. Conclusion Based on the current results, we recommend the use of vitamin E as topical intra-socket medication in reducing the early postoperative pain.
Collapse
Affiliation(s)
- Mohamed Salah Mohamed Yousef
- Oral and Maxillofacial Surgery Department, Misr University for Science and Technology, 6th of October City, Egypt
| | | | - Yasser Nabil ELhadidi
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain-Shams University, Cairo, Egypt
| | - Mohamed Diaa Zein El Abedin
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain-Shams University, Cairo, Egypt
- President of Ain Shams University, Ain Shams uniy, Cairo, Egypt
| |
Collapse
|
3
|
Dignam P, Elshafey M, Jeganathan A, Foo M, Park JS, Ratnaweera M. Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review. Int J Dent 2024; 2024:7712829. [PMID: 38756385 PMCID: PMC11098612 DOI: 10.1155/2024/7712829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs. Objectives This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence. Results Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity. Conclusion This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.
Collapse
Affiliation(s)
- Peter Dignam
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Mariam Elshafey
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Aparna Jeganathan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Magdalen Foo
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, Australia
- International Research Collaborative—Oral Health and Equity, School of Allied Health, The University of Western Australia, Crawley, Australia
- School of Engineering, Information Technology and Physical Sciences, Federation University Australia, Victoria, Ballarat, Australia
| | | |
Collapse
|
4
|
Nagaja SA, John RS, Krishnan M. Efficacy of Tranexamic Acid in Preventing Alveolar Osteitis in Post-extraction Sockets of First Premolars. Cureus 2024; 16:e51816. [PMID: 38327915 PMCID: PMC10847889 DOI: 10.7759/cureus.51816] [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: 12/02/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES The present study is a randomized trial for comparing the effectiveness of tranexamic acid as an antifibrinolytic agent in preventing alveolar osteitis in the post-extraction period in patients receiving orthodontic therapy that requires extraction. METHODOLOGY This research was carried out in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, India. A total of 40 patients were considered subjects for the research. Patients undergoing orthodontic treatment referred to the Department of Oral and Maxillofacial Surgery for the therapeutic extractions of the first premolars were considered for this study. Randomization was done to split the population into study and control. After the atraumatic extraction of the first premolars under local anesthesia using 2% lignocaine with 1:80000 adrenaline, a tranexamic acid solution of 500 mg soaked gauze over the extraction sockets was used as the intervention in the study group, and plain gauze was used on the control group. Patients were asked to hold the gauze in place for one hour. Participants were reviewed after three days for the incidence of alveolar osteitis and pain severity and healing of the extraction sockets. Results: The prevalence of Alveolitis sicca dolorosa was found to be 5% in the research group and 15% in the control group. Patients in the control group showed more pain than the patients in the research group. The period taken for healing ranged from 7 days to 10 days in the control group and 10 days to 12 days in the study group. Conclusion: This study gives an edge that tranexamic acid can be used as a local hemostatic agent in preventing fibrinolysis of clots and preventing alveolar osteitis.
Collapse
Affiliation(s)
- Sharanika A Nagaja
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Rubin S John
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| |
Collapse
|
5
|
Khan ZA, Prabhu N, Maqsood A, Issrani R, Ahmed N, Abbasi MS, Heboyan A, Marya A. Frequency and etiological denominators of alveolar osteitis at Northern Province of Kingdom of Saudi Arabia-An observational study. SAGE Open Med 2023; 11:20503121231219420. [PMID: 38146494 PMCID: PMC10749515 DOI: 10.1177/20503121231219420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023] Open
Abstract
Objective Alveolar osteitis is a painful complication that often arises after tooth extraction, presenting a significant clinical challenge. It is imperative to gain a comprehensive understanding of both its occurrence and the contributing factors to enhance the quality of dental care. The aim of this study was to assess the frequency and prevalence of alveolar osteitis among patients and compare these variables based on demographic characteristics (age and sex), the number of teeth extractions, operator experience, health status, and smoking habits in the target population. Methods This cross-sectional observational study was conducted from May 2019 to April 2020. It included all patients above 16 years of age, of both genders, who underwent permanent tooth extraction for various reasons. Patient demographics, smoking habits, health status, operating dental surgeon's clinical experience, extraction technique, and the number of teeth extracted were recorded. Statistical analysis was performed using SPSS version 25. Chi-square test and regression analysis were used to assess differences between age, sex, smoking habit, dentist category, and the number of teeth extractions in relation to alveolar osteitis. Results A total of 679 permanent tooth extractions were performed in 438 patients. Alveolar osteitis was observed in 107 cases (15.7%) following tooth extractions. Among these, 36 cases (33.6%) occurred in single tooth extraction cases, while 71 cases (66.4%) were present in patients with multiple extractions. Moreover, 67 cases (62.6%) of alveolar osteitis were found in cigarette smokers. In addition, 61 cases (57%) of dry sockets were reported after tooth extractions performed by dental interns, while 46 cases (43.0%) were noted in extractions performed by experienced dental surgeons and specialists. Conclusion The study found a 15.7% incidence of alveolar osteitis in tooth extraction patients in the Al-Jouf region. Alveolar osteitis was more prevalent in males and the age group of 56-77 years. Multiple tooth extractions were associated with higher alveolar osteitis incidence, while operator inexperience increased post-extraction complication risks. In addition, a promising novel protocol and risk assessment scoring system have been devised which require further validation and future research.
Collapse
Affiliation(s)
- Zafar Ali Khan
- Department of Oral and Maxillofacial Surgery, Frontier Medical and Dental College, Abbottabad Khyber Pukhtonkhwa, Pakistan
| | - Namdeo Prabhu
- Department of Oral, Maxillofacial Surgery, and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
| | - Afsheen Maqsood
- Department of Oral Pathology, Bahria University Medical and Dental College, Karachi, Pakistan
| | - Rakhi Issrani
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Maria Shakoor Abbasi
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University After Mkhitar Heratsi, Yerevan, Armenia
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Anand Marya
- Faculty of Dentistry, Department of Orthodontics, University of Puthisastra, Phnom Penh, Cambodia
| |
Collapse
|
6
|
Romero-Olid MDN, Bucataru E, Ramos-García P, González-Moles MÁ. Efficacy of Chlorhexidine after Oral Surgery Procedures on Wound Healing: Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:1552. [PMID: 37887254 PMCID: PMC10604691 DOI: 10.3390/antibiotics12101552] [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: 09/21/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Our objective was to evaluate qualitatively and quantitatively, through a systematic review and meta-analysis, available evidence on the efficacy of chlorhexidine (CHX) when applied after oral surgery on wound healing and related clinical parameters. MEDLINE/PubMed, Embase, CENTRAL, Web of Science, and Scopus were searched for studies published before January 2023. The quality of the methodology used in primary-level studies was assessed using the RoB2 tool; meta-analyses were performed jointly with heterogeneity and small-study effect analyses. Thirty-three studies and 4766 cases were included. The results point out that the application of CHX was significantly more effective, compared to controls where CHX was not employed, providing better wound healing after oral surgery (RR = 0.66, 95% CI = 0.55-0.80, p < 0.001). Stratified meta-analyses confirmed the higher efficacy of 0.20% CHX gel vs. other vehicles and concentrations (p < 0.001, respectively). Likewise, the addition of chitosan to CHX significantly increased the efficacy of surgical wound healing (p < 0.001). The use of CHX has also been significantly beneficial in the prevention of alveolar osteitis after any type of dental extraction (RR = 0.46, 95% CI = 0.39-0.53, p < 0.001) and has also been effective when applied as a gel for a reduction in pain after the surgical extraction of third molars (MD = -0.97, 95% CI = -1.26 to -0.68, p < 0.001). In conclusion, this systematic review and meta-analysis demonstrate on the basis of evidence that the application of CHX exerts a beneficial effect on wound healing after oral surgical procedures, significantly decreasing the patient's risk of developing surgical complications and/or poor wound healing. This benefit was greater when CHX was used at 0.20% in gel form with the addition of chitosan.
Collapse
Affiliation(s)
- María de Nuria Romero-Olid
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Elena Bucataru
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| |
Collapse
|
7
|
Albanese M, Zangani A, Manfrin F, Bertossi D, De Manzoni R, Tomizioli N, Faccioni P, Pardo A. Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study. Dent J (Basel) 2023; 11:238. [PMID: 37886923 PMCID: PMC10605236 DOI: 10.3390/dj11100238] [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: 08/18/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.
Collapse
Affiliation(s)
| | | | | | | | | | - Nicolò Tomizioli
- Dentistry and Maxillofacial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A, Scuro 10, 37134 Verona, Italy; (M.A.); (A.Z.); (D.B.); (R.D.M.); (P.F.); (A.P.)
| | | | | |
Collapse
|
8
|
Alissa M, Hjazi A, Abusalim GS, Aloraini GS, Alghamdi SA, Rizg WY, Hosny KM, Alblowi JA, Alkharobi H. Development and Optimization of a Novel Lozenge Containing a Metronidazole-Peppermint Oil-Tranexamic Acid Self-Nanoemulsified Delivery System to Be Used after Dental Extraction: In Vitro Evaluation and In Vivo Appraisal. Pharmaceutics 2023; 15:2342. [PMID: 37765310 PMCID: PMC10535350 DOI: 10.3390/pharmaceutics15092342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
In-depth studies on essential oil-based nanoemulsions (NEs) have centered on a variety of oral health issues. NEs improve the delivery of nonpolar active agents to sites and thereby boost the dissolution and distribution of the agents. Metronidazole-peppermint oil-tranexamic acid self-nanoemulsifying drug delivery systems (MZ-PO-TX-SNEDDS) were created and loaded into novel lozenges to act as antifungal, hemostatic, antimicrobial, and analgesic dosage forms after dental extractions. The design-of-experiments approach was used in creating them. To generate the NEs, different concentrations of MZ-PO (240, 180, and 120 mg), 2% TX (600, 450, and 300 mg), and Smix1:1 (600, 400, and 200 mg) were used. The ideal formulation had serum levels of 1530 U/mL of interleukin-6, a minimal inhibitory concentration against bacteria of 1.5 µg/mL, a droplet size of 96 nm, and a blood coagulation time of 16.5 min. Moreover, the produced NE offered better MZ release. The adopted design was used to produce the ideal formulation; it contained 240 mg of MZ-PO, 600 mg of 2% TX, and 600 mg of Smix1:1. It was incorporated into lozenges with acceptable characteristics and an improved capability for drug release. These lozenges had reasonable coagulation times, IL-6 serum levels, and MIC values. All of these characteristics are desirable for managing symptoms following tooth extractions. Therefore, these lozenges loaded with MZ-PO-TX-SNEDDs might be considered a beneficial paradigm for relieving complications encountered after tooth extractions.
