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Comparison of preemptive etoricoxib and dexamethasone in third molar surgery – a randomized controlled clinical trial of patient-reported and clinical outcomes

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Abstract

Objectives

To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction.

Materials and Methods

A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90 mg, dexamethasone 4 mg, or no premedication (control group) 1 h before surgery. Paracetamol 500 mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24 h, 48 h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale.

Results

In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05).

Conclusions

Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient’s postoperative functional ability.

Clinical Relevance

Preemptive etoricoxib and dexamethasone use may decrease patients’ discomfort following the impacted mandibular third molar extraction.

Trial registration

ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).

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References

  1. Martins-de-Barros AV, Barros AM, Siqueira AK, Lucena EE, Sette de Souza PH, Araújo FA (2021) Is Dexamethasone superior to Ketorolac in reducing pain, swelling and trismus following mandibular third molar removal? A split mouth triple-blind randomized clinical trial. Med Oral Patol Oral Cir Bucal 26:e141–e150. https://doi.org/10.4317/medoral.24088

    Article  PubMed  Google Scholar 

  2. Rodrigues ÉD, Pereira GS, Vasconcelos BC, Ribeiro RC (2019) Effect of preemptive dexamethasone and etoricoxib on postoperative period following impacted third molar surgery - a randomized clinical trial. Med Oral Patol Oral Cir Bucal 24:e746–e751. https://doi.org/10.4317/medoral.23095

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cetira Filho EL, Carvalho FSR, de Barros Silva PG, Barbosa DAF, Alves Pereira KM, Ribeiro TR et al (2020) Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: a systematic review with meta-analysis of placebo-controlled randomized clinical trials. J Craniomaxillofac Surg 48:293–307. https://doi.org/10.1016/j.jcms.2020.01.016

    Article  PubMed  Google Scholar 

  4. Pergolizzi JV, Magnusson P, LeQuang JA, Gharibo C, Varrassi G (2020) The pharmacological management of dental pain. Expert Opin Pharmacother 21:591–601. https://doi.org/10.1080/14656566.2020.1718651

    Article  PubMed  Google Scholar 

  5. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E (2009) The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:630–640. https://doi.org/10.1016/j.tripleo.2008.11.005

    Article  PubMed  Google Scholar 

  6. Ferrer MD, Busquets-Cortés C, Capó X, Tejada S, Tur JA, Pons A et al (2019) Cyclooxygenase-2 inhibitors as a therapeutic target in inflammatory diseases. Curr Med Chem 26:3225–3241. https://doi.org/10.2174/0929867325666180514112124

    Article  PubMed  Google Scholar 

  7. González-Barnadas A, Camps-Font O, Martín-Fatás P, Figueiredo R, Gay-Escoda C, Valmaseda-Castellón E (2020) Efficacy and safety of selective COX-2 inhibitors for pain management after third molar removal: a meta-analysis of randomized clinical trials. Clin Oral Investig 24:79–96. https://doi.org/10.1007/s00784-019-02910-3

    Article  PubMed  Google Scholar 

  8. Schjerning AM, McGettigan P, Gislason G (2020) Cardiovascular effects and safety of (non-aspirin) NSAIDs. Nat Rev Cardiol 17:574–584. https://doi.org/10.1038/s41569-020-0366-z

    Article  PubMed  Google Scholar 

  9. la Torre LF, Franco-González DL, Brennan-Bourdon LM, Molina-Frechero N, Alonso-Castro ÁJ, Isiordia-Espinoza MA (2021) Analgesic efficacy of etoricoxib following third molar surgery: a meta-analysis. Behav Neurol 2021:9536054. https://doi.org/10.1155/2021/9536054

    Article  PubMed  Google Scholar 

  10. Albuquerque AFM, Fonteles CSR, do Val DR, Chaves HV, Bezerra MM, Pereira KMA, et al (2017) Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1β in third molar surgery: a triple-blind, randomized, placebo-controlled study. Int J Oral Maxillofac Surg 46:1615–1625. https://doi.org/10.1016/j.ijom.2017.05.007

    Article  PubMed  Google Scholar 

  11. Costa FW, Soares EC, Esses DF, Silva PG, Bezerra TP, Scarparo HC et al (2015) A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120 mg on inflammatory events following removal of unerupted mandibular third molars. Int J Oral Maxillofac Surg 44:1166–1174. https://doi.org/10.1016/j.ijom.2015.06.012

    Article  PubMed  Google Scholar 

  12. Isola G, Matarese G, Alibrandi A, Dalessandri D, Migliorati M, Pedullà E et al (2019) Comparison of effectiveness of etoricoxib and diclofenac on pain and perioperative sequelae after surgical avulsion of mandibular third molars: a randomized, controlled, clinical trial. Clin J Pain 35:908–915. https://doi.org/10.1097/AJP.0000000000000748

