Management Of Dental Pain Research Articles

Management of dental pain in primary care.

SUMMARYPatients sometimes present to a medical practitioner with dental pain if they cannot see a dentistDoctors need to be aware of the common dental diseases that result in pain so they can help to manage the patient’s symptoms until they are able to see a dentistAppropriate advice regarding analgesics for dental pain is important. Paracetamol and ibuprofen are more effective in combination than either of them alone, with or without opioidsAntibiotics are only indicated as an adjunct to dental treatment when there are signs of systemic involvement, progressive and rapid spread of infection, or when the patient is immunocompromised

Selection of analgesics for the management of acute and postoperative dental pain: a mini-review.

Pain management is an important part of dental practice, and dentists frequently prescribe analgesics to improve clinical outcomes. Dentists should be aware of the pharmacological characteristics of the analgesics commonly used in dentistry and should choose appropriate analgesics to treat and prevent pain associated with inflammation or surgery. In this article, we review the potential benefits and risks of the analgesics frequently used in dental practice and provide a stepwise approach for pain management.

Opioid prescribing and misuse among dental patients in the US: a literature-based review.

Although health care practitioners have become more cognizant of the hazards of opioid use, opioid misuse has emerged as a leading public health problem in the United States, accounting for 20% of all deaths among older adolescents and young adults. Opioid analgesics are an important component of dental pain management following dental procedures. The aim of this study was to assess the status of literature on dental opioid prescriptions, their misuse, and relevant prevention strategies in the US. A keyword search of MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), and Web of Science was conducted in July 2018. The search criteria were carefully selected to include all practitioners treating patients presenting with dental issues and was not restricted to dentists. All peer-reviewed publications in the US written in English about patients with dental problems were included. The initial search led to 267 publications; after removing duplicates, the set consolidated to 196. After an appraisal of the title and abstract for relatedness, 82 publications were selected. Three major themes were identified: epidemiology of dental opioid prescriptions; recognition of the dental providers' contribution to opioid prescription practice; pain management protocols and guidelines in dentistry. There is moderate recognition of the contribution of dental prescriptions to the opioid epidemic. Several tools are available to increase patient education and practitioner knowledge about the safe use of opioids with a focus on patients at greatest risk.

Development and clinical evaluation of transmucosal mucoadhesive patch of lornoxicam for the odontogenic pain management: A preliminary study

Background: Pain is the most common complaint of the patient that brings him/her to the dentist, pain often occurring in conjunction with inflammation and which considerably reduces the quality of patient's life. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the dental pain management. The gastrointestinal complications associated with NSAIDs can be effectively overcome if they are delivered by transmucosal route in the form of buccal patch. Aim: The study aimed to evaluate the efficacy of mucoadhesive lornoxicam patches in odontogenic pain management. Materials and Methods: The present study was conducted in 60 adult patients of either sex, diagnosed with odontogenic pain, and were attending the outpatient department. Informed consent was obtained from all the patients. A 1 cm × 1 cm mucoadhesive patch containing 4 mg of lornoxicam was applied on the attached gingival region of the tooth with pain. Pain was recorded using a ten-point visual analog scale score before and every 5 min till 30 min after the application of the patch. Statistical analysis was performed using repeated measure ANOVA with P

Dental pain management with prescription opioids by nondental health care professionals in a health care system network

