Therapeutic efficacy and tolerability of the topical treatment of inflammatory conditions of the oral cavity with a mouthwash containing diclofenac epolamine: a randomized, investigator-blind, parallel-group, controlled, phase III study

Comparison of the analgesic efficacy of spray and tablet flurbiprofen for pain after soft tissue surgery

The aim of this randomized clinical study was to assess the comparative efficacy of flurbiprofen in tablet and spray formulations for postoperative pain management in oral soft tissue wounds undergoing primary closure while investigating the feasibility of achieving optimal analgesia with reduced dosage and risk. Forty patients who underwent epulis fissuratum and frenulum excision for pre-prosthetic surgery were randomly assigned to receive either tablet or spray forms of flurbiprofen. The lesion dimensions were measured preoperatively, followed by excision and primary closure. The tablet group received oral tablets containing 100 mg of flurbiprofen twice daily, whereas the spray group received an oral spray containing 0.25% flurbiprofen, administered as two sprays thrice daily. Postoperative pain was assessed using the Numerical Rating Scale (NRS) until the 7th day. Lesion size, drug consumption, and rescue analgesic use were compared between the groups. There were no statistically significant differences in the lesion size between the groups. However, the mean NRS score in the spray group was significantly lower in the spray group compared to than that in the tablet group at 6th hour postoperatively (p = 0.037). Significant differences favoring the tablet group were observed in the first three doses of the drug (p = 0.001). No patients required rescue analgesics. The spray formulation of flurbiprofen demonstrated effective and safe pain relief in oral soft tissue wounds undergoing primary closure, with no reported adverse effects.

Investigation on wound healing effect of Mediterranean medicinal plants and some related phenolic compounds: A review

ETHNOPHARMACOLOGICAL RELEVANCE

The human skin constitutes a biological barrier against external stress and wounds can reduce the role of its physiological structure. In medical sciences, wounds are considered a major problem that requires urgent intervention. For centuries, medicinal plants have been used in the Mediterranean countries for many purposes and against wounds.

AIM OF THIS REVIEW

Provides an outlook on the Mediterranean medicinal plants used in wound healing. Furthermore, the wound healing effect of polyphenolic compounds and their chemical structures are also summarized. Moreover, we discussed the wound healing process, the structure of the skin, and the current therapies in wound healing.

MATERIALS AND METHODS

The search was performed in several databases such as ScienceDirect, PubMed, Google Scholar, Scopus, and Web of Science. The following Keywords were used individually and/or in combination: the Mediterranean, wound healing, medicinal plants, phenolic compounds, composition, flavonoid, tannin.

RESULTS

The wound healing process is distinguished by four phases, which are respectively, hemostasis, inflammation, proliferation, and remodeling. The Mediterranean medicinal plants are widely used in the treatment of wounds. The finding showed that eighty-nine species belonging to forty families were evaluated for their wound-healing effect in this area. The Asteraceae family was the most reported family with 12 species followed by Lamiaceae (11 species). Tunisia, Egypt, Morocco, and Algeria were the countries where these plants are frequently used in wound healing. In addition to medicinal plants, results showed that nineteen phenolic compounds from different classes are used in wound treatment. Tyrosol, hydroxytyrosol, curcumin, luteolin, chrysin, rutin, kaempferol, quercetin, icariin, morin, epigallocatechin gallate, taxifolin, silymarin, hesperidin, naringin, isoliquiritin, puerarin, genistein, and daidzein were the main compounds that showed wound-healing effect.

CONCLUSION

In conclusion, medicinal plants and polyphenolic compounds provide therapeutic evidence in wound healing and for the development of new drugs in this field.

Diclofenac Mouthwash as a potential therapy for reducing pain and discomfort in chemo-radiotherapy-induced oral mucositis

AIMS

Oral and/or oropharyngeal acute mucositis during and after chemo-radiotherapy (chemo-RT) for head and neck squamous cell carcinoma (HNSCC) can be extremely painful, sometimes requiring nasogastric feeding to enable adequate nutrition. The MASCC/ISOO evidence-based guidelines recommend benzydamine mouthwash for mucositis prevention in RT (recently updated to include chemo-RT), and a Cochrane systematic review found other agents to be effective in prophylaxis. Diclofenac mouthwash is licensed for painful oral mucosal inflammatory conditions but to our knowledge has not been assessed in chemo-RT-associated oral mucositis.

