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Oliveira JA, da Silveira MI, Soares LFF, Alves RDO, Carrera TMI, Azevedo MR, Oliveira GJPLD, Pigossi SC. Wound-healing agents for palatal donor area: A network meta-analysis. Clin Oral Implants Res 2024; 35:359-376. [PMID: 38315151 DOI: 10.1111/clr.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The aim of this systematic review and network meta-analysis (NMA) was to assess the efficacy of different wound-healing agents for palatal donor area management after soft tissue graft harvesting. METHODS Electronic searches in six databases were conducted for publications up to October 2023. Studies with data from patients undergoing therapeutic approaches using agents for palatal healing after gingival graft harvesting were included. Data about postoperative pain, wound-healing and postoperative complications reported for each agent were extracted. Three different tools were used for the risk of bias within studies evaluation (Murad tool for case series and case report, RoB 2.0 tool for randomized studies and ROBINS-I tool for non-randomized studies). A Bayesian random effects NMA was conducted for postoperative pain levels and wound healing. RESULTS Eighty-four publications were included in the systematic review (qualitative analysis), with 14 of these subjected to NMA (quantitative analysis). The summarized results from the qualitative and quantitative analysis showed that all wound-healing agents evaluated promoted better pain control and wound healing compared to spontaneous healing and hemostatic sponges alone. The NMA outcomes reveal that leucocyte- and platelet-rich fibrin (L-PRF) was the most effective agent in reducing postoperative pain in all analyzed periods. Moreover, the L-PRF seems to accelerate wound healing and reduce postoperative complications compared to other agents. CONCLUSION In conclusion, the L-PRF was the most effective agent in reducing postoperative pain, accelerating wound healing and reducing postoperative complications after harvesting soft tissue grafts from the palatal area.
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Affiliation(s)
- Jovânia Alves Oliveira
- School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Lélio Fernando Ferreira Soares
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP - São Paulo State University (FOAr/UNESP), Araraquara, São Paulo, Brazil
| | - Roberta de Oliveira Alves
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Thaísa Macedo Iunes Carrera
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Mayra Resende Azevedo
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Suzane Cristina Pigossi
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
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Santos EC, Huller D, Brigola S, Ferreira MD, Pochapski MT, dos Santos FA. Pain management in periodontal therapy using local anesthetics and other drugs: an integrative review. J Dent Anesth Pain Med 2023; 23:245-256. [PMID: 37841520 PMCID: PMC10567545 DOI: 10.17245/jdapm.2023.23.5.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Background Surgical and non-surgical periodontal procedures often lead to postoperative pain. Clinicians use pharmacological methods such as anesthetics, anti-inflammatory drugs, and analgesics for relief. However, the multitude of options makes it challenging to select the best approach for routine dental care. Objective This review aimed to describe previous studies regarding the pharmacological management used for pain control during periodontal procedures as well as factors that may interfere with patients' perception of pain. Methods We included studies (period of 2000-2023, whose approach corresponded to the pharmacological protocols used for preoperative, trans-operative, and postoperative pain control in adult patients undergoing surgical and non-surgical periodontal therapy. Results A total of 32 studies were included in the analysis, of which 17 (53%) were related to anesthetic methods and 15 (47%) were related to therapeutic protocols (anti-inflammatory/analgesic agents). These studies predominantly involved nonsurgical periodontal procedures. Studies have reported that factors related to age, type of procedure, and anxiety can influence pain perception; however, only seven of these studies evaluated anxiety. Conclusions Numerous methods for pain control can be applied in periodontal therapy, which are accomplished through anesthetic methods and/or therapeutic protocols. Factors such as anxiety, age, and type of procedure are related to pain perception in patients. Thus, it is the responsibility of dentists to evaluate each clinical situation and define the best protocol to follow based on the literature.