Objectives Nondental health care professionals are often responsible for the management of dental-related complaints with use of prescription of opioids for analgesia. Prescribing patterns are influenced by prescribers’ inability to provide definitive dental treatment and limited patient access to dentists for care. The PRIMUM Group, a multidisciplinary team at our institution, formulated criteria based on peer-reviewed literature and consensus opinion to identify patients potentially at high risk for misuse, abuse, and diversion of prescription-controlled substances. These criteria have been implemented within our health care system network's electronic health records (EHRs) to generate an alert to the prescriber at the point of care should the patient meet one or more criteria. The objectives of our study are to determine the number of patients seeking treatment of dental pain from nondental health care professionals; characterize prescriptions written for these patients; identify and characterize patients at high risk for misuse, abuse, and diversion among this group based on the PRIMUM criteria; observe the ability of the EHR alert system to identify high-risk patient characteristics among the dental pain population; and develop baseline data on opioid prescribing patterns for dental pain–related encounters. Study Design We performed an in-depth retrospective data set analysis by using the EHRs from dental pain–related patient encounters within our health care system occurring between January 2016 and June 2018. Relevant encounters were identified by investigator-selected dental International Classification of Diseases (ICD)-9 and ICD-10 diagnosis codes. This case list was then linked to the PRIMUM database, which included all encounters where a prescription for an opioid was initiated. Data were collected for analysis and included prescriber, facility, date, ICD-9/ICD-10 codes, prescription details (i.e., medication, dose, date) and patient risk criteria as determined by the PRIMUM Group (3+ prescriptions in past 30 days; 2+ visits to the emergency department [ED] or urgent care with on-site treatment with opioids; history of opioid or benzodiazepine overdose; “early refill” (has open prescription with >50% remaining); and positive blood alcohol test or toxicology screen for cocaine or marijuana). Data was analyzed in order to characterize opioid prescribing patterns for dental pain-related encounters within our healthcare system. Results A total of 38,888 encounters related to dental pain ICD-9 and ICD-10 codes occurred between January 2016 and June 2018 across our expansive health care system's care locations; of these encounters, opioids were prescribed in 18,025 (46.3%). Over this period, 15.2% of patients were seen for 2 or more visits related to dental pain; and 1.6% of patients were seen for 4+ encounters related to dental pain. A total of 18,333 opioid prescriptions were written for the 18,025 opioid-prescribing encounters for dental-related pain, averaging 1 opioid prescription per encounter. The most common prescriptions written were hydrocodone–acetaminophen (58.9%), tramadol (27.3%), and oxycodone–acetaminophen (7.8%). Most prescriptions were written in the EDs and urgent care centers (90%), followed by primary care centers (8%). Advanced clinical practitioners were the most common prescribers (61.5%), followed by attending physicians (35.8%). Most patients treated for dental pain were between ages 25to 64 years (82%). This group also represented the group with the highest number of PRIMUM risk factors met, with 17.1% having at least 1 risk factor and 19.43% having greater than 1. The most common risk factor was a positive toxicology screen (14.7%), notably for marijuana (10.6%) and cocaine (4.4%). Conclusions Dental-related pain is often managed by nondental health care professionals in an ED or urgent care setting. An EHR alert may help quickly identify high-risk patients; however, the impact of alerts on prescribing patterns needs further evaluation. The decision regarding the type and quantity of medication to prescribe is complicated by lack of patient access to definitive dental treatment and lack of dental-specific training of prescribers. The limitations of this study include selective inclusion of encounters with specific ICD-9/ICD-10 codes, data limited to objectively searchable criteria, data collection for a relatively short period, and data originating from a single regional health care system. In the attempt to address the opioid epidemic, continued research may help assess the influence of improved awareness of the opioid epidemic on prescription selections over time and the ability of EHR alerts to assist prescribers in choosing alternative medications. Considerations include using EHR alerts to convey standardized guidelines and recommendations (i.e., from the American Dental Association and/or the Centers for Disease Control and Prevention for pain management and improving the collaboration between medical and dental health care professionals to formulate robust prescription guidelines for dental-related complaints. Additionally, information regarding reasons for repeat visits, such as access to care issues, needs to be explored further, and improvements need to be made so that definitive dental care may be provided rather than depending on pharmacologic management by nondental health care professionals.

