Pål Barkvoll

Combining diclofenac with acetaminophen or acetaminophen‐codeine after oral surgery: A randomized, double‐blind single‐dose study

In a randomized double‐blind study, 120 patients with moderate to strong pain after surgical removal of wisdom teeth were given the following in single oral doses: 100‐mg enteric‐coated diclofenac tablets; 1 g acetaminophen (INN, paracetamol); 1 g acetaminophen plus 60 mg codeine; 100‐mg enteric‐coated diclofenac tablets plus 1 g acetaminophen; or 100‐mg enteric‐coated diclofenac tablets plus 1 g acetaminophen plus 60 mg codeine. Patients recorded pain intensity and pain relief for 8 hours. Upside assay sensitivity was confirmed because acetaminophen plus codeine was superior to acetaminophen. Diclofenac plus acetaminophen with and without codeine had superior analgesic effect compared with diclofenac, acetaminophen, or acetaminophen plus codeine. Addition of 60 mg codeine increased the degree of side effects. These results support the clinical practice of combining diclofenac with acetaminophen for acute pain. Of clinical importance are superior and prolonged analgesia and fewer side effects after enteric‐coated diclofenac tablets plus acetaminophen compared with acetaminophen plus codeine.

The effect of soft-laser application on postoperative pain and swelling. A double-blind, crossover study.

The effect of soft-laser application on postoperative pain and swelling was evaluated in a double-blind, crossover study. Twenty-five healthy adults with bilateral identically impacted lower third molars were selected for this study. The teeth were removed in two separate operations. Laser treatment was tested in comparison with placebo laser, with a 40-mW, 830-nm Biophoton laser (Roenvig Dental, Denmark). All surgical procedures and measurements were done by the same surgeon. The following features were statistically analyzed: swelling, trismus, and subjective registration of pain on a visual analog scale. No statistically significant differences were observed in comparison of the experimental side with the placebo side. It may be concluded that soft-laser treatment has no beneficial effect on swelling, trismus, and pain after third molar surgery.

Clinical Implications of the Dry Mouth: Oral Mucosal Diseases

Abstract: Salivary hypofunction caused by salivary gland disease, medication, or radiation may predispose for secondary oral mucosal diseases. In these patients the protective coating of saliva is reduced or absent, leaving the oral mucosa more vulnerable. Candidiasis, burning mouth syndrome, and white lesions of the oral mucosa are increased in frequency. The aim of management is to prevent oral pathological changes. The management procedure may include proper oral hygiene, saliva‐stimulating agents, or saliva substitutes, depending on the severity of the salivary dysfunction. Treatment includes antifungal therapy if candidiasis is diagnosed. In severely distressed patients, local or systemic corticosteroids may be indicated. Precautions, like refraining from smoking and avoiding toothpastes containing sodium lauryl sulfate, should also be taken. In the future, agents combining antibacterial and antiinflammatory actions, like triclosan, may show promising effects in patients with oral mucosal diseases secondary to salivary hypofunction.

Effects of Inorganic Orthophosphate and Pyrophosphate on Dissolution of Calcium Fluoride in Water

Calcium and fluoride release from excess solid calcium fluoride was monitored for 15-30 min in aqueous solutions containing various concentrations of inorganic orthophosphate and pyrophosphate. Low concentrations of these ions (1-10 μmol/L) considerably inhibited the rate of dissolution of calcium fluoride. This inhibition was pH-dependent, being reduced at pH values below 5. It is suggested that a reduced calcium fluoride dissolution rate, in the presence of phosphate, can account for the relatively slow loss of calcium fluoride from dental enamel observed in recent clinical studies. It also appears that calcium fluoride coated with phosphate may provide a pH-controlled slow release of fluoride that may be of clinical significance and a major component of the cariostatic mechanism of topically applied fluoride.

Sodium lauryl sulfate and recurrent aphthous ulcers: A preliminary study

Sodium lauryl sulfate (SLS), a synthetic detergent commonly used in dentifrices, is an effective denaturant. The aim of the present study was to investigate the effect of SLS in patients with recurrent aphthous ulcers (RAU). Ten patients with multiple minor RAU participated in the study. The mean incidence of RAU was 17.8 during a 3-month period before the study. The patients used a dentifrice containing 1.2% SLS for a test period of 3 months followed by a dentifrice without SLS for the same time period. The results showed a statistically significant decrease in the number of aphthous ulcers from 14.3 after using the SLS-containing dentifrice to 5.1 ulcers after brushing with the SLS-free dentifrice (p < 0.05). It is suggested that the denaturing effect of SLS on the oral mucin layer, with exposure of the underlying epithelium, induces an increased incidence of RAU.

The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers.

