EVALUATION OF THE EFFECTIVENESS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN THE TREATMENT OF MAXILLARY ALVEOLITIS

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, & . (2022). EVALUATION OF THE EFFECTIVENESS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN THE TREATMENT OF MAXILLARY ALVEOLITIS. The American Journal of Medical Sciences and Pharmaceutical Research, 4(03), 29–34. https://doi.org/10.37547/TAJMSPR/Volume04Issue03-06
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Abstract

Alveolitis is one of the most frequent local complications of tooth extraction surgery, developing 2-4 days after extraction and characterized by impaired healing of the extraction site due to the destruction and/or absence of a clot, the addition of infection and the development of marked pain symptoms of varying severity [1, 2]. The prevalence of this complication is reported to be as high as 35% of possible postoperative problems (3, 5). Several other names for this pathological process - alveolar osteitis, "dry hole" - can be found in the ICD-10 and in the literature. For example, the work of J. Mamoun (2018) provides this description "the unscientific term 'dry socket' is the exposure of part or all of the bone within the socket or perimeter in the day or days after extraction due to the absence of an initial persistent blood clot or if the edges of the socket have not been covered by a layer of viable, dense, regenerating epithelium" [6]. According to clinical experience, these differences in terminology are directly related to the timing and severity of the inflammatory process. Several factors are considered to be the main causes leading to the development of this pathological condition in a dental extraction site: traumatic extraction of the tooth; inflammatory process in the periapical tissues; endodontic treatment and its complications such as fusion zone damage, root perforation; use of resorcinolinum treatment [7]. In addition, risk factors such as gender, smoking and use of oral contraceptives are also important.

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ABSTRACT

Alveolitis is one of the most frequent local complications of tooth extraction surgery, developing 2-4 days after
extraction and characterized by impaired healing of the extraction site due to the destruction and/or absence of a
clot, the addition of infection and the development of marked pain symptoms of varying severity [1, 2]. The prevalence
of this complication is reported to be as high as 35% of possible postoperative problems (3, 5). Several other names
for this pathological process - alveolar osteitis, "dry hole" - can be found in the ICD-10 and in the literature. For example,
the work of J. Mamoun (2018) provides this description "the unscientific term 'dry socket' is the exposure of part or
all of the bone within the socket or perimeter in the day or days after extraction due to the absence of an initial
persistent blood clot or if the edges of the socket have not been covered by a layer of viable, dense, regenerating
epithelium" [6]. According to clinical experience, these differences in terminology are directly related to the timing
and severity of the inflammatory process. Several factors are considered to be the main causes leading to the
development of this pathological condition in a dental extraction site: traumatic extraction of the tooth; inflammatory
process in the periapical tissues; endodontic treatment and its complications such as fusion zone damage, root
perforation; use of resorcinolinum treatment [7]. In addition, risk factors such as gender, smoking and use of oral
contraceptives are also important.

Research Article


EVALUATION OF THE EFFECTIVENESS OF NON-STEROIDAL ANTI-
INFLAMMATORY DRUGS IN THE TREATMENT OF MAXILLARY
ALVEOLITIS

Submission Date:

February 27, 2022,

Accepted Date:

March 17, 2022,

Published Date:

March 29, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue03-06


Farrukh Asliddinovich Ismatov

Assistant to the Department of Oral Surgery and Dental Implantology, Uzbekistan

Abdullozhon Abdurasulovich Mustafoyev

Resident of M.D. Department of Oral Surgery and Dental Implantology Samarkand State Medical
University Samarkand, Uzbekistan

Journal

Website:

https://theamericanjou
rnals.com/index.php/ta
jmspr

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.


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(2020:

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Publisher:

The USA Journals

KEYWORDS

Alveolitis, odontogenic inflammatory diseases, anti-inflammatory drugs.

INTRODUCTION

Odontogenic inflammatory diseases are characterized
by a pronounced sense of pain due to the peculiarities
of the maxillofacial tissues, in particular abundant
innervation and vascularization. The intensity of the
sense of pain requires adequate analgesia not only for
the surgical interventions required for the treatment of
odontogenic inflammatory diseases, but also for the
postoperative management of patients [10].

Severe pain increases the stress on almost all vital div
systems. This is primarily a reaction of the autonomic
system and the associated tachycardia, increased heart
muscle work and oxygen consumption by the heart.
Inadequate anaesthesia in the postoperative period
can lead to disruption of respiratory, endocrine and
immune system function, depletion of energy reserves
and mental health, and significantly increases the risk
of conditions such as respiratory distress syndrome,
intestinal paresis and cardiovascular accidents[12].

