Article

Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The aim of this study was to investigate the ability of serrapeptase to reduce postoperative swelling, pain and trismus after third molar surgery. Twenty-four healthy individuals with symmetrically impacted mandibular third molars underwent surgical removal in a prospective, intra-individual, randomized, double-blind, cross-over study. Teeth were removed in 2 sessions by the same surgeon. At each session, one third molar was removed under local anaesthesia via a buccal osteotomy. All patients received a combination of either serrapeptase 5mg or placebo tablets and 1000 mg paracetamol tablets at either the 1st or 2nd operation in accordance with the randomization plan. Cheek thickness, pain and interincisal distance were measured preoperatively, and on the 1st, 2nd, 3rd and 7th postoperative days. Cheek thickness and maximum interincisal distance were measured using calipers. Pain intensity was assessed clinically using a numeric scale. There was a significant reduction in the extent of cheek swelling and pain intensity in the serrapeptase group at the 2nd, 3rd and 7th postoperative days (P<0.05), but no significant difference in mean maximal interincisal distance was found between the 2 groups (P>0.05).

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Because conventional anti-inflammatory medications (steroid and NSAIDs) are associated with several adverse effects, natural anti-inflammatory proteolytic enzymes, such as trypsin, chymotrypsin, papain, serratiopeptidase, and bromelain have been used following lower third molars surgery [9][10][11]. ...
... Panoramic and pri-apical radiographs were taken to assess the third molar positions and to check the presence of any pathological lesion. Surgical extraction was performed by the same surgeon using a standardized technique [9] with the following steps: [1] Standard anesthesia of inferior alveolar nerve block and the long buccal nerve block using a solution of 2%lognocaine hydrochloride and epinephrine 1:100,000; [2] A triangular full-thickness mucoperiosteal flap with releasing incision on the disto-buccal aspect of the second molar; [3] Bone removal around the tooth with straight hand-piece under continuous irrigation with normal saline; [4] Tooth sectioning when necessary and gently elevated; [5] Sockets inspected and irrigated copiously with normal saline; [6] The flap suture back with interrupted 3-0 silk sutures; 7) Small gauze packs applied to the site and usual post-operative instructions were given to the patients. ...
... However, Al-Khateeb and Nusair compared between serratiopeptidase and placebo following lower third molars extraction, they found that Serratiopeptidase after surgical extraction of the third molar was associated with a significant reduction in the mean pain intensity scores at the 1st (p = 0.00), 2nd (p = 0.00), and 3rd (p = 0.00) postoperative days. So, their results were in disagreement with the presents results [9]. Similarities of achievement in reducing the postoperative sequalae after surgical extraction of impacted lower third molars among the three comparative groups (submucosal chymotrypsin and oral serratiopeptidase and dexamethasone) can be attributed to the relatively smaller sample size in each group (n =20), the absence of a placebo control group, inaccurate postoperative assessment methods (tape method for facial edema and VAS for pain intensity), patients incompliance and variation of patient's gender and age. ...
Article
Full-text available
Aim The study aimed to compare between chymotrypsin, oral serratiopeptidase, and oral dexamethasone following impacted mandibular third molars surgery in respect of postoperative complications. Materials and method: A randomized, double-blind clinical trial was conducted on 60 patients who were candidates for impacted mandibular third molars surgery and randomly allocated into the following 3 groups: submucosal chymotrypsin (5 mg), oral serratiopeptidase (10 mg), and oral dexamethasone (8 mg) (each group = 20). The outcome variables were postoperative pain (via visual analog scale), facial swelling (via tape method) and maximal mouth opening immediately after 2nd, 3rd, and 5th postoperative days. Results: A total of 60 patients underwent randomization and allocation concealment and were included in the current study. All of the subjects tolerated the medicines with no untoward side or adverse effects. There was no statistically significant difference between the three groups in respect of postoperative pain intensity, facial swelling and maximal mouth opening at the immediate first hour, 2nd, 3rd, and 5th postoperative days (P < 0.05). Conclusion: The present randomized clinical trial concluded that preemptive sub-mucosal injection of chymotrypsin yields a comparable effectiveness in decreasing postoperative sequelae following impacted mandibular third molars surgery when compared to oral serratiopeptidase or dexamethasone. This is the first Randomized Clinical Trail that assessed efficacy and safety of sub-mucosal injection of chymotrypsin Al-Moraissi et al. Chymotrypsin, Serratiopeptidase, Dexamethasone in Molar Surgery after impacted mandibular third molars surgery. This trial is registered at clinicaltrials.in.th, number (TCTR20200828006).
