Comparative effect of sodium dipyrone and sodium dipyrone associated to caffeine to control post-tooth extraction pain

BACKGROUND AND OBJECTIVES: Adequate postoperative pain control is a challenge among surgical specialties, in spite of recent advances in analgesic techniques and analgesics. Caffeine has been used as therapeutic adjuvant to potentiate analgesic efficacy of some drugs, however there are still no scientific investigation reports on the association with sodium dipyrone in the postoperative period of dental procedures. So, this study aimed at observing and comparing the efficacy of sodium dipyrone alone or in association with caffeine to control postoperative pain of dental procedures, considering hemodynamic parameters of patients as indicators of anxiety and pain during surgery. METHODS: This is a crossover and double-blind study involving 50 young and healthy patients (25 males and 25 females) referred for bilateral extraction of impacted mandibular third molars. Operated side, patient's gender and analgesic drug used were randomized. Visual analog scale scores were submitted to Friedman test (α = 0.05) to compare pain intensity at defined intervals (preoperative, immediate postoperative, 1, 2, 4 and 12 hours, 1, 2, 3 and 7 days after surgery). Blood pressure and heart rate were measured in the preoperative period, after anesthetic injection and in the postoperative period (Friedman test, (α = 0.05). RESULTS: Patients have referred mild pain in the first two postoperative days and there has been no statistically significant difference between the analgesic efficacy of sodium dipyrone alone or in association with caffeine in different evaluated intervals. Most cardiovascular changes were within normality, considering anxiety and stress induced by surgery. CONCLUSION: The therapeutic protocol proposed in this study has not shown statistically significant difference between sodium dipyrone associated or not to caffeine to control post-tooth extraction pain.O adequado controle da dor pós-operatória constitui um desafio entre as especialidades cirúrgicas, a despeito dos recentes avanços das técnicas de analgesia e dos analgésicos. A cafeína tem sido utilizada como adjuvante terapêutico para potencializar a eficácia analgésica de alguns fármacos, porém ainda não existe relatos de investigação científica da associação com a dipirona sódica em dor pós-operatória em procedimentos odontológicos. Dessa forma, o objetivo deste estudo foi observar e comparar a eficácia da dipirona sódica isolada e da dipirona sódica associada à cafeína no controle da dor pós-operatória em cirurgia dental, considerando os parâmetros hemodinâmicos dos pacientes como indicador de ansiedade e de dor durante a cirurgia. Estudo cruzado e duplo encoberto incluiu 50 pacientes jovens e saudáveis (25 homens e 25 mulheres) com indicação de exodontia bilateral de terceiros molares mandibulares impactados. O lado operado, o gênero do paciente e o fármaco analgésico usado foram randomizados. Os escores obtidos pela escala analógica visual foram submetidos ao teste de Friedman (α = 0,05) para comparação das intensidades dolorosas em intervalos definidos (pré-operatório, pós-operatório imediato, 1, 2, 4 12 horas, 1, 2, 3 e 7 dias após as cirurgias) e as alterações nos parâmetros de pressão arterial e frequên­cia cardíaca foram mensurados no pré-operatório, após a injeção anestésica e no pós-operatório (teste de Friedman, α = 0,05). Os pacientes experimentaram dor leve nos dois primeiros dias de pós-operatório e não houve diferença estatisticamente significante entre a eficácia analgésica da dipirona sódica isolada e da dipirona sódica associada à cafeína nos diferentes intervalos medidos. A maioria das alterações cardiovasculares observadas estava dentro da normalidade, considerando a ansiedade e estresse induzido pela cirurgia. O protocolo terapêutico proposto neste estudo não demonstrou diferença estatística significante na eficiência analgésica da dipirona sódica associada ou não a cafeína no controle da dor pós-exodontia143174178Adequate postoperative pain control is a challenge among surgical specialties, in spite of recent advances in analgesic techniques and analgesics. Caffeine has been used as therapeutic adjuvant to potentiate analgesic efficacy of some drugs, however there are still no scientific investigation reports on the association with sodium dipyrone in the postoperative period of dental procedures. So, this study aimed at observing and comparing the efficacy of sodium dipyrone alone or in association with caffeine to control postoperative pain of dental procedures, considering hemodynamic parameters of patients as indicators of anxiety and pain during surgery. This is a crossover and double-blind study involving 50 young and healthy patients (25 males and 25 females) referred for bilateral extraction of impacted mandibular third molars. Operated side, patient's gender and analgesic drug used were randomized. Visual analog scale scores were submitted to Friedman test (α = 0.05) to compare pain intensity at defined intervals (preoperative, immediate postoperative, 1, 2, 4 and 12 hours, 1, 2, 3 and 7 days after surgery). Blood pressure and heart rate were measured in the preoperative period, after anesthetic injection and in the postoperative period (Friedman test, (α = 0.05). Patients have referred mild pain in the first two postoperative days and there has been no statistically significant difference between the analgesic efficacy of sodium dipyrone alone or in association with caffeine in different evaluated intervals. Most cardiovascular changes were within normality, considering anxiety and stress induced by surgery. The therapeutic protocol proposed in this study has not shown statistically significant difference between sodium dipyrone associated or not to caffeine to control post-tooth extraction pai