One of the triggers of postoperative pain is the
excitation of multiple peripheral nociceptors by
mediators-algogens (prostaglandins, kinins) released
during surgical trauma [13].

Peripheral analgesics - inhibitors of the above
peripheral algogens - should therefore be an important
component of pain management in various surgical
areas. Naproxen is successfully used for pain relief in
various fields of medicine due to its analgesic effect,
which is comparable to that of tramadol.

However, the pronounced analgesic effect of
naproxen is combined with side effects such as
ulcerogenic effects on the gastrointestinal tract
mucosa and inhibition of platelet aggregation, given
which long-term use of the drug is not recommended.
Newer,

so-called

selective

non-steroidal

anti-

inflammatory drugs are being developed that have a
powerful anti-inflammatory effect while having a less
pronounced analgesic effect. An example of such
drugs is aceclofenac, which is widely used in medicine
[11].

The vast majority of studies on the therapeutic
potential and safety of aceclofenac have been
performed in individuals suffering from rheumatic
diseases. However, we did not find any scientific
studies on this drug in dental practice in the scientific
literature.

In the available literature we found no information on
the immunological activity of oral fluid during the use
of non-steroidal anti-inflammatory drugs for the
treatment of odontogenic inflammatory diseases.

PURPOSE OF THE STUDY

To improve the effectiveness of the treatment of
maxillary alveolitis with the use of non-steroidal anti-
inflammatory drugs.

MATERIALS AND METHODS OF RESEARCH

27 people with maxillary alveolitis and 17 healthy
volunteers without serious concomitant somatic


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pathology and with a sanitized oral cavity were under
observation and treatment. To conduct their own
research patients with odontogenic inflammatory
diseases were divided into 3 groups, randomised by
age and sex, the examination of which was carried out
by the same methods, but the set of drugs
administered differed (Table 1). Group 4 was formed to

analyse and evaluate the results of the laboratory
immunological tests and consisted of healthy
volunteers ('clean control').

Number of patients with odontogenic inflammatory diseases examined and

their distribution into groups

Group 1 (Mono-course

of NSAIDs)

Group 2 (Consecutive

course of NSAIDs)

Group No. 3

(Comparisons)

Alveolitis of the jaw

10

8

9

The criteria for selecting patients with odontogenic
inflammatory diseases in one group or another were:
the intensity of pain in the first hours after the surgical
intervention, the nature of the accompanying somatic
pathology. The criterion for selection of patients in
group 1 was "low intensity" pain. The criterion for
selection of patients to Group 2 was a feeling of pain of
"moderate to high intensity": 4 to 10 points. Group 3
included patients with varying levels of pain

Group 1

were patients whose medical treatment

included a mono-course of nonsteroidal anti-
inflammatory drug (nimesulide). Group 1 consisted of
10 patients (5 men and 5 women) aged 18 to 60 years.

Group 2

- patients whose medical treatment included a

consecutive course of non-steroidal anti-inflammatory
drugs (ketorolacatromethamine, nimesulide). Group 2
consisted of 8 patients (4 male and 4 female) aged
from 19 to 74 years (mean age 30,1 ± 0,76 years).

Group 3

were patients whose medical treatment

excluded the use of non-steroidal anti-inflammatory
drugs. Group 3 consisted of 9 patients (4 men and 5
women) aged 17-70 years.

Group 4

consisted of 18 healthy volunteers aged 20 to

27 years (mean age 23.2 ± 0.53).

The examination of the patients consisted of basic and
additional methods of investigation. The basic
examination methods were performed on the patients
at the initial and each follow-up visit, and included a
thorough history, external and intraoral examination.

The degree of inflammatory contracture of the
masticatory muscles was determined according to the
presence and character of mouth opening restriction.
For subsequent analysis of the data obtained, each
degree of inflammatory contracture was assigned a
score equivalent to the degree value.


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Publisher:

The USA Journals

"1" - mouth opening up to 3 cm - minor degree of
inflammatory contracture - 1 point

"2" - mouth opening up to 2 cm - moderate degree of
inflammatory contracture - 2 points

"3" - mouth opening up to 0.5 cm - pronounced degree
of inflammatory contracture - 3 points.

