Lidocaine 0.05% / Chlorhexidine 0.2% oromucosal spray sugar free

ObjectiveOral mucositis (OM) is a debilitating complication of cancer therapies, affecting up to 85% of patients undergoing bone marrow transplantation and nearly all receiving head and neck radiotherapy. Characterized by mucosal inflammation, ulceration, and severe pain, OM significantly impairs oral intake, speech, and quality of life. These disruptions, compounded by complications such as infection, bleeding, and increased healthcare costs, often necessitate treatment delays or modifications, negatively impacting cancer prognosis. Recent insights into nociceptive and neuropathic mechanisms of OM-related pain have led to the development of innovative management strategies. Given the debilitating nature of OM in cancer patients and the critical need for effective pain control, this review aims to examine pharmacological advancements targeting the complex nature of OM-related pain, including agents such as lidocaine, doxepin, benzydamine, methylene blue, opioids, gabapentin, palifermin, caphosol, and ketamine.MethodsA literature search was conducted in the PUBMED, COCHRANE, and MEDLINE databases, covering studies from 2000 to 2024. Studies focusing on OM pathogenesis and pain management strategies were screened. Inclusion criteria encompassed randomized controlled trials, meta-analyses, and systematic reviews involving adult patients treated with lidocaine, doxepin, benzydamine, methylene blue, opioids, gabapentin, palifermin, caphosol, or ketamine for OM-associated pain.ConclusionOM pain arises from nociceptive and neuropathic pathways involving inflammatory cytokines and neuropeptides. Current interventions, including topical and systemic agents, have shown promise, yet variability in treatment protocols and limited high-quality evidence hinder standardized practices. This review highlights the clinical applicability of emerging therapies, such as avasopasem manganese, which has demonstrated efficacy in mitigating OM progression. Ongoing clinical trials targeting novel pathways that modulate mucosal inflammatory response and limit disease severity offer hope for improved pain relief. Addressing the multifaceted nature of OM-associated pain is essential for enhancing quality of life and optimizing cancer treatment outcomes. Further research is needed to establish robust, evidence-based guidelines for OM pain management.

Abstract licence: CC BY-NC

ObjectiveThis study aimed to assess and compare the healing outcome associated with different aqueous-based calcium hydroxide intracanal medicaments in patients with pulpal necrosis and symptomatic apical periodontitis.MethodsSeventy five patients with pulpal necrosis and symptomatic apical periodontitis in permanent mandibular molar teeth were selected as the part of this study. The participants were randomly allocated to three groups, each comprising 25 patients, based on the type of intracanal medicament used during the treatment procedure. Group 1 consisted of calcium hydroxide (CH) mixed with 0.9% saline (NS), Group 2 contained CH combined with 2% lidocaine, and Group 3 included CH with 2% chlorhexidine (CHX). The Periapical Index Score was utilized to assess the healing of periapical lesions in preoperative and post-operative periapical radiographs at 3 month intervals for 12 months. The Kruskal-Wallis test was used to determine the significance, with Post Hoc Dunn tests for multiple comparisons.ResultsAt the 12-month follow-up, the CH+CHX group demonstrated significantly improved periapical healing, with a mean PAI score of 1.57 +- 0.66, compared to CH+LA (2.27+-0.63) and CH+NS (2.48+-0.79), with Kruskal-Wallis pConclusionThe findings of this study indicate that CH when combined with 2% CHX as an aqueous vehicle demonstrated superior healing of periapical lesions in patients with pulpal necrosis and symptomatic apical periodontitis compared to saline or lidocaine.

Abstract licence: CC BY-NC

Background: Ventilator-associated pneumonia (VAP) is a major cause of infection in patients, and reducing oral cavity contamination can lower mortality rates due to VAP. This study evaluates the effects of the combined administration of three medications, colistin, chlorhexidine, and tobramycin, on the prevention of VAP. Materials and Methods: This double-blind randomized clinical trial was conducted on 96 patients connected to ventilators and admitted to the intensive care unit of Al-Zahra Hospital in Isfahan. The patients were randomly divided into three groups of 32. Over five days, they received “Colistin + Chlorhexidine,” “Tobramycin + Chlorhexidine,” and “Chlorhexidine-alone” four times daily. The Clinical Pulmonary Infection Score (CPIS), patients’ oral hygiene using the Beck Oral Assessment Scale (BOAS), and positive or negative results of oral and tracheal cultures were evaluated before and after the intervention. Results: The results of the present study showed that the CPIS score in the chlorhexidine + colistin group, with the mean of 7.23 ± 1.87, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 12.32 ± 2.67 and 14.05 ± 1.10, respectively (P = .038). Additionally, the BOAS score in the chlorhexidine + colistin group, with the mean of 3.04 ± 1.02, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 6.25 ± 2.00 and 7.06 ± 2.35, respectively (P = .042). Conclusion: Preventive and hygienic oral care is an effective factor in reducing VAP. There was no significant difference among the three treatment combinations in reducing the incidence of VAP. However, it appears that adding colistin may have a slightly better performance in preventing lung infections and inhibiting bacterial agents.