... Because conventional anti-inflammatory medications (steroid and NSAIDs) are associated with several adverse effects, natural anti-inflammatory proteolytic enzymes, such as trypsin, chymotrypsin, papain, serratiopeptidase, and bromelain have been used following lower third molars surgery [9][10][11]. ...
... Panoramic and pri-apical radiographs were taken to assess the third molar positions and to check the presence of any pathological lesion. Surgical extraction was performed by the same surgeon using a standardized technique [9] with the following steps: [1] Standard anesthesia of inferior alveolar nerve block and the long buccal nerve block using a solution of 2%lognocaine hydrochloride and epinephrine 1:100,000; [2] A triangular full-thickness mucoperiosteal flap with releasing incision on the disto-buccal aspect of the second molar; [3] Bone removal around the tooth with straight hand-piece under continuous irrigation with normal saline; [4] Tooth sectioning when necessary and gently elevated; [5] Sockets inspected and irrigated copiously with normal saline; [6] The flap suture back with interrupted 3-0 silk sutures; 7) Small gauze packs applied to the site and usual post-operative instructions were given to the patients. ...
... However, Al-Khateeb and Nusair compared between serratiopeptidase and placebo following lower third molars extraction, they found that Serratiopeptidase after surgical extraction of the third molar was associated with a significant reduction in the mean pain intensity scores at the 1st (p = 0.00), 2nd (p = 0.00), and 3rd (p = 0.00) postoperative days. So, their results were in disagreement with the presents results [9]. Similarities of achievement in reducing the postoperative sequalae after surgical extraction of impacted lower third molars among the three comparative groups (submucosal chymotrypsin and oral serratiopeptidase and dexamethasone) can be attributed to the relatively smaller sample size in each group (n =20), the absence of a placebo control group, inaccurate postoperative assessment methods (tape method for facial edema and VAS for pain intensity), patients incompliance and variation of patient's gender and age. ...
Article
Full-text available
Aim The study aimed to compare between chymotrypsin, oral serratiopeptidase, and oral dexamethasone following impacted mandibular third molars surgery in respect of postoperative complications. Materials and method: A randomized, double-blind clinical trial was conducted on 60 patients who were candidates for impacted mandibular third molars surgery and randomly allocated into the following 3 groups: submucosal chymotrypsin (5 mg), oral serratiopeptidase (10 mg), and oral dexamethasone (8 mg) (each group = 20). The outcome variables were postoperative pain (via visual analog scale), facial swelling (via tape method) and maximal mouth opening immediately after 2nd, 3rd, and 5th postoperative days. Results: A total of 60 patients underwent randomization and allocation concealment and were included in the current study. All of the subjects tolerated the medicines with no untoward side or adverse effects. There was no statistically significant difference between the three groups in respect of postoperative pain intensity, facial swelling and maximal mouth opening at the immediate first hour, 2nd, 3rd, and 5th postoperative days ( P < 0.05). Conclusion: The present randomized clinical trial concluded that preemptive sub-mucosal injection of chymotrypsin yields a comparable effectiveness in decreasing postoperative sequelae following impacted mandibular third molars surgery when compared to oral serratiopeptidase or dexamethasone. This is the first Randomized Clinical Trail that assessed efficacy and safety of sub-mucosal injection of chymotrypsin after impacted mandibular third molars surgery. This trial is registered at clinicaltrials.in.th, number (TCTR20200828006).
... To date, published studies assessing the efficacy of serratiopeptidase after third molar extraction are minor with inadequate methodological quality [16][17][18]27]. ...
... We carried assessments until the 5th day. Alkhateeb and Nusair [27] assessed swelling using cheek thickness only. Our results differed from those of Al Khateeb and Nusair [27] who didn't find any changes in trismus, possibly because of the small number of patients examined. ...
