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Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid Brookes,Carolyn Dicus. Chief Resident, Department of Oral and Maxillofacial Surgery, MEDLINE(R) <1946 to Present> University of North Carolina at Chapel Hill, Chapel Hill, NC. Search Strategy: Berry,John. Chief Resident, Department of Anesthesiology, University of North Carolina at ------Chapel Hill, Chapel Hill, NC. 1 (poppy or poppies).tw. (830) Rich,Josiah. Research Associate, Department of Orthodontics, University of North Carolina 2 *Papaver/ (588) at Chapel Hill, Chapel Hill, NC. 3 exp *Morphine/ or exp *Morphine Derivatives/ (29446) Golden,Brent A. Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, 4 (morphine or opiat$).tw. (57493) University of North Carolina at Chapel Hill, Chapel Hill, NC. 5 opium.tw. (1805) Turvey,Timothy A. Professor and Chairman, Department of Oral and Maxillofacial Surgery, 6 1 or 2 or 3 or 4 or 5 (66805) University of North Carolina at Chapel Hill, Chapel Hill, NC. 7 limit 6 to dentistry journals (229) Blakey,George 3rd. Raymond P. White Distinguished Associate Professor and Program 8 exp Oral Surgical Procedures/ (52411) Director, Department of Oral and Maxillofacial Surgery, University of North Carolina at Chapel 9 (dental$ or dentist$ or tooth or teeth or periodont$ or endodont$ or "root canal").tw. Hill, Chapel Hill, NC. (325818) Kopp,Vincent. Professor, Department of Anesthesiology, University of North Carolina at 10 8 or 9 (353131) Chapel Hill, Chapel Hill, NC. 11 6 and 10 (523) Phillips,Ceib. Professor, Department of Orthodontics, University of North Carolina at Chapel 12 7 or 11 (620) Hill, Chapel Hill, NC. 13 animals/ not humans/ (3909043) Anderson,Jay. Associate Professor, Departments of Anesthesiology and Oral and 14 12 not 13 (405) Maxillofacial Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic 15 (rat or rats or mice or mouse or pig or pigs or dog or dogs or cat or cats or rabbit$).tw. address: [email protected]. (2629824) Title 16 14 not 15 (370) Multimodal protocol reduces postoperative nausea and vomiting in patients undergoing Le 17 limit 16 to english language (312) Fort I osteotomy. 18 limit 17 to (editorial or letter or news) (15) Source 19 17 not 18 (297) Journal of Oral & Maxillofacial Surgery. 73(2):324-32, 2015 Feb. 20 limit 19 to yr="2004 -Current" (92) Other ID 21 exp Substance-Related Disorders/ (228519) Source: NLM. NIHMS621847 [Available on 02/01/16] 22 (withdrawal or addict$ or abuse$).tw. (199055) Source: NLM. PMC4293274 [Available on 02/01/16] 23 20 not (21 or 22) (64) Local Messages 24 (opium adj smok$).tw. (45) THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY 25 23 not 24 (63) Abstract PURPOSE: To assess the impact of a multimodal antiemetic protocol on postoperative *************************** nausea and vomiting (PONV) after Le Fort I osteotomy.

<1> MATERIALS AND METHODS: Consecutive patients undergoing Le Fort I osteotomy with or Unique Identifier without additional procedures at a single academic institution were recruited as the 25443378 intervention cohort for an institutional review board-approved prospective clinical trial with a Status retrospective comparison group. The intervention cohort was managed with a multimodal In-Process antiemetic protocol, including total intravenous anesthesia; prophylactic ondansetron, Authors steroids, scopolamine, and droperidol; gastric decompression at surgery end; -sparing Brookes CD; Berry J; Rich J; Golden BA; Turvey TA; Blakey G 3rd; Kopp V; Phillips C; analgesia; avoidance of morphine and ; prokinetic erythromycin; and fluids at a Anderson J. minimum of 25 mL/kg. The comparison group consisted of consecutive patients from a larger Authors Full Name study who underwent similar surgical procedures before protocol implementation. Data, Brookes, Carolyn Dicus; Berry, John; Rich, Josiah; Golden, Brent A; Turvey, Timothy A; including occurrence of PONV, were extracted from medical records. Data were analyzed in Blakey, George 3rd; Kopp, Vincent; Phillips, Ceib; Anderson, Jay. bivariate fashion with the Fisher exact and Wilcoxon rank-sum tests. Logistic regression was Institution BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. used to compare the likelihood of nausea and vomiting in the 2 cohorts after controlling for Finger,Werner J. Professor and Guest Researcher, Liaison Center for Innovative Dentistry, demographic and surgical characteristics. A P value less than .05 was considered significant. Tohoku University Graduate School of Dentistry, Sendai, Japan. Sasaki,Keiichi. Professor and Chair, Department of Oral Function and Morphology, Tohoku RESULTS: The intervention (n = 93) and comparison (n = 137) groups were similar in University Graduate School of Dentistry, Sendai, Japan. gender (58% and 65% female patients; P = .29), race (72% and 71% Caucasian; P = .85), Title age (median, 19 and 20 years old; P = .75), proportion of patients with known risk factors for Texture of composite resins exposed to two- and three-body wear in vitro. PONV (P = .34), percentage undergoing bimaxillary surgery (60% for the 2 groups), and Source percentage for whom surgery time was longer than 180 minutes (63% and 59%; P = .51). Journal of Contemporary Dental Practice [Electronic Resource]. 15(2):232-41, 2014 Mar- Prevalence of postoperative nausea was significantly lower in the intervention group than in Apr. the comparison group (24% vs 70%; P < .0001). Prevalence of postoperative vomiting was Abstract likewise significantly lower in the intervention group (11% vs 28%; P = .0013). The likelihood PURPOSE: To analyze on scanning electron microscopy (SEM) pictures from eight that patients in the comparison group would develop nausea was 8.9 and that for vomiting composite resins, taken in the centers of the initial, the middle and the terminal thirds of in was 3.7 times higher than in the intervention group. vitro produced wear tracks morphological features to explain causative mechanisms for the material wear observed under two- and three-body wear. CONCLUSION: This multimodal protocol was associated with substantially decreased prevalence of PONV in patients undergoing Le Fort I osteotomy.Copyright Published by MATERIALS AND METHODS: In vitro wear behavior of eight composite resins, three Elsevier Inc. conventional and five nanofiller containing marketed products was evaluated using a custom- Publication Type made Zr-ball-on-disk sliding device. The composite specimens were subjected to 50,000 one- Journal Article. Research Support, N.I.H., Extramural. way sliding cycles (1.2 Hz, 50 N load), either simulating two-body wear with water as the Date Created intermediate medium or three-body wear using aqueous suspensions of polymethyl 20150112 methacrylate (PMMA) beads and poppy seeds, respectively. Volume loss of the materials Year of Publication was determined in previous study. Representative specimens were selected for inspection by 2015 scanning electron microscopy at 500-fold magnification. From each of the 24 wear tracks microphotographs were taken in the central deepest parts of the initial, middle and terminal <2> thirds of the tracks. Unique Identifier 25095850 RESULTS: For most materials morphological differences were detected depending on the Status location within the wear track. As a rule, the surface deterioration found increased toward the In-Process final part of the wear scar. According to common classification in tribology abrasive wear and Authors fatigue wear, or a combination of both mechanisms were found for all materials tested. Wear Iwasaki N; Takahashi H; Koottathape N; Kanehira M; Finger WJ; Sasaki K. was dependent both on the testing mode and on the composition of the individual composite Authors Full Name resin material. Iwasaki, Naohiko; Takahashi, Hidekazu; Koottathape, Natthavoot; Kanehira, Masafumi; Finger, Werner J; Sasaki, Keiichi. CONCLUSION: The morphological assessment of wear tracks refects the nature of the Institution abrasive and reveals insight into the mechanism generating wear patterns. Morphological Iwasaki,Naohiko. Assistant Professor, Oral Biomaterials Engineering, Course for Oral details confirmed abrasive and fatigue-related wear as main failure mechanisms. Selection of Health Engineering, School of Oral Health Care Sciences, Faculty of Dentistry, Tokyo food-like slurries as third-body media, such as poppy seed suspension is mandatory to Medical and Dental University, Tokyo, Japan. simulate wear of composite restorations in occlusal cavities where three-body wear is the Takahashi,Hidekazu. Professor and Chair, Oral Biomaterials Engineering, Course for Oral dominating determinant of loss of substance and surface deterioration. Health Engineering, School of Oral Health Care Sciences, Faculty of Dentistry, Tokyo Publication Type Medical and Dental University, Tokyo, Japan. Journal Article. Koottathape,Natthavoot. Lecturer Department of Prosthodontics, Faculty of Dentistry Date Created Chulalongkorn University, Pathumwan, Bangkok, Thailand. 20140806 Kanehira,Masafumi. Assistant Professor, Department of Restorative Dentistry, Division of Year of Publication Operative Dentistry, Tohoku University Graduate School of Dentistry Sendai, Japan. 2014

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<3> pill consumption, and mean patient perceived pain.Copyright © 2014 American Unique Identifier Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved. 25234526 Publication Type Status Comparative Study. Journal Article. Randomized Controlled Trial. MEDLINE Date Created Authors 20140919 Cillo JE Jr; Dattilo DJ. Year of Publication Authors Full Name 2014 Cillo, Joseph E Jr; Dattilo, David J. Institution <4> Cillo,Joseph E Jr. Assistant Professor and Program Director, Division of Oral and Unique Identifier Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA. 23928801 Electronic address: [email protected]. Status Dattilo,David J. Division Director, Division of Oral and Maxillofacial Surgery, Allegheny In-Data-Review General Hospital, Allegheny Health Network, Pittsburgh, PA. Authors Title Bozinovska C. Pre-emptive analgesia with and decreases postsurgical pain following Authors Full Name maxillomandibular advancement surgery: a randomized controlled clinical trial. Bozinovska, C. Source Institution Journal of Oral & Maxillofacial Surgery. 72(10):1909-14, 2014 Oct. Bozinovska,C. University Clinic of Toxicology, Faculty of Medicine, Skopje, R. Macedonia. Local Messages Title THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY University Clinic of Toxicology - historical note and present work. Abstract Source PURPOSE: The purpose of this study was to determine the efficacy of pre-emptive Makedonska Akademija na Naukite i Umetnostite Oddelenie Za Bioloshki i Meditsinski analgesia with pregabalin and celecoxib on narcotic consumption and perceived pain in adult Nauki Prilozi. 34(1):79-84, 2013. patients undergoing maxillomandibular advancement surgery for obstructive sleep apnea. Abstract (Full text is available at http://www.manu.edu.mk/prilozi). The University Clinic of Toxicology PATIENTS AND METHODS: This was a prospective, randomized, double-blinded, placebo- (UCT) in Skopje was founded as the Clinic for Toxicology and Emergency Internal Medicine controlled study of adult patients undergoing elective maxillomandibular advancement on January 15th 1976. Today UCT has a modern building with office space of 1,300 m(2) on surgery for obstructive sleep apnea. The groups received a masked 1-time preoperative oral 4 floors, 40 hospital beds and 72 employees including 18 doctors. UCT works in accordance dose of pregabalin 150 mg and celecoxib 400 mg (experimental group) or lactose powder 2 g with the public healthcare services in the Republic of Macedonia through the use of specialist (placebo group). In the postoperative period, pain management consisted of intravenous / consultative and hospital healthcare for people over the age of 14 years. The Clinic also morphine patient-controlled analgesia and oral 5 mg and acetaminophen 325 mg. provides services in the field of emergency internal medicine, acute poisoning with Patients completed a daily pain and narcotic log. Statistical significance between group medications, pesticides, corrosives, poisonous gases and mus-hrooms, heavy metals and means was determined by the 2-tailed independent t test. other chemicals. The Clinic takes an active part in the detoxification programme for users of and psychotropic substances, protocols for enteral and parenteral nutrition and RESULTS: There were statistically significant differences between the pregabalin plus guides for home treatment. Yearly there are more than 14,000 ambulance admissions, over celecoxib and placebo groups in average intravenous morphine consumption per 4-hour 1,400 hospitalized patients, over 4,000 urgent EHO checks, more than 1,000 urgent upper interval (6.0 +/- 5.9 vs 9.3 +/- 7.9 mg; P < .05), mean daily narcotic pill consumption (2.9 +/- endoscopies and over 700 other toxicological analyses and other interventions. The 2.9 vs 6.8 +/- 1.8 pills; P < .05), and mean daily visual analog scale scores (4.3 +/- 3.5 vs 5.5 educational services and activities are realized through the chair for internal medicine. The +/- 5.0; P < .05). Clinic offers undergraduate and graduate level education for medical students and dentists, for medical nurses, radiology technicians, speech therapists and physiotherapists. Over 300 CONCLUSION: Within the limitations of this study, a 1-time preoperative oral dose of papers and reports have been published to date by the medical staff at the UCT in the form of pregabalin and celecoxib before adult maxillomandibular advancement surgery for abstracts and integrated projects in the Republic of Macedonia and aboard. 8 doctorates obstructive sleep apnea decreased mean intravenous morphine consumption, mean daily have been successfully completed by employees from the Clinic as well as 4 master's theses and 1 in-depth project. UCT employees are the authors of some textbooks and monographs. BDA LIBRARY MEDLINE SEARCH

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UCT have undertaken some scientific projects. Employees from the Clinic of Toxicology are PATIENTS AND METHODS: 1581 people aged > 30 years old who were inhabitant of members taking an active part in many domestic and international associations. Key words: Rasht, Iran, enrolled in a cross-sectional study. For each individual a detailed questionnaire Toxicology Clinic, historical note, healthcare, education, research. based on the world health organization (WHO) guidelines in order to diagnosis of the lesions Publication Type was filled and it contained all the required data. Participants were divided into two groups with Journal Article. and without oral mucosal lesions and oral mucosal lesions were divided into two groups with Date Created and without. Demographic characteristics and clinical information including age, sex, smoking 20130809 (cigarette and tobacco), opium consumption, medication and oral and dental hygiene were Year of Publication collected and compared between these two groups. 2013 RESULTS: The prevalence of mucosal lesions in our study was 19.4%. Our data <5> demonstrated higher prevalence of oral mucosal lesions in males and young adults (30-40 Unique Identifier years). The most common mucosal lesion among our participants was Fissured tongue(4%), 24396581 followed by Fordyce granules(2.8%), geographic tongue(2.6%) , Pigmentation(2.5%), Status Candida(1.8%), Smoker Plate(1.6%), lingual Varices(1.5%), Petechiae(1.4%) and lingual PubMed-not-MEDLINE labial(1.4%) . Leukoplakia was observed only in two people (0.1%).No case of malignant Authors lesions was detected. No statistically significant difference was confirmed between the two Mansour Ghanaei F; Joukar F; Rabiei M; Dadashzadeh A; Kord Valeshabad A. groups regarding smoking, opium consumption, medication and oral and dental hygiene. Authors Full Name Mansour Ghanaei, Fariborz; Joukar, Farahnaz; Rabiei, Maryam; Dadashzadeh, Alireza; CONCLUSIONS: Our data has provided baseline information about epidemiologic aspects Kord Valeshabad, Ali. of oral mucosal lesions which can be valuable in organized national program targeting on oral Institution health and hygiene in the society. Mansour Ghanaei,Fariborz. Gastrointestinal and Liver Diseases Research Center (GLDRC), Publication Type Guilan University of Medical Sciences, Rasht, IR Iran. Journal Article. Joukar,Farahnaz. Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan Date Created University of Medical Sciences, Rasht, IR Iran. 20140107 Rabiei,Maryam. Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan Year of Publication University of Medical Sciences, Rasht, IR Iran. 2013 Dadashzadeh,Alireza. Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences, Rasht, IR Iran. <6> Kord Valeshabad,Ali. Gastrointestinal and Liver Diseases Research Center (GLDRC), Unique Identifier Guilan University of Medical Sciences, Rasht, IR Iran. 22902498 Title Status Prevalence of oral mucosal lesions in an adult Iranian population. MEDLINE Source Authors Iranian Red Crescent Medical Journal. 15(7):600-4, 2013 Jul. Herrera-Briones FJ; Prados Sanchez E; Reyes Botella C; Vallecillo Capilla M. Other ID Authors Full Name Source: NLM. PMC3871749 Herrera-Briones, Francisco Javier; Prados Sanchez, Estrella; Reyes Botella, Candela; Abstract Vallecillo Capilla, Manuel. BACKGROUND: Nowadays the importance of oral health to life quality is not obvious to Institution anyone in our world. Oral lesions can interfere with daily social activities in involved patients Herrera-Briones,Francisco Javier. Assistant Professor of the Masters in Oral Surgery and through impacts on mastication, swallowing and speech and symptoms like xerostomia, Implantology, University of Granada, Granada, Spain. Electronic address: halitosis or dysesthesia. [email protected]. Title OBJECTIVES: To assess the prevalence and types of oral lesions in a general population in Update on the use of corticosteroids in third molar surgery: systematic review of the Rasht, Northern Province of Iran. literature. [Review] Comments BDA LIBRARY MEDLINE SEARCH