During the intraoral examination, attention was paid to
the condition of the mucosa: changes in colour,
humidity of the mucosa, the presence of edema, ulcers
or wounds, infiltrates, exudate. The level of hygiene,
the nature of the relationship of the dental rows, the
condition of the teeth, periodontal tissues were
evaluated.

Additional

methods

of

examination

included

radiological (X-ray and ultrasound) and laboratory
tests.

Radiological methods of investigation were carried out
on the day of initial treatment of patients in order to
specify the diagnosis and differential diagnosis, and
included

intraoral

radiography

or

orthopantomography.

Laboratory tests of the mixed saliva, were used to
assess the indicators of the local immune protection
factors of the oral cavity, both in the norm and as
criteria for the effectiveness of the treatment carried
out. Local immune protection factors were studied on
the day of treatment and on the 7th day after the start
of treatment.

Patients with odontogenic inflammatory diseases
were carefully assessed for their sense of pain, both at
the time of the initial examination prior to treatment
and during the therapy phase. A Z-score developed by
Prof. S. T. was used to assess the dynamics of pain. Т.
Sokhov.

1 point - the postoperative course is completely
painless: within 2 hours, 4 hours, 6 hours, 12 hours, the
first day, second day, third day, fourth day, fifth day
after the dental intervention;

2 points - the postoperative course is slightly painful for
- 2 hours, 4 hours, 6 hours, 12 hours, the first day, the
second day, the third day, the fourth day, the fifth day
after the dental treatment, which does not require
additional medication and pain relief

3 points - the postoperative course is accompanied by
significant pain for - 2 hours, 4 hours, 6 hours, 12 hours,
the first day, the second day, the third day, the fourth
day, the fifth day after the dental intervention,
requiring additional medication and pain relief.

The examination of healthy volunteers was similar to
that of patients with odontogenic inflammatory
diseases and included collection of anamnesis, external
and intraoral examination, and laboratory tests.

RESULTS OF THE RESEARCH

It was found out that the most significant and reliable
decrease of clinical symptoms of inflammation in the
course of treatment was registered at use of mono-
course of NSAIDs (P<0,05), that proves its pronounced
anti-inflammatory action. However, the most striking
analgesic effect was registered when a consecutive
course of NSAIDs (naproxen and aceclofenac) was
used (P<0.02) . In our work, we found that the intensity
of the feeling of pain differed depending on the
nosology and period of the disease. For example,
during the period of referral to the clinic, pain was most
pronounced in patients diagnosed with alveolitis.

In an analysis of the sense of pain, we found that a
reduction in pain intensity at the end of the treatment
was recorded in each group of patients examined. By
day 5 of follow-up, pain intensity was approximately


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VOLUME

04

I

SSUE

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Pages:

29-34

SJIF

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MPACT

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(2020:

5.

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(2021:

5.

64

)

(2022:

6.

319

)

OCLC

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METADATA

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Publisher:

The USA Journals

equal in all groups, as indicated by the lack of
significant differences at this time (P>0.05). However,
the course and nature of pain manifestations in
different pharmacological courses had significant
differences, especially in the first postoperative hours,
up to the first day of observation.

So, by the 4th observation hour in the group №1 the
intensity of pain sense had not reliably decreased by
6,85 % (P>0,05), in the group №2 reliably decreased by
27,4% (P<0,05), in the comparison group reliable
increase of pain sense intensity by 50% (P<0,001) was
determined. At 6 and 12 hours of follow-up, pain
intensity was significantly lower in the mono- and
consecutive courses of NSAIDs than in the comparison
group (P<0.0001; P<0.02).

It should be noted that the decrease in pain intensity
during the use of naproxen was statistically significant
in all cases, unlike during the use of acetylophenac,
where the decrease in pain intensity was not
statistically significant. The unreliable nature of
changes in pain intensity between the periods of
observation in patients using acetylophenac was due
to a less pronounced analgesic effect of the latter. A
significant reduction in pain intensity while using
naproxen indicates a more pronounced analgesic
effect of naproxen.

CONCLUSIONS

A mono-course of NSAIDs is therefore effective in
controlling "low intensity" pain. A sequential course
has an effective analgesic effect in cases of "moderate
to severe" pain while using naproxen. With a switch to
acetylophenac for high intensity pain, the analgesic
effect weakens. The latter may justify prolonging the
use of naproxen in cases of 'moderate to severe' pain.

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Pages:

29-34

SJIF

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