JOURNAL
Current Issue
Journal Archive
.............................................................
November 2017 -
Volume 15, Issue 9

View this issue in pdf format -

........................................................
From the Editor

........................................................

 

Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

Comparison of the uterine artery Doppler indices during pregnancy between gestational diabetes and diabetes mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud Jaafarnejhad,
Parisa Bahrami Kamangar

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology and Islam
Simin Afrasibi, Zakieh Fattahi

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male students survivors of earthquake in the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh

Reviews

Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

Comparing Traditional and medical treatments for constipation : A Review Article
Mohammad Yaqub Rajput

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab

Review of percutaneous nephrolithotomy in children below 12 years old in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo

Physical and mental health in Islam
Bahador Mehraki, Abdollah Gholami

International Health Affairs

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

Calculation of Salaries and Benefits of Faculty Members in the Ministry of Health and Medical Education of Iran
Abdolreza Gilavand

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari Anbohi, Amir Almasi-Hashiani, Fariba Borhani

Clinical Research and Methods

Comparison of the Antibacterial Effects of Chlorhexidine Mouth washes with Jaftex Mouth wash on Some Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi

Study of the effect of plasma jet on Fusarium isolates with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

.........................................................

Publisher -
Lesley Pocock
medi+WORLD International
11 Colston Avenue,
Sherbrooke 3789
AUSTRALIA
Phone: +61 (3) 9005 9847
Fax: +61 (3) 9012 5857
Email
: lesleypocock@mediworld.com.au
.........................................................

Editorial Enquiries -
abyad@cyberia.net.lb
.........................................................

Advertising Enquiries -
lesleypocock@mediworld.com.au
.........................................................

While all efforts have been made to ensure the accuracy of the information in this journal, opinions expressed are those of the authors and do not necessarily reflect the views of The Publishers, Editor or the Editorial Board. The publishers, Editor and Editorial Board cannot be held responsible for errors or any consequences arising from the use of information contained in this journal; or the views and opinions expressed. Publication of any advertisements does not constitute any endorsement by the Publishers and Editors of the product advertised.

The contents of this journal are copyright. Apart from any fair dealing for purposes of private study, research, criticism or review, as permitted under the Australian Copyright Act, no part of this program may be reproduced without the permission of the publisher.

November 2017 - Volume 15, Issue 9

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger aqua-alcoholic extract after removing mandibular wisdom teeth


Sahar Zandi (1)
Seyyed Muhammadreza Alavi
(2)
Kamran Mirzaie
(3)
Ramin Seyedian
(4)
Narges Aria
(5)
Saman Jokar (6)

(1) Dentistry faculty, Bushehr University of Medical Sciences, Bushehr, Iran
(2) Dentistry faculty, Bushehr University of Medical Sciences, Bushehr, Iran
(3) Department of Social Medicine, Medicine faculty, Bushehr University of Medical Sciences, Bushehr, Iran
(4) Department of Pharmacology, Medicine faculty, Bushehr University of Medical Sciences, Bushehr, Iran
(5) Department of Oral & Maxillofacial Radiology, Dentistry faculty, Bushehr University of Medical Sciences, Bushehr, Iran
(6) Department of Oral & Maxillofacial Surgery, Dentistry faculty, Bushehr University of Medical Sciences, Bushehr, Iran

Corresponding Author:
Saman Jokar
Department of Oral & Maxillofacial Surgery,
Dentistry faculty, Bushehr University of Medical Sciences,
Bushehr, Iran
Tel: +989170412008
Email: saman.jokar@yahoo.com

Abstract

Introduction:
Removing wisdom tooth is one of the most damaging facial surgeries encountered. Dexamethasone is a complex of drugs used that has many side effects. On the other hand, ginger has anti-inflammatory properties without side effects. Therefore, this study compared anti-inflammatory properties of two soft tissue injections of dexamethasone sodium phosphate 1/6 mg, using topical mucobioadhesive containing ginger extract.

Method:
45 healthy patients were selected without any systemic diseases with double-sided wisdom teeth that they intended to have removed. Two-way teeth of the patients were removed by a similar procedure by maxillofacial surgeon. On one side of 2 cm² of mucobioadhesive containing ginger extract (20%) and on the other side, dexamethasone phosphate 1/6 mg was used. The maximal oral opening rate was measured by the researcher before surgery and 24 and 72 hours after surgery to evaluate Trismus.

Results:
45 patients with an average age of 28 years participated in this study. During the measurements, the mean of maximum mouth opening before teeth removal was 47/48 mm. At the side using the mucobioadhesive containing ginger extract (20%) this value after 24 hours was 39/57 and after 72 hours was 40 mm. At the side using dexamethasone phosphate 1/6 mg this value after 24 hours was 46/42 and after 72 hours was 44/55 mm.

