evaluation of self-medication efficiency in controlling odontal

Odontology
EVALUATION OF SELF-MEDICATION EFFICIENCY
IN CONTROLLING ODONTAL PATHOLOGY PAIN
T.M. Radu1 , A. Georgescu2 , Ruxandra Neac[u1 , S. Andrian3
1. PhD student, Dept of Odontology, Faculty of Med Dent. „Gr. T. Popa” U.M.Ph. Iasi
2. Assist Prof. Dept of Odontology, Faculty of Med Dent. „Gr. T. Popa” U.M.Ph. Iasi
3. Prof. PhD., Dept of Odontology, Faculty of Med Dent. „Gr. T. Popa” U.M.Ph. Iasi
Corresponding author: Radu Titus Marius - [email protected]
Abstract
The pain of dental origin is quite a common symptom
as, each year, 15 milion working days are lost because of
its manifestation (1). The present study analyzes the efficiency of analgesics in the treatment of painful pulp
syndroms, once known that, in our country, numerous
people suffering from dental pain resort to self-medication, using moderate analgesics, thus hoping to postpone
or even avoid stomatological actions. Emphasis has been
laid on the drugs most frequently used against pain, on
the amounts used and on their efficiency as, in the opinion of the authors, this might facilitate a more active and
efficient control of pain during stomatological treatments.
The investigation was performed on 109 adult patients
(63 men and 46 women) with average ages around 30
years. The patients filled in a standard questionnaire on
the character of pain and effect of the self-administered
medication, in view of its better control. The intake of
analgesics was reported to 84.12% of the men and 78.26%
of the women, respectively. While the patients considered that the action of analgesics was satisfactory in pulpar hyperemia and serous pulpite, they were viewed as
highly unsatisfactory in other diseases.
Keywords: self-medication, analgesics, painful
odontal pathology
INTRODUCTION
Pain may be defined as a subjective response,
of complex intensity, time, quality, impact and
personal significance, manifested as an unpleasant sensation and emotional experience occurring either with the actual or potential alteration
of a tissue, or described as an alteration. According to the International Association for the Study
of Pain (IASP), pain is an unpleasant sensorial and
emotional experience, caused by a real or potential
tissular lesion or by a description in terms referring
to such a lesion (2). Even if incomplete, such a
definition includes the essential parameters illustrating all aspects of such a phenomenon,
once known that, by its etiopathogeneic and
Journal of Romanian Medical Dentistry
clinical complexity, pain represents the reason
of an atitudinal behavioural dualism of the patient, frequently met in stomatological practice:
on one hand, the need of being examined and
urgently treated; on the other, avoidance of seeing a dentist (3). Pain is a significant symptom,
constantly occurring in pulpopathies or in their
complications. Dental pain is caused by the action of either painful or nociceptive stimuli upon
the receivers of pain, the stimuli being of mechanical, thermic and chemical nature. In each
of its stages, the stomatological treatment should
aim at reducing pain, which may be present in
the antecedents of the malady, being thus responsible for the visit of the patient to the consulting room, or it may be installed during some
stage of the stomatological treatment (4). The
action of pain combat and reduction of patient’s
suffering is, quite frequently, complicated by factors specific to each individual. Thus, one should
have in view the possible disease-drug or drugdrug interactions, previous or actual abuse of
drugs, age, culture and preferences of the patient. The administered drugs act either peripherically, by inhibiting initiation of the painful
signal and sensibility of the nervous terminations, thus blocking the synthesis of prostaglandines (AINS), or at a central level, by inhibiting
nociceptive afferent manifestations or by activating the endogenous analgesic systems (opioidtype analgesics)(5). The present paper discusses
the efficiency of analgesics in the treatament of
painful pulpar syndroms. As generally known,
in our country, numerous people suffering from
dental pain resort to self-medication, using moderate analgesics, thus hoping to postpone or even
avoid stomatological actions. Emphasis has been
laid on the drugs most frequently used for pain,
203
EVALUATION OF SELF-MEDICATION EFFICIENCY IN CONTROLLING ODONTAL PATHOLOGY PAIN
the amounts used and their efficiency as, in the
opinion of the authors, this might facilitate a
more active and efficient control of pain during
stomatological treatments.
