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Description
"Introduction
Wisdom tooth extraction is one of the most common surgeries carried out in the UK, and is notorious for causing post-operative complications. 1 in 6 patients experience a condition called alveolar osteitis “dry-socket” after wisdom tooth removal; a condition where the blood clot is lost and the extraction socket becomes painful. The condition is a serious problem and causes a financial burden to the NHS, with repeat hospital visits required. Treatment is aimed at managing the pain at the site of the extraction until the natural process of healing has occurred; this can take a number of weeks. Painkillers can be difficult to swallow due to soreness at the extraction site. Pain following wisdom tooth extraction and also dry-socket could be alleviated by the development of an oral patch to cover the wound post-surgery. We have recently developed a biodegradable, mucoadhesive oral patch that demonstrates long residence times in vivo (Santocildes-Romero et al., 2017). The patches are comprised of a two-layer electrospun polymer system; a highly bio-adhesive inner layer and an outer saliva-resistant, durable yet flexible protective layer. Here, we hypothesised that oral patches fabricated to contain the local anaesthetic, bupivacaine hydrochloride, and steroid, prednisolone, placed over a post-surgical socket could reduce post-operative pain, whilst also acting as a physical barrier to prevent blood clot dislodgment or bacterial infection.
Methodology
Patches were fabricated using uniaxial electrospinning, and the incorporation of bupivacaine and prednisolone investigated. Patches were characterised by examining fibre diameter, mass uniformity, thickness, pH, adhesion, swelling index, as well as measuring drug release.
Results
Fabricated oral patches were consistent in mass, fibre diameter and thickness. The patch was slightly alkaline when submerged in artificial saliva. Bupivacaine hydrochloride and prednisolone were released rapidly from the patch within the first 15 minutes, followed by gradual drug release over the next 45 minutes. In total the patches were able to release 0.3 mg of both bupivacaine and prednisolone over 60 minutes. An in vitro adhesion assay confirmed the ability of patches to attach to the oral mucosa for prolonged periods.
Conclusion
These data suggest that the mucoadhesive patches constitute a promising method for the prevention of post-operative pain and dry socket.
Santocildes-Romero, M., et al., ACS Applied Materials & Interfaces. 9(13), 11557-11567 (2017).
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