Patient description: The patient is a 53-year-old man complaining of frequent headaches, generalized bone pain and difficulty chewing that started 6 years ago and is getting worse. Examination shows bilateral swellings around the molars. The swellings have increased since his last examination. Several extraoral lesions of the head and face are detected. The swellings are non-tender and attached to the underlying bone. Further evaluation shows increased uptake of radioactive substance as well as an increase in urinary pyridinoline. The serum alkaline phosphatase is 300 IU/L (the normal range is 44- 147 IU/L). The patient's sister had the same problems. She was diagnosed with Paget's disease of bone when she was 52 years old. The diagnosis of Paget's Disease of Bone is confirmed and Bisphosphonate will be started as first-line therapy.

Clinical trial eligibility criteria: eligible ages (years): 0.0-999.0,  Healthy Tooth Extraction Male or female volunteers referred for third molar extraction willing to undergo 2 or 3 visits: 1 screening visit; 1 surgical appointment; and possible 1 follow-up research-related appointment Between the ages of 16 to 35 years (based upon eruption patterns and age-related complications associated with surgical extraction of third molars) In general good health American Society of Anesthesiologists (ASA) status I or II (healthy subjects based upon for safe administration of out-patient conscious sedation) Willing to undergo observation period for three hours postoperatively Ability to complete a 100 mm visual analog scale and a category scale every 20 minutes for the first 3 postoperative hours Willing to have a microdialysis probe placed beneath the surgical flap during the first 3 hours post-surgery Willing to have a preoperative biopsy on the day of surgery, and a postoperative biopsy either within 3 hours or at 24 hours following surgery Willing to return, if needed, 24 hours post-operation for the postoperative biopsy Must have two lower partial bony impacted wisdom teeth fully covered by intact soft tissue (rating equals 3) or fully bony impacted (rating equals 4) wisdom teeth (mandibular third molars) As assessed at the screening visit, the sum of the mandibular third molar surgical difficulty ratings must be between 6 to 8 in order to evaluate subjects experiencing similar pain levels  Patients who are allergic to aspirin, NSAIDs, sulfites, or amide anesthetics Patients who have had asthma, or hives Patients who are pregnant or nursing Patients with history of peptic ulcers and/or GI bleeding Chronic use of medications confounding the assessment of the inflammatory response or analgesia, for example, NSAIDs, COX-2 inhibitors, antihistamines, steroids, antidepressants Patients who have significant psychiatric history Patients who have a clinical signs suggestive of infection, inflammation, or pre-existing pain at either extraction site Patients with severe kidney disease Patients who are taking any of the following drugs: ACE inhibitor; potassium sparing diuretics; aspirin on a near daily basis; coumadin or other blood thinners Patients who are taking drugs known to inhibit P450 2C9 and drugs metabolized by P450 2D6 Patients who have G6PD deficiency and those taking St. John's Wort Unusual surgical difficulty (determined from panoramic radiograph or during the actual surgery)