    Article  PubMed  Google Scholar 

  13. Xie L, Sang L, Li Z (2021) Does low dose of etoricoxib play pre-emptive analgesic effect in third molar surgery? A randomized clinical trial. BMC Oral Health 21:462. https://doi.org/10.1186/s12903-021-01837-0

    Article  PubMed  PubMed Central  Google Scholar 

  14. Brown JD, Daniels SE, Bandy DP, Ko AT, Gammaitoni A, Mehta A et al (2013) Evaluation of multiday analgesia with etoricoxib in a double-blind, randomized controlled trial using the postoperative third-molar extraction dental pain model. Clin J Pain 29:492–498. https://doi.org/10.1097/AJP.0b013e318260c144

    Article  PubMed  Google Scholar 

  15. Xie L, Li Z, Shang ZJ (2021) Preemptive oral etoricoxib on health-related quality of life after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. Biomed Res Int 2021:8888151. https://doi.org/10.1155/2021/8888151

    Article  PubMed  PubMed Central  Google Scholar 

  16. Peskar BM, Ehrlich K, Egger T, Sattler W (2006) Dexamethasone impairs the gastric mucosal integrity in rats treated with a cyclooxygenase-1 but not with a cyclooxygenase-2 inhibitor. Pharmacology 76:180–184. https://doi.org/10.1159/000091575

    Article  PubMed  Google Scholar 

  17. Tanabe T, Tohnai N (2002) Cyclooxygenase isozymes and their gene structures and expression. Prostaglandins Other Lipid Mediat 68–69:95–114. https://doi.org/10.1016/s0090-6980(02)00024-2

    Article  PubMed  Google Scholar 

  18. Falci SGM, Lima TC, Martins CC, Santos C, Pinheiro MLP (2017) Preemptive effect of dexamethasone in third-molar surgery: a meta-analysis. Anesth Prog 64:136–143. https://doi.org/10.2344/anpr-64-05-08

    Article  PubMed  PubMed Central  Google Scholar 

  19. Santos BFE, Costa FO, Pinto Júnior AAC, Araújo AVA, Cyrino RM, Cota LOM (2021) Postoperative pain and edema control following different protocols of preemptive analgesia in the surgical removal of impacted third molars: A triple-blind parallel randomized placebo-controlled clinical trial. J Craniomaxillofac Surg 49:694–704. https://doi.org/10.1016/j.jcms.2021.01.002

    Article  PubMed  Google Scholar 

  20. Lima CAA, Favarini VT, Torres AM, da Silva RA, Sato FRL (2017) Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial. Oral Maxillofac Surg 21:321–326. https://doi.org/10.1007/s10006-017-0635-0

    Article  PubMed  Google Scholar 

  21. Al-Dajani M (2017) Can preoperative intramuscular single-dose dexamethasone improve patient-centered outcomes following third molar surgery? J Oral Maxillofac Surg 75:1616–1626. https://doi.org/10.1016/j.joms.2017.03.037

    Article  PubMed  Google Scholar 

  22. Kissin I (2000) Preemptive analgesia. Anesthesiology 93:1138–1143. https://doi.org/10.1097/00000542-200010000-00040

    Article  PubMed  Google Scholar 

  23. Sotto-Maior BS, Senna PM, de Souza Picorelli Assis NM (2011) Corticosteroids or cyclooxygenase 2-selective inhibitor medication for the management of pain and swelling after third-molar surgery. J Craniofac Surg 22:758–762. https://doi.org/10.1097/SCS.0b013e318207f3fe

    Article  PubMed  Google Scholar 

  24. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ et al (2010) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 340:c869. https://doi.org/10.1136/bmj.c869

    Article  PubMed  PubMed Central  Google Scholar 

  25. World Medical Association (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310:2191–2194. https://doi.org/10.1001/jama.2013.281053

    Article  Google Scholar 

  26. Lima CJ, Silva LC, Melo MR, Santos JA, Santos TS (2012) Evaluation of the agreement by examiners according to classifications of third molars. Med Oral Patol Oral Cir Bucal 17:e281-286. https://doi.org/10.4317/medoral.17483

    Article  PubMed  Google Scholar 

  27. Markovic A, Todorovic L (2007) Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial. Int J Oral Maxillofac Surg 36:226–229. https://doi.org/10.1016/j.ijom.2006.10.006

    Article  PubMed  Google Scholar 

  28. Momesso GAC, Grossi-Oliveira GA, Silva WPP, Akira R, Chiba F, Polo TOB et al (2021) A triple-blind randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories for preemptive action in third molar extractions. Sci Rep 11:24445. https://doi.org/10.1038/s41598-021-04068-z

    Article  PubMed  PubMed Central  Google Scholar 

  29. Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE (2014) Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain 155:2545–2550. https://doi.org/10.1016/j.pain.2014.09.014