Collapse
Affiliation(s)
- Mohammed Alissa
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (A.H.); (G.S.A.); (G.S.A.); (S.A.A.)
| | - Ahmed Hjazi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (A.H.); (G.S.A.); (G.S.A.); (S.A.A.)
| | - Ghadah S. Abusalim
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (A.H.); (G.S.A.); (G.S.A.); (S.A.A.)
| | - Ghfren S. Aloraini
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (A.H.); (G.S.A.); (G.S.A.); (S.A.A.)
| | - Suad A. Alghamdi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (A.H.); (G.S.A.); (G.S.A.); (S.A.A.)
| | - Waleed Y. Rizg
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.Y.R.); (K.M.H.)
- Center of Innovation in Personalized Medicine (CIPM), 3D Bioprinting Unit, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Khaled M. Hosny
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.Y.R.); (K.M.H.)
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Jazia A. Alblowi
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Hanaa Alkharobi
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| |
Collapse
|
9
|
Onuoha EO, Adekunle AA, Ajike SO, Gbotolorun OM, Adeyemo WL. Effect of manuka honey socket dressing on postoperative sequelae and complications following third molar extraction: A randomized controlled study. J Craniomaxillofac Surg 2023:S1010-5182(23)00072-0. [PMID: 37164834 DOI: 10.1016/j.jcms.2023.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/03/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
To evaluate the effect of manuka honey on the healing of mandibular third molar extraction sockets. This was a prospective randomized study at a tertiary health institution in Lagos, Nigeria. All extractions were transalveolar, using the distobuccal bone guttering technique. Participants were randomized into two study groups. Group A underwent intrasocket application of manuka honey, after which sockets were completely closed using the mucosal flap, while participants in group B underwent mucosal flap closure of the socket without application of manuka honey. The primary outcome was healing of the extraction socket at 7 days postoperatively. The secondary outcomes measured were postoperative sequelae, namely pain, swelling, and trismus on postoperative days 1, 3, and 7, and socket healing complications - specifically inflamed socket, infected socket, and alveolar osteitis. In total, 112 participants completed the study, with 56 participants per group. There were no significant differences in demographic variables between both groups. On the 7th day postoperatively, 26.8% of participants in group B had an unhealed extraction site, compared with 10.3% of participants in group A (p = 0.029). A significant difference was observed between pre- and postoperative pain scores in both study groups (p = 0.001). A comparison of postoperative mean facial swelling between the two groups showed no statistically significant differences on all the review days (p = 0.66). The difference in postoperative socket healing complication rate between both groups was statistically significant (χ2 = 4.747, p = 0.029). Within the limitations of the study it seems that the application of manuka honey appears to aid earlier healing of the third molar extraction socket, with a significantly lower frequency of complications. Therefore, the application of manuka honey is recommended whenever appropriate.
Collapse
Affiliation(s)
- Emmanuel Onyebuchi Onuoha
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
| | - Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Sunday Olusegun Ajike
- Department of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Olalekan Micah Gbotolorun
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| |
Collapse
|
10
|
La Rosa GRM, Marcianò A, Priolo CY, Peditto M, Pedullà E, Bianchi A. Effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis: a scoping review. Clin Oral Investig 2023:10.1007/s00784-023-05012-3. [PMID: 37014504 DOI: 10.1007/s00784-023-05012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The aim of this scoping review was to determine the effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis. MATERIALS AND METHODS Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A literature search was conducted in the PubMed and Scopus databases to identify all clinical studies on the application of platelet-rich fibrin in the control of pain caused by alveolar osteitis. Data were extracted independently by two reviewers and qualitatively described. RESULTS The initial search returned 81 articles, with 49 identified after duplicates removal; of these, 8 were selected according to the inclusion criteria. Three of the eight studies were randomized controlled clinical trials, and four were non-randomized clinical studies, two of which were controlled. One study was case series. In all of these studies, pain control was evaluated using the visual analog scale. Overall, the use of platelet-rich fibrin resulted effective in the control of pain determined by alveolar osteitis. CONCLUSIONS Within the limits of this scoping review, the application of platelet-rich fibrin in the post-extra-extraction alveolus reduced the pain associated with alveolar osteitis in almost all the included studies. Nevertheless, high-quality randomized trials with adequate sample size are warranted to draw firm conclusions. CLINICAL RELEVANCE Pain associated with alveolar osteitis causes discomfort to the patient and is challenging to be treated. Use of platelet-rich fibrin could be a promising clinical strategy for pain control in alveolar osteitis if its effectiveness will be confirmed by further high-quality studies.
Collapse
Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Antonia Marcianò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carlotta Ylenia Priolo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Matteo Peditto
- Postgraduate School of Oral Surgery, Department of Biomedical, Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Alberto Bianchi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| |
Collapse
|
11
|
da Costa RR, Freitas RDS, da Cunha G, de Oliveira SD, Weber JBB. Antimicrobial and bone repair effects of boric acid in a rat model of dry socket (alveolar osteitis) following dental extraction. J Trace Elem Med Biol 2023; 76:127118. [PMID: 36516573 DOI: 10.1016/j.jtemb.2022.127118] [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] [Received: 06/27/2022] [Revised: 11/20/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alveolitis occurs after dental extraction without blood clot formation, leading to an inflammatory process and bacterial contamination. Boric acid (BA) demonstrates anti-inflammatory, antimicrobial, and osteogenic properties. This study aims to evaluate the possible antimicrobial effects and bone repair of BA in a rat model of alveolitis (dry socket). METHODS 33 male Wistar rats were submitted to the extraction of the upper right incisor and dry socket induction. They were first divided into two groups: dry socket (n = 17) and dry socket + 0.75 % BA (n = 16). Samples for the microbiological analysis were collected immediately after dental extraction, at the detection of clinical alveolitis, 7, and 14 days after BA application. For microCT and histological analysis, samples from euthanized rats were used in 14 and 28 days after alveolitis detection. RESULTS Higher bacterial counts were found in 4-5 days after alveolitis induction, compared to the baseline in both experimental groups, decreasing significantly after 7 and 14 days of treatment with BA (P < 0.05). The microCT evaluation displayed increased bone volume, bone volume fraction, trabecular thickness, and bone mineral density in a time-dependent manner, regardless of BA treatment. On the other hand, the number of trabeculae and total bone porosity decreased over the 28 days of the experiment in the dry-socket group and both groups, respectively (P < 0.05). Histological analysis did not differ on bone repair in both experimental groups. CONCLUSION This was the first report investigating the effects of BA in a rat model of alveolitis regarding microbiological and bone repair aspects. The BA local application decreased the total aerobic and facultative bacteria counts and does not seem to benefit the bone repair after alveolitis development. This study paves the way for more studies involving alveolitis and different BA applications.
Collapse
Affiliation(s)
- Renan R da Costa
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, School of Health and Life Sciences, Post-Graduate Program in Dentistry, Porto Alegre, RS, Brazil
| | - Raquel D S Freitas
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, School of Medicine, Post-Graduate Program in Medicine and Health Sciences, Porto Alegre, RS, Brazil; Nutrition Thinking® Co., Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriela da Cunha
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, School of Health and Life Sciences, Post-Graduate Program in Dentistry, Porto Alegre, RS, Brazil
| | - Sílvia D de Oliveira
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, School of Health and Life Sciences, Post-Graduate Program in Dentistry, Porto Alegre, RS, Brazil
| | - João B B Weber
- Pontifical Catholic University of Rio Grande do Sul, PUCRS, School of Health and Life Sciences, Post-Graduate Program in Dentistry, Porto Alegre, RS, Brazil.
| |
Collapse
|
12
|
Ahmedi J, Agani Z, Ademi Abdyli R, Prekazi Loxha M, Hamiti‐Krasniqi V, Rexhepi A, Stubljar D. Comparison between ozone and CHX gel application for reduction of pain and incidence of dry socket after lower third molar removal. Clin Exp Dent Res 2023; 9:75-81. [PMID: 36245293 PMCID: PMC9932237 DOI: 10.1002/cre2.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the efficacy between ozone gas and 1% chlorhexidine (CHX) gel in the incidence of dry socket after surgical extraction of impacted lower third molars. MATERIAL AND METHODS Overall, 30 patients of both genders were included in the study, with indication of surgical extraction of lower third molar, positioned similarly after being clinically and radiographically checked by X-ray and orthopantomography. Each patient was subjected to both groups in separate sessions: treated with ozone gas and with CHX gel 1%. Data on pain intensity, number of taken analgesics-painkillers, and dry socket were recorded for 48 h and at Day 7. RESULTS Ozone gas and CHX gel effectively reduced pain intensity and prevented dry socket. The number of taken analgesics 48 h and 7 days after surgery showed no statistical significance. The same was observed for the distribution of pain. Only one patient reported the occurrence of dry socket 7 days after the surgical extraction. CONCLUSIONS Ozone gas and CHX 1% gel are both efficient in decreasing postoperative symptoms and incidence rates of dry socket, but in comparison to each other, the use of ozone gas is showing a bit better prevention capability.
Collapse
Affiliation(s)
- Jehona Ahmedi
- Department of Oral SurgeryUniversity of PrishtinaPrishtinaKosovo
| | - Zana Agani
- Department of Oral SurgeryUniversity of PrishtinaPrishtinaKosovo
| | | | | | | | | | - David Stubljar
- In‐medico, Department of Research and DevelopmentMetlikaSlovenia
| |
Collapse
|
13
|
Is Chitosan Dental Dressing Better Than Cotton Gauze in Achieving Hemostasis in Patients on Antithrombotics? J Oral Maxillofac Surg 2023; 81:224-231. [PMID: 36403660 DOI: 10.1016/j.joms.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Tooth extraction leads to bleeding which may be longer in patients on antithrombotics. This study was aimed to evaluate the hemostatic and wound healing efficacy of chitosan-based dressing in comparison to the cotton pressure pack after tooth extraction in patients receiving single or dual antithrombotics. MATERIALS AND METHODS This is a prospective, randomized split mouth study. Patients undergoing tooth extractions taking either single or dual antithrombotics, with an international normalized ratio (INR) value ≤ 3 were enrolled at JSS Dental College & Hospital, Mysuru, India during February 2020 to January 2022. The study compared the efficiency of chitosan dressing in achieving quicker hemostasis in comparison to cotton pressure pack. The primary outcome was time to achieve hemostasis and the secondary outcomes were alveolar clinical healing index and alveolar osteitis. The covariates were gender, age, reason for extraction, INR, type of antithrombotic therapy, and the disease condition. RESULTS Of the 54 enrolled subjects, 39 were males and 15 were females, aged between 33 and 86 years. Thirty six patients were on single antithrombotics, whereas 18 patients were on dual antithrombotics. The reason for extraction was periodontitis in 37 patients and dental caries in 17 patients. The time to achieve hemostasis was lesser with chitosan dental dressing when compared to cotton pressure packs (96 ± 4 and 797 ± 23 seconds; P < .001). In the chitosan group, the time to hemostasis was similar irrespective of single or dual antithrombotic therapy (90 ± 6 and 109 ± 8 seconds, respectively). On the contrary, in the cotton pressure pack group, patients on dual antithrombotics had longer time to achieve hemostasis compared to those on single antithrombotics (940 ± 20 and 726 ± 26 seconds; P < .001). The time to achieve hemostasis was dependent on INR only in cotton pressure pack group (r2 = 0.7756). The alveolar clinical healing index was better in 88.9% with chitosan and only 3.7% with cotton pressure packs. None of the patients treated with chitosan presented with alveolar osteitis, as opposed to 3.7% of patients with cotton pressure packs. CONCLUSION When compared to cotton pressure packs, chitosan-based dressing was more effective in controlling postoperative bleeding in patients treated with single and dual antithrombotic therapy.