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Comment in: Evid Based Dent. 2013 Dec;14(4):111; PMID: 24357822 Source: NLM. PMC3428455 Source Abstract Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 116(5):e342-51, 2013 Pain plagues daily activity and hence its management would require alleviation at both the Nov. mental and physical planes, thus, bringing about comfort. It includes delivering in Abstract parenteral or oral form, or patches depending on the intensity and availability. Best OBJECTIVES: Third molar extraction produces inflammation, pain, and trismus, and regimens are ones that offer broad coverage, easy to administer, safe and economical. A different pharmacologic therapies have been evaluated for the minimization of postsurgical drug seemingly appropriate to treat moderate to severe pain would be symptoms. The most frequently prescribed drugs are nonsteroidal anti-inflammatories, hydrochloride, a centrally acting synthetic opioid analgesic with lower -like dependence followed by steroids and opiates. than Morphine. , a pyrrolo-pyrrole derivative, possesses analgesic, anti- inflammatory and anti-pyretic activity would also appear equally suitable. Fifty adult ASA MATERIAL AND METHODS: A systematic search of the literature was carried out in grade I and II patients undergoing surgery under GA in the Department of Oral & Maxillofacial PubMed, Scopus, MEDLINE, and Cochrane using steroid and third molar as key words. Surgery, College of Dental Sciences, Davangere, were included. Ketorolac (30 mg IM) for 25 patients and Tramadol (100 mg IM) for 25 patients were administered at the time of skin RESULTS: The most relevant randomized controlled trials and meta-analyses (n = 28) were closure and repeated after 8 and 16 h from the conclusion of surgery. Pain, using the VAS at selected from among 72 articles. the 2nd, 4th, 6th, 12th and 24th post-operative hour, was assessed and compared using chi(2)-test. Vitals were monitored and adverse events were looked for. Though both the drugs CONCLUSIONS: Administration of corticosteroids improves the postoperative experience of resulted in significant decrease in pain intensity from the 2nd to 24th post-operative hour, patients and has a significant impact on trismus and inflammation. Greater effects appear to Tramadol always resulted in better pain control than Ketorolac at every post-operative hour be achieved by using the parenteral route and by administering the corticosteroid before the (P < 0.050). To conclude, intramuscular Tramadol seemed useful in controlling pain following surgery.Copyright © 2013 Elsevier Inc. All rights reserved. surgery, with better levels of tolerance than intramuscular Ketorolac. However, both the drugs Publication Type produced mild side effects but did not appear to influence the outcome. Journal Article. Review. Publication Type Date Created Journal Article. 20131014 Date Created Year of Publication 20130902 2013 Year of Publication 2012 <7> Unique Identifier <8> 23997475 Unique Identifier Status 23896996 PubMed-not-MEDLINE Status Authors MEDLINE Shankariah M; Mishra M; Kamath RA. Authors Authors Full Name Koottathape N; Takahashi H; Finger W; Kanehira M; Iwasaki N; Aoyagi Y. Shankariah, Manjunath; Mishra, Madan; Kamath, Rajay A D. Authors Full Name Institution Koottathape, Natthavoot; Takahashi, Hidekazu; Finger, Wernerj; Kanehira, Masafumi; Shankariah,Manjunath. Department of Oral & Maxillofacial Surgery, College of Dental Iwasaki, Naohiko; Aoyagi, Yujin. Sciences & Hospital, Room No. 2, Ground Floor, New Block, Pavilion Road, P. O. Box 327, Institution Davangere, 577004 Karnataka India. Koottathape,Natthavoot. Advanced Biomaterials, Department of Restorative Sciences, Title Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Tramadol versus ketorolac in the treatment of postoperative pain following maxillofacial Medical and Dental University, Tokyo. surgery. Title Source Quantification of in vitro produced wear sites on composite resins using contact profilometry Journal of Maxillofacial & Oral Surgery. 11(3):264-70, 2012 Sep. and CCD microscopy: a methodological investigation. Other ID Source BDA LIBRARY MEDLINE SEARCH

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Journal of Medical & Dental Sciences. 59(2):53-6, 2012. BACKGROUND: Emergency departments (EDs) act as the safety net and alternative care Abstract site for patients without insurance who have dental pain. BACKGROUND: Although attritive and abrasive wear of recent composite resins has been substantially reduced, in vitro wear testing with reasonably simulating devices and METHODS: We conducted a retrospective chart review of visits to an urban teaching quantitative determination of resulting wear is still needed. Three-dimensional scanning hospital ED over a 12-month period, looking at patients who presented with a chief complaint methods are frequently used for this purpose. The aim of this trial was to compare maximum or ICD code indicating dental pain, toothache, or dental abscess. depth of wear and volume loss of composite samples, evaluated with a contact profilometer and a non-contact CCD camera imaging system, respectively. RESULTS: The number of visits to this ED by patients with a dental complaint was 1,013, representing approximately 1.3% of all visits to this ED. Dental patients had a mean age of 32 METHOD: Twenty-three random composite specimens with wear traces produced in a ball- (+/- 13) years, and 60% of all dental visits were made by African Americans. Dental patients on-disc sliding device, using poppy seed slurry and PMMA suspension as third-body media, were more likely to be self-pay than all other ED patients (61% versus 22%, P < 0.001). At were evaluated with the contact profilometer (TalyScan 150, Taylor Hobson LTD, Leicester, the vast majority of dental ED visits (97%), the patient was treated and discharged; at most UK) and with the digital CCD microscope (VHX1000, KEYENCE, Osaka, Japan). The target visits (90%) no dental procedure was performed. ED treatment typically consisted of pain parameters were maximum depth of the wear and volume loss.Results - The individual time control and antibiotics; at 81% of visits, the patient received an opiate prescription on of measurement needed with the non-contact CCD method was almost three hours less than discharge, and at 69% of visits, the patient received an antibiotic prescription on discharge. that with the contact method. Both, maximum depth of wear and volume loss data, recorded with the two methods were linearly correlated (r(2) > 0.97; p < 0.01). LIMITATIONS: This retrospective chart review covered a limited period of time, included only patients at a large urban academic medical center, and did not incorporate follow-up CONCLUSION: The contact scanning method and the non-contact CCD method are equally analysis. suitable for determination of maximum depth of wear and volume loss of abraded composite resins. CONCLUSION: Although they make up a small percentage of all ED visits, dental ED visits Publication Type are more common among the uninsured, seldom result in definitive care or hospital Comparative Study. Journal Article. admission, and often result in prescription of an opioid or antibiotic. These findings are cause Date Created for concern and have implications for public policy. 20130730 Publication Type Year of Publication Journal Article. 2012 Date Created 20121128 <9> Year of Publication Unique Identifier 2012 23189415 Status <10> MEDLINE Unique Identifier Authors 23083806 Hocker MB; Villani JJ; Borawski JB; Evans CS; Nelson SM; Gerardo CJ; Limkakeng AT. Status Authors Full Name MEDLINE Hocker, Michael B; Villani, John J; Borawski, Joseph B; Evans, Christopher S; Nelson, Authors Scott M; Gerardo, Charles J; Limkakeng, Alex T. Koottathape N; Takahashi H; Iwasaki N; Kanehira M; Finger WJ. Institution Authors Full Name Hocker,Michael B. Department of Surgery, Duke University Medical Center #3096, 2301 Koottathape, Natthavoot; Takahashi, Hidekazu; Iwasaki, Naohiko; Kanehira, Masafumi; Erwin Rd, Durham, NC 27710, USA. [email protected] Finger, Werner J. Title Institution Dental visits to a North Carolina emergency department: a painful problem. Koottathape,Natthavoot. Advanced Biomaterials, Graduate School of Medical and Dental Source Sciences, Tokyo Medical and Dental University, Tokyo, Japan. North Carolina Medical Journal. 73(5):346-51, 2012 Sep-Oct. Title Abstract Two- and three-body wear of composite resins. BDA LIBRARY MEDLINE SEARCH

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Source Lawson,Nathaniel C. Department of Biomedical Engineering, University of Alabama, Dental Materials. 28(12):1261-70, 2012 Dec. Birmingham, AL, USA. [email protected] Local Messages Title THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Characterization of third-body media particles and their effect on in vitro composite wear. Abstract Source OBJECTIVE: The aim of the present study was to investigate two- and three-body wear of Dental Materials. 28(8):e118-26, 2012 Aug. microfilled, micro-hybrid and nano-hybrid composite resins using a ball-on-disc sliding device. Other ID Source: NLM. NIHMS376461 METHODS: One microfilled (Durafill VS), one micro-hybrid (Filtek Z250), one hybrid (Clearfil Source: NLM. PMC3397658 AP-X), one nanofilled (Filtek Supreme XT), and two nano-hybrid (MI Flow, Venus Diamond) Local Messages composite resins were examined. The composites were filled in a cylindrical cavity, and light THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY polymerized. After storage in 37degreeC distilled water for 7days, all specimens were tested Abstract with a custom-made ball-on-disc sliding device with a zirconia ball as antagonist (50N loads, OBJECTIVES: The purpose of this study was to compare four medium particles currently 1.2Hz, 10,000 cycles) immersed in water, poppy seed slurry and polymethyl methacrylate used for in vitro composite wear testing (glass and PMMA beads and millet and poppy slurry, respectively. Maximum wear depth and volume loss of worn surfaces were quantified seeds). by a digital CCD microscope and analyzed with two-way analysis of variance. METHODS: Particles were prepared as described in previous wear studies. Hardness of RESULTS: The interactions between composite resin and condition of their maximum wear medium particles was measured with a nano-indentor, particle size was measured with a depth and volume loss were significant (p<0.01). The abrasive wear produced at three-body particle size analyzer, and the particle form was determined with light microscopy and image loading with poppy seed slurry was very large for the microfilled composite, and small for all analysis software. Composite wear was measured using each type of medium and water in other composites tested. In contrast, two-body wear of the microfilled composite, and one the Alabama wear testing device. Four dental composites were compared: a hybrid (Z100), nano-hybrid composite was very low. flowable microhybrid (Estelite Flow Quick), micromatrix (Esthet-X), and nano-filled (Filtek Supreme Plus). The test ran for 100,000 cycles at 1.2 Hz with 70 N force by a steel SIGNIFICANCE: The ball-on-disc sliding device used is considered suitable to simulate antagonist. Volumetric wear was measured by non-contact profilometry. A two-way analysis sliding of an antagonist cusp on an opposing occlusal composite restoration, either in the of variance (ANOVA) and Tukey's test was used to compare both materials and media. two- or the three-body wear mode. All tested materials except for the microfilled composite showed low surface wear when exposed to poppy seed as the third-body medium.Copyright RESULTS: Hardness values (GPa) of the particles are (glass, millet, PMMA, and poppy, © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved. respectively): 1.310(0.150), 0.279(0.170), 0.279(0.095), and 0.226(0.146). Average particle Publication Type sizes (mum) are (glass, millet, PMMA, and poppy, respectively): 88.35(8.24), 8.07(4.05), Comparative Study. Journal Article. 28.95(8.74), and 14.08(7.20). Glass and PMMA beads were considerably more round than Date Created the seeds. During composite wear testing, glass was the only medium that produced more 20121026 wear than the use of water alone. The rank ordering of the materials varied with each Year of Publication medium, however, the glass and PMMA bead medium allowed better discrimination between 2012 materials.

<11> SIGNIFICANCE: PMMA beads are a practical and relevant choice for composite wear Unique Identifier testing because they demonstrate similar physical properties as seeds but reduce the 22578990 variability of wear measurements.Copyright © 2012 Academy of Dental Materials. Published Status by Elsevier Ltd. All rights reserved. MEDLINE Publication Type Authors Comparative Study. Journal Article. Lawson NC; Cakir D; Beck P; Litaker MS; Burgess JO. Date Created Authors Full Name 20120710 Lawson, Nathaniel C; Cakir, Deniz; Beck, Preston; Litaker, Mark S; Burgess, John O. Year of Publication Institution 2012

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<12> Shantiaee Y; Mahjour F; Dianat O. Unique Identifier Authors Full Name 21972258 Shantiaee, Yazdan; Mahjour, Faranak; Dianat, Omid. Status Institution MEDLINE Shantiaee,Yazdan. Endodontic Department, Dental School, Shahid Beheshti University of Authors Medical Sciences, Tehran, Iran. Viet CT; Schmidt BL. Title Authors Full Name Efficacy comparison of periapical infiltration injection of dexamethasone, morphine and Viet, C T; Schmidt, B L. placebo for postoperative endodontic pain. Institution Source Viet,C T. Department of Oral Maxillofacial Surgery, New York University College of International Dental Journal. 62(2):74-8, 2012 Apr. Dentistry, 421 First Avenue, 233W, New York, NY 10010, USA. Local Messages Title THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Biologic mechanisms of oral cancer pain and implications for clinical therapy. [Review] Abstract Source OBJECTIVE: To evaluate the efficacy of periapical infiltration injection of dexamethasone Journal of Dental Research. 91(5):447-53, 2012 May. and morphine in reducing postoperative endodontic pain. Other ID Source: NLM. PMC3327727 METHOD: Ninety patients participated in this double-blind randomised controlled clinical Local Messages trial. They were referred to the dental school of Shahid Beheshti Medical University, Tehran, THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Iran for conventional endodontic treatment of molar teeth. The canals of each tooth were Abstract completely prepared with cleansing and shaping. The patients were randomly divided into Cancer pain is an ever-present public health concern. With innovations in treatment, cancer three experimental groups to receive dexamethasone, morphine or normal saline (1 mL). patients are surviving longer, but uncontrollable pain creates a poor quality of life for these Patients were then instructed to complete a pain diary 4, 8, 24 and 48 h after the patients. Oral cancer is unique in that it causes intense pain at the primary site and appointment. Statistical analysis consisted of chi-squared test, analysis of variance and significantly impairs speech, swallowing, and masticatory functions. We propose that oral Kruskal-Wallis test. cancer pain has underlying biologic mechanisms that are generated within the cancer microenvironment. A comprehensive understanding of key mediators that control cross-talk RESULTS: There was a statistically significant correlation between dexamethasone or between the cancer and peripheral nervous system, and possible interventions, underlies morphine treatment and decreased levels and incidence of endodontic pain at 4, 8 and 24 h, effective cancer pain management. The purpose of this review is to explore the current but not at 48 h (P < 0.05). It was also observed that dexamethasone was significantly more studies on oral cancer pain and their implications in clinical management for cancer pain in effective (56.7% no pain) than morphine (43.3% no pain). general. Furthermore, we will explore the endogenous opioid systems and novel cancer pain therapeutics that target these systems, which could solve the issue of opiate tolerance and CONCLUSION: Periapical infiltration of dexamethasone and morphine led to a considerable improve quality of life in oral cancer patients. decrease in postoperative endodontic pain during the first 24 h after operation. Publication Type Dexamethasone was more effective than morphine in pain reduction.Copyright © 2012 FDI Journal Article. Research Support, N.I.H., Extramural. Review. World Dental Federation. Date Created Publication Type 20120417 Comparative Study. Journal Article. Randomized Controlled Trial. Year of Publication Date Created 2012 20120316 Year of Publication <13> 2012 Unique Identifier 22420475 <14> Status Unique Identifier MEDLINE 22169050 Authors Status BDA LIBRARY MEDLINE SEARCH

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MEDLINE efficacy compared with placebo use and comparable efficacy with acetaminophen (300 mg) Authors with codeine (30 mg) therapy after impacted third molar extraction and in tension- type Gatoulis SC; Voelker M; Fisher M. headache.Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved. Authors Full Name Publication Type Gatoulis, Sergio C; Voelker, Michael; Fisher, Matt. Comparative Study. Journal Article. Randomized Controlled Trial. Institution Date Created Gatoulis,Sergio C. Bayer HealthCare, Morristown, New Jersey; Rutgers, The State 20120130 University of New Jersey, Piscataway, NJ, USA. Year of Publication Title 2012 Assessment of the efficacy and safety profiles of and acetaminophen with codeine: results from 2 randomized, controlled trials in individuals with tension-type headache and <15> postoperative dental pain. Unique Identifier Comments 21091369 Comment in: J Evid Based Dent Pract. 2012 Dec;12(4):220-1; PMID: 23177505 Status Source MEDLINE Clinical Therapeutics. 34(1):138-48, 2012 Jan. Authors Abstract Hayes JA; Forrest CR; Walsh W; Petroz GC; Adeli K; Bissonnette B. BACKGROUND: Aspirin is a widely used NSAID that has been extensively studied in Authors Full Name numerous conditions. Nonprescription analgesics, such as aspirin, are frequently used for a Hayes, J A; Forrest, C R; Walsh, W; Petroz, G C; Adeli, K; Bissonnette, B. wide variety of common ailments, including conditions such as dental pain and tension-type Title headache. Continuous bupivacaine infusion post-iliac crest bone graft harvesting in pediatric cleft surgery: role and comparison with ketorolac. OBJECTIVE: We sought to compare the efficacy and safety profiles of aspirin, Source acetaminophen with codeine, and placebo in the treatment of post-operative dental pain and Cleft Palate-Craniofacial Journal. 48(5):532-7, 2011 Sep. tension-type headache. Local Messages THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY METHODS: These were 2 randomized, double-blind, placebo-controlled, single-dose clinical Abstract trials that assigned participants (2:2:1) to receive either aspirin (1000 mg), acetaminophen OBJECTIVE: To investigate the use of intravenous ketorolac and iliac crest bupivacaine (300 mg) with codeine (30 mg), or placebo. The primary efficacy end point was the sum of infusion in the management of iliac crest donor-site pain in the pediatric cleft population. The pain intensity differences from baseline (SPID) over 6 hours for the dental pain study and null hypothesis was there is no difference with respect to pain scores between ketorolac and over 4 hours for the tension-type headache study. Other common analgesic measures, in iliac crest bupivacaine infusion as analgesic adjuncts to intravenous . addition to safety, were also evaluated. METHODS: A total of 54 children and adolescents (27 boys, 27 girls) undergoing alveolar RESULTS: The results of the dental pain study for aspirin and acetaminophen with codeine cleft repair or Le Fort I osteotomy were assigned randomly in a prospective, single-blinded suggest statistically significant efficacy for all measures compared with placebo at all time fashion to one of three groups: intravenous ketorolac plus iliac crest normal saline infusion, points. Aspirin provided statistically significant efficacy compared with acetaminophen with intravenous ketorolac plus iliac crest bupivacaine infusion, or iliac crest bupivacaine infusion codeine for SPID(0-4) (P = 0.028). In the tension-type headache study, aspirin and alone. Iliac crest infusions and ketorolac were administered for 48 hours or until discharge, acetaminophen with codeine provided statistically significant efficacy compared with placebo whichever occurred first. All patients received morphine via a patient-controlled analgesia for SPID(0-4) and SPID(0-6) (P < 0.001) and for total pain relief (P < 0.001). There were no device. significant differences between aspirin and acetaminophen with codeine at any evaluation of SPID (P > 0.070), complete relief (P > 0.179), or time to meaningful relief (P > 0.245). MAIN OUTCOME MEASURE(S): Primary outcome was pain score, and secondary Regarding safety, there were no statistically significant differences between treatment groups outcomes were morphine consumption and satisfaction scores. in the incidence of adverse events in the dental pain and tension-type headache studies. RESULTS: Pain scores, morphine consumption, and satisfaction scores were not CONCLUSIONS: These 2 randomized, double-blind, placebo-controlled studies significantly different among groups. Estimated costs were significantly higher for bupivacaine demonstrate that treatment with aspirin (1000 mg) provides statistically significant analgesic infusion than intravenous ketorolac. BDA LIBRARY MEDLINE SEARCH

