Comparing Ibuprofen and Etodolac on Swelling and Pain After Wisdom Teeth Removal

An interesting article titled “Comparative Assessment of the Effect of Ibuprofen and Etodolac on Edema, Trismus, and Pain in Lower Third Molar Surgery: A Randomized Clinical Trial” appears in the 2016 Journal of Oral an Maxilofacial Surgery written by Julio Cesar Silva de Oliveira and et al. (vol. 74, pp. 1524-1530). The authors set out to explore if ibuprofen or etodolac is more effective in managing pain, swelling, and trismus after wisdom teeth removal.

After wisdom teeth removal symptoms such as swelling, pain and limited mouth opening (trismus) can present. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the rapid relief of moderate pain in inflammatory conditions and soft tissue trauma. The mechanism of action of NSAIDs is the inhibition of the release of cyclooxygenase (COX), an enzyme that is responsible for the production of prostaglandins (PGs). Ibuprofen is an NSAID which inhibits COX-1 and COX-2. Etodolac differs from other NSAIDs by being more selective to the inducible COX-2. Specifically the authors set out to peform a double-blind, randomized, paired crossover study to compare the antiinflammatory effects of ibuprofen, 600 mg, with those of etodolac, 300 mg, both used with dexamethasone, 4 mg, given preoperatively, on pain, edema, and mouth-opening limitation.

A total of 20 patients were included treated at Aracatuba Dental School in Brazil. For the first treatment, 1 hour before the procedure, the patient ingested 1 tablet of dexamethasone, 4 mg. The patient then underwent extraction of the right or left lower wisdom tooth, randomly chosen. The patient received 9 tablets of ibuprofen, 600 mg, or etodolac, 300 mg, orally, immediately after surgery and repeating doses every 8 hours for 3 days. For the second treatment, after a minimum of 21 days, the same patient ingested 1 tablet of dexamethasone, 4 mg, 1 hour before the procedure and then underwent extraction of the other lower wisdom tooth. After surgery, the patient received 9 tablets of etodolac, 300 mg, or ibuprofen, 600 mg (whichever drug was not used in the first treatment), orally, immediately after surgery and  repeating doses every 8 hours for 3 days.

Patients were instructed to mark a pain rating at 6, 12, and 24 hours after surgery ranging from 0 to 10. To access swelling the facial contour of each patient was evaluated by measuring the distance from the tip of the chin to the lower edge of the earlobe through the mandibular interincisal line using measuring tape after surgery, 48 hours later, and 168 hours later. To access mouth opening the maximum interincisal opening was measured with a digital caliper between the incisal edge of the upper central incisors and the lower central incisors on the right side after surgery, 48 hours later, and 168 hours later.

During the first two days after extraction, swelling was more pronounced in the ibuprofen group than in the etodolac group. However, after seven days there was no difference in swelling between the two groups. Mouth opening was significantly more reduced in the ibuprofen group than in the etodolac group both two days and seven days after surgery. After the first 6 hours after extraction the etodolac group had better pain releif but after this point there was no difference in the two groups. In addition the etodolac group had less of a need for any additional rescue analgesics.

Based on the study results the authors feel that etodolac may be better than ibuprofen for preventing inflammatory effects that occur after wisdom teeth extractions.

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