Impacted Wisdom Teeth Research Articles

Dental pain in Brazilian preschool children: association with the severity of dental caries and impact on oral health-related quality of life.

This study aimed to verify the association between dental pain and severity of dental caries (caries morbidity stages) and the impact on oral health-related quality of life (OHRQoL) in preschool children. A cross-sectional study with 199 children (2-5years old) enrolled at preschools in Capão do Leão-RS, Brazil. The self-report of mothers of children with a history of dental pain in the last 6months and perception of their child's OHRQoL (ECOHIS) were obtained through a structured questionnaire. This questionnaire also collected independent variables. Children's oral examination was performed using the CAST instrument to determine caries morbidity stage. Crude and adjusted Poisson regression analysis was performed. The prevalence of dental pain was 14.57%. The chance of the occurrence of dental pain was higher among children diagnosed in morbidity [Prevalence ratio-PR: 5.29 (95% confidence interval-95% CI 1.91-14.61); p = 0.001] and severe morbidity [RP = 6.12 (95 CI% 2.25-16.64); p < 0.001] stages. Children with dental pain presented higher scores in the total ECOHIS [rate ratio = 7.11 (95% CI 4.55-11.09); p < 0.001] and in all of the domains of this instrument. Furthermore, children with a history of dental trauma [PR = 2.41 (95% CI 1.15-5.04); p < 0.001] and those whose reason for last visit to the dental office was for restorative/endodontic/extraction treatment [PR = 1.29 (95% CI 1.01-6.19); p = 0.049] had a higher prevalence of dental pain. A substantial prevalence of dental pain in the last 6months and negative impact on children's OHRQoL was identified in this sample. Children diagnosed with carious dentin lesions and abscess and fistula were more likely to have dental pain.

More than clean teeth! Identifying factors that contribute to the development of early childhood caries.

This review aimed to identify established and updated evidence-based factors that could contribute to a child's development of Early Childhood Caries (ECC). Four online databases were used to source evidence including the Cochrane Library, EMBASE, MEDLINE, and Scopus. The data search selected studies published between 2017 and 2021. Three specific terms were used to search: Dental Caries, Children, and Risk Assessment. There were three teams involved in data collection, two teams then reviewed selected articles. Exclusion criteria included any duplicate studies, commentaries, and editorials. Inclusion criteria included only randomised control trials and cohort studies. Selected studies must include children younger than 72 months, define the demographics, their clinical characteristics, and have clear follow-up of the patients involved. Commonly identified factors that were mentioned in multiple studies were then collected and assigned strength depending on the evidence measured using ratios. These could then beutilised to form a draft Caries Risk Assessment tool. 512 abstracts and 52 articles were screened, having matched the criteria set. Extraction of the data was completed under four headings: the child's age at the time of study (in years/months), risk predictors, the outcome, and the quality of the evidence presented. The GRADE system was then employed to separate the studies into high, moderate, low, and very low categorisation. Eventually, 22 new studies were included that would build on the original 25 articles that were identified in the previous systematic review. The most defining factors across the most recent systematic reviews in 2021 highlighted behavioural factors such as toothbrushing quality - parental supervision, frequency, and fluoride exposure. Specifically, the presence of plaque was used as a marker for oral hygiene evaluation. Dietary history included snacking frequency and, controversially, baby-toddler breastfeeding patterns. However, this does not take into consideration the dental impact - mainly the frequency or timing of breastfeeding (e.g. overnight). The review emphasises the importance of consideration of socio-economic factors though this may be a difficult topic of discussion if families are struggling i.e. household income and education level of parents or guardians. There is also mention of factors that do not have a significant evidence base such as the child's gender, ethnicity, and parental smoking status. In conclusion, the factors found to be relevant in the development of ECC were the child's age, toothbrushing quality/plaque control, parental involvement in toothbrushing, fluoride exposure, pattern of dental attendance, dietary sugar exposure, and habits, clinically carious active lesion presence, the oral bacterial composition (Streptococcus mutanspresence) and the socio-economic status of the child and their family. Though the review encourages identification of the caries risk factors in the mentioned groups, separated by both dental and non-dental professionals, ideally the aim would be to create a holistic care approach for management and signposting.