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the last 10-15 years, several molecules with peripherally restricted opioid agonist activity CONCLUSIONS: Iliac crest donor-site pain is well managed in this patient population. have been developed and several more are in the "clinical pipeline. "Although none is Intravenous ketorolac and iliac crest bupivacaine infusion provide comparable analgesia for available as an approved medication till date, a few (e.g.; the peripherally restricted kappa- iliac crest bone graft donor-site pain in children and adolescents. agonist FE200665, also known as CR665) have completed phase I clinical trials and currently Publication Type in phase II. Others such as , which is approved for use as an antidiarrheal drug, Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't. have been found to be variably useful as a peripherally acting opioid analgesic. Date Created 20110830 CONCLUSIONS: Substantive research is currently underway and this is an exciting Year of Publication research area for both basic and applied clinical fields. Various ways to enhance peripheral 2011 opioid analgesia are suggested. Publication Type <16> Journal Article. Review. Unique Identifier Date Created 21434585 20110325 Status Year of Publication MEDLINE 2011 Authors Vadivelu N; Mitra S; Hines RL. <17> Authors Full Name Unique Identifier Vadivelu, Nalini; Mitra, Sukanya; Hines, Roberta L. 20973736 Institution Status Vadivelu,Nalini. Department of Anesthesiology, Yale University School of Medicine, New MEDLINE Haven, Connecticut, USA. Authors Title Simoes A; de Freitas PM; Bello-Silva MS; Tuner J; de Paula Eduardo C. Peripheral agonists for analgesia: a comprehensive review. [Review] Authors Full Name Source Simoes, Alyne; de Freitas, Patricia Moreira; Bello-Silva, Marina Stella; Tuner, Jan; de Journal of Opioid Management. 7(1):55-68, 2011 Jan-Feb. Paula Eduardo, Carlos. Abstract Institution BACKGROUND: It is established that opioid receptors are present in the dorsal root ganglia Simoes,Alyne. Centro de Pesquisa em Biologia Oral, Departamento de Materiais Dentarios, and the central as well as peripheral terminals ofprimary afferent neurons. Now, it has been Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo, Brazil. [email protected] shown that peripheral terminals of afferent nerves can be the sites of the intrinsic modulation Title of nociception and that opioid analgesia can be mediated by peripheral opioid receptors as Laser phototherapy for Stevens-Johnson syndrome: a case report. well. Source Photomedicine and Laser Surgery. 29(1):67-9, 2011 Jan. AIM: This review focuses on two areas: the first on describing the peripheral Abstract system, and the second on the review of the current state of development of peripherally BACKGROUND AND OBJECTIVE: Stevens-Johnson syndrome (SJS) is a life-threatening active opioid receptor agonists with theirpotential clinical applications. dermatosis characterized by epidermal sloughing and stomatitis. We report the case of a 7- year-old boy in whom laser phototherapy (LPT) was highly effective in reversing the effects of METHODS: Online and manual search using key words such as peripheral opioid receptors, an initial episode of SJS that had apparently developed in association with treatment with peripheral (or peripherally restricted) opioid agonists, and peripheral mu-, kappa-, and delta- phenobarbital for a seizure disorder. The patient was first seen in the intensive care unit opioid receptor agonists, followed by full-text access and further cross-referencing. (ICU) of our institution with fever, cutaneous lesions on his extremities, trunk, face, and neck; mucosal involvement of his genitalia and eyes (conjunctivitis); ulcerative intraoral lesions; and RESULTS: The obvious theoretical advantage of using these molecules is that analgesia is swollen, crusted, and bleeding lips. He reported severe pain at the sites of his intraoral and achieved while avoiding the bothersome-to-dangerous centrally mediated adverse effects of skin lesions and was unable to eat, speak, swallow, or open his mouth. centrally acting opioids. Molecules knownum for their central action (e.g.,, morphine) have been used in peripheral tissues (joints, bone, teeth) with reasonable but varied success. Over BDA LIBRARY MEDLINE SEARCH

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MATERIALS AND METHODS: Trying to prevent and minimize secondary infections, gastric BACKGROUND: Codeine is an opioid metabolised to active analgesic compounds, problems, pain, and other complications, the patient was given clindamycin, ranitidine, including morphine. It is widely available by prescription, and combination drugs including low dipyrone, diphenhydramine (Benadryl) drops, and morphine. In addition, he was instructed to doses of codeine are commonly available without prescription. use bicarbonate solution and Ketoconazole (Xylogel) in the oral cavity. Because of the lack of progress of the patient, the LPT was selected. OBJECTIVES: To assess the efficacy, the time to onset of analgesia, the time to use of rescue medication and any associated adverse events of single dose oral codeine in acute RESULTS: At 5 days after the initial session of LPT, the patient was able to eat gelatin, and postoperative pain. on the following day, the number and severity of his intraoral lesions and his labial crusting and swelling had diminished. By 6 days after his initial session of LPT, most of the patient's SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE and PubMed to intraoral lesions had disappeared, and the few that remained were painless; the patient was November 2009. able to eat solid food by himself and was removed from the ICU. Ten sessions of LPT were conducted in the hospital. The patient underwent three further and consecutive sessions at SELECTION CRITERIA: Single oral dose, randomised, double-blind, placebo-controlled the School of Dentistry, when complete healing of his oral lesions was observed. trials of codeine for relief of established moderate to severe postoperative pain in adults.

CONCLUSION: The outcome in this case suggests that LPT may be a new adjuvant DATA COLLECTION AND ANALYSIS: Studies were assessed for methodological quality modality for SJS complications. and data independently extracted by two review authors. Summed total pain relief (TOTPAR) Publication Type or pain intensity difference (SPID) over 4 to 6 hours were used to calculate the number of Case Reports. Journal Article. participants achieving at least 50% pain relief, which were used to calculate, with 95% Date Created confidence intervals, the relative benefit compared to placebo, and the number needed to 20110111 treat (NNT) for one participant to experience at least 50% pain relief over 4 to 6 hours. Year of Publication Numbers using rescue medication over specified time periods, and time to use of rescue 2011 medication, were sought as additional measures of efficacy. Data on adverse events and withdrawals were collected. <18> Unique Identifier MAIN RESULTS: Thirty-five studies were included (1223 participants received codeine 60 20393966 mg, 27 codeine 90 mg, and 1252 placebo). Combining all types of surgery (33 studies, 2411 Status participants), codeine 60 mg had an NNT of at least 50% pain relief over 4 to 6 hours of 12 MEDLINE (8.4 to 18) compared with placebo. At least 50% pain relief was achieved by 26% on codeine Authors 60 mg and 17% on placebo.Following dental surgery the NNT was 21 (12 to 96) (15 studies, Derry S; Moore RA; McQuay HJ. 1146 participants), and following other types of surgery the NNT was 6.8 (4.6 to 13) (18 Authors Full Name studies, 1265 participants). The NNT to prevent use of rescue medication within 4 to 6 hours Derry, Sheena; Moore, R Andrew; McQuay, Henry J. was 11 (6.3 to 50) (11 studies, 765 participants, mostly non-dental); the mean time to its use Institution was 2.7 hours with codeine and 2.0 hours with placebo. More participants experienced Derry,Sheena. Pain Research and Nuffield Department of Anaesthetics, University of adverse events with codeine 60 mg than placebo; the difference was not significant and none Oxford, West Wing (Level 6), John Radcliffe Hospital, Oxford, Oxfordshire, UK, OX3 9DU. were serious. Two adverse event withdrawals occurred with placebo. Title Single dose oral codeine, as a single agent, for acute postoperative pain in adults. [Review] AUTHORS' CONCLUSIONS: Single dose codeine 60 mg provides good analgesia to few [53 refs] individuals, and does not compare favourably with commonly used alternatives such as Source , NSAIDs and their combinations with codeine, especially after dental surgery; Cochrane Database of Systematic Reviews. (4)CD008099, 2010. the large difference between dental and other surgery was unexpected. Higher doses were Other ID not evaluated. [References: 53] Source: NLM. EMS58283 Publication Type Source: NLM. PMC4160845 Journal Article. Meta-Analysis. Review. Abstract Date Created 20100415 Year of Publication BDA LIBRARY MEDLINE SEARCH

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2010 result in a satisfactory outcome, with no need to resort to open joint surgery. This case series is limited by its size and further research on surgical intervention on EDS patients with <19> temporomandibular disorders is recommended.Copyright 2010 Mosby, Inc. All rights Unique Identifier reserved. 20659691 Publication Type Status Journal Article. MEDLINE Date Created Authors 20100727 Jerjes W; Upile T; Shah P; Abbas S; Vincent A; Hopper C. Year of Publication Authors Full Name 2010 Jerjes, Waseem; Upile, Tahwinder; Shah, Priya; Abbas, Syedda; Vincent, Anna; Hopper, Colin. <20> Institution Unique Identifier Jerjes,Waseem. University College London Hospital Head and Neck Centre, London, United 20337865 Kingdom. [email protected] Status Title MEDLINE TMJ arthroscopy in patients with Ehlers Danlos syndrome: case series. Authors Source Cairns BE. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 110(2):e12-20, Authors Full Name 2010 Aug. Cairns, B E. Local Messages Institution THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Cairns,B E. Canada Research Chair in Neuropharmacology, Faculty of Pharmaceutical Abstract Sciences, University of British Columbia, 2146 East Mall, Vancouver, Canada. OBJECTIVE: The purpose of this report was to assess the outcome of temporomandibular [email protected] joint (TMJ) arthroscopy in patients with temporomandibular disorders (TMDs) associated with Title Ehlers Danlos syndrome (EDS). Pathophysiology of TMD pain--basic mechanisms and their implications for pharmacotherapy. [Review] [129 refs] STUDY DESIGN: This retrospective case series describes 18 patients with EDS who Source underwent arthroscopy for temporomandibular disorders. The patients' demographics were Journal of Oral Rehabilitation. 37(6):391-410, 2010 May. recorded, along with preoperative TMJ symptoms, Wilkes classification, mouth opening, and Local Messages the presence of systemic involvement. The incidence of early and late postoperative THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY complications and the final outcome were noted. Abstract This article discusses the pathophysiology of temporomandibular disorders (TMD)-related RESULTS: All of the patients were females, with EDS Type III, and had a mean age of 34 pain and its treatment with analgesic drugs. Temporomandibular disorders are comprised of years. A high proportion of the patients had joints other than the TMJ affected. Five patients a group of conditions that result in temporomandibular joint pain (arthralgia, arthritis) and/or were classified as stage II according to the Wilkes classification, 9 patients were stage III, 3 masticatory muscle pain (myofascial TMD). In at least some patients with TMD, a peripheral patients were stage IV, and only 1 patient was diagnosed with stage V Wilkes before mechanism contributes to this pain. However, there is often a poor correlation between the intervention. Arthroscopy, followed by arthrocentesis and balloon dilatation of the affected severity of TMD-related pain complaints and evidence of definitive tissue pathology. This has TMJs was performed and intra-articular morphine injections were given to all patients. The led to the concept that pain in some patients with TMD may result from altered central main pre- and early postoperative complaint was pain, but this resolved in most cases. nervous system pain processing and further that this altered pain processing may be Improvement of mouth opening was noted from 23.4 +/- 4.2 to 27.8 +/- 5.1 mm after attributable to specific genes that are heritable. Psychosocial stressors are also thought to arthroscopy. Patients were followed for an average of 62 months and all were asymptomatic contribute to the development of TMD-related pain, particularly masticatory muscle pain. at their last review appointment. Finally, substantially more women suffer from TMD than men. Although there are arguably multiple reasons for sex-related differences in the prevalence of TMD, one candidate for the CONCLUSION: For patients where conservative measures of treating TMD are not increased occurrence of this disorder in women has been suggested to be the female sex effective, arthroscopy is a minimally invasive surgical procedure that has been shown to hormone oestrogen. Analgesic drugs are an integral part of the primary treatment for TMD- BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. related pain and dysfunction with more that 90% of treatment recommendations involving use agents intraoperatively. The procedure type, gender, and health status were not statistically of medications. The most commonly used agents include non-steroidal anti-inflammatory associated with the number of agents administered. Younger patients, however, were drugs, corticosteroids, muscle relaxants, anxiolytics, opiates and tricyclic antidepressants, statistically more likely to receive additional analgesic medications. however, evidence in support of the effectiveness of these drugs is lacking. Continued research into the pathophysiology of TMD-related pain and the effectiveness of analgesic CONCLUSIONS: Our study suggests that a minority of patients have postoperative treatments for this pain is required. [References: 129] discomfort in the postanesthesia care unit; mild to moderate analgesics were administered Publication Type during intraoperative phases of dental rehabilitation. Journal Article. Review. Publication Type Date Created Journal Article. 20100526 Date Created Year of Publication 20100520 2010 Year of Publication 2010 <21> Unique Identifier <22> 20483018 Unique Identifier Status 20393966 MEDLINE Status Authors MEDLINE Carter L; Wilson S; Tumer EG. Authors Authors Full Name Derry S; Moore RA; McQuay HJ. Carter, Laura; Wilson, Stephen; Tumer, Erwin G. Authors Full Name Institution Derry, Sheena; Moore, R Andrew; McQuay, Henry J. Carter,Laura. Dentist in Private Practice, Flower Mound, Texas, USA. Institution Title Derry,Sheena. Pain Research and Nuffield Department of Anaesthetics, University of Descriptive study of perioperative analgesic medications associated with general anesthesia Oxford, West Wing (Level 6), John Radcliffe Hospital, Oxford, Oxfordshire, UK, OX3 9DU. for dental rehabilitation of children. Title Source Single dose oral codeine, as a single agent, for acute postoperative pain in adults. [Review] Pediatric Dentistry. 32(2):141-5, 2010 Mar-Apr. [53 refs] Local Messages Source THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Cochrane Database of Systematic Reviews. (4)CD008099, 2010. Abstract Other ID PURPOSE: The purpose of this retrospective chart review was to document sedation and Source: NLM. EMS58283 analgesic medications administered preoperotively, intraoperatively, and during Source: NLM. PMC4160845 postanesthesia care for children undergoing dental rehabilitation using general anesthesia Abstract (GA). BACKGROUND: Codeine is an opioid metabolised to active analgesic compounds, including morphine. It is widely available by prescription, and combination drugs including low METHODS: Patient gender, age, procedure type performed, and ASA status were recorded doses of codeine are commonly available without prescription. from the medical charts of children undergoing GA for dental rehabilitation. The sedative and analgesic drugs administered pre-, intra-, and postoperatively were recorded. Statistical OBJECTIVES: To assess the efficacy, the time to onset of analgesia, the time to use of analysis included descriptive statistics and cross-tabulation. rescue medication and any associated adverse events of single dose oral codeine in acute postoperative pain. RESULTS: A sample of 115 patients with a mean age of 64 (+/-30) months was studied; 47% were females, and 71% were healthy. Over 80% of the patients were administered SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE and PubMed to medications primarily during pre- and intraoperative phases, with fewer than 25% receiving November 2009. medications postoperatively. Morphine and were the most frequently administered BDA LIBRARY MEDLINE SEARCH

