Analgesic Efficacy of Cordia Verbenacea-based Gel in the Reduction of Pain Associated with Use of Separator Elastics/ Eficácia Analgésica do Gel à base de Cordia Verbenacea na Redução de Dor Associada ao Uso de Elásticos Separadores

Itauana Vettorello, Daniele Michelin Paganotte, Adilson Sartorato, Vivian Fernandes Furletti de Góes, Andrea Aparecida de Aro, William Custodio, Cristina Maria Franzini


Introduction: In Orthodontics separator elastics are used to create space for inserting the bands. This causes pain. Phytotherapy has been promising as a therapy. Objective. This double blind randomized clinical trial evaluated the level of pain due to the use of elastic separator (SE) after intraoral topical administration of Cordia verbenacea gel (CV). Methods. 50 volunteers received the SE on the mesial and distal surfaces of the maxillary first molars. In a blinded manner, 0.5 g of the gel was used in one hemi-arch, and placebo in the other hemi-arch on the free gingival margin of the first molar, every 8 hours, for 3 days. Pain was measured on a visual analog scale (VAS), before insertion of the SE (t0), immediately after (t1) and every hour after the following applications. Sensory analysis of the was performed for effects of taste and burning. Wilcoxon (comparison between sides) and Friedman and Nemenyi tests were performed for comparisons between times (α=0.05). Results. The pain was lower on the side that received the phytotherapeutic gel, from the first application until before the removal of the elastic (p< 0.05).  As regards the burning sensation, the experimental side had higher scores and 20% of the subjects considered the CV gel had an unpleasant taste. It was concluded that the use of the intrabucal topic of CV has an analgesic potential for pain resulting from the insertion of SE.


Pain, Orthodontics, Therapeutic action, Cordea verbenacea.

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Krishnan V (2007). Orthodontic pain: from causes to management--a review. Eur J Orthod, Apr;29(2):170-9 Krishnan V (2007). Orthodontic pain: from causes to management--a review. Eur J Orthod, Apr;29(2):170-9

Asiry MA, Albarakati SF, Al-Marwan MS, & Al-Shammari RR (2014). Perception of pain and discomfort from elastomeric separators in Saudi adolescents. Saudi Med J, 35(5):504–07.

Hussain AS, Al Toubity MJ, & Elias WY (2017). Methodologies in Orthodontic Pain Management: A Review. Open Dent J, 31;11:492-497.

Kohli SS, & Kohli VS (2011). Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences. Angle Orthod, 81(6):1097-102.

Becker DE, & Reed KL (2012). Local anesthetics: review of pharmacological considerations. Anesth Prog, 59(2):90–103.

Newman DJ, & Cragg GM (2016). Natural Products as Sources of New Drugs from 1981 to 2014. J Nat Prod, 25;79(3):629-61.

Freires IA, & Rosalen PL (2016). How Natural Product Research has Contributed to Oral Care Product Development? A Critical View. Pharm Res, 33(6):1311-7.

Akisue MK, Oliveira F, Moraes MS, Akisue G, & Mancini B (1983). Caracterização farmacognóstica da droga e da tintura de Cordia verbenacea A. DC. - BORAGINACEAE. Rev Bras Cienc Farm, 5:69–82.

Passos GF, Fernandes ES, da Cunha FM, Ferreira J, Pianowski LF, Campos MM, & Calixto JB (2007). Anti-inflammatory and anti-allergic properties of the essential oil and active compounds from Cordia verbenacea. J Ethnopharmacol, 21;110(2):323-33.

Perini JA, Angeli-Gamba T, Alessandra-Perini J, Ferreira LC, Nasciutti LE, & Machado DE (2015). Topical application of Acheflan on rat skin injury accelerates wound healing: a histopathological, immunohistochemical and biochemical study. BMC Complement Altern Med, 30;15:203.

Pimentel SP, Barrella GE, Casarin RC, Cirano FR, Casati MZ, Foglio MA, Figueira GM, & Ribeiro FV (2012). Protective effect of topical Cordia verbenacea in a rat periodontitis model: immune-inflammatory, antibacterial and morphometric assays. BMC Complement Altern Med, 21;12:224.

Oliveira CMB, Sakata RK, Issy AM, Gerola LR & Salomão R (2011). Citocinas e Dor. Rev Bras Anestesiol. 61: 2: 255-265.