Profile and Prevalence of Oral and Maxillofacial Diseases Among Armed Forces Personnel and Their Families in Military Dental Centre, Cumilla

Background: Oral and maxillofacial diseases encompass a wide range of conditions in and around oral cavity and in maxillofacial region. It includes maxillofacial trauma, cyst and tumour of jaw bones, conditions involving impacted wisdom teeth, oral premalignant and malignant lesions, fascial space infection around maxillofacial region, temporomandibular joint disorder, dental implantology, salivary gland disorder and congenital defects of jaw bones. Maxillofacial region is more vulnerable to sustain injuries in the battlefield. In peace time, various maxillofacial diseases reduce the overall performances of the troops. The aim of this study is to delineate rank wise distribution of armed forces personnel reported with maxillofacial diseases, gender distribution, types of maxillofacial diseases, different types of surgical procedures performed and types of anesthesia used. Methods: A descriptive cross-sectional study was conducted to assess the prevalence of maxillofacial diseases among the armed forces personnel and their entitled family members during the period of 1st January 2019 to 31st December 2019 in Military Dental Centre, Cumilla. Purposive sampling technique and semi structured questionnaire was used to include the patients in this study.Data were analyzed by using Statistical Packages for Social Sciences (SPSS) version 25. Results: A total of 170 cases were evaluated and treated. Male patients were 110(65%) and female were 60(35%). Among the military personnel numbers of sainik (privates) were highest 32(35%). Impacted wisdom teeth cases were mostly found 80(47%). In case of impacted teeth mesio angular impactions were most 35(35%). In case of maxillofacial pathological conditions cystic lesions were most in number 22(39%) (n=56). Maxillofacial soft tissue laceration cases were highest 05(29%) (n=17) among all trauma patients. Surgical extraction of wisdom teeth were mostly performed surgery 80(59%) (n=138). In regards to administration of anesthesia, 128(93%) cases were performed under local anesthesia and 10(7%) were under general anesthesia. Conclusion: The present study imparts valuable perception about the types and prevalence of maxillofacial diseases and the treatment modalities among the armed forces personnel and their families in Cumilla area. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 24-30

Modern approach to the treatment of postoperative symptoms of patients undergoing oral surgery

Introduction. Removal of wisdom teeth is always accompanied by the appearance of collateral edema of varying severity, pain, neurological dysfunction and inflammatory contracture of the masticatory muscles.Purpose. To evaluate the use of local apparatus hypothermia and the method of three-dimensional facial scanning for the treatment of patients after extraction of mandibular third molars.Materials and methods. 60 patients had their wisdom teeth removed. Depending on the group, local apparatus hypothermia (LAH) (study group of 30 patients) and local ice hypothermia (LIH) (control group of 30 patients) were performed after surgery. Evaluation criterion: three-dimensional scanning of the face on days 3, 5, 7.Results. In the control group, on the 3rd day the size of the edema was 6.31 mm (SD 0.81), on the 5th day – 4.88 mm (SD 0.73), on the 7th day – 3.44 mm (SD 0.88). In the study group, on the 3rd day the size of the edema was 5.09 mm (SD 0.80), on the 5th day – 2.73 mm (SD 0.71), on the 7th day – 1.28 mm (SD 0,62). In the control group, the size of edema on the 5th day changed by 22.67% compared to the 3rd day, on the 7th day by 30.12% compared to the 5th day and by 45.94% compared to 3rd day. In the study group, the size of edema on the 5th day changed by 46.42% compared to the 3rd day, on the 7th day by 53.16% compared to the 5th day and by 75.32% compared 3rd day. Comparison of groups 3, 5 and 7 in terms of absolute values of edema size and percentage change showed a statistically significant difference (p&lt;0.001).Conclusion. The use of local apparatus hypothermia in the postoperative period can reduce the severity of collateral edema in a shorter period compared to standard methods of local hypothermia.

