1
|
Khalil W. A New Approach for Explaining and Treating Dry Sockets: A Pilot Retrospective Study. Cureus 2023; 15:e41347. [PMID: 37546073 PMCID: PMC10398614 DOI: 10.7759/cureus.41347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Dry socket, a common complication following a tooth extraction, is characterized by severe and radiating pain that typically begins one to four days after the extraction. Despite several risk factors, the exact cause and underlying mechanisms of dry sockets remain unclear. This study aims to propose a novel pathogenesis and management approach for dry sockets based on an infectious process. Methods The study was conducted by reviewing medical records, at a private dental clinic, of patients who fit the inclusion criteria; these patients appeared to have come between April 2022 and April 2023. The study included all patients with age ≥17 years diagnosed with dry socket that was resistant to conventional topical treatment, and who received treatment with ciprofloxacin 500 mg three times per day during the study period. Results Out of 15 patients who received treatment with ciprofloxacin 500 mg three times per day during the study period, 11 patients (73.3%) were completely relieved of symptoms within 24 hours, with no need for additional painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, two patients (13.3%) had a partial response after 48 hours, where their pain was ameliorated from severe to moderate with the use of conventional painkillers (including paracetamol and NSAIDs) and steroidal anti-inflammatory drugs such as dexamethasone (8 mg IM daily) to have total relief. On the other hand, the other two patients (13.3%) had a negative response to the treatment and were out of reach for follow-up. Conclusion These clinical outcomes, coupled with previous laboratory data, could explain all clinical aspects of dry sockets and provide substantial support for the hypothesis that an infectious mechanism plays the principal role in the pathophysiology of dry sockets.
Collapse
Affiliation(s)
- Wael Khalil
- Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, LBN
| |
Collapse
|
2
|
Sadeghi SH, Sharifi S, Dizaj SM, Ghavimi MA, Shahi S, Ghoreishizadeh A, Negahdari R. Antimicrobial agent containing absorbable gelatin sponge to prevent dry socket: A systematic review. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2208111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The use of absorbable gelatin sponges (AGSs) as a hemostatic surgical material resulted in a reduction of dry sockets occurrence. The systemic use of antibiotics and antimicrobial agents can also reduce the infection of extracted teeth, and therefore, it may show pain-relieving effects on the dry socket as well.
Objective:
Given the high prevalence of dry sockets in the extracted teeth, the main objective of this review was a brief overview of AGSs, including antimicrobial agents to prevent dry sockets.
Methods:
The electronic search of the literature was done on the Pubmed and Google Scholar databases with the MESH keywords of Antimicrobials, Gelatin sponge, Gelfoam, Dry socket, Antibiotics, Alveolar osteitis. Only papers published in English were investigated. No limitations were put on the publication date.
Results:
Of the 279 electronic papers, 79 articles were found relevant to the study. All abstracts were reviewed, and only desired articles were selected. The final electronic and manual search led to 15 articles for use in this study. Among these studies, 5 studies were related to AGSs, including antimicrobial agents to prevent dry sockets.
Conclusion:
The reviewed literature showed that the systemic/topical use of antibiotics and antimicrobial agents can reduce infection and, therefore, may show pain-relieving effects on the dry socket. Besides, antimicrobial-loaded AGSs can be helpful in curing or preventing dry sockets. There were a limited number of clinical trials that used antimicrobial loaded AGSs for dry socket. More clinical studies are needed, especially in subgroups of patients with a high risk of infectious conditions, to validate the effectiveness of antimicrobial-loaded AGSs for dry socket.
Collapse
|
3
|
Daly BJ, Sharif MO, Jones K, Worthington HV, Beattie A. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database Syst Rev 2022; 9:CD006968. [PMID: 36156769 PMCID: PMC9511819 DOI: 10.1002/14651858.cd006968.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Alveolar osteitis (dry socket) is a complication of dental extractions more often involving mandibular molar teeth. It is associated with severe pain developing 2 to 3 days postoperatively with or without halitosis, a socket that may be partially or totally devoid of a blood clot, and increased postoperative visits. This is an update of the Cochrane Review first published in 2012. OBJECTIVES: To assess the effects of local interventions used for the prevention and treatment of alveolar osteitis (dry socket) following tooth extraction. SEARCH METHODS An Information Specialist searched four bibliographic databases up to 28 September 2021 and used additional search methods to identify published, unpublished, and ongoing studies. SELECTION CRITERIA We included randomised controlled trials of adults over 18 years of age who were having permanent teeth extracted or who had developed dry socket postextraction. We included studies with any type of local intervention used for the prevention or treatment of dry socket, compared to a different local intervention, placebo or no treatment. We excluded studies reporting on systemic use of antibiotics or the use of surgical techniques because these interventions are evaluated in separate Cochrane Reviews. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We followed Cochrane statistical guidelines and reported dichotomous outcomes as risk ratios (RR) and calculated 95% confidence intervals (CI) using random-effects models. For some of the split-mouth studies with sparse data, it was not possible to calculate RR so we calculated the exact odds ratio (OR) instead. We used GRADE to assess the certainty of the body of evidence. MAIN RESULTS We included 49 trials with 6771 participants; 39 trials (with 6219 participants) investigated prevention of dry socket and 10 studies (with 552 participants) looked at the treatment of dry socket. 16 studies were at high risk of bias, 30 studies at unclear risk of bias, and 3 studies at low risk of bias. Chlorhexidine in the prevention of dry socket When compared to placebo, rinsing with chlorhexidine mouthrinses (0.12% and 0.2% concentrations) both before and 24 hours after extraction(s) substantially reduced the risk of developing dry socket with an OR of 0.38 (95% CI 0.25 to 0.58; P < 0.00001; 6 trials, 1547 participants; moderate-certainty evidence). The prevalence of dry socket varies from 1% to 5% in routine dental extractions to upwards of 30% in surgically extracted third molars. The number of patients needed to be treated (NNT) with chlorhexidine rinse to prevent one patient having dry socket was 162 (95% CI 155 to 240), 33 (95% CI 27 to 49), and 7 (95% CI 5 to 10) for control prevalence of dry socket 0.01, 0.05, and 0.30 respectively. Compared to placebo, placing chlorhexidine gel intrasocket after extractions reduced the odds of developing a dry socket by 58% with an OR of 0.44 (95% CI 0.27 to 0.71; P = 0.0008; 7 trials, 753 participants; moderate-certainty evidence). The NNT with chlorhexidine gel (0.2%) to prevent one patient developing dry socket was 180 (95% CI 137 to 347), 37 (95% CI 28 to 72), and 7 (95% CI 5 to 15) for control prevalence of dry socket of 0.01, 0.05, and 0.30 respectively. Compared to chlorhexidine rinse (0.12%), placing chlorhexidine gel (0.2%) intrasocket after extractions was not superior in reducing the risk of dry socket (RR 0.74, 95% CI 0.46 to 1.20; P = 0.22; 2 trials, 383 participants; low-certainty evidence). The present review found some evidence for the association of minor adverse reactions with use of 0.12%, 0.2% chlorhexidine mouthrinses (alteration in taste, staining of teeth, stomatitis) though most studies were not designed explicitly to detect the presence of hypersensitivity reactions to mouthwash as part of the study protocol. No adverse events were reported in relation to the use of 0.2% chlorhexidine gel placed directly into a socket. Platelet rich plasma in the prevention of dry socket Compared to placebo, placing platelet rich plasma after extractions was not superior in reducing the risk of having a dry socket (RR 0.51, 95% CI 0.19 to 1.33; P = 0.17; 2 studies, 127 participants; very low-certainty evidence). A further 21 intrasocket interventions to prevent dry socket were each evaluated in single studies, and there is insufficient evidence to determine their effects. Zinc oxide eugenol versus Alvogyl in the treatment of dry socket Two studies, with 80 participants, showed that Alvogyl (old formulation) is more effective than zinc oxide eugenol at reducing pain at day 7 (mean difference (MD) -1.40, 95% CI -1.75 to -1.04; P < 0.00001; 2 studies, 80 participants; very low-certainty evidence) A further nine interventions for the treatment of dry socket were evaluated in single studies, providing insufficient evidence to determine their effects. AUTHORS' CONCLUSIONS Tooth extractions are generally undertaken by dentists for a variety of reasons, however, all but five studies included in the present review included participants undergoing extraction of third molars, most of which were undertaken by oral surgeons. There is moderate-certainty evidence that rinsing with chlorhexidine (0.12% and 0.2%) or placing chlorhexidine gel (0.2%) in the sockets of extracted teeth, probably results in a reduction in dry socket. There was insufficient evidence to determine the effects of the other 21 preventative interventions each evaluated in single studies. There was limited evidence of very low certainty that Alvogyl (old formulation) may reduce pain at day 7 in patients with dry socket when compared to zinc oxide eugenol.
