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01-08-2020 | Paracetamol | Review

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

Authors: Leonardo Stephan Caporossi, Cinthia Studzinski dos Santos, Thayanne Brasil Barbosa Calcia, Maximiliano Sergio Cenci, Francisco Wilker Mustafa Gomes Muniz, Giana da Silveira Lima

Published in: Clinical Oral Investigations | Issue 8/2020

Abstract

Objectives

To assess and compare the pharmacological effect of different drugs on pain relief after periodontal surgery.

Materials and methods

Five databases were searched up to September 2019. The eligible studies comprised randomized clinical trials, involving only adult individuals that received any periodontal surgery and presenting two distinct groups of therapeutic regimens to control postoperative pain. Placebo groups could be included. The risk of bias was assessed with the RoB 2 Cochrane tool and the GRADE system. Meta-analyses were performed using different follow-up and drug comparisons.

Results

Overall, 2398 studies were identified, of which 35 were included. Low risk of bias was determined for the majority of the studies. The meta-analyses showed that the comparison of dexamethasone or non-steroidal anti-inflammatory drugs (NSAID) versus placebo favored the use of both interventions in a follow-up of 1 to 8 h for open flap procedures (OFP). However, no statistical difference was found for the comparison between NSAID and dexamethasone for OFP.

Conclusions

Patients may benefit from several pharmacological schemes for pain relief after periodontal surgeries. However, due to the high heterogeneity among studies, no fixed pharmacological protocol could be proposed.

Clinical relevance

There is not enough evidence to recommend one therapeutic scheme. However, untreated pain is harmful to the patients and it is not advisable.

Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJL, Marcenes W (2014) Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res 93:1045–1053. https://doi.org/10.1177/0022034514552491 CrossRefPubMedPubMedCentral

Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, Greenwell H, Herrera D, Kao RT, Kebschull M, Kinane DF, Kirkwood KL, Kocher T, Kornman KS, Kumar PS, Loos BG, Machtei E, Meng H, Mombelli A, Needleman I, Offenbacher S, Seymour GJ, Teles R, Tonetti MS (2018) Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Clin Periodontol 89:S173–S182. https://doi.org/10.1111/jcpe.12946 CrossRef

Mei CC, Lee FY, Yeh HC (2016) Assessment of pain perception following periodontal and implant surgeries. J Clin Periodontol 43:1151–1159. https://doi.org/10.1111/jcpe.12618 CrossRefPubMed

Canakçi CF, Canakçi V (2007) Pain experienced by patients undergoing different periodontal therapies. J Am Dent Assoc 138:1563–1573. https://doi.org/10.14219/jada.archive.2007.0105 CrossRefPubMed

Riley JL, Tomar SL, Gilbert GH (2004) Smoking and smokeless tobacco: increased risk for oral pain. J Pain 5:218–225. https://doi.org/10.1016/j.jpain.2004.03.003 CrossRefPubMed

Moore PA, Hersh EV (2013) Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc 144:898–908. https://doi.org/10.14219/jada.archive.2013.0207 CrossRefPubMed

Khademi H, Kamangar F, Brennan P, Malekzadeh R (2016) Opioid therapy and its side effects: a review. Arch Iran Med 19:870–876 0161912/AIM.0010 PubMed

Bailey E, Worthington H, Coulthard P (2014) Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth, a Cochrane systematic review. Br Dent J 216:451–455. https://doi.org/10.1038/sj.bdj.2014.330 CrossRefPubMed

Seymour RA, Blair GS, Wyatt FAR (1983) Post-operative dental pain and analgesic efficacy. Part I. Br J Oral Surg 21:290–297. https://doi.org/10.1016/0007-117X(83)90017-3 CrossRefPubMed

10.

Moher D, Liberati A, Tetzlaff J, Altman D (2009) Preferred Reporting Items for Systematic Reviews and MetaAnalyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.7326/0003-4819-151-4-200908180-00135 CrossRefPubMedPubMedCentral

11.

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898 CrossRefPubMed

12.

Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A (2011) GRADE guidelines: a new series of articles in the journal of clinical epidemiology. J Clin Epidemiol 64:380–382. https://doi.org/10.1016/j.jclinepi.2010.09.011 CrossRefPubMed

13.

Naseh M, Rezaiekalat S (2012) Comparison of the effects of celecoxib, naproxen and ibuprofen on pain control after periodontal surgeries. J Mash Dent Sch 35:307–314

14.

Cantor M (1968) A comparison of propoxyphene HCl (Darvon) and an analgesic mixture (Percogesic) in pain relief after gingivectomy. J Oral Ther Pharmacol 4:224–228

15.