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Affiliation(s)
| | - Daniela Huller
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Paraná, Brazil
| | - Sabrina Brigola
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Paraná, Brazil
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Wu X, Ye M, Sun J, Yan Q, Shi B, Xia H. Patient-reported outcome measures following surgeries in implant dentistry and associated factors: a cross-sectional study. BMJ Open 2022; 12:e059730. [PMID: 35710257 PMCID: PMC9207936 DOI: 10.1136/bmjopen-2021-059730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the patient-reported outcome measures (PROMs) of dental implant surgeries and analyse the associated indicators. DESIGN A cross-sectional study design was used. SETTING Department of Oral Implantology, Hospital of Stomatology, Wuhan University (May 2020-April 2021). PARTICIPANTS Participants with missing teeth in need of implant-supported rehabilitation. INTERVENTIONS Dental implant placement and/or bone augmentation procedures. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was discomfort on postoperative day 1, measured using a numerical rating scale (NRS). Secondary outcomes included pain and anxiety during surgery; discomfort on postoperative days 3, 7 and 14; and post-surgical complications. RESULTS A total of 366 participants were included, of which 288 (78.7%) and 328 (89.7%) reported no to mild pain and anxiety (NRS 0-3) during surgery, respectively. The proportion of patients reporting discomfort decreased from postoperative day 1 (57.7%) to day 3 (36.1%) and day 7 (17.5%). The most frequent postoperative adverse events were pain and swelling. Patient-related factors (age, sex, smoking, alcohol consumption, history of periodontitis, and pain and anxiety during surgery) and surgery-related factors (type and extent of surgical procedure) were analysed. The factors associated with the severity of discomfort after surgery included alcohol consumption, pain perception during surgery, bone augmentation procedures and age (p<0.05). Similarly, the factors associated with the duration of discomfort included alcohol consumption, pain perception during surgery and age (p<0.05). CONCLUSIONS PROMs related to dental implant surgeries can be predicted using certain risk indicators. Alcohol consumption, pain during surgery and age were associated with discomfort following dental implant surgery.
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Affiliation(s)
- Xinyu Wu
- The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Mengjie Ye
- The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jiahui Sun
- The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qi Yan
- The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bin Shi
- The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Haibin Xia
- The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Valentim Bitencourt F, Cardoso De David S, Schutz JDS, Otto Kirst Neto A, Visioli F, Fiorini T. Effect of photobiomodulation therapy on patient morbidity and wound healing at donor site after free gingival graft harvesting: a triple-blind randomized-controlled clinical trial. Clin Oral Implants Res 2022; 33:622-633. [PMID: 35305280 DOI: 10.1111/clr.13923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 02/02/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effect of photobiomodulation therapy (PBMT) on patient morbidity and donor site healing after free gingival graft (FGG) harvesting. METHODS Forty-four patients requiring FGG were selected for this trial. Individuals were randomly assigned to test group (PBMT, n=22) or control group (placebo, n=22) applied immediately after surgery, 24 and 48 hours after. Demographic, surgical-related and psychosocial variables possibly associated with treatment response were collected. The primary outcome was postoperative pain at the donor site evaluated using Visual Analogue Scale (VAS) immediately after surgery and 6, 24, 48 and 72 hours after. Secondary outcomes include medication consumption, patient-reported outcome measures (PROMs) and percentage of wound closure. RESULTS Intragroup analysis showed no differences in VASLog means for placebo group throughout the study (p>0.05), whereas a significant difference in PBMT group at 6h, 24h, 48h and 72h (p<0.05) were observed. Postoperative rescue analgesic requirement was significantly higher in the placebo group (p=0.004). The number needed to treat(NNT) was 2.43. PBMT group reported significant better function related to sleeping, going to work/school and daily routine activities, less restriction to mouth opening, chewing and food consumption, less swelling and bleeding (p<0.05), mainly in the first 48hs. PBMT group presented a significantly higher palatal wound closure at 7 days compared to placebo group (33.41 vs 21.20 respectively, p=0.024) after adjustment for confounding. No adverse effects were reported. CONCLUSIONS PBMT accelerated the pain resolution time and palatal closure, decreased rescue medication consumption and significantly improved patient satisfaction in the postoperative period.