Collapse
|
14
|
Muacevic A, Adler JR, Harfouch M. Comparative Clinical Study Between Chlorhexidine Gel (0.2%) and Hyaluronic Gel (1%) in the Prevention of a Dry Socket After Tooth Extraction for Orthodontic Treatment. Cureus 2022; 14:e32391. [PMID: 36636542 PMCID: PMC9831615 DOI: 10.7759/cureus.32391] [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: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Several articles have investigated the intra-alveolar applications of bioadhesive gels containing various medicines and active chemicals, such as chlorhexidine (CHX) and hyaluronic acid (HA) to minimize the numerous postoperative sequelae, such as a dry socket. The purpose of this study was to investigate the postoperative outcomes of intra-alveolar application of 0.2% chlorhexidine or hyaluronic acid following atraumatic extraction. Methods A randomized clinical trial was conducted on a sample of 36 patients who need extraction of lower first premolar for orthodontic treatment. The patients were assigned randomly into two groups: CHX group and HA group. The signs and symptoms of the dry socket were evaluated on the third day in two groups. Results There was no statistically significant difference between the study and control groups when comparing the CHX group (P=0.2.6). In contrast, a significant difference was seen between the study and control sides in the HA group. Conclusions Within the limitation of this clinical trial, using hyaluronic gel with a gelatin sponge may be a preventive strategy for a dry socket following tooth extraction. After non-surgical tooth extraction, the topical administration of CHX with a gelatin sponge as a carrier did not seem to act as a protective substance against a dry socket.
Collapse
|
15
|
Oral Contraceptive Use and Alveolar Osteitis Following Third Molar Extraction: A Systematic Review and Meta-Analysis. Int J Dent 2022; 2022:7357845. [PMID: 36389647 PMCID: PMC9643054 DOI: 10.1155/2022/7357845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Alveolar osteitis (AO) is a common postoperative complication of third molar extractions that is thought to be associated with the intake of oral contraceptives (OCPs). This meta-analysis sought to evaluate the risk of AO associated with OCP use and sex independently and whether this risk was affected by the use of postoperative analgesics or antibiotics. METHODS PubMed/Medline, EMBASE, and Cochrane databases were searched for articles pertaining to OCP use and the incidence of AO using MESH terms. The measured outcome was the development of AO following a third molar extraction. Additional variables such as sex, analgesic, and antibiotic use were documented and included in the analysis. The data were analyzed in R using the Mantel-Haenszel method. RESULTS Fifteen studies with a total of 1366 female participants who were OCP users and 2919 nonuser female participants were included in this meta-analysis. OCP users were approximately twice (pooled-RR: 1.98, 95% CI: 1.42-2.76) as likely to develop AO following a third molar extraction when compared to nonuser females. The increased incidence of AO in the OCP group was statistically significant (p < 0.01). The pooled-RR of AO in females not taking OCPs was not significantly different from males (p=0.45). CONCLUSIONS OCP use significantly elevated the risk of AO in females. Females who did not take OCPs had a similar risk of developing AO compared to males, suggesting that OCP use is a potential effect modifier. Neither postoperative antibiotics use nor the type of postoperative analgesic significantly affected AO incidence in those taking OCPs.
Collapse
|
16
|
El Halawany M, Latif R, AbouGhaly MHH. Hemostatic Alginate/Nano-Hydroxyapatite Composite Aerogel Loaded with Tranexamic Acid for the Potential Protection against Alveolar Osteitis. Pharmaceutics 2022; 14:pharmaceutics14102255. [PMID: 36297689 PMCID: PMC9608763 DOI: 10.3390/pharmaceutics14102255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2022] Open
Abstract
Wound control in patients on anticoagulants is challenging and often leads to poor hemostasis. They have a higher tendency to develop alveolar osteitis after tooth extraction. The application of a hemostatic dressing that has a high absorbing capacity and is loaded with an antifibrinolytic drug could help in controlling the bleeding. Alginate/nano-hydroxyapatite (SA/Nano-HA) composite aerogels loaded with tranexamic acid (TXA) were prepared. Nano-HA served as a reinforcing material for the alginate matrix and a source of calcium ions that helps in blood clotting. It influenced the porosity and the water uptake capacity. TXA release from SA/Nano-HA aerogels showed a biphasic profile for up to 4 h. Blood coagulation studies were performed on human whole blood. The TXA-loaded aerogel significantly reduced the clotting time by 69% compared to the control (p < 0.0001). Recalcification time was significantly reduced by 80% (p < 0.0001). Scanning electron microscopy analysis revealed the porous nature of the aerogels and the ability of the optimum aerogel to activate and adhere platelets to its porous surface. The cell migration assay showed that there was a delay in wound healing caused by the TXA aerogel compared to the control sample after treating human fibroblasts. Results suggest that the developed aerogel is a promising dressing that will help in hemostasis after tooth extraction.
Collapse
Affiliation(s)
- Mai El Halawany
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Ainy Street, Cairo 11562, Egypt
- Correspondence: ; Tel.: +20-10-0846-3596; Fax: +20-22-362-8246
| | - Randa Latif
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Ainy Street, Cairo 11562, Egypt
| | - Mohamed H. H. AbouGhaly
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Ainy Street, Cairo 11562, Egypt
- Department of Pharmaceutics and Industrial Pharmacy, School of Pharmacy, Newgiza University, Km. 22 Cairo-Alex Road, Giza P.O. Box 12577, Egypt
| |
Collapse
|
17
|
Sadeghi SH, Sharifi S, Dizaj SM, Ghavimi MA, Shahi S, Ghoreishizadeh A, Negahdari R. Antimicrobial agent containing absorbable gelatin sponge to prevent dry socket: A systematic review. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2208111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The use of absorbable gelatin sponges (AGSs) as a hemostatic surgical material resulted in a reduction of dry sockets occurrence. The systemic use of antibiotics and antimicrobial agents can also reduce the infection of extracted teeth, and therefore, it may show pain-relieving effects on the dry socket as well.
Objective:
Given the high prevalence of dry sockets in the extracted teeth, the main objective of this review was a brief overview of AGSs, including antimicrobial agents to prevent dry sockets.
Methods:
The electronic search of the literature was done on the Pubmed and Google Scholar databases with the MESH keywords of Antimicrobials, Gelatin sponge, Gelfoam, Dry socket, Antibiotics, Alveolar osteitis. Only papers published in English were investigated. No limitations were put on the publication date.
Results:
Of the 279 electronic papers, 79 articles were found relevant to the study. All abstracts were reviewed, and only desired articles were selected. The final electronic and manual search led to 15 articles for use in this study. Among these studies, 5 studies were related to AGSs, including antimicrobial agents to prevent dry sockets.
Conclusion:
The reviewed literature showed that the systemic/topical use of antibiotics and antimicrobial agents can reduce infection and, therefore, may show pain-relieving effects on the dry socket. Besides, antimicrobial-loaded AGSs can be helpful in curing or preventing dry sockets. There were a limited number of clinical trials that used antimicrobial loaded AGSs for dry socket. More clinical studies are needed, especially in subgroups of patients with a high risk of infectious conditions, to validate the effectiveness of antimicrobial-loaded AGSs for dry socket.
Collapse
|
18
|
Daly BJ, Sharif MO, Jones K, Worthington HV, Beattie A. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database Syst Rev 2022; 9:CD006968. [PMID: 36156769 PMCID: PMC9511819 DOI: 10.1002/14651858.cd006968.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Alveolar osteitis (dry socket) is a complication of dental extractions more often involving mandibular molar teeth. It is associated with severe pain developing 2 to 3 days postoperatively with or without halitosis, a socket that may be partially or totally devoid of a blood clot, and increased postoperative visits. This is an update of the Cochrane Review first published in 2012. OBJECTIVES: To assess the effects of local interventions used for the prevention and treatment of alveolar osteitis (dry socket) following tooth extraction. SEARCH METHODS An Information Specialist searched four bibliographic databases up to 28 September 2021 and used additional search methods to identify published, unpublished, and ongoing studies. SELECTION CRITERIA We included randomised controlled trials of adults over 18 years of age who were having permanent teeth extracted or who had developed dry socket postextraction. We included studies with any type of local intervention used for the prevention or treatment of dry socket, compared to a different local intervention, placebo or no treatment. We excluded studies reporting on systemic use of antibiotics or the use of surgical techniques because these interventions are evaluated in separate Cochrane Reviews. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We followed Cochrane statistical guidelines and reported dichotomous outcomes as risk ratios (RR) and calculated 95% confidence intervals (CI) using random-effects models. For some of the split-mouth studies with sparse data, it was not possible to calculate RR so we calculated the exact odds ratio (OR) instead. We used GRADE to assess the certainty of the body of evidence. MAIN RESULTS We included 49 trials with 6771 participants; 39 trials (with 6219 participants) investigated prevention of dry socket and 10 studies (with 552 participants) looked at the treatment of dry socket. 16 studies were at high risk of bias, 30 studies at unclear risk of bias, and 3 studies at low risk of bias. Chlorhexidine in the prevention of dry socket When compared to placebo, rinsing with chlorhexidine mouthrinses (0.12% and 0.2% concentrations) both before and 24 hours after extraction(s) substantially reduced the risk of developing dry socket with an OR of 0.38 (95% CI 0.25 to 0.58; P < 0.00001; 6 trials, 1547 participants; moderate-certainty evidence). The prevalence of dry socket varies from 1% to 5% in routine dental extractions to upwards of 30% in surgically extracted third molars. The number of patients needed to be treated (NNT) with chlorhexidine rinse to prevent one patient having dry socket was 162 (95% CI 155 to 240), 33 (95% CI 27 to 49), and 7 (95% CI 5 to 10) for control prevalence of dry socket 0.01, 0.05, and 0.30 respectively. Compared to placebo, placing chlorhexidine gel intrasocket after extractions reduced the odds of developing a dry socket by 58% with an OR of 0.44 (95% CI 0.27 to 0.71; P = 0.0008; 7 trials, 753 participants; moderate-certainty evidence). The NNT with chlorhexidine gel (0.2%) to prevent one patient developing dry socket was 180 (95% CI 137 to 347), 37 (95% CI 28 to 72), and 7 (95% CI 5 to 15) for control prevalence of dry socket of 0.01, 0.05, and 0.30 respectively. Compared to chlorhexidine rinse (0.12%), placing chlorhexidine gel (0.2%) intrasocket after extractions was not superior in reducing the risk of dry socket (RR 0.74, 95% CI 0.46 to 1.20; P = 0.22; 2 trials, 383 participants; low-certainty evidence). The present review found some evidence for the association of minor adverse reactions with use of 0.12%, 0.2% chlorhexidine mouthrinses (alteration in taste, staining of teeth, stomatitis) though most studies were not designed explicitly to detect the presence of hypersensitivity reactions to mouthwash as part of the study protocol. No adverse events were reported in relation to the use of 0.2% chlorhexidine gel placed directly into a socket. Platelet rich plasma in the prevention of dry socket Compared to placebo, placing platelet rich plasma after extractions was not superior in reducing the risk of having a dry socket (RR 0.51, 95% CI 0.19 to 1.33; P = 0.17; 2 studies, 127 participants; very low-certainty evidence). A further 21 intrasocket interventions to prevent dry socket were each evaluated in single studies, and there is insufficient evidence to determine their effects. Zinc oxide eugenol versus Alvogyl in the treatment of dry socket Two studies, with 80 participants, showed that Alvogyl (old formulation) is more effective than zinc oxide eugenol at reducing pain at day 7 (mean difference (MD) -1.40, 95% CI -1.75 to -1.04; P < 0.00001; 2 studies, 80 participants; very low-certainty evidence) A further nine interventions for the treatment of dry socket were evaluated in single studies, providing insufficient evidence to determine their effects. AUTHORS' CONCLUSIONS Tooth extractions are generally undertaken by dentists for a variety of reasons, however, all but five studies included in the present review included participants undergoing extraction of third molars, most of which were undertaken by oral surgeons. There is moderate-certainty evidence that rinsing with chlorhexidine (0.12% and 0.2%) or placing chlorhexidine gel (0.2%) in the sockets of extracted teeth, probably results in a reduction in dry socket. There was insufficient evidence to determine the effects of the other 21 preventative interventions each evaluated in single studies. There was limited evidence of very low certainty that Alvogyl (old formulation) may reduce pain at day 7 in patients with dry socket when compared to zinc oxide eugenol.