METHOD

A clinical observation and service evaluation study in 10 patients undergoing chemo-RT for HNSCC to assess the potential value of diclofenac mouthwash (0.74 mg/mL) in reducing symptoms. Patients used 20ml of mouthwash up to 4 times a day starting in week 3 (of a 6-week course of treatment), recording pain and discomfort scores using a visual analogue scale on days 0, 1,7 and 14 (until the end of week 4). As per our current clinical practice, oral mucositis was not clinically scored as an outcome. Statistical analysis was performed using a one-way ANOVA.

RESULTS

Using diclofenac mouthwash, 9/10 patients experienced pain score reduction from day 0 (mean score 6.75 ± SD 1.83) to day 2 (5.05 ± SD 1.62) and day 14 (4.09 ± SD 1.96).

CONCLUSIONS

Diclofenac mouthwash may be beneficial for managing chemo-RT-induced oral mucositis. While a prospective randomised clinical trial is needed, it can be prescribed for this condition within its current licence.

Molecular Mechanisms at the Basis of Pharmaceutical Grade Triticum vulgare Extract Efficacy in Prompting Keratinocytes Healing

BACKGROUND

It has been shown that many plant- or microbial-derived oligos and polysaccharides may prompt tissue repair. Among the different extracts that have been studied, the aqueous one of Triticum vulgare (TVE) that was obtained from a whole germinated plant has been proven to have different biological properties that are useful in the process of wound healing. Nevertheless, with the long tradition of its use in pharmaceutical cream and ointments, especially in Italy, a new protocol was recently proposed (and patented) to improve the extraction process.

METHODS

In a simplified in vitro model, human keratinocyte monolayers were scratched and used to run time lapse experiments by using time lapse video microscopy (TLVM) to quantify reparation rate while considering a dose-response effect. Contemporarily, the molecular mechanisms that are involved in tissue repair were studied. In fact, key biomarkers that are involved in remodeling, such as MMP-2 and MMP-9, and in matrix structure assembly, such as collagen I, elastin, integrin αV and aquaporin 3, were evaluated with gene expression analyses (RT-PCR) and protein quantification in western blotting.

RESULTS

All TVE doses tested on the HaCat-supported cell proliferation. TVE also prompted cell migration in respect to the control, correctly modulating the timing of metalloproteases expression toward a consistent and well-assessed matrix remodeling. Furthermore, TVE treatments upregulated and positively modulated the expression of the analyzed biomarkers, thus resulting in a better remodeling of dermal tissue during healing.

CONCLUSIONS

The in vitro results on the beneficial effects of TVE on tissue elasticity and regeneration may support a better understanding of the action mechanism of TVE as active principles in pharmaceutical preparation in wound treatment.

Randomized controlled trial to compare oral analgesic requirements and patient satisfaction in using oral non-steroidal anti-inflammatory drugs versus benzydamine hydrochloride oral rinses after mandibular third molar extraction: a pilot study

Background

Third molar extraction is associated with considerable pain and discomfort, which is mostly managed with oral analgesic medication. We assessed the analgesic effect of benzydamine hydrochloride, a topical analgesic oral rinse, for controlling postoperative pain following third molar extraction.

Methods

A randomized controlled trial was conducted in 40 patients divided into two groups, for extraction of fully erupted third molar. Groups A received benzydamine hydrochloride mouthwash and group B received normal saline gargle with oral ibuprofen and paracetamol. Oral ibuprofen and paracetamol was the rescue analgesic drug in group A. Patients were evaluated on the 3^rd and 7^th post-operative days (POD) for pain using the visual analogue score (VAS), trismus, total number of analgesics consumed, and satisfaction level of patients.

Results

The VAS in groups A and B on POD3 and POD7 was 4.55 ± 2.54 and 3.95 ± 1.8, and 1.2 ± 1.64 and 0.95 ± 1.14, respectively and was statistically insignificant. The number of analgesics consumed in groups A and B on POD3 (5.25 ± 2.22 and 6.05 ± 2.43) was not statistically different from that consumed on POD7 (9.15 ± 5.93 and 10.65 ± 6.46). The p values for trismus on POD3 and POD7 were 0.609 and 0.490, respectively and those for patient satisfaction level on POD3 and POD7 were 0.283 and 0.217, respectively.

Conclusions

Benzydamine hydrochloride oral rinses do not significantly reduce intake of oral analgesics and are inadequate for pain relief following mandibular third molar extraction.

