1: J Pain. 2007 Jan 29; [Epub ahead of print] 

Expression of COX-1 and COX-2 in a Clinical Model of Acute Inflammation.

Khan AA, Iadarola M, Yang HY, Dionne RA.

National Institute of Dental and Craniofacial Research.

Cyclooxygenase (COX) plays an important role in the induction of pain and
inflammation as well as the analgesic actions of NSAIDs and coxibs. This study
evaluates the expression of the two isoforms COX-1 and COX-2 in a clinical model
in which the surgical removal of impacted third molars is used to evaluate the
analgesic activity of anti-inflammatory drugs. A 3-mm punch biopsy was performed
on the oral mucosa overlying one impacted third molar immediately before
extraction of two impacted lower third molars. After the second tooth was
extracted, a second biopsy was performed adjacent to the surgical site either
immediately after surgery or 30, 60, or 120 minutes after surgery. RNA was
extracted from the biopsy specimens, and RT-PCR was performed to assess mRNA
levels of COX-1, COX-2, and glyceraldehyde-3-phosphate dehydrogenase (G3PDH).
The RT-PCR products in the biopsy specimens were normalized to G3PDH and
compared with baseline. COX-2 mRNA was progressively increased at 30, 60, and
120 minutes after surgery (P < .05); COX-1 mRNA was transiently decreased at 60
minutes during the postsurgical period (P < .05). The results demonstrate
peripheral elevation of COX-2 after tissue injury, which may contribute to
increased prostaglandin E(2) at the site of injury, pain onset, and the
analgesic activity of both nonselective NSAIDs and selective COX-2 inhibitors.
PERSPECTIVE: This clinical study uses a physiologically relevant model to
determine the time course of expression of COX-1 and COX-2 in acute inflammation
of the human oral mucosa. This study furthers our understanding of the
contribution of the COX isoforms to acute pain.

PMID: 17270500 [PubMed - as supplied by publisher]

2: Int J Paediatr Dent. 2007 Mar;17(2):145-50. 

Leukaemic infiltration of the mandible in a young girl.

Benson RE, Rodd HD, North S, Loescher AR, Farthing PM, Payne M.

School of Clinical Dentistry, University of Sheffield, Sheffield, UK.

This report presents a case of leukaemic infiltration of the mandible in a
10-year-old female of Sudanese extraction. Case report. The patient was in
remission from acute lymphoblastic leukaemia when she presented with pain
localized to the alveolar ridge overlying the unerupted lower right second
permanent molar. Two days later, she developed right inferior alveolar nerve
paraesthesia. Radiographic imaging demonstrated cortical line absence around the
developing lower right second and third permanent molars, and distal
displacement of the lower right third molar. In addition, the cortical outline
of the right inferior dental canal lacked clarity. Biopsy confirmed leukaemia
recurrence demonstrating the Philadelphia chromosome. Tailored chemotherapy was
commenced, and a bone marrow transplant was carried out 12 weeks later. At
6-month dental review, the patient remained exceptionally well with no bone pain
and normal sensation in the right lower lip. Conclusion. The importance of
regular and long-term dental examination of patients with leukaemia is
discussed.

PMID: 17263867 [PubMed - in process]

3: Int J Oral Maxillofac Surg. 2007 Jan 15; [Epub ahead of print] 

Prophylaxis versus pre-emptive treatment for infective and inflammatory
complications of surgical third molar removal: a randomized, double-blind,
placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic
acid (1000/62.5mg).

Lacasa JM, Jimenez JA, Ferras V, Bossom M, Sola-Morales O, Garcia-Rey C, Aguilar
L, Garau J.

Service of Internal Medicine, Hospital Mutua de Terrassa, University of
Barcelona, Barcelona, Spain.

