Corticosteroids or Cyclooxygenase 2-Selective Inhibitor Medication for the Management of Pain and Swelling After Third-Molar Surgery

The dental-impaction pain model is the most commonly used and widely accepted acute pain model for assessing the analgesic effect of drugs in humans. The aim of this randomized crossover clinical trial was to observe and compare the anti-inflammatory effects of corticosteroid and nonsteroidal cyclooxygenase 2-selective inhibitor medication on pain, swelling, and trismus after third-molar surgery. For this, 50 adult subjects, 25 male and 25 female, with ages ranging between 18 and 29 years (mean, 22.5 years) and no local or systemic problems, presenting bilateral impacted lower third molars in similar position with surgical extraction indicated were selected. The subjects were submitted to 1 surgical procedure for each side with interval of 3 weeks between each procedure, in which they were given 120 mg etoricoxib, nonsteroidal anti-inflammatory (group 1), or 4 mg dexamethasone, corticosteroid anti-inflammatory (group 2), 1 hour before the procedures. Data were registered at preoperative baseline and 24 and 48 hours postoperatively. Postoperative pain was evaluated using a visual analog scale, and the degree of swelling was evaluated through facial reference points' variation. The presence of trismus was analyzed through measurement of the interincisal distance. These assessments were obtained before the operation and at 24 and 48 hours after the surgeries. There was no statistically significant difference between anti-inflammatory treatments. However, at 48 hours, the facial swelling increased in both groups despite trismus reduction. The effects of nonsteroidal and steroidal anti-inflammatory drugs were similar for pain, swelling, and trismus.