Collapse
Affiliation(s)
- Blánaid Jm Daly
- Special Care Dentistry, Division of Child & Public Health, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | | | | | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anna Beattie
- School of Dental Science, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| |
Collapse
|
19
|
Jadun S, Shah A. An overview of assessment and management of acute dental pain. Prim Dent J 2022; 11:126-131. [PMID: 36073039 DOI: 10.1177/20501684221113421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Dental care practitioners are often the first port of call for patients presenting with acute dental pain. Due to the increasing backlog of patients in the UK resulting from the COVID-19 pandemic, it is expected that an increasing number of patients will present to dental care practitioners with acute dental problems. This article aims to provide an overview of common presentations of acute dental pain, the importance of thorough assessment and accurate diagnosis, and the management of such conditions.
Collapse
Affiliation(s)
- Sarah Jadun
- SpR in Oral Surgery, King's College Hospital Dental Institute, London, UK
| | - Aneesha Shah
- Consultant Oral Surgeon, Department of Oral Surgery, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
20
|
de la Puente Dongo JL, Grillo R, Bueno BU, Teixeira RG. Effectiveness of Honey in the Treatment and Prevention of Alveolar Osteitis: Systematic Review and Meta-analysis. J Maxillofac Oral Surg 2022; 21:1007-1014. [PMID: 36274888 PMCID: PMC9474795 DOI: 10.1007/s12663-021-01611-3] [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: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
Abstract
Objectives Honey has been used for millennia as a treatment for covering wounds that are difficult to repair. Hippocrates already reported the benefits of honey with this type of treatment. The objective of this work is to evaluate the literature on the use of honey in cases as preventive as treatment complications after extractions, more specifically alveolar osteitis or alveolitis. Material and Methods A systematic literature review was carried out on PubMed, LILACS and Dimensions platforms, following PRISMA guidelines, to gain more knowledge on the topic. Due to the scarcity of articles on the topic, there are no restrictions regarding languages, publication dates or impact factor journal. Animal studies and reviews were excluded. Risk of bias was assessed through Review Manager Software 5.4. Results With simple, low-cost, and affordable medications, many of the complications after tooth extractions can be resolved more quickly and less painfully for patients with more significant difficulties, whether financial or access, to other treatments. Conclusion Honey is an effective prevention and treatment for alveolar osteitis.
Collapse
|
21
|
Assari AS, Alrafie HS, Al Ghashim AH, Talic FN, Alahmari AM, Al Manea MY, Alrashdan RY. Effectiveness of different socket dressing materials on the postoperative pain following tooth extraction: a randomized control trial. J Med Life 2022; 15:1005-1012. [PMID: 36188642 PMCID: PMC9514811 DOI: 10.25122/jml-2022-0140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
We aimed to prospectively evaluate and compare the effectiveness of Alvogyl and Cutanplast as intra-alveolar dressings for managing pain associated with extraction and incidence of dry socket. All patients who underwent maxillary and mandibular teeth extraction and fulfilled our inclusion and exclusion criteria from Feb 2021 to Oct 2021 were included in our study. Patients who were diagnosed with postoperative pain after tooth extraction were randomly allocated to three groups: Group A (Alvogyl), Group B (Cutanplast), and Group C (placebo). Pain relief and healing of the socket were compared between these groups. The collected data were analyzed using the Chi-square test and Z test of proportionality. Alvogyl was superior to the other medication for providing initial pain relief, and the incidence of dry socket was significantly lower than in the Cutanplast and placebo groups (p<0.05). However, wound healing was statistically non-significant among groups A, B, and C (p>0.05). Alvogyl is still the material of choice in terms of pain relief, wound healing, and low incidence of dry socket. Furthermore, no statistically significant difference was detected between the groups in the biographic information, location, and condition of the extracted tooth, presence of a radiologic pathology, or type of extraction procedure. Moreover, whether it is the first extraction or not, Alvogyl and Cutanpast are comparable in postoperative pain management as intra-alveolar dressing materials.
Collapse
Affiliation(s)
- Ahmad Salem Assari
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Riyadh Elm University, Riyadh, Saudi Arabia,Corresponding Author: Ahmad Salem Assari, Oral and Maxillofacial Surgery and Diagnostic Sciences, Riyadh Elm University, Saudi Arabia, Riyadh, Saudi Arabia. E-mail:
| | - Hamad Saud Alrafie
- Riyadh Third Health Cluster, Saudi Ministry of Health, Riyadh, Riyadh, Saudi Arabia,Riyadh Elm University, Riyadh, Saudi Arabia
| | | | | | | | | | | |
Collapse
|
22
|
Jadhav AN, Shushma G, Deshmukh VD. Efficacy of tranexamic acid in prevention of alveolar osteitis following surgical removal of impacted mandibular third molar. Natl J Maxillofac Surg 2022; 13:S85-S90. [PMID: 36393943 PMCID: PMC9651232 DOI: 10.4103/njms.njms_298_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 06/16/2023] Open
Abstract
CONTEXT Many preventive measures are described to avoid alveolar osteitis (AO) during third molar surgery (TMS), but very few are found to be effective. Tranexamic acid (TA), an antifibrinolytic agent, impedes the proteolytic degradation of fibrin and prevents blood clot disintegration. AIMS The study was conducted to determine the efficacy of intra-alveolar application of TA soaked in Gelfoam in prevention of AO. SETTINGS AND DESIGN This was a randomized control trial. MATERIALS AND METHODS A total of 200 patients (100 in control group and 100 in study group) reporting for TMS were allocated randomly. Following surgery, TA soaked in gel foam was placed in socket and sutured in the study group, while in the control group, closure was done by suturing. Patients followed subsequently to observe the incidence of AO, pain severity, and duration of healing after AO. STATISTICAL ANALYSIS Z-test, Mann-Whitney test, and t-test were applied, respectively, to compare the incidence of AO, severity of pain, and duration of healing between the two groups. RESULTS The incidence of AO in the control group was 18% and 6% in the study group. Patients in the control group experienced severe pain as compared to patients in the study group. The duration of healing varied from 12 to 16 days in the control group, but in the study group, it was <10 days. CONCLUSION TA significantly reduces the incidence of AO in addition to the reduced severity of pain and enhanced healing. We recommend the routine use of TA, owing to its astonishing rewards.
Collapse
Affiliation(s)
- Ajinath Nanasaheb Jadhav
- Department of Dentistry, JIIU'S Indian Institute of Medical Sciences and Research, Jalna, Maharashtra, India
| | - G. Shushma
- Department of Dentistry, Koppal Institute of Medical Sciences, Koppal, Bhagyanagar, Karnataka, India
| | - Vijay Dnyandev Deshmukh
- Department of Dentistry, JIIU'S Indian Institute of Medical Sciences and Research, Jalna, Maharashtra, India
| |
Collapse
|
23
|
Al-Shamiri HM, Al-Maweri SA, AlAhmary AW, Aljunayh MS, Aldosari AO, Alqahtani NM, Alabdulaziz JI, Al-Sharani HM. EFFICACY OF LASER THERAPY FOR ALVEOLAR OSTEITIS: A SYSTEMATIC REVIEW OF THE AVAILABLE EVIDENCE. J Evid Based Dent Pract 2022; 22:101711. [DOI: 10.1016/j.jebdp.2022.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
|
24
|
Divine KA. Multilocular Myospherulosis of the Mandible: A Case Report. J Endod 2022; 48:961-964. [PMID: 35421406 DOI: 10.1016/j.joen.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022]
Abstract
Myospherulosis in the jaw is a rare, foreign body reaction that typically follows tooth extraction and the use of petrolatum-based medicaments. It appears as a radiolucency and can be mistaken for endodontic pathosis or other lesions without thorough clinical and radiographic evaluation as well as biopsy submission. Treatment is surgical removal and the recurrence is rare. This case report presents a unique finding of a posterior mandible multilocular radiolucency appearing as an apical lesion on two-dimensional panoramic imaging until visualized with three-dimensional imaging. Clinical testing and patient referral led to a biopsy and diagnosis of myospherulosis. This is the first case report of myospherulosis presented in the endodontic literature.