Collapse
Affiliation(s)
- Blánaid Jm Daly
- Special Care Dentistry, Division of Child & Public Health, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | | | | | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anna Beattie
- School of Dental Science, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| |
Collapse
|
4
|
Clinical Efficacy of 1% CHX Gluconate Gel and 0.12% CHX Solution: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159358. [PMID: 35954713 PMCID: PMC9368169 DOI: 10.3390/ijerph19159358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
Chlorhexidine (CHX) is an effective antibacterial agent and is used in dental treatment in several formulations. The aim of this study was to compare the effectiveness of CHX solution and CHX gel on dental plaque inhibition and gingivitis relief by a randomized clinical trial. Thirty-eight participants were randomly divided into two groups: control group (0.12% CHX solution) and test group (1% CHX gel). Participants were provided with CHX products and were instructed to use each product in the morning and evening for 1 week. Clinical results were evaluated by analyzing the collected data of Turesky et al. the modified Quigley-Hein Plaque Index (TQHPI), gingival index (GI) and the BANA test. Measurements were conducted 4 weeks and 8 weeks after using chlorhexidine products. The results were analyzed using repeated measured ANOVA and paired t-test. TQHPI and GI were significantly different after treatments in both groups (p < 0.001). The GI decreased more in the test group compared to the control group 4 weeks and 8 weeks later. In both groups, the BANA score also significantly decreased (p < 0.001) after 8 weeks, though the BANA score decreased relatively more in the CHX gel group than the CHX solution group. These results suggest that 1% CHX gel is more effective in reducing gingivitis and bacteria of periodontal disease than the 0.12% CHX solution. Therefore, the 1% CHX gel is expected to be actively used for non-surgical treatment of periodontal disease patients.
Collapse
|
5
|
Taberner-Vallverdú M, Camps-Font O, Gay-Escoda C, Sánchez-Garcés MA. Previous dry socket as a risk factor for alveolar osteitis: A nested case-control study in primary healthcare services. J Clin Exp Dent 2022; 14:e479-e485. [PMID: 35765360 PMCID: PMC9233910 DOI: 10.4317/jced.59586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Dry socket is one of the most common complications following tooth extraction, though no studies have been made on its main risk factors in the primary healthcare services of Barcelona (Spain). Objectives: To analyze the influence of different factors upon the appearance of dry socket in patients attended in the primary care setting, and to determine the possible presence of risk factors in patients who have suffered a previous episode of dry socket.
Material and Methods During 24 months, questionnaires were filled with data on the patients seen in different public primary healthcare services in the area of Barcelona (Spain). A case-control study was conducted to identify the main risk factors for developing complications in the form of dry socket.
Results A mandibular location of the extracted tooth, poor oral hygiene, difficult extraction, and previous dry socket increased the risk of developing this complication. In patients with dry socket in the past, the risk of developing the same complication again, adjusted for difficulty of extraction, was seen to increase 11.45-fold (OR: 11.45; 95%CI: 1.06 to 123.74; p = 0.045).
Conclusions The risk factors for dry socket are a mandibular location of the extracted tooth, poor oral hygiene, difficult extraction, and particularly a history of dry socket in the past. The identification of these factors the prevention of dry socket in each patient could be improved. Key words:Dry socket, risk factors, extraction, complications.
Collapse
Affiliation(s)
| | - Octavi Camps-Font
- Associate Professor of Oral Surgery. Professor of the Master Degree Program in Oral Surgery and Implantology, School of Dentistry, University of Barcelona, Barcelona (Spain)
| | - Cosme Gay-Escoda
- MD, DDS, PhD, MS, EBOS, OMFS. Chairman and Professor of Oral and Maxillofacial Surgery, School of Dentistry, Barcelona. Director of the Master Degree Program in Oral Surgery and Implantology (EHFRE International University/ FUCSO). Coordinator/Researcher of the IDIBELL Institute. Head of the Department of Oral Surgery, Implantology and Maxillofacial Surgery, Teknon Medical Center, Barcelona (Spain)
| | - Maria-Angeles Sánchez-Garcés
- MD, DDS, PhD, MS, EBOS. Lecturer in Oral Surgery. Professor of the Master Degree Program in Oral Surgery and Implantology, School of Dentistry, University of Barcelona. Researcher of the IDIBELL Institute, Barcelona (Spain)
| |
Collapse
|
6
|
Ghosh A, Aggarwal VR, Moore R. Aetiology, Prevention and Management of Alveolar Osteitis-A Scoping Review. J Oral Rehabil 2021; 49:103-113. [PMID: 34625985 DOI: 10.1111/joor.13268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/09/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alveolar osteitis (AO) is a poorly understood, common, painful complication following exodontia. It is sometimes managed by inappropriate prescription of antibiotics which contributes to the global threat of antimicrobial resistance. Use of intra-alveolar chlorhexidine also presents a serious risk of anaphylaxis to the patient. OBJECTIVE This scoping review aims to investigate the aetiology, prevention and management of AO and highlight the extent of inappropriate prescribing and intra-alveolar chlorhexidine use. DESIGN A scoping review was undertaken using the PRISMA guidelines. Medline, Ovid and Pubmed were searched between 2010 and 2020, from which 63 studies were selected for review that related to the aetiology, prevention or management of AO. Data were analysed for frequency of studies reporting information on risk factors for aetiology, prevention strategies and management including inappropriate management using antibiotic prescribing and intra-alveolar chlorhexidine. RESULTS Impaired immune response, surgical technique and age were identified as significant factors in the development of AO, while there is conflicting evidence regarding the effects of smoking and gender. With regard to prevention, the use of prophylactic antibiotics is not supported within the literature. Saline irrigation and eugenol pastes used preventively have been shown to be cheap and effective alternatives to chlorhexidine with no adverse effects. Hyaluronic acid and low-level laser therapies showed a significant reduction in pain and soft-tissue inflammation in the management of AO compared to Alveogyl. CONCLUSIONS Further understanding of the pathophysiology of AO is needed, in addition to large high-quality RCTs or long-term observational studies into the aetiology, prevention, and management of AO to produce up-to-date evidence-based clinical guidelines. Clinicians should also be mindful of their contribution to growing antimicrobial resistance and avoid inappropriate prescribing of antibiotics. Saline should replace chlorhexidine as the intra-alveolar irrigant of choice.