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SELECTION CRITERIA: Single oral dose, randomised, double-blind, placebo-controlled Institution trials of codeine for relief of established moderate to severe postoperative pain in adults. Ziegler,Christoph M. Department of Oral and Maxillofacial Surgery, St Olavs University Hospital, Norwegian University for Science and Technology, Trondheim, Norway. DATA COLLECTION AND ANALYSIS: Studies were assessed for methodological quality [email protected] and data independently extracted by two review authors. Summed total pain relief (TOTPAR) Title or pain intensity difference (SPID) over 4 to 6 hours were used to calculate the number of Analgesic effects of intra-articular morphine in patients with temporomandibular joint participants achieving at least 50% pain relief, which were used to calculate, with 95% disorders: a prospective, double-blind, placebo-controlled clinical trial. confidence intervals, the relative benefit compared to placebo, and the number needed to Source treat (NNT) for one participant to experience at least 50% pain relief over 4 to 6 hours. Journal of Oral & Maxillofacial Surgery. 68(3):622-7, 2010 Mar. Numbers using rescue medication over specified time periods, and time to use of rescue Local Messages medication, were sought as additional measures of efficacy. Data on adverse events and THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY withdrawals were collected. Abstract PURPOSE: A number of reports have shown a direct analgesic effect of opioids by way of MAIN RESULTS: Thirty-five studies were included (1223 participants received codeine 60 the peripheral receptors. Nevertheless, only a very few studies have reported using opioids in mg, 27 codeine 90 mg, and 1252 placebo). Combining all types of surgery (33 studies, 2411 the temporomandibular joint (TMJ), and nearly all of them were connected to surgical patient participants), codeine 60 mg had an NNT of at least 50% pain relief over 4 to 6 hours of 12 groups. The present study was designed to evaluate the analgesic efficacy and safety of (8.4 to 18) compared with placebo. At least 50% pain relief was achieved by 26% on codeine repeated intra-articular morphine applications compared with a and saline 60 mg and 17% on placebo.Following dental surgery the NNT was 21 (12 to 96) (15 studies, solution in the management of TMJ pain. 1146 participants), and following other types of surgery the NNT was 6.8 (4.6 to 13) (18 studies, 1265 participants). The NNT to prevent use of rescue medication within 4 to 6 hours PATIENTS AND METHODS: A total of 48 patients with articular pain related to the TMJ was 11 (6.3 to 50) (11 studies, 765 participants, mostly non-dental); the mean time to its use were entered in a clinical, prospective, randomized, double-blind, single-center study. The was 2.7 hours with codeine and 2.0 hours with placebo. More participants experienced analgesic effect of repeated intra-articular infiltration with morphine (5 or 10 mg morphine adverse events with codeine 60 mg than placebo; the difference was not significant and none sulfite), bupivacaine 0.5% (Carbostesin; AstraZeneca, London, UK), and isotonic saline were serious. Two adverse event withdrawals occurred with placebo. solution as a placebo in the TMJ was examined. The efficiency after 3 injections of the same substance with an interval of 48 hours between each application was measured using a pain AUTHORS' CONCLUSIONS: Single dose codeine 60 mg provides good analgesia to few relief scale, visual analog scale, pain intensity scale, and the potential need for accessory individuals, and does not compare favourably with commonly used alternatives such as peripheral analgesics (paracetamol). paracetamol, NSAIDs and their combinations with codeine, especially after dental surgery; the large difference between dental and other surgery was unexpected. Higher doses were RESULTS: All patients showed, independent of the treatment group, pain relief within 60 not evaluated. [References: 53] minutes after the first injection. Patients with saline and Carbostesin reported almost Publication Type complete pain recurrence before the second injection. At 1 week after the last and third Journal Article. Meta-Analysis. Review. injection, the 10-mg morphine group still showed a distinct effect, with 16.7% reporting Date Created complete (no pain) and 41.7% distinct pain relief. In addition, 33.3% had a poor response and 20100415 8.3% had no improvement. None of the other groups reported complete improvement; Year of Publication however, 25% of the patients who received 5 mg morphine had distinct pain relief, and 50% 2010 had at least poor pain relief. In the Carbostesin group, distinct improvement was reported by 8.3%, with a poor response in 41.7%, and no effect in the remaining 50%. Patients treated <23> with saline had a poor response in 16.7%, but most (83.3%) reported no improvement 1 week Unique Identifier after treatment. 20171481 Status CONCLUSIONS: Independent of the applied substances, initial pain relief can be registered MEDLINE in the TMJ: either from the arthrocentesis effect or at least the placebo effect. Morphine at a Authors dosage of 10 mg showed the best and most long-lasting analgesic efficiency. Morphine, in Ziegler CM; Wiechnik J; Muhling J. general (5 and 10 mg), and, with limitations, Carbostesin were more or less efficient for Authors Full Name postoperative pain control but without distinct effects in the long term. With regard to our Ziegler, Christoph M; Wiechnik, Jan; Muhling, Joachim. results, we can recommend intra-articular morphine application at a dose of 10 mg for pain BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. management. Carbostesin showed no promising long-term effects.Copyright (c) 2010 Status American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights MEDLINE reserved. Authors Publication Type Lindsten R; Larsson E. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't. Authors Full Name Date Created Lindsten, Rune; Larsson, Erik. 20100222 Institution Year of Publication Lindsten,Rune. Department of Orthodontics, The Institute for Postgraduate Dental 2010 Education, Jonkoping, Sweden. [email protected] Title <24> Pacifier-sucking and breast-feeding: a comparison between the 1960 s and the 1990 s. Unique Identifier Source 19713261 Journal of Dentistry for Children (Chicago, Ill.). 76(3):199-203, 2009 Sep-Dec. Status Local Messages MEDLINE THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Authors Abstract Stone ME; Meyer MR; Alston TA. PURPOSE: Pacifiers and their forerunners have been condemned in past centuries, Authors Full Name probably beginning in the 17(th) and 18(th) centuries when and opiates were Stone, Martha E; Meyer, Marlene R; Alston, Theodore A. incorporated as fillings in sucking rags in Great Britain. Nowadays, the modern pacifier is Institution criticized for reducing breast-feeding time and encouraging weaning. The purpose of this Stone,Martha E. Treadwell Library, Boston, MA, USA. study was to analyze if pacifier-sucking has been detrimental to breast-feeding in the past Title few decades. Elton Romeo Smilie, the not-quite discoverer of ether anesthesia. Source METHODS: In the present study, 2 groups of young children born 30 years apart (1967 and Anesthesia & Analgesia. 110(1):195-7, 2010 Jan 1. 1995 to 1997) in the same geographic area were analyzed in the first 6 months of age Abstract regarding their sucking and feeding habits, including initial and prolonged pacifier-sucking Like William T.G. Morton, Elton Romeo Smilie (1819-1889) was raised in Massachusetts, and breast-feeding. attended medical school in New England, practiced dentistry there, strove for clinical invention, and moved to Boston. In October 1846, both announced that inhaled ethereal RESULTS: Findings do not support the commonly held opinion that pacifier-sucking reduces preparations achieved reversible insensibility in surgical patients. Smilie published a report in breast-feeding time. In the 30 years that separate the 2 groups, the pacifier-sucking habit the Boston Med Surg J 3 wk before Bigelow used that forum to broadcast Morton's Ether increased by 32% and prolonged use of a pacifier increased. At the same time, breast- Day. Smilie's preparation was an ethereal tincture of opium, and, as he mistakenly believed feeding at 6 months old has increased 20-fold in the contemporary group (born between 1995 the opium to be volatile and important, he ceded priority to Morton for ether anesthesia. The and 1997) as compared with the 1967 group. two authors collaborated on chloroform, but Smilie soon headed off in the Gold Rush to California. It is tempting to speculate that Charles T. Jackson and Morton were indebted in CONCLUSIONS: The results suggest that mothers might be unable to satisfy their child's part to Smilie. sucking urge through breast-feeding alone, and that they use the pacifier as a supplement. Publication Type Pacifier use does not negatively affect the prevalence of breast-feeding. Biography. Historical Article. Journal Article. Publication Type Date Created Comparative Study. Journal Article. 20091221 Date Created Year of Publication 20091127 2010 Year of Publication 2009 <25> Unique Identifier <26> 19941761 Unique Identifier BDA LIBRARY MEDLINE SEARCH

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19925973 was added, a difference that was statistically (and clinically) significant (P < Status .001). MEDLINE Authors CONCLUSION: The addition of buprenorphine to the local anesthetic used for intraoral Modi M; Rastogi S; Kumar A. nerve blocks in the present study provided a 3-fold increase in the duration of postoperative Authors Full Name analgesia, with complete analgesia persisting 30 hours beyond the duration provided by the Modi, Mancy; Rastogi, Sanjay; Kumar, Ashish. local anesthetic alone in 75% of patients. This practice can be of particular benefit to patients Institution undergoing minor oral surgery by providing prolonged analgesia after discharge from the Modi,Mancy. Department of Periodontics, Dr D.Y. Patil Dental College and Hospital, Nerul, hospital. Navi Mumbai, Mumbai, India. Publication Type Title Journal Article. Randomized Controlled Trial. Buprenorphine with bupivacaine for intraoral nerve blocks to provide postoperative Date Created analgesia in outpatients after minor oral surgery. 20091120 Source Year of Publication Journal of Oral & Maxillofacial Surgery. 67(12):2571-6, 2009 Dec. 2009 Local Messages THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY <27> Abstract Unique Identifier PURPOSE: The demonstration that opioid receptors exist in the peripheral nervous system 19716489 offers the possibility of providing postoperative analgesia in the ambulatory surgical patient. Status Over the previous decade, many investigators have studied this approach and have MEDLINE compared the efficacy of various opioids added to the local anesthetic near the brachial Authors plexus; and it appears from several of these studies that buprenorphine provides the longest Geha H; Nimeskern N; Beziat JL. duration of analgesia, the most important parameter of postoperative analgesia in Authors Full Name outpatients. One of these studies indicated that the agonist-antagonist, buprenorphine, added Geha, H; Nimeskern, N; Beziat, J L. to bupivacaine provided a longer period of postoperative analgesia than the traditional Institution opiates, but none of the studies was performed in patients undergoing minor oral surgery to Geha,H. Service de Chirurgie Maxillofaciale et Stomatologie, CHU Rouen, Rouen, France. check the efficacy of buprenorphine to provide postoperative analgesia in dental patients. [email protected] The present study was undertaken to ascertain the efficacy of buprenorphine in providing Title prolonged postoperative analgesia when added to 0.5% bupivacaine with epinephrine Patient-controlled analgesia in orthognathic surgery: evaluation of the relationship to anxiety 1:200,000. and anxiolytics. Source PATIENTS AND METHODS: Fifty healthy, consenting adult patients scheduled for upper Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 108(3):e33-6, extremity surgery were enrolled in the study. Patients were assigned randomly to 1 of 2 equal 2009 Sep. groups based on the agents used for the blocks. Patients in group I received 40 mL of a local Local Messages anesthetic alone, and those in group II received the same local anesthetic plus THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY buprenorphine 0.3 mg. The study was kept double-blind by having one dentist prepare the Abstract solutions, a second dentist perform the blocks, and a third dentist monitor the anesthesia and BACKGROUND: Although patient-controlled analgesia' (PCA) use has been reported in oral analgesia thereafter, up to and including the time of the first request for an analgesic and maxillofacial surgery,(8) it has not been evaluated for use in orthognathic surgery. In this medication. The data were reported as means +/- standard errors of the mean, and study, we evaluated the relationship between age, gender, and preoperative anxiety and differences between groups were determined using t test. A P value less than .01 was postoperative morphine intake after orthognathic surgery in the PCA environment. considered statistically significant. STUDY DESIGN: Fifty-one patients (34 female, 17 male) underwent orthognathic surgery. RESULTS: The mean duration of postoperative pain relief after injection of the local Patients' anxiety was evaluated preoperatively. All patients received morphine-based anesthetic alone was 8.34 +/- 0.11 hours compared with 28.18 +/- 1.02 hours after postoperative PCA. Relationship between preoperative anxiety and postoperative visual BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. analog scale (VAS) and 24 hour morphine intake was evaluated. Patients were randomly neuromuscular cause was identified. The diagnosis of CCHS was suspected and grouped according to whether preoperative oral anxiolytics were prescribed. subsequently confirmed by blood polymerase chain reaction analysis that revealed a heterozygous polyalanine expansion mutation of the PHOX2B gene (five polyalanine RESULTS: Age and VAS were correlated, as well as preoperative anxiety score and repeats). postoperative morphine intake (P < .05). Female patients receiving anxiolytics before surgery had less morphine consumption than those who did not. CONCLUSIONS: This report describes the unusual presentation of severe cor pulmonale in an adolescent with so-called "late-onset" CCHS. CCHS was previously thought to be a CONCLUSION: Preoperative anxiety directly influences postoperative PCA morphine disease affecting only neonates, but the late-onset phenotype has now been well described intake. Anxiolytics preoperatively seem to reduce the need for postoperative analgesics. in adults. It should be considered in any child presenting with unexplained right heart failure Publication Type without an identifiable cause, particularly if central sleep apnea is present, because early Comparative Study. Journal Article. Randomized Controlled Trial. initiation of ventilatory support can prevent cardiac and neurologic sequelae and improve Date Created outcome. 20090831 Publication Type Year of Publication Case Reports. Journal Article. 2009 Date Created 20090708 <28> Year of Publication Unique Identifier 2009 19584633 Status <29> MEDLINE Unique Identifier Authors 19237264 Fine-Goulden MR; Manna S; Durward A. Status Authors Full Name MEDLINE Fine-Goulden, Miriam R; Manna, Soumendu; Durward, Andrew. Authors Institution Shiiba M; Takei M; Nakatsuru M; Bukawa H; Yokoe H; Uzawa K; Tanzawa H. Fine-Goulden,Miriam R. Paediatric Intensive Care, Evelina Childrens Hospital, Guy's and St Authors Full Name Thomas Foundation Trust, London, United Kingdom. Shiiba, M; Takei, M; Nakatsuru, M; Bukawa, H; Yokoe, H; Uzawa, K; Tanzawa, H. Title Institution Cor pulmonale due to congenital central hypoventilation syndrome presenting in Shiiba,M. Department of Dentistry and Oral Surgery, Chiba University Hospital, Chiba adolescence. University, Chiba city, Chiba, Japan. [email protected] Source Title Pediatric Critical Care Medicine. 10(4):e41-2, 2009 Jul. Clinical observations of postoperative delirium after surgery for oral carcinoma. Abstract Source OBJECTIVE: To report the first case of congenital central hypoventilation syndrome (CCHS) International Journal of Oral & Maxillofacial Surgery. 38(6):661-5, 2009 Jun. presenting with severe cor pulmonale in an adolescent. Local Messages THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY METHODS AND DESIGN: Case report and literature review. Our Institutional Review Board Abstract waived the need for consent. The aim of the present study was to clarify the clinical characteristics of postoperative delirium and to determine appropriate postoperative management for its prevention. The SETTING: Pediatric intensive care unit in a tertiary care children's hospital. authors analysed 132 cases of primary surgery for oral carcinoma and observed 24 (18%) cases of postoperative delirium. Univariate analysis revealed that significant risk factors for PATIENT: A 12-year-old girl who developed profound hypoxia following routine dental postoperative delirium were older age, male gender, extensive surgery and morphine pain extraction under intravenous opiate sedation and became progressively obtunded due to control. Logistic regression analysis showed that older age and male gender were significant marked hypoventilation without hypoxic arousal, requiring mechanical ventilation. She had risk factors for postoperative delirium, while patient-controlled analgesia with fentanyl was evidence of severe right heart failure, but no cardiac, pulmonary, neurologic, or effective for prevention of postoperative delirium. There was a trend for postoperative BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. delirium to be associated with extensive surgery. In those who had delirium, blood tests (P = 0.041), 75 mg (P = 0.001), 100 mg (P < 0.001), and 200 mg (P < 0.001); morphine revealed that alkaline phosphatase, total protein, sodium, chlorine, red blood cell count, sulfate 60 mg (P < 0.001); and ibuprofen 400 mg (P < 0.001) in a nonparametric analysis of haemoglobin and haematocrit were significantly diminished after surgery. These results the primary end point. The significantly higher TOTPAR-8 score for compared with indicate that general condition is closely related to the onset of postoperative delirium, and placebo established the sensitivity of the model. Mean TOTPAR-4 was higher and onset of suggest that appropriate postoperative management can reduce the incidence of this action appeared more rapid for HCl 200 mg than morphine sulfate 60 mg. Pain complication. relief scores with morphine sulfate 60 mg were between those of tapentadol HCl 100 and 200 Publication Type mg. The incidence of nausea and vomiting appeared to be lower with all doses of tapentadol Journal Article. HCl compared with morphine sulfate 60 mg, but was not statistically significant. Date Created 20090609 CONCLUSION: Single oral doses of tapentadol 75 mg or higher effectively reduced Year of Publication moderate-to-severe postoperative dental pain in a dose-related fashion and were well- 2009 tolerated relative to morphine. These data suggest that tapentadol is a highly effective, centrally acting analgesic with a favorable side effect profile and rapid onset of action. <30> Publication Type Unique Identifier Clinical Trial, Phase II. Journal Article. Randomized Controlled Trial. 19020157 Date Created Status 20081121 MEDLINE Year of Publication Authors 2008 Kleinert R; Lange C; Steup A; Black P; Goldberg J; Desjardins P. Authors Full Name <31> Kleinert, Regina; Lange, Claudia; Steup, Achim; Black, Peter; Goldberg, Jutta; Unique Identifier Desjardins, Paul. 19020153 Institution Status Kleinert,Regina. Grunenthal GmbH, Zieglerstr. 6 52078, Aachen, Germany. MEDLINE Title Authors Single dose analgesic efficacy of tapentadol in postsurgical dental pain: the results of a Christensen KS; Cohen AE; Mermelstein FH; Hamilton DA; McNicol E; Babul N; Carr randomized, double-blind, placebo-controlled study. DB. Source Authors Full Name Anesthesia & Analgesia. 107(6):2048-55, 2008 Dec. Christensen, Kyle S; Cohen, Amy E; Mermelstein, Fred H; Hamilton, Douglas A; McNicol, Abstract Ewan; Babul, Najib; Carr, Daniel B. BACKGROUND: Tapentadol is a novel, centrally acting analgesic with two modes of action, Institution combining mu-opioid agonism and norepinephrine reuptake inhibition in a single molecule. Christensen,Kyle S. Jean Brown Associates, Salt Lake City, Utah, USA. We compared the efficacy and tolerability of tapentadol and a standard dose of morphine with Title placebo in a model of moderate-to-severe postoperative dental pain. The analgesic efficacy and safety of a novel intranasal morphine formulation (morphine plus chitosan), immediate release oral morphine, intravenous morphine, and placebo in a METHODS: Patients undergoing mandibular third molar extraction and experiencing postsurgical dental pain model. moderate-to-severe pain postsurgery were randomized to receive single, oral doses of Source tapentadol HCl (25, 50, 75, 100, or 200 mg), morphine sulfate (60 mg), ibuprofen (400 mg; Anesthesia & Analgesia. 107(6):2018-24, 2008 Dec. used to establish model sensitivity), or placebo. Mean total pain relief over 8 h (TOTPAR-8) Abstract was the primary end point. Secondary end points included mean total pain relief over 4 h BACKGROUND: Opioids are standard treatment for postoperative pain. In this study, we (TOTPAR-4) and onset of analgesia. Pairwise comparisons of study drug to placebo were compared the safety and efficacy of intranasal (i.n.) morphine to i.v. and oral morphine and assessed using the Fisher least significant difference test. Adverse events were recorded. placebo.