Collapse
|
25
|
Pain Relief and Antimicrobial Activity in Alveolar Osteitis after Platelet-Rich Fibrin Application—A Non-Randomized Controlled Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The objective was to compare pain relief in alveolar osteitis achieved by the application of platelet-rich fibrin (PRF) and aspirin cones, and to assess the influence of both treatments on bacterial concentrations in post-extraction wounds. A split-mouth, single-center, non-randomized controlled trial was conducted in 30 patients. Pain relief was assessed using the visual analog scale at three time points (before, 24 h after, and 48 h after intervention). Bacterial concentrations were evaluated from cultures of swab samples collected at the three time points. A Wilcoxon matched-pairs signed-rank test was performed to detect differences in distributions of scalar variables between treatment with PRF and aspirin cones. Pain relief at 24 h and 48 h after treatment was significantly higher (p = 0.003) with PRF application than with aspirin cone placement. Additionally, PRF application caused a significantly higher reduction in aerobic bacteria concentration, an average increase, instead of a decrease, in lactic acid bacilli concentration in the first 24 h, and a significantly greater increase in streptococci concentration at 48 h follow-up. PRF provides better pain relief than aspirin cones in alveolar osteitis. Bacterial concentrations in the extraction wounds are consistent with the pain relief achieved after PRF or aspirin application.
Collapse
|
26
|
Khan ZA, Prabhu N, Ahmed N, Lal A, Issrani R, Maqsood A, Vohra F, Alam MK. A Comparative Study on Alvogyl and a Mixture of Black Seed Oil and Powder for Alveolar Osteitis: A Randomized Double-Blind Controlled Clinical Trial. Int J Clin Pract 2022; 2022:7756226. [PMID: 35685605 PMCID: PMC9159183 DOI: 10.1155/2022/7756226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Alveolar osteitis (AO) is the most common complication faced by exodontia patients and is usually seen 24-74 hours after tooth extraction, heralded by severe throbbing pain. Nigella sativa is commonly known as black seed known to have anti-inflammatory and antibacterial properties along with other reparative properties that enhance bone formation. This study aimed to evaluate and compare the effects of Alvogyl and a mixture of Nigella sativa powder and oil in the treatment of dry sockets. MATERIALS AND METHODS Sixty patients above the age of 18 and below 70 years, from both genders, who underwent extraction of teeth and were clinically diagnosed with a dry socket at the clinic of the College of Dentistry, Jouf University, Saudi Arabia, were included in this study. Pain scores were assessed after placement of the dressing at the following intervals: 5 minutes, 30 minutes, 60 minutes, 2nd day, 4th day, and 7th day. Patients were randomly allocated to three groups, namely, Group 1 (Alvogyl), Group 2 (mixture of Nigella sativa's powder and oil), and Group 3 (control). Pain relief and healing of the socket were compared between the three groups. The collected data were subjected to statistical analysis through Spearman's correlation test, independent t-test, ANOVA, and post hoc test. RESULTS A mixture of Nigella sativa powder and oil showed a statistically significant difference in relieving pain compared to the Alvogyl group. A mixture of Nigella sativa's powder and oil required fewer dressings when compared to the Alvogyl group. CONCLUSION A mixture of Nigella sativa powder and oil is the more efficacious dressing material for the management of dry sockets compared to Alvogyl. It provides immediate and complete pain relief and fewer numbers of repeated visits.
Collapse
Affiliation(s)
- Zafar Ali Khan
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Namdeo Prabhu
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi 75500, Pakistan
- Prosthodontics Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Abhishek Lal
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi 75500, Pakistan
| | - Rakhi Issrani
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al Jouf 72345, Saudi Arabia
| | - Afsheen Maqsood
- Department of Oral Pathology, Bahria University Dental College, Karachi 75530, Pakistan
| | - Fahim Vohra
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Khursheed Alam
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al Jouf 72345, Saudi Arabia
- Center for Transdisciplinary Research (CFTR), Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
| |
Collapse
|
27
|
Garola F, Gilligan G, Panico R, Leonardi N, Piemonte E. Clinical management of alveolar osteitis. A systematic review. Med Oral Patol Oral Cir Bucal 2021; 26:e691-e702. [PMID: 34704976 PMCID: PMC8601644 DOI: 10.4317/medoral.24256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/27/2021] [Indexed: 11/06/2022] Open
Abstract
Background Alveolar Osteitis (AO) is one of the most common complications of tooth extraction. Several therapeutic interventions have been described for the treatment of AO, however, there are no treatment standardized protocols. The aim of this study was to conduct a systematic review on the efficacy in pain control of the different treatments for AO. The feasibility of the application of these interventions is also discussed. Material and Methods A structured electronic and hand search strategy was applied to PubMed, Scopus, Cochrane Library, OpenGrey, and Google Scholar between January 2010 and July 2020 to identify studies according to PRISMA guidelines. The inclusion criteria were original English and Spanish clinical trials that analyzed pain-control parameters according to visual analog scale (VAS, 0-10 scale), or pain relief patients’ percentages. Those treatments that reach VAS ≤ 4 on day 2 or before; or ≥ 85% of patients with absence of pain symptoms at day 7 or before were considered accepTable for their recommendation. Results The final review included 17 clinical trials. Among them, there were analyzed a total of 39 different AO treatments. 53,8% of the treatments fulfill the proposed parameters for pain control. Conclusions Treatment alternatives are multiple, heterogeneous, and difficult to compare. The management of AO is summarized in basic (intra-alveolar irrigation) and specific procedures (Alveogyl®, Neocones®, SaliCept Patch®, Low-Level Laser, Platelet-Rich Fibrin) that reach pain control success. They could be selected according to their availability and advantages or disadvantages. Key words:Dry socket, alveolar osteitis, treatment, management, pain control, pain relief.
Collapse
Affiliation(s)
- F Garola
- Haya de la Torre SN PA: 5000. Ciudad Universitaria Córdoba, Argentina
| | | | | | | | | |
Collapse
|
28
|
Assessment of the Effect of A-PRF Application during the Surgical Extraction of Third Molars on Healing and the Concentration of C-Reactive Protein. Pharmaceutics 2021; 13:pharmaceutics13091471. [PMID: 34575547 PMCID: PMC8469162 DOI: 10.3390/pharmaceutics13091471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Extraction procedures for mandibular third molars are performed all over the world every day. Local inflammation resulting from surgery, and the pain that patients experience, often make it impossible to take up daily life activities, such as work or sports. Growth and anti-inflammatory factors, located in the fibrin network, have a positive effect on tissue-healing processes and should also reduce local inflammation. Advanced platelet-rich fibrin (A-PRF) applied locally influences such processes as: angiogenesis, osteogenesis and collagenogenesis. It also affects mesenchymal cell lines and anti- and pro-inflammatory mediators. Due to the autologous origin of the material, their use in guide bone regeneration (GBR) is more and more widespread in dentistry. The results of previous studies indicate that the use of A-PRF in the treatment area significantly reduces postoperative pain, while the formation of edema is not affected. C-reactive protein (CRP), which is an acute phase protein, appears in the blood as a consequence of inflammation. Due to the dynamics of changes in concentration of CRP, it is a protein that is sufficiently sensitive and is used in studies to monitor the tissue healing process. The effect of A-PRF application on CRP concentrations, before and after surgery, has not been investigated yet. The study was conducted on 60 generally healthy patients. A faster decrease of CRP levels was shown in patients who used A-PRF after the procedure. Additionally, it accelerated healing and reduced the occurrence of a dry socket close to 0.
Collapse
|
29
|
Reeshma S, Dain CP. Comparison of platelet-rich fibrin with zinc oxide eugenol in the relief of pain in alveolar osteitis. Health Sci Rep 2021; 4:e354. [PMID: 34401528 PMCID: PMC8358232 DOI: 10.1002/hsr2.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND AIMS Alveolar osteitis (AO) is the most common painful post-operative complication after tooth extraction. The common modalities used in the management of AO are lavage, placement of medicated dressings, analgesics, and antibiotics. The present study was undertaken to compare platelet-rich fibrin (PRF) and zinc oxide eugenol (ZOE) for pain relief in AO. METHODS All cases meeting the eligibility criteria received two different treatment modalities over a span of 18 months. At the analysis stage, the final sample size comprised 70 patients, with 35 patients appropriated in each group. Group A patients received ZOE and Group B received PRF. Pain scores were measured on "1st, 3rd, 5th, and 7th" days based on a visual analogue scale (VAS) and compared in both groups of patients. The collected data were analyzed using the chi-square test, t test, and Mann-Whitney U test. RESULTS In patients treated with ZOE dressing, the average VAS scores observed were 7.4 ± 1.5, 5.1 ± 1.1, 3.4 ± 0.9, and 2.1 ± 0.7, respectively, on the "1st, 3rd, 5th, and 7th" follow-up days. In patients treated with PRF, the average VAS score observed were 4.1 ± 1.2, 2.6 ± 0.9, 1.7 ± 0.9, and 0.8 ± 0.8 respectively. CONCLUSION Both ZOE and PRF were effective in pain control during the follow-up period. However, the pain intensity measured as a pain score using VAS was, lower in the PRF group than in the ZOE group on all follow-up days.
Collapse
Affiliation(s)
- Satheesh Reeshma
- Department of Oral and Maxillofacial SurgeryGovernment Dental CollegeTrivandrumIndia
| | - Chacko Pearl Dain
- Department of Oral and Maxillofacial SurgeryGovernment Dental CollegeTrivandrumIndia
| |
Collapse
|
30
|
Alenazi A, Aleidan A, Alotheem M, Alqahtani R. Knowledge and Awareness of Postextraction Complications among Dental Seniors and Interns in Riyadh Province. J Pharm Bioallied Sci 2021; 13:S602-S607. [PMID: 34447162 PMCID: PMC8375916 DOI: 10.4103/jpbs.jpbs_721_20] [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: 11/01/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 11/04/2022] Open
Abstract
Background Postextraction complications are multifactorial. Taking proper medical and dental history, thorough planning, and a skillful dentist can help the prediction and reduction of these complications. Objective This study aims to assess and compare the knowledge of senior students and interns regarding postextraction complications in government and private colleges in Riyadh Province. Materials and Methods A random sampling technique was used to select a minimum of 250 participants for this study. A self-designed, close-ended questionnaire was disseminated through an online platform in a manner. Sixth-year (senior) dental students and interns were included in the study. Data were coded and entered into spreadsheet software and analyzed using Chi-square tests. Results More than half were dental interns (54.04%), and the rest were senior students (45.96%). Male participants comprised 52.57% of the total participants, whereas females were 47.43%. Most participants were from government colleges (53.31%), whereas 46.69% belonged to private colleges. Male interns from government colleges demonstrated the best knowledge among all the participants. In private colleges, females demonstrated better knowledge than males in both the senior and intern groups, and the difference was statistically significant. The difference in knowledge between participants from government and private colleges was found to be statistically significant (P = 0.001). Government colleges were found to demonstrate more complications than private colleges, and the difference was statistically significant (P = 0.003). Conclusion Male interns from government colleges had the best knowledge about the postextraction complications among the candidates.
