Efficacy of Ibuprofen and Aceclofenac on Pain, Facial Swelling and Trismus Following Extraction of Impacted Third Molar

5 Nov, 20

Introduction

The removal of impacted mandibular third molar is one of the most frequently performed oral surgical procedure carried out in daily dental practice. Severe pain, swelling owing to trauma and inflammation of soft tissue and bone and trismus are the common postoperative complaints following third molar surgery (TMS). The quality of life after lower third molar surgery is affected three times more in patients with pain, swelling and trismus alone or in combinations. The efficacy of ibuprofen in postoperative dental pain is well established. However, there is lack of data on the role of this drug in severe pain associated with swelling such a TMS. There are few studies directly comparing the efficacies of aceclofenac and ibuprofen in alleviating pain following TMS.

Aim

The efficacy of ibuprofen 400 mg and aceclofenac 100 mg in alleviation of postoperative pain, facial swelling and trismus has been compared in this study after surgical removal of impacted mandibular third molar.

Study Design

Randomized study

Patient Profile

Patients with impacted mandibular third molar indicated for extraction

Treatment Strategy

The cohort comprised 100 patients who underwent routine blood and radiographic assessments
- The patients were randomized into two groups
- Group A (n=50) received ibuprofen 400 mg
Group B (n = 50) received aceclofenac 100 mg
Both the drugs were given postoperatively after every 8 hours for three days
Follow-up was done on 1^st, 2^nd, 5^th and 7^th day postoperatively

Endpoints

Facial swelling determined by recording facial size
Pain using the visual analogue scale (VAS)
Mouth opening scores by measuring maximum inter-incisal distance

Results

Both the groups demonstrated similar efficacy in controlling postoperative facial swelling, pain and mouth opening compared with their own baseline measurements
The baseline facial measurement in ibuprofen group increased by 2.2% and 3.5% on postoperative day 1 and 2 respectively; p<0.001, with a gradual reduction on days 5 and 7
The baseline facial measurement in aceclofenac group increased by 4.5% and 4.6% on postoperative day 1 and 2 respectively; p<0.001, with a gradual reduction on days 5 and 7
The control of facial swelling was found comparable between the groups except on postoperative day 1.
The differences in facial swelling from baseline on different days have been compared in Figure 1.

Figure 1. Differences in facial swelling from baseline on different days

The ibuprofen group had better relief of pain compared to the aceclofenac group; p<0.001
Figure 2 demonstrates the comparison of differences of pain scores from day 1

Figure 2. Comparison of differences of pain scores from day 1

The ibuprofen group had better mouth opening scores as compared to aceclofenac group
Figure 3 demonstrates comparison of differences of mouth opening from day 1

Figure 3. Comparison of differences of mouth opening from day 1

Conclusion

Ibuprofen (400 mg) and aceclofenac (100 mg) were found to be effective in controlling postoperative swelling, pain and trismus after surgical removal of impacted lower-third molars.
Alleviation of pain and trismus was found to be better with ibuprofen as compared to aceclofenac.
Both the drugs had comparable efficacy with respect to control of facial swelling.

J Evolution Med Dent Sci.2017;6(21):1670-677. Doi: 10.14260/Jemds/2017/368.