MATERIALS AND METHOD
The study included only patients with pain
caused by pulpopathies. To establish whether
pulp pain had been caused by pulpar factors,
the following criteria were considered:
1. pain exacerbated by thermic and/or
percution stimuli;
2. an obvious carious lesion;
3. clinical or radiological evidencing of a lesion;
4. character of pain.
For a correct identification of the diagnosis,
the character of pain, the objective symptoms
and, in some cases, radiographic images, were
considered. The study was performed on 109
adult patients (63 men and 46 women) with average ages around 30 years. The patients under
investigation were apparently healthy, with no
significnt general or personal antecedents. At the
same time, when the study was carried out, none
of them had been subjected to a long-term drug
treatment, which might have influenced one’s
response to analgesic medication.
The patients were divided into 3 groups, according to the duration of pain: 1-3, 4-6 and 7
days, or more. The patients having reported that,
in the last 24 hr, had suffered from dental pain
were asked to answer the questions from the
questionnaire-type form, which was completed,
after clinical and paraclinical investiagtions,
with the diagnosis for the respective tooth.
Considering the variety and types of analgesics used, they were classified according to the
frequency of their usage:
· Algozone
· Nurofen
· Piafen
· Other analgesics
204
RESULTS
In order to analyse the results obtained, there
were established: the duration of pain, the
amount of analgesic (on types of drugs), the
graph of the relative efficiency of analgesics as a
function of analgesic type, sex and pulpar disease.
The duration of the dental pain experienced
by patients was the following:
Table 1: Duration of dental pain
1 – 3 days
4 – 6 days
7 days or >
TOTAL
Men
32
8
23
63
Women
20
7
19
46
On the average, the patients suffered pain for
3-5 days prior to asking for a treatment. The difference between the mean duration of pain in
men and women was insignificant. Also insignificant was the difference between the duration
of pain among the patients having taken analgesics and those who did not take them. The intake
of analgesics was reported to 84.12% of men
and 78.26%, respectively, of women. 10 men and
9 women took no pill. Solpadeine, aspirine,
antinevralgics were administered in much lower
amounts comparatively with the other analgesics, which made the authors include them all in
only one group, named “other analgesics”.
Table 2: Average analgesic dose
Men
Women
5.6
5.1
pills
pills
2.Nurofen
4.4
3.9
3.Piafen
3.2
3.4
4. Other
1.8
2.,1
1.Algozone
compounds
volume 14 • issue 3 July / September 2010 • pp 203-208
T.M. Radu, A. Georgescu, Ruxandra Neac[u, S. Andrian
Table 3: Patients having taken analgesics
Men Women
1.Algozone
26
18
2.Nurofen
15
10
3.Piafen
5
4
4.Other analgesics
7
5
5.No pills
10
9
6.TOTAL
63
46
Table 4: Distribution of dental maladies on sexes
Men Women
1. Pulpar hyperemy
5
4
2. Partial serous pulpite
8
6
3.Total serous pulpite
16
11
4.Partial purulent pulpite
5
3
5.Total purulent pulpite
13
10
6.Reacutized chronic pulpite
16
12
The main drugs used, as well as the number
of patients having used them (both men and
women), for each malady in part, are listed in
Table 5:
while those who marked it between 5-10 viewed
them as satisfactory. As the patients considered
the action of analgesics in pulpar hyperemy and
serous pulpite as satisfactory, in the other maladies, the administered drugs were viewed as significantly unsatisfacatory. On the whole, 68% of
the men and 62% of the women considered the
drugs they had taken as unsatisfactory. No significant difference was observed in the apparent
efficiency of the administered analgesics:
Algozone, Nurofen, Piafen and others. At the
same time, it seems that the applied analgesic
dose had no significant influence on the apparent efficiency of the used analgesics, which will
be graphically illustrated in the following
graphs. Thus, the first 4 figures show the manner in which, whatever the disease, the patients
have appreciated the efficiency of each type of
analgesic in part. The following 9 graphs illustrate, for each affection in part, the way in which
the patients suffering from dental pain caused
by these maladies appreciated separately the efficiency of each analgesic. The graphs offer information on the subjective response to the action of self-medication in dental pain.