Effect of Music on Pain and Anxiety in Pediatric Dental Patients

Dental anxiety and pain management in pediatric children is always challenging,Management of Pain and anxiety are the utmost concern for a paediatrician in order to achieve patient cooperation which plays an essential role in the success of the treatment. Interventions aimed at improving the health and wellbeing of children may also cause pain and anxiety. Inadequate pain control during medical procedures can have long-term detrimental effects, especially among very young children. Hence this review article aims at determining the effect of music on pain and anxiety in pediatric dental patients.

Behavioral Sciences in the Promotion of Oral Health

The importance and value of behavioral sciences in dentistry have long been recognized, and their contribution to dental education, research, clinical practice, and oral health policy has been significant over the past half century. Over time behavioral sciences have expanded our understanding of oral health beyond “disease” to a broader biopsychosocial concept of oral health. This in turn has led dentistry away from a focus of “treatment” to oral health “care,” notably in the new millennium. Key oral health behaviors have been identified for more than half a century: the importance of diet, oral hygiene, dental services, and other factors. Various behavioral models and theories have been proposed, particularly since the 1970s, providing useful frameworks with sound psychological basis to help understand the paths of oral health behaviors. These models draw on theories of self-efficacy, motivation, counseling, and “behavior change.” Since the 1980s, there has been a greater understanding that these behaviors often share a common pathway with the etiology of other diseases (common risk factors). Furthermore, the relationship between individual factors and the broader environmental factors has been increasingly emphasized since the 1990s, leading to a united call for action in addressing oral health inequalities. Within the past decade, there are useful examples of models, frameworks, and techniques of behavior change with respect to oral health, involving planning, prompting, encouraging, goal setting, and/or motivating. In particular, there is a growing interest and use of motivational interviewing. Likewise, behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain, and psychosomatic dental and oral problems, with promising results. Recommendations are outlined for future directions for behavioral sciences in the promotion of oral health.

ADVANCE CARE PLANNING COMMUNICATION: AN INTERACTIVE WORKSHOP WITH ROLE-PLAY FOR STUDENTS AND PRIMARY CLINICIANS

There is a need for increased clinician training on advance care planning (ACP). Common barriers to ACP include perceived lack of confidence, skills, and knowledge necessary to engage in these discussions. Furthermore, many clinicians feel inadequately trained in prognostication. There is evidence that multimodality curricula are effective in teaching ACP, and may be simultaneously targeted to trainees and practicing clinicians with success. We developed a 3-hour workshop incorporating lecture, patient-oriented decision aids, prognostication tools, small group discussion, and case-based role-play to communicate a values-based approach to ACP. Cases included discussion of care goals a patient with severe COPD and one with mild cognitive impairment. The workshop was delivered to 4th year medical students, then adapted in two primary care clinics. In the clinics, we added an interprofessional case applying ACP to management of dental pain in advanced dementia. We evaluated the workshops using pre-post surveys. 34 medical students and 14 primary care providers participated. Self-reported knowledge and comfort with ACP significantly improved; attitudes toward ACP were strongly positive both before and after. The workshop was well received. On a seven-point Likert scale, (1=Unacceptable, 7=Outstanding), the median overall rating was 6 (“Excellent”). In conclusion, we developed an ACP workshop applicable to both students and primary clinicians. We saw improvements in self-reported knowledge and comfort with ACP, though long-term effects were not studied. Participants found the role-play especially valuable. Most modifications for primary care clinics focused on duration rather than content. Future directions include expanding the interprofessional workshop content.

Evaluation of effect of warm local anesthetics on pain perception during dental injections in children: a split-mouth randomized clinical trial

