Analgésicos, antimaláricos e anti-inflamatórios em Odontologia: análise de eventos adversos e uso racional para o controle da dor

Abstract

This doctoral thesis evaluated the profile of adverse events and the rational use of three drug classes—analgesics, antimalarials, and anti-inflammatories—in dental practice, with an emphasis on pain control and patient safety. It is organized into three complementary articles: 1. Scoping review on oral hyperpigmentation associated with chloroquine and hydroxychloroquine, which concluded that the risk and extent of hyperpigmentation correlate directly with both dosage and treatment duration of these antimalarials; 2. Systematic review of randomized clinical trials (RCTs) assessing the preemptive use of intravenous ibuprofen prior to lower third molar extraction; the included studies reported significant reductions in postoperative pain and overall analgesic consumption during the first 48 hours, supporting the benefit of this approach in hospital and medium-complexity outpatient settings; 3. Case report and literature review on toxic epidermal necrolysis (TEN) in a pediatric patient, featuring a PubMed survey that identified 69 eligible reports of drug-induced TEN. Concurrently, a clinical case of a six-year-old patient with dipyrone-associated TEN was described in detail, including the therapeutic protocol: immediate discontinuation of the suspected agent, standard topical wound care, and daily application of low-intensity laser therapy at a red wavelength. Collectively, these studies underscore the need for evidence-based prescribing protocols that carefully balance analgesic efficacy with risk reduction. The antimalarial review highlights the importance of long-term monitoring for delayed adverse effects; the preoperative use of IV ibuprofen appears to reduce post-extraction morbidity; and the TEN case report demonstrates the critical role of the dental surgeon within multidisciplinary teams, incorporating adjuvant therapies such as laser treatment. Finally, the thesis proposes that future long-term RCTs establish clear guidelines on drug dosages, routes of administration, and clinical indications—particularly within the Brazilian Unified Health System (SUS)—to ensure that evidence-based protocols are safe, effective, and cost-effective in dental care.