The most common complications after surgical extraction of the third mandibular
molar are trismus, oedema or swelling, local pain, dysphagia and infection. The
aim of this comparative, double-blind, randomized clinical trial was to evaluate
the efficacy of two sustained release amoxicillin/clavulanate regimens in the
reduction of infection after third molar extractive surgery. A total of 225
patients were randomized into three equal groups: placebo, prophylaxis with
single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5mg, and
pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate
1000/62.5mg BID for 5 days. A higher rate of infection (P=0.006) was found among
patients receiving placebo (16%) than those receiving single-dose prophylaxis
(5.3%) or 5-day pre-emptive therapy (2.7%). A relationship between both the
duration (13.8% for long versus 7.4% for medium versus 1.6% for short) and
difficulty (12.7% with ostectomy versus 3.5% without ostectomy; P=0.011) of
surgical procedure and incidence of subsequent infection was also observed. Both
prophylactic and therapeutic regimens versus placebo achieved greater reduction
of pain after surgery on day 3 (P=0.001). Logistic regression analysis revealed
a risk of infection of 24%, 9% and 4% for ostectomy with placebo, prophylaxis
and pre-emptive treatment, respectively, whereas it was 7%, 2% and 1% if
ostectomy was not performed. Pre-emptive therapy with the oral sustained release
amoxicillin/clavulanate formulation reduced the rate of subsequent infection in
patients undergoing ostectomy. Prophylaxis was beneficial in simpler procedures
and may be indicated in cases where ostectomy is not performed.

PMID: 17229548 [PubMed - as supplied by publisher]

4: Arch Oral Biol. 2007 Jan 6; [Epub ahead of print] 

Na(v)1.7 sodium channel expression in human lingual nerve neuromas.

Bird EV, Robinson PP, Boissonade FM.

Department of Oral and Maxillofacial Medicine and Surgery, School of Clinical
Dentistry, University of Sheffield, Claremont Crescent, Sheffield S10 2TA,
United Kingdom.

OBJECTIVE: Peripheral branches of the trigeminal nerve are often damaged during
the removal of lower third molar teeth, and a small proportion of patients who
sustain an injury develop persistent chronic pain. The cause of the pain is not
clear and there are no satisfactory methods of treatment. The aim of the present
study was to examine the expression of the sodium channel subtype Na(v)1.7 in
damaged human lingual nerves, and to identify any association between Na(v)1.7
expression and reported symptoms of dysaesthesia. METHODS: Eleven
neuromas-in-continuity (NICs) and 11 nerve-end neuromas (NENs) were studied, and
were all obtained at the time of surgical repair of the damaged lingual nerve.
Specimens were categorised as being obtained from patients with symptoms or
without symptoms, according to the degree of pain, tingling or discomfort that
had been experienced. The tissue was prepared and processed for indirect
immunofluorescence, and image analysis was used to quantify the percentage area
of PGP 9.5-labelled tissue that also contained Na(v)1.7. RESULTS: The results
demonstrated that sodium channel Na(v)1.7 was expressed in human lingual nerve
neuromas. There was no direct relationship between the level of expression of
Na(v)1.7 and the patients' symptoms of dysaesthesia. However, in NICs there was
found to be an inverse correlation between Na(v)1.7 and macrophage expression,
and in symptomatic NICs a direct correlation was found between Na(v)1.7
expression and axonal apposition. CONCLUSIONS: These data suggest that Na(v)1.7
expression alone does not play a primary role in initiating the painful symptoms
of dysaesthesia. The development of neuropathic pain may involve complex
interactions including changes in ultrastructure and ion channel density.

PMID: 17210118 [PubMed - as supplied by publisher]

5: J Oral Rehabil. 2007 Jan;34(1):15-26. 

Changes in jaw muscle EMG activity and pain after third molar surgery.

Ernberg M, Schopka JH, Fougeront N, Svensson P.

Department of Clinical Oral Physiology, Aarhus University, Aarhus, Denmark.
malin.ernberg@ki.se

Limited jaw-opening capacity is frequently encountered following third molar
surgery and may impair function. The aim of this study was to investigate the
electromyographic (EMG) activity in jaw muscles after third molar surgery to
obtain more insight into the mechanisms of restrictions in jaw opening. Twenty
subjects were examined before, 24 h and 1 week after surgery. Ten healthy
controls were subjected to the same examination at two different occasions for
intersession variability. The EMG activity of the masseter and anterior
digastricus muscles was recorded at different jaw positions and during maximum
voluntary clenching. Pain intensity was assessed at rest and during movements.
The EMG activity in the jaw muscles increased with opening level (P < 0.01), but
did not change after surgery. In contrast, the EMG activity during clenching was
decreased in all muscles after surgery (P < 0.05). The pain intensity after
surgery increased with jaw opening level (P < 0.001), but was in general not
correlated to EMG level. Pain intensity during clenching was increased after
surgery (P < 0.001), but not correlated to EMG level. The EMG activity did not
change between visits in the control group. In conclusion, the results indicate
that third molar surgery does not influence the EMG activity in the masseter and
anterior digastricus muscles during various levels of static jaw opening, but
decreases the EMG activity during clenching. However, these changes are not
influenced by pain intensity. The results have implications for the
understanding of the phenomenon of trismus.

