Godwin Toyin Arotiba

Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery.

BackgroundThe apparent interactions between the mechanisms of action of non-steroidal anti-inflammatory drugs (NSAIDS) and steroids suggest that co-therapy may provide beneficial inflammatory and pain relief in the absence of side effects. The aim of the study was to compare the effect of co-administered dexamethasone and diclofenac potassium (diclofenac K) with diclofenac K alone on the postoperative pain, swelling and trismus after surgical removal of third molars.Patients and MethodsA prospective randomized double-blind study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Nigeria. A total of 100 patients were randomly allocated to two treatment groups of dexamethasone (prophylactic 8 mg and postoperative 4 mg IV) and diclofenac K (50 mg Oral before and after surgery), and diclofenac K alone (as with first group). The overall analgesic efficacy of the drug combinations was assessed postoperatively by determination of pain intensity using a category rating scale. Facial swelling was measured using a tape measure placed from tragus to gonion to tragus, while interincisal mouth-opening of patients was measured using a vernier calibrated caliper pre-operatively and post-operatively.ResultsCo-administration of dexamethasone and diclofenac K was significantly superior to diclofenac alone for the relief of pain (P < 0.05), and facial swelling up to post-operative 48 hour (P < 0.05). However, there was no significant difference for trismus relief between the two medication protocols (P > 0.05).ConclusionThis study illustrates enhanced effects of co-administered dexamethasone and diclofenac K on short-term post-operative pain and swelling, compared to diclofenac potassium alone in third molar surgery.

Preoperative administration of 0.2% chlorhexidine mouthrinse reduces the risk of bacteraemia associated with intra-alveolar tooth extraction.

The aim of the study was to investigate the effect of preoperative 0.2% chlorhexidine mouthwash on the risk of bacteraemia following routine intra-alveolar tooth extraction. The study was a randomized controlled clinical study of 101 subjects who underwent intra-alveolar dental extractions under local anaesthesia. Subjects were randomly assigned to either chlorhexidine or a control group. The chlorhexidine group had 0.2% chlorhexidine mouthwash administered for 1 min before any dental manipulation, and the control group had a mouthrinse of sterile water. Blood samples were collected at baseline, 1 min and 15 min after the dental extractions. Subculture and further identification of the isolated bacteria were performed by conventional microbiological techniques. There was a statistically significant difference in the incidence of bacteraemia between the control group (52.4%) and chlorhexidine group (27.1%) (P = 0.012). Bacteraemia was most frequently detected at 1 min after extraction (33.3%). Of the 30 subjects who had positive blood culture at 1 min, bacteraemia persisted in 8 (26.7%) of the subjects after 15 min. Bacteria isolated included Staphylococcus aureus, Actinomycetes naesulendi, Prevotella species, Streptococcus spp., and Acinetobacter iwoffii. Routine use of 0.20% chlorhexidine mouthwash before dental extraction is recommended to reduce the risk of bacteraemia following tooth extraction.

Prospective, randomized, open-label, pilot clinical trial comparing the effects of dexamethasone coadministered with diclofenac potassium or acetaminophen and diclofenac potassium monotherapy after third-molar extraction in adults

BACKGROUND Patients who experience pain, swelling, and trismus after third-molar extraction are reported to experience a 3-fold higher rate of adverse effects (AEs) on quality of life compared with those who are asymptomatic after this surgery. Therefore, investigators emphasize the necessity for better control of this triad of sequelae. Steroids can reduce the risk for physiologic processes of inflammation, thereby suppressing the development of inflammation. OBJECTIVE The aim of this study was to compare the effects of dexamethasone 8 mg IM and diclofenac potassium (K) 50 mg PO, dexamethasone 8 mg IM and acetaminophen 1000 mg PO, and monotherapy with diclofenac K 50 mg PO on postoperative pain, swelling, and trismus after surgical removal of third molars. METHODS This prospective, randomized, open-label pilot study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria. Patients were randomly allocated to 1 of 3 treatment groups: concomitant treatment with dexamethasone 8 mg IM and diclofenac K 50 mg PO or acetaminophen 1000 mg PO, or monotherapy with diclofenac K 50 mg PO. Overall analgesic efficacy of the drug combinations was assessed for 7 days postoperatively using a 4-point categorical pain-intensity rating scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). Facial swelling was measured in 1 dimension on days 1, 2, and 7 after surgery using a tape measure placed from the tip of the tragus, to gonion, to the tip of the contralateral tragus, and trismus was assessed using interincisal mouth-opening ability, measured using a vernier-calibrated caliper on postoperative days 1, 2, and 7. Tolerability was assessed using direct questioning of the patients at follow-up visits. RESULTS A total of 150 patients (50 per treatment group) were included in the analysis (76 women, 74 men; mean [SD] age, 26.8 [5.04] years [range, 18-45 years]; 100% Nigerian). The proportion of patients reporting no pain on the pain-intensity rating scale was significantly higher in the group receiving dexamethasone and diclofenac K compared with that in the groups receiving dexamethasone and acetaminophen or diclofenac K monotherapy (44% vs 22% and 24%, respectively; both, P < 0.05). Facial swelling was significantly less with dexamethasone and diclofenac K or dexamethasone and acetaminophen compared with diclofenac K alone (day 1: P = 0.013 and P = 0.011, respectively; day 2: P = 0.002 and P = 0.004, respectively). However, trismus relief was statistically similar between the 3 treatment groups on postoperative days 1 and 2. No AEs or complications were recorded. CONCLUSION In this open-label pilot study, concomitant treatment with dexamethasone and diclofenac K provided significant relief of postsurgical pain and swelling compared with dexamethasone and acetaminophen or monotherapy with diclofenac K after third-molar extraction in these patients.

