Discussion
Oral surgical wound is painful and is associated with prolonged healing. There are limited topical analgesics for pain management. Our study shows an initial moderate pain score of 4.20 at day 0 with the same baseline characteristics between groups. After 14-day period of Sucralfate in the experimental group, the pain score was significantly reduced early on in the postoperative period (p=0.007 at day7). At day 3, the Sucralfate group had a significant reduction pain score up to 44.1% from baseline while in the control group, it took more time for pain score to be reduced by 50.26% at day 7. This correlates with the previous study of post tonsillectomy [1] and post uvuloplasty wound [2] in which Sucralfate has great effect on improving postoperative pain. This could be explained by the mechanism of Sucralfate and how direct contact with the open wound surface can seal it underneath from the external environment. However, the coating barrier formed by Sucralfate in this suspension form (1g/5ml) wears off from the epithelial surface in 5-6 hours[6], so it is recommended to reapply Sucralfate every 5-6 hours.
Adverse reactions from Sucralfate use have reported minor and rare including bloating and constipation in high dosage. Systemic absorption is only 2-5% through the gastrointestinal tract. Sucralfate use of up to 12g/day has not been found to be a lethal dose[7]. In our study, we found no adverse effect from Sucralfate and in terms of wound healing, Sucralfate also shows no interference with the healing process. A previous clinical trial studying Sucralfate use in post tonsillectomy wound[1] and major aphthous ulcer[3] even found that Sucralfate accelerates reepithelialization time. Theoretically, Sucralfate could facilitate the healing process by recruiting essential cytokines in the inflammatory stage (days 0-3) and by its coating effect, provides an optimum wound healing environment in the proliferative or reepithelialization stage (weeks 1-2) of wound healing. However, in this study Sucralfate group showed neither superior nor inferior effect in wound healing promotion. Wound grade distribution and wound length reduction were the same at all time points in both groups over the 2-week postoperation period.
Although there are no previous clinical studies about wound healing process, specifically in oral surgical wound, a preclinical experimental study [6] and some previous clinical studies in oral surgical secondary healing wound [1,2,8] have reported that it takes about 2 weeks for complete epithelialization similar to other area of mucosal wound. Still, only 15.4% of our sample population had complete reepithelialization at day14.