Effect of Diclofenac Mouthwash on Postoperative Pain after Periodontal Surgery

INTRODUCTION

Non-Steroidal AntiInflammatory Drugs (NSAIDs) are widely used drugs for the management of pain. Oral administration of NSAIDs has various adverse events like gastrointestinal alterations - nausea, dyspepsia and gastrointestinal bleeding, hepatotoxicity and blood dyscrasias. As orally given NSAIDs are associated with systemic side effects, it is preferred to alleviate pain and inflammation using topical medication. Thus, recently the focus has been on the development of topical administration of NSAIDs in the form of gels, toothpastes and rinses.

AIM

To determine if diclofenac mouthwash, would be a better alternative to its systemic administration post surgery, in terms of patient acceptance and to minimize the adverse effects of orally administered drug.

MATERIALS AND METHODS

The study was designed as a single blinded, randomized, controlled clinical trial. Thirty chronic periodontitis patients scheduled for full mouth flap surgeries were randomized to receive either Diclofenac Mouthwash (MW) or Diclofenac Tablets (TB), post surgery. The MW group patients (15) were advised to rinse undiluted 15 ml solution for 30 secs, twice daily for three days. TB group (15) was advised to take 50 mg tablet twice daily for three days. A 10 point Visual Analog Scale (VAS) and Wong Baker Facial Rating Scale (FRS) was recorded to measure the pain perception by the patients. Gingival status was assessed by the Modified Gingival Index (MGI) at Baseline and seventh day. Data pertaining to pain perception were analysed using repeated measures of ANOVA (Analysis of Variance) with post-hoc LSD test.

RESULTS

Intra group comparisons showed a significant reduction in pain, post surgery. Inter group comparisons showed a significant reduction only in the MGI scores of MW group, when compared to TB group. Intergroup comparisons showed no significant reduction in pain scores between both the groups, stating that diclofenac mouthwash is as effective as oral administration.

CONCLUSION

Diclofenac mouthwash is a better alternative to the systemic administration post surgery, in terms of patient acceptance and to minimize the adverse effects of orally administrated drug.

Comparative bioavailability and tolerability of single and multiple doses of 2 diclofenac sodium sustained-release tablet formulations in fasting, healthy chinese male volunteers

Background

Diclofenac is a nonsteroidal anti-inflammatory drug used for the treatment of patients with osteoarthritis.

Objectives

Our primary objective was to compare bioavailability and tolerability of a generic sustained-release tablet with the established reference sustained-release tablet of diclofenac sodium in a fasting, healthy Chinese male population.

Methods

A randomized, open-label, single- and multiple-dose study design was used. After the single dose, volunteers received diclofenac sodium sustained-release tablet once daily for 5 days. In the single-dose phase, blood samples were collected from 0 to 36 hours after drug administration. In the multiple-dose phase, samples were obtained before drug administration at 8:00 am on Days 3 and 4 to determine C_min,ss of diclofenac sodium; on Day 5, samples were collected from 0 to 36 hours. Adverse events were monitored via subject interview, vital signs, and blood sampling.

Results

Twenty-four Chinese male volunteers were enrolled. The pharmacokinetic parameters (mean [SD]) for diclofenac after single dose of 75 and 100 mg were: C_max 473.5 [179.5] and 546.6 [154.9] ng/mL; AUC_0–∞ 3841.2 [1402.3], and 5019.1 [2,314.0] ng·h/mL; T_max 4.9 [2.4], and 4.3 [2.2] hours; t_1/2 5.9 [2.5], and 6.0 [2.2] hours. Mean [SD] values after multiple doses of 75 and 100 mg were: C_max,ss 525.6 [127.4] and 650.5 [167.0] ng/mL, C_min,ss 33.9 [20.9] and 62.9 [34.9] ng/mL, AUC_ss 4316.3 [633.0] and 5335.1 [1291.9] ng·h/mL, C_av,ss 179.8 [26.4] and 222.3 [53.8] ng/mL, T_max 5.1 [1.8] and 4.5 [0.9] hours and t_1/2 5.2 [2.9] and 5.5 [2.8] hours, respectively.

Conclusions

This diclofenac sodium 75 mg tablet has features compatible with the 100 mg sustained-release tablet and appeared to be well tolerated. ClinicalTrials.gov identifier: 2010L01969