The present study evaluates the efficacy of warm local anesthetic (37 °C) administration and injections of local anesthetics at room temperature (21 °C) in reducing pain during injections in children undergoing dental procedures. Enrolled for this split-mouth randomized clinical study were 100 children aged 5-8 years. Within the random crossover design selected for the study, each patient was randomly assigned to receive either a body or room temperature local anesthesia in the first session and the other local anesthesia on the second session. During the injection, the Wong-Baker Faces Pain Rating Scale was used as a subjective measure of discomfort, and heart rate as an objective measure. The Face, Legs, Arms, Cry, and Consolability (FLACC) scale was used to record the child's pain, based on the perception of the dental assistant. The data were analyzed using a Wilcoxon sign rank test and a paired t test. Based on the score of the Wong-Baker Faces Pain Rating Scale, the FLACC scale, and heart rate, the sensation of pain during dental injection in both girls and boys is statistically significantly lower at body temperature than at room temperature (p < 0.05). It was determined that the application of local anesthetic at body temperature reduces dental injection pain significantly when compared with local anesthetics administered at room temperature. The successful management of dental injection pain is an important issue during dental procedures in children. Accordingly, warming the local anesthesia prior to use in children can be recommended to clinicians.

Is it time US dentistry ended its opioid dependence?

BackgroundIn 2017, 11.4 million US citizens misused prescription opioids, resulting in 46 overdose deaths daily and a $78.5 billion burden on the economy. Dentists are one of the most frequent prescribers of opioids, and there is concern that dental prescribing is contributing to the opioid crisis. MethodsA 2019 study showed 22.3% of US dental prescriptions were for opioids compared with 0.6% of dental prescriptions in England where nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen accounted for most analgesic prescriptions. This observation prompted a review of international analgesic prescribing habits and of the advantages and disadvantages of opioids and NSAIDs for treating dental pain. ResultsUS opioid prescribing far exceeded that in other countries where NSAIDs accounted for most dental analgesic prescribing. Furthermore, results from reviews published respectively in 2018 and 2016 help confirm that NSAIDs and NSAID-acetaminophen combinations are as effective as or more effective than opioids for controlling dental pain and cause significantly fewer adverse effects. ConclusionsIn light of the potential for misuse and evidence that NSAIDs are as effective as opioids and have fewer adverse effects, there is clear patient benefit in avoiding opioids for the prevention or management of dental pain. Practical ImplicationsA growing preponderance of evidence shows that opioids are not needed for routine oral health care. This article provides an overview of the evidence and outlines possible pain management models to minimize opioid use in dentistry. The purpose is to stimulate debate about this important topic and encourage the development of definitive guidance by professional bodies, health care providers, and state and federal agencies.

Potential Novel Strategies for the Treatment of Dental Pulp-Derived Pain: Pharmacological Approaches and Beyond.

The diagnosis and management of pain is an everyday occurrence in dentistry, and its effective control is essential to ensure the wellbeing of patients. Most tooth-associated pain originates from the dental pulp, a highly vascularized and innervated tissue, which is encased within mineralized dentin. It plays a crucial role in the sensing of stimuli from the local environment, such as infections (i.e. dental caries) and traumatic injury, leading to a local inflammatory response and subsequently to an increase in intra-pulp pressure, activating nerve endings. However, thermal, chemical, and mechanical stimuli also have the ability to generate dental pulp pain, which presents mechanisms highly specific to this tissue and which have to be considered in pain management. Traditionally, the management of dental pulp pain has mostly been pharmacological, using non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, or restorative (i.e. removal of dental caries), or a combination of both. Both research areas continuously present novel and creative approaches. This includes the modulation of thermo-sensitive transient receptor potential cation channels (TRP) by newly designed drugs in pharmacological research, as well as the use of novel biomaterials, stem cells, exosomes and physical stimulation to obtain pulp regeneration in regenerative medicine. Therefore, the aim of this review is to present an up-to-date account of causes underlying dental pain, novel treatments involving the control of pain and inflammation and the induction of pulp regeneration, as well as insights in pain in dentistry from the physiological, pharmacological, regenerative and clinical perspectives.

