Comparison of etodolac, aspirin and placebo for pain after oral surgery.

Single oral doses of etodolac 50, 100 and 200 mg were compared with aspirin 650 mg and placebo in a double-blind, parallel group study of 189 outpatients reporting moderate or severe pain after oral surgery. Overall efficacy of test drugs was evaluated by sum of pain intensity difference (SPID) scores and total pain relief (TOTPAR) scores over 0.5-3, 0.5-6, 0.5-8 and 0.5-12 hours. Etodolac 200 mg provided significantly greater analgesia than aspirin by these measurements over all SPID and all but one TOTPAR interval, and was significantly more effective than placebo over all intervals. Etodolac 100 mg was superior to aspirin for SPID 0.5-8 and 0.5-12 hours, and superior to placebo for both SPID and TOTPAR over all time intervals. Onset of analgesia for etodolac 100 mg, 200 mg and aspirin was 1 hour or less for the majority of patients in each group; 42% receiving etodolac 200 mg reported onset of analgesia within 0.5 hour. Duration of analgesia for etodolac 200 mg appeared twice that of aspirin. A significant positive dose-response relationship was obtained for the three doses of etodolac. A low frequency of side effects was observed in all treatment groups.

Picenadol in a large multicenter dental pain study.

STUDY OBJECTIVE: To estimate the analgesic dose of picenadol hydrochloride equal to codeine 60 mg in a dental pain model. DESIGN: Randomized, double-blind, parallel, dose-response study. SETTING: Four university-based dental clinics. PATIENTS: Four hundred eight adult patients with moderate or severe pain after extraction of one or more impacted molar teeth plus bone removal. INTERVENTIONS: Patients received orally administered single doses of picenadol 15 and 30 mg, codeine phosphate 30 and 90 mg, or placebo. METHODS: Single oral doses of picenadol 15 and 30 mg, an opioid agonist-antagonist, were compared with codeine 30 and 90 mg and placebo in 408 patients with moderate or severe pain from third molar extraction in a randomized, double-blind, parallel study. Assessments were performed for pain intensity, pain relief, and adverse events for up to 6 hours after drug administration. MAIN RESULTS: Picenadol 30 mg and codeine 90 mg were more effective than placebo based on sum of pain intensity differences, total pain relief, peak pain relief, and duration of analgesia (p < 0.05). Compared with placebo, the frequency of adverse events was highest for patients receiving codeine 90 mg (p < 0.05). No patients discontinued due to adverse events, and all such events resolved spontaneously. CONCLUSIONS: Picenadol 22 mg was estimated to be equianalgesic to codeine 60 mg, and picenadol 30 mg was safe in this dental pain model.

Carotid system arteritis: an overlooked and misdiagnosed syndrome.

Because of the broadened scope of dental practice, a thorough knowledge and understanding of head and neck pain is necessary to diagnose adequately and to treat the patient properly. The complexities of disease related to head and neck pain may mislead and confuse the diagnostician. Carotid system arteritis may be easily overlooked in everyday practice. Diseases with similar symptoms must be considered before rendering treatment. Although the mortality rate of arteritis is extremely low, the condition merits immediate recognition and treatment for relief of pain. The need to include head and neck arteritis in the differential diagnosis of orofacial-neck pain has been discussed and a treatment regimen with use of corticosteroids has been suggested.

Amelogenesis imperfecta: local hypoplastic type with pulpal calcification.

A case report of a patient with local hypoplastic type of amelogenesis imperfecta is presented. Developmentally absent canines and unerupted teeth in the anterior maxilla and calcifications in the apical third of the pulp chambers of the molars were noticed and discussed. A family history was analyzed as consistent with an autosomal dominant form of transmission of the disorder.

A double-blind, randomized, parallel-group study of the pharmacokinetics and onset of action of Naprelan in patients following oral surgery.