Large adenomatoid odontogenic tumor: Case report

The adenomatoid odontogenic tumor (AOT) is an uncommon, benign neoplasm of odontogenic epithelial origin, believed to have originated from two remnants of the dental lamina or enamel organ, representing 2-7% of all odontogenic tumors. Clinically, they are slow growing, asymptomatic and rarely exceed 3.0 cm in diameter. TOA presented three different clinicopathological variants without relevant clinical and radiographic differences: intraosseous follicular (associated with dental impaction, generally comprising 70% of the two cases); extra-follicular intraosseous (present between erupted teeth, representing 25% of the two cases); and peripheral (extra-osseous, 5% two cases). The aim of this paper is to report a case of a large and aggressive adenomatoid odontogenic tumor. Patient, male, 13 years old, undergoing direct increase in maxillary volume with evolution of 01 month. Upon physical examination, an increase in volume in the middle third of the face was observed, directly causing facial asymmetry. normal appearance, absence of unit, tooth 13, stable dental occlusion, poor mouth opening, poor oral hygiene. On imaging (face tomography) there was a hypodense image in the maxillary region directly, osteolytic, well circumscribed, with a radiopaque halo, causing expansion of the cortical bones without breaking them, associated with the impacted and included dental unit 13. Enucleation and complete healing of the lesion and associated extraction of unit 13 were performed, with a lesion presenting a fibrous capsule in the non-transoperative period. The patient is being followed up by a team, weeks of recurrence at the moment. In this way, a rapid and aggressive evolution appears, being clinically perceptible and confused with the behavior of an amelolastoma, however, the histopathological diagnosis of TOA was confirmed, although the lesion responded to a conservative surgical technique through enucleation and dressing, presenting a excellent result.

Bilateral Maxillary Bone Swelling - Comprehensive Differential Diagnosis and the Role of Impacted Wisdom Teeth

Bilateral Maxillary Bone Swelling - Comprehensive Differential Diagnosis and the Role of Impacted Wisdom Teeth

Impact of dental caries on the daily lives of geriatric patients visiting dental hospitals in Rawalpindi, Pakistan.

The objectives were to assess the impact of dental caries on the daily living of the geriatric population and determine the factors that influence the relationship between dental health and the daily living of the geriatric population. A descriptive cross-sectional study was carried out over six months at Rawalpindi's public and private dental hospitals. Participants aged≥60 years, both male and female, were selected. The calculated sample size was 281. Desired sample from one of the dental hospitals was collected using a non-probability consecutive sampling strategy. Data about sociodemographic characteristics and the DMFT index were collected. Adapted validated tool dental impact on daily living (DIDL) was used to assess the impact of dental health on daily living. Chi-squared test of association showed a positive association between the DIDL and sociodemographic variables, including age (P=0.001), gender (P=0.001), education (P=0.001), income (P=0.001), occupation (P=0.029), marital status (P=0.001), living arrangement (P=0.001), and history of chronic illnesses (P=0.001). The association between the DMFT index and DIDL also showed statistically significant results (P=0.001). Binary logistic regression analysis indicated that gender (OR=6.98, P=0.005) and the individual's dental health (OR=6.43, P=0.001) were the strongest predictors of the impact experienced in daily life activities. The overall model was statistically significant (χ2=51.24, P=0.001), and the variables were responsible for 32.4% of the variance in the outcome variable. The study provides strong evidence that sociodemographic factors, DMFT index, gender, and individual dental health significantly contribute to the impact of dental health on daily living. Gender and individual dental health emerge as particularly influential predictors. These findings emphasize the need for targeted interventions and awareness programs, especially for groups with a higher risk of experiencing a significant impact on daily life due to dental issues.

Osteogenic Differentiation and Proliferation of Apical Papilla Stem Cells Using Chitosan-Coated Nanohydroxyapatite and Bioactive Glass Nanoparticles.