Al-Melh MA, & Andersson L (2017). The effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with orthodontic elastomeric separator placement. Prog Orthod, 18(1):1.

Eslamian L, Akbarian RadN, Rahbani NB, & Mortazavi SA (2018). Effect of a 5% naproxen patch on reducing pain caused by separators prior to fixed orthodontic treatment. J Dent Anesth Pain Med, 18(3):151-159.

Eslamian L, Kianipour A, & Mortazavi SAR (2017). The Analgesic Efficacy of 5% Naproxen Gel for Pain Associated with Orthodontic Separator Placement: A Randomized Double-Blind Controlled Trial. Anesth Pain Med, 8;7(2):e42708.

Farias RD, Closs LQ, & Miguens SAJr (2016). Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: A randomized split-mouth clinical trial. Angle Orthod, 86(2):193-8.

Proestos C, Sereli D, & Komaiti M (2006). Determination of phenolic compounds in aromatic plants br RP-HPLC and GC-MS. Food Chem, 95(1):44-52.

Zanon RG, Brasil AK, & Imamura M (2006). Continuous ultrasound for chronic plantar fasclitis treatment. Acta ortop. bras. v.14 n.3 São Paulo.

Nogueira MNM, Correia MF, Fontana A, Bedran TBL, & Spolidorio DMP (2013). Avaliação Comparativa “In Vivo” da Eficácia do Óleo de Melaleuca, Clorexidina e Listerine sobre Streptococcus mutans e Microrganismos Totais na Saliva. Pesq Bras Odontoped Clin Integr, 13(4): 3 43-49.

Cioffi L, Michelotti A, Perrotta S, Chiodini P, & Ohrbach R (2016). Efeito da amplificação somatossensorial e da ansiedade nas características na dor ortodôntica induzida experimentalmente. Eur J Oral. 124:127-34.

Thilander B, Rygh P, & Reitan K (2000). Tissue reactions in orthodontics. In: Graber TM, Vanarsdall RL, editors. Orthodontics: current principles and techniques. 3rd ed. St Louis: C. V. Mosby; p. 117-91.

Eslamian L, Borzabadi-Farahani A, Edini HZ, Badiee MR, Lynch E, Mortazavi A (2013). The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study. Acta Odontol Scand. Sep;71(5):1168-73.

Carvalho PMJR, Rodrigues RF, Sawaya AC, Marques MO, & Shimizu MT (2004). Composição química e atividade antimicrobiana do oleo essencial de Cordia verbenacea DC. Ethnopharmacol. 95:297-301.

Sertié JA, Woisky RG, Wiezel G, Rodrigues M (2005). Ensaio farmacológico de Cordia verbenacea V: atividade anti-inflamatória oral e tópica, efeito analógico e toxicidade para um extrato de folha bruta. Fitomedicina, 12:338-344.

Chaves JS, Leal PC, Pianowisky L, & Calixto JB (2008). Farmacocinética e distribuição tecidual do sesquiterpeno alfa-humuleno nos camundongos. Planta Médica, 74:1678-83.

Him A, Ozbek H, Turel I & Oner AC (2008). Antinociceptive activity of alpha-pinene and fenchone. Pharmacologyonline, 3: 363-369.

Fernandes ES, Passos GF, Medeiros R, da Cunha FM, Ferreira J, Campos MM, Pianowski LF, & Calixto JB (2007). Anti-inflammatory effects of compounds alpha-humulene and (-)-trans-caryophyllene isolated from the essential oil of Cordia verbenacea. Eur J Pharmacol. Aug 27;569(3):228-36.

Câmara CC, Nascimento NR, Macêdo-Filho CL, Almeida FB, Fonteles MC. Antispasmodic effect of the essential oil of Plectranthus barbatus and some major constituents on the guinea-pig ileum. Planta Med. 2003 Dec;69(12):1080-5.

Lubi NC, Sato MEO, & Gsensly F (2003). Desenvolvimento de forma farmacêutica líquida de uso oral, isenta de substâncias glicogênicas, com extrato fluido de Mikania glomerata Sprengel - Asteraceae (guaco). Rev. bras. farmacogn. [online]. vol.13, suppl.1, pp.43-46.

Simões CMO, Schenkel EP, Gosmann G, Mello jCP, Mentz lA, Petrovick PR. Farmacognosia da planta ao medicamento. 6ª edição. Editora da UFSC, 2007.



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