Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Abstract Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Microbiological evaluation of acute periradicular abscesses by DNA-DNA hybridization / Avaliação microbiológica do acesso periradicular agudo por hibridização DNA-DNA

Objective: The purpose of the present investigation was to examine the microbiota of acute periradicular abscesses of endodontic origin by using a molecular genetic method. Study design: Pus was collected by aspiration from 27 cases diagnosed as acute abscesses of endodontic origin, and DNA was extracted to evaluate the occurrence of 49 bacterial species by using whole genomic DNA probes and checkerboard DNA-DNA hybridization. The presence of bacterial DNA in clinical samples was confirmed by polymerase chain reactin with ubiquitous bacterial 16S rRNA gene primers. Results: The results of the checkerboard DNA-DNA hybridization analysis revealed that 37 of the 49 DNA probes tested were reactive wilth one or more samples. The number of bacterial species in the pus samples ranged from 1 to 33 (mean, 5.9). Eighteen of the 27 pus samples were positive for at least one DNA probe. The most prevalent species found were: bacteroides forsythus (29.6 percent of the cases); Porphyromonas gingivalis (29.6 percent); Streptococcus constellatus (25.9 percent), Prevotella intermedia (22.2 percent), Prevotella nigrescens (22.2 percent), Fusobacterium periodonticum (18.5 percent), Fusobacterium nucleatum subspecies nucleatum (18.5 percent), and Eikenella corrodens (18.5 percent). Conclusions: The microbiologic data of the present investigation indicated that molecular genetic methods could provide additional knowledge regarding the microbiota of acute periradicular abscesses by detecting bacterial species that are difficult-or even impossible-to grow

Incidência de dor frente ao tratamento da inflamaçäo periapical aguda e crônica / The incidence of pain in acute and chronic periapical inflammation treatment

Os autores analisaram a incidência de dor em 176 pacientes, após o completo preparo do canal radicular, e o emprego imediato do hidróxido de cálcio como medicaçäo intracanal, em dentes necrosados com e sem rarefaçäo óssea periapical, apresentando ou näo sintomatologia prévia. Frente ao exame dos resultados, nas três situaçöes que apresentavam sintomatologia prévia (necrose pulpar, necrose com rarefaçäo difusa e necrose com rarefaçäo circunscrita), observou-se no pós-operatório o completo desaparecimento da dor em 64,3 por cento, 68,2 por cento e 61,5 por cento, respectivamente nas situaçöes descritas, enquanto nos casos assintomáticos, o percentual foi superior a estes, ficando em 87,4 por cento, 82,4 por cento e 84 por cento