Abstract licence: CC BY-NC-SA 4.0

ObjectiveThis study compares the effects of Nanosil® mouthwash, a multi-component formulation containing hydrogen peroxide, silver ions, eugenol, and menthol and chlorhexidine on healing, pain, and complications following impacted mandibular third molar surgery. Impacted mandibular third molars extraction, often accompanied by complications like pain, dry socket, swelling, trismus, and infection. Mouthwashes are used to reduce infection risk and promote healing by eliminating oral microorganisms.MethodologyThis double-blind, randomized clinical trial involved 62 patients (aged 18-50 years) with Pell and Gregory A and B impacted third molars. Participants were allocated to two groups: 15 cc of Nanosil® mouthwash and 250 ml of 0.2% chlorhexidine mouthwash (Najo®) before and after surgery. Pain was assessed with the Visual Analog Scale (VAS), swelling was measured on days 1, 3, and 7, and wound healing was evaluated. Data were analyzed using t-tests and Mann-Whitney tests.ResultsHealing on day 3 was significantly better in the Nanosil group (p = 0.001). No infections or discharge were observed. A dry socket occurred in one patient in the Nanosil group, but it was not statistically significant. Swelling was significantly lower in the Nanosil group on day 3 (p ConclusionNanosil promoted better healing and reduced swelling compared to chlorhexidine on the third day post-surgery. No significant differences were found regarding pain, infection, discharge, or dry socket.Trial registrationThe study was registered in the Iranian Clinical Trials Center with the code IRCT20171216037893N6 on 16/12/2021. https://irct.behdasht.gov.ir/trial/60568 .

Abstract licence: CC BY-NC-ND

Selecting the appropriate surgical level in patients with multilevel cervical disc disease remains challenging when relying solely on clinical examination and magnetic resonance imaging (MRI) findings. Fluoroscopy-guided selective nerve root blocks (SNRBs) carry risks of vascular injury from inadvertent intra-arterial injection. This technical report describes the technical aspects of ultrasound-guided SNRB for preoperative surgical-level localization and provides a reproducible protocol for clinical implementation. The procedure utilizes a high-frequency (12 MHz) linear transducer with color/power Doppler capability. Transverse process morphology guides level identification: C7 exhibits a rudimentary anterior tubercle with a prominent posterior tubercle; C6 displays a sharp, prominent anterior tubercle; and C3-C5 demonstrate the characteristic "two-humped camel" sign. The vertebral artery is identified anterior to C7 and confirmed with Doppler. Using an in-plane posterolateral to anteromedial approach, a 25-gauge needle is advanced toward the oval hypoechoic nerve root between the anterior and posterior tubercles (or anterior to the posterior tubercle for C7). After negative aspiration, 1 mL of 1% lidocaine is injected. For multilevel assessment, sequential blocks are performed, with a minimum of four-hour intervals between injections, blocking from caudal to cephalad. A positive response is defined as ≥50% reduction in arm pain on the Visual Analog Scale at 30 minutes post-injection. This technique was developed and validated during a randomized controlled trial (NCT05145530), whose clinical outcomes have been published separately. The present technical report focuses on the procedural aspects. Ultrasound guidance enabled consistent visualization of target nerve roots in all 30 intervention patients (72 blocks). Power Doppler identified radicular arteries adjacent to nerve roots in 25% of procedures, allowing trajectory adjustment to avoid vascular puncture. No procedure-related complications occurred. The sequential block protocol successfully identified symptomatic levels in all patients, demonstrating the feasibility of the technique to inform surgical planning. Ultrasound-guided cervical SNRB is a safe, radiation-free technique that enables real-time visualization of nerve roots and vascular structures, thereby enhancing the safety profile compared to fluoroscopy-guided approaches. The detailed step-by-step technique described herein should enable other clinicians to incorporate this approach into practice for accurate preoperative level selection in patients with multilevel cervical disc disease.

Abstract licence: CC BY