RESULTS: Four hundred patients were randomized to treatment and completed the study. METHODS: Two-hundred-twenty-five patients with moderate-to-severe pain after third Compared with placebo, mean TOTPAR-8 was significantly greater for tapentadol HCl 50 mg molar extraction were randomized to receive a single dose of i.n. morphine 7.5 mg or 15 mg, BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. i.v. morphine 7.5 mg, oral morphine 60 mg or placebo. Pain intensity was assessed using emotions increase pain, whereas positive emotions have the opposite effect. Other more visual analog and categorical scales, and pain relief using a categorical scale. Outcomes complex psychological states alter the way we feel pain. For instance, empathy for another included total pain relief, pain intensity difference, summed pain intensity difference, time to person who is suffering increases our own pain experience, and expectation of pain relief analgesic onset, time to requesting rescue medication, and patients' global evaluation of their underlies much of the placebo effect. Neuroimaging studies show a physiological basis for treatment. Safety assessments included adverse event recording and nasal examinations. psychological pain modulation, with activity in pain pathways altered by attentional state, positive and negative emotions, empathy and the administration of a placebo. The same RESULTS: Across the various efficacy outcomes, both i.n. morphine doses were statistically psychological factors activate intrinsic modulatory systems in the brain, including those similar to the positive comparators (i.v. and oral morphine), and all four morphine treatments stimulated when opiates are given for pain relief. It is important for the dentist and patients to were statistically superior to placebo. Overall, i.n. morphine 15 mg presented an efficacy understand the influence of psychological state on pain transmission. Such an understanding profile similar to i.v. morphine 7.5 mg; both treatments demonstrated rapid onset of efficacy, will not only help patients learn how to participate in their own pain control, but will also help generally persistent throughout the 6-h assessment period. The lower dose of i.n. morphine, the clinician create a fostering environment. 7.5 mg, was statistically similar to the other active treatments at 2 h and 6 h and similar to Publication Type placebo at 4 h. Study medications were generally well tolerated, with no withdrawals due to Journal Article. Research Support, Non-U.S. Gov't. adverse events or other safety concerns, and no serious adverse events reported. The most Date Created frequently reported adverse events were typical systemic opioid effects. 20080915 Year of Publication CONCLUSIONS: I.n. morphine offers a noninvasive alternative to i.v. morphine for 2008 postoperative analgesia. Publication Type <33> Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't. Unique Identifier Date Created 18383657 20081121 Status Year of Publication MEDLINE 2008 Authors Anonymous. <32> Title Unique Identifier Oral mucositis due to cancer treatments. Orodental hygiene and ice cubes. 18789200 Source Status Prescrire International. 17(93):33-5, 2008 Feb. MEDLINE Abstract Authors (1) Oral mucositis is a frequent adverse effect of cancer chemotherapy and radiotherapy. Loggia ML; Schweinhardt P; Villemure C; Bushnell MC. Fluorouracil, radiotherapy and conditioning regimens for haematopoietic stem cell grafting Authors Full Name often cause severe oral mucositis, preventing patients from drinking and eating normally. (2) Loggia, Marco L; Schweinhardt, Petra; Villemure, Chantal; Bushnell, M Catherine. A randomised trial suggests that this complication can be attenuated by timely orodental care Institution such as extraction of damaged teeth, treatment of tooth decay, and care of trauma due to Loggia,Marco L. Brigham and Women's Hospital and Harvard Medical School, Boston, dentures. (3) In 3 randomised controlled trials involving about 200 patients at high risk of Massachusetts, USA. severe oral mucositis, sucking ice during chemotherapy reduced the incidence of severe oral Title mucositis, from 14-74% to 4-21%. (4) Other treatments are no more effective and carry a risk Effects of psychological state on pain perception in the dental environment. of known or poorly documented adverse effects. (5) Analgesics (especially morphine) should Source be used to treat intense pain. Local anaesthetics have not been tested in patients with Journal (Canadian Dental Association). 74(7):651-6, 2008 Sep. damaged oral mucosa, but they can cause a burning sensation and carry a risk of swallowing Local Messages disorders due to anaesthesia of the oropharyngeal junction. (6) In practice, prevention of oral THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY mucositis due to cancer chemotherapy or radiotherapy is based on orodental care and ice Abstract rather than drugs. Psychological factors have an important influence on pain perception. Both in the clinic and Publication Type in experimental settings, distraction has been shown to reduce pain. Further, negative Journal Article. BDA LIBRARY MEDLINE SEARCH

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Date Created PERSPECTIVE: Previously, we reported that the produces both analgesic and 20080402 anti-analgesic effects and that the can enhance nalbuphine Year of Publication analgesia by selectively antagonizing the anti-analgesic effect. Here we show that morphine, 2008 given in a subanalgesic dose, reverses nalbuphine-induced anti-analgesia in males, perhaps by a similar mechanism. <34> Publication Type Unique Identifier Journal Article. Research Support, N.I.H., Extramural. 18201935 Date Created Status 20080331 MEDLINE Year of Publication Authors 2008 Gear RW; Gordon NC; Hossaini-Zadeh M; Lee JS; Miaskowski C; Paul SM; Levine JD. Authors Full Name <35> Gear, Robert W; Gordon, Newton C; Hossaini-Zadeh, Mehran; Lee, Janice S; Unique Identifier Miaskowski, Christine; Paul, Steven M; Levine, Jon D. 18184245 Institution Status Gear,Robert W. Department of Oral and Maxillofacial Surgery, University of California, San MEDLINE Francisco, California 94143-0440, USA. Authors Title Bhananker SM; Azavedo LF; Splinter WM. A subanalgesic dose of morphine eliminates nalbuphine anti-analgesia in postoperative Authors Full Name pain. Bhananker, Sanjay M; Azavedo, Lawrence F; Splinter, William M. Source Institution Journal of Pain. 9(4):337-41, 2008 Apr. Bhananker,Sanjay M. Department of Anesthesiology, Children's Hospital of Eastern Ontario, Other ID Ottawa, ON, Canada. [email protected] Source: NLM. NIHMS46285 Title Source: NLM. PMC2364600 Addition of morphine to local anesthetic infiltration does not improve analgesia after Abstract pediatric dental extractions. UNLABELLED: The agonist-antagonist kappa-opioid nalbuphine administered for Source postoperative pain produces greater analgesia in females than in males. In fact, males Paediatric Anaesthesia. 18(2):140-4, 2008 Feb. administered nalbuphine (5 mg) experience pain greater than those receiving placebo, Abstract suggesting the existence of an anti-analgesic effect. These sexually dimorphic effects on BACKGROUND: Opioid receptors have been noted in the peripheral nerve endings of postoperative pain can be eliminated by coadministration of a fixed ratio of the prototypical afferent neurons. Blockade of these receptors with peripherally administered opioids is opioid receptor antagonist naloxone with nalbuphine, implying a role for opioid receptors in believed to result in analgesia. the anti-analgesic as well as analgesic effects of nalbuphine. In the present study, we further evaluated the role of opioid receptors in the sex-specific effects on pain produced by METHODS: In a prospective, randomized, double-blind study, we studied the analgesic nalbuphine by coadministering a dose of morphine low enough that it does not produce effects of adding a subsystemic dose of morphine to local anesthetic infiltration ( analgesia. After extraction of bony impacted third molar teeth, nalbuphine (5 mg) was hydrochloride) during pediatric dental extractions. Forty-two subjects, aged 2-7 years of ASA administered alone or in combination with either of 2 low doses of morphine (2 mg or 4 mg). physical status I-II, were randomized to receive submucous infiltration with either morphine Both doses of morphine reversed nalbuphine-induced anti-analgesia in males, but only the 25 microg.kg(-1) in 2% lidocaine hydrochloride with 1 : 1 00 000 epinephrine (morphine lower dose (2 mg) reached statistical significance. Neither dose affected nalbuphine-induced group) or 2% lidocaine hydrochloride with 1 : 1 00 000 epinephrine (control group) at the end analgesia in females, and when administered alone in either males or females, morphine (2 of surgery. mg) had no analgesic effect. Though not observed in females, the effect of morphine in males argues that, like naloxone, low-dose morphine may act as an anti-analgesia opioid receptor RESULTS: There was no difference in postoperative analgesic requirements within the first antagonist. 24 h. In-hospital acetaminophen consumption was 85% in the morphine group compared with 81% in the control group.

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CONCLUSION: We conclude that there is no benefit of adding a subsystemic analgesic CONCLUSION: This study suggests that laser therapy can be useful in oral mucositis to dose of morphine to local anesthetics for analgesia after dental extractions in children. HSCT patients and improve the patient's quality of life. However, controlled randomized trials Publication Type should be performed to confirm the real efficacy of laser therapy. Journal Article. Randomized Controlled Trial. Publication Type Date Created Evaluation Studies. Journal Article. 20080110 Date Created Year of Publication 20071019 2008 Year of Publication 2007 <36> Unique Identifier <37> 17944669 Unique Identifier Status 17884802 MEDLINE Status Authors MEDLINE Jaguar GC; Prado JD; Nishimoto IN; Pinheiro MC; de Castro DO Jr; da Cruz Perez DE; Authors Alves FA. Plantevin F; Pascal J; Morel J; Roussier M; Charier D; Prades JM; Auboyer C; Molliex Authors Full Name S. Jaguar, G C; Prado, J D; Nishimoto, I N; Pinheiro, M C; de Castro, D O Jr; da Cruz Authors Full Name Perez, D E; Alves, F A. Plantevin, F; Pascal, J; Morel, J; Roussier, M; Charier, D; Prades, J-M; Auboyer, C; Institution Molliex, S. Jaguar,G C. Department of Stomatology, Cancer Hospital A.C. Camargo, Sao Paulo, Brazil. Institution Title Plantevin,F. Departement d'Anesthesie-Reanimation, CHU Hopital Bellevue, bd Pasteur, Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell 42055 Saint-Etienne Cedex 2, France. transplantation. Title Source Effect of mandibular nerve block on postoperative analgesia in patients undergoing Oral Diseases. 13(6):538-43, 2007 Nov. oropharyngeal carcinoma surgery under general anaesthesia. Local Messages Source THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY British Journal of Anaesthesia. 99(5):708-12, 2007 Nov. Abstract Abstract AIM: To evaluate the clinical effects of laser therapy on the prevention and reduction of oral BACKGROUND: Postoperative analgesia after oropharyngeal carcinoma surgery remains mucositis in patients who underwent hematopoietic stem cell transplantation (HSCT). poorly studied. This study investigates the effects of mandibular nerve block (MNB) with ropivacaine 10 mg ml(-1) in conjunction with general anaesthesia (GA) on postoperative PATIENTS AND METHODS: From January 2003 to September 2004, 24 patients received analgesia after partial glossectomy or transmandibular lateral pharyngectomy. prophylactic laser therapy (L+ group). The applications started from the beginning of the conditioning regimen up to day +2. The oral assessment was performed daily until day +30. METHODS: In a randomized double-blind study, 42 patients (21 in each group) received an This group was compared with historical controls, namely 25 patients, who did not receive MNB by the lateral extra-oral approach (MNB group) or a deep s.c. injection of normal saline laser therapy (L- group). (control group). Both groups received a standardized general anaesthetic. Postoperative analgesia included fixed dose of i.v. acetaminophen and morphine via a patient-controlled RESULTS: All patients developed some grade of mucositis. However, the L- group analgesia device. Consumption of morphine and supplemental analgesics and pain scores at presented initial mucositis by 4.36 days, whereas the L+ group presented it in 6.12 days (P = rest were measured. 0.01). The maximum mucositis occurred between day +2 and day +6 with healing by day +25 in the L- group and between day +2 and day +7 with healing by day +14 for the L+ group (P = RESULTS: The mean cumulative morphine consumption was reduced by 56 and 45% at 12 0.84). Laser therapy also reduced the time of oral pain from 5.64 to 2.45 days (P = 0.04), and and 24 h after operation in the MNB group. The administration of analgesic rescue decreased the consumption of morphine (P = 0.07). medications was delayed in the MNB group. The visual analogue scale (VAS) pain scores were comparable in the two groups during the first 24 h. Adequate analgesia (mean VAS < or BDA LIBRARY MEDLINE SEARCH

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= 3) was observed throughout the study period in the MNB group, but only from 4 h after operation onwards in the control group. The number of patients who experienced severe pain MAIN OUTCOME MEASURE: Pain scores in the immediate postoperative period for 2 (VAS > 7) during the first postoperative day was lower in the MNB group than in the control hours following surgery; this outcome measure was decided prior to data collection. group (3 vs 10. respectively, P < 0.05). RESULTS: The pain score and other outcome measures were all blinded. Measurements CONCLUSIONS: In this study, MNB performed before GA for oropharyngeal carcinoma are all evident from the nature of the results. surgery improved postoperative analgesia, resulting in reduced morphine consumption at 24 h and severe pain in fewer patients. CONCLUSIONS: There was no clinically significant difference observed in the analgesic Publication Type effect of either drug on the two groups studied. Journal Article. Randomized Controlled Trial. Publication Type Date Created Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non- 20071015 U.S. Gov't. Year of Publication Date Created 2007 20070831 Year of Publication <38> 2007 Unique Identifier 17760494 <39> Status Unique Identifier MEDLINE 17652345 Authors Status Fenlon S; Somerville N. MEDLINE Authors Full Name Authors Fenlon, S; Somerville, N. McKay MP. Institution Authors Full Name Fenlon,S. Department of Anesthesia, Queen Victoria Hospital, West Sussex, UK. McKay, Mary Pat. Title Institution Comparison of codeine phosphate and morphine sulphate in infants undergoing cleft palate McKay,Mary Pat. The George Washington University Medical Center-Emergency Medicine, repair. 2150 Pennsylvania Avenue, NW Suite 2B, Washington, DC 20037, USA. Source [email protected] Cleft Palate-Craniofacial Journal. 44(5):528-31, 2007 Sep. Title Local Messages Maritime health emergencies. THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Source Abstract Occupational Medicine (Oxford). 57(6):453-5, 2007 Sep. OBJECTIVE: To ascertain the quality of analgesia provided by morphine in comparison to Abstract codeine. BACKGROUND: Commercial ships flying the US flag must conform to Coast Guard standards and have medical care available onboard. Consultation with a physician is required DESIGN: The study is a prospective, randomized, double-blind trial of analgesic effect if medication is to be prescribed. employing validated pain scores. AIM: To evaluate the epidemiology of medical contacts for US ships at sea. PATIENTS: Infants having primary cleft palate repair with informed parental consent to enter the study. METHOD: Retrospective analysis of cases where shipboard caregivers made contact with US emergency medicine physicians for advice. INTERVENTIONS: Infants received one of two analgesics intraoperatively for immediate postoperative pain relief. Morphine was given by intravenous injection and codeine by the RESULTS: There were 866 cases and 1720 contacts in 48 consecutive months of study. intramuscular route. Eighty-eight per cent of cases were men with a mean age of 43.7 years (SD 13.7). Eighty- BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. four per cent of cases were medical, 14% were injuries and 2% were purely psychiatric. Fifty- Year of Publication eight per cent of medical cases, 50% of psychiatric cases and 42% of injury cases were 2007 handled with a single contact. Injuries and psychiatric cases required a higher number of contacts per case compared with medical cases (P < 0.01). Five categories of illness <41> accounted for 43% of medical cases (respiratory infections, abdominal problems, Unique Identifier genitourinary complaints, rashes and dental issues). Psychiatric cases required the most 17656271 medication, with 12% requiring four medications. The most common categories of medication Status given were pain relievers (non-steroidal anti-inflammatory drugs, opiates, heartburn relief) MEDLINE and antibiotics. Authors Zuniga JR; Ibanez C; Kozacko M. CONCLUSIONS: Even with pre-screening of seafarers and the potential dangers of life at Authors Full Name sea, the majority of cases requiring physician advice are not related to trauma. However, Zuniga, John R; Ibanez, Carlos; Kozacko, Mark. cases of injury or acute psychiatric problems required more physician interaction and Institution medication than medical cases. Zuniga,John R. Department of Surgery, Division of Oral and Maxillofacial Surgery, Publication Type University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. Journal Article. [email protected] Date Created Title 20070830 The analgesic efficacy and safety of intra-articular morphine and mepivicaine following Year of Publication temporomandibular joint arthroplasty. 2007 Source Journal of Oral & Maxillofacial Surgery. 65(8):1477-85, 2007 Aug. <40> Local Messages Unique Identifier THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY 17656293 Abstract Status PURPOSE: This study was designed to evaluate the efficacy and safety of intra-articular MEDLINE morphine, mepivacaine, or a combination of both in the management of temporomandibular Authors joint (TMJ) pain in a 24-hour period after arthroplasty. Desjardins PJ; Black PM; Daniels SE; Bird SR; Petruschke RA; Chang DJ; Smugar SS; Tershakovec AM. PATIENTS AND METHODS: This was a randomized, double-blind, prospective, parallel, Authors Full Name placebo-controlled, single-injection study of 35 patients who underwent TMJ arthroplasty. Desjardins, Paul J; Black, Peter M; Daniels, Stephen E; Bird, Steven R; Petruschke, Patients were randomized into 4 groups. Group M (morphine) received 1 mg of morphine Richard A; Chang, David J; Smugar, Steven S; Tershakovec, Andrew M. sulfate in 1 mL of saline; group MEP (mepivicaine) received 30 mg of mepivacaine Institution hydrochloride in 1 mL of saline; group M/MEP received 30 mg of mepivacaine hydrochloride Desjardins,Paul J. Clinical Research and Clinical Site Operations, SCIREX Clinical and 1 mg of morphine in 1 mL of saline; and group C (saline control) received 1 mL of saline. Research Centers, Austin, TX 78705, USA. [email protected] Patients received a single dose of study medication when their postoperative pain reached a Title moderate or severe intensity and was 50 mm or greater on a 100-mm pain scale. Analgesic A double-blind randomized controlled trial of and multidose efficacy measures included the time to meaningful pain relief measured using a stop watch oxycodone/acetaminophen in dental impaction pain. and time to rescue medication. Pain relief and pain intensity ratings were recorded at the time Source to relief and time to rescue medication. A global evaluation for the effectiveness of the Journal of Oral & Maxillofacial Surgery. 65(8):1624-32, 2007 Aug. medications was recorded within 24 hours after dosing. Adverse events were recorded and Local Messages categorized by system effect. THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Publication Type RESULTS: MEP and M/MEP were significantly more effective than placebo for all the Comparative Study. Journal Article. Multicenter Study. Randomized Controlled Trial. analgesic measures. Morphine alone provided only mild analgesia and did not differ from Date Created placebo in the primary efficacy measures. The average overall pain relief was substantially 20070727 better for MEP than M and M/MEP (P = .03). In patients receiving MEP, the mean time to BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. pain relief was 2.9 minutes and the mean analgesic duration was 9.7 hours (586 minutes); 3 Abstract patients required no rescue medication in the 24 hour postdosing period. In patients receiving Nitrous oxide (N(2)O) has been used for well over 150 years in clinical dentistry for its M/MEP, the mean time to analgesia was 7.6 minutes and the duration of analgesia was 2.7 analgesic and anxiolytic properties. This small and simple inorganic chemical molecule has hours (175 minutes). The average time to onset and duration of analgesia in the MEP and indisputable effects of analgesia, anxiolysis, and anesthesia that are of great clinical interest. M/MEP groups was statistically significantly better (P < .001) then in the M alone group (17.7 Recent studies have helped to clarify the analgesic mechanisms of N(2)O, but the minutes, 0.43 hours, respectively) and the placebo C group (16.1 minutes, 0.17 hours, mechanisms involved in its anxiolytic and anesthetic actions remain less clear. Findings to respectively). At the end of the study, 80% of the patients given MEP rated the medication as date indicate that the analgesic effect of N(2)O is opioid in nature, and, like morphine, may a very good or excellent pain reliever, whereas only 40% of patients given M/MEP, 10% of involve a myriad of neuromodulators in the spinal cord. The anxiolytic effect of N(2)O, on the patients given M, and no patients given placebo gave these same ratings. No serious other hand, resembles that of benzodiazepines and may be initiated at selected subunits of adverse events occurred in this study. Gastrointestinal adverse events were the most the gamma-aminobutyric acid type A (GABA(A)) receptor. Similarly, the anesthetic effect of common side effect noted in the MEP and M/MEP groups but were mild in intensity and N(2)O may involve actions at GABA(A) receptors and possibly at N-methyl-D-aspartate reversed without treatment. receptors as well. This article reviews the latest information on the proposed modes of action for these clinical effects of N(2)O. [References: 105] CONCLUSION: All intra-articular TMJ injections of active substances provided better Publication Type analgesia than placebo. Morphine alone provided only mild and short-acting analgesia. The Journal Article. Review. local anesthetic, mepivacaine, given alone was safe, provided the quickest, longest acting Date Created and most effective analgesia. This proof of concept study suggests that local anesthetics are 20070313 superior analgesics when given intra-articularly for postoperative TMJ surgery pain and Year of Publication should be investigated for dose response and multiple or continuous infusion effectiveness. 2007 Publication Type Journal Article. Randomized Controlled Trial. <43> Date Created Unique Identifier 20070727 17125899 Year of Publication Status 2007 MEDLINE Authors <42> Dowling AH; Fleming GJ. Unique Identifier Authors Full Name 17352529 Dowling, Adam H; Fleming, Garry J P. Status Institution MEDLINE Dowling,Adam H. Materials Science Unit, Division of Oral Biosciences, Dublin Dental School Authors and Hospital, Trinity College Dublin, Dublin 2, Ireland. [email protected] Emmanouil DE; Quock RM. Title Authors Full Name The impact of montmorillonite clay addition on the in vitro wear resistance of a glass- Emmanouil, Dimitris E; Quock, Raymond M. ionomer restorative. Institution Source Emmanouil,Dimitris E. Department of Pediatric Dentistry, School of Dentistry, Athens Journal of Dentistry. 35(4):309-17, 2007 Apr. University, Athens, Greece. [email protected] Local Messages Title THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Advances in understanding the actions of nitrous oxide. [Review] [105 refs] Abstract Source OBJECTIVES: The in vitro wear resistance of a glass-ionomer (GI) restorative ChemFil Anesthesia Progress. 54(1):9-18, 2007. Superior (Dentsply DeTrey, Kanstanz, Germany) reinforced with either a pristine calcium Other ID montmorillonite (Ca-MMT) or an organically modified 12-amino-dodecanoicacid treated Source: NLM. PMC1821130 montmorillonite (ADA-MMT) clay was evaluated to investigate the potential of MMT Local Messages reinforced GI restoratives as posterior filling materials. THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY BDA LIBRARY MEDLINE SEARCH