PMID: 17207074 [PubMed - in process]

6: Med Oral Patol Oral Cir Bucal. 2007 Jan 1;12(1):E60-4. 

Evaluation of lidocaine and mepivacaine for inferior third molar surgery.

Porto GG, Vasconcelos BC, Gomes AC, Albert D.

Department of Oral and Maxillofacial Surgery, University of Pernambuco,
Recife-Brazil.

OBJECTIVE: The aim of this study was to compare 2% lidocaine and 2% mepivacaine
with 1:100,000 epinephrine for postoperative pain control. STUDY DESIGN: A group
of 35 patients, both genders were recruited, whose had ages ranged from 13 to 27
years-old and had two inferior third molars in similar positions to be
extracted. The cartridges were distributed to the patients according to a
randomised pattern, where lidocaine was in the control group and mepivacaine in
the experimental group. RESULTS: Results showed no significant association
between the anesthetics and postoperative pain, pulp sensibility after one hour,
gender, tooth position and duration of the surgical procedure. CONCLUSIONS: It
was shown that lidocaine and mepivacaine have similar time of anesthesia, they
are adequate for surgical procedures that last one hour, and there was no
difference between the two anesthetics in relation to the severety of
post-operative pain.

PMID: 17195831 [PubMed - in process]

7: Br J Oral Maxillofac Surg. 2006 Dec 21; [Epub ahead of print] 

Routine antibiotic prophylaxis is not necessary during operations to remove
third molars.

Ataoglu H, Oz GY, Candirli C, Kiziloglu D.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University
of Selcuk, Konya, Turkiye.

The purpose of this study was to evaluate the efficacy of antibiotic prophylaxis
during removal of impacted third molars. We studied 150 patients with impacted
mandibular or maxillary third molars who were divided randomly into three
groups. The first was given amoxicillin 2g combined with clavulanic acid, orally
daily for 5 days postoperatively; starting at the end of the operation. The
second group was given the same drugs but the regimen started 5 days before the
operation. The third was given no antibiotics. Pain, infection, swelling,
alveolar osteitis, and interincisal mouth opening (mm) were evaluated. There
were no significant differences among the groups in the incidence of these
complications. We cannot recommend routine oral antibiotic prophylaxis in third
molar surgery.

PMID: 17188409 [PubMed - as supplied by publisher]

8: Expert Rev Med Devices. 2007 Jan;4(1):23-32. 

P-Stimtrade mark auricular electroacupuncture stimulation device for pain
relief.

Sator-Katzenschlager SM, Michalek-Sauberer A.

Department of Anesthesiology and Intensive Care Medicine (B), Medical University
of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
sabine.sator-katzenschlager@meduniwien.ac.at , Department of Anesthesiology and
Intensive Care Medicine (B), Medical University of Vienna, Waehringer Guertel
18-20, A-1090 Vienna, Austria. andrea.michalek-sauberer@meduniwien.ac.at.

Acupuncture is now accepted as a complementary analgesic treatment. Auricular
acupuncture is a distinct form of acupuncture. Electrical stimulation of
acupoints (electroacupuncture) increases the effects of acupuncture. Recently,
an auricular electroacupuncture device, the P-Stimtrade mark, has become
available. Clinical studies in outpatients have investigated the P-Stim in
chronic musculoskeletal pain and its use for minor surgery. In chronic cervical
or low back pain, auricular electroacupuncture was more effective than
conventional auricular acupuncture. The results in acute pain were
controversial. Auricular electroacupuncture reduced pain and remifentanil
consumption during oocyte aspiration when compared with conventional auricular
acupuncture or a sham treatment. However, after third molar tooth extraction,
auricular electroacupuncture and auricular acupuncture failed to reduce either
postoperative pain or analgesic consumption. Further large-scale studies are
required to evaluate the analgesic efficacy of auricular electroacupuncture.

PMID: 17187468 [PubMed - as supplied by publisher]

9: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Jan;103(1):e7-9. Epub
2006 Oct 6. 

Comparison of methylprednisolone and ketoprofen after multiple third molar
extraction: a randomized controlled study.

Leone M, Richard O, Antonini F, Rousseau S, Chabaane W, Guyot L, Martin C.

