Comment on controlling dental post-operative pain and the intraoral local delivery of drugs

Anti-Inflammatory and Antibacterial Activity of the Chitosan/Chlorhexidine Gel Commercial Preparation for Postexodontia Treatment: An In Vitro Study

Objective  The present study aimed to assess in vitro the antibacterial activity, cytotoxicity, and the expression of prostaglandin E ₂ (PGE ₂ ) of Bexident post topical gel (BP).

Materials and Methods  The broth dilution test was performed to analyze the antimicrobial activity of BP against Staphylococcus aureus , Escherichia coli , and Streptococcus mutans . Minimal bactericidal concentrations (MBCs) and minimal inhibitory concentrations (MICs) were assessed. Cytotoxic activity was performed by the MTT (tetrazolium dye) method on human gingival fibroblast (HGF), human bone cells (HBC), and human pulp cells (HPC) (from primary cell culture) and HGF-1 from American Type Culture Collection. The expression of PGE ₂ produced by RAW 264.7 cells was determined by ELISA utilizing an Enzyme Immuno-Assay Kit.

Statistical Analysis  Shapiro–Wilks normality test and Mann–Whitney U test were performed for all data.

Results  The MBCs of BP for S. aureus , E. coli , and S. mutans were found at 25, 50, and 12.5%, respectively. The MICs for the same strains were found at 12.5, 25, and 3.125%. The CC ₅₀ of BP gel for HBC, HPC, and HGF, and HGF-1 were 12.5 ± 1.09, 0.37 ± 0.02, 0.35 ± 0.02, and 20.4 ± 0.02%, respectively. The levels of expression PGE ₂ produced by RAW 264.7 cells treated with IL-1β exhibit an inverse dose-dependent effect on the concentrations of BP gel used.

Conclusion  Our results indicate that the BP gel has a great antibacterial effect, adequate biocompatibility, showing a decrease in the expression of PGE ₂ on cells with previously induced inflammation. Due to the above, its use as a healing agent after oral surgery seems to be adequate.

Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial

BACKGROUND

Individuals who abuse prescription opioids often use leftover pills that were prescribed for friends or family members. Dental surgery has been identified as a common source of opioid prescriptions. We measured rates of used and unused opioids after dental surgery for a pilot program to promote safe drug disposal.

METHODS

We conducted a randomized controlled trial of opioid use patterns among patients undergoing surgical tooth extraction at a university-affiliated oral surgery practice. The primary objective was to describe opioid prescribing and consumption patterns, with the number of unused opioid pills remaining on postoperative day 21 serving as the primary outcome. The secondary aim was to measure the effect of a behavioral intervention (informing patients of a pharmacy-based opioid disposal program) on the proportion of patients who disposed or reported intent to dispose of unused opioids. (NCT02814305) Results: We enrolled 79 patients, of whom 72 filled opioid prescriptions. On average, patients received 28 opioid pills and had 15 pills (54%) left over, for a total of 1010 unused pills among the cohort. The behavioral intervention was associated with a 22% absolute increase in the proportion of patients who disposed or reported intent to dispose of unused opioids (Fisher's exact p=0.11).

CONCLUSION

Fifty-four percent of opioids prescribed in this pilot study were not used. The pharmacy-based drug disposal intervention showed a robust effect size but did not achieve statistical significance. Dentists and oral surgeons could potentially reduce opioid diversion by moderately reducing the quantity of opioid analgesics prescribed after surgery.