Gallardo F, Rossi E (1980) Double-blind evaluation of naproxen and ibuprofen in periodontal surgery. Pharmacol Ther Dent 5:69–72PubMed

16.

Giorgetti APO, De Matos R, Casarin RCV et al (2018) Preemptive and postoperative medication protocols for root coverage combined with connective tissue graft. Braz Dent J 29:23–29. https://doi.org/10.1590/0103-6440201801452 CrossRefPubMed

17.

Tejaswi DV, Prabhuji MLV, Shaeesta Khaleelahmed B (2014) Comparative evaluation of transdermal diclofenac patch and oral diclofenac as an analgesic modality following root coverage procedures. Gen Dent 62:68–71PubMed

18.

Al-Hezaimi K, Al-Askar M, Selamhe Z et al (2011) Evaluation of novel adhesive film containing ketorolac for post-surgery pain control: a safety and efficacy study. J Periodontol 82:963–968. https://doi.org/10.1902/jop.2010.100553 CrossRefPubMed

19.

Isler SC, Eraydin N, Akkale H, Ozdemir B (2018) Oral flurbiprofen spray for mucosal graft harvesting at the palatal area: a randomized placebo-controlled study. J Periodontol 89:1174–1183. https://doi.org/10.1002/JPER.17-0381 CrossRefPubMed

20.

Popova C, Mlachkova A, Emilov D (2008) Effectiveness of NSAIDs Aulin and ibuprofen on the postoperative pain at gingival graft procedures - a preliminary study. J IMAB 2:12–15

21.

Kashefimehr A, Babaloo A, Ghanizadeh M, Ghasemi SH, Mollazadeh H (2017) Effect of prophylactic administration of Novafen for periodontal surgery on postoperative pain relief. J Med Life 10:127–130PubMedPubMedCentral

22.

Peres MFS, Ribeiro FV, Ruiz KGS, Nociti-Jr FH, Sallum EA, Casati MZ (2012) Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing periodontal surgery. Braz Dent J 23:621–628. https://doi.org/10.1590/S0103-64402012000600001 CrossRefPubMed

23.

Cooper SA, Wagenberg B, Eskow R, Zissu J (1983) Double-blind evaluation of Suprofen and aspirin in the treatment of periodontal pain. Pharmacology 27:23–30. https://doi.org/10.1159/000137896 CrossRefPubMed

24.

Cooper SA, Wagenberg B, Zissu J, Kruger GO, Reynolds DC, Gallegos LT, Allwein JB, Desjardins PJ, Friedmann N, Danna RP (1986) The analgesic efficacy of suprofen in periodontal and oral surgical pain. Pharmacotherapy 6:267–276CrossRefPubMed

25.

Minutello JS, Newell DH, Thrash WJ, Terezhalmy GT (1988) Evaluation of preoperative diflunisal for postoperative pain following periodontal surgery. J Periodontol 59:390–393CrossRefPubMed

26.

Minutello JS, Newell DH, Thrash WJ, Terezhalmy GT (1991) Evaluation of postoperative diflunisal for periodontal surgery pain. Am J Dent 4:33–36PubMed

27.

Betancourt JW, Kupp LI, Jasper SJ, Farooqi OA (2004) Efficacy of ibuprofen-hydrocodone for the treatment of postoperative pain after periodontal surgery. J Periodontol 75:872–876. https://doi.org/10.1902/jop.2004.75.6.872 CrossRefPubMed

28.

Agarwal S, Mathu S, Kothiwale S, Benjamin A (2010) Efficacy and acceptability of 0.074% diclofenac-containing mouthwash after periodontal surgery: a clinical study. Indian J Dent Res 21:408–412. https://doi.org/10.4103/0970-9290.70814 CrossRefPubMed

29.

Mishra A, Amalakara J, Avula H, Reddy K (2017) Effect of diclofenac mouthwash on postoperative pain after periodontal surgery. J Clin Diagn Res 11:ZC24–ZC26. https://doi.org/10.7860/JCDR/2017/22165.965 CrossRefPubMedPubMedCentral

30.

Rajeswari S, Gowda T, Kumar T et al (2015) An appraisal of innovative meloxicam mucoadhesive films for periodontal postsurgical pain control: a double-blinded, randomized clinical trial of effectiveness. Contemp Clin Dent 6:299–304. https://doi.org/10.4103/0976-237X.161857 CrossRefPubMedPubMedCentral

31.