Department of Intensive Care Medicine and Trauma Center, Centre Hospitalier et
Universitaire Nord, Marseille, France. marc.leone@ap-hm.fr

In a prospective, double blind, and randomized study, we compared
methylprednisolone and ketoprofen after anesthesia for multiple third molar
extraction. In addition to paracetamol, 90 patients were allocated to receive
intravenously either ketoprofen 100 mg or methylprednisolone 1 mg/kg. Severity
of pain was measured with visual analogue scale (VAS) in recovery room.
Sixty-three percent of patients receiving methylprednisolone had a VAS score <30
mm compared with 42% of those receiving ketoprofen (P = 0.04), with no
difference in the consumption of morphine. We observed only marginal difference
between methylprednisolone and ketoprofen to relieve pain after this surgery.

Publication Types:
    Randomized Controlled Trial

PMID: 17178485 [PubMed - indexed for MEDLINE]

10: Anesth Prog. 2006 Fall;53(3):78-82. 

Attenuation of C-reactive protein increases after exodontia by tramadol and
ibuprofen.

El-Sharrawy EA, El-Hakim IE, Sameeh E.

Department of Oral and Maxillofacial Surgery, Tanta University, Cairo, Egypt.
elsharrawy@hotmail.com

The anti-inflammatory effects of ibuprofen and tramadol were investigated by
measuring C-reactive protein concentrations after removal of an impacted lower
third molar. Forty-five American Society of Anesthesiologists Class I patients
were randomly categorized into 3 equal groups according to postoperative
analgesic medication. The first group received tramadol (100 mg every 8 hours),
the second group received ibuprofen (400 mg every 8 hours), and the last group
received half doses of both drugs in combination (50 mg tramadol every 8 hours
and 200 mg ibuprofen every 8 hours). C-reactive protein was measured before
surgery to exclude the presence of any preexisting inflammatory condition that
might interfere with the study. C-reactive protein was also determined
immediately after surgery and 72 hours postoperatively. At 72 hours, C-reactive
protein had increased over postsurgery baseline by 123% in the tramadol group (P
< .001), 84% in the ibuprofen group (P < .001), and only 37% in the combined
analgesic group (P = .078). These results suggest that tramadol may produce
supra-additive anti-inflammatory effects with ibuprofen after third-molar
extractions.

Publication Types:
    Randomized Controlled Trial

PMID: 17175820 [PubMed - indexed for MEDLINE]

11: J Evid Based Dent Pract. 2006 Dec;6(4):269-70. 

Comment on:
    Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Oct;100(4):e74-80.

Rofecoxib provides relief of pain following third molar extractions.

Moore PA.

Department of Anesthesiology, Oral Health Science Institute 552 Salk Hall School
of Dental Medicine University of Pittsburgh Pittsburgh, PA 15261, USA.
pam7@pitt.edu <pam7@pitt.edu>

Publication Types:
    Comment

PMID: 17174248 [PubMed]

12: Int J Oral Maxillofac Surg. 2007 Feb;36(2):123-7. Epub 2006 Dec 8. 

A comparison of pre-emptive analgesic efficacy of diflunisal and lornoxicam for
postoperative pain management: a prospective, randomized, single-blind,
crossover study.

Pektas ZO, Sener M, Bayram B, Eroglu T, Bozdogan N, Donmez A, Arslan G, Uckan S.

Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Baskent
University, Ankara, Turkey.

Diflunisal and lornoxicam are currently available non-steroidal
anti-inflammatory drugs (NSAIDs) that have been shown to be effective to various
degrees in pain relief when administered either pre-emptively or
postoperatively. The pre-emptive analgesic efficacy of diflunisal 1000mg was
compared with that of lornoxicam 16mg in 40 ASA I patients undergoing surgical
removal of bilateral impacted third molars. The impacted third molar teeth on
one side were removed at the first surgical appointment using one of the two
drug regimens being assessed and the teeth on the contralateral side were
removed at a second appointment using the alternate drug regimen; all operations
were performed by the same surgeon. Acetaminophen up to 2000mg daily was
provided as rescue medication. The postoperative rescue analgesic consumption
was recorded and pain scores were evaluated with a visual analogue scale at 2,
4, 6, 12 and 24h postoperatively. No statistically significant differences were
found between groups with respect to rescue analgesic consumption and
postoperative pain scores. Pre-emptive administration of both NSAIDs proved to
be effective in the management of pain following the surgical removal of
impacted third molar teeth.

