The effects of systemic proteolytic enzyme therapy on pain and swelling in third molar surgery equal to diclofenac thera
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ORIGINAL ARTICLE
The effects of systemic proteolytic enzyme therapy on pain and swelling in third molar surgery equal to diclofenac therapy: a prospective randomized double blinded clinical trial T. Gandhewar 1 & N. N. Andrade 1 & Neha Aggarwal 1
&
S. Choradia 1 & P. C. Mathai 1 & S. Nerurkar 1
Received: 13 August 2019 / Accepted: 29 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective The aim of this study was to determine if the timing of administration of systemic enzyme therapy [SET] has any effect on its efficacy in controlling postoperative sequelae of third molar surgery. Study design A double blinded prospective randomized control trial was planned. The sample included patients requiring impacted mandibular third molar surgical extraction. Patients were randomly allocated to four groups (50 patients per group). Group A included administration of SET 48 h prior to surgery; Group B, started on the day of surgery; Group C started immediately after surgery and control group D included NSAIDS started 3 h after surgery. The predictor variable was timing of administration of SET. The primary outcome variables were pain and swelling measured on 1st day, 5th day, and 7th day after surgery. Findings Groups A and D reported lower mean and median VAS scores and lesser swelling than groups C and D on postop day 1. On days 5 and 7, all four groups were comparable. On overall analysis, no statistically significant difference (p > 0.05) was evident. Interpretation The results of the study showed that the differences in swelling and pain with starting the SET 2 days before, on the day of surgery, or immediately after when compared with diclofenac was not statistically significant. Trial registration CTRI Registration Number CTRI/2018/03/012502 Keywords Third molar . Systemic enzyme therapy . Proteolytic enzymes
Introduction
* Neha Aggarwal [email protected] T. Gandhewar [email protected] N. N. Andrade [email protected] S. Choradia [email protected] P. C. Mathai [email protected] S. Nerurkar [email protected] 1
Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Dr. A.L.Nair Road, Opp. Maratha Mandir, Mumbai 400008, India
Surgical extractions of impacted molars are one of the most commonly performed oral surgeries which involve considerable trauma to the adjacent bone and soft tissues. This results in significant postoperative pain, swelling, and trismus which affect the quality of life of the patient [1]. Pain usually peaks at 6 to 8 h after surgery, is markedly diminished after 12 h and gradually disappears within a few days. Swelling reaches a maximum about 36 h after surgery and normally disappears within a week. Trismus reaches a maximum after 2 to 3 days and then subsides more slowly than the swelling. The quality of life is significantly affected in the first 3 days of the postoperative period [2]. Various factors have been studied relating to these sequelae such as operator time, operator experience, and type and level of
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