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Affiliation(s)
| | - Silvia Cardoso De David
- Department of Conservative Dentistry - Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jasper da Silva Schutz
- Department of Conservative Dentistry - Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alfredo Otto Kirst Neto
- Department of Conservative Dentistry - Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Visioli
- Department of Conservative Dentistry - Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tiago Fiorini
- Department of Conservative Dentistry - Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Liu Y, Zhang C, Wu J, Yu H, Xie C. Evaluation of the relationship among dental fear, scaling and root planing and periodontal status using periodontitis stages: A retrospective study. J Dent Sci 2022; 17:293-299. [PMID: 35028050 PMCID: PMC8739248 DOI: 10.1016/j.jds.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
Background/purpose Patients with periodontal disease have higher dental fear levels, which may have negative effects on their clinical outcome during scaling and root planing (SRP). The present study used the new classification of periodontitis and validated questionnaires to assess the relationship among dental fear, SRP pain and periodontal status. Materials and methods A total of 120 periodontitis patients were enrolled and staging according to the new classification of periodontitis. SRP was performed, and the visual analog scale (VAS) to assess pain was used with every patient after treatment. Questionnaires, including Corah's Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and short-form Dental Anxiety Inventory (S-DAI) were implemented from the first attendance and subsequent visits after 6 months. The patients were grouped by DAS scores. The statistical analysis was performed using T-test, chi-square, Pearson and Spearman correlative analysis. Results Compared to pre-SRP treatment, the dental fear level on DFS was decreased in the posttreatment period for all periodontitis stages. There were no statistically significant differences in S-DAI and DAS between pretreatment and posttreatment periods in stage I and II; meanwhile, there were statistically differences in stage III and IV. The correlation among periodontitis stages, VAS and dental fear level was significant. The proportion of high periodontitis stages was increased in high dental fear group. Conclusion SRP can reduce dental fear levels in all periodontitis stages, especially in stage III and IV. Correlations exist among periodontal status, dental fear and SRP pain. High dental fear is associated with poor periodontal status.
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Affiliation(s)
- Yeungyeung Liu
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Caimei Zhang
- Department of Endodontics, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Jingyi Wu
- Department of Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Huimin Yu
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Chengjie Xie
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, China
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TEZCİ N, KARADUMAN B. The Effects of Different Pre-operative Information Timings on Patients’ Anxiety Level and Pain Perception. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.801354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Santos BFE, Costa FO, Vasconcelos AMA, Cyrino RM, Cota LOM. Preemptive effects of ibuprofen and nimesulide on postoperative pain control after open flap periodontal surgeries: A randomized placebo-controlled split-mouth clinical trial. J Periodontol 2021; 93:298-307. [PMID: 34031888 DOI: 10.1002/jper.20-0887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Data on preemptive analgesia in periodontal surgeries are scarce and still diverse. The aim of this study was to evaluate and compare the analgesic effects of the preemptive administration of ibuprofen and nimesulide in open flap periodontal surgeries. METHODS The present randomized controlled clinical trial comprised 40 individuals, divided into two groups (n = 20), according to the test drug (ibuprofen and nimesulide) to be administered 1 hour preoperatively. Participants underwent bilateral periodontal surgeries at two different times, and were randomly given the test drug or placebo in a split-mouth design. Postoperative pain and rescue medication were evaluated at different times. Comparisons between ibuprofen and nimesulide were performed through a Generalized Estimation Equation model, using test drug and evaluation times, along with an interaction between these two variables as predictors. RESULTS In intergroup comparisons regarding pain control, ibuprofen showed better effects than placebo only at the first postoperative hour, whereas nimesulide showed better effects than placebo at 1, 6, 24, and 48 postoperative hours. In intergroup comparisons, nimesulide showed better effects than ibuprofen at 24, 48, and 72 postoperative hours, demonstrating a higher overall preemptive effect. No differences were observed in relation to the number of rescue medication. CONCLUSION Preemptive administration of nimesulide showed better overall preemptive effects on postoperative pain control when compared with ibuprofen.