PMID: 17157478 [PubMed - in process]

13: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):725-32.
Epub 2006 Jul 14. 

Influence of lower third molar position on the incidence of preoperative
complications.

Almendros-Marques N, Berini-Aytes L, Gay-Escoda C.

School of Dentistry, University of Barcelona, Barcelona, Spain.

OBJECTIVE: The present study sought to relate the clinical outcome of mandibular
third molar impaction surgery to the orthopanoramic radiographically determined
position of the affected teeth based on the classifications of Pell and Gregory,
and Winter. STUDY DESIGN: A retrospective study was made of 165 patients
undergoing the surgical extraction of lower third molars at School of Dentistry
of the University of Barcelona, Barcelona, Spain. The positions of the 259
extracted third molars were documented according to the classifications of Pell
and Gregory, and Winter, together with the type of mucosal and bony coverage
involved. These tooth position parameters were radiologically assessed using
Radio Memory software and were retrospectively correlated to the observed
infectious, noninfectious, and neurological postsurgical outcomes. RESULTS: A
statistically significant relationship (P < .05) was recorded between the
appearance of infectious complications and the position parameters "Pell and
Gregory classification," "mucosal coverage," and "bony coverage." A
statistically significant relationship (P < .05) was observed between the
appearance of noninfectious problems and the parameter "Winter classification."
Finally, a significant association (P < .05) was recorded between the position
variables and the existence of unwanted neurological changes. CONCLUSIONS: The
mandibular position of the impacted third molar may be able to be correlated to
the development of complications resulting from impaction removal. Vertical
third molars in positions IIA and IIB of the Pell and Gregory classification,
with partial mucosal and bony coverage, are the most susceptible to undesired
outcomes.

PMID: 17138172 [PubMed - indexed for MEDLINE]

14: J Oral Maxillofac Surg. 2006 Dec;64(12):1821-5. 

Traumatic changes of the inferior alveolar nerve and Gasserian ganglion after
removal of a mandibular third molar: report of a case.

Eriksson L, Hillerup S, Reibel J, Persson S, Brun A.

Department of Oral and Maxillofacial Surgery, Faculty of Odontology, University
of Malmo, and University Hospital of Malmo, Malmo, Sweden.
lar.o.eriksson@skane.se

Publication Types:
    Case Reports

PMID: 17113453 [PubMed - indexed for MEDLINE]

15: J Oral Maxillofac Surg. 2006 Dec;64(12):1761-6. 

The effect of a single dose prednisolone with and without diclofenac on pain,
trismus, and swelling after removal of mandibular third molars.

Buyukkurt MC, Gungormus M, Kaya O.

Department of Oral and Maxillofacial Surgery, Ataturk University, Erzurum,
Turkey. mcbuyukkurt@yahoo.com

PURPOSE: The purpose of this study was to evaluate the effect of a single
intramuscular dose of prednisolone and the prednisolone-diclofenac combination
on postoperative pain, trismus, and edema after the removal of third molars.
PATIENTS AND METHODS: Forty-five patients who were to undergo surgical removal
of lower third molars were studied. Patients were divided into 3 groups. In the
first group, each patient was given 25 mg prednisolone intramuscularly
immediately after surgery. In the second group, each patient was given 25 mg
prednisolone and diclofenac intramuscularly immediately after surgery, and in
the third group, each patient was given sterile saline solution as control
group. Postoperative pain was evaluated by visual analogue scale on the day of
surgery. Facial swelling and trismus were evaluated on postoperative days 2 and
7. ANOVA was used to analyze these data. RESULTS: Statistical analysis of the
data indicated the prednisolone-diclofenac combination suppressed pain intensity
in comparison with control (P < .05) at the 6-hour observation. Both the
prednisolone and prednisolone-diclofenac combinations suppressed pain at the
seventh postoperative hour in comparison with the control (P < .05). The
prednisolone-diclofenac combination group also had a smaller loss of opening at
postoperative days 2 and 7 in comparison with both the prednisolone and control
groups (P < .05). Postoperative swelling was less in both the prednisolone and
prednisolone-diclofenac combination groups, as compared with the control group
(P < .05) at postoperative day 2. The prednisolone-diclofenac combination group
also had a smaller swelling at postoperative day 7 in comparison with both the
prednisolone and control groups (P < .05). CONCLUSION: It was determined that
the combination of a single dose of prednisolone and diclofenac is well-suited
to the treatment of postoperative pain, trismus, and swelling after dental
surgical procedures and should be used when extensive postoperative swelling of
soft tissue is anticipated.

