UNIVERSITY OF MALTA
RESEARCH SEMINARS
Abstract form
Title: A comparison of the effects of paracetamol and corticosteroid against
an NSAID on the sequelae following the surgical removal of
mandibular third molars
Presenter: Dr Adam Bartolo B.Ch.D., M.Sc.
Contact address: Dental Department, St. Luke’s Hospital, G’Mangia
Tel: 25951586
Fax:
Email: abartolo@global.net.mt
Presentation date: 9th January 2005
Abstract
The reduction of postoperative discomfort from oral surgical procedures is an area of great concern to all
practicing dental surgeons, as well as their patients. Pain, swelling and trismus (limitation of opening) are the
common sequelae after surgical removal of impacted mandibular third molars, and a wide variety of therapeutic
measures have been used to reduce the incidence of these sequelae.
The factors contributing to the postoperative pain, oedema, and trismus (a form of loss of function) are
complex, but many of the contributing factors are related to the inflammation following tissue trauma. These
may, therefore, be reduced in intensity or severity by pharmacologically controlling the extent of the
inflammatory process. In most cases, unless contraindicated, non-steroidal anti-inflammatory drugs (NSAIDs)
have been used to prevent postoperative pain, while corticosteroids appear to have maximal effect in
controlling oedema, but have minimal analgesic effects.
In this double-blind randomised controlled clinical trial, a combination of oral paracetamol 1g and oral
dexamethasone 1mg four times daily, was evaluated against oral diclofenac sodium 50mg three times daily, for
the control of postoperative pain, swelling and trismus following the surgical removal of mandibular third
molars under local anaesthesia. The purpose for such a study was to find an alternative drug regimen for the
control of the common postoperative sequelae of oral surgery, especially for those patients in whom the usual
drug regimens (e.g. NSAIDs) are contraindicated.
Postoperative pain was recorded 8-hourly by the patients using a visual analogue scale pain chart for 7 days,
while facial swelling and trismus were assessed by the investigator on the second, fourth and seventh
postoperative days. Facial swelling was determined using a measuring tape, while trismus was evaluated by
measuring maximal interincisal opening.
ANOVA for repeated measures analysis indicated that the patients in the paracetamol and dexamethasone
group experienced an overall mean reduction of 36% in pain (p<0.05), of 76% in facial swelling (p>0.001) and
of 56% in trismus (p>0.001) as compared to the patients in the diclofenac sodium control group. Levene’s test
for equality of variances showed that the inter-patient variation with respect to pain, swelling and trismus in the
paracetamol and dexamethasone group, was also significantly less than that in the diclofenac sodium group
(p<0.05). Pearson bivariate correlation tests show that the reduction in swelling and trismus (p<0.05) are
significantly correlated in both groups. None of the patients reported any adverse drug reactions.
It could therefore be concluded that in the absence of contraindications, a combination of oral paracetamol 1g
and oral dexamethasone 1mg four times daily, was significantly superior to oral diclofenac sodium 50mg three
times daily, in safely reducing the postoperative pain, swelling and trismus following the surgical removal of
mandibular third molars under local anaesthesia in otherwise healthy patients. Also, a more predictable and
consistent patient response could be expected with paracetamol and dexamethasone combination therapy than
with the diclofenac sodium.
This may be especially beneficial for those patients in whom the usual drug regimens (e.g. NSAIDs) are
contraindicated. The use of paracetamol and dexamethasone combination therapy following this kind of oral
surgical procedure, may also obviate the need for the common hospital practice to admit patients overnight in
order to allow parenteral administration of opioid analgesia if necessary, thus reducing healthcare costs and
avoiding opioid-associated adverse effects.