Conclusion:
Based on the statistical data obtained from this study, it seems that topical administration of tissue glue containing ginger extract (20%) and soft tissue injection of dexamethasone sodium phosphate (1/6 mg) after surgery both reduced trismus after surgery. But dexamethasone sodium phosphate was slightly more successful than the mucobioadhesive containing ginger extract.

Key words: third molar removal, trismus, mucobioadhesive, ginger, dexamethasone sodium phosphate,


INTRODUCTION

Nowadays, the act of removing wisdom teeth, whether surgically or non-surgically, is one of the most commonly used actions by general and specialized dentists. Many reasons cause patients and dentists to remove the wisdom teeth. In this regard, root analysis of second molar tooth (in case of a false growth pattern of the tooth (horizontally), the formation of cysts and tumors with dental origin around the latent wisdom teeth, which may be benign or malignant depending on the lesion, jaw bone weakening by a latent tooth and lacking the mechanical strength of the jaw bone against impact, and facing irregularity and mess in the rest of the jaw teeth can be observed (1). Also, extensive caries or damage in the pulp of the wisdom teeth due to the difficulty of working conditions and performing root canal surgery on these teeth, as well as weakness, inability of the patient to cooperate or patient’s desire, is a preferred decision to remove wisdom teeth. The prevalence of impacted wisdom teeth in the mandible has been reported 31/9% in mandibular left third molar, and 28% in mandibular right third molar. Based on the abundance of data, it includes the following types: The mesioangular impacted teeth (43%), Vertical impaction (38%), distoangular impaction (6%), horizontal impaction (3%). In general, tooth extraction toughness (easy to hard, respectively) is as follows: Vertical, angle to mesial, horizontal, angle to distal (2). In general, the most common problems after removing the wisdom tooth are complications such as pain, swelling, trismus, and the anesthetic of the lingual nerve, infection, etc. which occur due to the trauma to the tissue and the inflammation caused by it (3, 4). Inflammation is the natural defense mechanism of the body to damage or cell death, which is characterized by redness, warmth, pain and swelling in the area (5). When tissue damage occurs, a large amount of histamine, bradykinin, serotonin, and other chemicals are released in the area. These substances, in particular, histamine, cause local vasodilatation, increased blood flow to the affected area, as well as the permeability of the capillaries and venules (6-8). Following this, edema occurs which itself causes the patient’s unpleasant experience, pain, disability and possibly greater paresthesia (9). The complications of removing these teeth and surgical pain that occurs in 90% of patients with moderate to severe severity and the effect on the daily activities of the patient, has turned the removal of pain and discomfort into one of the important goals in dentistry. And for many years, science has sought to find ways to reduce pain (10, 11).

In this context, these strategies include less manipulation during surgery, maintaining periost health, taking painkillers, corticosteroid injections, etc. (12). Nowadays, drugs such as non-steroidal anti-inflammatory drugs, drug-containing painkillers and corticosteroids, etc. are available to reduce pain and side effects (6). The use of corticosteroid drugs, such as dexamethasone and betamethasone, is also one of the methods for controlling pain, swelling and trismus after wisdom teeth surgery (13, 14). Dexamethasone is a pharmaceutical and long-acting form of corticosteroids (half-life of the plasma is 110-120 minutes and the biological half-life is 36-45 hours). One of the most useful methods is intraoral injection of dexamethasone, which has already been reported to have an effect on pain and edema caused by dental surgery similar to that of intramuscular injection (15). Therefore, it has a significant effect on postoperative pain and edema. Even mucosal injections are better than muscle injections due to less complications and equal effects (16).

Despite the benefits mentioned, this drug has different short-term and long-term complications (17, 18). The most common side effects of dexamethasone that appear in the short term include euphoria, insomnia, decreased or blurred vision, frequent urination, irritation, excessive thirst, numbness, mental weakness, pain and swelling, allergy, infection at the injection site, pain at the injection site, restlessness, skin rash, redness, eye sensitivity to light, gastrointestinal ulcer and the most important complications are seizure, heart failure, bloody stools, heart rate disorder, muscle pain and muscle weakness, menstrual disorder, nausea and vomiting, pain in the back of the arms, headache, swelling of the legs, etc. (19). Due to its anti-inflammatory effects, dexamethasone is one of the most widely used drugs in Iran and an overdoing process of consuming it has taken place. (20).