Publication Types:
    Randomized Controlled Trial

PMID: 17113442 [PubMed - indexed for MEDLINE]

16: Int J Oral Maxillofac Surg. 2007 Jan;36(1):26-31. Epub 2006 Nov 16. 

Analgesic and anti-inflammatory dose-response relationship of 7.5 and 15mg
meloxicam after lower third molar removal: a double-blind, randomized, crossover
study.

Calvo AM, Sakai VT, Giglio FP, Modena KC, Colombini BL, Benetello V, Sakamoto
FC, Freire TM, Dionisio TJ, Lauris JR, Trindade AS Jr, Faria FA, Santos CF.

Bauru School of Dentistry, University of Sao Paulo, Bauru/SP, Brazil.

Fifty patients were scheduled to undergo removal of symmetrically positioned
lower third molars in two separate appointments. Meloxicam 7.5 or 15mg was once
daily administered in a double-blind, randomized and crossover manner after the
surgery for 4 days. Objective and subjective parameters were recorded for
comparison of postoperative courses. Patients treated with 7.5mg meloxicam who
underwent osteotomy reported higher pain scores at 1.5, 3, 4, 10, 12 and 16h
(P<0.05) and ingested a greater amount of rescue analgesic medication (P<0.05)
than those who did not require osteotomy. A higher percentage of patients who
underwent osteotomy medicated with 7.5mg meloxicam needed rescue medication as
compared to those who did not require osteotomy (P<0.05). There was a similar
mouth opening at suture removal compared with preoperative values for both doses
(P>0.05). There were no significant differences concerning swelling observed on
the 2nd or 7th postoperative days in comparison with baseline (P>0.05) between
the two doses. Pain, trismus and swelling after lower third molar removal not
requiring osteotomy can be successfully controlled by a dose regimen of 7.5mg
meloxicam once daily. For more aggressive extractions 15mg meloxicam is
advisable.

PMID: 17112703 [PubMed - in process]

17: Brain Res. 2007 Jan 5;1127(1):59-65. Epub 2006 Nov 14. 

Vanilloid receptor 1 (TRPV1) expression in lingual nerve neuromas from patients
with or without symptoms of burning pain.

Biggs JE, Yates JM, Loescher AR, Clayton NM, Boissonade FM, Robinson PP.

Department of Oral and Maxillofacial Surgery, School of Clinical Dentistry,
University of Sheffield, Claremont Crescent, Sheffield, S10 2TA, UK.
j.biggs@sheffield.ac.uk

The lingual nerve, a peripheral branch of the trigeminal nerve, can be damaged
during the surgical removal of lower third molar teeth. This damage can lead to
the development of dysaesthesia, with some patients complaining of burning pain.
We investigated the hypothesis that vanilloid receptor 1 (TRPV1), a transducer
of noxious heat stimuli, was involved in the development of this burning pain.
Neuroma specimens were obtained from patients undergoing microsurgical repair of
a damaged lingual nerve. Repair was undertaken where there was little evidence
of spontaneous recovery, 7-41 months after the initial injury. Preoperatively
the incidence of dysaesthesia was determined by reported symptoms and using
visual analogue scales (VAS) for pain, tingling and discomfort. Nine neuromas
were studied from patients with burning dysaesthesia and six from patients with
a sensory deficit but no dysaesthesia. Indirect immunofluorescence for protein
gene product (PGP) 9.5 and TRPV1 was used to quantify the percentage area of PGP
9.5 positive neuronal tissue that also expressed TRPV1. The results showed no
significant difference between the mean percentage area of TRPV1 expression in
neuromas from patients with or without burning dysaesthesia. Furthermore, there
was no correlation between TRPV1 expression and the VAS scores for pain,
tingling or discomfort. However, if data from all patients was pooled, there was
a negative correlation between the level of TRPV1 expression and the time after
initial injury. These data do not rule out involvement of TRPV1 in the aetiology
of burning dysaesthesia following lingual nerve injury but suggest that TRPV1 at
the injury site does not play a primary role.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 17109831 [PubMed - in process]

18: Clin Ther. 2006 Sep;28(9):1279-95. 

Analgesic efficacy of the cyclooxygenase-inhibiting nitric oxide donor AZD3582
in postoperative dental pain: Comparison with naproxen and rofecoxib in two
randomized, double-blind, placebo-controlled studies.

