New guideline details dental pain management strategies for pediatric patients

 

Acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are recommended as first-line treatments for managing short-term dental pain in children under age 12, according to a new clinical practice guideline developed by the American Dental Association Science & Research Institute (ADASRI), the University of Pittsburgh School of Dental Medicine and the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine. The guideline has been endorsed by the American Dental Association.

A guideline panel determined that, when used as directed, acetaminophen alone, NSAIDs (like ibuprofen) alone or acetaminophen in combination with NSAIDS can effectively manage a child’s pain after a tooth extraction or during a toothache when dental care is not immediately available. These and other recommendations are now available in the September issue of The Journal of the American Dental Association. 

The guideline evaluated doses of acetaminophen and NSAIDs that may differ from the dosing printed on the over-the-counter packages of these medications. According to the guideline, when acetaminophen or NSAIDs are administered as directed by a dentist or other health care provider, the risk of harm to children from either medication is low. 

Guideline senior author Paul Moore, D.M.D., Ph.D., M.P.H., is professor emeritus at the University of Pittsburgh’s School of Dental Medicine. He said the recommendations align with previous guidance from the U.S. Food and Drug Administration (FDA), which contraindicated the use of codeine and tramadol in children under age 12 in 2017.

“While prescribing opioids to children has become less frequent overall, this guideline ensures that both dentists and parents have evidence-based recommendations to determine the most appropriate treatment for dental pain,” Dr. Moore said. “Parents and caregivers can take comfort that widely available medications that have no abuse potential, such as acetaminophen or ibuprofen, are safe and effective for helping their children find relief from short-term dental pain.”

In 2020, the FDA awarded the University of Pittsburgh and ADASRI a three-year $1.5 million grant to develop a clinical practice guideline for the management of acute pain in dentistry in children, adolescents and adults. A group of researchers and methodologists from ADASRI, the University of Pittsburgh School of Dental Medicine, the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine, McMaster University and the Art of Democracy worked together to develop the guideline.

“This clinical prescribing guideline is a critical step in supporting appropriate treatment of pediatric acute dental pain through the use of acetaminophen and NSAIDs," said Patrizia Cavazzoni, M.D., director of the FDA Center for Drug Evaluation and Research. “Not only will this advice allow for better treatment of this kind of pain, but it will help prevent unnecessary prescribing of medications with abuse potential, including opioids.” 

This is the first of two guidelines on acute dental pain management. A second set of recommendations for adolescents and adults is in development. The new acute pediatric pain management guideline can be found at ada.org/painmanagement.

For more information on how the ADA is working to combat opioid misuse, while continuing to help patients manage dental pain, visit ada.org/opioids.

The contents of the guidelines are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, FDA, HHS or the U.S. government.

Metformin is ameliorating hmgb1-mediated oxidative stress in periodontitis

 

 

IMAGE: PERIODONTITIS INCREASE THE EXPRESSION OF PROINFLAMMATORY CYTOKINE HMGB1. HMGB1 AFFECTS THE EXPRESSION OF INFLAMMATION-RELATED CYTOKINES (IL-6, IL-8) AND AGGRAVATES PERIODONTAL TISSUE DESTRUCTION AND OXIDATIVE STRESS. METFORMIN ACTIVATES AUTOPHAGY THROUGH MTOR PATHWAY, REGULATE THE EXPRESSION, TRANSLOCATION AND RELEASE OF HMGB1, AND THEN REDUCE THE OXIDATIVE STRESS AND TISSUE DESTRUCTION OF PERIODONTAL TISSUE. view more 

CREDIT: GENES & DISEASES

Periodontitis, a prevalent global health concern, results in the gradual destruction of tooth-supporting tissues and is often exacerbated by oxidative stress conditions and bacterial changes. Current treatment methodologies include mechanical debridement, anti-inflammatory drugs, and regenerative surgery.

The research published in the journal of Genes & Diseases, conducted detailed examinations on cellular interactions with Metformin, investigating its role in relation to HMGB1 during the progression of periodontitis. It was observed that Metformin could inhibit oxidative stress, and activate autophagy via the AMPK/mTOR pathway. Experimental periodontitis was induced in a murine model, and Metformin was found to attenuate alveolar bone resorption, a major hallmark of the disease.

A notable discovery from this study is that Metformin not only decreases oxidative stress in periodontal ligament cells but also activates autophagy, a cellular waste removal and recycling process, through the AMPK/mTOR pathway. This pathway has been shown to inhibit HMGB1-mediated oxidative stress in periodontal tissues.

The study concludes that Metformin can mitigate periodontal tissue damage through its anti-inflammatory effects, which involve reducing the expression and translocation of HMGB1, a key pro-inflammatory factor. These results align with previous studies demonstrating Metformin's capabilities in reducing oxidative stress.

HMGB1's pivotal role in inducing oxidative stress in periodontal cells adds further credence to this protein being a potential target for periodontal intervention. This opens up a promising avenue for future research and the development of drugs aimed at HMGB1.

"While our study presents compelling evidence on the protective role of Metformin in periodontitis, further research is needed," the research team stated. "We are optimistic that our findings will pave the way for more comprehensive studies on the relationship between Metformin and HMGB1 in periodontitis, ultimately leading to more effective treatment options."

The potential role of Metformin in managing periodontitis could be transformative, especially for patients suffering from both diabetes and periodontitis. The study's results offer hope for an affordable, well-tolerated, and readily available therapeutic option, building on Metformin's known antidiabetic effects. This aligns with the broader medical goal of developing targeted treatments that manage the disease's symptoms while also addressing its root cause.

###