Collapse
Affiliation(s)
- Adel Alenazi
- Department of Oral and Maxillofacial Surgery, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Mohammed Alotheem
- Dental Intern, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Rakan Alqahtani
- Dental Intern, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| |
Collapse
|
31
|
Initial Observation of Factors Interfering with the Treatment of Alveolar Osteitis Using Hyaluronic Acid with Octenidine-A Series of Case Reports. Biomolecules 2021; 11:biom11081157. [PMID: 34439823 PMCID: PMC8391686 DOI: 10.3390/biom11081157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 12/15/2022] Open
Abstract
Alveolar osteitis (AO) is a common complication following the extraction of the teeth, particularly the lower third molars. It starts within a few days after the extraction and manifests mainly as pain in the extraction site. Several strategies of treatment are available in order to relieve pain and heal the extraction wound. Recently, a novel medical device combining hyaluronic acid (HA) and octenidine (OCT) was introduced for the treatment of AO. This series of case reports aims to summarize the initial clinical experiences with this new device and to highlight factors possibly interfering with this treatment. The medical documentation of five patients with similar initial situations treated for AO with HA + OCT device was analyzed in detail. Smoking and previous treatment with Alveogyl (Septodont, Saint-Maur-des-Fossés, France) were identified as factors interfering with the AO treatment with the HA + OCT device. In three patients without these risk factors, the treatment led to recovery within two or three days. The patient pretreated with Alveogyl and the smoker required six and seven applications of the HA + OCT device, respectively. According to these initial observations, it seems smoking and previous treatment with Alveogyl prolong the treatment of AO using the HA + OCT device that, in turn, shows a rapid effect if these risk factors are not present.
Collapse
|
32
|
Otake H, Sato Y, Nakatani E, Hawke P, Takei S, Ogino A, Asai H, Abe A, Fukuta K, Adachi M. Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study. PLoS One 2021; 16:e0254221. [PMID: 34214141 PMCID: PMC8253388 DOI: 10.1371/journal.pone.0254221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. Methods This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). Results The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. Conclusions and clinical relevance Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.
Collapse
Affiliation(s)
- Hiroki Otake
- Department of Oral and Maxillofacial Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yoko Sato
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Eiji Nakatani
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Philip Hawke
- School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Shingo Takei
- Department of Oral and Maxillofacial Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Akihiko Ogino
- Department of Oral and Maxillofacial Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Hideaki Asai
- Department of Oral and Maxillofacial Surgery, Holy Spirit Hospital, Nagoya, Japan
| | - Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Kohta Fukuta
- Department of Oral and Maxillofacial Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Moriyasu Adachi
- Department of Oral and Maxillofacial Surgery, Shizuoka General Hospital, Shizuoka, Japan
- * E-mail:
| |
Collapse
|
33
|
Selvido DI, Bhattarai BP, Rokaya D, Niyomtham N, Wongsirichat N. Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management. Eur J Dent 2021; 15:588-598. [PMID: 34041732 PMCID: PMC8382502 DOI: 10.1055/s-0041-1725212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.
Collapse
Affiliation(s)
- Diane Isabel Selvido
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Dinesh Rokaya
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Nattisa Niyomtham
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| |
Collapse
|
34
|
Patil V, Ramaraj P, Sharma M, Singh R, George A, Roy B. Effects of intraoperative placement of tetracycline, tetracycline + gelatin sponge, and placebo on postoperative pain after mandibular molar extraction: A comparative prospective study. Natl J Maxillofac Surg 2021; 12:211-218. [PMID: 34483579 PMCID: PMC8386275 DOI: 10.4103/njms.njms_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/25/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Painless postoperative period is a major requisite following routine dental extractions. Reduction in the postextraction complication is beneficial to both clinician and patients. Hence, emphasis should be given to the techniques and agents that help reduce the complications for better postoperative recovery. MATERIALS AND METHODS Three groups of 30 patients each requiring mandibular molar extractions were randomly selected with intrasocket placement of tetracycline, tetracycline plus gelatin sponge, and placebo control after extraction. A small piece of collagen membrane was used on the superior surface of the socket after the placement of the medicament in Group A and Group B. The postoperative pain scores were evaluated at 24 h, 48 h, and 7 days postoperatively. RESULTS Ninety patients requiring mandibular molar teeth extraction were enrolled as the study participants. Forty-two patients (55.26%) were male and 34 (44.73%) were female. Tetracycline alone and tetracycline + gelatin sponge group shows no statistical significant difference in reducing postoperative pain after 7 days, but the pain score values were less in Tetracycline + gelatin sponge group. The comparison between tetracycline alone and control group showed no significant difference observed between the groups at 24 h but showed statistically significant difference between the groups after 48 h and 7 days, whereas comparison between tetracycline + gelatin sponge and control group showed statistically significant difference between the groups after 24 h, 48 h, and 7 days (P = 0.009, 0.001, and 0.017, respectively). CONCLUSION Tetracycline and gelatin sponge intrasocket placement provides a good substitute to the prolong use of analgesics and as a good adjuvant in reducing pain in the first few days after routine dental extraction.
Collapse
Affiliation(s)
- Vinay Patil
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Center, Nanded, Maharashtra, India
| | - P.N. Ramaraj
- Department of Oral Surgery, KVG Dental College, Sullia, India
| | - Mandeep Sharma
- Department of Dentistry, Government Medical College, Kathua, Jammu and Kashmir, India,Address for correspondence: Dr. Mandeep Sharma, Senior Resident, Department of Dentistry, GMC Kathua, Kathua, Jammu and Kashmir, India, House No. 29 Sector 5, Upper Roop Nagar, Jammu, Jammu and Kashmir - 180 013, India. E-mail:
| | - Rohit Singh
- Niharika Dental, Oral and Maxillofacial Surgery Clinic and Implant Centre, Surat, Gujarat, India
| | - Abhijith George
- Department of Head and Neck Surgical Oncology, HCG, Bengaluru, Karnataka, India
| | - Bhaskar Roy
- GSR Hospital and Craniofacial Research Center, Hyderabad, Telangana, India
| |
Collapse
|
35
|
Guida A, Perri F, Ionna F, Ascierto PA, Grimaldi AM. New-generation anticancer drugs and medication-related osteonecrosis of the jaw (MRONJ): Late onset 3 years after ipilimumab endovenous administration with a possible role of target therapy. Clin Case Rep 2021; 9:61-66. [PMID: 33489133 PMCID: PMC7813008 DOI: 10.1002/ccr3.3418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 12/24/2022] Open
Abstract
Association of immunotherapy and/or chemotherapy and/or targeted therapy, in sequence or as single therapies, may induce osteonecrosis of the jaw. Multidisciplinary team management of these patients should be provided.
Collapse
Affiliation(s)
- Agostino Guida
- Maxillo‐facial and ENT Surgery UnitINT – IRCCS “Fondazione G. Pascale”NaplesItaly
| | - Francesco Perri
- Head & Neck/Thyroid Medical Oncology UnitINT – IRCCS “Fondazione G. Pascale”NaplesItaly
| | - Franco Ionna
- Maxillo‐facial and ENT Surgery UnitINT – IRCCS “Fondazione G. Pascale”NaplesItaly
| | - Paolo A. Ascierto
- Melanoma, Oncological Immunotherapy and Innovative Therapies DepartmentINT – IRCCS “Fondazione G. Pascale”NaplesItaly
| | - Antonio M. Grimaldi
- Melanoma, Oncological Immunotherapy and Innovative Therapies DepartmentINT – IRCCS “Fondazione G. Pascale”NaplesItaly
| |
Collapse
|
36
|
Keshini MP, Shetty SK, Sundar S, Chandan SN, Manjula S. Assessment of Healing Using Alvogyl and Platelet Rich Fibrin in Patients with Dry Socket - An Evaluative Study. Ann Maxillofac Surg 2020; 10:320-324. [PMID: 33708574 PMCID: PMC7944002 DOI: 10.4103/ams.ams_259_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/02/2019] [Accepted: 04/04/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction: Dry socket is one of the most common postoperative complications following the extraction of permanent teeth, which is characterized by pain and exposed bone. The usual protocol followed for its management is irrigation of the socket and packing of the socket with medicated gel or paste to provide relatively faster pain relief and allow normal wound healing. In this study, we evaluated the outcome of management of dry socket with platelet-rich fibrin (PRF) and intraalveolar alvogyl dressing, in terms of improvement in pain and socket epithelialization after the treatment. Methodology: Thirty participants with established dry socket were randomly divided into two groups: Group A and Group B. The participants in Group A were treated with alvogyl and those in Group B were treated with PRF. Clinical parameters were assessed for both groups on the 1st day of the procedure and on the 3rd and 10th-day postoperatively for the reduction in pain and wound healing. Results: There was a significant decrease in pain and the number of socket wall exposure in both the groups by the 3rd postoperative day. In both the groups, the pain had completely resolved and socket fully epithelialized by the 10th postoperative day. Discussion: The use of PRF in the present study yielded promising results in terms of both pain reduction and improved wound healing which was comparable to the conventional alvogyl dressing. It may be concluded that PRF is an effective modality for the management of dry socket.
Collapse
Affiliation(s)
- M P Keshini
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Sahith Kumar Shetty
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Shyam Sundar
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - S N Chandan
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - S Manjula
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| |
Collapse
|
37
|
Abstract
This article explores how to prevent and manage complications of dentoalveolar surgery. Many complications are avoidable. Surgical skills and knowledge of anatomy play an important role in prevention of complications. Prevention starts with detailed history and physical examination of the patient. Key to perioperative management of patients is risk assessment. Without a proper history and physical examination, the clinician is unable to assess the risk of performing surgery and anesthesia for each patient. Some illnesses and medications increase the risk of complications. The following complications are discussed: alveolar osteitis, displacement, fracture, hemorrhage, infection, nonhealing wound, oroantral communication, swelling, and trismus.
Collapse
Affiliation(s)
- Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, 1919 7th Avenue South, SDB 419, Birmingham, AL 35294, USA.
| |
Collapse
|
38
|
Pergolizzi JV, Magnusson P, LeQuang JA, Gharibo C, Varrassi G. The pharmacological management of dental pain. Expert Opin Pharmacother 2020; 21:591-601. [PMID: 32027199 DOI: 10.1080/14656566.2020.1718651] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Dental pain is primarily treated by dentists and emergency medicine clinicians and may occur because of insult to the tooth or oral surgery. The dental impaction pain model (DIPM) has been widely used in clinical studies of analgesic agents and is generalizable to many other forms of pain.Areas Covered: The authors discuss the DIPM, which has allowed for important head-to-head studies of analgesic agents, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations. Postsurgical dental pain follows a predictable trajectory over the course of one to 3 days. Dental pain may have odontic origin or may be referred pain from other areas of the body.Expert opinion: Pain following oral surgery has sometimes been treated with longer-than-necessary courses of opioid therapy. Postsurgical dental pain may be moderate to severe but typically resolves in a day or two after the extraction. Opioid monotherapy, rarely used in dentistry but combination therapy (opioid plus acetaminophen or an NSAID), was sometimes used as well as nonopioid analgesic monotherapy. The dental impaction pain model has been valuable in the study of analgesics but does not address all painful conditions, for example, pain with a neuropathic component.