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Affiliation(s)
- Bianca F E Santos
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Fernando O Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Andrea M A Vasconcelos
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Renata M Cyrino
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Luís O M Cota
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
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Khouly I, Braun RS, Ordway M, Alrajhi M, Fatima S, Kiran B, Veitz-Keenan A. Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig 2021; 25:2511-2536. [PMID: 33839939 DOI: 10.1007/s00784-021-03859-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the clinical efficacy of various analgesic medications in mitigating orofacial pain following dental implant surgery. MATERIALS AND METHODS A systematic search was conducted to identify randomized controlled clinical trials (RCTs). The primary outcomes examined were post-operative pain (POP) and consumption of rescue analgesics following implant placement; secondary outcomes included adverse effects, post-operative inflammation, infection, swelling, bleeding, patient satisfaction, and quality of life. Random effects meta-analysis was conducted for risk ratios of dichotomous data. RESULTS Nine RCTs fulfilled the eligibility criteria. Individual studies and meta-analysis of two studies indicated that nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced POP and consumption of rescue analgesics after dental implant placement compared to placebo. Transdermal administration of NSAIDs may be superior to the oral route as it was similarly effective for POP control and resulted in fewer side effects. Glucocorticoids administered as primary analgesics or NSAID adjuvants resulted in comparable pain sensation compared to NSAIDs alone. Caffeine-containing analgesics were reported as acceptable and effective for the treatment of POP and swelling when compared to codeine adjuvants. With regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 h following dental implant placement. Risk of bias assessment indicated an overall low risk of bias across the included trials. CONCLUSION Within the limitations of this review, POP following implant surgery may be effectively treated with the short-term use of analgesic medications. However, given the heterogeneity in the available RCTs, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery. CLINICAL RELEVANCE Short-term use of analgesic medications may be sufficient for post-operative pain management in dental implant surgery. Ultimately, the clinician's analgesic prescription should be directed by a patient's medical history, in order to increase the success of pain management in a short period of time and decrease potential adverse effects. TRIAL REGISTRATION CRD42018099324.
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Affiliation(s)
- Ismael Khouly
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 421 First Avenue - BCCR 2W, New York, NY, 10010, USA.
| | - Rosalie Salus Braun
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - Michelle Ordway
- Department of Periodontics, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
| | - Mashal Alrajhi
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA
| | - Sana Fatima
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - Bhupesh Kiran
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA
| | - Analia Veitz-Keenan
- Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
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Al-Bayati O, Font K, Soldatos N, Carlson E, Parsons J, Powell CA. Evaluation of the need to prescribe opioid medication to control post-surgical pain of different periodontal/oral surgeries. J Periodontol 2020; 92:1030-1035. [PMID: 33155320 DOI: 10.1002/jper.20-0315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/16/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND To determine the level of perceived pain after different types of periodontal/oral surgical procedures, and the differences in patients' selection of pain management, over the counter (OTC) versus opioid, based on procedure type. METHODS Patients undergoing surgical procedures were asked to complete a pain questionnaire at four time points: 1) before surgery 2) first dose of analgesic at home, 3) 24 hours postoperatively, and 4) 72 hours postoperatively. The questionnaire consisted of numerical and descriptive scales to describe the perceived pain. RESULTS A total of 198 patients completed the questionnaire. All surgical procedures were grouped into five major categories: bone augmentation procedures (11% BAP), teeth extractions (26% EXT), surgical implant placement (25% IP), mucogingival surgeries (21% MGS), and pocket elimination procedures (17%). IP surgery was associated with significantly less pain compared with MGS and EXT (P <0.05). There was a statistically significant difference for taking any medication based on type of surgical procedure at 24 hours (P <0.05). CONCLUSIONS IP is associated with significantly lower perceived pain compared with EXT and MGS surgery. Analgesic consumption was generally parallel to pain perception. A considerable number of patients elected to control the post-surgical pain using OTC medication up to 72 hours. Periodontal/oral surgery procedures vary in the amount of perceived postoperative pain. Tailoring postoperative medications to the type of periodontal/oral surgery performed will help prevent overprescribing of opioids.