The aim of this study was to evaluate the osteogenic differentiation ability and proliferation of apical papilla stem cells (SCAPs) using chitosan-coated nanohydroxyapatite and bioactive glass nanoparticles. Hydroxyapatite, chitosan-coated nanohydroxyapatite, and bioactive glass 45S5 nanoparticles were prepared and characterized using a transmission electron microscope and X-ray diffraction. SCAPs were harvested from freshly extracted impacted wisdom teeth, cultured, and characterized using flow cytometric analysis. Tested nanomaterials were mixed and samples were classified into five equal groups as follows: negative control group: SCAP with Dulbecco's modified eagle's medium, positive control group: SCAP with inductive media, first experimental group: nanohydroxyapatite with SCAP, second experimental group: chitosan-coated nanohydroxyapatite with SCAP, third experimental group: bioactive glass nanoparticles with SCAP. Osteoblastic differentiation was assessed using an alkaline phosphatase (ALP) assay. Receptor activator of nuclear factor kappa beta ligand (RANKL) expression was evaluated using specific polyclonal antibodies by fluorescence microscope. The proliferation of SCAP was assessed using cell count and viability of trypan blue in addition to an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Isolated SCAP showed a nonhematopoietic origin. Chitosan-coated nanohydroxyapatite showed the highest ALP concentration followed by nanobioactive glass, nanohydroxyapatite, and negative control. Chitosan-coated nanohydroxyapatite showed the highest H score followed by nanobioactive glass, nanohydroxyapatite, and negative control in RANKL expression. Chitosan-coated nanohydroxyapatite showed the highest viable cell count. SCAP isolation is achievable from extracted fully impacted immature third molars. All tested biomaterials have the ability to induce osteogenic differentiation and proliferation of SCAP. Composite nanoparticle materials show better osteogenic differentiation and proliferation of SCAP than single nanoparticles.

Dynamics of changes in the microflora of the oral fluid after the removal of lower wisdom teeth against the background of antibiotic therapy and phage therapy

The purpose of our study was to study the effectiveness of the drug «Sextafag» as a therapeutic and prophylactic agent after the removal of impacted lower third molars.Recently, there has been a large number of patients with antibiotic resistance, so it is to find an alternative to traditional antibiotic therapy. This article examines the qualitative and quantitative composition of the oral microbiota after removal of impacted lower wisdom teeth. We studied the dynamics of changes in microflora during antibacterial treatment and phage therapy. The data obtained confirm the clinical and bacteriological effectiveness of oral phage therapy for inflammatory diseases in dental practice and can serve as the basis for the development of a new algorithm for the use of bacteriophages in the treatment of purulent-inflammatory diseases of the oral cavity.

Adjunctive Effect of Photobiomodulation Therapy with Nd:YAG Laser in the Treatment of Inferior Alveolar Nerve Paresthesia.

Background: Disruption of peripheral branches of the trigeminal nerve in the field of maxillofacial surgery is a known risk due to the close connection of these branches with the bony structures of the maxilla and mandible. As a result, injuries of the lingual nerve and inferior alveolar nerve take place within routine maxillofacial surgery procedures, including local anesthetic injection, wisdom tooth surgery, and dental implant placement, resulting in paresthesia and dysesthesia. During the last three decades, low-level lasers (LLL) have been frequently used in various medical fields. Lately, this application has increased in several sectors. Methods and materials: This experiment was designed to explore the effect of low-level laser therapy (LLLT) with Nd:YAG on the paresthesia and dysesthesia of the lower lip. This ethics committee of Tbzmed, Tabriz, Iran, proved the present experiment with ethical code: IR.TBZMED.REC.1401.839. Results: After completing 10 sessions of laser therapy for the case group consisting of 25 patients with lower lip anesthesia, the visual analog scale index results revealed that following six sessions of laser therapy, a significant difference appeared in contrast to the control group. Also, according to the two-point tests, significant difference among the experimental and the control group appeared after ninth session of the laser therapy. Conclusions: Altogether, these data suggested LLLT with Nd:YAG as an effective treatment option for decreasing the anesthesia of the lower lip.

Public interest and seasonal peaks for wisdom teeth related web inquiries - A google trends analysis.

With the help of the online search query tool, Google Trends, the public interest in the primary search term "wisdom teeth" for the timeframe between January 1st, 2004 and September 31st, 2021 was analyzed. To do so, a country-specific search was conducted in English-speaking countries (the USA, the UK, Canada, and Australia) in the northern and southern hemispheres. The extracted time series was examined for reliability, and a Cosinor analysis evaluated the statistical significance of seasonal interest peaks. The reliability of averaged time series data on the search term "wisdom teeth" was excellent in all examined countries. In all countries analyzed, "wisdom teeth removal" was one of the most common related search terms. Significant interest peaks for wisdom teeth-related search terms were found in Canada and the USA during summer (p < .001). In Canada and the USA, significant seasonal patterns with the highest interest during the summer months, could be displayed. This phenomenon could be caused by increased wisdom teeth-related complaints induced by seasonal climate changes.

