Postoperative or preoperative medication? Which one is more effective in the management of postoperative extraction dental pain in children?

Document Type : Original Article

Authors

1 Associate Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center AND Department of Pediatric Dentistry, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

2 Assistant Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center AND Department of Pediatric Dentistry, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

3 Resident, Department of Pediatric Dentistry, School of Dentistry AND Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran

Abstract

BACKGROUND AND AIM: Alleviating a painful procedure like tooth extraction by compound analgesics in a single dose using the synergistic effects, particularly before the beginning of extraction pain, is favourable. The aim of the present study was to evaluate the beneficial effect of time (preoperative/postoperative) to prescribe medication in the management of postoperative dental pain following primary tooth extraction.
METHODS: The present double-blind clinical trial study included 121 healthy children aged 6-12 years old. The children were classified into four groups, including Group 1: Neurobion forte-vitamin B complex-vitamin B12 as placebo 30 minutes before extraction, Group 2: Neurobion forte-vitamin B complex-vitamin B12 30 minutes after extraction, Group 3: concurrent ibuprofen-acetaminophen combination 30 minutes before extraction, and Group 4: concurrent ibuprofen-acetaminophen combination 30 minutes after extraction. The researcher was blind about which group took placebo or main drug. Patient was blind too. The rate of pain was evaluated with visual analogue scale (VAS) immediately, 30 minutes after extraction, and 6 and 24 hours later. Data were collected and analyzed using SPSS software. T-test was used to compare between groups (P < 0.05). Repeated measures test was used to compare between the placebo and main drug groups during measurement times.
RESULTS: Population of the study included 58 (47.9%) boys and 63 (52.1%) girls. It was found that mean pain intensity in group 3 was considerably lower than other groups immediately after intervention. Moreover, in group 2, it was significantly more than other groups. However, under 30 minutes, 6 hours, and 24 hours, repeated measures test showed that the mean severity of pain in group 2 was significantly more than other groups.
CONCLUSION: According to the results, concurrentpreoperative ibuprofen-acetaminophen administration would provide better analgesic efficacy compared to the postoperative ibuprofen-acetaminophen combination in 6-12 years old children. Moreover, the effect of induction in children could be demonstrated.

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  1. Baygin O, Tuzuner T, Isik B, Kusgoz A, Tanriver M. Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction. Int J Paediatr Dent 2011; 21(4): 306-13.
  2. Kashefimehr A, Babaloo A, Ghanizadeh M, Ghasemi SH, Mollazadeh H. Effect of prophylactic administration of Novafen for periodontal surgery on postoperative pain relief. J Med Life 2017; 10(2): 127-30.
  3. Derry S, Derry CJ, Moore RA. Single dose oral ibuprofen plus oxycodone for acute postoperative pain in adults. Cochrane Database Syst Rev 2013; (6): CD010289.
  4. Derry S, Wiffen PJ, Moore RA. Single dose oral ibuprofen plus caffeine for acute postoperative pain in adults. Cochrane Database Syst Rev 2015; (7): CD011509.
  5. Gaskell H, Derry S, Wiffen PJ, Moore RA. Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2017; 5: CD007355.
  6. Gross EL, Nowak AJ. The dynamics of change. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH, editors. Pediatric dentistry. 6th ed. Philadelphia, PA: Elsevier; 2019. p. 181-99.
  7. Serna Munoz C, Perez Silva A, Solano F, Castells MaT, Vicente AN, Ortiz Ruiz AJ. Effect of antibiotics and NSAIDs on cyclooxygenase-2 in the enamel mineralization. Sci Rep 2018; 8(1): 4132.
  8. Hartling L, Ali S, Dryden DM, Chordiya P, Johnson DW, Plint AC, et al. How safe are common analgesics for the treatment of acute pain for children? A Systematic Review. Pain Res Manag 2016; 2016: 5346819.
  9. Le MS, Ali S, Khadra C, Drendel AL, Trottier ED, Gouin S, et al. Pain management of pediatric musculoskeletal injury in the emergency department: A systematic review. Pain Res Manag 2016; 2016: 4809394.

10. Vincent-Viry M, La Du BN, Lepage L, Mikstacki T. Distribution of different phenotypes of paraoxonase in a French population. Ann Biol Clin (Paris) 1986; 44(3): 233-8. [In French].

11. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain 2016; 13: 67-75.

12. Kimiaei Asadi H, Jamalpour MR, Saeedi A. Clinical trial of combination of acetaminophen, ibuprofen and caffeine on pain relief and analgesic use after impacted lower third molar surgery. Shiraz E-Med J 2017; 18(7): e13092.

13. Kharouba J, Ratson T, Somri M, Blumer S. Preemptive analgesia by paracetamol, ibuprofen or placebo in pediatric dental care: A randomized controlled study. J Clin Pediatr Dent 2019; 43(1): 51-5.

14. Abou El FR, Gowely M, Helmi M, Obeid M. Effects of pre-emptive analgesia on efficacy of buccal infiltration during pulpotomy of mandibular primary molars: a double-blinded randomized controlled trial. Acta Odontol Scand 2019; 77(7): 552-8.

15. Demirbas AE, Karakaya M, Bilge S, Canpolat DG, Kutuk N, Alkan A. Does single-dose preemptive intravenous ibuprofen reduce postoperative pain after third molar surgery? A prospective, randomized, double-blind clinical study. J Oral Maxillofac Surg 2019; 77(10): 1990-7.

16. Hosseinzadeh Nik T, Shahsavari N, Ghadirian H, Ostad SN. Acetaminophen versus liquefied ibuprofen for control of pain during separation in orthodontic patients: A randomized triple blinded clinical Trial. Acta Med Iran 2016; 54(7): 418-21.

17. Bondarsky EE, Domingo AT, Matuza NM, Taylor MB, Thode HC, Singer AJ. Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: A randomized, controlled trial. Am J Emerg Med 2013; 31(9): 1357-60.

18. de MM, Chiarugi A, Boner A, Montini G, De' Angelis GL. Working towards an appropriate use of ibuprofen in children: An evidence-based appraisal. Drugs 2017; 77(12): 1295-311.

19. Cardile S, Martinelli M, Barabino A, Gandullia P, Oliva S, Di NG, et al. Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children. World J Gastroenterol 2016; 22(5): 1877-83.

20. Berlin H, Vall M, Bergenas E, Ridell K, Brogardh-Roth S, Lager E, et al. Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review. PLoS One 2019; 14(12): e0227027.

21. Gazal G, Al-Samadani KH. Comparison of paracetamol, ibuprofen, and diclofenac potassium for pain relief following dental extractions and deep cavity preparations. Saudi Med J 2017; 38(3): 284-91.

22. Nugrahani I, Khalida FN. Green method for act and ibuprofen simultaneous assay in the combination tablet using FTIR. Int J App Pharm 2018; 10(3): 77-85.