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Affiliation(s)
- Omar Al-Bayati
- Division of Periodontics, Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, CO
| | - Kerri Font
- Division of Periodontics, Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, CO
| | - Nikolaos Soldatos
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas Health Science Center at Houston, TX
| | - Emanouela Carlson
- Division of Endodontics, Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, CO
| | - Joseph Parsons
- Division of Endodontics, Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, CO
| | - Charles A Powell
- Department of Surgical Dentistry, Division of Periodontics, Director of Postdoctoral Periodontics, Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, CO.,Department of Periodontics, UT Health San Antonio, San Antonio, TX
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10
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Beaudette JR, Fritz PC, Sullivan PJ, Piccini A, Ward WE. Patients undergoing periodontal procedures commonly use dietary supplements: A consideration in the design of intervention trials. Clin Exp Dent Res 2020; 7:123-128. [PMID: 32954684 PMCID: PMC7853901 DOI: 10.1002/cre2.328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023] Open
Abstract
Objective Diet and dietary supplement use are associated with periodontal health while a cause and effect relationship is less clear. Although associations with specific nutrients and supplements suggest a potential benefit to healing of periodontal tissues after periodontal procedures, this study determined if patients undergoing periodontal surgery currently take dietary supplements to gage whether patients may accept use of such supplements as a potential intervention. Materials and methods Patients who were undergoing implant placement or soft tissue graft surgery completed a questionnaire indicating any dietary supplements they consumed. Patient demographics, such as age, sex, and smoking status, were gathered from patients' charting records. Results Data on dietary supplement usage were collected from 221 patients. More than half (64.7%) the population surveyed reported using one or more dietary supplements. The most commonly used dietary supplements were vitamin D (31%), multivitamin (28%), and B‐complex (17.2%). Females were more likely to be taking calcium, vitamin B12, and magnesium than males. Adults, aged 51 years and older, were more likely to be taking dietary supplements than their younger counterparts. They were also more likely to be taking four or more supplements than those under the age of 50 years. There was no association between supplement use and sex, but when the number of different supplements being used was assessed, females were more likely than males to be taking four or more different supplements. Conclusions The majority of the study population is already taking dietary supplements as part of their routine. Based on this study, future studies to determine if supplement usage, potentially at levels higher than current levels of intake, can be used to maintain or promote periodontal health seem highly feasible.
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Affiliation(s)
- Jennifer R Beaudette
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Center for Bone and Muscle Health, Brock University, St. Catharines, Ontario, Canada
| | - Peter C Fritz
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Periodontal Wellness & Implant Surgery, Fonthill, Ontario, Canada.,Center for Bone and Muscle Health, Brock University, St. Catharines, Ontario, Canada
| | - Philip J Sullivan
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Assunta Piccini
- Periodontal Wellness & Implant Surgery, Fonthill, Ontario, Canada
| | - Wendy E Ward
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Center for Bone and Muscle Health, Brock University, St. Catharines, Ontario, Canada
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11
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Font K, Johnson L, Powell C. Five different solutions to mitigate overprescribing opioid medications. J Dent Educ 2020; 85:31-36. [PMID: 32929746 DOI: 10.1002/jdd.12393] [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: 06/04/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE The University of Colorado School of Dental Medicine took 5 distinct actions to mitigate the amount of opioids prescribed at the dental school between the years 2016-2020. METHODS This retrospective study evaluated a comprehensive 5-step quality improvement strategy which was implemented to decrease opioid prescribing. a) development of a Dental Pain Management Protocol, b) implementation of the protocol with pre-doctoral students, c) incorporating the results of a Master's project that determined the actual postoperative pain after periodontal/oral surgical procedures, d) development of a favorite electronic prescription list, and e) creation of patient instructions to allow for information on nonopioid analgesic use after dental procedures to be disseminated to the patient. RESULTS There was a significant decrease (P = 0.05) in the opioid prescribing trend with the implementation of these 5 actions, resulting in an overall 68.8% decrease for prescription writing of opioids and a 78.6% decrease of opioid pills over this 3 year period. CONCLUSION Simple guidelines and protocols resulted in a drastic decrease in opioid prescribing, with limited negative feedback from faculty and patients.