The aim of the present clinical double-blind crossover study was to investigate the effect of two different toothpaste detergents, sodium lauryl sulfate (SLS) and cocoamidopropyl betaine (CAPB), as compared with a detergent-free paste, on 30 patients with frequent occurrences of recurrent aphthous ulcers. The study consisted of three 6-week periods during which the patients brushed twice daily with the different test toothpastes. The localization and number of new ulcers were assessed. A significantly higher frequency of aphthous ulcers was demonstrated when the patients brushed with an SLS- than with a CAPB-containing or a detergent-free placebo paste. An SLS-free toothpaste may thus be recommended for patients with recurrent aphthous ulcers.

A preliminary study: Desquamative effect of sodium lauryl sulfate on oral mucosa

Sodium lauryl sulfate (SLS) is the most commonly used detergent in dentifrices. The present study was concerned with the effect of SLS content of toothpastes on oral epithelial desquamation in an experimental model. Ten dental hygiene students participated in this double-blind cross-over study. Five dentifrices with different concentrations of SLS (ranging from 0.0% to 1.5%) were used in randomized order in the study. One centimeter of each test dentifrice was applied in a cap-splint, which covered both attached and non-attached oral mucosa of the upper jaw for 2 min twice daily. The test period for each experimental dentifrice was 4 days, followed by a 10-day rest period. The dentifrice without SLS did not result in any onward reaction, whereas the dentifrice containing 1.5% SLS provoked desquamation in 60% of the subjects.

Effect of Sodium Lauryl Sulfate on the Deposition of Alkali-Soluble Fluoride on Enamel in vitro

There are indications that sodium lauryl sulfate may reduce the cariostatic effect of fluoride when present together with sodium monofluorophosphate during topical application. The aim of the present study was to examine the in vitro deposition of alkali soluble fluoride on enamel during topical application with sodium fluoride in combination with sodium lauryl sulfate. It was found that increasing amounts of lauryl sulfate decreased the amount of alkali soluble fluoride deposited on the enamel. The amount of fluoride deposited from toothpaste supernatants was less than that from aqueous solutions of NaF with the same concentration of fluoride. Enamel pieces, pretreated with sodium lauryl sulfate showed a reduced deposition of alkali-soluble fluoride after incubation in a fluoride solution. It was also observed that the presence of lauryl sulfate increased the solubility of CaF2 in water.

Skin Reactions and Irritation Potential of Four Commercial Toothpastes

Skin reactions to 4 toothpastes were tested in 19 healthy dental students in a double-blind study. The hypothesis was that common toothpaste brands with and without sodium lauryl sulfate (SLS) and triclosan and with different additives/emulgators differ in irritation potential. An occlusion test system on human skin was used. The toothpastes tested were A) Zendium (non-ionic detergent), B) Solidox F (SLS/polyethylene glycol), C) Colgate Total (triclosan/copolymer/SLS/propylene glycol), and D) Solidox G (triclosan/zinc citrate/SLS/polyethylene glycol). Toothpaste C was the greatest irritant, causing skin erythema in 16 of the 19 subjects, whereas toothpaste D gave no reactions. Toothpaste B provoked three reactions (two severe), whereas toothpaste A caused only one mild reaction. Although this study was carried out on skin and hence not directly applicable to the oral cavity, these and previous results may indicate that a toothpaste without propylene glycol and SLS may be preferred by susceptible persons.

Mandibular third molar surgery in 396 patients at a Norwegian university clinic: Morbidity recorded after 1 week utilizing an e-infrastructure for clinical research

Abstract Objective To evaluate morbidity 1 week after mandibular third molar (3M) surgery in the authors’ department. Materials and methods A prospective 1-year clinical study of patients followed up for 1 week after 3M surgery was performed. Consecutive patients of 18 years or older having 3M surgery under local anaesthesia were included. Patients not able to attend a follow-up appointment after 1 week were excluded. Demographic data, indication for surgery and clinical findings were recorded. Outcome variables were days requiring analgesic, days absent from work/school and complications. All data recording was performed utilizing an e-infrastructure for clinical research (InReach, University Health Network, www.uhnsl.com). Results Three hundred and ninety-six patients were examined 1 week after surgery. Mean number of days requiring analgesics was 3.8 and mean number of days absent from work/school after surgery was 0.6. Minor complications were reported by 7% of patients. Female patients reported more days requiring analgesics compared to male patients. Smokers had a higher odds ratio for being absent ≥3 days. Prophylactic removal of 3Ms was associated with fewer days requiring analgesics and days absent from work/school as compared to teeth with local disease. Conclusion Overall morbidity after 3M surgery was low. Compared to patients subjected to therapeutic removal of 3Ms, patients undergoing prophylactic removal seem to have less pain and a faster return to normal activities.