Analgesic efficacy of diclofenac sodium versus ibuprofen following surgical extraction of impacted lower third molars.
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OBJECTIVE: An evaluation is made of the analgesic efficacy of diclofenac sodium versus ibuprofen after impacted lower third molar surgery. STUDY DESIGN: The patients were randomly assigned to one of two groups (ibuprofen or diclofenac). The difficulty of third molar surgery, performed under local anesthesia, was assessed by the degree of inclusion involved. The recorded study variables were pain intensity and the need for rescue medication during one week. The recordings were made once a day at the same time, using a patient-completed questionnaire. RESULTS: Eighty-one patients were finally included in the study (87.1%). The results were similar in the first 48 postoperative hours in both groups, though on the third day the diclofenac group tended to show higher pain scores--the differences being nonsignificant, however (p<0.05). This tendency was also reflected by an increased need for rescue medication and the consumption of a larger number of tablets in the diclofenac group. CONCLUSIONS: There were no statistically significant differences in analgesic efficacy between diclofenac sodium and ibuprofen, though the former was associated with an increased need for supplementary medication in the first two postoperative days (p<0.05). (+info)
Patients' perceptions of recovery after surgical exposure of impacted maxillary teeth treated with an open-eruption surgical-orthodontic technique.
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This study assessed patient perceptions of immediate post-operative recovery after the surgical exposure of impacted maxillary teeth with an open-eruption technique. Thirty patients (24 females and six males) underwent surgical exposure of 39 impacted maxillary teeth using this technique. After surgery the patients were contacted by telephone daily for 7 days, to complete a health-related quality of life (HRQOL) questionnaire, which assessed their perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. Severe pain was reported by 30 per cent of the patients in the first post-operative day (POD 1), which declined to 6.7 per cent by POD 6. Consumption of analgesics declined gradually over the post-operative days (POD 1: 80 per cent, POD 7: 20 per cent). Difficulty in eating required 5 days to reach minimal levels; enjoying everyday food, 2.5 days; school attendance, limitations in daily routine, swallowing, and speech, 2 days each; swelling, bad taste/smell, 1.5 days each; within 1 day all other measures attained minimal levels. The need for bone removal during the exposure resulted in delayed recovery with regard to the ability to eat. In general, females reported delayed recovery for pain. The present data may serve as basic guidelines against which future studies which assess post-operative management of patients after surgical exposure of impacted teeth by an open-eruption technique may be compared. (+info)
Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience.
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BACKGROUND: Iatrogenic paresthesia in the third division of the trigeminal nerve remains a complex clinical problem with major medicolegal implications. However, most lawsuits can be prevented through better planning of procedures and by obtaining informed consent. The purpose of this article is to present the authors" clinical experience over the past 12 years, to review the principles of prevention and management of trigeminal paresthesia and to highlight the resulting medicolegal implications. METHODS: The files of all 165 patients referred to the oral and maxillofacial surgery department for evaluation of iatrogenic paresthesia in the third division of the trigeminal nerve were reviewed. The characteristics of the subgroup of patients who had taken an attending dentist to court were compared with those of the other patients. RESULTS: Surgical extraction of impacted molars was the main cause of paresthesia in 109 (66%) of the 165 subjects. The alveolar nerve was affected in 89 (54%) subjects, the lingual nerve in 67 (41%) subjects, and both nerves were affected in 9 (5%) subjects. There were more female than male patients (ratio 2.2:1). Lawsuits were initiated in 33 (20%) of the cases; patients who initiated lawsuits were younger, were more likely to have experienced anesthesia and were more likely to need microsurgery (all p < 0.001). Poor surgical planning and lack of informed consent were the most common errors on the part of the dentists. CONCLUSIONS: An accurate evaluation of surgical indications and risk, good surgical technique, preoperative informed consent and sufficient postoperative follow-up should help to reduce the frequency of neurosensory deficits after dental treatment and attendant lawsuits. (+info)
Canine transposition following trauma and loss of a central incisor: treatment options.
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The aim of this article is to make clinicians aware of the possibility of canine transposition following loss of the upper central incisor. Using two case reports it considers the opportunities for rehabilitation of the occlusion, and discusses surgical, orthodontic and restorative considerations. (+info)
Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery.
