All-Natural Oral Gel for Tooth Extraction Pain - A Case Study

COURSE OBJECTIVES

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• Understand efficacy of current standard therapy for pain management after tooth extraction, including proposed mechanisms of action.

• Understand safety issues of current standard therapy for pain management after tooth extraction.

• Discuss the two mechanisms of action of the all-natural gel that provide excellent pain relief.

• Emphasize the lack of toxicity of the plant-based gel.

• Emphasize the need of dentistry to incorporate the all-natural gel into the everyday practice of dentistry.

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ABSTRACT

 

Tooth extraction requires pain management.  The historical practice of prescribing narcotics for tooth extraction has largely been replaced with dentists recommending OTC medications, due to the current opioid crisis.  Popular OTC medications (acetaminophen, ibuprofen, etc) can provide some pain relief, but also present potential side effects and even toxicities.  This case study presents the use of an all-natural gel after surgical tooth extraction.  The product, comprised of all-natural food ingredients, has no inherent toxicity, and provided fast, excellent pain relief after surgical tooth extraction.  The incorporation of this product into standard dental care would represent a huge step in providing patients with the safest, most effective pain relief currently available. ​

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INTRODUCTION

 

Tooth extraction is a major part of dental care.  The most common means of addressing the pain after tooth extraction is oral analgesics.  Historically, narcotics such as hydrocodone, oxycodone, and codeine, combined with acetaminophen or ibuprofen, have been routinely prescribed for almost all tooth extractions.  

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With the current opioid crisis, more dentists are recommending over-the-counter analgesics, with the combination of acetaminophen and ibuprofen a common treatment.1  In addition, alternative methods have been tested, such as transcutaneous electrical nerve stimulation (TENS), acupuncture, and conditioned pain modulation (CPM), formerly termed diffuse noxious inhibitory control.2,3 These methods can provide some pain relief, but the cost of treatment, as well as time involved, can make alternative methods impractical for many people. 

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Following is a case in which a patient obtained excellent pain relief after surgical tooth extractions with use of a drug-free gel which consists of 100% plant-based food ingredients.

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Patient Case Report

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Medical History:  

Diagnosed with scoliosis in 20s.  Underwent five back surgeries, with subsequent spinal fusion.  Has received physical therapy for her back within the last year.  Rx: Baclofen, 10 mg prn for back spasms.

Developed spontaneous blood clots at age 32 that resolved. No medication prescribed.

Diagnosed with hypothyroidism within last 5 years.  Rx: Cytomel (liothyronine), 25 mcg/day.

Diagnosed with mild depression.  Rx:  Zoloft (sertraline), 50 mg/day. 

 

Dental History: 

Received orthodontic treatment as a teenager.

Five composite restorations in anterior and posterior teeth. 

Root canal therapy #15 with composite restoration ~20 years ago?

 

Diagnostic records:  Periapical radiograph revealed lucency around roots of tooth #15.

Treatment: Patient underwent second endodontic treatment of #15, with no relief.  Also experienced pain elsewhere in mouth, but could not locate source.  Sought second opinion with oral surgeon, who diagnosed root canal failure #15, and fracture in tooth #18.  Surgically extracted both #s 15 and 18; IV sedation and local anesthetic.  Root fragments on both teeth had to be retrieved.

 

Treatment Progress: Patient recovered uneventfully from tooth extractions.

Initial Pain Management:  Oral surgeon provided the patient with an all-natural gel to use prn for pain relief.  Patient used the gel with good effect.  She also took 400 mg ibuprofen twice the first day, then needed only the gel the second day.  She experienced no pain by the 3rd day. 

 

Self-administered treatment:  The patient also obtained the rinse form of the gel from the oral surgeon, and uses it once every day to help keep her mouth clean, healthy and comfortable.

 

Post-treatment documentation: This patient is pleased with the excellent pain relief she received after tooth extraction with the gel, with the need of two doses of ibuprofen the first day.  Pain relief with the gel lasted around 4 hours, at which time she re-applied the gel for immediate relief.  No more gel was required for pain relief after the second day. 

 

Discussion

Tens of millions of teeth are extracted in the US every year.4  Pain medication is either prescribed or recommended by the dentist for almost every patient who undergoes tooth extraction.  Historically, narcotics were routinely prescribed after tooth extractions.  With the opioid crisis, of which dentistry has played a major part, many dentists have turned to other means of addressing pain.5 

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Over-the-counter pain medications, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs; e.g. ibuprofen, naproxen), are now routinely prescribed for post-extraction pain.  Studies have shown that acetaminophen (APAP), or NSAIDs, can give some pain relief after tooth extraction, and the combination of APAP and ibuprofen is more effective than either alone.  Studies have shown that the combination of APAP and ibuprofen can be as effective, or more so, than narcotics.6-8  The American Dental Association, in fact, now recommends NSAIDs with or without acetaminophen as first-line treatment for acute dental pain in patients 12 years old and older.9

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Another important issue is toxicity, and adverse side effects associated with oral analgesics.  Opioids are not particularly toxic at prescribed doses, but have the potential for abuse.  OTC meds are generally safe at recommended doses, but do come with some inherent toxicities and potential for adverse events.  For example, acetaminophen is particularly toxic to the liver.  Patients can develop a cavalier attitude about OTC meds, and can overdose, especially when seeking added pain relief.  Indeed, acetaminophen overdosage is the leading cause of acute liver failure in the US.10,11  Other common side effects are headache, nausea, vomiting, diarrhea, abdominal pain and constipation.  Other more serious adverse effects are much less common, but do occur.12 