Assessment of the stresses produced on the bone implant/tissue interface to the different insertion angulations of the implant - a three-dimensional analysis by the finite elements method

The present study aimed to assess the stresses produced on the surface of the bone tissue around dental implants with three different insertion angulations subjected to axial and oblique loading. The study was created according to the recommendations of the Checklist for Reporting In-vitro Studies (CRIS). The Straumann? bone level RC (4.1 x 10 mm) implant, Cone Morse connection (CM), RC Straumann Variobase? with abutment (3.5 mm) was placed in the region of element 16, with the platform positioned at the height of the bone crest. Three assessment models were produced: model M1 or control - implant perpendicular to the bone crest; model M2 - implant angulated at 17° relative to the bone crest; and model M3 - implant angulated at 30° relative to the bone crest. The masticatory loads were simulated with 100 N of intensity and two loading patterns (axial and oblique) were applied to each model. Then, the models were exported to the finite elements simulation software Ansys Workbench V19.2 (Ansys Inc., Canonsburg, PA, USA). To assess the finite elements, qualitative and quantitative analyses were performed. It was observed that, under axial loading, qualitatively, the peaks occurred in the cavosurface region, palatal aspect in M1 and M2, and buccal aspect in M3. Quantitatively, the greatest angulation resulted in a low stress peak. Under oblique loading, qualitatively, the peaks occurred in the cavosurface region, buccal aspect in the three groups. Quantitatively, the greatest angulation of the implant resulted in an increase in stress peaks on the buccal aspect. Under axial loading, the three insertion angulations of the implant - M1, M2, and M3 - were clinically viable. When subjected to oblique loading, the 30° angulation (M3) suggested a significant risk of bone loss and it was contraindicated

The influence of local anesthetic solutions storage on tissue inflammatory reaction

Objective: This study aimed to analyze the influence of storage conditions of local anesthetic solutions in the inflammatory reaction after injection in rats. Study design: Twenty-four rats received in their oral mucosa the injection of 2% lidocaine with epinephrine 1:100.000 solutions (LA) submitted to the following storage conditions during a twelve-month period: G1 - inside the original packaging, in refrigerator (5±1°C); G2 - inside the original box, under light shelter, at room temperature; G3 - outside the original box at room temperature (exposed to artificial light for 12 hours/day) and G4 - brand new solution. For the controls tests, 0.9% sodium chloride solution was injected in the opposite side. After 6 and 24 hours, three animals of each group were sacrificed and their maxilla along with the soft tissue were removed and submitted to histological analysis (HE). Results: The pH of LA was measured before and after the storage period and no statistically differences were observed between G1 and G4, but both were different from G2 and G3. All the scores of the testing solutions were higher than their respective negative controls, except for G1 at 6 hours. The order of the scores of inflammation after 6 hours was G3>G4>G2=G1. After 24 hours the order was G3>G2>G1>G4. Conclusion: The study showed that the method of storage can influence the pH and the level of inflammatory reaction after the injection of 2% lidocaine with epinephrine 1:100.000

Methylparaben concentration in commercial Brazilian local anesthetics solutions

OBJECTIVE: To detect the presence and concentration of methylparaben in cartridges of commercial Brazilian local anesthetics. MATERIAL AND METHODS: Twelve commercial brands (4 in glass and 8 in plastic cartridges) of local anesthetic solutions for use in dentistry were purchased from the Brazilian market and analyzed. Different lots of the commercial brands were obtained in different Brazilian cities (Piracicaba, Campinas and São Paulo). Separation was performed using high performance liquid chromatography (HPLC) with UV-Vis detector. The mobile phase used was acetonitrile:water (75:25 - v/v), pH 4.5, adjusted with acetic acid at a flow rate of 1.0 ml.min-1. RESULTS: When detected in the solutions, the methylparaben concentration ranged from 0.01% (m/v) to 0.16% (m/v). One glass and all plastic cartridges presented methylparaben. CONCLUSION: 1. Methylparaben concentration varied among solutions from different manufacturers, and it was not indicated in the drug package inserts; 2. Since the presence of methylparaben in dental anesthetics is not regulated by the Brazilian National Health Surveillance Agency (ANVISA) and this substance could cause allergic reactions, it is important to alert dentists about its possible presence

