Efficacy of lidocaine versus mepivacaine in the management of myofascial pain.

OBJECTIVES: There are many treatment modalities for myofascial pain, and recent findings reported in the literature highlight the superiority of using local anesthetics as the treatment of choice. The objective of the present study was to compare the effectiveness of two of the most used local anesthetic agents-lidocaine and mepivacaine-in the management of myofascial pain. MATERIALS AND METHODS: Thirty patients (20 females, 10 males) were randomly assigned to one of two groups: 50% received lidocaine and 50% received mepivacaine. Trigger point injections in the orofacial region were administered 4 times, 10 days between each injection, with 4 weeks of follow-up after the end of the treatment course. Pain levels were recorded using a visual analog scale (VAS) at the time of follow-up and 30 min after injection. RESULTS: All patients exhibited statistically significant improvement when comparing pre- and post-treatment mean values. Both local anesthetics (i.e., lidocaine and mepivacaine) were similarly effective for the management of myofascial pain (p = 0.875). The mepivacaine-treated group exhibited significantly lower post-injection tenderness than the lidocaine group (p = 0.038). There was no relationship between sex and treatment response. Female and male patients both reported similar responses in terms of VAS scores (p = 0.818). CONCLUSION: No drug was superior in the long term; thus, the clinician's choice can be based on drug availability and patient medical history.

Early Screening of Diabetes and Hypertension in Primary Care Dental Clinics at King Saud University in Riyadh, Kingdom of Saudi Arabia.

INTRODUCTION: Diabetes mellitus and hypertension are the leading chronic diseases in Saudi Arabia; 23.1% of the Saudi population are diabetic and 25.5% are hypertensive. This cross-sectional study was made on dental setting to determine the effectiveness of screening of diabetes and hypertension in dental clinics. MATERIALS AND METHODS: This study was carried out in the primary care dental clinics at the Dental College in King Saud University in Riyadh, Saudi Arabia. Before starting any treatment, a face-to-face interview was administered to collect a brief medical history and personal data followed by measurement of body mass index (BMI). After that, blood pressure level reading was obtained using electrical sphygmomanometer. Finally, a glucose level reading was obtained from capillary blood from the patient's third fingertip using glucose reader. RESULTS: Our study included 283 participants, 118 of whom were females (41.7%). Our study showed that a significant amount of the participants are at risk of having hypertension (44.8%). In addition, a significant number (10.2%) of the participants are at risk of having diabetes. Furthermore, 35.7% of the sample had obesity as a risk factor for diabetes and hypertension. CONCLUSION: The dental team can play an important role in screening of diabetes, hypertension, and other chronic diseases. In Saudi Arabia, public awareness of the chronic diseases is still critically insufficient. CLINICAL SIGNIFICANCE: Our study showed the importance of the screening even for patients with negative history of diabetes or hypertension.

Anti-nociceptive effect of IL-12p40 in a rat model of neuropathic pain.

IL-12p70 is a proinflammatory cytokine secreted by dendritic cells, monocytes and macrophages. It plays a crucial role in cell-mediated immunity by inducing proliferation of T cell and natural killer cells, and enhancing their cytotoxic activity. In adaptive immune response, it acts on naive T cells to differentiate into Th1-type cells. It is composed of two subunits, p35 and p40. The latter can be secreted in the form of monodimer or heterodimer, which is also referred as IL-12p80. Recently IL-12p70 has been proven to locally provoke nociceptive effect in naïve rats. This study investigated pain response following systemic administration of IL-12p70 and IL-12p40 homodimer in chronic neuropathic pain model, induced by chronic constriction injury. The doses tested were IL-12p40 homodimer or IL12p70 at 15, 150 and 1500ng/kg, respectively. Pain was assessed at 1, 4, 7 and 24h after injection, in the form of tactile allodynia and mechanical hyperalgesia. The side effect of sensory motor disability was measured by rotarod performance. By all behavioral measures, IL-12p70 of any dosage, at any time point, had no significant effect on tactile allodynia and mechanical hyperalgesia. A high dose of IL-12p40 homodimer induced significant analgesic effect by the measure of hind paw tactile allodynia from 1h to 4h after injection. Medium and low doses of IL-12p40 homodimer exerted their analgesic effect 4h post injection. Mechanical hyperalgesia, following high and medium doses of IL-12p40 administration, was significantly reduced at 4h after application. Also, no significant sensory motor dysfunction was detected for all dosage for both homodimers. These findings suggest that systemic application of IL-12p40 homodimer induces time-dependent analgesia to mechanical stimulation in rats exposed to neuropathic pain.