    Article  PubMed  Google Scholar 

  30. Dourado GB, Volpato GH, de Almeida-Pedrin RR, PedronOltramari PV, Freire Fernandes TM, de Castro Ferreira Conti AC (2021) Likert scale vs visual analog scale for assessing facial pleasantness. Am J Orthod Dentofacial Orthop 160:844–852. https://doi.org/10.1016/j.ajodo.2020.05.024

    Article  PubMed  Google Scholar 

  31. Carrillo JS, Calatayud J, Manso FJ, Barberia E, Martinez JM, Donado M (1990) A randomized double-blind clinical trial on the effectiveness of helium-neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars. Int Dent J 40:31–36

    PubMed  Google Scholar 

  32. Almeida RAC, Lemos CAA, de Moraes SLD, Pellizzer EP, Vasconcelos BC (2019) Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 48:118–131. https://doi.org/10.1016/j.ijom.2018.05.023

    Article  PubMed  Google Scholar 

  33. Erdil A, Akbulut N, Altan A, Demirsoy MS (2021) Comparison of the effect of therapeutic elastic bandage, submucosal dexamethasone, or dexketoprofen trometamol on inflammatory symptoms and quality of life following third molar surgery: a randomized clinical trial. Clin Oral Investig 25:1849–1857. https://doi.org/10.1007/s00784-020-03487-y

    Article  PubMed  Google Scholar 

  34. Nehme W, Fares Y, Abou-Abbas L (2021) Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial. BMC Oral Health 21:393. https://doi.org/10.1186/s12903-021-01759-x

    Article  PubMed  PubMed Central  Google Scholar 

  35. Fernandes IA, de Souza GM, Pinheiro MLP, Falci SGM (2019) Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 48(5):659–668. https://doi.org/10.1016/j.ijom.2018.09.014

    Article  PubMed  Google Scholar 

  36. Shoohanizad E, Parvin M (2020) Comparison of the effects of dexamethasone administration on postoperative sequelae before and after “third molar” extraction surgeries. Endocr Metab Immune Disord Drug Targets 20:356–364. https://doi.org/10.2174/1871530319666190722120405

    Article  PubMed  Google Scholar 

  37. Daniels SE, Bandy DP, Christensen SE, Boice J, Losada MC, Liu H et al (2011) Evaluation of the dose range of etoricoxib in an acute pain setting using the postoperative dental pain model. Clin J Pain 27:1–8. https://doi.org/10.1097/ajp.0b013e3181ed0639

    Article  PubMed  Google Scholar 

  38. Canellas J, Ritto FG, Tiwana P (2022) Comparative efficacy and safety of different corticosteroids to reduce inflammatory complications after mandibular third molar surgery: a systematic review and network meta-analysis. Br J Oral Maxillofac Surg 60:1035–1043. https://doi.org/10.1016/j.bjoms.2022.05.003

    Article  PubMed  Google Scholar 

  39. Gulen M, Satar S, Acehan S, Yildiz D, Aslanturkiyeli EF, Aka Satar D et al (2022) Perfusion index versus visual analogue scale: as an objective tool of renal colic pain in emergency department. Heliyon 8:e10606. https://doi.org/10.1016/j.heliyon.2022.e10606

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia

    Iva Mijailovic, Bojan Janjic, Ana Todorovic, Branislav Ilic, Tijana Misic, Nikola Markovic & Aleksa Markovic

  2. Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Dr. Subotica 8, Belgrade, 11000, Serbia

    Biljana Milicic

Authors
  1. Iva Mijailovic
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Contributions

I.M., A.M., and B.J. conceptualized the research. A.T., B.I., and N.M. searched and prepared the literature data. I.M., A.M., A.T., and T.M. designed the research methodology. B.M. performed the formal analysis. I.M., A.M., and B.J. performed the investigation. I.M., B.I., T.M., and N.M. registered and stored the study data. I.M., A.M., A.T., and T.M. wrote the original manuscript draft. I.M. and B.M. prepared tables and figures. A.M., I.M., B.I., and N.M. critically reviewed and edited the manuscript. A.M., B.J., and I.M. supervised the research.

Corresponding author

Correspondence to Iva Mijailovic.

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Ethics approval

This study was performed according to the principles of the 1964 Helsinki Declaration, as well as its later amendments. Ethical approval was granted by the Ethics Committee of Belgrade School of Dental Medicine (Date 15/09/2021/No. 36/22).

Consent to participate

Informed consent was obtained from all the participants included in the clinical trial.

Competing interests

The authors declare no competing interests.

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Mijailovic, I., Janjic, B., Milicic, B. et al. Comparison of preemptive etoricoxib and dexamethasone in third molar surgery – a randomized controlled clinical trial of patient-reported and clinical outcomes. Clin Oral Invest 27, 5263–5273 (2023). https://doi.org/10.1007/s00784-023-05146-4

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  • DOI: https://doi.org/10.1007/s00784-023-05146-4

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