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NSAIDs have long been known to inhibit the activities of cyclooxygenases (COX), specifically COX-2.  The cyclooxygenases are enzymes involved in the production of prostaglandins, which are lipids that play important roles in development of inflammation.  NSAIDs are now known to also inhibit certain lipoxygenases (LOX), which are involved in the production of lipids that are also involved in inflammation.  Pain invariably accompanies inflammation.  So, inhibition of COX and LOX activity helps alleviate inflammation and pain.13,14 

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NSAIDs come with adverse effects, though.  Common side effects include headache, dizziness, tingling or numbness in hands and feet, tinnitus, blurred vision, nausea/vomiting, diarrhea, stomach bleeding, constipation and others.  NSAIDs can also elevate blood pressure and exacerbate heart conditions, increasing the risk of cardiovascular events​.15  Because they are anti-inflammatory, NSAIDs also inhibit wound healing.  The inflammatory phase is critical for optimal wound healing.  Therefore, NSAIDs can adversely affect the healing of both soft tissue and bone.16,17

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The patient was given a hydrogel wound dressing comprised of 100% plant-based food ingredients, that has been on the market since 2007, and is used by general dentists and specialists (especially oral surgeons and periodontists) after surgical procedures because of the fast, profound pain relief enjoyed by patients for hours, with little or no need for other pain medications.  This is especially significant in light of the opioid crisis, but also because of the total lack of toxicity.  This product can be used as often as needed to maintain comfort after procedures.  Another benefit that patients love is that this product produces an analgesic effect, without anesthetizing the area, as do topical anesthetics such as benzocaine.  People want pain relief, not numbness, which can be uncomfortable but also can lead to accidental bites of lips, cheeks or tongue. 

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A clinical trial in immediate denture patients 24 hours after multiple extractions and delivery of dentures, demonstrated that the gel produced significantly enhanced pain relief than that provided by 10 mg hydrocodone/APAP (Lortab).18  

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Testing occurred at 24-hr recall appointment.  Pain scale…0 = no pain, 10 = excruciating pain; Red is mean of 44 patients who took Lortab (10 mg hydrocodone/500 mg APAP) 1 to 1.5 hr before testing; Blue is mean of 44 patients who had OraSoothe Sockit hydrogel wound dressing applied to dentures immediately prior to testing. 

 

The pain relief results from two mechanisms.  First, it coats and protects wounded areas.  This is seen with burns, for example, when noticeable relief is obtained by just covering the burn and protecting it from the air.  Second, the gel binds sodium ions, and inhibits their influx into the neuron.  Preventing this first step in the generation of the action potential will result in pain relief.

As in this case, the gel provides significant pain relief within 5 minutes, and excellent pain relief is generally experienced for 3-4 hours.  This is a significant benefit over that provided by oral medications that must be absorbed and distributed throughout the body.  Time delay for meaningful pain relief is at least 45 minutes, and peak efficacy is generally seen after an hour or so, then can last for 2-3 hours, before beginning to wane.19

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Conclusion

The results obtained by this patient mirrors those reported over the last 17 years from patients who have enjoyed the profound pain relief provided by this product after tooth extraction, periodontal surgery, and other procedures that produce pain and require attention.  It would behoove all dentists to incorporate this product into their practices and provide their patients the same safe, excellent pain relief enjoyed by this patient.

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VERIFICATION CODE: 5003

 

REFERENCES

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3. Fujii-Abe K, Umino M, Kawahara H, Terada C, Satomura K, Fukuyama H. New method for postoperative pain relief using a combination of noxious and non-noxious stimuli after impacted wisdom tooth extraction. J Oral Sci. 2019;61(2):364-69

4. ADA survey, 2005-6

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7. Miroshnychenko A, Ibrahim S, Azab M, et al. Acute postoperative pain due to dental extraction in the adult population: a systematic review and network meta-analysis. J Dent Res. 2023;102(4):391-401

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10. Stravitz RT, Lee WM. Acute liver failure. Lancet. 2024;394(10201):869-81 

11. Tujios S, Stravitz RT, Lee WM. Management of acute liver failure: update 2022. Semin Liver Dis. 2022;42(3):362-78

12. Acetaminophen side effects. Drugs.com; https://www.drugs.com/sfx/acetaminophen-side-effects.html.  Last modified March 22, 2024

13. Mashima R, Okuyama T. The role of lipoxygenases in pathophysiology; new insights and future perspectives. Redox Biol. 2015;297-310

14. Pelletier JM, Lajeunesse D, Reboul P, Pelletier J-P. Therapeutic role of dual inhibitors of 5-LOX and COX, selective and non-selective non-steroidal anti-inflammatory drugs. Ann Rheum Dis. 2003;62:501-09

15. Kumar K. Ibuprofen - uses, side effects, and more.  WebMD. 2024;https://www.webmd.com/drugs/2/drug-5166-9368/ibuprofen-oral/ibuprofen-oral/details

16. Fairweather M, Heit YI, Buie J, et al. Celecoxib inhibits early cutaneous wound healing. J Surg Res. 2015;194(2):717-24

17. Pountos I, Panteli M, Walters G, Giannoudis PV. NSAIDs inhibit bone healing through the downregulation of TGF-β3 expression during endochondral ossification. Injury. 2021;52(6):1294-99

18. Kennedy TJ, Hall JE, A drug-free oral hydrogel wound dressing for pain management in immediate denture patients.  Gen Dent. 2009;57(4):420-7

19. Kellstein D, Leyva R. Evaluation of fixed‐dose combinations of ibuprofen and acetaminophen in the treatment of post-surgical dental pain: a pilot, dose‐ranging, randomized study.  Drugs in R&D. 2020;20:237-47