Konuganti K, Rangaraj M, Elizabeth A (2015) Pre-emptive 8 mg dexamethasone and 120 mg etoricoxib for pain prevention after periodontal surgery: a randomised controlled clinical trial. J Indian Soc Periodontol 19:474–476. https://doi.org/10.4103/0972-124X.153475 CrossRefPubMedPubMedCentral

32.

Steffens JP, Santos FA, Pilatti GL (2011) The use of etoricoxib and celecoxib for pain prevention after periodontal surgery: a double-masked, parallel-group, placebo-controlled, randomized clinical trial. J Periodontol 82:1238–1244. https://doi.org/10.1902/jop.2011.100682 CrossRefPubMed

33.

Steffens JP, Santos FA, Sartori R, Pilatti GL (2010) Preemptive dexamethasone and etoricoxib for pain and discomfort prevention after periodontal surgery: a double-masked, crossover, controlled clinical trial. J Periodontol 81:1153–1160. https://doi.org/10.1902/jop.2010.100059 CrossRefPubMed

34.

Huskisson EC (1974) Measurement fo pain. Lancet 2:1127–1131. https://doi.org/10.1016/s0140-6736(74)90884-8

35.

Ohnhaus EE, Adler R (1975) Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Pain 1:379–384. https://doi.org/10.1016/0304-3959(75)90075-5

36.

Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126. https://doi.org/10.1016/0304-3959(86)90228-9 CrossRefPubMed

37.

Melzack R, Katz J (2001) The McGill pain questionnaire: appraisal and current status

38.

Diwan V, Srinivasa T, Ramreddy K, Agrawal V, Nagdeve S, Parvez H (2019) A comparative evaluation of transdermal diclofenac patch with oral diclofenac sodium as an analgesic drug following periodontal flap surgery: a randomized controlled clinical study. Indian J Dent Res 30:57–60. https://doi.org/10.4103/ijdr.IJDR-84-17 CrossRefPubMed

39.

Pearlman B, Boyatzis S, Daly C, Evans R, Gouvoussis J, Highfield J, Kitchings S, Liew V, Parsons S, Serb P, Tseng P, Wallis C (1997) The analgesic efficacy of ibuprofen in periodontal surgery: a multicentre study. Aust Dent J 42:328–334. https://doi.org/10.1111/j.1834-7819.1997.tb00139.x CrossRefPubMed

40.

Tucker PW, Smith JR, Adams DF (1996) A comparison of 2 analgesic regimens for the control of postoperative periodontal discomfort. J Periodontol 67:125–129. https://doi.org/10.1902/jop.1996.67.2.125 CrossRefPubMed

41.

Gallardo F, Rossi E (1992) Effects of sodium meclofenamate on postoperative pain following periodontal surgery. J Periodontol 63:166–168. https://doi.org/10.1902/jop.1992.63.3.166 CrossRefPubMed

42.

Steffens JP, Santos FA, Pilatti GL (2011) Postoperative periodontal pain prevention using two dexamethasone medication protocols: a double-blind, parallel-group, placebo-controlled randomized clinical trial. Am J Dent 24:354–356PubMed

43.

Gallardo F, Rossi E (1990) Analgesic efficacy of flurbiprofen as compared to acetaminophen and placebo after periodontal surgery. J Periodontol 61:224–227. https://doi.org/10.1902/jop.1990.61.4.224 CrossRefPubMed

44.

Rashwan WAM (2009) The efficacy of acetaminophen–caffeine compared to ibuprofen in the control of postoperative pain after periodontal surgery: a crossover pilot study. J Periodontol 80:945–952. https://doi.org/10.1902/jop.2009.080637 CrossRefPubMed

45.

Pilatti GL, André dos Santos F, Bianchi A, Cavassim R, Tozetto CW (2006) The use of celecoxib and dexamethasone for the prevention and control of postoperative pain after periodontal surgery. J Periodontol 77:1809–1814. https://doi.org/10.1902/jop.2006.060128 CrossRefPubMed

46.

O’brien TP, Roszkowski MT, Wolff L et al (1996) Effect of a non-steroidal anti-inflammatory drug on tissue levels of immunoreactive prostaglandin E2, immunoreactive leukotriene, and pain after periodontal surgery. J Periodontol 67:1307–1316CrossRefPubMed

47.

Trombelli L, Schincaglia GP, Zangari F, Scapoli C, Calura G (1996) Effect of pretreatment with ketorolac tromethamine on post-operative pain following periodontal surgery. J Clin Periodontol 23:128–132. https://doi.org/10.1111/j.1600-051X.1996.tb00545.x CrossRefPubMed

48.