Accomplishments and challenges in tobacco control endeavors - Report from the Gulf Cooperation Council countries.

OBJECTIVES: To review the tobacco governance and national responsibility for control, and existing countering measures to reduce the tobacco use among the Gulf Cooperation Council (GCC) member states. METHODS: We reviewed the data in regards to tobacco control efforts and difficulties encountered during implementation of the policies for all the GCC member states from the respective country profile in the WHO report on the global tobacco epidemic. Also, we utilized the measures outlined in the FCTC's MPOWER package to not only assess the degree of national commitment, but also compare it against the level of significance that the legislatures give to this matter. RESULTS: We observed that there have been genuine advancements towards tobacco control in the GCC member states over the past few years. All the countries except Bahrain have national offices committed to tobacco control and 5 nations (excluding Oman) have dedicated support services for smoking cessation accessible to the general public. Similarly, majority of the member states have implemented a national-level ban on tobacco advertisement through national media cells as well as free dissemination of marketing material. CONCLUSION: Application and implementation of measures outline in the MPOWER package, formulation and enforcement of sturdy laws on tobacco control, and development of infrastructure and trained workforce are fundamental to manage and reinforce tobacco control measures in the GCC region.

Self-perception, knowledge, and awareness of halitosis among female university students.

BACKGROUND: Halitosis or oral malodor is defined as an unpleasant breath odor. It can become a serious problem affecting individuals' social communication and self-confidence. Furthermore, it is a discomforting issue for the people around the person affected, because they consider it embarrassing to inform the person of the problem. AIM: This study was designed to measure self-perception, knowledge, and awareness of halitosis among female university students in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional survey was implemented with 392 volunteer participants who responded to a questionnaire on their self-perception, knowledge, and awareness of halitosis. RESULTS: The response rate was 89.1% (392/440). Self-perception of halitosis was low (21.4%), whereas a larger percentage (78.1%) indicated noticing people with bad breath. Most participants (80.4%) thought that the gastrointestinal tract is the primary source of halitosis. Seventy-seven percent preferred using personal methods such as mouthwash and chewing gum to treat oral malodor. According to 82.1% of respondents, a dentist is the most appropriate professional to treat halitosis. CONCLUSION: The investigation revealed low self-perception and limited knowledge regarding halitosis. Therefore, the role of dentists in informing and educating their patients concerning oral malodor should be enhanced. Public education about the causes of and possible ways of managing bad breath should be increased.

Interleukin-17 levels in rat models of nerve damage and neuropathic pain.

In the present study, we assessed IL-17 levels at 3 and 8 days following various forms of injuries to the sciatic nerve and related the cytokine levels to the pain behaviors associated with the injuries. The four experimental models employed were chronic constriction injury (CCI), partial sciatic ligation (PSL), complete sciatic transection (CST) and perineural inflammation (Neuritis). Behavior withdrawal thresholds for mechanical stimulus and withdrawal latency for thermal stimulation were used to measure mechanical allodynia and thermal hyperalgesia. IL-17 levels of the affected, contralateral and naïve rats' sciatic nerve were assessed employing enzyme-linked immunosorbent assay (ELISA). Rats exposed to CCI and Neuritis displayed significant mechanical allodynia and thermal hyperalgesia 3, 5 and 8 days following the procedure, rats exposed to PSL displayed significant mechanical allodynia 5 and 8 days following the procedure and rats exposed to CST developed significant hypoesthesia. Three days following the procedure, IL-17 levels increased significantly compared to naïve rats only in the PSL model. Eight days following the procedure, IL-17 levels in nerves exposed to CCI, CST, PSL and Neuritis were significantly elevated compare to intact nerve levels. It is likely that IL-17 has a limited role in the acute phase of nerve injury and the associated acute pain, but may have a role in later phases of the processes of the development of neuropathic pain.