Effect of transcutaneous electrical nerve stimulation on pain, edema, and trismus after surgical removal of impacted third molars: a split-mouth randomized clinical trial

BACKGROUND

The transcutaneous electrical nerve stimulation (TENS) stimulus inhibits the activity of nociceptive neurons of the central nervous system. Pain relief is achieved by increasing the pulse amplitude of TENS to induce a non-painful paranesthesia beneath the electrodes. This study aimed to assess the effect of TENS on acute pain, edema, and trismus after surgical removal of impacted third molars.

MATERIAL AND METHODS

This randomized, double blind, split-mouth clinical trial was conducted on 37 patients with bilaterally impacted mandibular third molars. The angle and body of mandible at the site of surgery in one randomly selected quadrant underwent TENS immediately after surgery (50 Hz, 100-µs short pulse, 15 minutes for 6 days). The TENS stimulator device was used in off mode for the placebo quadrant. The pain score (primary outcome) was measured for 7 days postoperatively, and edema and trismus (secondary outcomes) were assessed at 2, 4 and 7 days, postoperatively. The results were analyzed by repeated measures ANOVA using R software (alpha=0.05).

RESULTS

The overall mean pain score was significantly lower in the TENS than the placebo group (P<0.05). The number of taken analgesics in the first 3 days was significantly lower in the TENS group (P<0.001). Postoperative edema in the TENS group was lower than the placebo group but only the difference was not statistically significant (P>.05). The inter-incisal distance, as an index to assess trismus, was not significantly different between the two group at day 2, but it was significantly higher in the TENS group after the second day (P<0.001).

CONCLUSIONS

TENS effectively decreased pain and trismus following impacted third molar surgery, and may be recommended as a non-pharmaceutical method to relieve postoperative symptoms.

Salivary Nitric Oxide Levels in Adults with Different DMFT Scores in a Selected Iranian Population: A Cross-Sectional Study

Objectives

Due to the emphasis on the protective and antimicrobial role of Nitric Oxide against gastrointestinal diseases, investigating its relationship with dental caries is a right topic. Therefore, this research has investigated the amount of saliva Nitric Oxide in different volumes of DMFT indicator in adults.

Material and Methods

In this descriptive- analytical cross-sectional study, 80 participants (20-35 years old), without a history of systemic disease and drug use participated as research samples, (53.8% of the participants in the study were women). Participants were selected from patients who had visited dental Department. The participants were divided in four groups based on DMFT (DMFT=0, 1≤DMFT≤3, 3<DMFT<10, DMFT≥10). Non-stimulating saliva was collected from all participants between 9-11 am in a calibrated tube. Saliva Nitric Oxide was measured using a Nitrous Oxide test, based on the Griess reaction. We used a correlation test to analyze quantitative variables, and t-test or ANOVA for qualitative and quantitative variables.

Results

A significant relationship between DMFT and age was identified. At different levels of DMFT, significant relationship between DMFT and sex was not found. In different groups of DMFT, no significant relationship between Nitric Oxide and DMFT exist.

Conclusion

The level of Nitric Oxide saliva was not affected by the amount of DMFT.

Relationship between Posterior Permanent Dentition Pattern and Radiographic Changes of the Mandibular Condyle

This study assessed the relationship between posterior permanent dentition and radiographic changes of the mandibular condyle. This descriptive, cross-sectional study was conducted on 300 panoramic radiographs of patients over 40 years of age (188 females and 112 males). Panoramic radiographs were evaluated for condylar changes such as flattening, subcortical sclerosis, subcortical cyst, erosion, osteophytes, and generalized sclerosis. Presence of muscle pain and temporomandibular joint (TMJ) pain and sounds, and history of TMJ trauma were also assessed. The occlusal scheme of posterior teeth was analyzed according to the Eichner's index. The frequency of condylar changes was calculated in the right and left sides, and their association with posterior permanent dentition was analyzed by the Chi-square test (alpha = 0.05). The frequency of flattening, muscle pain, TMJ sounds, and erosion was 11.7%, 9.7%, 5.7%, and 3.7% in the right side, respectively. The frequency of flattening, muscle pain, erosion, and subcortical cyst was 12%, 9.3%, 5%, and 5% in the left side, respectively. The frequency of bilateral muscle pain, flattening, TMJ sounds, and TMJ pain was 18%, 16.7%, 11.7%, and 9.3%, respectively. Cases with TMJ trauma, generalized sclerosis, and osteophytes were few. According to the Eichner's index, most patients with condylar changes had classes A and B, and a smaller percentage had class C. No significant difference was noted between healthy individuals and those with condylar changes regarding dentition patterns. No relationship existed between condylar changes and posterior permanent dentition pattern.

The relationship of mandibular radiomorphometric indices to skeletal age, chronological age and skeletal malocclusion type

Background

The present study was performed with the following aims: (1) to assess the relationship between skeletal age, measured using the cervical vertebral maturity (CVM) method, and chronological age; (2) to determine the correlation of skeletal and chronological age to the cortical thickness of the lower border of the mandible using the linear radiomorphometric; and (3) to explore the relationship between these indices and skeletal malocclusion type.

Material and Methods

The data were collected from the records of 180 patients, including 57 males (31.7%) and 123 females (68.3%). The data were based on the panoramic and lateral cephalograms of each patient. The CVM stages were determined on the basis of the patients’ lateral cephalograms. Three radiomorphometric indices were measured: AI, MI and GI. The patients were divided up into three groups of skeletal malocclusion: Class I, II, and III. For all the tests, statistical significance was set at P<0.05.

Results

The relationship between chronological age and skeletal age was 0.496. Furthermore, with an increase in chronological and skeletal age, the cortical thickness of the lower border of the mandible and consequently the radiomorphometric indices increase, except for the GI (P > 0.05). Lastly, the relationship between GI and skeletal malocclusion type proved significant.

Conclusions

AI and MI were found to increase significantly with increasing age, so the assessment of mandibular radiomorphometric indices could be clinically useful in estimating of the growth and maturation of the mandible.

Key words:Orthodontics, Radiomorphometric indices, Skeletal age, Skeletal malocclusion.