Opioid-prescribing Habits of Practitioner and Educator Members of the American Association of Endodontists: Report of a National Survey

Dentists and physicians alike often prescribe opioids for dental pain management. The purpose of this study was to identify the common practices among United States endodontists for prescribing opioids to their patients. A descriptive, cross-sectional survey was developed to query 1000 American Association of Endodontists members from all 7 districts in the United States. The 20-question survey addressed provider demographics, types and frequency of medications prescribed, and clinical scenarios that compelled prescription-writing habits. The anonymous survey was electronically mailed. There was a preference to prescribe nonsteroidal anti-inflammatory drugs and/or acetaminophen followed by hydrocodone to manage endodontic pain. The majority of respondents limited an opioid prescription to ≤4 days. Different demographics played a role in the response to direct questions if they ever felt or succumbed to pressure toward prescribing opioids. Opioids are the second most prescribed medication to manage endodontic postoperative pain. Practice background was a significant factor in feeling pressure to prescribe an opioid.

Antioxidant effects of vitamin E on diclofenac induced hepatotoxicity in male rats

Drug induced liver injury possesses a major clinical problem and has become leading cause of acute liver failure and transplantation. Overstressed liver compromises its detoxification role which may expose it to a variety of diseases and disorders. The present study was to determine whether pre- administration of various doses of vitamin E would have protective effect against diclofenac induced hepatotoxicity in wistar male rats. Twenty-four albino male rats weighing 180-200g were divided equally into four groups. In control group rats were administrated with physiological saline 2ml/kg b.wt /intramuscularly. Another group with 50mg/kg b.wt/ intramuscularly/seven days diclofenac was used for inducing toxicity. In experimental groups rats were administrated with different doses of vitamin E along with diclofenac sodium [200 and 400 IU orally and 50mg/kg b.wt/ intramuscularly/seven days]. Showed that there was a rapid increase in the levels of liver function test in diclofenac treated group, which was significantly decreased after pre-treatment with high dose than low dose of vitamin E. The liver acinus showed Centro acinar necrosis of hepatocytes after 7 days of diclofenac treatment, which was prevented by administration of Vitamin E. Drug-induced liver injury possesses a major clinical problem and has become a leading cause of acute liver failure and transplantation. Overstressed liver compromises its detoxification role which may expose it to a variety of diseases and disorders. Diclofenac sodium is a phenylacetic acid derivative, a widely used nonsteroidal anti-inflammatory drug (NSAID) for the treatment of inflammatory conditions such as osteoarthritis, rheumatoid arthritis, polymyositis, dermatomyositis, dental pain, spondyloarthritis, acute migraine, gout attacks and pain management in gall and renal stones. Although the exact mechanism by with diclofenac injuries liver is not understood, some studies explain the toxicity by affecting cytochrome P 450 leading to the production of active metabolites. Administration of different dose of diclofenac sodium induces severe adverse effects in liver and kidney.

Short‐term Ibuprofen Treatment cause Gender‐Specific Differences in Proteasomal and Mitochondrial functions in Mice Heart