Michael Hill C, Sindet-Pederson S, Seymour RA, Hawkesford JE 2nd, Coulthard P,
Lamey PJ, Gerry Cowan C, Wickens M, Jeppsson L, Dean AD, Svensson O.

University Dental Hospital, Heath Park, Cardiff, United Kingdom.
hillcm@cardiff.ac.uk

OBJECTIVE: This study assessed the analgesic efficacy of single doses of
4-(nitrooxy)butyl-(2S)-2-(6-methoxy-2-naphthyl) propanoate (AZD3582) in acute
postoperative dental pain after the removal of an impacted mandibular third
molar (ie, wisdom tooth). METHODS: Two randomized, placebo-controlled,
double-blind studies were performed. In a dose-finding study, 242 patients were
randomized to AZD3582 375, 750, 1500, or 2250 mg (n = 41, 37, 42, and 41,
respectively); naproxen 500 mg (n = 39); or placebo (n = 42). In a comparator
study, 282 patients were randomized to AZD3582 500 mg (n = 78) or 750 mg (n =
83), rofecoxib 50 mg (n = 80), or placebo (n = 41). Primary outcomes included
time to rescue medication, time to pain relief, and mean pain intensity
difference (MPID), as well as safety profile. Pain was rated on a visual analog
scale. RESULTS: In the dose-finding study, 52% (126/242) were women; the mean
(SD) age was 25.1 (4) years, mean weight was 69.0 kg, and the mean (SD) body
mass index (BMI) was 23.7 (3) kg/m2. In the comparator study, 58% (164/282) were
women; the mean (SD) age was 27 (6.4) years, mean weight was 71 kg, and mean
(SD) BMI was 24.2 (3) kg/m2. In the dose-finding study, the AZD3582 750-, 1500-,
and 2250-mg groups were superior to placebo in the primary variables "time to
rescue medication (0-8 hours)" (hazard ratios [HRs] [95% CIs], 0.17 [0.07-0.42],
P < 0.003; 0.23 [0.11-0.50], P < 0.001; and 0.15 [0.06-0.36], P < 0.001,
respectively), "time to meaningful pain relief" (HRs [95% CIs], 3.42
[1.87-6.25], P < 0.003; 2.49 [1.37-4.50], P < 0.003; and 3.07 [1.70-5.55], P <
0.001, respectively), and MPID (analysis of covariance [ANCOVA] least squares
mean [LSM] differences [95% CIs], 25.8 [17.3-34.4], P < 0.003; 20.4 [12.1-28.7],
P < 0.003; and 29.3 [20.9-37.6], P < 0.001, respectively). AZD3582 and naproxen
did not show any statistically significant differences for the 3 primary
variables, except that naproxen was superior to the AZD3582 375-mg dose for the
variables time to meaningful pain relief (HR difference, 0.48 [95% CI,
0.29-0.78], P < 0.004) and MPID (difference in ANCOVA LSM, -10.2, [95% CI, -18.2
to -2.2], P < 0.012). The median times to meaningful pain relief were 115
minutes for AZD3582 375 mg, 66 minutes for 750 mg, 85 minutes for 1500 mg, 81
minutes for 2250 mg, and 162 minutes for placebo (P = NS, P = 0.003, P < 0.003,
and P < 0.001, respectively). The median time to first rescue medication was 144
minutes for placebo, and <50% of the subjects on any of the AZD3582 doses or
naproxen took rescue medication within 8 hours after dosing. In the comparator
study, AZD3582 750 mg was superior to placebo in "time to rescue medication
(0-24 hours)" (HR [95% CI], 0.4 [0.3-0.6], P < 0.001), "time to confirmed
perceptible pain relief" (2.1 [1.1-3.8], P = 0.02), and MPID (11.9 [4.2-19.5], P
= 0.002). However, inferiority of AZD3582 to rofecoxib for MPID could not be
excluded (tolerance limit of 10 mm; P = NS for noninferiority testing). The
median times to confirmed perceptible pain relief were 45 minutes for AZD3582
500 mg, 40 minutes for 750 mg, and 37 minutes for rofecoxib. The median times to
first rescue medication were 218 minutes for AZD3582 500 mg, 365 minutes for 750
mg, 635 minutes for rofecoxib, and 90 minutes for placebo. Overall, AZD3582 was
well tolerated. However, an effect on orthostatic blood pressure could not be
excluded because there seemed to be more subjects with dizziness and orthostatic
blood pressure reduction who were administered AZD3582 > or =750 mg. The
proportions of patients with vertigo and decreased orthostatic blood pressure
each group were as follows: AZD3582 500 mg, 6%; AZD3582 750 mg, 12%; rofecoxib,
3%; and placebo, 5%. CONCLUSIONS: AZD3582 750 mg had similar analgesic efficacy
as equimolar doses of naproxen, but noninferiority to rofecoxib was not
demonstrated.

