title: Efficacy of chlorhexidine, dexpanthenol, allantoin and chitosan gel in comparison with bicarbonate oral rinse in controlling post-interventional inflammation, pain and cicatrization in subjects undergoing dental surgery.
abstract: BACKGROUND
  Reducing post-interventional inflammation and pain in odontostomatological surgery procedures, such as tooth extractions, implants or oral biopsies is a relevant clinical goal. Chlorhexidine oral rinse is commonly used with this aim. Recently a new product containing chlorhexidine, dexpanthenol, allantoin and chitosan (Bexident Post [BP]) in a gel formulation has been developed. We evaluated the efficacy of BP in controlling postsurgical inflammation and pain and in promoting cicatrization in subjects undergoing molar extractions.
  
  
  METHODS
  We conducted a prospective sequential cross-over, randomized controlled study in patients undergoing surgical removal of at least two impacted mandibular third molars (teeth numbers 38 and 48) (numbers 17 and 32 in the Universal Tooth Numbering System), in two separate sessions, to determine the effect of BP in comparison with bicarbonate (BC) oral rinse (one spoonful in 200 ml of water), both used three times daily. Each subject utilized both products in a randomized sequential manner after each tooth extraction. Primary outcomes of the study were post-procedure pain and inflammation. Secondary outcomes were analgesic pill rescue use (metamizole 1 cap every 8 hours if needed) and an assessor-blinded evaluation of cicatrization with a semi-quantitative scale (good, satisfactory and insufficient). Post-procedure pain was assessed 6 hours after tooth extraction and for seven consecutive days by means of a 10 cm visual analogue scale (VAS) (from 0: no pain to 10: extreme pain). The extent of inflammation was evaluated through metric measurements of facial perimeter using standardized anatomical reference points.
  
  
  RESULTS
  A total of 47 patients (22 men and 25 women; mean age 34 years) were enrolled with a total of 94 molars extracted. Nineteen subjects applied BC as the first sequential treatment and 28 BP as the first. Before surgery no mean differences in the two treatments in inflammation measurements were observed. After surgery mean VAS pain score was similar between the two treatments in the first 6 hours (VAS score = 6.5). A marked progressive reduction in pain intensity with the use of BP was observed throughout the treatment period in comparison with BC (7 day mean scores 3.7 vs. 5.3; p = 0.0001). BP was superior to BC in reducing inflammation with -50% of the inflammation-related measurement (6 mm vs. 12 mm; p = 0.0001). Analgesic pill consumption was lower with BP in comparison with BC (13 pills vs. 24; p < 0.05). Cicatrization was scored 'good' in a higher percentage of subjects during BP use (64%) in comparison with the BC group (13%) (p = 0.0001). No serious side effects were reported with either treatment regimen.
  
  
  CONCLUSIONS
  In this trial BP performed better than BC in controlling pain and inflammation in subjects undergoing dental surgery, reducing the consumption of analgesics and favoring better cicatrization.
authors.forename: Jose
authors.initials: J
authors.lastname: Lopez-Lopez
authors.affiliation: a a Department of Odontostomatology , University of Barcelona and Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat , Barcelona , Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Lope-Lopez
authors.affiliation: a a Department of Odontostomatology , University of Barcelona and Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat , Barcelona , Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Jan-Pallí
authors.forename: Beatriz Gonzá
authors.initials: BG
authors.lastname: lez-Navarro
authors.affiliation: a a Department of Odontostomatology , University of Barcelona and Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat , Barcelona , Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: González-Navarro
authors.affiliation: a a Department of Odontostomatology , University of Barcelona and Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat , Barcelona , Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Jané-Salas
authors.affiliation: a a Department of Odontostomatology , University of Barcelona and Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat , Barcelona , Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Estrugo-Devesa
authors.affiliation: b b Medical Department , Isdin Barcelona , Spain.
authors.forename: Massimo
authors.initials: M
authors.lastname: Milani
mesh_terms: D000328:Adult; D000481:Allantoin / Q000008:administration & dosage; D000700:Analgesics / Q000627:therapeutic use; D001639:Bicarbonates / Q000008:administration & dosage; D048271:Chitosan / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D002921:Cicatrix / Q000517:prevention & control*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010205:Pantothenic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011446:Prospective Studies; D014081:Tooth Extraction / Q000379:methods*; D055815:Young Adult
chemical_list: D000700:Analgesics; D001639:Bicarbonates; D010205:Pantothenic Acid; C007288:dexpanthenol; D000481:Allantoin; D048271:Chitosan; D002710:Chlorhexidine
keywords: Chitosan; Chlorhexidine; Controlled clinical trial; Dexpanthenol; Oral rinse; Oral surgery