Vogel RI, Desjardins PJ, Major KVO (1992) Comparison of presurgical and immediate postsurgical ibuprofen on postoperative periodontal pain. J Periodontol 63:914–918. https://doi.org/10.1902/jop.1992.63.11.914 CrossRefPubMed

49.

Schirmer C, dos Santos GO, Rost JF, Ferreira MBC, Weidlich P (2018) Factors associated with pain and analgesic consumption following non-surgical periodontal therapy under local anaesthesia and carried out by dental students. J Clin Periodontol 45:68–77. https://doi.org/10.1111/jcpe.12833 CrossRefPubMed

50.

West NX, Lussi A, Seong J, Hellwig E (2013) Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin. Clin Oral Investig 17:S9–S19. https://doi.org/10.1007/s00784-012-0887-x

51.

Burian M, Geisslinger G (2005) COX-dependent mechanisms involved in the antinociceptive action of NSAIDs at central and peripheral sites. Pharmacol Ther 107:139–154. https://doi.org/10.1016/j.pharmthera.2005.02.004 CrossRefPubMed

52.

Cashman JN (1996) The mechanisms of action of NSAIDs in analgesia. Drugs 52(Suppl):5–23. https://doi.org/10.2165/00003495-199600525-00004 CrossRef

53.

Guindon J, LoVerme J, De Léan A et al (2006) Synergistic antinociceptive effects of anandamide, an endocannabinoid, and nonsteroidal anti-inflammatory drugs in peripheral tissue: a role for endogenous fatty-acid ethanolamides? Eur J Pharmacol 550:68–77. https://doi.org/10.1016/j.ejphar.2006.08.045 CrossRefPubMed

54.

Arslan R, Bektas N (2018) The role of TRP and K+ ion channels in analgesic effect of NSAIDs. Clin Exp Heal Sci 8:301–307. https://doi.org/10.5152/clinexphealthsci.2018.832 CrossRef

55.

Wong YJ, Keenan J, Hudson K et al (2016) Opioid, NSAID, and OTC analgesic medications for dental procedures: PEARL network findings. Compend Contin Educ Dent 37:710–718PubMed

56.

Thornhill MH, Suda KJ, Durkin MJ, Lockhart PB (2019) Is it time US dentistry ended its opioid dependence? J Am Dent Assoc 150:883–889. https://doi.org/10.1016/j.adaj.2019.07.003 CrossRefPubMedPubMedCentral

57.

Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT (2019) Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med 179:145–152. https://doi.org/10.1001/jamainternmed.2018.5419 CrossRefPubMed

58.

Sotto-Maior BS, Senna PM, Assis NMDSP (2011) Corticosteroids or cyclooxygenase 2-selective inhibitor medication for the management of pain and swelling after third-molar surgery. J Craniofac Surg 22:758–762. https://doi.org/10.1097/SCS.0b013e318207f3fe CrossRefPubMed

59.

Troullos ES, Hargreaves KM, Butler DP, Dionne RA (1990) Comparison of nonsteroidal anti-inflammatory drugs, ibuprofen and flurbiprofen, with methylprednisolone and placebo for acute pain, swelling, and trismus. J Oral Maxillofac Surg 48:945–952. https://doi.org/10.1016/0278-2391(90)90007-O CrossRefPubMed

60.

Fernandes IA, de Souza GM, Pinheiro MLP, Falci SGM (2019) Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 48:659–668. https://doi.org/10.1016/j.ijom.2018.09.014 CrossRefPubMed

61.

Tieppo Francio V, Davani S, Towery C, Brown TL (2017) Oral versus topical diclofenac sodium in the treatment of osteoarthritis. J Pain Palliat Care Pharmacother 31:113–120. https://doi.org/10.1080/15360288.2017.1301616 CrossRefPubMed

62.

Yaghini J, Abed AM, Mostafavi SA, Roshanzamir N (2011) The effect of diclofenac mouthwash on periodontal postoperative pain. Dent Res J (Isfahan) 8:146–149. https://doi.org/10.7860/JCDR/2017/22165.965 CrossRef

Title: Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis
Authors: Leonardo Stephan Caporossi
Cinthia Studzinski dos Santos
Thayanne Brasil Barbosa Calcia
Maximiliano Sergio Cenci
Francisco Wilker Mustafa Gomes Muniz
Giana da Silveira Lima
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Paracetamol
Diclofenac
Ibuprofen
Analgesics in Dentistry
Dexamethasone
Published in: Clinical Oral Investigations / Issue 8/2020
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-020-03401-6

At a glance: The STEP trials

Springer Medicine

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

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