A comparative study of the effect of prednisolone and celecoxib on mmo (maximum mouth opening) and pain following removal of impacted mandibular third molars

J. Maxillofac. Oral Surg. DOI 10.1007/s12663-012-0401-7

COMPARATIVE STUDY

A Comparative Study of the Effect of Prednisolone and Celecoxib on MMO (Maximum Mouth Opening) and Pain Following Removal of Impacted Mandibular Third Molars
Ali Akbar Moghaddamnia • Kamran Nosrati Mohammad Mehdizadeh • Shabnam Milani • Maral Aghvami
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Received: 11 February 2012 / Accepted: 28 May 2012 ÓAssociation of Oral and Maxillofacial Surgeons of India 2012

Abstract Objective The purpose of this study was to compare the effects of prednisolone and celecoxib on pain and maximum mouth opening (MMO) after surgical removal of mandibular third molars. Methods and Materials This double-blind clinical study was conducted upon 60 subjects. These patients received 4 tablets of either 100 mg celecocxibor 5 mg prednisolone: one tablet before surgery and the rest for every 8 h postoperation. The subjects were asked to take acetaminophen codeine as rescue dose. Interincisal distance of upper and lower central teeth and pain measurements (according to Visual Analogue Scale) were taken before surgery, 24 h, 48 h and 7 days after surgery. Results Average pain intensity in 24 h after surgery inpatients receiving celecoxib was 3.6 ± 2.5 with significant difference to the other group (p = 0.041), but in subsequent evaluations prednisolone group reported less pain intensity, but the differences were not significant. MMO in 48 h after surgery was lower in prednisolone group (p = 0.640) and in further evaluations the groups were almost similar. Analyzing the data revealed no significant differencebetween groups in MMO. Conclusion According to this study there is no significant difference in the effects of prednisolone or celecoxib upon

MMO, while celecoxib had better results for pain relief in 24 h after surgery in comparison to prednisolone. Keywords Celecoxib Á Prednisolone Á Pain Á Maximum mouth opening Á Third molar surgery

Introduction Removal of impacted third molars is acommon procedure in the field of oral and maxillofacial surgery [1]. The most important step in removal of impacted mandibular third molars is achieving an appropriate mucoperiosteal flap that provides enough access to the tooth. An envelope flap with or without releasing is the common flap design [2]. Pain generated following third molar surgery has got short duration and moderate intensity that peaks inshort time after the procedure and drives the patients into taking some analgesic medications [3]. Limitation of mouth opening is one of the problems which occurs following this surgery; this could be related to the inflammation of masticatory muscles. The medial pterygoid muscle is usually involved because of being inadvertently penetrated by the needle during inferior alveolar nerve blockinjection. This complication is not often severe and it will improve in 10–14 days [4]. Glucocorticoid agents and NSAIDs are generally used in managing some post-operation difficulties. Inhibiting the cyclooxygenase path is the mechanism of action of NSAIDS while glucocorticoids restrain production of acid arachidonic by inhibiting the phospholipase A2 enzyme [5]. COX-2 is considered as the mainisoenzyme in producing pro-inflammatory prostaglandins [3]. Although some side effects such as cardiovascular risks, GI bleeding and acute renal failure should be kept in mind [6], some recent

A. A. Moghaddamnia Á S. Milani (&) Á M. Aghvami Pharmacology Department, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran e-mail: shabnammilani@aol.com K. Nosrati Á M. MehdizadehDepartment of Oral and Maxillofacial Surgery, Faculty of Dentistry, Babol University of Medical Sciences, Babol, Iran

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studies showed that there is no relationship between celecoxib consumption and mentioned risks [7, 8]. The aim of this study was to compare the efficacy of prednisolone with celecoxib on maximum mouth opening (MMO) and pain relief following impacted...