Collapse
Affiliation(s)
- Anna Ghosh
- Department of Oral and Maxillofacial Surgery, Hull Royal Infirmary, Hull, United Kingdom of Great Britain and Northern Ireland
| | - Vishal R Aggarwal
- Department of Academic Oral Surgery & Oral Medicine, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Richard Moore
- Lecturer in Oral Surgery, Department of Academic Oral Surgery & Oral Medicine, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
7
|
Buonavoglia A, Leone P, Solimando AG, Fasano R, Malerba E, Prete M, Corrente M, Prati C, Vacca A, Racanelli V. Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice. Antibiotics (Basel) 2021; 10:antibiotics10050550. [PMID: 34065113 PMCID: PMC8151289 DOI: 10.3390/antibiotics10050550] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
The antimicrobial resistance (AMR) phenomenon is an emerging global problem and is induced by overuse and misuse of antibiotics in medical practice. In total, 10% of antibiotic prescriptions are from dentists, usually to manage oro-dental pains and avoid postsurgical complications. Recent research and clinical evaluations highlight new therapeutical approaches with a reduction in dosages and number of antibiotic prescriptions and recommend focusing on an accurate diagnosis and improvement of oral health before dental treatments and in patients’ daily lives. In this article, the most common clinical and operative situations in dental practice, such as endodontics, management of acute alveolar abscesses, extractive oral surgery, parodontology and implantology, are recognized and summarized, suggesting possible guidelines to reduce antibiotic prescription and consumption, maintaining high success rates and low complications rates. Additionally, the categories of patients requiring antibiotic administration for pre-existing conditions are recapitulated. To reduce AMR threat, it is important to establish protocols for treatment with antibiotics, to be used only in specific situations. Recent reviews demonstrate that, in dentistry, it is possible to minimize the use of antibiotics, thoroughly assessing patient’s conditions and type of intervention, thus improving their efficacy and reducing the adverse effects and enhancing the modern concept of personalized medicine.
Collapse
Affiliation(s)
- Alessio Buonavoglia
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Patrizia Leone
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Antonio Giovanni Solimando
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Rossella Fasano
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Eleonora Malerba
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Marcella Prete
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | | | - Carlo Prati
- Endodontic Clinical Section, Department of Biomedical and NeuroMotor Sciences, Dental School, University of Bologna, 40125 Bologna, Italy;
| | - Angelo Vacca
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Vito Racanelli
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
- Correspondence:
| |
Collapse
|
8
|
González-Serrano J, López-Pintor RM, Cecilia-Murga R, Torres J, Hernández G, López-Quiles J. Application of propolis extract, nanovitamin C and nanovitamin E to prevent alveolar osteitis after impacted lower third molar surgery. A randomized, double-blind, split-mouth, pilot study. Med Oral Patol Oral Cir Bucal 2021; 26:e118-e125. [PMID: 33609021 PMCID: PMC7980291 DOI: 10.4317/medoral.23915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 01/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Propolis has anti-inflammatory, analgesic and healing properties. The purpose of this study was to determine whether a gel containing 2% of propolis extract, 0.2% of ascorbic acid and 0.2% of tocopherol acetate is effective in preventing surgical complications related to impacted lower third molar extractions. MATERIAL AND METHODS A randomized, double-blind, split-mouth study was performed. Fifteen patients were recruited who needed bilateral impacted lower third molar extractions with a similar surgical difficulty. A test or placebo gel was administered randomly inside post-extraction sockets. Each patient was instructed to apply the gel 3 times/day in the surgical wound for a week. After a month, the contralateral third molar was extracted, and the opposite gel applied. The following parameters were diagnosed/evaluated and then recorded: alveolar osteitis following Blum's criteria, swelling and trismus at day one, two, three and seven post-intervention, wound healing at day 7 post-intervention, and postoperative pain using a visual analog scale, as well as, the number of analgesic pill intake. RESULTS A total of twenty-six surgical procedures were performed in 13 patients (mean age 20.67±2 years). Alveolar osteitis was reported in 3 patients from the placebo group (23.1%) and none in the test group (0%) (p=0.25). No statistically significant differences were reported in swelling, trismus, wound healing or analgesic pill consumption between two groups. But statistically lower postoperative pain during the 7 days after surgical extractions was found according to visual analog scale in test group compared to the placebo group (p=0.007). No side effects were reported. CONCLUSIONS The application of this gel may be effective in preventing alveolitis and thus reducing postoperative pain after impacted third molar extractions. More randomized clinical trials with larger sample are needed to confirm these results.
Collapse
Affiliation(s)
- J González-Serrano
- Departamento de Especialidades Clínicas Odontológicas Facultad de Odontología. Universidad Complutense de Madrid Plaza Ramón y Cajal s/n, 28040, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
9
|
Liao R, Jiang X, Wang R, Li X, Zheng Q, Huang H. Removal of Horizontally Impacted Mandibular Third Molars With Large Root Bifurcations Using a Modified Tooth Sectioning Method. J Oral Maxillofac Surg 2020; 79:748-755.e1. [PMID: 33434519 DOI: 10.1016/j.joms.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to introduce the method and first results of a modified tooth sectioning technique for the extraction of horizontally impacted mandibular third molars (M3Ms) with large root bifurcation. PATIENTS AND METHODS A total of 300 horizontally impacted M3Ms with large root bifurcation in medically healthy patients were included in this prospective study. Patients were divided into 2 groups: the modified method group (test group), in which the M3M was sectioned between the distal root and the remainder of the tooth at the point of root bifurcation; and the conventional method group (control group), in which the M3M was sectioned between the crown and the root at the cementoenamel junction. Operation duration, postoperative reactions, complications, and patient satisfaction were analyzed and compared between the 2 groups. RESULTS Each group included 150 M3Ms which were all successfully extracted. Operation durations in the test and control group were 10.48 ± 3.78 and 15.09 ± 4.24 minutes, respectively (P < .05). The test group had significantly better results than the control group with regard to postoperative reactions and complications (P < .05). Patients in the test group had higher satisfaction ratings regarding operation duration and the healing process than those in the control group (P < .05). CONCLUSIONS The modified method of tooth sectioning between the distal root and the remainder of the tooth can efficiently eliminate resistance from the bone and adjacent mandibular second molar and allow for just 1 sectioning of the M3M in most cases, which could make the operation straightforward and safe.