Naprelan (Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) is a novel formulation of naproxen sodium designed to offer both a rapid onset and a sustained duration of analgesia. Its onset of action was assessed in a double-blind, double-dummy, randomized, parallel-group study of 129 patients who had just undergone oral surgery to remove impacted third molars. Patients received Naprelan (500 mg or 1,000 mg), naproxen (500 mg), codeine (30 mg), or placebo. Both doses of Naprelan compared favorably with the established Naprosyn (formulation of naproxen; Syntex Laboratories, Inc., Palo Alto, California) with respect to onset of action, which occurred within 30 minutes in the majority of patients. The relative adverse effect profile showed that both Naprelan doses were as well tolerated as Naprosyn, codeine, and placebo. Pharmacokinetic and pharmacodynamic analysis confirmed the findings of previous Phase I studies in healthy subjects.

Multiple hamartoma and neoplasia syndrome (Cowden's syndrome).

A case report involving a patient with Cowden's syndrome is presented. The patient's family is shown to be affected in a pattern consistent with an autosomal dominant form of transmission of this inherited disorder. The disorder can be diagnosed in its early stages by gingival and cutaneous manifestations; it is emphasized that the dentist is therefore perhaps the best-qualified health care professional to recognize the disease in its early stages and to alert the patient to be monitored for later predictable neoplasia which can perhaps be treated before metastasis develops.

The efficacy of etodolac for patients with pain following oral surgery.

The analgesic efficacy of etodolac for 161 patients reporting moderate to severe pain after oral surgery was evaluated. The patients were given single oral doses of one of the following test drugs--aspirin, 650 mg; etodolac, 50 mg; or etodolac, 200 mg--or placebo. There were at least 39 patients in each drug group. After medication, patients recorded pain intensity and pain relief at half-hour intervals for the first hour and then hourly for up to eight hours. Pain intensity differences, total pain relief, onset of analgesia, and each patient's overall opinion of the drug were analyzed. Time--effect curves were derived from the pain relief and pain intensity difference scores. Analgesic effects produced by both doses of etodolac were comparable with those of 650 mg of aspirin. All active drugs were significantly more effective than placebo, and the 200-mg dose of etodolac provided an earlier onset and longer duration of analgesia than the other test drugs.

Mandibular prognathism and apertognathia associated with cleidocranial dysostosis in a father and son.

No reports to date have described apertognathia as an associated finding of cleidocranial dysostosis. The case of a patient with prognathism and apertognathia associated with cleidocranial dysostosis is reported. Periodontal, restorative, prosthetic, and oral surgical services were necessary to rehabilitate this patient orofacially. A review of the syndrome and of the patient's familial history is presented.

Single dose and multidose analgesic study of ibuprofen and meclofenamate sodium after third molar surgery.

The purpose of this study was to compare the analgesic efficacy and safety of meclofenamate sodium with ibuprofen after dental impaction surgery. This study was double-blind and used a unique methodology. Patients (N = 254) were first randomized into the single dose phase of the study that included placebo, meclofenamate 50 mg, meclofenamate 100 mg, ibuprofen 200 mg, and ibuprofen 400 mg, followed by a 7-day multidose phase in which patients in the placebo group were rerandomized into one of the active treatment cells. In the single dose phase, all active treatments were significantly more efficacious than placebo for every summary analgesic measure. A positive dose-response was seen for both active drugs with meclofenamate 100 mg and ibuprofen 400 mg exhibiting the greatest efficacy for pain relief, pain reduction, time to remedication, and overall evaluation. Side effects were reported by 26 patients. They were evenly distributed among treatment groups with headache and drowsiness being the most common. During the multidose phase, there were only small differences in efficacy measures among active treatment groups. However, meclofenamate produced a higher incidence of stomach cramps and diarrhea than did ibuprofen (8.8% and 7.2% versus 0.8% and 0.8%). This study indicates that higher doses of nonsteroidal anti-inflammatory drugs are most effective immediately after surgery and that lower doses of these drugs can be used after the first postoperative day. The side effect profile of nonsteroidal anti-inflammatory analgesics is best observed with the use of a multidose study design.