Ibuprofen is the most common pain‐killer widely used for the management of dental pain, headache, migraine and rheumatoid arthritis. Concern has been raised due to adverse cardiovascular side effects associated with the chronic use of ibuprofen. Thus, understanding the short‐term effects of ibuprofen on cardiac function is crucial to the safe use of the drug among individuals with established cardiovascular disorders. The objective of this study was to evaluate whether ibuprofen caused gender‐specific differences in mitochondrial and proteasomal functions in mice cardiac tissue and to gain insights into the molecular mechanisms underlying these differences. To determine whether there is a sex difference on protein homeostasis with respect to ibuprofen treatment 8‐week‐old aged matched male and female C57BL/6J mice were treated with ibuprofen (100 mg/kg/day) dissolved in drinking water for seven days and were randomly assigned to control group and group treated with ibuprofen. Ibuprofen significantly reduced caspase‐like (β1), and trypsin‐like (β2) 26S proteasome activities in both male and female heart. However, ibuprofen reduced chymotrypsin‐like (β5 proteasome activity) in the female heart but not male hearts. Notably, immunoproteasome β1i (expression) and β5i (expression and activity) significantly increased in females relative to males. In contrast, a trend towards the decrease in expression of β2i and β5i immunoproteasome was observed in ibuprofen‐treated male mice. To determine mitochondrial function, measurement of mitochondrial respiratory chain complexes revealed that ibuprofen treatment significantly decreased complex I activity in female heart compared with males. Short‐term ibuprofen treatment also decreased heart weight in male mice but not in female mice. Western blots and oxyblots analysis showed no differences in the expression levels of polyubiquitinated proteins, free ubiquitins and oxidized proteins in both males and females. Our in vitro study with rat cardiac H9c2 cells showed that ibuprofen‐induced reactive oxygen species (ROS) generation, decreased mitochondrial complex II activity, reduced mitochondrial membrane potential and had variable effects on cell viability. In conclusion, our findings suggest that short‐term ibuprofen treatment results in gender‐specific adverse changes in cardiac mitochondrial function and protein homeostasis.Support or Funding InformationAmerican Heart Association (AHA) 16GRNT31350040 grant (A.V.G.)This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Optimizing Acute Post-Operative Dental Pain Management Using New Health Information Technology

Optimizing Acute Post-Operative Dental Pain Management Using New Health Information Technology

Algesia and Analgesia in Pediatric Dentistry

Aim: To summarize the basic and current concepts of algesia and analgesia in pediatric dental practice by a thorough systematic literature research of databases. Background: Electronic databases were used to conduct a computerized search like MEDLINE, Pub Med, Scopus and Evidence-based Medicine reviews using the terms ‘‘analgesics,’’ “drugs for pain,” “pain in children,” and “dental pain management”. Review results: Effective management of pain in children is a major priority for patients, parents, and health-care providers. Analgesics, class of drugs which helps to relieve pain, act either on peripheral nerve endings or in the central nervous system. Dental practitioners’ knowledge to prescribe the most effective drug and appropriate dose to alleviate pain is necessary. Conclusion: A pain management strategy in pediatric dentistry includes the ‘3-D’ approach that provides a systematic way of evaluating and managing the acute dental pain patient using combined non-pharmacologic and pharmacologic strategies. Clinical significance: Thorough knowledge about the drugs and its combination can result in achieving required postoperative analgesia thereby reducing adverse effects in children

Polymeric and Non Polymeric Injectable In-situ Forming Implant Systems for Sustained Delivery of Lornoxicam: In vitro and In vivo Evaluation.

Formulation of injectable In situ forming implant (ISI) systems of lornoxicam for dental and postoperative pain management to decrease dosing frequency and increase patient compliance. Polymeric in situ implant solutions were prepared using different concentrations and inherent viscosities of Poly-DL-lactide (PDL) or DL-lactide/glycolide copolymer (PDLG) using 22X4 factorial experimental design. Nonpolymeric systems were prepared using different concentrations of lipids like cetyl alcohol and stearyl alcohol and also sucrose acetate isobutyrate (SAIB) using 32 factorial experimental design. In vitro release study, rheological measurement, syringeability assessment and effect of γ-sterilization were used for evaluation of the prepared formulae. In vivo pharmacokinetic study of lornoxicam from the most optimum formula was conducted in a rabbit model using HPLC analysis of blood samples. Polymeric systems showed high burst release followed by very slow release rate over 72 hours. Formula I 24 (containing SAIB 80% (w/w)) showed relatively low burst release followed by diffusion controlled release pattern, low viscosity, Newtonian flow behavior and good syringeability. γ- sterilization had no significant effect on the in vitro release and the physical nature of the most optimum formula. In vivo study concluded that intramuscularly injected In situ implant formula I 24 showed prolonged release pattern compared to the marketed product which was indicated by the increased Tmax and the extended mean residence time. Lornoxicam ISI systems could be promising as convenient injectable sustained release delivery systems for dental and postoperative pain management.

Association between beliefs about medicines and self-medication with analgesics among patients with dental pain.