Collapse
Affiliation(s)
- Rui Liao
- Associate Professor, Department of Oral Surgery, Hangzhou Stomatology Hospital, Savaid Medical School, University of Chinese Academy of Sciences, Hangzhou, China
| | - Xiujing Jiang
- Nurse, Department of Oral Surgery, Hangzhou Stomatology Hospital, Savaid Medical School, University of Chinese Academy of Sciences, Hangzhou, China
| | - Renfei Wang
- Professor, Department of General Dentistry, Hangzhou Stomatology Hospital, Savaid Medical School, University of Chinese Academy of Sciences, Hangzhou, China
| | - Xiaofeng Li
- Professor, Department of General Dentistry, Hangzhou Stomatology Hospital, Savaid Medical School, University of Chinese Academy of Sciences, Hangzhou, China
| | - Qian Zheng
- Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanyao Huang
- Resident, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| |
Collapse
|
10
|
Burdurlu MÇ, Cabbar F, Dagasan VÇ, Işıksaçan NS, Olgaç V. The preventive effect of medicinal herbal extract and gelatin sponge on alveolar osteitis: An in vivo micro-computed tomography and immunohistochemical analysis in rats. Arch Oral Biol 2020; 122:105002. [PMID: 33316659 DOI: 10.1016/j.archoralbio.2020.105002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the preventive effect of medicinal herbal extract (MHE) and gelatin sponge on alveolar osteitis (AO) in an experimental rat model. DESIGN Twenty-one Sprague-Dawley male rats with a mean age of 12 weeks were used. After extraction of the maxillary right first molar, an AO model was created for each animal. The animals were randomly separated to three equal groups. Group I served as a control, Group II was subjected to an intra-alveolar MHE application, and gelatin sponge was left in the sockets of Group III. On the 7th post-extraction day, the animals were sacrificed. The specimens were analyzed by micro-computed tomography (micro-CT), histopathologically and immunohistochemically. RESULTS Macroscopic evaluation revealed mild to intense signs of AO in all groups, but the difference was not significant (p < 0.05). Micro-CT analysis showed that bone formation was the highest in Group III (bone volume/total volume; 10.63 ± 4.9 %), whereas bone mineral density was the highest in Group I (2.05 ± 0.2 g/cm3). The difference was not significant (p > 0.05). In Group III, only 16.7 % of specimens showed no signal of inflammatory response (p < 0.01). The difference was not significant between the positive labeling for receptor activator of nuclear kappa-β (RANK), receptor activator of nuclear kappa-β ligand (RANKL), osteoprotegerin and osteopontin, but the intensity of Groups II and III was higher than the Group I for osteopontin (p < 0.01). CONCLUSIONS MHE and gelatin sponge were not effective enough to prevent alveolar osteitis, but positive results were obtained in bone healing.
Collapse
Affiliation(s)
- Muammer Çağrı Burdurlu
- Department of Oral & Maxillofacial Surgery, Yeditepe University Faculty of Dentistry, Bagdat Caddesi No.238, Kadikoy, Istanbul, Turkiye.
| | - Fatih Cabbar
- Department of Oral & Maxillofacial Surgery, Yeditepe University Faculty of Dentistry, Bagdat Caddesi No.238, Kadikoy, Istanbul, Turkiye
| | - Volkan Çağrı Dagasan
- Department of Oral & Maxillofacial Surgery, Yeditepe University Faculty of Dentistry, Bagdat Caddesi No.238, Kadikoy, Istanbul, Turkiye
| | - Nevzat Sezer Işıksaçan
- Department of Oral & Maxillofacial Surgery, Yeditepe University Faculty of Dentistry, Bagdat Caddesi No.238, Kadikoy, Istanbul, Turkiye
| | - Vakur Olgaç
- Department of Pathology, Oncology Institute, Istanbul University Faculty of Medicine, Topkapı, Turgut Özal Millet Cd No:118, 34093, Fatih, İstanbul, Turkiye
| |
Collapse
|
11
|
WANG CH, YANG SH, JEN HJ, TSAI JC, LIN HK, LOH EW. Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials. J Nurs Res 2020; 29:e137. [PMID: 32956135 PMCID: PMC7808365 DOI: 10.1097/jnr.0000000000000401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature. PURPOSE A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO. METHODS PubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model. RESULTS The RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.
Collapse
Affiliation(s)
- Chia-Hui WANG
- PhD, RN, Supervisor, Department of Nursing, Taipei Medical University Shuang Ho Hospital, and Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC
- contributed equally
| | - Shu-Hui YANG
- BSN, RN, Department of Nursing, Taipei Medical University Shuang Ho Hospital, Taiwan, ROC
- contributed equally
| | - Hsiu-Ju JEN
- BSN, RN, Head Nurse, Department of Nursing, Taipei Medical University Shuang Ho Hospital, and Adjunct Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC
| | - Jui-Chen TSAI
- MSN, RN, Consultant, Department of Nursing, Taipei Medical University Shuang Ho Hospital, and Adjunct Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC
| | - Hsi-Kuei LIN
- DDS, Department of Dentistry, Taipei Medical University Shuang Ho Hospital, and Lecturer, School of Dentistry, College of Oral Medicine, Taipei Medical University, Taiwan, ROC
| | - El-Wui LOH
- PhD, Joint Appointment Medical Researcher, Center for Evidence-Based Health Care and Shared Decision Making Resource Center, Department of Medical Research, and Department of Dentistry, Taipei Medical University Shuang Ho Hospital; Researcher, Cochrane Taiwan, Taipei Medical University; and Assistant Professor, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan, ROC
| |
Collapse
|
12
|
Intrasocket interventions to prevent alveolar osteitis after mandibular third molar surgery: A systematic review and network meta-analysis. J Craniomaxillofac Surg 2020; 48:902-913. [DOI: 10.1016/j.jcms.2020.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/18/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023] Open
|
13
|
Özveri Koyuncu B, Işık G, Özden Yüce M, Günbay S, Günbay T. Effect of concentrated growth factors on frequency of alveolar Osteitis following partially-erupted mandibular third molar surgery: a randomized controlled clinical study. BMC Oral Health 2020; 20:222. [PMID: 32807173 PMCID: PMC7433081 DOI: 10.1186/s12903-020-01210-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 08/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background The aim of this prospective study was to assess the effectiveness of concentrated growth factors (CGF) in preventing the development of alveolar osteitis (AO) after the extraction of partially-erupted mandibular third molars. Methods Seventy patients (26 men and 44 women) 18 years or older (mean age 25.86; range 18–35) underwent 140 third molar extractions. All the patients presented with bilateral, partially-erupted mandibular third molars and underwent surgical extractions. In each case, one socket received CGF and the other served as a control. The predictor variable was the CGF application and the sides were categorized as ‘CGF’ and ‘non-CGF’. The outcome variable was the development of AO during the first postoperative week. Other study variables included age and gender. Data were analyzed using Cochran’s Q test with the significance level set at a P value less than 0.05. Results The overall frequency of AO was 11.4% for the control group. The frequency of AO in the CGF group was significantly lower than in the non-CGF group (p < 0.001). Conclusions Based on the results of this study, application of CGF fibrin gel may decrease the risk of AO development after mandibular third molar surgery. Trial registration This study was registered in ClinicalTrials.gov database on November 1, 2019 (ID: NCT04151147, retrospectively registered).
