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      A comparative evaluation of the effect of diclofenac sodium with and without per-orally administered methylprednisolone on the sequelae of impacted mandibular third molar removal: A cohort randomized double-blind clinical trial

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          Abstract

          Aim and Objectives:

          This study evaluated the efficacy of oral methylprednisolone and diclofenac sodium on post-operative sequelae after third molar surgery.

          Settings and Design:

          A randomized double-blind clinical trial was conducted (with institutional and university approval for dissertation) to evaluate the effect of methylprednisolone with diclofenac sodium (group A) as compared with diclofenac sodium and placebo (group B) on three variables: Pain, swelling and trismus, after third molar surgery.

          Materials and Methods:

          Thirty consecutive consenting patients for surgical removal of mandibular impacted third molar were randomly placed into two groups of 15 each (groups A and B). Pain, swelling and trismus were observed by visual analog scale, facial measurements and inter-incisal opening. Scores were recorded after 24 and 72 h and on the seventh post-operative day. Results were subjected to the Chi-square test and independent sample t-test ( P = 0.05).

          Results:

          Mean difference in pain experienced between the two groups was statistically significant at 24 h ( P = 0.015) and 72 h ( P = 0.001) and on the seventh day ( P = 0.005). Difference in inter-incisal distance was insignificant ( P = 0.239) pre-operatively, but significant after 24 h ( P = 0.014) and 72 h ( P = 0.001) and on the seventh post-operative day ( P = 0.001). Mean difference in swelling was highly significant after 24 h ( P = 0.001) and 72 h ( P = 0.0001) and on the seventh post-operative day ( P = 0.047).

          Conclusions:

          The combination of oral dose of methylprednisolone (a corticosteroid) diclofenac sodium (a non-steroidal anti-inflammatory drug) was found to be more effective than diclofenac sodium alone on the sequelae of surgical removal of impacted mandibular third molar.

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          Most cited references41

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          The pain visual analog scale: is it linear or nonlinear?

          The visual analog scale (VAS) is a tool widely used to measure pain, yet controversy surrounds whether the VAS score is ratio or ordinal data. We studied 52 postoperative patients and measured their pain intensity using the VAS. We then asked them to consider different amounts of pain (conceptually twice as much and then half as much) and asked them to repeat their VAS rating after each consideration (VAS2 and VAS3, respectively). Patients with unrelieved pain had their pain treated with IV fentanyl and were then asked to rate their pain intensity when they considered they had half as much pain. We compared the baseline VAS (VAS1) with VAS2 and VAS3. The mean (95% confidence interval) for VAS2:1 was 2.12 (1.81-2.43) and VAS3:1 was 0.45 (0.38-0.52). We conclude that the VAS is linear for mild-to-moderate pain, and the VAS score can be treated as ratio data. A change in the visual analog scale score represents a relative change in the magnitude of pain sensation. Use of the VAS in comparative analgesic trials can now meaningfully quantify differences in potency and efficacy.
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            A review of perioperative corticosteroid use in dentoalveolar surgery.

            Dental surgeons are often advised to use corticosteroids during and after third molar removal and other dentoalveolar surgery to reduce postsurgical edema, but recommendations for use are rarely accompanied by definitive guidance regarding the type of steroid, dosage, or duration of administration. Many regimens in use appear to be based on anecdotal information from articles in the 1960s and 1970s and might be subtherapeutic. Few regimens have been updated with data from more recent studies, and well-designed comparison studies are lacking. In this article, the literature from the past 30 years is reviewed, meaningful findings are highlighted, and available data are used as a basis for formulating interim clinical recommendations for corticosteroid use pending the emergence of more evidence-based data. A meta-analysis of data was not performed. Recent data suggest that perioperative corticosteroid regimens should be administered in higher doses and for longer durations than recommended in the past and should be started before surgery for optimum benefit. Based on the literature review, interim recommendations for the use of corticosteroids are proposed, including dosages and regimens that appear rational for oral, intramuscular, or intravenous corticosteroid administration before and after extractions and other dentoalveolar surgery. These largely empiric recommendations might require adjustment when evidence-based data become available in future studies. There is a great need for well-designed clinical research to further evaluate protocols for corticosteroid use.
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              Cyclo-oxygenase-2: pharmacology, physiology, biochemistry and relevance to NSAID therapy.

              Cyclo-oxygenase is expressed in cells in two distinct isoforms. Cyclo-oxygenase-1 is present constitutively whilst cyclo-oxygenase-2 is expressed primarily after inflammatory insult. The activity of cyclo-oxygenase-1 and -2 results in the production of a variety of potent biological mediators (the prostaglandins) that regulate homeostatic and disease processes. Inhibitors of cyclo-oxygenase include the nonsteroidal anti-inflammatory drugs (NSAIDs) aspirin, ibuprofen and diclofenac. NSAIDs inhibit cyclo-oxygenase-2 at the site of inflammation, to produce their therapeutic benefits, as well as cyclo-oxygenase-1 in the gastric mucosa, which produces gastric damage. Most recently selective inhibitors of cyclo-oxygenase-2 have been developed and introduced to man for the treatment of arthritis. Moreover, recent epidemiological evidence suggests that cyclo-oxygenase inhibitors may have important therapeutic relevance in the prevention of some cancers or even Alzheimer's disease. This review will discuss how the new advancements in NSAIDs research has led to the development of a new class of NSAIDs that has far reaching implications for the treatment of disease.
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                Author and article information

                Journal
                Indian J Dent
                Indian J Dent
                IJDENT
                Indian Journal of Dentistry
                Medknow Publications & Media Pvt Ltd (India )
                0975-962X
                2213-3666
                Jan-Mar 2016
                : 7
                : 1
                : 11-16
                Affiliations
                [1] Department of Oral and Maxillofacial Surgery, Swami Devi Dayal Hospital and Dental College, Panchkula, Haryana, India
                [1 ] Department of Oral and Maxillofacial Surgery, B.R.S. Dental College and Hospital, Panchkula, Haryana, India
                [2 ] Department of Oral and Maxillofacial Surgery, Gian Sagar Dental College and Hospital, Ram Nagar, Rajpura, India
                [3 ] Department of Oral and Maxillofacial Surgery, Sukhmani Dental College and Hospital, Derabassi, Punjab, India
                Author notes
                Address for correspondence: Dr. Deepti V. Prashar, 5456, Modern Housing Complex, Manimajra, Chandigarh - 160 101, Punjab, India. E-mail: prashardeepti@ 123456yahoo.co.in
                Article
                IJDENT-7-11
                10.4103/0975-962X.158187
                4836092
                27134449
                4f6728d0-d351-4ead-a2ee-d576bd71ba36
                Copyright: © Indian Journal of Dentistry

                This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                glucocorticosteroid,non-steroidal anti-inflammatory drug,pain,swelling,trismus

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