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METHODS: The wear resistance of a GI restorative reinforced with 0.5-2.5 wt.% Ca-MMT In a prospective, double blind, and randomized study, we compared methylprednisolone and ADA-MMT was assessed for groups of four disc-shaped specimens using the OHSU oral and after anesthesia for multiple third molar extraction. In addition to paracetamol, wear simulator operating at 20 N abrasion and 90 N attrition forces for 50,000 cycles at a 90 patients were allocated to receive intravenously either ketoprofen 100 mg or frequency of 1 Hz in the presence of a poppy seed and PMMA micro-sphere slurry. The wear methylprednisolone 1 mg/kg. Severity of pain was measured with visual analogue scale facet of each specimen was quantified by measuring the mean wear depth and mean (VAS) in recovery room. Sixty-three percent of patients receiving methylprednisolone had a volumetric wear in the abrasion (40-60% of wear facet) and attrition (80-90%) regions in VAS score <30 mm compared with 42% of those receiving ketoprofen (P = 0.04), with no conjunction with the mean total wear depth and mean total volumetric wear. difference in the consumption of morphine. We observed only marginal difference between methylprednisolone and ketoprofen to relieve pain after this surgery. RESULTS: The addition of Ca-MMT clay resulted in a significant increase in the mean total Publication Type volumetric wear and mean total wear depth of the GI restorative as the concentration of clay Journal Article. Randomized Controlled Trial. was increased utilising the one-way ANOVA and Tukey's test comparisons at a 95% Date Created significance level. When ADA-MMT clay was added to the GI no significant differences in 20061220 mean total volumetric wear and mean total wear depth were evident (P<0.05). Year of Publication 2007 CONCLUSIONS: The addition of Ca-MMT clay to the GI restorative resulted in a significant decrease in the in vitro wear resistance. ADA-MMT clay additions to the powder element of <45> the GI restorative did not significantly enhance the in vitro wear resistance. Unique Identifier Publication Type 24494021 Journal Article. Status Date Created PubMed-not-MEDLINE 20070307 Authors Year of Publication Talati A; Bidar M; Sadeghi G; Nezami H. 2007 Authors Full Name Talati, Ali; Bidar, Maryam; Sadeghi, Ghazal; Nezami, Hossein. <44> Institution Unique Identifier Talati,Ali. Department of Endodontics, School of Dentistry, Mashhad University of Medical 17178485 Sciences, Mashhad, Iran. Status Bidar,Maryam. Department of Endodontics, School of Dentistry, Mashhad University of MEDLINE Medical Sciences, Mashhad, Iran. Authors Sadeghi,Ghazal. Department of Endodontics, School of Dentistry, Mashhad University of Leone M; Richard O; Antonini F; Rousseau S; Chabaane W; Guyot L; Martin C. Medical Sciences, Mashhad, Iran. Authors Full Name Nezami,Hossein. Department of Endodontics, School of Dentistry, Tabriz University of Leone, Marc; Richard, Olivier; Antonini, Francois; Rousseau, Sebastien; Chabaane, Medical Sciences, Tabriz, Iran. Wajdi; Guyot, Laurent; Martin, Claude. Title Institution A comparative study of lidocaine and lidocaine- mannitol in anesthetizing human teeth with Leone,Marc. Department of Intensive Care Medicine and Trauma Center, Centre Hospitalier inflamed pulps. et Universitaire Nord, Marseille, France. [email protected] Source Title Iranian Endodontic Journal. 1(1):19-23, 2006. Comparison of methylprednisolone and ketoprofen after multiple third molar extraction: a Other ID randomized controlled study. Source: NLM. PMC3909611 Source Abstract Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 103(1):e7-9, INTRODUCTION: Failure to achieve adequate and profound anesthesia in teeth with acute 2007 Jan. pulp inflammation is a common condition during emergency visits in root canal therapy. Many Local Messages different anesthetic solutions such as morphine and have accordingly been THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY examined. Mannitol- an alcoholic sugar with high osmotic pressure level- is applicated for Abstract reducing intracranial and post retinal pressure in medicine. It has also been used for its BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. diuretic effect. In combination with local anesthetic solution, it increases permeability of the Abstract nerve fiber sheath and leads to influx of the local anesthetic through cytoplasmic membrane As previously suggested, (oxidation product of codeine) induces non-apoptotic .The purpose of the present study was to compare the efficacy of routine local anesthesia cell death, characterized by marginal caspase activation and the lack of DNA fragmentation with or without using mannitol in teeth with inflamed pulps. in HL-60 human promyelocytic leukemia cells, which was inhibited by N-acetyl-L-cysteine. Whether, , an oxidative metabolite of morphine, also induced a similar type of cell MATERIALS AND METHODS: one hundred patients with acute dental pain in posterior death in HL-60 cells was investigated. Morphinone showed slightly higher cytotoxic activity teeth were selected. Vials with 3 ml anesthetic solution containing 2.5% lidocaine with against human tumor cell lines (oral squamous cell carcinoma HSC-2, HSC-3, HSC-4, NA, 1/80000 epinephrine or 2.5% lidocaine with 1/80000 epinephrine and 0.5 mol mannitol were Ca9-22, promyelocytic leukemia HL-60, cervical carcinoma HeLa) than against normal oral used for anesthesia. For each patient, the routine injection technique was applied, during the human cells (gingival fibroblast HGF, pulp cells HPC, periodontal ligament fibroblast HPLF). removal of decay and dentine. Depth of anesthesia was evaluated and the supplementary Morphinone also induced an almost undetectable level of internucleosomal DNA injection was done in case of pain feeling and then pulpotomy was done. The analysis of data fragmentation in the HL-60 cells. Morphinone did not activate caspase-8 or -9 in these cells. was done using chi-square statistical test. Morphinone dose-dependently activated caspase-3 in both HL-60 and HSC-2 cell lines, but to a much lesser extent than actinomycin D. Electron microscopy demonstrated that RESULTS: The results showed that complete anesthesia after the first injection was morphinone induced mitochondrial shrinkage, vacuolization and production of obtained with lidocaine mannitol in 46% and with lidocaine alone in 38% of cases. However, autophagosome and the loss of cell surface microvilli, without destruction of cell surface and the difference was not significant. nuclear membranes in the HL-60 cells. The autophagy inhibitor 3-methyladenine (0.3-10 mM) slightly inhibited the morphinone-induced cytotoxicity, when corrected for its own cytotoxicity. CONCLUSION: These finding suggest that the addition of mannitol to the standard These data suggest that morphinone induces non-apoptotic cell death in HL-60 cells. anesthetic solution could insignificantly increase the level of anesthesia in teeth with inflamed Publication Type pulps. Journal Article. Research Support, Non-U.S. Gov't. Publication Type Date Created Journal Article. 20061110 Date Created Year of Publication 20140204 2006 Year of Publication 2006 <47> Unique Identifier <46> 16967674 Unique Identifier Status 17094451 MEDLINE Status Authors MEDLINE Ram S; Kumar SK; Clark GT. Authors Authors Full Name Takeuchi R; Hoshijima H; Nagasaka H; Chowdhury SA; Kikuchi H; Kanda Y; Kunii S; Ram, Saravanan; Kumar, Satish K S; Clark, Glenn T. Kawase M; Sakagami H. Institution Authors Full Name Ram,Saravanan. Orofacial Pain and Oral Medicine Center, University of Southern California Takeuchi, Risa; Hoshijima, Hiroshi; Nagasaka, Hiroshi; Chowdhury, Shahead Ali; Kikuchi, School of Dentistry, Los Angeles 90089, USA. Hirotaka; Kanda, Yumiko; Kunii, Shiro; Kawase, Masami; Sakagami, Hiroshi. Title Institution Using oral medications, infusions and injections for differential diagnosis of orofacial pain. Takeuchi,Risa. Division of Anesthesiology, Department of Comprehensive Medical Source Sciences, Meikai University School of Dentistry, Sakado, Saitama 350-0283, Japan. Journal of the California Dental Association. 34(8):645-54, 2006 Aug. Title Local Messages Induction of non-apoptotic cell death by morphinone in human promyelocytic leukemia HL- THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY 60 cells. Abstract Source Chronic orofacial pain is a rapidly evolving and challenging field that deals with the Anticancer Research. 26(5A):3343-8, 2006 Sep-Oct. management of pain originating from neurogenic, osseous, muscular, or vascular structures BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. of the head and neck. The challenge lies in the accurate diagnosis of orofacial pain Institution conditions, which may be difficult to differentiate in many clinical situations. As pain cannot be Modaresi,Jalil. Department of Endodontics, Dental School, Shahid Sadoughi University of "seen" or precisely located or its intensity measured with any device, clinicians must rely Medical Sciences, Yazd and Isfahan, Iran. heavily on the patient's own description of type, duration and location of pain, and thus, Title history plays a crucial role in diagnosis. Advances in neuroscience, pharmacology, and pain The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication management have made medications one of the primary therapeutic modalities in the therapy on the depth of anesthesia during treatment of inflamed teeth. management of pain including orofacial pain conditions. Despite this, these medications will Source not help patients if the origin and nature of pain is not accurately diagnosed. Hence, Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 102(3):399-403, diagnosis is critical for successful management of orofacial pain conditions. Experience and 2006 Sep. knowledge of practice in pain management have led clinicians to devise several clinical Local Messages diagnostic tests using medications in various forms (topical, oral, injections, intravenous THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY infusions) to differentiate certain orofacial pain disorders where the nature of pain is unclear Abstract and the presentation of pain is at multiple sites. Although the diagnostic tests are not 100 The purpose of this study was to elucidate whether premedication therapy with percent accurate, they are very effective in many clinical scenarios, especially in orofacial acetaminophen-codeine or ibuprofen is able to increase the depth of anesthesia in inflamed pain conditions. Topical medications such as anesthetics and anti-inflammatories, oral teeth. Sixty patients with the diagnosis of irreversible pulpitis in 1 mandibular tooth requiring medications such as anti-inflammatory drugs and skeletal muscle relaxants, injections such root canal therapy (RCT) were selected. Two other teeth in the same quadrant were selected as local anesthetics and corticosteroids, and vapocoolant sprays are some examples of the as controls. An electric pulp tester (EPT) was used to evaluate pulp sensitivity at the baseline modalities used by clinicians to manage orofacial pain conditions. These medications may and after drug administration and anesthesia injection. The subjects were divided into 3 also be used for diagnostic tests to aid in accurate diagnosis of some orofacial pain groups randomly, and in each group 1 of the 3 drugs including acetaminophen-codeine, conditions. In addition, there are special cases where medications such as triptans, ibuprofen, and placebo were administered 1 hour before anesthesia delivery. After 1 hour, and indomethacin may be used as diagnostic tests to confirm diagnosis of anesthesia was injected and after a waiting period, the EPT measurement was recorded. The migraines, neuralgias, or stabbing headaches, respectively. Based on the concept of using reversed EPT scale was used to evaluate the depth of anesthesia achieved during RCT. medications to predict which treatment would be best for certain pain conditions or to aid in Data were analyzed to statistically compare the results before and after intervention in cases better diagnosis, diagnostic intravenous infusions of lidocaine, morphine, and have and controls of each group and among different groups. Significanly lower tooth sensitivity been studied to test the response to adjuvant analgesics and oral . levels (TSLs) were observed after intervention in acetaminophen-codeine and ibuprofen Paradoxically, taking the patients off their current medications can be of diagnostic groups, which was more significant in the ibuprofen group. The comparison of inflamed teeth significance in conditions like medication overuse headache and serotonin selective reuptake TSLs in the acetaminophen-codeine group and the placebo group after anesthesia and drug inhibitor-induced clenching. In summary, this paper focuses on the use of medications in administration showed significant differences (P = .001). This comparison between ibuprofen different forms as useful diagnostic tests for differential diagnosis of orofacial pain conditions and placebo groups also showed significant differences (P approximately 0). Also, that are difficult to diagnose or are refractory to past or current treatment. significantly lower TSL of inflamed teeth was observed in the ibuprofen group in comparison Publication Type with the acetaminophen-codeine group (P = .002). This study reflected preoperative Journal Article. administration of ibuprofen, if not contraindicated, as a drug of choice 1 hour before local Date Created anesthesia injection as an effective method for achieving a deep anesthesia during RCT of 20060913 teeth with irreversible pulpitis. Year of Publication Publication Type 2006 Journal Article. Randomized Controlled Trial. Date Created <48> 20060821 Unique Identifier Year of Publication 16920550 2006 Status MEDLINE <49> Authors Unique Identifier Modaresi J; Dianat O; Mozayeni MA. 16713811 Authors Full Name Status Modaresi, Jalil; Dianat, Omid; Mozayeni, Mohammad Ali. MEDLINE BDA LIBRARY MEDLINE SEARCH