Collapse
Affiliation(s)
- Banu Özveri Koyuncu
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey.
| | - Gözde Işık
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
| | - Meltem Özden Yüce
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
| | - Sevtap Günbay
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
| | - Tayfun Günbay
- Department of Oral Surgery, Faculty of Dentistry, Ege Univeristy, Bornova, İzmir, Turkey
| |
Collapse
|
14
|
Fiorillo L. Chlorhexidine Gel Use in the Oral District: A Systematic Review. Gels 2019; 5:gels5020031. [PMID: 31212600 PMCID: PMC6631404 DOI: 10.3390/gels5020031] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022] Open
Abstract
Chlorhexidine compounds and their different formulations have been investigated several times, especially in the dentistry field. Chlorhexidine application for mouth rinsing immediately underwent oral contraindications, linked to the possibility of causing pigmentation to the teeth or relating to possible cytotoxic events after oral surgery. The positive effects, however, are considerable and its topical antiseptic action has been widely demonstrated by in vitro and clinical research. That’s the reason for its large application in different fields of dentistry. The aim of this study is to collect all the literature regarding the use of chlorhexidine gel in dentistry and all the numerous applications. The initial search on search engines obtained 232 results; then, following the application of the inclusion criteria there were 24 selected articles. The chlorhexidine gel appliance in the dental daily practice is direct to oral surgery, conservative endodontics, prevention and prophylaxis. The use of chlorhexidine has shown some positive effects, also in the case of systemic diseases prevention. Surely, this topical medicine used both professionally and prescribed for home use, can be considered a great help for the prevention of several oral pathologies with systemic implications too.
Collapse
Affiliation(s)
- Luca Fiorillo
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, Messina University, 98100 Messina, Italy.
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80100 Naples, Italy.
| |
Collapse
|
15
|
Common risk factors of dry socket (alveolitis osteitis) following dental extraction: A brief narrative review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:407-411. [DOI: 10.1016/j.jormas.2018.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/31/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022]
|
16
|
Saghiri MA, Asatourian A, Sheibani N. Angiogenesis and the prevention of alveolar osteitis: a review study. J Korean Assoc Oral Maxillofac Surg 2018; 44:93-102. [PMID: 29963489 PMCID: PMC6024058 DOI: 10.5125/jkaoms.2018.44.3.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/02/2017] [Accepted: 09/13/2017] [Indexed: 12/22/2022] Open
Abstract
Angiogenesis is one of the essential processes that occur during wound healing. It is responsible for providing immunity as well as the regenerative cells, nutrition, and oxygen needed for the healing of the alveolar socket following tooth extraction. The inappropriate removal of formed blood clots causes the undesirable phenomenon of alveolar osteitis (AO) or dry socket. In this review, we aimed to investigate whether enhanced angiogenesis contributes to a more effective prevention of AO. The potential pro- or anti-angiogenic activity of different materials used for the treatment of AO were evaluated. An electronic search was performed in the PubMed, MEDLINE, and EMBASE databases via OVID from January 2000 to September 2016 using the keywords mentioned in the PubMed and MeSH (Medical Subject Headings) terms regarding the role of angiogenesis in the prevention of AO. Our initial search identified 408 articles using the keywords indicated above, with 38 of them meeting the inclusion criteria set for this review. Due to the undeniable role of angiogenesis in the socket healing process, it is beneficial if strategies for preventing AO are directed toward more proangiogenic materials and modalities.
Collapse
Affiliation(s)
- Mohammad Ali Saghiri
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Armen Asatourian
- Angiogenesis Regenerative Medicine Sector, Dr. H. Afsar Lajevardi Research Cluster (DHALC), Shiraz, Iran
| | - Nader Sheibani
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
17
|
Eshghpour M, Danaeifar N, Kermani H, Nejat AH. Does Intra-Alveolar Application of Chlorhexidine Gel in Combination With Platelet-Rich Fibrin Have an Advantage Over Application of Platelet-Rich Fibrin in Decreasing Alveolar Osteitis After Mandibular Third Molar Surgery? A Double-Blinded Randomized Clinical Trial. J Oral Maxillofac Surg 2018; 76:939.e1-939.e7. [DOI: 10.1016/j.joms.2017.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 01/28/2023]
|
18
|
Mamoun J. Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques. J Korean Assoc Oral Maxillofac Surg 2018; 44:52-58. [PMID: 29732309 PMCID: PMC5932271 DOI: 10.5125/jkaoms.2018.44.2.52] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/28/2017] [Accepted: 06/10/2017] [Indexed: 01/30/2023] Open
Abstract
Dry socket, also termed fibrinolytic osteitis or alveolar osteitis, is a complication of tooth exodontia. A dry socket lesion is a post-extraction socket that exhibits exposed bone that is not covered by a blood clot or healing epithelium and exists inside or around the perimeter of the socket or alveolus for days after the extraction procedure. This article describes dry socket lesions; reviews the basic clinical techniques of treating different manifestations of dry socket lesions; and shows how microscope level loupe magnification of 6× to 8× or greater, combined with co-axial illumination or a dental operating microscope, facilitate more precise treatment of dry socket lesions. The author examines the scientific validity of the proposed causes of dry socket lesions (such as bacteria, inflammation, fibrinolysis, or traumatic extractions) and the scientific validity of different terminologies used to describe dry socket lesions. This article also presents an alternative model of what causes dry socket lesions, based on evidence from dental literature. Although the clinical techniques for treating dry socket lesions seem empirically correct, more evidence is required to determine the causes of dry socket lesions.
Collapse
|
19
|
Taberner-Vallverdú M, Sánchez-Garcés MÁ, Gay-Escoda C. Efficacy of different methods used for dry socket prevention and risk factor analysis: A systematic review. Med Oral Patol Oral Cir Bucal 2017; 22:e750-e758. [PMID: 29053647 PMCID: PMC5813994 DOI: 10.4317/medoral.21705] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 06/29/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dry socket is one of the most common complications that develops after the extraction of a permanent tooth, and its prevention is more effective than its treatment. OBJECTIVES Analyze the efficacy of different methods used in preventing dry socket in order to decrease its incidence after tooth extraction. MATERIAL AND METHODS A Cochrane and PubMed-MEDLINE database search was conducted with the search terms "dry socket", "prevention", "risk factors", "alveolar osteitis" and "fibrynolitic alveolitis", both individually and using the Boolean operator "AND". The inclusion criteria were: clinical studies including at least 30 patients, articles published from 2005 to 2015 and written in English. The exclusion criteria were case reports and nonhuman studies. RESULTS 30 publications were selected from a total of 250. Six of the 30 were excluded after reading the full text. The final review included 24 articles: 9 prospective studies, 2 retrospective studies and 13 clinical trials. They were stratified according to their level of scientific evidence using SIGN criteria (Scottish Intercollegiate Guidelines Network). CONCLUSIONS All treatments included in the review were aimed at decreasing the incidence of dry socket. Locally administering chlorhexidine or applying platelet-rich plasma reduces the likelihood of developing this complication. Antibiotic prescription does not avoid postoperative complications after lower third molar surgery. With regard to risk factors, all of the articles selected suggest that patient age, history of previous infection and the difficulty of the extraction are the most common predisposing factors for developing dry socket. There is no consensus that smoking, gender or menstrual cycles are risk factors. Taking the scientific quality of the articles evaluated into account, a level B recommendation has been given for the proposed-procedures in the prevention of dry socket.