Evaluation of Different Drugs for Prevention of Dry Socket after Extraction of Lower Wisdom Teeth

Dry socket is one of the most common complications of tooth extraction especially after lower wisdom tooth removal. Many drugs have been used to decrease the incidence of this complication. The purpose of this study was to evaluate different drugs in prevention of dry socket. In this study 150 patients needs removal of lower wisdom tooth were included. The patients divided into five equal groups were and each group received different type of drug postoperatively. The patients were evaluated for the presence of dry socket in the 2nd, 5th, and 7th day after tooth extraction. The females were affected more than males in this study with 2.1: 1 rat io. The incidence of dry socket in the total number of the patients was 17.3%. The analysis of the data showed no significant relations between the five groups as the P value was &gt; 0.05.The use of different drugs postoperative in this study showed no differences in the incidence of dry socket which high lighten the use of preventive measures to decrease the occurrences of such condition.

EVALUATION OF POSTOPERATIVE PARESTHESIA FOLLOWING ORAL SURGERY IN DOCUMENTED CASES at FORENSIC MEDICINE

Objective: Surgical procedures applied in dentistry are open to different complications and one of the most important of these complications is nerve damage. Paresthesia occurs at varying rates according to the degree of damage to the affected nerve. The aim of this study is to compare the surgical procedures applied in cases where paresthesia has occurred.&#x0D; &#x0D; Methods: The study was designed retrospectively on cases referred to the Department of Dentistry of the 7th Specialization Board of the Council of Forensic Medicine between April 2019 and May 2023, with complaints of paresthesia following oral, dental and maxillofacial surgery operations. A total of 387 surgical procedures were divided into 3 groups as impacted mandibular wisdom tooth surgery, orthognathic surgery and dental implant surgery and the groups were compared with each other. The groups were also evaluated in terms of the technique, patient age and gender, and local factor variables applied within themselves.&#x0D; &#x0D; Results: Of the cases, 58.9% were female (229 people) and 41.1% (159 people) were male (p

Influences of ultrasound osteotome on wound infection and wound complications following removal of mandibular wisdom teeth.

We conducted this study to assess the effect of ultrasound osteotome on surgical site wound infection and pain following removal of mandibular wisdom teeth. A computerised search of Embase, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for publicly available randomised controlled trials (RCTs) on the clinical effects of applying ultrasound osteotome to extract mandibular wisdom teeth was conducted from the inception of the databasesto September 2023. Two researchers independently screened the retrieved results for literature screening, quality assessment and data extraction. RevMan 5.4 software was applied for data analysis. A total of 17 RCTs were included in this study, including 848 cases in the ultrasound osteotome group and 842 cases in the control group. The analysis revealed, compared with the control group, the ultrasound osteotome group showed a significantly lower incidence of postoperative wound infection (1.42% vs. 5.46%, odds ratio [OR]: 0.30, 95% confidence intervals [CI]: 0.17-0.53, p < 0.0001), fewer postoperative complications (6.35% vs. 22.12%, OR: 0.23, 95% CI: 0.17-0.32, p < 0.00001), shorter operative time (standardised mean differences [SMD]: -1.30, 95% CI: -1.97 to -0.64, p = 0.0001) and lower wound pain scores (SMD: -2.26 95% CI -2.80 to -1.73, p < 0.00001). Strong evidence suggests that ultrasound osteotome applied to extract mandibular wisdom teeth is more advantageous in terms of lower postoperative wound infection, less wound pain, fewer postoperative complications and shorter operative time compared with conventional treatment methods, but large-scale, multicentre RCTs are still needed to obtain more accurate results.

Autologous blood concentrates application for post-extractional wound healing after impacted inferior wisdom tooth removal