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Authors Institution Brennan PA; Ilankovan V. Donaldson,A B P. Department of Anaesthesia, Royal Brisbane and Women's Hospital, Authors Full Name Brisbane, Queensland. Brennan, Peter A; Ilankovan, Vellupillai. Title Institution The effect of supplemental oxygen on postoperative nausea and vomiting in children Brennan,Peter A. Queen Alexandra Hospital, Portsmouth, UK. undergoing dental work. [email protected] Source Title Anaesthesia & Intensive Care. 33(6):744-8, 2005 Dec. Arthrocentesis for temporomandibular joint pain dysfunction syndrome. Abstract Source Administration of 80% intraoperative oxygen has been proposed as being a cheap, safe and Journal of Oral & Maxillofacial Surgery. 64(6):949-51, 2006 Jun. effective means of reducing postoperative nausea and vomiting (PONV) but no studies have Local Messages been performed in the high risk paediatric population. We tested whether 80% intraoperative THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY oxygen reduces PONV in well children undergoing elective day-stay dental treatment under Abstract general anaesthesia. Ninety-five children received standardized sevoflurane, morphine, The management of refractory temporomandibular joint (TMJ) pain is both challenging and vecuronium anaesthesia with either 30% or 80% intraoperative oxygen and no antiemetic controversial. A number of simple, noninvasive approaches have been used in the prophylaxis in a randomized, double blind, prospective trial. There was no difference in management of this condition with variable success. In patients who fail to respond to PONV or in the use of rescue ondansetron between the groups. The total incidence of PONV conventional conservative measures, in a joint that is not deemed to be grossly mechanically was 40% in the group that received 30% oxygen and 33% in those that received 80% deranged, we advocate the use of TMJ arthrocentesis. In our practice, this is followed by oxygen. High inspired intraoperative oxygen was not found to significantly reduce PONV in intra-articular morphine infusion in an attempt to give long-term pain relief. Arthrocentesis is a well children undergoing dental work under general anaesthesia. simple technique with minimal morbidity that can be tried instead of more invasive Publication Type procedures. To date we have used arthrocentesis of the upper joint space, with intra-articular Comparative Study. Journal Article. Randomized Controlled Trial. morphine injection in over 500 TMJs. Approximately 90% of patients have found the Date Created procedure beneficial, with pain often being reduced 1 year after the procedure. We 20060109 recommend arthrocentesis as an effective, minimally invasive technique in patients with Year of Publication continuing pain in the TMJ that is unresponsive to conservative management. We additionally 2005 advocate the use of intra-articular morphine as a long acting analgesic in these patients. Although arthrocentesis is a well documented technique and there have been many studies <51> published in relation to the use of intra-articular morphine in orthopedic surgery, further Unique Identifier research is required, to delineate its use in the TMJ more fully. 16182156 Publication Type Status Journal Article. MEDLINE Date Created Authors 20060522 Chang DJ; Bird SR; Bohidar NR; King T. Year of Publication Authors Full Name 2006 Chang, David J; Bird, Steven R; Bohidar, Norman R; King, Thomas. Institution <50> Chang,David J. Clinical Development, Merck & Co, Inc, West Point, Pennsylvania, USA. Unique Identifier Title 16398379 Analgesic efficacy of rofecoxib compared with codeine/acetaminophen using a model of Status acute dental pain. MEDLINE Comments Authors Comment in: J Evid Based Dent Pract. 2006 Dec;6(4):269-70; PMID: 17174248 Donaldson AB. Source Authors Full Name Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 100(4):e74-80, Donaldson, A B P. 2005 Oct. BDA LIBRARY MEDLINE SEARCH

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Local Messages Journal of Oral & Maxillofacial Surgery. 63(7):903-7, 2005 Jul. THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Local Messages Abstract THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY OBJECTIVE: To determine analgesic efficacy of a single oral dose of rofecoxib 50 mg Abstract compared with acetaminophen/codeine 600/60 mg, we conducted a double-blind, PURPOSE: The purpose of this study was to compare the anesthetic requirements and randomized, placebo- and active-comparator-controlled, parallel-group study. hemodynamic and oxygenation variables involved between the bolus midazolam/fentanyl intravenous sedation-analgesia technique, and the same technique combined with STUDY DESIGN: Patients (N = 390) experiencing moderate or severe pain postextraction continuous-infusion propofol. of 2 or more third molars, with at least 1 mandibular impaction, were randomized to placebo (n = 30), rofecoxib (n = 180), or codeine/acetaminophen 60/600 mg (n = 180). Time to PATIENTS AND METHODS: This was a retrospective chart analysis of 41 consecutive confirmed perceptible pain relief, and patient evaluations of pain intensity, pain relief, and patients undergoing full-face carbon dioxide laser resurfacing with either bolus global assessments were recorded. midazolam/fentanyl (n = 15) or midazolam/fentanyl with continuous propofol infusion anesthesia (n = 26) techniques. Data recorded were noninvasive baseline and intraoperative RESULTS: For total pain relief over 6 hours (primary end point), rofecoxib was superior to hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), codeine/acetaminophen (15.5 vs 10.7; P < .001). Rofecoxib was statistically significantly diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse superior to codeine/acetaminophen with respect to TOPAR4, patient global assessment, (P), and rate-pressure product (RPP), respiratory rate (RR), and oxygen saturation (SpO2). peak pain relief, and duration of analgesic effect. Median onset of analgesia was similar for Data collected were reported as mean values with standard deviation. Statistical analyses both drugs. The codeine/acetaminophen group had more patients with 1 or more adverse were performed with the Student's t test and found statistically significant for P < .05. events. RESULTS: Statistically significant decreases in averages were seen in SBP (P < .001), DBP CONCLUSION: Rofecoxib provided superior analgesic efficacy compared with (P = .02), MAP (P = .004), P (P < .00l), RPP (P < .00l), and RR (P < .001), but not PP (P = .4) codeine/acetaminophen with fewer gastrointestinal and nervous system adverse events. and SpO2 (P = .08) in the midazolam/fentanyl/continuous propofol infusion group compared Publication Type with the midazolam/fentanyl only group. Changes from baseline were statistically significant Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non- only for MAP (P = .04), but statistically insignificant for all other measurements, SBP (P = .7), U.S. Gov't. DBP (P = .4), P (P = .95), PP (P = .97), RPP (P = .6), RR (P = .6), and SpO2 (P = .4). Date Created Statistically significant smaller amounts of midazolam (P = .01) and fentanyl (P < .001) were 20050926 used in the midazolam/fentanyl/continuous propofol infusion pump group. Length of Year of Publication procedure was statistically insignificant between groups (P = .4). Conclusion The addition of 2005 a continuous propofol pump maintained hemodynamic and oxygenation values close to baseline, while decreasing the amount of respiratory depressing opiates administered and <52> without affecting the length of the procedure. Unique Identifier Publication Type 16003614 Comparative Study. Journal Article. Status Date Created MEDLINE 20050708 Authors Year of Publication Cillo JE Jr; Finn R. 2005 Authors Full Name Cillo, Joseph E Jr; Finn, Richard. <53> Institution Unique Identifier Cillo,Joseph E Jr. Oral and Maxillofacial Surgery, parkland Memorial Hospital, The 15922815 University of Texas Southwestern Medical Center, Dallas, TX, USA. Status Title MEDLINE Moderate intravenous sedation for office-based full face laser resurfacing using a Authors continuous infusion propofol pump. Litkowski LJ; Christensen SE; Adamson DN; Van Dyke T; Han SH; Newman KB. Source Authors Full Name BDA LIBRARY MEDLINE SEARCH

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Litkowski, Leonard J; Christensen, Steven E; Adamson, Dennis N; Van Dyke, Thomas; received oxycodone 5 mg/ibuprofen 400 mg (6.5% and 3.2%, respectively) and placebo Han, Seung-Ho; Newman, Kenneth B. (3.2% and 1.6%). Rates of nausea and vomiting were significantly lower with oxycodone 5 Institution mg/ibuprofen 400 mg compared with oxycodone 5 mg/acetaminophen 325 mg (P = 0.011 Litkowski,Leonard J. Center for Clinical Studies, Dental School, University of Maryland, and P = 0.009, respectively) but not with 7.5 mg/acetaminophen 500 mg. Baltimore, Maryland 21201, USA. [email protected] Title CONCLUSIONS: In this study in patients with moderate to severe pain after surgery to Analgesic efficacy and tolerability of oxycodone 5 mg/ibuprofen 400 mg compared with remove impacted third molars, oxycodone 5 mg/ibuprofen 400 mg provided significantly those of oxycodone 5 mg/acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen better analgesia throughout the 6-hour study compared with the other opioid/nonopioid 500 mg in patients with moderate to severe postoperative pain: a randomized, double-blind, combinations tested, and was associated with fewer adverse events. placebo-controlled, single-dose, parallel-group study in a dental pain model. Publication Type Source Clinical Trial. Journal Article. Multicenter Study. Randomized Controlled Trial. Research Clinical Therapeutics. 27(4):418-29, 2005 Apr. Support, Non-U.S. Gov't. Abstract Date Created BACKGROUND: Combination therapy has been widely used for the clinical management of 20050530 acute pain. By combining 2 drugs with different mechanisms of action, such therapy provides Year of Publication additive analgesic effects while reducing the risk for adverse effects. 2005

OBJECTIVE: This study compared the efficacy and tolerability of oxycodone 5 mg/ibuprofen <54> 400 mg with those of oxycodone 5 mg/acetaminophen 325 mg, hydrocodone 7.5 Unique Identifier mg/acetaminophen 500 mg, and placebo in a dental pain model. 15876493 Status METHODS: This was a multicenter, randomized, double-blind, placebo- and active- MEDLINE controlled, parallel-group, single-dose study in patients experiencing moderate to severe pain Authors after surgical removal of > or = 2 ipsilateral impacted third molars. Patients were randomly Kaczmarzyk T; Stypulkowska J. assigned to receive oxycodone 5 mg/ibuprofen 400 mg, oxycodone 5 mg/acetaminophen 325 Authors Full Name mg, hydrocodone 7.5 mg/acetaminophen 500 mg, or placebo. The primary outcome Kaczmarzyk, Tomasz; Stypulkowska, Jadwiga. measures were total pain relief through 6 hours after dosing (TOTPAR6), sum of pain Institution intensity differences through 6 hours (SPID6), and adverse events. Secondary efficacy Kaczmarzyk,Tomasz. Department of Oral Surgery, Medical College, Jagiellonian University, measures included SPID3 and TOTPAR3, peak pain relief, peak pain intensity difference, ul. Montelupich 4, PL-31-155 Krakow, Poland. [email protected] time to onset of pain relief, time to use of rescue medication, proportion of patients reporting Title pain half gone, and the patient's global evaluation. Assessment of the effectiveness of peripheral administration of morphine with local articaine anaesthesia for surgery in inflamed oral and maxillofacial tissues. RESULTS: Two hundred forty-nine patients (43.5% male; 87.5% white; mean age, 19.1 Source years; mean body weight, 153.6 pounds) were randomized to treatment as follows: 62 to Pain. 115(3):348-54, 2005 Jun. oxycodone 5 mg/ibuprofen 400 mg, 61 to oxycodone 5 mg/acetaminophen 325 mg, 63 to Abstract hydrocodone 7.5 mg/acetaminophen 500 mg, and 63 to placebo. Oxycodone 5 mg/ibuprofen The controversy surrounding clinical trials of peripherally applied morphine with local 400 mg provided significantly greater analgesia compared with oxycodone 5 anaesthetic and the attendant ambiguous results led to a study of our own clinical material. mg/acetaminophen 325 mg, hydrocodone 7.5 mg/acetaminophen 500 mg, and placebo The aim of the study was to assess the effectiveness of peripheral administration of morphine (mean [SD] TOTPAR6, 14.98 [5.37], 9.53 [6.77], 8.36 [6.68], and 5.05 [6.49], respectively; P with local articaine anaesthesia in inflamed oral and maxillofacial tissues. Sixty patients who < 0.001, oxycodone 5 mg/ibuprofen 400 mg vs all other treatments). SPID6 values also qualified for the randomized, double-blinded study were randomly divided into two groups. differed significantly for oxycodone 5 mg/ibuprofen 400 mg compared with all other Group 'LA' received a standard local anaesthetic solution (articaine plus epinephrine) while treatments (mean: 7.78 [4.11], 3.58 [4.64], 3.32 [4.73], and 0.69 [4.85]; P < 0.001). group 'LA-Mo' received the standard solution with an addition of 1 mg of morphine. Pain Oxycodone 5 mg/ibuprofen 400 mg was significantly more effective compared with the other intensity was assessed using the Visual Analogue Scale, before and directly after surgery as treatments on all secondary end points (P < 0.001, all variables except peak PID vs well as at 1, 2, 6, 12, 24 and 48 h after completion of surgery. Furthermore, supplemental oxycodone 5 mg/acetaminophen 325 mg [P = 0.006]), with the exception of the time to onset consumption of the prescribed analgesic was recorded. Despite a very similar average level of analgesia. The lowest frequency of nausea and vomiting occurred in the groups that of initial pain, there was a marked difference between the groups in the pain level during BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. surgery. Moreover, during the next 12 h, there were significant differences observed in the analgesic efficacy (TOPAR6) (13.2 units) versus oxycodone/acetaminophen (10.2 units); and level of pain between both groups. There was also considerable difference between both codeine/acetaminophen (6.0 units); p < 0.001 for all. All active treatments were superior to groups in the time of first analgesic intake and the total amount of analgesic. Our results placebo. Median time to onset was significantly (p < 0.001) shorter for show that modified local anaesthesia may be of benefit for the relief of operative and post- oxycodone/acetaminophen (20 min) and numerically but not significantly shorter (p = 0.259) operative pain and may also help reduce analgesic intake after oral surgery. for codeine/acetaminophen (26 min) compared with (40 min). Etoricoxib (24 h) had Publication Type a significantly longer lasting analgesic effect than oxycodone/acetaminophen (5.3 h), Clinical Trial. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. codeine/acetaminophen (2.7 h), and placebo (1.7 h) (p < 0.001 for all). Etoricoxib patients Gov't. experienced fewer clinical adverse experiences than patients on oxycodone/acetaminophen Date Created and codeine/acetaminophen, specifically, significantly (p < 0.05) fewer episodes of nausea. 20050524 Year of Publication CONCLUSION: Etoricoxib 120 mg provided superior overall analgesic effect with a smaller 2005 percentage of patients experiencing nausea versus both oxycodone/acetaminophen 10 mg/650 mg and codeine/acetaminophen 60 mg/600 mg. <55> Publication Type Unique Identifier Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial. Research 15881486 Support, Non-U.S. Gov't. Status Date Created MEDLINE 20050509 Authors Year of Publication Malmstrom K; Ang J; Fricke JR; Shingo S; Reicin A. 2005 Authors Full Name Malmstrom, Kerstin; Ang, Jennifer; Fricke, James R; Shingo, Sumiko; Reicin, Alise. <56> Institution Unique Identifier Malmstrom,Kerstin. Departments of Clinical Immunology and Analgesia, Merck Research 15823764 Laboratories, Rahway, NJ, USA. Status Title MEDLINE The analgesic effect of etoricoxib relative to that of cetaminophen analgesics: a randomized, Authors controlled single-dose study in acute dental impaction pain. Van Dyke T; Litkowski LJ; Kiersch TA; Zarringhalam NM; Zheng H; Newman K. Source Authors Full Name Current Medical Research & Opinion. 21(1):141-9, 2005 Jan. Van Dyke, Thomas; Litkowski, Leonard J; Kiersch, Theodore A; Zarringhalam, Nooshin Abstract Majd; Zheng, Hongjie; Newman, Kenneth. BACKGROUND: To compare the analgesic effect of single doses of etoricoxib 120 mg, Institution oxycodone/ acetaminophen 10 mg/650 mg and codeine/ acetaminophen 60 mg/600 mg in Van Dyke,Thomas. Goldman School of Dental Medicine, Boston University, 100 East acute pain using the dental impaction model. Newton Street, Rm. 107, Boston, MA 02118, USA. [email protected] Title METHODS: In this randomized, double-blind, placebo-controlled, parallel-group study, Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of postoperative pain: a patients reported pain intensity and pain relief (16 times) and global scores (twice) during a double-blind, placebo- and active-controlled parallel-group study. 24-h period. The primary endpoint was the overall analgesic effect, total pain relief over 6 h Source (TOPAR6). Other endpoints were patient global evaluation, time to onset (2-stopwatch Clinical Therapeutics. 26(12):2003-14, 2004 Dec. method), duration of analgesic effect (median time to and amount of rescue medication use). Abstract Tolerability was evaluated by overall and opioid-related (nausea and vomiting) adverse OBJECTIVE: This study compared the efficacy and safety of a single dose of oxycodone 5 experiences. mg/ibuprofen 400 mg versus its individual components and placebo in a third-molar extraction model. RESULTS: 302 patients (mean age 23; 63% women; 63 % White) were randomized to etoricoxib 120 mg, oxycodone/acetaminophen 10 mg/650 mg, codeine/acetaminophen 60 METHODS: In this multicenter, double-blind, double-dummy, parallel-group investigation, mg/600 mg, and placebo (2:2:1:1). Etoricoxib demonstrated significantly greater overall subjects with moderate to severe pain within 5 hours after extraction of > or =2 ipsilateral BDA LIBRARY MEDLINE SEARCH

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To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. bony impacted third molars were randomized to single doses of oxycodone 5 mg/ibuprofen Abstract 400 mg, ibuprofen 400 mg, oxycodone 5 mg, or placebo. Primary efficacy variables were the BACKGROUND: The combination of tramadol and acetaminophen has demonstrated good sum of pain intensity difference over 6 hours (SP1D6) and total pain relief through 6 hours efficacy in various clinical pain models. However, there is a need for comparisons of the (TOTPAR6). The pharmacokinetics of oxycodone and ibuprofen, alone and in combination, onset of analgesia and other measures of analgesic efficacy with this combination and other were also determined in a subset of patients. strong combination analgesics for the management of acute pain.