Collapse
Affiliation(s)
| | - Peter Magnusson
- Centre for Research and Development, Uppsala/Region, Sweden.,Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | | | - Christopher Gharibo
- Anesthesiology, Pain Medicine, and Orthopedics, New York University Langone Health, New York, NY, USA
| | - Giustino Varrassi
- Paolo Procacci Foundation, Roma, Italy.,World Institute of Pain, Winston-Salem, NC, USA
| |
Collapse
|
39
|
Çebi AT. Evaluation of the effects of intra-alveolar irrigation with clindamycin, rifampicin and sterile saline in alveolar osteitis treatment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:680-683. [PMID: 31991214 DOI: 10.1016/j.jormas.2020.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND To evaluate the efficacy of intra-alveolar irrigation made with clindamycin, rifampicin and sterile saline on pain and alveolar mucosa healing in the treatment of alveolar osteitis (dry socket). METHODS Fifty-four patients diagnosed with alveolar osteitis were divided into three groups for the treatment protocol. Sterile saline was used in Group A, rifampicin was used in Group B and clindamycin was used in Group C for intra-alveolar irrigation. In the groups, the patients were evaluated for their pain levels and alveolar mucosa healing. RESULTS The incidence of alveolar osteitis was significantly higher in females and mandibles at a statistically significant. In the group that used clindamycin for intra-alveolar irrigation, the pain level was found lower than the two other groups. Clindamycin and rifampicin groups were superior to the sterile saline group in clinical alveolar mucosa healing. CONCLUSION Irrigation with clindamycin appears to reduce the pain associated with alveolar osteitis when compared to rifampicin and sterile saline. In the treatment of alveolar osteitis, irrigation with antibiotics following curettage was found effective for pain relief and alveolar mucosa healing.
Collapse
Affiliation(s)
- A T Çebi
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Karabuk University, Karabuk, Turkey.
| |
Collapse
|
40
|
Abstract
Complex oral surgery procedures are occurring more commonly in primary care, performed by both specialist oral surgeons and non-specialists/tier 2 providers. Practitioners in the UK are working in an increasingly litigious environment which is often at the forefront of a practitioner's mind and prevention of complaints and claims of negligence is vital in maintaining confidence in our practise. In this ever-increasing litigious environment practitioners need to be aware of the risks associated with oral surgery procedures and have to be able to assess and treatment plan patients effectively and safely. Consent is critical to all procedures, and the recent Montgomery case reinforces the importance of this process which must be individual to each patient. It is vital that as practitioners we are aware of our scope of practice and are able to fully inform patients of the risks and benefits of treatment. Practitioners must know their limits and when to refer on to secondary care. This paper discusses the essentials of risk management in oral surgery and describes key stages in the management of patients undergoing an oral surgery procedure. Initial assessment of the patient, which includes medical and dental history will be discussed followed by investigations to support the clinical diagnosis. Once diagnosis has been confirmed, the process of obtaining consent and the legal implications of this are discussed. Finally, a discussion on the appropriate evidence-based management of common complications which may arise when performing oral surgery will complete the paper.
Collapse
Affiliation(s)
- Richard Moore
- Lecturer & Specialist in Oral Surgery, The University of Leeds, UK.
| | - Rachel Miller
- Senior Dental Officer (Special Care Dentistry), Northern Lincolnshire & Goole NHS Foundation Trust, UK
| | | |
Collapse
|
41
|
Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 78:515-527. [PMID: 31883443 DOI: 10.1016/j.joms.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of the present systematic review was to compare the postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery. MATERIALS AND METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from the inception date to November 2018. Randomized and nonrandomized controlled trials were included if they had met certain inclusion and exclusion criteria. The predictor variable was the flap design, envelope or triangular. The outcome variables were operation time, pain, trismus, alveolar osteitis (AO) incidence, wound dehiscence, and swelling. The methodologic quality assessment was performed in accordance with the Cochrane Collaboration guidelines. The meta-analysis was performed using Review Manager, version 5.2. RESULTS A total of 21 studies were included for qualitative synthesis, 18 of which were included in the meta-analysis. The use of envelope flaps required less operation time than triangular flaps (P < .00001; I2 = 9%). In the Pell and Gregory A and B subgroups, envelope flaps were associated with a significantly lower visual analog scale score at 3 (P = .05, I2 = 0%) and 7 (P = .02; I2 = 0%) postoperative days and with a greater postoperative interincisal distance at 7 postoperative days (P = .04; I2 = 0%). In contrast, envelope flaps were associated with a greater AO incidence in the subgroup of split-mouth randomized controlled trials (P = .001; I2 = 0%). CONCLUSIONS Envelope flaps required a shorter operation time than triangular flaps and were associated with less postoperative pain and trismus when applied to impacted mandibular third molars of Pell and Gregory Class A or B. In contrast, triangular flaps were associated with a decreased incidence of AO compared with envelope flaps.
Collapse
|
42
|
Abu-Mostafa N, Al-Daghamin S, Al-Anazi A, Al-Jumaah N, Alnesafi A. The influence of intra-alveolar application of honey versus Chlorhexidine rinse on the incidence of Alveolar Osteitis following molar teeth extraction. A randomized clinical parallel trial. J Clin Exp Dent 2019; 11:e871-e876. [PMID: 31636855 PMCID: PMC6797456 DOI: 10.4317/jced.55743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/09/2019] [Indexed: 11/05/2022] Open
Abstract
Background Alveolar Osteitis (AO) is a complication occurs on the post-extraction days that includes pain and disintegrated blood clot. Chlorhexidine (CHX) rinse after extraction is an effective method for decreasing the incidence of AO. Honey has natural antibacterial properties and effectiveness when it is used as a dressing on burns and wounds. However, the effect of intraoral honey dressings on healing is still not adequately studied. This study aimed to compare pain and AO after extraction of a molar tooth in a group of patients who received the intra-alveolar application of Manuka Honey post-operatively with another group who used 0.2% CHX rinse. Material and Methods A randomized clinical trial of parallel groups was carried out on 100 patients who had a single molar tooth extraction. They were randomly divided into two groups. Group1 (G1) used 0.2 % CHX twice daily for 7 days. In Group2 (G2), Manuka Honey applied topically by a cotton swab into the socket directly after extraction and on Day3. Re-evaluation, including pain assessment, empty socket, and halitosis was done on day 3 and day 7. Results G1 included 43 patients and G2 included 57 patients. Higher grades of pain, more empty sockets, and halitosis were found in G2 than in G1 on day3 and day7 without significant differences. Four cases of AO were found in G1 (9.3%) and 7 cases in G2 (12.3%), without significant difference between the two groups according to Chi-squared tests (p=0.753). Conclusions The application of Manuka honey in the extraction socket directly after extraction and on day 3 has been found to be insignificantly less efficient in the prevention of AO than CHX rinse twice daily for seven days. However, honey is promising as natural dressing material and further studies are recommended. Key words:Manuka honey, Chlorhexidine, Alveolar Osteitis, extraction, dry socket.
Collapse
Affiliation(s)
- Nedal Abu-Mostafa
- Assistant Professor in Oral and Maxillofacial Surgery and Diagnostic Science Department, Riyadh Elm University, Kingdom of Saudi Arabia
| | | | - Asma Al-Anazi
- Dental Interns, Riyadh Elm University, Kingdom of Saudi Arabia
| | | | - Amenah Alnesafi
- Dental Interns, Riyadh Elm University, Kingdom of Saudi Arabia
| |
Collapse
|
43
|
Suchánek J, Ivančaková RK, Mottl R, Browne KZ, Pilneyová KC, Pilbauerová N, Schmidt J, Suchánková Kleplová T. Hyaluronic Acid-Based Medical Device for Treatment of Alveolar Osteitis-Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193698. [PMID: 31581430 PMCID: PMC6801692 DOI: 10.3390/ijerph16193698] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022]
Abstract
Alveolar Osteitis (AO) is a complication following the extraction of a tooth. AO manifests through localized pain in, and around, the extraction site, where the post-operative blood clot has been disintegrated. The aim of this single cohort study was to evaluate the outcome of a treatment of AO, using a pharmacological device composed of hyaluronic acid and octenidine dihydrochloride. The tested device is a sponge-like material, composed solely of a fully dissoluble medicaments (hyaluronic acid, calcium chloride, and octenidine dihydrochloride). It was designed to serve as a non-toxic, slow-dissolving antiseptic, that adheres to mucosa and obturates the wound. This study includes 58 subjects who were diagnosed with AO. The tested device was administered once daily until local pain subsided to < 20 mm of the Visual Analog Scale (VAS). The treatment was considered effective when the pain subsided to < 20 mm VAS in < 8 days of treatment; as per comparative studies. Our findings provide a statistically significant success rate of 96.0% (95.0% confidence interval of 75.75% to 97.8%) after pharmacological device administrations. No adverse medical effects were detected. Acquired data confirmed that lyophilized hyaluronic acid, combined with octenidine, is effective for the treatment of AO. The results are clinically important as AO is a common complication after third molar extractions.