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Affiliation(s)
- Kerri Font
- Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Lonnie Johnson
- Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Charles Powell
- Department of Surgical Dentistry, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
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Fernandez-Aguilar J, Guillén I, Sanz MT, Jovani-Sancho M. Patient's pre-operative dental anxiety is related to diastolic blood pressure and the need for post-surgical analgesia. Sci Rep 2020; 10:9170. [PMID: 32513987 PMCID: PMC7280201 DOI: 10.1038/s41598-020-66068-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
In order to study the relationship of the patient’s anxiety level from Corah’s Dental Anxiety Scale (DAS) vs different physiological parameters: pre and post-operative blood pressure, and pre and post-operative heart rates, and subsequently, relate the results to the patient’s post-operative anti-inflammatory analgesic need, 185 patients requiring a simple dental extraction were recruited. They filled out the DAS in the waiting room prior to their procedure and once in the examination room, their preoperative blood pressure and heart rate was measured. Once the dental extraction had been completed, their blood pressure and heart rate were measured again. Before leaving the clinic, the patient was given an analgesic form in which they had to indicate whether or not they had required analgesia after the procedure. Diastolic blood pressure (DBP) showed statistically significant differences between pre-operative and post-operative (P = 0.001). DAS was related with pre-operative diastolic blood pressure (pre-DBP) (P = 0.001) and post-operative diastolic blood pressure (post-DBP) as well as pre-operative heart rate (pre-HR) (P = 0.027) and post-operative heart rate (post-HR) (P = 0.013). Patients with high levels of DAS tend to take more Ibuprofen 400 mg (P = 0.038). The different levels of anxiety will determine what type of anti-inflammatory analgesia the patient will take, if necessary.
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Affiliation(s)
- Javier Fernandez-Aguilar
- Dentistry Department, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, 46115, Alfara del Patriarca, Valencia, Spain
| | - Isabel Guillén
- Pharmacy Department, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, 46115, Alfara del Patriarca, Valencia, Spain
| | - María T Sanz
- Didactics of Mathematics Department, University of Valencia, Valencia, 46022, Spain
| | - Mar Jovani-Sancho
- Dentistry Department, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, 46115, Alfara del Patriarca, Valencia, Spain.
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Hunter TA, Sonalkar S, Schreiber CA, Perriera LK, Sammel MD, Akers AY. Anticipated Pain During Intrauterine Device Insertion. J Pediatr Adolesc Gynecol 2020; 33:27-32. [PMID: 31563628 PMCID: PMC6980875 DOI: 10.1016/j.jpag.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/15/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To identify predictors of anticipated pain with intrauterine device (IUD) insertion in adolescents and young women. DESIGN We performed linear regression to identify demographic, sexual/gynecologic history, and mood covariates associated with anticipated pain using a visual analogue scale pain score collected as part of a single-blind randomized trial of women who received a 13.5-mg levonorgestrel IUD. SETTING Three academic family planning clinics in Philadelphia Pennsylvania. PARTICIPANTS Ninety-three adolescents and young adult women aged 14-22 years. INTERVENTION Participants received either a 1% lidocaine or sham paracervical block. MAIN OUTCOME MEASURES Anticipated pain measured using a visual analogue scale before and perceived pain at 6 time points during the IUD insertion procedure. RESULTS Black or African American participants had a median anticipated pain score of 68 (interquartile range [IQR], 52-83), White participants had a median anticipated pain of 51 (IQR, 35-68), whereas participants of other races had a median anticipated pain score of 64 (IQR, 36-73); P = .012. In multivariate analysis, race was the only covariate that significantly predicted anticipated pain at IUD insertion. Women with anticipated pain scores above the median had significantly higher perceived pain during all timepoints of the IUD insertion procedure. CONCLUSION Increased anticipated pain is associated with increased perceived pain with IUD insertion. Black adolescent women experience greater anticipated pain with IUD insertion. This population might benefit from counseling and clinical measures to reduce this barrier to IUD use.