Collapse
|
20
|
Armond ACV, Jalles Milani LM, de Fátima Barbosa Fonseca J, de Castro Martins C, Moreira Falci SG. Does the use of intra-alveolar chlorhexidine gel reduces the rate of alveolar osteitis, pain, edema and trismus after the extraction of lower third molars? A meta analysis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2017.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Kaur J, Raval R, Bansal A, Kumawat V. Repercussions of intraalveolar placement of combination of 0.2% chlorhexidine & 10 Mg metronidazole gel on the occurrence of dry sockets- A randomized control trial. J Clin Exp Dent 2017; 9:e284-e288. [PMID: 28210450 PMCID: PMC5303332 DOI: 10.4317/jced.53262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the effects of intraalveolar placement of gel containing 0.2% chlorhexidine and 10gm of metronidazole on the incidence of alveolar osteitis. Material and Methods A total of 300 impacted third molars were extracted in 150 patients enrolled in this trial. In each subject a socket was randomly selected and packed to the crest of alveolar ridge with the gel. The contralateral socket was packed with placebo dressing. The occurrence of dry socket was assessed during 3rd and 5th postoperative days .The data was analysed using a meta analytical program. Study Design Double blind, prospective, placebo controlled trial. Results The combination of metronidazole + chlorhexidine gel significantly reduced dry socket incidence from 22.6% to 6.6% (P ≤ 0.001) [McNemar and chi-square tests]. Conclusions The decrease in incidence of adverse reactions and complications related to local application of metronidazole and chlorhexidine gel explains its clinical use, specifically in mandibular molar extractions where the chances of dry sockets are high. Key words:Chlorhexidine, dry socket, intra-alveolar, metronidazole, placebo.
Collapse
Affiliation(s)
- Jasleen Kaur
- Postgraduate student, Dept of Oral and maxillofacial surgery, Maharaja Ganga Singh Dental College and Research Centre, 11, LNP, Hanumangarhroad, Near RICCO, Sri Ganganagar, Rajasthan, India
| | - Rushik Raval
- Postgraduate student, Dept of Oral and maxillofacial surgery, Maharaja Ganga Singh Dental College and Research Centre, 11, LNP, Hanumangarhroad, Near RICCO, Sri Ganganagar, Rajasthan, India
| | - Anupam Bansal
- Assistant Professor, department of oral and maxillofacial surgery, Darshan Dental college, Udaipur
| | - Vinod Kumawat
- Postgraduate student, Dept of Oral and maxillofacial surgery, Maharaja Ganga Singh Dental College and Research Centre, 11, LNP, Hanumangarhroad, Near RICCO, Sri Ganganagar, Rajasthan, India
| |
Collapse
|
22
|
Rodríguez Sánchez F, Rodríguez Andrés C, Arteagoitia Calvo I. Does Chlorhexidine Prevent Alveolar Osteitis After Third Molar Extractions? Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2017; 75:901-914. [PMID: 28189661 DOI: 10.1016/j.joms.2017.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The prevention of alveolar osteitis (AO) in dental extractions remains a controversial issue. Chlorhexidine is one of the most widely studied antiseptics for the prevention of AO. The purpose of this systematic review and meta-analysis was to assess the efficacy and effectiveness of chlorhexidine in the prevention of AO after third molar extractions. MATERIALS AND METHODS The authors searched databases and the references of each article retrieved up to December 2015. Clinical randomized controlled trials (RCTs) using only chlorhexidine were included. The predictor variable was whether chlorhexidine was used in any formulation, concentration, or regimen. The outcome measurement was the incidence of postoperative AO. The authors also recorded variables describing the characteristics of the included studies. Statistical analysis was performed using STATA 12.0. Meta-analysis of binary data was conducted using a fixed-effects model. Risk ratios and 95% confidence intervals (CIs) were estimated. Forest, l'Abbé, and funnel plots were constructed. RESULTS Twenty-three studies published from 1979 to 2015, corresponding to 18 trials (16 parallel-group and 2 split-mouth RCTs), that reported on 2,824 third molar extractions (1,458 in experimental group and 1,366 in control group) were included. The overall relative risk (RR) was 0.53 (95% CI, 0.45-0.62; P < .0001). There was no evidence of heterogeneity (I2 = 9.3%; P = .336 by χ2 test). The number needed to treat was 8 (95% CI, 7-11). There were no relevant differences between chlorhexidine rinse (RR = 0.58; 95% CI, 0.47-0.71) and gel (RR = 0.47; 95% CI, 0.37-0.60). Chlorhexidine did not cause a larger proportion of adverse reactions than placebo. CONCLUSION The use of chlorhexidine, in any formulation, concentration, or regimen, is efficacious and effective in preventing AO in patients who have undergone third molar extraction. Chlorhexidine gel was found to be moderately more efficacious than the rinse formulation.
Collapse
Affiliation(s)
| | - Carlos Rodríguez Andrés
- Department Head and Professor, Department of Epidemiology and Public Health, University of the Basque Country (UPV/EHU)
| | - Iciar Arteagoitia Calvo
- Associate Professor of Maxillofacial Surgery, University of the Basque Country (UPV/EHU); Member, Department of Maxillofacial Surgery, BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU)
| |
Collapse
|
23
|
Hasani A, Ahmadi Moshtaghin F, Roohi P, Rakhshan V. Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg 2016; 46:230-235. [PMID: 27810140 DOI: 10.1016/j.ijom.2016.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/19/2016] [Accepted: 10/07/2016] [Indexed: 01/18/2023]
Abstract
The aim of this study was to evaluate the diagnostic accuracies of cone beam computed tomography (CBCT) and panoramic techniques in predicting inferior alveolar nerve (IAN) exposure. The sample size was determined based on a pilot study. This prospective clinical series study included 59 third molar extraction sites with any of seven previously suggested panoramic signs of IAN exposure. The diagnosis of nerve exposure was done on panoramic and CBCT images. Molars were extracted and nerve exposure was evaluated clinically. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CBCT method, and sensitivity and PPV of panoramic method were estimated). The panoramic and CBCT methods correctly classified 67.7% and 93.3%, respectively, of 60 cases. This difference was statistically significant (χ2=13.333, P=0.000). The sensitivity, specificity, PPV, and NPV for CBCT were 97.4%, 85.7%, 92.7%, and 94.7%, respectively. The sensitivity and PPV of panoramic radiography were 67.8% and 97.6%, respectively. The signs with the highest sensitivity were interruption of the mandibular canal border and abrupt canal narrowing. None of the Pell and Gregory criteria, molar angulations, or three-dimensional canal-apex relationships was significantly associated with clinically confirmed IAN exposure. Panoramic radiography may miss about one-third of exposure cases, but a positive panoramic diagnosis is most likely to be a real exposure and should be taken seriously.