Comparison of piezosurgery and conventional rotary instruments in schneider?s membrane sinus lifting : a pilot randomized trial

The present study aimed to evaluate and compare the postoperative effects of the piezoelectric device and conventional rotary instruments in Schneider's membrane sinus lifting procedure. Twenty patients requiring bilateral maxillary bone graft augmenta

Influence of nicotine on machined- and anodized-surface implants. Histometric analysis

Background: The nicotine may generate a influence on bone repair and longevity of dental implants. This fact makes studies to improve the surface of the implants are constantly conducted. This study aimed to evaluate the influence of subcutaneous nicotine injection in the osseointegration process on different implant surfaces, through histomorphometric analysis. Material and Methods: Therefore, twenty-two male rabbits were randomly distributed into two groups according to the subcutaneous injections: (1) nicotine, 3 mg/day/kg and (2) 0.9% NaCI, 3 mL/day/kg, three times a day. Subgroups were then designated - machined and anodized dental implants were installed in the right and left tibia bones, respectively. The animals were subjected to euthanasia after periods of eight weeks for histomorphometric analysis. The bone samples with implants were removed and the routine histological processing was performed. Next, the images obtained from the blades were evaluated by the Image Tool? software, assessing the osseointegrated areas of implants (BIC), in pixels. Data obtained were subjected to intergroup statistical analysis through the Kruskal-Wallis non-parametric test (?=5%). Results: The test result showed no statistically significant difference among the groups studied ( p =0.446). Conclusions: Based on the methodology studied, it is concluded that the daily application of low doses of nicotine did not interfere with the osseointegration of machined and anodized implants

Preemptive use of intravenous ibuprofen to reduce postoperative pain after lower third molar surgery: a systematic review of randomized controlled trials

This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including “grey literature.” The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The “Joanna Briggs Institute for Randomized Controlled Trials” tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure

Self‐medication and pain catastrophizing in patients with myofascial pain : are they related?

Evidence shows that acute symptoms of temporomandibular dysfunction (TMD) would eventually lead to chronicity and self‐medication would play a significant interfering role on such dynamics (Dias, Bastos, Alves, & Leite, 2019; Pastore, Goulart, Pastore, Prati, & de Moraes, 2018). Furthermore, some authors concluded that both propensity to catastrophize and depression contribute to the progression of chronic temporomandibular muscle and joint disorders (Velly et al., 2011). Hence, the aim of this study was to assess the relationship between the habit of self‐medicating and the propensity to catastrophize pain in a clinical population with myofascial pain (MP).© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reservedinfo:eu-repo/semantics/publishedVersio

Methylparaben concentration in commercial Brazilian local anesthetics solutions

OBJECTIVE: To detect the presence and concentration of methylparaben in cartridges of commercial Brazilian local anesthetics. MATERIAL AND METHODS: Twelve commercial brands (4 in glass and 8 in plastic cartridges) of local anesthetic solutions for use in dentistry were purchased from the Brazilian market and analyzed. Different lots of the commercial brands were obtained in different Brazilian cities (Piracicaba, Campinas and São Paulo). Separation was performed using high performance liquid chromatography (HPLC) with UV-Vis detector. The mobile phase used was acetonitrile:water (75:25 - v/v), pH 4.5, adjusted with acetic acid at a flow rate of 1.0 ml.min(-1). RESULTS: When detected in the solutions, the methylparaben concentration ranged from 0.01% (m/v) to 0.16% (m/v). One glass and all plastic cartridges presented methylparaben. CONCLUSION: 1. Methylparaben concentration varied among solutions from different manufacturers, and it was not indicated in the drug package inserts; 2. Since the presence of methylparaben in dental anesthetics is not regulated by the Brazilian National Health Surveillance Agency (ANVISA) and this substance could cause allergic reactions, it is important to alert dentists about its possible presence

Atividade antimicrobiana de soluções a base de alho (Allium sativum), oleo de melaleuca (Melaleuca alternifolia) e clorexidina sobre microrganismos totais e estreptococos do grupo mutans : estudo in vivo

Orientador: Francisco Carlos GroppoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaMestrad