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Analgesic effect of Apernyl® and phenol-camphor solution on alveolitis
Int. J. Oral Surg. 1975: 4:157-159 (Key words: alveolitis," a~algesic~)
Analgesic effect of Apernyl | and phenol-camphor solution on alveolitis RISTO LEHTINEN
Department o/ Oral Surgery, Institute of Dentistry, University of Turku, Turku, Finland
AaSTmtCT -- Phenol-camphor or Apernyl| were applied in 82 patients in whom alveolitis had been diagnosed. The effect of the drugs was recorded during the following days according to the patients' subjective judgment. The analgesic effect of Apernyl was significantly better than that of phenol-camphor. The treatment with phenol-camphor took an average of 1.8 days longer than that with Apernyl.
(Received for publication 10 March, accepted 4 May 1975)
Phenol-camphor solution2 has been used in the treatment of alveolitis in Scandinavia~2 and Finland1~ 13. T a m p o n a d e is usually performed daily. K6IaLE• G maintained that the effect of phenol-camphor lasts less than 24 hours and recommended more frequent packing of tampons. One of the newest drugs used in alveolitis is Apernyl| Its application has been recommended by MENZEL~, NEURER & SCHEGG 8, KJELLMAN n, and KESKITALO PERSSON 4. NORDENRAM ~r BANG~ have filled bone cavities in guinea pigs with Apernyl; no histologic differences were noted in the course of healing between the filled and control cavities. Apernyl inhibits fibrinolytie activity in alveolitisL It blocks the activatorproactivator plasminogen reaction ~1. The purpose of this investigation was to compare the analgesic effects on alveolitis of phenol-camphor and Apernyl.
Material and methods The subjects were 82 patients in whom alveo~ litis had been diagnosed at the Institute of Dentistry, University of Turku, Pain, disappearance of the blood clot and putrid odor were considered the signs of alveolitis. The patients were divided into two groups according to the degree of difficulty of the extraction. In one group the bone had been drilled during extraction; in the other group no drilling had been performed. The distribution of patients as to difficulty of operation was similar for both phenol-camphor and Apernyl treatment. An alveolar cone of Apernyl contains 32 mg acetylsalicylic acid, 3 mg propylic ester of p-hydroxy-benzoic acid and 20 mg tablet mass of unknown composition. The propylic ester of p-hydroxy-benzoic acid alone may have an antifibrinolytic effectz~. Phenol-camphor was applied by filling the alveolus loosely with gauze amply impregnated with the solution. Medication with Apernyl was performed by placing two cones in the sockets of extracted molars and one cone in the extraction sites of other teeth, The alveoli
158
LEHTINEN
were rinsed with physiologic saline prior to medication. The effect of the drugs was recorded during the following days, beginning about 24 hours after application, and was evaluated according to the patients' subjective judgment, using a three-grade scale: (1) pain totally disappeared, (2) pain mild but continuing, or recommencing before the next application of analgesic, and (3) severe pain continuing unchanged in spite of medication.
Results The analgesic effect of ApernyI was significantly (P "< 0.01) better than that of the phenol-camphor solution (Table 1). During the first 24 hours the number of totally painless cases was significantly (P < 0.01) greater in the Apernyl group than in the phenol-camphor group. Patients whose pain disappeared en the first day remained free from pain. Of the 35 patients whose pain was moderated by phenol-camphor in the first 24 hours, 19 were completely free from pain the following day. Treatment was continued daily until the alveolus was no longer sore. On average this took 1.8 days longer with phenolcamphor t h a n with Apernyl. No side-effects were noticed with phenol-camphor. In the Apernyl group one patient had an eczematype rash covering the whole body. This disappeared when the medication was over. The patients had not previously shown signs of being sensitive to acetylsalicylic acid.
Discussion Earlier investigations~, s have d e a r with cases in which Apernyl was the only drug used, or in which the effect of an A p e m y l cone was compared with that of a placebo ~. In this investigation the effects o f two drugs in the treatment of alveolitis are compared. Since the analgesic effect of A p e r n y l was better and the medication times s h o r t e r than those of the p h e n o l - c a m p h o r solution, A p e r n y l seems preferable in t h e t r e a t m e n t of MveoIitis. Phenol, which dissoIves b u t has a weak chemical bond to the surrounding phase, makes the phase an antiseptic 3. The results of this investigation support K~JHLER'S opinion G that the effect of the phenol-camphor solution lasts only 6-8 hours. The results of this study agreed with those of KESKITALO ~Y~PERSSONa.
References 1. BIRN, H.: Antifibrinolytie effect of Apernyl in "dry socket". Int. J. Oral Surg. 1972: 1: 190-194. 2. CHL~rMSKY, V.: Ober die Behandlung der chirurgischen Infektionen mit Phenolkampfer. Zentralbl. Chir. 1905: 857-860. 3. HAUSCmLD, F.: Pharmakologie und Grundlagen der Toxikologte. Thieme, Leipzig 1961, p. 69. 4. I~SKIT^LO, E. & PERSSON, G.: A clinical trial of Apemyl| cones and tamponade with Ward's Wonder Pack| in treatment of dry socket. Swed. Dent. J. 1973: 66: 197-210.
Table 1. Incidence of pain 24 hours after the application of Apernyl and according to the patient's subjective judgment No pain
Pain moderated
phenol-camphor
Pain unchanged
Total
Apernyl
24
89 %
3
11%
-
0%
27
Phenol-camphor
20
34 %
35
59 %
4
7%
59
Total
44
51%
38
44 %
4
5%
86
EFFECT OF APERNYL|
5. KJELLMAN,O.: Apernyl as alveolar inlay in connection with the removal of impacted third molars of the lower jaw. Swed. Dem. J. 1973: 66: 197200. 6. K6HLER, J.: Zahn~irztliche Chirurgie. 1st ed. Dr. Alfred Hiittig, Heidelberg 1953, p. 163-165. 7. MF.NZEL, H. J.: Die Behandlung der Osteiris post extracfionem mit Apernyl| Dtsch. Zahnaerztebl. i969: 23: 80-83. 8. NEtmE~t, O. & ScHg~O, H, K.: Erfahrungen rnit Apernyl bei der Behandlung und Verhtitung des dolor post extractionem. Schweiz. Monatsschr. Zahnheilkd. 1969: "/9: 630-635. 9. NORDmqI~M, A. & BANG, B.: Bone-healing after topical application of Apernyl. A
Address: Lemminkliisenkatu 2 SF-20520 Turku 52 Finland
10.
11.
12. 13.
14.
ON ALVEOLITIS
159
histopathologic study in guinea pigs. Stand. J. Dent. Rex. 1970: 78: 544-546. RANT~N, A. V.: Fenolikamferiliuoksesta. Suom. Hammaslaeaek. Toim, 1957: 53: 127130. SC~IULTn, W.: Die antifibrinolyfische Wirkung -con Apernyl| Dtsch. Zahnaerztl. Z. 1971: 26: 863-870. THILANDER,H.: Svar och ansvar avd. Sven. Tandlaek. Tidn. 1951: 18: 812. TnLmX, I.: Muutamia nlikSkohtia bammaskirurgisesta tamponoinnista. Suom. Hammaslaeaek. Tolm. 1937: 58: 41-49. VEDTOFTE,P., Rrrzaiu, M. & DONaTSKY,O.: Use of propylic ester of p-hydroxy-benzoic acid ester after removal of impacted mandibular third molars. Int. J. Oral. Surg. 1974: 3: 394-399.
Analgesic effect of Apernyl | and phenol-camphor solution on alveolitis RISTO LEHTINEN
Department o/ Oral Surgery, Institute of Dentistry, University of Turku, Turku, Finland
AaSTmtCT -- Phenol-camphor or Apernyl| were applied in 82 patients in whom alveolitis had been diagnosed. The effect of the drugs was recorded during the following days according to the patients' subjective judgment. The analgesic effect of Apernyl was significantly better than that of phenol-camphor. The treatment with phenol-camphor took an average of 1.8 days longer than that with Apernyl.
(Received for publication 10 March, accepted 4 May 1975)
Phenol-camphor solution2 has been used in the treatment of alveolitis in Scandinavia~2 and Finland1~ 13. T a m p o n a d e is usually performed daily. K6IaLE• G maintained that the effect of phenol-camphor lasts less than 24 hours and recommended more frequent packing of tampons. One of the newest drugs used in alveolitis is Apernyl| Its application has been recommended by MENZEL~, NEURER & SCHEGG 8, KJELLMAN n, and KESKITALO PERSSON 4. NORDENRAM ~r BANG~ have filled bone cavities in guinea pigs with Apernyl; no histologic differences were noted in the course of healing between the filled and control cavities. Apernyl inhibits fibrinolytie activity in alveolitisL It blocks the activatorproactivator plasminogen reaction ~1. The purpose of this investigation was to compare the analgesic effects on alveolitis of phenol-camphor and Apernyl.
Material and methods The subjects were 82 patients in whom alveo~ litis had been diagnosed at the Institute of Dentistry, University of Turku, Pain, disappearance of the blood clot and putrid odor were considered the signs of alveolitis. The patients were divided into two groups according to the degree of difficulty of the extraction. In one group the bone had been drilled during extraction; in the other group no drilling had been performed. The distribution of patients as to difficulty of operation was similar for both phenol-camphor and Apernyl treatment. An alveolar cone of Apernyl contains 32 mg acetylsalicylic acid, 3 mg propylic ester of p-hydroxy-benzoic acid and 20 mg tablet mass of unknown composition. The propylic ester of p-hydroxy-benzoic acid alone may have an antifibrinolytic effectz~. Phenol-camphor was applied by filling the alveolus loosely with gauze amply impregnated with the solution. Medication with Apernyl was performed by placing two cones in the sockets of extracted molars and one cone in the extraction sites of other teeth, The alveoli
158
LEHTINEN
were rinsed with physiologic saline prior to medication. The effect of the drugs was recorded during the following days, beginning about 24 hours after application, and was evaluated according to the patients' subjective judgment, using a three-grade scale: (1) pain totally disappeared, (2) pain mild but continuing, or recommencing before the next application of analgesic, and (3) severe pain continuing unchanged in spite of medication.
Results The analgesic effect of ApernyI was significantly (P "< 0.01) better than that of the phenol-camphor solution (Table 1). During the first 24 hours the number of totally painless cases was significantly (P < 0.01) greater in the Apernyl group than in the phenol-camphor group. Patients whose pain disappeared en the first day remained free from pain. Of the 35 patients whose pain was moderated by phenol-camphor in the first 24 hours, 19 were completely free from pain the following day. Treatment was continued daily until the alveolus was no longer sore. On average this took 1.8 days longer with phenolcamphor t h a n with Apernyl. No side-effects were noticed with phenol-camphor. In the Apernyl group one patient had an eczematype rash covering the whole body. This disappeared when the medication was over. The patients had not previously shown signs of being sensitive to acetylsalicylic acid.
Discussion Earlier investigations~, s have d e a r with cases in which Apernyl was the only drug used, or in which the effect of an A p e m y l cone was compared with that of a placebo ~. In this investigation the effects o f two drugs in the treatment of alveolitis are compared. Since the analgesic effect of A p e r n y l was better and the medication times s h o r t e r than those of the p h e n o l - c a m p h o r solution, A p e r n y l seems preferable in t h e t r e a t m e n t of MveoIitis. Phenol, which dissoIves b u t has a weak chemical bond to the surrounding phase, makes the phase an antiseptic 3. The results of this investigation support K~JHLER'S opinion G that the effect of the phenol-camphor solution lasts only 6-8 hours. The results of this study agreed with those of KESKITALO ~Y~PERSSONa.
References 1. BIRN, H.: Antifibrinolytie effect of Apernyl in "dry socket". Int. J. Oral Surg. 1972: 1: 190-194. 2. CHL~rMSKY, V.: Ober die Behandlung der chirurgischen Infektionen mit Phenolkampfer. Zentralbl. Chir. 1905: 857-860. 3. HAUSCmLD, F.: Pharmakologie und Grundlagen der Toxikologte. Thieme, Leipzig 1961, p. 69. 4. I~SKIT^LO, E. & PERSSON, G.: A clinical trial of Apemyl| cones and tamponade with Ward's Wonder Pack| in treatment of dry socket. Swed. Dent. J. 1973: 66: 197-210.
Table 1. Incidence of pain 24 hours after the application of Apernyl and according to the patient's subjective judgment No pain
Pain moderated
phenol-camphor
Pain unchanged
Total
Apernyl
24
89 %
3
11%
-
0%
27
Phenol-camphor
20
34 %
35
59 %
4
7%
59
Total
44
51%
38
44 %
4
5%
86
EFFECT OF APERNYL|
5. KJELLMAN,O.: Apernyl as alveolar inlay in connection with the removal of impacted third molars of the lower jaw. Swed. Dem. J. 1973: 66: 197200. 6. K6HLER, J.: Zahn~irztliche Chirurgie. 1st ed. Dr. Alfred Hiittig, Heidelberg 1953, p. 163-165. 7. MF.NZEL, H. J.: Die Behandlung der Osteiris post extracfionem mit Apernyl| Dtsch. Zahnaerztebl. i969: 23: 80-83. 8. NEtmE~t, O. & ScHg~O, H, K.: Erfahrungen rnit Apernyl bei der Behandlung und Verhtitung des dolor post extractionem. Schweiz. Monatsschr. Zahnheilkd. 1969: "/9: 630-635. 9. NORDmqI~M, A. & BANG, B.: Bone-healing after topical application of Apernyl. A
Address: Lemminkliisenkatu 2 SF-20520 Turku 52 Finland
10.
11.
12. 13.
14.
ON ALVEOLITIS
159
histopathologic study in guinea pigs. Stand. J. Dent. Rex. 1970: 78: 544-546. RANT~N, A. V.: Fenolikamferiliuoksesta. Suom. Hammaslaeaek. Toim, 1957: 53: 127130. SC~IULTn, W.: Die antifibrinolyfische Wirkung -con Apernyl| Dtsch. Zahnaerztl. Z. 1971: 26: 863-870. THILANDER,H.: Svar och ansvar avd. Sven. Tandlaek. Tidn. 1951: 18: 812. TnLmX, I.: Muutamia nlikSkohtia bammaskirurgisesta tamponoinnista. Suom. Hammaslaeaek. Tolm. 1937: 58: 41-49. VEDTOFTE,P., Rrrzaiu, M. & DONaTSKY,O.: Use of propylic ester of p-hydroxy-benzoic acid ester after removal of impacted mandibular third molars. Int. J. Oral. Surg. 1974: 3: 394-399.