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Drug-Free Oral Wound Dressing Makes for Happier Patients (and a More Pleasant Office) Dr. Haroon Ismaili

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For decades science has recognized that wound dressings are extremely important components of wound care and are necessary for optimal wound healing. Wound dressings perform three basic functions: they protect wounds, they help prevent infection and they maintain optimal moisture. Maintenance of optimal moisture is not typically a major problem in the mouth, although, ironically, many products used to treat oral wounds cause the same cell damage or death that a dry environment would cause. For example, many products currently in use might contain alcohols, iodine, chlorhexidine, topical anesthetics or other harsh chemicals known to be toxic to cells such as fibroblasts and endothelial cells.1-3 Damage to these cells can impair the wound healing process. Protection of wounds and prevention of microbial colonization is extremely important in wounds of the mouth, where a vibrant and varied microbiota flourish. Unfortunately, standard wound dressings are not practical in dentistry.

Unlike medicine, where the thought of sending a patient home with an open wound would be considered malpractice, in dentistry, we typically send patients home with gaping wounds (e.g. tooth sockets) with nothing more than a prescription for pain medication, a pat on the back and a cursory "Good Luck" – not ideal for compromised tissues in such a hostile environment as the mouth. So, dentists resort to the use of various antimicrobial rinses (cytotoxicity and all), coverage with systemic antibiotics or, just as often, no treatment at all. Dentistry needs a practical, predictably effective means to manage intraoral wounds. An ideal product for oral wounds:
  • would adhere to injured tissues for a sustained period of time.
  • would protect wounds from irritation and contamination.
  • would provide significant, continuous pain relief.
  • would not damage the cells involved in wound healing.
  • would have no contraindications.
  • could be used as often as needed to continuously provide protection and pain relief.
Standard products that contain drugs or harsh chemicals cannot meet all of these requirements. Drugs with contraindications and harsh chemicals such as chlorhexidine are toxic to cells necessary for wound healing. A great need exists for a drug-free product free of toxic chemicals.

Turns out, a product like this already exists. It's a topical gel called SockIt. Our oral surgery practice has used it for the last three years. This product is drug-free, is comprised entirely of all-natural, food-grade ingredients and provides all the benefits listed. Pain relief is without numbness, because the product contains no anesthetics. Most patients prefer an analgesic effect to an anesthetic effect, so this is another plus for this product.

We use this product in all our surgery patients (almost 5,000 to date) because they obtain more pain relief than that provided with prescription medication only. This observation mirrors the results seen in immediate denture patients who experienced significant pain relief within one minute with this product, with increasing relief over time, above that provided by narcotic alone (see chart at bottom of this page).4 We have also seen a dramatic decrease in the incidence of alveolar osteitis (dry socket) and other post-operative complaints. This obvious benefit to our patients translates to a more enjoyable office environment. Our staff enjoys the reduced number of phone calls regarding post-operative complaints, and I enjoy the reduced stress of treating happy patients.

In addition to improved patient care, the product provides another income center for our office. We include it in all our treatment plans, apply it at the time of surgery, then send it home with patients with instructions to use it as often as needed to maintain comfort and to use for wound management. Most patients obtain about three to four hours of pain relief before the gel washes away, so they need to use it four to six times each day to stay comfortable and to keep the wound protected. Many patients return to the office and ask for more of the product. They like the ability to stay comfortable without numbness, and without the effects of narcotics. In addition, the office benefits from fewer phone calls handled by our staff, and less chairtime addressing post-operative complaints at no charge to the patient.

Many well-known products claim to be all-natural; however, almost all of them contain one or more man-made compound. Generally, these agents should not be swallowed because of potential adverse effects. Natural food ingredients, on the other hand, are by nature, very safe, and the body already knows how to metabolize and dispose of foods. This product is comprised of nutrients in concentrations equal to or less than those found in the food sources, which assures even greater safety.

Various essential oils in foods are known to be antibacterial, antifungal and antiviral.5-8 Tests conducted by a registered microbiology laboratory demonstrated that this product is as effective or more effective than a generic of Peridex (Chlorhexidine Gluconate Oral Rinse [chlorhexidine gluconate 0.12%]; CVS Pharmacy) against three candidal species, and 14 bacterial species that are implicated in dental decay, periodontitis, streptococcal pharyngitis, bacterial endocarditis, pulmonary infections and other conditions (unpublished data, see table on right).