RESULTS: A total of 498 subjects were randomized to treatment (187 to oxycodone 5 OBJECTIVE: The goal of this study was to compare the time to onset of analgesia and other mg/ibuprofen 400 mg, 186 to ibuprofen 400 mg, 63 to oxycodone 5 mg, and 62 to placebo). measures of analgesic efficacy with tramadol/acetaminophen 75/650 mg (Tr/Ac) and Baseline demographics were generally similar among treatment groups, despite differences codeine/acetaminophen/ibuprofen 20/500/400 mg (Co/Ac/Ib) in the management of acute in sex (P = 0.041) and race (P = 0.023). Combination therapy was associated with greater pain after oral surgery. analgesia than ibuprofen alone, oxycodone alone, or placebo (mean [SE] TOTPAR6: 13.3 [0.52], 12.2 [0.52], 4.3 [0.82], and 4.2 [0.83], respectively [P < 0.001 vs oxycodone or METHODS: This was a single-center, single-dose, randomized, active-controlled, parallel- placebo, P = 0.012 vs ibuprofen]; mean [SE] SP1D6: 6.54 [0.42], 5.41 [0.44], 0.14 [0.60], and group study in healthy subjects who had undergone surgical extraction of > or =1 impacted 0.32 [0.59], respectively [P < 0.001 vs oxycodone or placebo, P = 0.002 vs ibuprofen]). third molar requiring bone removal. When patients reported at least moderate pain after Combination therapy was well tolerated. Pharmacokinetic results implied no interaction dental surgery (score > or =5 on a 10-point scale), they were randomized to 1 of 2 treatment between oxycodone and ibuprofen. groups. The time to onset of analgesia was measured using a 2-stopwatch technique. The time to the onset of perceptible and meaningful pain relief, pain intensity, pain relief, patient's CONCLUSIONS: In this study, a single dose of oxycodone 5 mg/ibuprofen 400 mg was fast- overall assessment, and adverse events were recorded for 6 hours after dosing. acting, effective, and well tolerated in subjects with moderate to severe pain after dental surgery. Oxycodone 5 mg alone did not provide an efficacy benefit over placebo in this study. RESULTS: One hundred twenty-eight subjects participated in the study, 64 in each Publication Type treatment group. The 2 groups were similar in terms of baseline pain severity and Clinical Trial. Journal Article. Multicenter Study. Randomized Controlled Trial. demographic characteristics (mean age, 23.7 and 23.4 years in the Tr/Ac and Co/Ac/Ib Date Created groups, respectively; mean body weight, 58.5 and 60.3 kg). The median times to the onset of 20050412 perceptible pain relief were a respective 21.0 and 24.4 minutes, and the median times to the Year of Publication onset of meaningful pain relief were 56.4 and 57.3 minutes. Mean total pain relief and the 2004 sum of pain intensity difference were also similar in the early period after dosing (0-4 hours). However, between 4 and 6 hours, Co/Ac/Ib was associated with significant differences in <57> both variables compared with Tr/Ac (P < 0.05). Although similar through the 4-hour Unique Identifier assessment, mean pain intensity difference was significantly greater with Co/Ac/Ib at 5 to 6 15336468 hours. The proportion of patients assessing their assigned treatment as good or better was Status significantly greater with Co/Ac/Ib compared with Tr/Ac (P < 0.05). The safety profile of Tr/Ac MEDLINE was comparable to that of Co/Ac/Ib. Authors Jung YS; Kim DK; Kim MK; Kim HJ; Cha IH; Lee EW. CONCLUSIONS: In this small and selected group of subjects, the onset of analgesia and Authors Full Name analgesic efficacy of Tr/Ac was comparable to that of Co/Ac/Ib. Tr/Ac provided rapid and Jung, Young-Soo; Kim, Dong Kee; Kim, Moon-Key; Kim, Hyung-Jun; Cha, In-Ho; Lee, effective analgesia for acute postoperative dental pain in this population. Eui-Wung. Publication Type Institution Clinical Trial. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Jung,Young-Soo. Department of Oral and Maxillofacial Surgery, Oral Science Research Gov't. Center, College of Dentistry, Yonsei University, Seoul, Korea. Date Created Title 20040831 Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and Year of Publication codeine/acetaminophen/ibuprofen in acute postoperative pain: a single-center, single-dose, 2004 randomized, active-controlled, parallel-group study in a dental surgery pain model. Source <58> Clinical Therapeutics. 26(7):1037-45, 2004 Jul. Unique Identifier BDA LIBRARY MEDLINE SEARCH

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15333415 Authors Status Betancourt JW; Kupp LI; Jasper SJ; Farooqi OA. MEDLINE Authors Full Name Authors Betancourt, James W; Kupp, Leo I; Jasper, Samuel J; Farooqi, Owais A. Chang DJ; Desjardins PJ; King TR; Erb T; Geba GP. Institution Authors Full Name Betancourt,James W. Mayo Clinic, Department of Dental Specialties, Rochester, MN, USA. Chang, David J; Desjardins, Paul J; King, Thomas R; Erb, Tara; Geba, Gregory P. Title Institution Efficacy of ibuprofen-hydrocodone for the treatment of postoperative pain after periodontal Chang,David J. Merck & Co. Inc, West Point, PA, USA. surgery. Title Source The analgesic efficacy of etoricoxib compared with oxycodone/acetaminophen in an acute Journal of Periodontology. 75(6):872-6, 2004 Jun. postoperative pain model: a randomized, double-blind clinical trial.[Erratum appears in Local Messages Anesth Analg. 2005 Sep;101(3):644] THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY Source Abstract Anesthesia & Analgesia. 99(3):807-15, table of contents, 2004 Sep. BACKGROUND: Previous studies have shown that non-steroidal anti-inflammatory drugs Abstract (NSAIDs) have significant benefits in the control of postoperative pain after periodontal or oral Our objective in this study was to compare the analgesic effects of etoricoxib and surgical procedures. The combination of a peripherally acting NSAID with a centrally acting oxycodone/acetaminophen in a postoperative dental pain model. Patients experiencing opioid drug is found to be more effective. The purpose of this study was to compare an moderate to severe pain after extraction of two or more third molars were randomized to alternative combination of ibuprofen 400 mg with 5 mg of hydroxycodone to ibuprofen 400 mg single doses of etoricoxib 120 mg (n = 100), oxycodone/acetaminophen 10/650 mg (n = 100), used alone in the management of pain following periodontal surgery. or placebo (n = 25). The primary end-point was total pain relief over 6 h. Other end-points included patient global assessment of response to therapy; onset, peak, and duration of METHODS: This study used a double-masked cross-over design with the patients acting as effect; and rescue opioid analgesic use. Active treatments were statistically significantly their own controls. Twelve patients underwent two periodontal surgeries in different superior to placebo for all efficacy measures. Total pain relief over 6 h for etoricoxib was quadrants of the same dental arch at least 2 weeks apart. A standardized amount of local significantly more than for oxycodone/acetaminophen (P < 0.001). Patient global assessment anesthetic and similar extent and duration of surgery for each side was required. The patients of response to therapy at 6 and 24 h was superior for etoricoxib. Both drugs achieved rapid received four doses of medication at predetermined intervals and filled out a visual analog onset, although the time was faster for oxycodone/acetaminophen by 5 min. The peak effect pain scale every 2 hours for the first 12 hours after surgery. was similar for both drugs. Compared with oxycodone/acetaminophen patients, etoricoxib patients experienced a longer analgesic duration, had a smaller percentage requiring rescue RESULTS: The overall pain reported by the patients on visual analog scale was 1.55 (SE opioids during 6 and 24 h, and required less rescue analgesia during 6 and 24 h. +/- 0.16), out of a possible 10. More pain was reported with ibuprofen alone, 1.81 (SE +/- Oxycodone/acetaminophen treatment resulted in more frequent adverse events (AEs), drug- 0.12), compared to the ibuprofen with hydrocodone combination, 1.30 (SE +/- 0.16). The related AEs, nausea, and vomiting compared with etoricoxib treatment. In conclusion, difference was statistically significant (P<0.05). etoricoxib 120 mg provided superior overall efficacy compared with oxycodone/acetaminophen 10/650 mg and was associated with significantly fewer AEs. CONCLUSION: The findings suggest that a combination analgesic preparation of ibuprofen Publication Type (400 mg) with hydrocodone (5 mg) results in better pain control compared to ibuprofen used Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial. alone. Date Created Publication Type 20040830 Clinical Trial. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Year of Publication Gov't. 2004 Date Created 20040805 <59> Year of Publication Unique Identifier 2004 15295955 Status <60> MEDLINE Unique Identifier BDA LIBRARY MEDLINE SEARCH

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15225946 MEDLINE Status Authors MEDLINE Korn S; Vassil TC; Kotey PN; Fricke JR Jr. Authors Authors Full Name Joshi A; Parara E; Macfarlane TV. Korn, Scott; Vassil, Theodore C; Kotey, Paul N-A; Fricke, James R Jr. Authors Full Name Institution Joshi, Ameeta; Parara, Eleni; Macfarlane, Tatiana V. Korn,Scott. Merck Research Laboratories, BLA-33, Bluebell, PA 19422, USA. Institution [email protected] Joshi,Ameeta. Department of Oral and Maxillofacial Sciences, University Dental Hospital of Title Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. [email protected] Comparison of rofecoxib and oxycodone plus acetaminophen in the treatment of acute pain: Title a randomized, double-blind, placebo-controlled study in patients with moderate to severe A double-blind randomised controlled clinical trial of the effect of preoperative ibuprofen, postoperative pain in the third molar extraction model. , paracetamol with codeine and placebo tablets for relief of postoperative pain after Source removal of impacted third molars. Clinical Therapeutics. 26(5):769-78, 2004 May. Source Abstract British Journal of Oral & Maxillofacial Surgery. 42(4):299-306, 2004 Aug. BACKGROUND: Opiates, acetaminophen, nonselective nonsteroidal anti-inflammatory Local Messages drugs (NSAIDs), and cyclooxygenase-2-selective inhibitors such as rofecoxib are used in the THIS JOURNAL IS AVAILABLE IN THE BDA LIBRARY treatment of acute pain because of their anti-inflammatory and/or analgesic properties. Abstract Rofecoxib has demonstrated an improved gastrointestinal safety profile compared with We conducted a randomised double-blind placebo-controlled single-centre study to nonselective NSAIDs. compare the effect of preoperative ibuprofen 600 mg, diclofenac 100 mg, paracetamol 1 g with codeine 60 mg or placebo (Vitamin C 50 mg) tablets for relief of postoperative pain in OBJECTIVE: The aim of this study was to compare the analgesic efficacy and tolerability 119 patients who had day case operations under general anaesthesia for removal of profile of rofecoxib 50 mg with those of the centrally acting, nonsalicylate, opiate/nonopiate impacted third molars. Patients were given the tablets 1 h before operation. Pain was analgesic combination oxycodone/acetominophen 5/325 in patients with pain after dental assessed using visual analogue scales and verbal rating scales preoperatively at 15 and 30 surgery. min and 1 and 3 h postoperatively. After they had gone home, patients were contacted by telephone at 6 and 24 h postoperatively to find out whether they had any adverse effects from METHODS: In this randomized, double-blind, placebo- and active comparator-controlled the analgesics. There was no significant difference in the extent of postoperative pain among study, patients experiencing moderate to severe postoperative pain after extraction of > or =2 the four groups, but the placebo group had significantly shorter times before their first request third molars (including > or =1 mandibular impaction) received a single oral dose of rofecoxib for postoperative analgesics (median 17 min, range 14-90) than the diclofenac group (median 50 mg, oxycodone/acetaminophen 5/325 mg, or placebo. End points included total pain relief 32, range 15-150). Preoperative analgesics at the stated doses are effective in providing over 6 hours (TOPAR6, the primary end point) and 4 hours (TOPAR4), patient's global immediate postoperative pain control after operations on third molars. There were, however, assessment of treatment at 6 hours (GLOBAL6) and 24 hours (GLOBAL24), summed pain some side-effects including nausea, vomiting, headaches, and gastrointestinal discomfort, intensity difference over 6 hours (SPID6), onset of analgesic effect (time to but there were no significant differences among the active analgesic groups with respect to perceptible/meaningful pain relief, using a 2-stopwatch method), peak pain relief (PEAKPR), adverse events either shortly after operation or at 6 or 24 h. peak pain intensity difference (PEAKPID), and duration of analgesic effect (time to use of Publication Type rescue analgesia). Clinical Trial. Journal Article. Randomized Controlled Trial. Date Created RESULTS: Two hundred twelve patients (63% female, 37% male; 76% white, 24% other; 20040630 mean [SD] age, 20.9 [4.4] years; age range, 16-41 years) were enrolled in the study and Year of Publication received a single oral dose of rofecoxib 50 mg (n = 90), oxycodone/acetaminophen 5/325 mg 2004 (n = 91), or placebo (n = 31). The analgesic effect of rofecoxib was significantly greater than that of oxycodone/acetaminophen at P < 0.001 for TOPAR6, TOPAR4, GLOBAL6, <61> GLOBAL24, and SPID6; at P < 0.010 for PEAKPR and PEAKPID; and at P < 0.001 for Unique Identifier median time to use of rescue analgesia. Significantly fewer patients in the rofecoxib group 15220020 (72.2%) took rescue analgesia within 24 hours postdose compared with the Status oxycodone/acetaminophen group (94.5%; P < 0.001) and the placebo group (96.8%; P < BDA LIBRARY MEDLINE SEARCH

POPPY (MORPHINE/OPIUM) USE IN DENTISTRY 2004-2015

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0.02). Both active treatments were similar with respect to onset of analgesic effect. Both were endpoints included total pain relief over 8 hours (TOPAR8, primary end point), sum of pain generally well tolerated; the overall incidence of adverse experiences in the rofecoxib, intensity difference over 8 hours, patient's global evaluation, onset, peak, and duration of oxycodone/acetaminophen, and placebo groups was 51.1%, 64.8%, and 48.4%, respectively. analgesia. Rofecoxib was associated with a significantly lower incidence of nausea (18.9% vs 39.6%; P < 0.001) and vomiting (6.7% vs 23.1%; P < 0.001) compared with RESULTS: Etoricoxib 120 mg had a significantly greater least squares (LS) mean TOPAR8 oxycodone/acetaminophen. score than placebo (20.9 vs 5.4; P < 0.001) and acetaminophen/codeine 600/60 mg (20.9 vs 11.5; P < 0.001), and a similar LS mean TOPAR8 score to sodium 550 mg (20.9 vs CONCLUSIONS: In study patients with moderate to severe pain after dental surgery, 21.3). All three active treatments had rapid onset of analgesia, median time approximately 30 rofecoxib 50 mg had a greater analgesic effect than oxycodone/acetaminophen 5/325 mg minutes. The duration of analgesic effect, defined as median time to rescue medication use, and was associated with less nausea and vomiting. was >24 hours for etoricoxib, 20.8 hours for naproxen sodium, 3.6 hours for Publication Type acetaminophen/codeine, and 1.6 hours for placebo. Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial. Date Created DISCUSSION: Etoricoxib is a new COX-2 selective inhibitor under development for 20040628 treatment of osteoarthritis, rheumatoid arthritis, and acute pain. In this study, etoricoxib 120 Year of Publication mg provided rapid and long-lasting pain relief to patients with moderate-to-severe postdental 2004 surgery pain. Etoricoxib was generally well tolerated. Publication Type <62> Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial. Research Unique Identifier Support, Non-U.S. Gov't. 15100590 Date Created Status 20040421 MEDLINE Year of Publication Authors 2004 Malmstrom K; Kotey P; Coughlin H; Desjardins PJ. Authors Full Name <63> Malmstrom, Kerstin; Kotey, Paul; Coughlin, Heather; Desjardins, Paul J. Unique Identifier Institution 14693612 Malmstrom,Kerstin. Department of Clinical Immunology & Analgesia and Department of Status Biostatistics, Merck Research Laboratories, Rahway, NJ 07065, USA. MEDLINE [email protected] Authors Title Van Aken H; Thys L; Veekman L; Buerkle H. A randomized, double-blind, parallel-group study comparing the analgesic effect of Authors Full Name etoricoxib to placebo, naproxen sodium, and acetaminophen with codeine using the dental Van Aken, Hugo; Thys, L; Veekman, Luc; Buerkle, Hartmut. impaction pain model. Institution Source Van Aken,Hugo. Department of Anesthesiology and Intensive Care Medicine, University Clinical Journal of Pain. 20(3):147-55, 2004 May-Jun. Hospital, University of Munster, Albert-Schweitzer-Strasse 33, D-48149 Munster, Germany. Abstract [email protected] OBJECTIVE: To compare the overall analgesic effect, including time to onset, peak and Title duration of effect for etoricoxib 120 mg, a new COX-2 selective inhibitor, in patients with Assessing analgesia in single and repeated administrations of for acute pain to that of placebo. Naproxen sodium 550 mg and acetaminophen/codeine 600/60 postoperative pain: comparison with morphine after dental surgery. mg were the active comparators. Source Anesthesia & Analgesia. 98(1):159-65, table of contents, 2004 Jan. METHODS: A total of 201 patients with moderate to severe pain following surgical Abstract extraction of > or = 2 third molars, of which at least the mandibular tooth was impacted, were UNLABELLED: We conducted this double-blinded, randomized study to assess the randomly allocated to receive single oral doses of placebo (n = 50), etoricoxib 120 mg (n = analgesic effect of repeated administrations of paracetamol, administered as propacetamol, 50), naproxen sodium 550 mg (n = 51), or acetaminophen/codeine 600/60 mg (n = 50). The an injectable prodrug formulation of paracetamol, and to compare this with the analgesic BDA LIBRARY MEDLINE SEARCH

POPPY (MORPHINE/OPIUM) USE IN DENTISTRY 2004-2015

To request copies of any of these articles please use one of our request forms. Articles can be emailed or posted for a charge of £2.50 each. effects of morphine. Patients experiencing moderate to severe pain after elective surgical removal of bone-impacted third-molar teeth under general anesthesia were randomly assigned to receive IV propacetamol 2 g (n = 31), IM morphine 10 mg (n = 30), or placebo (n = 34). Five hours later, the treatments were readministered at half of the previous dosages. Standard measures of analgesia were collected repeatedly for 10 h. Propacetamol and morphine were significantly more effective than placebo in all primary measures of analgesia over 5 h after the first administration and globally over 10 h (first and second administrations). After the first dose, 21 of the 34 patients in the placebo group required rescue medication, compared with 6 of the 31 in the propacetamol group (P < 0.0009) and 4 of the 30 in the morphine group (P < 0.0001). No statistically or clinically significant differences were found between propacetamol and morphine for any sum or peak measures of analgesia. No serious adverse events were reported; adverse events were significantly less frequent in the propacetamol group than in the morphine group (P < 0.027). Propacetamol administered IV in repeated doses (2 g followed by 1 g) has a significant analgesic effect that is indistinguishable from that of morphine administered IM (10 mg followed by 5 mg) after dental surgery, with better tolerability.

IMPLICATIONS: After moderately painful surgical procedures, IV paracetamol, administered as propacetamol, may be an asset in the control of acute postoperative pain. Publication Type Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't. Date Created 20031224 Year of Publication 2004