Wisdom teeth extraction is the most common OMF surgical intervention. After the surgery, there might emerge some complications that persist even if all the indications recommended by the doctor were followed. Purpose: To settle, based on a prospective case–control research, the performance of platelet–rich fibrin, introduced as A–PRF into the socket, on clinical development after wisdom teeth removal. Materials and methods: 24 patients aged between 22 and 46 years old, with an mean age of 28,38±7,06, participated in this research. All of them had their impacted lower wisdom teeth extracted, assessed according to the Modified Parent Scale with extraction difficulty index III. The patients were divided into two groups, each with 12 patients: Case — patients who had A–PRF plugs introduced into the socket and Control — patients undergoing conventional treatment. The patients were examined after the surgery on day 1, 3, 7, 10 where three variables were analyzed — pain, based on the Numerical Pain Rating Scale, edema, according to the Laskin method and regeneration with the Landry index. Results and discussion: Patients in the experimental group presented a lower pain index, none of which reported severe pain. In the control group, one patient reported severe pain on the first postoperative day. Regeneration of the oral mucosa clinically was faster and without complications, compared to the control group, in which 2 patients presented post–extraction bleeding on the next day of the surgery. No significant differences were observed between the groups in the clinical appearance of facial edema. Conclusions: Fibrin clots introduced into the socket reduced the risk of post–extractional bleeding with positive signs of faster surgical wound healing, with less pain for patients in the experimental group compared to those in the control group, but studies in larger groups of patients are necessary due to the relatively small number of patients included in this study.

Anxiety and Pain Perception in Patients Using Analgesics Before Wisdom Tooth Surgery

Anxiety and Pain Perception in Patients Using Analgesics Before Wisdom Tooth Surgery

A Prospective Study to Compare the Effects of Preemptive Piroxicam and Oral Dexamethasone on Edema, Trismus and Pain in Third Molar Surgery: A Randomized Controlled Trial

Abstract Introduction: Surgical extraction of impacted third molars is an increasingly common procedure but is associated with postoperative sequelae such as pain, swelling, and trismus. This study aims to compare the effects of preemptive piroxicam and oral dexamethasone on pain, swelling and trismus following third molar surgery. Materials and Methods: A prospective randomized study consisting of 31 patients requiring lower third molar surgery were selected. They were randomly allocated to two treatment groups, oral dexamethasone (8 mg) and oral piroxicam (20 mg). The overall analgesic efficacy and anti-inflammatory effect of the two drugs were assessed postoperatively after 24, 48, 72 h, and on day 7 for pain, swelling, and trismus. Results: The difference in the mean scores of piroxicam group and dexamethasone group was statistically significant with the dexamethasone group showing better analgesia at the end of 24 h, 48 h, and 72 h done using Mann–Whitney U test. The swelling was compared between the two groups using an independent t-test. These results were statistically significant and dexamethasone was more effective at return to normal preoperative measurements 1-week postsurgery. When the mouth opening at day 7 was compared with the preoperative values, subjects in the piroxicam group showed a decrease of 0.18 ± 0.13, and those in the dexamethasone group showed a decrease of 0.05 ± 0.13 showing that dexamethasone group was significantly closer to returning to normal mouth opening at the end of 1 week post-surgery using independent t-test. Conclusion: We can conclude that the use of 8 mg oral dexamethasone 1 h preoperatively leads to a more comfortable and pain-free period for patients who undergo wisdom teeth removal, within its limitations.

Pattern of oro-dental disease in dental clinic of a tertiary care center

Introduction: The oro-dental diseases are major public health problem throughout the population in Nepal and other countries of the world. It affects people throughout their lifetime. Unhealthy lifestyles, environment and oral health related behavior are the primary causes of oro-dental diseases. We aimed to study the descriptive variables related to oro-dental dental diseases amongst patients attending tertiary care center. Method: A three-year data (April 2019 to April 2022) of patients registered for the treatment of oro-dental diseases in the record book of dental department of Patan Hospital were collected retrospectively. The collected data were entered in Microsoft Excel, and statistical analysis was carried out by using Statistical Package for the Social Science (SPSS) version 16. Result: In the study, 15,879 patients were included; among them 8,652(54.49%) were female and 7,227(45.51%) were male. The most prevalent oro-dental disease was gingivitis/periodontitis 5,076(31.96%) followed by dental caries 5,028(31.66%), abrasion 3,525(22.2%), malocclusion 951(5.99%), impaction 585(3.68%), pulpitis 384(2.42%) and edentulous 330(2.08%). In male, majority 1,800(24.9 %) belonged to 60 years and above age group, in female, majority 1,749 (20.21 %) belonged to 20-29 y. Conclusion: The most prevalent oro-dental diseases was gingivitis/periodontitis followed by dental caries, abrasion, malocclusion, impaction, pulpitis and edentulous. The female patients had more oro-dental problems than males.