Algozo
ne
6
5
Table 5: Main drugs used for each malady
Algozone
Nurofen
Piafen
Other
No pills
4
Total
B
F
B
F
B
F
B
F
B
F
B
F
1
1
1
1
1
1
0
0
0
2
2
5
4
2
3
3
2
2
1
0
1
0
1
1
8
6
3
6
5
4
2
3
1
2
2
1
1
16
11
4
1
1
2
1
0
0
1
1
1
0
5
3
5
8
4
3
2
0
2
1
1
1
1
13
10
6
7
4
3
2
0
1
2
1
4
4
16
12
18
15
10
5
4
7
5
10
9
63
46
Total 26
3
2
analgesics
1
0
1
2
3
4
5
6
Man
7
8
9
10
Women
Fig. 1. Graph of apparent efficiency
Nurofen
3.5
A graphical comparison was made between
the efficiency of analgesics in each group, for
both men and women, the coordinates being
apparent efficiency (from the analogous visual
scale) and the number of patients. Distribution
was made as follows: the pacients who had visually marked the analogous scale in perimeter 0-5
considered the analgesics as unsatisfacatory,
Journal of Romanian Medical Dentistry
3
2.5
2
1.5
1
0.5
0
1
2
3
4
5
Man
6
7
8
9
10
Women
Fig. 2. Graph of apparent efficiency
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EVALUATION OF SELF-MEDICATION EFFICIENCY IN CONTROLLING ODONTAL PATHOLOGY PAIN
5
Piafen
4.5
4
2.5
3.5
2
3
2.5
1.5
2
1
1.5
1
0.5
0.5
0
0
1
1
2
3
4
5
6
7
8
9
2
3
4
Algozone
Man
5
6
7
8
9
10
10
Nurofen
Piafen
Other analg.
Women
Fig. 3. Graph of apparent efficiency
Fig. 7: Apparent efficiency in p.a.s.t.
3
Other analgezics
2.5
2.5
2
2
Nr.
pa 1.5
cie
nti 1
1.5
1
0.5
0.5
0
0
1_2
1
2
3
4
5
6
7
8
9
Algozone
Apparent efficiency
Man
3_4
5_6
7_8
9_10
10
Nurofen Piafen
Other analg.
Women
Fig. 8. Apparent efficiency in p.a.p.p.
Fig. 4. Graph of apparent efficiency
5
4.5
4
3
3.5
2.5
3
2
2.5
1.5
1.5
2
1
1
0.5
0.5
0
1
2
3
4
5
6
7
8
9
10
0
0
1_2
3_4
Algozone
Nurofen
5_6
Piafen
7_8
9_10
Algozone
Nurofen
Piafen
Other analg.
Other analg.
Fig. 5. Apparent efficiency in hyperemy
Fig. 9. Apparent efficiency in p.a.p.t.
4
3.5
5
4.5
3
4
3.5
3
2.5
2
1.5
1
0.5
0
2.5
2
1.5
1
0.5
0
1
0_1
2_3
4_5
Algozone
Nurofen
6_7
Piafen
8_9
10
2
3
Algozone
4
5
Nurofen
6
Piafen
7
8
9
10
Other analg.
Other analg.
Fig. 6. Apparent efficiency in p.a.s.p.
Fig. 10. Apparent efficiency in p.cr. r.
DISCUSSION
The efficiency of analgesics in treating the
pain caused by pulpopathies has been largely
206
volume 14 • issue 3 July / September 2010 • pp 203-208
T.M. Radu, A. Georgescu, Ruxandra Neac[u, S. Andrian
studied by several authors(6,7), the results obtained indicating their insufficient and unconstant action in reducing dental pain. The action of analgesics appears as not closely related
to the administration dose or type, but rather to
the anatomo-clinical form of the disease. While,
in some forms of pulpopathies, the analgesics
seem to have an important influence, in others
they appear as completely inefficient(8). The objective of the present study was to estimate the
use of analgesics and their apparent efficiency
on a group of adult patients having dental pain
of pulpar origin. The analogous visual scale appeared to be a safe method for registering the
subjective symptoms. Consequently, it has been
applied in a large range of investigations for recording pain severity and its subsiding action.
