Introduction

Wound healing (WH) is an integral part of a surgical process. Patients undergoing tooth extraction often experience pain, that gradually settles down within 72 hours. Various inflammatory markers, including matrix metalloproteinases (MMPs) and transforming growth factor-beta 1 (TGF-β1) can help in tracking the WH process. Commonly used pain relievers, inhibit the cyclooxygenase (COX) pathway, reduce the activity of MMPs, delay WH and may also lead to malunion of bones and weakened newly formed bones.  Paracetamol and ibuprofen are commonly prescribed pain relievers used in dental treatments.  

Aim

To evaluate the WH and anti-inflammatory effects of paracetamol and ibuprofen on tooth extraction wounds in patients.

Patient Profile

• Patients requiring removal of fully erupted upper third molar under local anaesthesia (n=20)

Methods

Study Design

• A randomized, double-blind, controlled clinical trial.

Treatment Strategy

• The study subjects either received 400 mg of ibuprofen (n=10) or 500 mg of paracetamol (n=10) for seven days.

Assessment

• The WH was evaluated using Landry, Turnbull, Howley Index (LTHI) scores.

Outcomes

• Change in salivary MMP-9 and TGF-β1 concentrations

Results

• The LTHI values on days 3 and 7 after tooth extraction did not differ significantly between the two treatment groups (Table 1).

Table 1: LTHI on days 3 and 7 after surgery

• Patients in the paracetamol-treated group had lower levels of salivary MMP-9 levels (P < 0.01) on day 3 and 7.
• Patients in the ibuprofen-treated group had an increase in salivary MMP-9 levels on day 3 but the same decreased subsequently on day 7 (P < 0.01).
• The LTHI concentration correlated negatively with the MMP-9 concentration (r = -0.433, P <0.05). On the contrary, the correlation between LTHI concentration and the salivary TGF-β1 concentration was positive (r = 0.369, P < 0.05).
• MMP-9 correlated negatively with TGF-β1 in the ibuprofen treatment group (r² = -0.351), but not in the paracetamol group.

Conclusions

• Ibuprofen can inhibit the inflammatory process and delay healing in the extraction socket.
• Nevertheless, the wound healing characteristics for ibuprofen and paracetamol did not differ significantly on day 7, once the former was discontinued.
• Salivary MMP-9 concentrations correlated nega­tively with salivary TGF-β1 concentrations and LTHI values, conversely, salivary TGF-β1 showed a positive correlation with LTHI.

BMC Oral Health.  2025) 25:484. DOI:10.1186/s12903-024-04916-0.