Self-medication with analgesics in dental pain management is a common practice as most of these medicines are available over-the-counter (OTC). The study aims to examine the relationship between beliefs about medicines and self-medication with analgesics in dental pain management in Malaysia. This cross-sectional study was conducted among conveniently sampled patients attending dental clinics, located in Kuala Lumpur, Malaysia to assess association between self-medication with analgesics and patient’s beliefs about medicines via Beliefs about Medicines Questionnaire. Participants were evaluated for their self-medication practices via 4 items. Further assessment was done via Quantitative Analgesic Questionnaire (QAQ) regarding the analgesics taken. Statistical analyses were performed using SPSS version 24, with 0.05 as level of significance. The prevalence of self-medication with analgesics was 29.4%, with 95.6% of the participants took analgesics when necessary. Participants practising self-medication for dental pain reported more positive beliefs in General-Necessity (13.04 vs. 9.98, p = 0.001) than those not practising self-medication. However, these participants had weaker beliefs in General-Harm (12.00 vs. 10.29, p = 0.006) and General-Overuse (11.38 vs. 10.31, p = 0.032) than those not practising self-medication. Participants beliefs in General-Harm (r = -0.243; p = 0.003) and General-Overuse (r = -0.203; p = 0.012) were negatively correlated with total QAQ point. The study found that individuals who practised self-medication had stronger beliefs about the benefits of medicines and weaker beliefs in viewing medicines as harmful and overused. Findings can guide public education to improve the safety aspects of self-medication with analgesics in dental practice.

Extraction and characterization of cashew tree (Anacardium occidentale) gum; use in aceclofenac dental pastes

In the current work, the usefulness of extracted cashew tree gum (CG) as pharmaceutical excipient in dental pastes containing aceclofenac (AC) for the pain management in the periodontitis treatment was investigated. CG was extracted from crude exudate of cashew tree (Anacardium occidentale, family: Anacardiaceae) (yield 19.22%). Physicochemical characteristics like colour, odour, taste, solubility, pH and viscosity of extracted CG were estimated; the phytochemical identification tests indicated the presence of carbohydrates and mucilage within it. It was also characterized by FTIR spectroscopy and 1H NMR analyses. Using the extracted CG (as natural mucoadhesive polymer) with calcium carbonate (abrasive agent), glycerin (humectant and cosolvent), methyl paraben (preservative), sodium lauryl sulfate (surfactant) and camphor (flavoring agent), 1% w/w AC dental pastes was formulated via conventional trituration. The drug contents, viscosities and pHs, tube extrudabilities and tube spreadabilities of these dental pastes were observed within permissible ranges. The dental pastes demonstrated sustained AC releasing over 6 h, in vitro and also revealed good adhesion to the oral mucosal membrane. These 1% w/w AC dental pastes can be used in the effectual management of dental inflammation and pain through local delivery of AC over a prolonged in the periodontitis treatment.

Placebo hypoalgesic effects in pain: Potential applications in dental and orofacial pain management

Placebo and nocebo effects are present within every treatment and intervention, and can be purposefully enhanced and reduced, respectively, in order to improve patients’ clinical outcomes. A plethora of research has been conducted on the mechanisms of placebo hypoalgesia and nocebo hyperalgesia in experimental and clinical settings. However, its implications in particular clinical settings such as orthodontic pain management remain underexplored. We conducted a search of the literature regarding placebo analgesia, orthodontic pain management, and orofacial and dental pain. Articles were qualitatively assessed and selected based on the scope of this narrative review. Although no studies investigating the extent of the implications of the placebo and nocebo phenomena in the orthodontic clinical setting were found, we herein present a comprehensive review on the influences of placebo and nocebo effects in experimental and clinical pain management, as well as on the potential for engaging placebo-related endogenous pain modulation for orthodontic pain management. Ethical considerations for the clinical application of placebos are discussed, and future research directions are presented.