School of Dental Medicine, University of Zagreb, Croatian Dental Society - Croatian Medical Association
Abstract
Uklanjanje boli jedan je od glavnih izazova stomatološke prakse. Akutna bol značajka je većine odontogenih boli i često je povezana sa samoupotrebom analgetika. No samoliječenje stvara rizik uzimanja prekomjerne doze lijeka, preduge upotrebe, klinički znatnih interakcija s već pripisanim lijekovima, te polipragmazije i mogućih štetnih učinaka. Početno zbivanje kod većine bolnih stanja jest bolni podražaj koji izaziva destrukciju tkiva, sintezu i otpuštanje bikemijskih medijatora koji sudjeluju u nastanku boli. Za ublažavanje boli najčešće se rabe analgeticiantipiretici, nesteroidni (NES) lijekovi koji djeluju na periferiji. Oni inhibiraju biokemijske medijatore boli. Svi NES analgetici izazivaju kvalitativno slične neželjene učinke, uzimaju se kroz usta i lako su dostupni u ljekarnama bez recepta - u slobodnoj prodaji.
Svrha ovoga rada bila je odrediti čestoću samoliječenja analgeticima stomatoloških bolesnika s akutnom boli. 32 bolesnika sa zuboboljom u dobi od 19 do 73 godine, prosječne dobi 32,5 godine i oba spola, ispitana su o intenzitetu boli prije liječenja i o uporabi lijekova. 68% bolesnika opisalo je svoju bol kao jaku, 21,9% kao umjerenu i 10,1% kao neugodni osjećaj. Rezultati su pokazali da je 99,6% bolesnika samo uzelo lijek za neposredno otklanjanje bolova. Najčešće uzeti analgetici jesu: kombinacija analgetika- antipiretika (propifenazon+paracetamol+kofein+kodein) u 33% i dikofenak (Voltaren) u 29,1%, zatim metamizol u 21,8, aspirin u 13% i ibuprofen u 3,1% slučajeva. 56% bolesnika lijekove je nabavilo kod ljekarnika, a 44 % iz kućne zalihe. Bolesnici (87,5%) su dobro obaviješteni o mogućim neželjenim učincima i toksičnosti NES analgetika. Neželjene učinke opisalo je 21,8% bolesnika, većinom kao gastrointestinalne simptome: mučnina i želučana bol. To je u skladu s dobro opisanim nuspojavama NESanalgetika, koje su najvjerojatnije rezultat inhibicije ciklooksigenaza i znatan uzrok bolesti.Pain is one of the major challenges in dental care. The most common types of odontogenic pain are characterised as acute pain which is frequently associated with selfmedication with analgesics. However , there is a risk with self-medication such as the use of excessive drug dosage, prolonged duration of use, clinically significant interactions with prescription medicines and polypharmacy and possible side effects. The initial event for most painful conditions is a noxious stimulus that results in tissue destruction, the synthesis and the release of biochemical mediators involved in the pain process. Peripherally acting nonsteroid analgesic-antipyretic drugs /NSAIDs/ are the most commonly used analgesics. They inhibit these biochemical mediators of pain. All NSAIDs share a qualitatively similar side ellect profile, the oral route of administration and all of them are freely available to the general public without prescription over the counter drugs (OTC).
The aim of this study was to determine the incidence of auto medication with analgesics among dental patients with acute pain. 32 patients aged from 19 to 73 years, (32.5) of both sexes and with odontalgia were interviewed personally regarding the intensity of their pre-treatment pain and the use of medications. 68% of patients described their pain as severe, 21.9% as moderate pin and 10.1% as unpleasant sensation. The results showed that 99.6% of the patients self-medicated a drug for the immediate relief of toothache. The most frequently self-medicated analgesics were: analgesic-atipyretic combined formulations (propiphenazon + paracetamol + coffeine + codeine) in 33% and diclofenac (Voltaren) in 29.1%, the metamizol in 21.8%, aspirin in 13% and ibuprofen in 3.1%. Selfmedicated drugs came from the pharmacist in 56% patients and 44% from the family stock. Patients (87.5%) were well informed about possible side effects and toxicity of NSAIDs. Adverse effects during therapy was reported by 21.8% patients, mainly as gastrointestinal symptoms: nausea and gastric pain. This is in egreement with the wel documented NSAIDs side effects which are presumably the result of inhibiting cyclooxygenases and a significant cause of morbidity