Publication Types:
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17062301 [PubMed - indexed for MEDLINE]

19: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):591-5.
Epub 2006 Jul 11. 

Dextromethorphan premedication reduced postoperative analgesic consumption in
patients after oral surgery.

Aoki T, Yamaguchi H, Naito H, Shiiki K, Ota Y, Kaneko A.

Department of Oral and Maxillofacial Surgery, Tokai University School of
Medicine, Isehara, Japan. taoki123jp@ybb.ne.jp <taoki123jp@ybb.ne.jp>

OBJECTIVE: N-methyl-D-aspartate (NMDA) receptor antagonist premedication reduces
postoperative pain. In this study, we examined if NMDA antagonist premedication
might reduce postoperative pain after oral surgery, testing dextromethorphen.
STUDY DESIGN: One hundred eleven patients undergoing mandibular third molar
extraction under local anesthesia were included. Patients were randomly
allocated into 3 groups. Group A (n = 37), B (n = 38), and C (n = 36) patients
were emphasis-placed on dextromethorphan 30 mg, diclofenac 25 mg, or placebo
orally before surgery, respectively. Postoperatively, patients were allowed to
use oral diclofenac, 25 mg, for postoperative pain relief. Postoperative pain
was evaluated the 1st, 7th, and 14th day after surgery, respectively, by using a
visual analog scale (VAS) and the number of diclofenac consumed. VAS score and
the number of diclofenac consumption were compared among the groups. RESULTS:
VAS score was similar among the 3 groups during the study period. Total
postoperative diclofenac consumption was significantly less in group A than in
group C (P < 0.05). CONCLUSION: Dextromethorphan premedication reduced
postoperative analgesic consumption after oral surgery.

Publication Types:
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't 

PMID: 17052633 [PubMed - indexed for MEDLINE]

20: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):e4-8. Epub
2006 Aug 10. 

Postoperative analgesia after lower third molar surgery: contribution of the use
of long-acting local anesthetics, low-power laser, and diclofenac.

Markovic AB, Todorovic L.

Faculty of Stomatology, Oral Surgery Clinic, University of Belgrade, Belgrade,
Serbia and Montenegro. markovicaleks@sezampro.yu <markovicaleks@sezampro.yu>

OBJECTIVES: Postoperative pain is a common phenomenon after surgical extraction
of lower third molars (LTM), and its successful control is an essential part of
routine oral surgery. The aims of the study were twofold: (1) to evaluate the
postoperative analgesic efficacy, comparing long-acting and intermediate-acting
local anesthetics; and (2) to compare the use of low-power laser irradiation and
the nonsteroid anti-inflammatory drug diclofenac, which are claimed to be among
the most successful aids in postoperative pain control. STUDY DESIGN: A twofold
study of 102 patients of both sexes undergoing surgical extraction of LTM was
conducted. In the first part of the study, 12 patients with bilaterally impacted
LTMs were treated in a double-blind crossover fashion; local anesthesia was
achieved with 0.5% bupivacaine plain or 2% lidocaine with 1:80.000 epinephrine.
In the second part of the study, 90 patients undergoing LTM surgical extraction
with local anesthesia received postoperative low-power laser irradiation (30
patients) and a preoperative single dose of 100 mg diclofenac (30 patients), or
only regular postoperative recommendations (30 patients). RESULTS: The results
of the first part of the study showed a strikingly better postoperative
analgesic effect of bupivacaine than lidocaine/epinephrine (11 out of 12; 4 out
of 12, respectively, patients without postoperative pain). In the second part of
the study, low-power laser irradiation significantly reduced postoperative pain
intensity in patients premedicated with diclofenac, compared with the controls.
CONCLUSION: Provided that basic principles of surgical practice have been
achieved, the use of long-acting local anesthetics and low-power laser
irradiation enables the best postoperative analgesic effect and the most
comfortable postoperative course after surgical extraction of LTMs.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 17052624 [PubMed - indexed for MEDLINE]