Given the complications, new research suggests the use of complementary medicine, especially herbal medicine, as a low-cost treatment with minimal side effects. Ginger is one of the most widely used medicinal plants, which has been introduced in ancient medicine as an anti-inflammatory herb (21). The antioxidant and anti-inflammatory properties of ginger are well known and are influenced by substances such as gingerol in this plant. Its anti-cancer properties have also been proven inside the laboratory. In the process of drying ginger, gingerol is converted to shogoal (22).

Recent research has proven shogoal’s properties in preventing Alzheimer’s disease. The active compounds of this plant, such as zingerone, shogaol, gingerdion, gingerol have the ability to inhibit the production of prostaglandins and nitrite oxide and even interleukins involved in inflammation. In addition, and more specifically, the enzymes that produce these inflammatory mediators are controlled by the active ingredients of ginger (23).

With regard to the above, and that wisdom teeth surgery is one of the most commonly used traumatic dentistry actions that causes a patient significant inflammation and pain, and on the other hand, suggested strategies to reduce this distressing pain are the use of steroidal anti-inflammatory and non-steroidal anti-inflammatory drugs, which they themselves cause serious damage, including digestive, cardiovascular and bone damage; therefore, considering the anti-inflammatory and analgesic properties of ginger extract which is a medicinal herb with high efficiency and low side effects, it seems that if it is effective, it can replaced a harmful steroidal drug. Therefore, this study, by comparing the effect of topical application of ginger aqua-alcoholic extract with topical injection of dexamethasone 1/6 mg, intends to introduce this method, in case of efficiency, as an alternative to dexamethasone injection.


MATERIALS AND METHODS


45 patients referred to the Bushehr faculty of Dentistry clinic in 2017 who had double mandibular wisdom teeth and were referred to have a simple tooth extraction (without surgery) or extraction with surgical procedures. The similarity of the two mandibular teeth was determined by an expert Oral & Maxillofacial radiologist through panoramic radiography images and based on the indications in the radiology images and the classifications available in the reference books as well as by a clinical examination by a Oral & Maxillofacial surgeon to make sure that the angle of tooth placement in the jaw, the amount of bone and soft tissue on the tooth, as well as the condition of the tooth is similar to that of the Ramos anterior border. The tooth extraction toughness was determined by the Winter’s & Terence guidelines and the Pell-Gregory criteria (24). Patients underwent injections of two carpule of lidocaine anesthetics using the method of inferior alveolar nerve block and long buccal, then teeth were removed by maxillofacial surgeon and under the mucoperiosteal flap cutting procedure (if surgery was required) or by simple dragging. Then, with a random choice based on random numbers, 4 cm² of bioadhesive containing 20% ginger extract was placed in the extracted cavity, or 1/8 ml dexamethasone 1/6 mg was injected there.

Criteria for entering the study:
The patient has a double-sided dental wisdom in the lower jaw (according to the angle of tooth placement in the jaw, the amount of bone and soft tissue on the tooth, the condition of the tooth relative to the Ramos anterior border), and has a tendency to cooperate and has no prohibition of dental surgery and allergy to ginger. The mentioned tooth do not have any pathological lesions in the root zone in clinical and radiographic examinations. Failure to perform any other surgery for at least two weeks.

Criteria for exiting the study:
Systemic diseases, including kidney or liver, bleeding problems such as hemophilia, neutropenia, blood platelet deficiency, etc., previous or current stomach ulcers, any heart disease, known allergies, allergies or individual reactions to each of the medicines used or the medicines that are likely to be used in the study (Ginger, Lidocaine anesthesia, Acetaminophen Codeine 300, Gelofen 400, Amoxicillin 500, and Metronidazole 250 mg), pregnancy and lactation, the use of analgesic or anti-inflammatory drugs 24 hours before the study, taking any anti-inflammatory or analgesic medicine etc., except for the prescribed analgesic substance (acetaminophen Codeine 300 mg), having pain and other inflammatory symptoms including swelling, high blood pressure, any deviations and inability to open the full mouth before the study, smoking or consuming other tobacco products less than a week before the study, smoking or consuming other tobacco products up to two weeks after surgery, alcohol consumption.

The amount of opening the patient’s mouth before surgery (Trismus Status Review) was measured and recorded using a tool named “Caliper” in each side, 24 hours and 72 hours after surgery.

The method of data collection and statistical analysis

The method of collecting information in this study field and its tool was a questionnaire, observation and checklist. Descriptive statistics, abundance (percentage) and mean (standard deviation, mean, and range) were used to analyze the data, and for the inflation situation, the McNemar test was used at a significant level of 0.05 and using SPSS V.19 statistical software.