Acetylated mannans are safe, potent stimulators of macrophage activity. Macrophages are large phagocytic cells that clear wounds of pathogenic microbes, debris and damaged tissues. Macrophages are also the cells that control the wound healing process. Their enhanced activity results in increased infection control and faster healing.9-12 With this product we now have the benefits of both the safety and efficacy provided by certain nutrients for use intraorally.

According to the ADA, each year in the U.S. there are approximately:
  • 46 million teeth extracted.
  • 569,000 gingivectomy or gingivoplasty procedures.
  • 834,000 osseous surgeries.
  • 500,000 bone replacement grafts.
  • hundreds of thousands of other periodontal procedures.
  • two million surgical implants placed.
  • 13 million scaling and root planing (SRP) procedures.
  • five million complete dentures delivered, many of which are immediate dentures.13
This all-natural product is ideal for treatment of all these indications. It performs three important functions that are not provided by any other single product:
  1. It reduces microbial contamination by means of its potent preservative system.
  2. It alleviates pain without drugs by patient-controlled, unrestricted use.
  3. It provides mannans to activate macrophages and promote optimal healing.
To summarize, this drug-free, all-natural product provides our patients the safest and most effective pain management, as well as optimal wound care, that has ever been available in dentistry. We no longer have to rely on drugs or harsh chemicals, with their potential adverse effects, to manage wounds and address pain. Hopefully, other similar products will be developed for use in medicine as well as in dentistry. Their use will result in happier, healthier patients, which also means happier staff and doctors, and that is a winning scenario for everyone!

Disclaimer – Dr. Ismaili is not affiliated in any way with SockIt! gel or its manufacturers.





References
  1. Cabral CT, Fernandes MH. In vitro comparison of chlorhexidine and povidone-iodine on the long-term proliferation and functional activity of human alveolar bone cells. Clin Oral Investig 2007;11(2):155-64
  2. Wilken R et al. In vitro cytotoxicity of chlorhexidine gluconate, benzydamine-HCl and povidone iodine mouthrinses on human gingival fibroblasts. SADJ 2001;56(10):455-60
  3. Harris KL et al. The effect of topical analgesics on ex vivo skin growth and human keratinocyte and fibroblast behavior. Wound Repair Regen 2009;17(3):340-6
  4. Kennedy TJ, Hall, JE. A drug-free oral hydrogel wound dressing for pain management in immediate denture patients. Gen Dent 2009;57(4):420-7
  5. Lambert et al. A study of the minimum inhibitory concentration and mode of action of oregano essential oil, thymol and carvacrol. J Appl Microbiol 2001;91(3):453-62
  6. Chaieb K et al. The chemical composition and biological activity of clove essential oil, Eugenia caryophyllata (Syzigium aromaticum L. Myrtaceae): a short review. Phytother Res 2007;21(6):501-6
  7. Burt S. Essential oils: Their antibacterial properties and potential applications in foods – a review. Int J Food Micobiol 2004;94(3):223-53
  8. Oussaiah M et al. Mechanism of action of Spanish oregano, Chinese cinnamon, and savory essentail oils against cell membranes and walls of Escherichia coli O157:H7 and Listeria monocytogenes. J Food Prot 2006;69(5):1046-55
  9. Schepetkin IA et al. Botanical polysaccharides: Macrophage immunomodulation and therapeutic potential. Int Immunopharmacol 2006;6:317-33
  10. Jettanacheawchankit S et al. Acemannan stimulates gingival fibroblast proliferation, expressions of keratinocyte growth factor-1, vascular endothelial growth factor, and type I collagen; and wound healing. J Pharmacol Sci 2009;109(4):525-31
  11. Tizard IR et al. The biological activities of mannans and related complex carbohydrates. Mol Biother 1989;1(6):290-6
  12. Plemons JM et al. Evaluation of acemannan in the treatment of recurrent aphthous stomatitis. Wounds 1994;6(2):4
  13. American Dental Association: 2005-06 survey of dental services rendered. www.ada.org 2007; 34-40
Author’s Bio
Dr. Haroon Ismaili received his DDS from New York University and completed his residency in oral and maxillofacial surgery at the Washington Hospital Center in Washington, D.C. He is a diplomate of the American Board of Oral and Maxillofacial Surgery, and is a fellow of the American College of Oral and Maxillofacial Surgeons and the International Society of Oral and Maxillofacial Surgery. Dr. Ismaili practices oral and maxillofacial surgery in Arlington, Texas.
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