[Daily rhythmic differences in the duration of the effect of various local anesthetics].
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Biomedical subjects
Publications and source records attributed to L Pöllmann.
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The course of a swelling after oral surgery was investigated by measuring the distance Tragus-Pogonium. The postoperative swelling does not diminish continuously, but changes according to a circaseptan (about 7-days) rhythm. Antiphlogistic drugs may reduce the extent of the postsurgical swelling, but they also disturb the reactive periods of the circaseptan rhythms. This could indicate either an acceleration of wound healing or a damping down or disturbance of the regenerating mechanisms of the organism. At the present, however, a decision cannot be made, although this question is of considerable clinical importance.
In accordance with clinical experience, the duration of the action of a local anaesthetic agent used in dental surgery changes depending on the time of day. A statistically significant circadian rhythm in the duration of a local anaesthesia produced by mepivacaine, was found in teeth. The longest duration was ascertained at approximately 15.00 (3 p.m.), the shortest at night and in the early morning. These findings coincide with the results of other authors concerning other organs as well.
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The course of swelling after maxillo-facial surgery was investigated by measuring the distance from the tragus to the pogonium. Post-operative distension does not diminish progressively, but decreases in a circaseptan rhythm. Antiphlogistic agents reduce the extent of the post-surgical swelling, but they also disturb the circaseptan reactive periodicity. This could indicate either an acceleration of the wound healing or a damping down or disturbance of the regeneration mechanisms of the organism. Although this question is of considerable clinical importance, present research has not yet provided an answer.
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A maximum of the pain sensibility of the teeth is found during the night. Simultaneous observations of epicritic and nociceptive functions reveal an opposite circadian cycle. During the day-time an analgesic agent effects in the teeth a quicker and longer elevation of the pain threshold than in the night-hours. During the day a placebo results in a greater and more rapid increase of the pain threshold in teeth than during the night.
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More than 2000 young "healthy" men were asked whether they had noticed sounds emanating from the temporo-mandibular joints when being examined in connection with preventive dentistry. They were examined subsequently. About 20% of the patients said they had noticed occasional sounds emanating from the jaw joints; on palpation, crepitation or clicking was found in more than 10%. Auscultatory examination demonstrated sounds in almost 80% of the individuals examined. Phonographically a smaller group demonstrated sounds in more than 90% of the young men. The evaluation of the symptom "sounds in the joint", important in general practice, is not easy when one considers its frequency in "healthy" individuals.
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The occurrence of hyperplastic alterations of the gingiva were surveyed in the context of employment physicals for 3000 young "healthy" men. Hyperplastic alterations of the gingiva were found in 21% of the subjects; a so-called dirt gingivitis with hyperplasia of the interdental papillae was present in 12%. The etiology could not be determined with 8%; smoking habits may be influential here.
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Placebo doses can influence the pain threshold of healthy teeth according to the label. Systematic longitudinal researches over the day with measuring the utilization time of cold stimulus on healthy front teeth demonstrate that the placebo effect is subject to significant circadian variations. During daytime a pseudo-analgesic causes a stronger and steeper onset of increase of the tooth pain threshold than during the night, when the pain threshold is influenced only minimal or even inverse. The placebo effect can come up to 40% of the pain threshold increase caused by a usual analgesic; this portion, however, is as well subject to high circadian variations. The extent of the placebo effect corresponds to the order of magnitude of the spontaneous circadian variations of pain threshold and correlates positively to it. These correlations are considered as indicating that those vegetative mechanisms causing the circadian variations of the pain threshold are equally involved in affecting the placebo actions.