Collapse
Affiliation(s)
- Jakub Suchánek
- Department of Dentistry, Charles University - Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
- Department of Histology and Embryology, Charles University - Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03 Hradec Králové, Czech Republic
| | - Romana Koberová Ivančaková
- Department of Dentistry, Charles University - Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic.
| | - Radovan Mottl
- Department of Dentistry, Charles University - Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Klára Zoe Browne
- Department of Histology and Embryology, Charles University - Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03 Hradec Králové, Czech Republic
| | - Kristýna Charlotte Pilneyová
- Department of Dentistry, Charles University - Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Nela Pilbauerová
- Department of Dentistry, Charles University - Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Jan Schmidt
- Department of Dentistry, Charles University - Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Tereza Suchánková Kleplová
- Department of Dentistry, Charles University - Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| |
Collapse
|
44
|
Comparative Analysis of Blood Clot, Plasma Rich in Growth Factors and Platelet-Rich Fibrin Resistance to Bacteria-Induced Fibrinolysis. Microorganisms 2019; 7:microorganisms7090328. [PMID: 31500263 PMCID: PMC6780161 DOI: 10.3390/microorganisms7090328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/22/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022] Open
Abstract
Alveolar osteitis (AO) is a common, painful postoperative complication after tooth extraction. Fibrinolytic activity in the extraction socket is one etiological factor. Platelet concentrates are used to prevent and treat AO. The aim of this study was to find out whether the positive effect of platelet concentrates can be related to resistance to bacteria-induced fibrinolysis. Blood from 45 human volunteers was used to prepare four media: blood clot medium as control group; PRF and PRGF first fraction (PRGF I) and PRGF second fraction (PRGF II) as study groups. Additionally, collected blood was used for blood plasma preparation on which evaluation of initial value of d-dimer concentration was performed. A solution of five different microbes (Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumonia, Bacillus cereus, and Candida albicans) was adjusted to 0.5 McFarland (1 × 108 CFU/mL) and then diluted to 0.25 McFarland (0.5 × 108 CFU/mL). The d-dimer concentration was evaluated after one and three hours of bacteria exposure. The resistance to fibrinolysis was not statistically distinguished among any media groups at any time. S. pneumoniae was statistically active in PRF after three hours. C. albicans was statistically active in PRGF II after one hour and in PRF between the first and third hour and after three hours. S. aureus and B. cereus were statistically active in PRGF II after three hours. S. pyogenes was statistically active after one hour, between the first and third hour, and after the third hour in all groups. S. pyogenes was the most active bacterium. Different blood formulations were not distinguishable based on resistance to bacteria-induced fibrinolysis. Low fibrinolytic properties of the found major microbes suggests that bacteria-induced fibrinolysis is one of the leading causes of absence of a clot in a post-extraction socket to be clinically insignificant. The initial absence of a clot or its mechanical elimination during formation or the healing period are major causes of dry socket.
Collapse
|
45
|
The use of a tetracycline drain reduces alveolar osteitis: a randomized prospective trial of third molar surgery under local anesthetics and without the use of systemic antibiotics. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:205-212. [DOI: 10.1016/j.oooo.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/03/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022]
|
46
|
Mummery TA, John M, Stokes SM. A quality improvement project to assess the use of preventative measures against acute alveolar osteitis. BDJ Open 2019; 5:10. [PMID: 31258931 PMCID: PMC6594952 DOI: 10.1038/s41405-019-0019-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 11/09/2022] Open
Abstract
Aims A quality improvement project was conducted in a General Dental Practice environment. The aim was to reduce the rate of Acute Alveolar Osteitis, which was locally found to be at 19.4%. Methods A range of quality improvement tools were utilised to determine and measure potential interventions, and the results from the initial Plan-Do-Study-Act cycle utilising perioperative 0.2% Chlorhexidine as a preventative method are presented. Results The use of perioperative 0.2% Chlorhexidine mouthwash showed an absolute risk reduction of 6.2%. Discussion Generalisation from the results is highly dependent on local factors, although the favourable reduction in acute alveolar osteitis and cost savings found supported the project. Conclusions This project highlights the strengths of Quality Improvement methodologies in implementing and assessing changes to improve service provision and patient outcomes.
Collapse
Affiliation(s)
| | - Miriam John
- LINCymru Clinical Lead, Quality Improvement Skills Training Section, Health Education and Improvement Wales, Cardiff, UK
| | - Susan Mary Stokes
- Dental Educator Quality Improvement, Dental Postgraduate Section Health Education Improvement Wales, Cardiff, UK
| |
Collapse
|
47
|
Paul S, Choudhury R, Kumari N, Rastogi S, Sharma A, Singh V, Laskar S, Dubey T. Is treatment with platelet-rich fibrin better than zinc oxide eugenol in cases of established dry socket for controlling pain, reducing inflammation, and improving wound healing? J Korean Assoc Oral Maxillofac Surg 2019; 45:76-82. [PMID: 31106135 PMCID: PMC6502748 DOI: 10.5125/jkaoms.2019.45.2.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/16/2018] [Accepted: 04/21/2018] [Indexed: 02/02/2023] Open
Abstract
Objectives To appraise the effectiveness of platelet-rich fibrin (PRF) in the management of established dry socket in terms of pain, inflammation, and wound healing. Materials and Methods Two hundred patients with established alveolar osteitis were studied to determine the efficacy of PRF and zinc oxide eugenol (ZOE) for pain control, inflammation reduction, and wound healing. Patients were randomly allocated to Group A (PRF) or Group B (ZOE). Patients were examined on the 1st, 3rd, 7th, and 14th postoperative day and evaluated for pain using visual analogue scale scores, inflammation with a gingival index score, and wound healing through a determination of the number of bony walls exposed. Results Group A showed better results in terms of pain remission, control of inflammation, and wound healing compared to Group B. Results between groups were statistically significant (P<0.05). Conclusion PRF is a better alternative than ZOE for the effective management of alveolar osteitis.
Collapse
Affiliation(s)
- Sam Paul
- Department of Orthodontics and Dentofacial Orthopaedics, Educare Institute of Dental Sciences, Malappuram, India
| | - Rupshikha Choudhury
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, India
| | - Nandini Kumari
- Faculty of Dental Sciences, Trauma Centre, Banaras Hindu University, Varanasi, India
| | - Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre (KDCRC), Moradabad, India
| | - Ashish Sharma
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre (KDCRC), Moradabad, India
| | - Vikas Singh
- Department of Public Health Dentistry, Teerthanker Mahaveer Dental College and Research Centre (TMDCRC), Moradabad, India
| | - Shyamalendu Laskar
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre (KDCRC), Moradabad, India
| | - Tushar Dubey
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre (KDCRC), Moradabad, India
| |
Collapse
|
48
|
Levitin SA, Grbic JT, Finkelstein J. Completeness of Electronic Dental Records in a Student Clinic: Retrospective Analysis. JMIR Med Inform 2019; 7:e13008. [PMID: 30896435 PMCID: PMC6447991 DOI: 10.2196/13008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A well-designed, adequately documented, and properly maintained patient record is an important tool for quality assurance and care continuity. Good clinical documentation skills are supposed to be a fundamental part of dental student training. OBJECTIVE The goal of this study was to assess the completeness of electronic patient records in a student clinic. METHODS Completeness of patient records was assessed using comparative review of validated cases of alveolar osteitis treated between August 2011 and May 2017 in a student clinic at Columbia University College of Dental Medicine, New York, USA. Based on a literature review, population-based prevalence of nine most frequently mentioned symptoms, signs, and treatment procedures of alveolar osteitis was identified. Completeness of alveolar osteitis records was assessed by comparison of population-based prevalence and frequency of corresponding items in the student documentation. To obtain all alveolar osteitis cases, we ran a query on the electronic dental record, which included all cases with diagnostic code Z1820 or any variation of the phrases "dry socket" and "alveolar osteitis" in the notes. The resulting records were manually reviewed to definitively confirm alveolar osteitis and to extract all index items. RESULTS Overall, 296 definitive cases of alveolar osteitis were identified. Only 22% (64/296) of cases contained a diagnostic code. Comparison of the frequency of the nine index categories in the validated alveolar osteitis cases between the student clinic and the population showed the following results: severe pain: 94% (279/296) vs 100% (430/430); bare bone/missing blood clot: 27% (80/296) vs 74% (35/47) to 100% (329/329); malodor: 7% (22/296) vs 33%-50% (18/54); radiating pain to the ear: 8% (24/296) vs 56% (30/54); lymphadenopathy: 1% (3/296) vs 9% (5/54); inflammation: 14% (42/296) vs 50% (27/54); debris: 12% (36/296) vs 87% (47/54); alveolar osteitis site noted: 96% (283/296) vs 100% (430/430; accepted documentation requirement); and anesthesia during debridement: 77% (20/24) vs 100% (430/430; standard of anesthetization prior to debridement). CONCLUSIONS There was a significant discrepancy between the index category frequency in alveolar osteitis cases documented by dental students and in the population (reported in peer-reviewed literature). More attention to clinical documentation skills is warranted in dental student training.
Collapse
Affiliation(s)
- Seth Aaron Levitin
- Division of Foundational Sciences, Columbia University College of Dental Medicine, New York, NY, United States
| | - John T Grbic
- Division of Foundational Sciences, Columbia University College of Dental Medicine, New York, NY, United States
| | - Joseph Finkelstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
49
|
Common risk factors of dry socket (alveolitis osteitis) following dental extraction: A brief narrative review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:407-411. [DOI: 10.1016/j.jormas.2018.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/31/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022]
|
50
|
The use of chlorhexidine in the prevention of alveolar osteitis after third molar extractions. Evid Based Dent 2018; 19:18-19. [PMID: 29568017 DOI: 10.1038/sj.ebd.6401289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Data sourcesCochrane Central Register of Controlled Trials (CENTRAL), Medline through PubMed, Scopus, Science Direct, ISI Web of Science, Evidence-Based Dentistry, ClinicalTrials.gov, the European Union Clinical Trials Register, the Spanish General University Board database of doctoral theses in Spain (TESEO), the Spanish National Research Council (CSIC) bibliographic databases, and the Spanish Medical Index (IME).Study selectionRandomised controlled trials (RCTs) (with or without placebo) of patients of any age or gender who underwent maxillary or mandibular third molar extractions. Studies were required to have analysed the efficacy of only chlorhexidine in any concentration, formulation or treatment regimen for preventing alveolar osteitis (AO). There was no language restriction.Data extraction and synthesisData extraction was carried out independently by two researchers, and a third researcher was consulted in case of disagreements. When explicit data were not stated in the text, they were calculated using data from the tables where possible. In addition, authors were contacted to obtain any necessary missing information. Datasets were assessed for heterogeneity, and meta-analysis was conducted on homogenous datasets. Publication bias was assessed through funnel plots. The research was conducted and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsTwenty-three studies published from 1979 to 2015, corresponding to 18 trials (16 parallel-group and two split-mouth RCTs), that reported on 2,824 third molar extractions (1,458 in experimental group and 1,366 in control group) were included. The overall relative risk (RR) was 0.53 (95% CI, 0.45-0.62; P<.0001). There was evidence of low heterogeneity (I2 = 9.3%; P = 0.336 by X2 test). The number needed to treat was eight (95% CI, 7-11). There were no differences between chlorhexidine rinse (RR = 0.58; 95% CI, 0.47-0.71) and gel (RR = 0.47; 95% CI, 0.37-0.60) for the prevention of AO after third molar extractions. Chlorhexidine did not cause more adverse reactions than placebo.ConclusionsThe use of chlorhexidine, in any formulation (rinse or gel), concentration (0.12% or 0.20%), or regimen (before, during and/or after surgery), is efficacious and effective in preventing AO in patients who have undergone third molar extraction. The findings showed that in order to prevent one case of AO, eight patients would have to be treated with chlorhexidine. Chlorhexidine gel was found to be moderately more efficacious than the rinse formulation.
Collapse
|