A Comparative Clinical Evaluation of the Effect of Preoperative and Postoperative Antimicrobial Therapy on Postoperative Sequelae after Impacted Mandibular Third Molar Extraction

ABSTRACT Objectives To compare the effect of preoperative and postoperative antibiotics therapy on postoperative sequelae after impacted mandibular third molar extractions. Material and Methods This was a prospective study conducted at Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospitalon consecutive patients with impacted third molar extractions for a 12 month period. Group I (n = 31) had administration of 1 gram of oral metronidazole and 1 gram of amoxicillin capsules 30 minutes preoperative and Group II (n = 31) had 500 milligrams of amoxicillin capsule 8 hourly and 400 milligrams of metronidazole tablets administered post operatively for 5 days. Pain, facial swelling and mouth opening assessment were done postoperatively and on days 1, 3 and 7. Results The general pattern of postoperative pain, regardless of antimicrobial use revealed that pain increased from day 1 to day 3 postoperatively and began to decrease in intensity subsequently up to the seventh day. There was however a statistically significant difference (P = 0.0001) between the two groups on the 7th postoperative day with the subjects in Group I showing lower pain intensity. The mean difference of the facial width on days 1 and 3 was significant (P = 0.04 and P = 0.0001 respectively) with subjects in Group II having a reduced facial width compared to those in Group I. Conclusions This study suggested that the administration of preoperative or postoperative antibiotics showed no marked differences in the degree of postoperative sequaele that occur after impacted mandibular third molar extractions.

Knowledge, attitude, and practice of dental implantology in Nigeria.

Aim:The purpose of this study was to assess the knowledge, attitude, and practice of dental implantology among dentists practicing in Nigeria. Materials:Self-administered questionnaires to assess the knowledge, practice, and attitude of dental implantology were sent to dentists practicing in all the 6 geopolitical zones of Nigeria (i.e., all tertiary dental institutions, and selected general and private hospitals within the zones). Data collected were analyzed and presented in descriptive and tabular forms. Results:The response rate was 77%. Only 2 (1.3%) of the respondents claimed to have employed implant(s) for dental restoration in their practice, while 152 respondents (98.7%) have never used implants as a method of tooth/teeth restoration. Of the latter, 46.1% have suggested implants for full/partial denture patients, 31.8% have suggested dental implants to patients needing single-tooth replacement, and 89.6% were ready for dental implant placement if equipment and materials for dental implants backed up with adequate training were provided. Of respondents, 83.1% also believed that implantology is a multidisciplinary approach, and 42.9% rated implants as the best option for dental restoration. Conclusions:The practice of implant dentistry is presently very low in Nigeria. Clearly, there is a need for dental implant education for Nigerian dentists to increase their knowledge and proficiency in dental implant dentistry. In addition, all efforts should be made to include implant education and practice in dental curricula in undergraduate and postgraduate institutions in Nigeria.

Dermatofibrosarcoma protuberans: clinicopathologic presentation in Nigerians

Introduction Dermatofibrosarcoma protuberance (DFSP) is in general a rare low grade malignant sarcoma and possesses a tendency for local recurrence. It has a site predilection for the trunk. Occurrence in the facial area is extremely rare. Ample knowledge of its clinical, histological and biologic characteristics is vital for accurate and prompt recognition. Methods Over 13 years, clinicohistologic information of cases was retrieved. Histological and immunohistochemical re-evaluation were performed to re-confirm diagnosis. Data collected and analyzed with SPSS Statistics version 20 were presented as frequency tables, charts and proportions as appropriate. Results Of 191 soft tissue sarcomas, a total of 28 cases were diagnosed as DFSP (14.7%). Facial types occurred in 3 cases (1.6%). Tumour had age and site predilections for the 4th decade and trunk respectively. There was an equal gender distribution among cases. Most common clinical presentation was in form of painless protruding nodular mass. General histologic presentation revealed cellular lesions composed of spindle to oval neoplastic cells arranged in a storiform pattern. Mitotic figures were rare. All cases showed positive expressions to CD34. Conclusion Facial DFSP is rare among Nigerians. Its clinical appearance may mimic other common benign lesions of the head and neck region often resulting in misdiagnoses. A comprehensive knowledge of its clinical and histologic presentations and biologic behavior, combined with its identification with the aid of advanced histologic and radiographic techniques results in prompt confirmatory diagnosis. Appropriate treatment should include adequate surgical excision techniques combined with adjuvant radiotherapy or chemotherapy.