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.