Analgesic onset and efficacy of a fast-acting formulation of acetaminophen in a postoperative dental impaction pain model

Objectives Speed of onset can be critical to an analgesic’s efficacy treating acute pain. To enhance onset, a new oral acetaminophen formulation intended to be fast acting was developed. Two studies evaluated the analgesic onset, efficacy, and safety of this fast-acting acetaminophen (FA-acetaminophen) tablet relative to commercial acetaminophen caplets (ES-acetaminophen) and commercial ibuprofen liquid-filled gelatin capsules (LG-ibuprofen). Methods Two single-center, single-dose, inpatient, randomized, double-blind, triple-dummy, placebo-controlled, parallel group design clinical trials were conducted using the postoperative dental impaction pain model. Subjects were healthy men and women aged 17–50 years experiencing moderate-to-severe pain after surgical extraction of at least three impacted third molars. In both studies, four treatment groups were evaluated: 1,000 mg acetaminophen as two 500 mg FA-acetaminophen tablets, 1,000 mg as two 500 mg ES-acetaminophen caplets, 400 mg ibuprofen as two 200 mg LG-ibuprofen capsules, and placebo. To maintain blinding, each subject received six units of study medication. Times to confirmed perceptible pain relief (TCPR) and meaningful pain relief (TMPR) were obtained using the double-stopwatch method. Pain intensity and relief were measured over 6 h following drug administration using a 0–10 numerical rating scale. Time to use of rescue medication (naproxen sodium) and subject global evaluations of study medications at 6 h were collected. Pharmacokinetic blood sampling and safety assessments were performed. Results Studies 1 and 2 enrolled 240 and 420 subjects, respectively. No clinically important differences among treatment groups were observed for any demographic or baseline characteristics. Efficacy results showed all active treatments statistically superior to placebo. In Study 1, TCPR was statistically significantly shorter for FA-acetaminophen compared to ES-acetaminophen and LG-ibuprofen. In Study 2, no statistically significant differences in TCPR were noted across the active treatment groups. In Study 1, FA-acetaminophen 1,000 mg provided significantly shorter TMPR compared with LG-ibuprofen but not compared with ES-acetaminophen. In Study 2, no significant differences in TMPR were noted across the active treatment groups. In both Study 1 and 2 at 15 min after administration of study drug, PID and PAR scores were greater for FA-acetaminophen than LG-ibuprofen. Conclusions Both studies suggested FA-acetaminophen had faster onset of action compared to ES-acetaminophen and LG-Ibuprofen. In light of the difference in TCPR and TMPR results between Study 1 and 2, an additional study is needed to further investigate time to analgesic onset of FA-acetaminophen compared with ES-acetaminophen and LG-Ibuprofen. Study registry numbers Study 1: NCT02735122; Study 2: NCT03224403

Dental impact of anti-fibroblast growth factor 23 therapy in X-linked hypophosphatemia

Elevated fibroblast growth factor 23 (FGF23) in X-linked hypophosphatemia (XLH) results in rickets and phosphate wasting, manifesting by severe bone and dental abnormalities. Burosumab, a FGF23-neutralizing antibody, an alternative to conventional treatment (phosphorus and active vitamin D analogs), showed significant improvement in the long bone phenotype. Here, we examined whether FGF23 antibody (FGF23-mAb) also improved the dentoalveolar features associated with XLH. Four-week-old male Hyp mice were injected weekly with 4 or 16 mg·kg−1 of FGF23-mAb for 2 months and compared to wild-type (WT) and vehicle (PBS) treated Hyp mice (n = 3–7 mice). Micro-CT analyses showed that both doses of FGF23-mAb restored dentin/cementum volume and corrected the enlarged pulp volume in Hyp mice, the higher concentration resulting in a rescue similar to WT levels. FGF23-mAb treatment also improved alveolar bone volume fraction and mineral density compared to vehicle-treated ones. Histology revealed improved mineralization of the dentoalveolar tissues, with a decreased amount of osteoid, predentin and cementoid. Better periodontal ligament attachment was also observed, evidenced by restoration of the acellular cementum. These preclinical data were consistent with the retrospective analysis of two patients with XLH showing that burosumab treatment improved oral features. Taken together, our data show that the dentoalveolar tissues are greatly improved by FGF23-mAb treatment, heralding its benefit in clinics for dental abnormalities.