Collapse
Affiliation(s)
- A Hasani
- Department of Maxillofacial Surgery, Dental Branch, Islamic Azad University, Tehran, Iran
| | | | - P Roohi
- Private Practice, Tehran, Iran
| | - V Rakhshan
- Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
24
|
Zhou J, Hu B, Liu Y, Yang Z, Song J. The efficacy of intra-alveolar 0.2% chlorhexidine gel on alveolar osteitis: a meta-analysis. Oral Dis 2016; 23:598-608. [PMID: 27479137 DOI: 10.1111/odi.12553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/22/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective of this meta-analysis was to assess the effect of 0.2% chlorhexidine gel in preventing alveolar osteitis following mandibular third molar extraction(s). METHODS PubMed, Cochrane Library, Embase, Web of Science, Science Direct and the references of identified articles were searched for relevant studies that met our eligibility criteria. Treatment effects were combined by meta-analysis using RevMan 5.3 and Stata 12.0 software. RESULTS We included 11 trials in this meta-analysis. Compared to the control, 0.2% chlorhexidine gel reduced the risk of alveolar osteitis by 62% (RR = 0.38, 95% CI = 0.28-0.53, P < 0.00001) following mandibular third molar extraction(s). The subgroup analysis results indicated that 0.2% chlorhexidine gel reduced the risk of alveolar osteitis after mandibular third molar extraction(s) by 75% (RR = 0.25, 95% CI = 0.11-0.58) and 56% (RR = 0.44, 95% CI = 0.30-0.63) compared to no treatment and placebo, respectively. However, the occurrence of alveolar osteitis following mandibular third molar extraction(s) was not significantly different between 0.2% chlorhexidine gel and 0.12% chlorhexidine mouthwash (RR = 0.24, 95% CI = 0.06-1.00). CONCLUSION The results showed that 0.2% chlorhexidine gel was effective in preventing alveolar osteitis after lower third molar extraction(s).
Collapse
Affiliation(s)
- J Zhou
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - B Hu
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Y Liu
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Z Yang
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - J Song
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, College of Stomatology, Chongqing Medical University, Chongqing, China
| |
Collapse
|
25
|
Requena-Calla S, Funes-Rumiche I. Effectiveness of intra-alveolar chlorhexidine gel in reducing dry socket following surgical extraction of lower third molars. A pilot study. J Clin Exp Dent 2016; 8:e160-3. [PMID: 27034756 PMCID: PMC4808311 DOI: 10.4317/jced.52444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/05/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dry socket is one of the most studied complications in dentistry and several studies have sought an effective and safe method for its prevention and treatment. The aim of this study was to evaluate the effectiveness of intra-alveolar gel chlorhexidine in preventing dry socket after the surgical removal of third molars. MATERIAL AND METHODS The sample involved the treatment of 40 patients who required extraction of third molars impacted, which were randomly assigned to research groups: experimental group (chlorhexidine gel 0.12%) and control group (placebo gel). Performed the extraction was administered 1 mL of chlorhexidine gel or 1 mL of placebo gel within the socket. The removal of suture was on the fifth postoperative day in which the presence or absence of dry socket was evaluated. RESULTS No relationship between the appearance of dry socket after application of chlorhexidine gel or placebo gel (X2 test, p = 0.311) was found. However, significant differences (U Mann-Whitney test, p = 0.036) in the pain presented on the fifth postoperative day were evident (VAS). CONCLUSIONS The administration of intra-alveolar chlorhexidine gel 0.12% could generate a better response to postoperative pain after the removal of third molars. KEY WORDS Third molar surgery, dry socket, chorhexidine gel.
Collapse
|
26
|
Elo JA, Sun HHB, Dong F, Tandon R, Singh HM. Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:124-33. [PMID: 27055733 DOI: 10.1016/j.oooo.2016.01.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 01/21/2016] [Accepted: 01/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To measure the influence of flap design on alveolar osteitis (AO) and postoperative complications following mandibular third molar surgery. STUDY DESIGN This study was designed as a randomized single-blind, split-mouth clinical trial. The predictor variable was flap type. Envelope flap, modified triangular flap (MTF), and two related experimental flaps (second molar mesial papilla-sparing marginal incision with distobuccal release with double-pass single-layered primary closure [MPMI-2 X] and single-pass single-layered primary closure [MPMI-1 X]) were used. The primary outcome variable was AO. The secondary outcome variables were wound dehiscence and infection. Bivariate and logistic analyses were computed. P value < .05 was considered to be statistically significant. RESULTS One hundred ninety-six patients with symmetric bilateral partial bony or full bony impacted mandibular third molars participated. No sites (0 of 196) treated with MPMI-2 X developed AO, and only two sites (2 of 196) treated with MPMI-2 X developed postoperative infection. Both MPMI-1 X and MPMI-2 X were associated with decreased odds of complications compared with MTF and envelope flap. MPMI-2 X sites were significantly less likely than MTF sites to experience complications for both sides. CONCLUSIONS MPMI-2 X is a reliable technique to reduce complications, such as AO, wound dehiscence, and infection in mandibular third molar surgery.
Collapse
Affiliation(s)
- Jeffrey A Elo
- Associate Professor, Division of Oral and Maxillofacial Surgery, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA; Assistant Professor, Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
| | - Ho-Hyun Brian Sun
- Dental Student, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA
| | - Fanglong Dong
- Associate Professor, Biostatistician, Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, California, USA
| | - Rahul Tandon
- Resident, Department of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hardev M Singh
- Assistant Professor, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA
| |
Collapse
|
27
|
Sawada K, Caballé-Serrano J, Bosshardt DD, Schaller B, Miron RJ, Buser D, Gruber R. Antiseptic solutions modulate the paracrine-like activity of bone chips: differential impact of chlorhexidine and sodium hypochlorite. J Clin Periodontol 2015; 42:883-891. [PMID: 26284317 DOI: 10.1111/jcpe.12447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 12/14/2022]
Abstract
AIM Chemical decontamination increases the availability of bone grafts; however, it remains unclear whether antiseptic processing changes the biological activity of bone. MATERIALS AND METHODS Bone chips were incubated with four different antiseptic solutions including (1) povidone-iodine (0.5%), (2) chlorhexidine diguluconate (0.2%), (3) hydrogen peroxide (1%) and (4) sodium hypochlorite (0.25%). After 10 min. of incubation, changes in the capacity of the bone-conditioned medium (BCM) to modulate gene expression of gingival fibroblasts was investigated. RESULTS Conditioned medium obtained from freshly prepared bone chips increased the expression of TGF-β target genes interleukin 11 (IL11), proteoglycan4 (PRG4), NADPH oxidase 4 (NOX4), and decreased the expression of adrenomedullin (ADM), and pentraxin 3 (PTX3) in gingival fibroblasts. Incubation of bone chips with 0.2% chlorhexidine, followed by vigorously washing resulted in a BCM with even higher expression of IL11, PRG4 and NOX4. These findings were also detected with a decrease in cell viability and an activation of apoptosis signalling. Chlorhexidine alone, at low concentrations, increased IL11, PRG4 and NOX4 expression, independent of the TGF-β receptor I kinase activity. In contrast, 0.25% sodium hypochlorite almost entirely abolished the activity of BCM, whereas the other two antiseptic solutions, 1% hydrogen peroxide and 0.5% povidone-iodine, had relatively no impact respectively. CONCLUSION These in vitro findings demonstrate that incubation of bone chips with chlorhexidine differentially affects the activity of the respective BCM compared to the other antiseptic solutions. The data further suggest that the main effects are caused by chlorhexidine remaining in the BCM after repeated washing of the bone chips.