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BACKGROUND: The purpose of this randomized double-blind study was to compare the efficacy and safety of propacetamol 2 g (an i.v. acetaminophen 1 g formulation) administered as a 2-min bolus injection (n=50) or a 15-min infusion (n=50) with oral acetaminophen 1 g (n=50) or placebo (n=25) for analgesia after third molar surgery in patients with moderate to severe pain after impacted third molar removal. METHODS: All patients were evaluated for efficacy during the initial 6 h period after treatment administration (T(0)) and for safety during the entire week after T(0). RESULTS: The onset of analgesia after propacetamol was shorter (3 min for bolus administration, 5 min for 15-min infusion) than after oral acetaminophen (11 min). Active treatments were significantly better for all parameters (pain relief, pain intensity, patient's global evaluation, duration of analgesia) than placebo (P<0.05). Adverse events were more frequent after propacetamol, especially pain at the injection site. Propacetamol bolus resulted in a much higher incidence of local adverse events than the infusion (propacetamol bolus 90% vs propacetamol infusion 52%) with no clinically significant benefits in terms of analgesic efficacy. CONCLUSION: I.V. propacetamol, administered as a 15-min infusion, is a fast-acting analgesic agent. It is more effective in terms of onset of analgesia than a similar dose of oral acetaminophen. (+info)
Calcifying odontogenic cyst associated with complex odontoma: case report and review of the literature.
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We report a calcifying odontogenic cyst associated with odontoma (COCaO) and an included permanent canine in the superior maxilla, in a 19 year-old-man. The calcifying odontogenic cyst (COC) was first described as a distinct entity by Gorlin et al in 1962. The lesion is a mixed odontogenic benign tumor, and although most of the cases present cystic characteristics, a few are of the solid type (15%), and its rare malignant transformation is well documented. The COC may occur in association with other odontogenic tumors, the most common is the odontoma, occurring in about 24% of the cases. For this association the term Odontocalcifying odontogenic cyst has been suggested. Radiographically is a well defined mixed lesion and histologically consists of a large cyst. In the central area of the cyst enamel and dentin deposits can be found, irregularly distributed in areas and in other parts it takes on a well defined organoid aspect. A thorough review of literature takes place and the pathogenesis is discussed. (+info)
Space conditions and dental and occlusal features in patients with palatally impacted maxillary canines: an aetiological study.
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The aetiology of palatal canine impaction is unclear. The aim of this research was to investigate the occlusal features that could contribute to the aetiology of palatal maxillary canine impaction. The material consisted of the pre-treatment dental casts of 34 patients (27 female and seven male) with unilateral palatal canine impaction (impaction group). The average age of this group was 17.7 years (+/- 4.6). These were matched according to age, gender and type of malocclusion with a comparison group of pre-treatment dental casts from unaffected orthodontic patients. From the dental casts the following parameters were obtained: (1) dentoalveolar arch relationship, (2) missing or anomalous teeth, (3) the mesiodistal width of each maxillary tooth, (4) the upper arch perimeter, (5) the maxillary inter-premolar and inter-molar widths. The arch length-tooth size discrepancy was only calculated for subjects with no missing teeth. Palatal canine impaction occurred most frequently in subjects with a Class II division 2 malocclusion. There was an association between palatal canine impaction and anomalous lateral incisors (P = 0.01). The transverse arch dimension was significantly wider in the impaction group than in the comparison group (P < 0.01). There was no statistically significant difference in the mesiodistal width of maxillary teeth or in the arch length-tooth size discrepancy between the palatal canine impaction group and their matched comparisons (P > 0.05). These results suggest that the presence of an 'excess palatal width' and anomalous lateral incisor may contribute to the aetiology of palatal canine impaction. (+info)
Third molar angulation during and after treatment of adolescent orthodontic patients.
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The purpose of this study was to analyse the effect of premolar extraction therapy on third molar angulation during active treatment, and to test the significance of such changes on subsequent impaction of the third molars. Lateral cephalograms made before (T1) and after (T2) treatment and at long-term follow-up (T3) of 157 patients treated non-extraction (non-ex) or with extraction of four premolars (ex), all accurately diagnosed for impaction versus eruption of at least one third molar at T3, were evaluated. Linear regression models demonstrated that the maxillary third molars uprighted more from T1 to T2 (P < 0.05) and were less distally angulated at T2 (P < 0.01) in the ex than in the non-ex patients. No such differences were detected in the mandible (P > 0.05). The regression models also showed similar uprighting of the maxillary and mandibular third molars from T1 to T2 and similar angulation of the maxillary third molars at T2 in those patients with subsequent eruption and impaction (P > 0.05), but more mesially angulated mandibular third molars at T2 in the impaction patients (P < 0.01). Chi square testing demonstrated a higher frequency of distal tipping of the maxillary third molars from T1 to T2 in the impaction patients (P < 0.01), while mesial tipping from T1 to T2 of the mandibular third molars occurred with similar frequency in the two patient groups (P > 0.05). Chi square analysis also showed a higher frequency of greater than 30 degree distal angulation as well as an amount mesial angulation of the maxillary third molars at T2 (P < 0.01), and a higher frequency of greater than 40 degree mesial angulation of the mandibular third molars at T2 (P < 0.01) in patients with impaction than in those with eruption. (+info)