In the present paper, the analogous visual scale
of 10 units was used for putting into evidence
the apparent efficiency of analgesics. It is a very
simple method permitting evaluation and retrospective analysis of analgesics efficiency in the
treatment of dental pain. In the other diseases
here considered, most of the patients appreciated as unsatisfactory the self-administered analgesic, which was quite similar for all the other
drugs employed. The patients were asked to
evaluate the intake and efficiency of the analgesic 24 hr before coming to the dentist. Such a
deadline was established by the authors, to permit the patient to remember easily the painful
experience and the details of the analgesic intake. The placebo effect was left aside, as the
placebo response is very difficult to identify and
eliminate, similarly difficult being to introduce
the tendency in the result. The method here applied for showing the efficiency of analgesics has
the advantage of considering the subjective response in dental pain to the action of analgesics
or of the self-administered drugs. Generally, the
results obtained suggest their low efficiency. A
simple remark indicates that, even if undesirable at short time levels, it is favourable for long
times as, in this way, pain finally convinces the
patient to see a doctor. If analgesics might efficiently control dental pain, then numerous patients would resort to self-medication, instead of
seeing a specialist, which will bring about unde-
Journal of Romanian Medical Dentistry
sirable adverse (both pharmacological and stomatological) results. The action of the drugs
employed may be efficient in such maladies precisely through their antiinflammatory effect. The
analgezics used were non-steroidian antiinflammatory drugs, elimination of pain being
due to the interruption of the inflammatory process through blocking of prostaglandine synthesis.
CONCLUSIONS
The results of the present study showed that
Algozone and Nurofen were mostly employed
in the self-medication for dental pain. Apparently, in recent years, a new tendency has been
manifested in self-medication against dental
pain. More precisely, if, in the last decades of the
last century, Algocalmine, Aspirine, Paracetamol
were mainly used, nowadays patients prefer
Algozone, Nurofen, Solpadeine, Piafen. In
comparison with some older studies, the present
results show a significant reduction of Aspirine
usage, in parallels with an increased use of last
generation analgesics (9). One of the main factors responsible for reducing Aspirine use refers
to its multiple secondary effects, such as gastrointestinal irritations and hemorrhages. The patients here investigated had dental pain, on the
average, three days prior to coming to the dentist’s. The number of self-administered pills generally corresponded to the dose recommended
in the prospect. The overall results obtained on
the efficiency of analgesics from the analogous
visual scale show the existence of some diseases
in which all administered analgesics were considered as efficient. These are pulpar hyperemy
and chronic reacutized pulpite. Anatomopahtologically, such maladies are characterized by initially reversible stages of the inflammation,
when the biochemical cascade does not induce
the occurrence of the bio-feed-back cycle capable of re-feeding the continuous inflammatory
process towards irreversible stages.
As a general conclusion, the present study
demonstrates that the efficiency of self-prescribed analgesics for dental pain is relatively
good in incipient inflammatory stages, but low
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EVALUATION OF SELF-MEDICATION EFFICIENCY IN CONTROLLING ODONTAL PATHOLOGY PAIN
in their advanced stages. Apparently, the efficiency of analgesics seems related neither to the
type of analgesic nor to the applied dose.
References
1. Hasselgren G, Calev D: Endodontics emergency
treatment sound and simplified, NYSDJ, June/
July 1994
2. Cohen St, Hagreaves K: Pathways of the pulp, 9 th
edit.Mosby-Elsevier(2006); Diagnosis and management of orofacial dental pain emergencies: 4059
3. Ashkenaz PJ:One-visit endodontics, 1984. Dent Clin
Nort Am 28: 853
208
4. Bender IB: Pulpal pain diagnosis-a review, 2000, J
Endod26: 175
5. Hersh EV, Moore PA: Drug interactions in dentistry,
2004. J Am Dent Assoc 135: 298
6. Hutter JW et al:Principles and practice of endodontics, 2002, ed3, Philadephia, WB Sounders
7. Rosenberg PA:Clinical strategies for managing endodontic pain,2002, Endodon Topics 3:78
8. Malamed: Medical emergencies in the dental office,
ed 5, St. Louis,2000, Mosby
9. Keiser K, Hargreaves KM: Building effective strategies for the management of endodontic pain,
2002, Endodon Topics, 3.1, 93
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