Collapse
Affiliation(s)
- Kosaku Sawada
- Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jordi Caballé-Serrano
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Dieter D Bosshardt
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Benoit Schaller
- Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Richard J Miron
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Daniel Buser
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Reinhard Gruber
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland.,Department of Oral Biology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
28
|
Azizi A, Sarlati F, Bidi M, Mansouri L, Azaminejad SMM, Rakhshan V. Effects of smoking severity and moderate and severe periodontitis on serum C-reactive protein levels: an age- and gender-matched retrospective cohort study. Biomarkers 2015; 20:306-12. [DOI: 10.3109/1354750x.2015.1068864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
29
|
Rakhshan V. Common risk factors for postoperative pain following the extraction of wisdom teeth. J Korean Assoc Oral Maxillofac Surg 2015; 41:59-65. [PMID: 25922816 PMCID: PMC4411729 DOI: 10.5125/jkaoms.2015.41.2.59] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/04/2014] [Accepted: 12/11/2014] [Indexed: 12/01/2022] Open
Abstract
The extraction of third molars is a common task carried out at dental/surgery clinics. Postoperative pain is one of the two most common complications of this surgery, along with dry socket. Knowledge of the frequent risk factors of this complication is useful in determining high-risk patients, planning treatment, and preparing the patients mentally. Since the risk factors for postoperative pain have never been summarized before while the risk factors for dry socket have been highly debated, this report summarizes the literature regarding the common predictors of postextraction pain. Except for surgical difficulty and the surgeon's experience, the influences of other risk factors (age, gender and oral contraceptive use) were rather inconclusive. The case of a female gender or oral contraceptive effect might mainly be associated with estrogen levels (when it comes to dry socket), which can differ considerably from case to case. Improvement in and unification of statistical and diagnostic methods seem necessary. In addition, each risk factor was actually a combination of various independent variables, which should instead be targeted in more comprehensive studies.
Collapse
Affiliation(s)
- Vahid Rakhshan
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran. ; Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
30
|
Tarakji B, Saleh LA, Umair A, Azzeghaiby SN, Hanouneh S. Systemic review of dry socket: aetiology, treatment, and prevention. J Clin Diagn Res 2015; 9:ZE10-3. [PMID: 26023661 PMCID: PMC4437177 DOI: 10.7860/jcdr/2015/12422.5840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/23/2015] [Indexed: 11/24/2022]
Abstract
Our systemic review is to make a comprehensive review about the aetiology, treatment and the prevention of dry socket, the inclusion criteria were all the studies that discuss the dry socket and its etiology, treatment and prevention and exclusion criteria were all the studies that discuss the other complications of tooth extraction, the materials and methods used for this systemic review was to search in the Pub Medline database between 2008 to 2013, using specific words "dry socket, aetiology, treatment and prevention" and published in the English language, the articles were screened by abstract for relevance to aetiology, treatment and prevention of dry socket, 82 papers were identified in pub med but a total of 36 out of Publications were included in the final systemic review according to the specific keywords and materials mentioned above. The occurrence of dry socket in an everyday oral surgery or dental practice is unavoidable. The risk factors are smoking, surgical trauma, single extractions, age, sex, medical history, systemic disorder, extraction site, amount of anaesthesia, operator experience, antibiotics use prior to surgery, difficulty of the surgery and the previous surgical site infection in addition to oral Contraceptives, menstrual cycle and immediate postextraction socket irrigation with normal saline. The traditional options of treatment are directed toward palliative care, such as the irrigation of the surgical site, avoiding curetting the extraction socket, Packing with a zinc oxide- eugenol paste on iodoform gauze can be considered to relieve acute pain episodes, there is also new agents in the market can accelerate the healing of the socket such as PRGF and GECB. The prevention methods include avoiding smoking before and after surgery and a traumatic surgery, the use of antibiotics, such as, azithromycin, can be considered, the other preventive measures such as chlorhecidine rinse or gel can be effective in the reduction of dry socket incidence.
Collapse
Affiliation(s)
- Bassel Tarakji
- Faculty, Department of Oral Maxillofacial Sciences, Alfarabi CollegesSaudi Arabia
| | - Lubna Ahmed Saleh
- Faculty, Department of Oral Maxillofacial Sciences, Alfarabi CollegesSaudi Arabia
| | - Ayesha Umair
- Faculty, Department of Oral Maxillofacial Sciences, Alfarabi CollegesSaudi Arabia
| | | | - Salah Hanouneh
- Faculty, Department of Oral Maxillofacial Sciences, Alfarabi CollegesSaudi Arabia
| |
Collapse
|
31
|
Haraji A, Rakhshan V. Chlorhexidine gel and less difficult surgeries might reduce post-operative pain, controlling for dry socket, infection and analgesic consumption: a split-mouth controlled randomised clinical trial. J Oral Rehabil 2014; 42:209-19. [PMID: 25251411 DOI: 10.1111/joor.12230] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2014] [Indexed: 12/01/2022]
Abstract
Reports on post-surgical pain are a few, controversial and flawed (by statistics and analgesic consumption). Besides, it is not known if chlorhexidine can reduce post-extraction pain adjusting for its effect on prevention of infection and dry socket (DS). We assessed these. A total of 90 impacted mandibular third molars of 45 patients were extracted. Intra-alveolar 0·2% chlorhexidine gel was applied in a split-mouth randomised design to one-half of the sockets. None of the included patients took antibiotics or analgesics afterwards. In the first and third post-operative days, DS formation and pain levels were recorded. Predictive roles of the risk factors were analysed using fixed-effects (classic) and multilevel (mixed-model) multiple linear regressions (α = 0·05, β≤0·1). In the first day, pain levels were 5·56 ± 1·53 and 4·78 ± 1·43 (out of 10), respectively. These reduced to 3·22 ± 1·41 and 2·16 ± 1·40. Pain was more intense on the control sides [both P values = 0·000 (paired t-test)]. Chlorhexidine had a significant pain-alleviating effect (P = 0·0001), excluding its effect on DS and infection. More difficult surgeries (P = 0·0201) and dry sockets were more painful (P = 0·0000). Age had a marginally significant negative role (P = 0·0994). Gender and smoking had no significant impact [P ≥ 0·7 (regression)]. The pattern of pain reduction differed between dry sockets and healthy sockets [P = 0·0102 (anova)]. Chlorhexidine can reduce pain, regardless of its infection-/DS-preventive effects. Simpler surgeries and sockets not affected by alveolar osteitis are less painful. Smoking and gender less likely affect pain. The role of age was not conclusive and needs future studies.
Collapse
Affiliation(s)
- A Haraji
- Department of Oral and Maxillofacial Surgery, Dental Branch, Islamic Azad University, Tehran, Iran
| | | |
Collapse
|