title: Prescriptions of NSAIDs to patients undergoing third molar surgery : an observational, prospective, multicentre survey.
abstract: OBJECTIVE
  Surgical extraction of an impacted third molar is generally followed by acute post-operative pain that has been shown to be primarily inflammatory. Thus, use of NSAIDs in this context is appropriate and has been shown to be effective. Several drugs are employed for this purpose, but no information exists on the reasons why preference is given to one rather than another. The principal objective of this study was to evaluate the pattern of administration of NSAIDs in patients undergoing surgery for impacted third molar extraction. The study also aimed to collect information on the efficacy, onset and duration of the analgesic effect of routinely prescribed NSAIDs and to assess the duration of treatment with these drugs and their tolerability.
  
  
  METHODS
  This was an observational, multicentre, prospective survey. A total of 616 patients (38% male and 62% female) from the Italian Stomatology Clinics of the Universities of Bologna, Brescia, Cagliari, Chieti, Pavia, Pisa, Siena and Varese and from the Department of Oral and Maxillo-Facial Surgery of Semmelweis University, Budapest, were eligible for the study. Patients were evaluated over the 7 days following surgical extraction. NSAIDs were prescribed according to the normal prescribing habits of the centre and physician involved. The main outcomes of interest in the survey were the efficacy, onset and duration of analgesic effect, duration of therapy, and tolerability of the NSAIDs prescribed.
  
  
  RESULTS
  Nimesulide was the most prescribed NSAID (68%), followed by diclofenac, ketoprofen and ibuprofen. Because of the low proportion of patients receiving other NSAIDs, these patients were considered a single treatment group for evaluation purposes. Nimesulide, especially when given before patients started experiencing pain after surgery, was more effective than other NSAIDs in reducing the severity of pain on the day of surgery, in delaying the time to maximum intensity of pain, in providing complete pain relief and in prolonging the duration of analgesic effect on the day of surgery. These results are consistent with the known anti-inflammatory and analgesic actions of nimesulide and with the important role of inflammation in the onset of pain after this type of surgery.
  
  
  CONCLUSIONS
  These results confirm nimesulide as an effective reference drug for the treatment of post-operative dental pain and show that it has a positive benefit/risk profile in this setting.
authors.affiliation: Clinica Odontoiatrica, Università dell'Insubria, Varese, Italy. luca.levrini@unisubria.it
authors.forename: Luca
authors.initials: L
authors.lastname: Levrini
authors.forename: M
authors.initials: M
authors.lastname: Carraro
authors.forename: S
authors.initials: S
authors.lastname: Rizzo
authors.forename: S
authors.initials: S
authors.lastname: Salgarello
authors.forename: E
authors.initials: E
authors.lastname: Bertelli
authors.forename: G A
authors.initials: GA
authors.lastname: Pelliccioni
authors.forename: V
authors.initials: V
authors.lastname: Garau
authors.forename: M
authors.initials: M
authors.lastname: Bandettini
authors.forename: S
authors.initials: S
authors.lastname: Caputi
authors.forename: A
authors.initials: A
authors.lastname: Lörincz
authors.forename: A
authors.initials: A
authors.lastname: Szûcs
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D003753:Dental Health Surveys; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006814:Hungary; D007052:Ibuprofen / Q000008:administration & dosage / Q000627:therapeutic use; D007558:Italy; D007660:Ketoprofen / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008964:Molar, Third / Q000601:surgery*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D011446:Prospective Studies; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013449:Sulfonamides; D004008:Diclofenac; D007660:Ketoprofen; C012655:nimesulide; D007052:Ibuprofen
references.citation: Br Dent J. 2004 Oct 9;197(7):407-11; discussion 397
references.pmid: 15475903
references.citation: Oral Surg Oral Med Oral Pathol. 1992 Jul;74(1):19-23
references.pmid: 1508502
references.citation: Drugs. 1993;46 Suppl 1:168-70
references.pmid: 7506162
references.citation: Proc Natl Acad Sci U S A. 1999 Jun 22;96(13):7563-8
references.pmid: 10377455
references.citation: J Pain. 2007 Apr;8(4):349-54
references.pmid: 17270500
references.citation: Drug Saf. 2001;24(14):1081-90
references.pmid: 11735663
references.citation: Spine (Phila Pa 1976). 2000 Jun 15;25(12):1579-85
references.pmid: 10851109
references.citation: J Oral Maxillofac Surg. 2003 Sep;61(9):997-1003
references.pmid: 12966473
references.citation: J Can Dent Assoc. 2002 Sep;68(8):476-82
references.pmid: 12323103
references.citation: Drugs. 2003;63(24):2709-23
references.pmid: 14664651
references.citation: Anesthesiology. 2002 Sep;97(3):565-73
references.pmid: 12218521
references.citation: Clin J Pain. 2007 Sep;23(7):565-70
references.pmid: 17710005
references.citation: Minerva Stomatol. 1990 Oct;39(10):827-31
references.pmid: 2074867
references.citation: J Oral Maxillofac Surg. 1997 Nov;55(11):1223-6
references.pmid: 9371111
references.citation: Drugs. 2003;63 Suppl 1:37-46
references.pmid: 14506910
references.citation: Curr Med Res Opin. 2006 Jun;22(6):1161-70
references.pmid: 16846549
references.citation: Br Med Bull. 2004 Dec 13;71:13-27
references.pmid: 15596866
references.citation: Oral Surg Oral Med Oral Pathol. 1993 Dec;76(6):680-7
references.pmid: 8284070
references.citation: Rheumatology (Oxford). 1999 May;38 Suppl 1:1-3
references.pmid: 10369398
references.citation: G Stomatol Ortognatodonzia. 1984 Apr-Jun;3(2):184-91
references.pmid: 6396255
references.citation: Gen Dent. 2006 May-Jun;54(3):201-7; quiz 208, 221-2
references.pmid: 16776415
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Aug;98(2):146-52
references.pmid: 15316540
references.citation: Drug Saf. 2004;27(6):411-20
references.pmid: 15144234
references.citation: Minerva Stomatol. 1990 Dec;39(12):1039-46
references.pmid: 2092187
references.citation: Drugs. 1993;46 Suppl 1:162-7
references.pmid: 7506161
references.citation: Curr Med Res Opin. 2004 Jan;20(1):107-12
references.pmid: 14741079
references.citation: Int J Clin Pract Suppl. 2002 Jul;(128):11-9
references.pmid: 12166613
references.citation: Cephalalgia. 2004 May;24(5):356-62
references.pmid: 15096224
references.citation: Minerva Chir. 1990 Dec;45(23-24):1469-75
references.pmid: 2087280
references.citation: Drugs. 1993;46 Suppl 1:171-3
references.pmid: 7506163
references.citation: Rheumatology (Oxford). 1999 May;38 Suppl 1:33-8
references.pmid: 10369404
references.citation: Eur J Rheumatol Inflamm. 1994;14(4):33-8
references.pmid: 7601181