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1XPEHU RI SUHVFULSWLRQV prescription (72.3%, n = 81) but only 19.6% (n = 22)
mentioned the dose. It is notable that most
dentists preferred injectable steroid therapy (58.9%,
n = 66) [Table 2].

DISCUSSION

A review of our study results shows that most of the
dentists prescribed traditional NSAIDs to patients
undergoing routine dental implant surgery. Only a
marginal section of the dentists prescribed the newer
cyclo‑oxygenase selective group of drugs on a regular
Figure 1: Prescription trend of analgesic/anti‑inflammatory drugs for oral basis. Similar prescription patterns for analgesics in
implant surgery. PCM: Paracetamol the dental setting have also been observed in studies
conducted in Istanbul, Bangladesh, Karnataka [11]
[9]
[10]
as an additional drug in combination with some other and Alabama. It is noteworthy that analogous results
[12]
analgesic, and in no case was paracetamol used as an have also been reported in a study illustrating country
analgesic‑anti‑inflammatory drug alone. comparisons in analgesic usage. [13]
More than half of the dentists prescribed more than one Evaluation of the prescription patterns revealed that there
drug (64.7%, n = 215), and of these 8.4% (n = 28) simply was a great deal of variability in the drugs prescribed
stated that they prescribed NSAIDs, without specifying and the protocols followed for their prescription.
any drug or trade name. Also, majority (56.9%, n = 189) Regarding the analgesic drug prescribed, ibuprofen was
used generic drugs names in their prescriptions, brand the most prescribed, followed by diclofenac. The role
name was used by 37.3% (n = 124) and 5.7% mentioned of both these drugs in the management of dental and
both (n = 19). A single NSAID drug was prescribed by only post‑surgical inflammatory pain is recommended by
35.2% (n = 117) dentists. Unrelated drugs were mentioned many authors. [14‑17] Amongst recommendations regarding
by 27.4% (n = 91) dentists and 58.1% (n = 193) indicated the use of NSAIDs in dentistry, it has been suggested
the use of pre‑formulated drug combinations. that ibuprofen is an ideal prototype for consideration in
The use of semi‑synthetic opioids was noted by pain of dental origin. [2]
9.0% (n = 30) dentists. Tramadol alone was prescribed A noteworthy aspect of our study was the finding that
by 3.3% (n = 11) dentists while 1.5% (n = 5) gave it in the most common prescription pattern was the use
combination with paracetamol. Dextropropoxyphene was of ibuprofen in combination with paracetamol, and
prescribed by 1.5% (n = 5) dentists only and it was part of diclofenac with paracetamol. No dentist prescribed
a pre‑formulated commercially available drug formulation. paracetamol alone as an analgesic drug. Guidelines on
[16]
Additional drugs were also prescribed along with sedation and management of dental pain state that it
analgesic‑anti‑inflammatory drugs. These included tissue is irrational to combine two or more NSAIDs in therapy,
enzymes such as serratiopeptidase (10.8%, n = 36), however, paracetamol or opioid analgesics are suitable
chymotrypsin (0.3%, n = 1) and chlorzoxazone (4.2%, for combination with NSAIDs whenever a combination is
[18‑21]
n = 14). Caffeine was present in 1.5% (n = 5) of required in severe pain only. A review of literature
the prescriptions. All of these drugs were part of related to ibuprofen‑paracetamol combination shows that
the two drugs tend to provide efficacious pain control in
pre‑formulated commercially available drug formulations.
the dental model when used together. [22]
Drug dose was mentioned by 5.4% (n = 18) dentists Additionally, our study participants have also prescribed a
only. The peri‑operative treatment protocol (pre‑surgical variety of other NSAIDs such as piroxicam and ketorolac.
dose followed by post surgical regimen) was preferred However, it may be noted that these drugs have not been
by 35.5% (n = 118) dentists while 64.7% (n = 215) gave recommended for pain control in the dental pain model
the medication postoperatively only. The term ‘Stat and are known to have more severe side effects. [2,4] Some
on Symptoms’ was also mentioned by 21.6% (n = 72) dentists have also mentioned the use of unrelated NSAIDs
dentists. Post‑operative prescription duration ranged from in their prescriptions, indicating a subjective preference in
0 to 9 days, the most common being 5 days.
prescribing different drugs to different patients.
The oral route was recommended by all 332 dentists Another matter for concern regarding the use of NSAIDs
with an additional injection via intramuscular route (3.0%, for analgesia is the incidence of side effects, specifically
n = 10) or intravenous route (1.5%, n = 5) along with gastrointestinal (GI) bleeding. The safest drug in this
[23]
this.
regard has been noted as Ibuprofen. However, this has
[24]
Regarding steroids, out of the 33.7% (n = 112) participants also been related to the frequency and duration of overall
that prescribed steroids, dexamethasone (50.8%, n = 57) NSAID therapy. This may not be significant in normal
was the most preferred, followed by prednisolone (29.4%, healthy individuals taking short‑term therapy for oral
n = 33). Also, majority used generic names in their surgical related pain. [2,4,25]

Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015 53