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Affiliation(s)
- Tegan A Hunter
- University of Miami Miller School of Medicine, Miami, Florida.
| | - Sarita Sonalkar
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa K Perriera
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mary D Sammel
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aletha Y Akers
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Dell'Olio F, Capodiferro S, Lorusso P, Limongelli L, Tempesta A, Massaro M, Grasso S, Favia G. Light Conscious Sedation in Patients with Previous Acute Myocardial Infarction Needing Exodontia: An Observational Study. Cureus 2019; 11:e6508. [PMID: 32025429 PMCID: PMC6988723 DOI: 10.7759/cureus.6508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim This study evaluated a protocol of light conscious sedation for multimodal analgesia in patients with a clinical history of acute myocardial infarction requiring tooth extraction and to assess postoperative pain by using the quantity intake of acetaminophen as the indicator. Material and methods All 50 patients received preliminary anxiolysis via oral chlordemethyldiazepam administration. After 15 to 20 minutes, only patients reporting they were not fully relaxed received additional intravenous diazepam before tooth extraction. Acetaminophen 1000 mg was suggested as the preferred postoperative analgesic drug. Results The studied patients included 39 women and 11 men with a mean age of 69.4 ± 17.1 years. They were classified according to the American Society of Anesthesiologists Physical Status classification system as follows: 12 patients belonging to class II, 32 patient to class III, and the remaining six to class IV. Based on the Modified Dental Anxiety Scale, six patients were phobic and seven anxious. Nevertheless, intravenous conscious sedation was needed in 23 patients via diazepam. The first day after surgery, 76% of patients took acetaminophen, and 58% took acetaminophen the second day, with a mean two-day total intake of acetaminophen of 1020 ± 789 mg/day. Stratified statistical analysis was performed and revealed that 60.87% of patients receiving intravenous diazepam needed to take acetaminophen on the first day after dental extraction in contrast to the 88.89% of patients who did not receive intravenous diazepam (χ2 test; P = .021). Conclusions Our data suggest that anxiety related to dental procedures is widespread, although often unmentioned by patients. Moreover, the percentage of patients needing analgesics during the first 24 hours following surgery demonstrated that overall perioperative pain might be controlled by the light conscious sedation protocol for patients with previous acute myocardial infarction proposed in the current study.
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Affiliation(s)
- Fabio Dell'Olio
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
| | - Saverio Capodiferro
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
| | | | - Luisa Limongelli
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
| | - Angela Tempesta
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
| | - Maria Massaro
- Emergency Department, University of Bari Aldo Moro, Bari, ITA
| | | | - Gianfranco Favia
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
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15
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Beaudette JR, Fritz PC, Sullivan PJ, Piccini A, Ward WE. Investigation of factors that influence pain experienced and the use of pain medication following periodontal surgery. J Clin Periodontol 2018; 45:578-585. [PMID: 29500837 PMCID: PMC5969096 DOI: 10.1111/jcpe.12885] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Abstract
Aims To determine the relationship between anticipated pain and actual pain experienced following soft tissue grafting or implant surgery; to identify the factors that predict actual pain experienced and the use of pain medication following soft tissue grafting or implant surgery. Materials and Methods Prior to dental implant placement (n = 98) or soft tissue grafting (n = 115) and for seven days following the procedure, patients completed a visual analog scale indicating anticipated or experienced pain, respectively. The use of pain medication and alcohol, and smoking were measured. Results Actual pain experienced on day 1 was lower (p < .01) than anticipated pain and continued to decrease (p ≤ .01) for each of the 7 consecutive days. Anticipated and actual pain were positively correlated. Increasing age (p < .05), having sedation during the surgery (p < .05), and lower use of pain pills (p < .01) predicted lower pain experienced. Actual pain experienced was a predictor of pain pill use (p < .01). Greater nervousness (p < .01) prior to surgery was a predictor of greater anticipated pain. Conclusions Patients anticipated more pain than they actually experienced. Sedation, age and number of pain pills used predicted pain experienced. This trial was registered with clinicaltrials.gov as NCT03064178.
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Affiliation(s)
| | - Peter C Fritz
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Periodontal Wellness and Implant Surgery, Fonthill, ON, Canada
| | - Philip J Sullivan
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Assunta Piccini
- Periodontal Wellness and Implant Surgery, Fonthill, ON, Canada
| | - Wendy E Ward
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
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