... Alkhateeb and Nusair [27] assessed swelling using cheek thickness only. Our results differed from those of Al Khateeb and Nusair [27] who didn't find any changes in trismus, possibly because of the small number of patients examined. Furthermore, they carried the exam until the 7th day where trismus usually disappears. ...
Article
Full-text available
Background Serratiopeptidase has been clinically used in controlling surgical and non-surgical inflammatory conditions. This study was conducted to assess the therapeutic effect of Serratiopeptidase in patients undergoing surgical removal of impacted mandibular third molar. Methods This randomized clinical trial investigated the efficacy of Serratiopeptidase and Paracetamol after surgical removal of impacted third molar for 5 days (n = 67) as compared with an equivalent dose of placebo and Paracetamol (n = 66). Outcome measures were reported pain, trismus and swelling using Laskin method. All outcome measures were recorded on days 0, 1, 2, 4, and 5 post-surgeries. Results In this clinical trail 133 patients (mean age 23 years, 54% female) completed the study. Baseline characteristics were comparable across treatment groups. Serratiopeptidase significantly improved trismus compared with control on the 4th day (27.30 ± 7.3 mm and 32.06 ± 7.7 mm, respectively (P < 0.001) Swelling markedly improved, The distance from the lower edge of the earlobe to the midpoint of the symphysis for cases vs control were 111.49 ± 8.1 mm and 115.39 ± 9.9 mm, respectively (P < 0.001). Reported pain, showed no statistical significance difference. Conclusion Serratiopeptidase resulted in better inflammation improvement than placebo over 5 days. Further studies are warranted to assess longer-term and clinical outcomes, as well as safety. Clinical relevance Serratiopeptidase administered postoperatively helps in improving trismus and swelling after removal of impacted lower third molars. Trial registration The study was registered in ClinicalTrial.gov under the number NCT02493179. Registered 1st of June 2015, https://clinicaltrials.gov/ct2/results?cond=serratiopeptidase.
... It is mainly used as an anti-inflammatory agent. This enzyme has widespread applications in arthritis, chronic bronchitis, sinusitis, atherosclerosis, wound debridment and fibrocystic breast disease [8][9][10]. Entrapment of this metalloprotease has been investigated by PLGA, Eudragit S100 microspheres and liposome nanoparticles, but immobilization of enzyme on isoluble matrix has not been reported [11][12][13]. ...
... The determination of pH on the activity of free and immobilized enzyme was performed over a range of pH (4)(5)(6)(7)(8)(9)(10)(11)(12) at 37°C for 10 min under previously mentioned conditions. A substrate consisting of 1% (w/v) casein in Briton-Robison universal buffer (0.04 M H 3 PO 4 , 0.04 M H 3 BO 3 , 0.04 M CH 3 COOH) was used [18]. ...
Article
Objective In the present work, we have extended the study and immobilized the metalloprotease enzyme in glutaraldehyde cross-linked chitosan nanogels to scrutinize the enzyme’s features including stability over its soluble free form. Method The immobilized metalloprotease was characterized using scanning electron microscopy (SEM), followed by Fourier transform infrared (FTIR) spectroscopy. The enzyme is optimally active at 50°C and pH range of 8.0–10. Results Thermal stability of the enzyme enhanced when immobilized on the nanogel. After 5 min of incubation at 50°C, immobilized enzymes retained 60% of their original activity, while negligible activity (23%) was observed in the case of the free enzyme. Conclusion The results obtained here provide a powerful demonstration of the benefits of taking the glutaraldehyde cross-linked chitosan matrices to enhance metalloprotease stability. The high stability of the immobilized enzyme serves to improve its performance for possible application on the industrial scale.
... [1] An extensive search of the literature to control the immediate postsurgry inflammatory response revealed modalities such as medications like analgesics, antibiotics, corticosteroids and proteolytic enzymes, laser application, physical therapeutic methods like cryotherapy, manual lymph drainage, and various taping methods. [2,3] The literature does not provide consensus that a single method is standard enough to be clinically applied as a protocol for the prevention of postoperative periorbital swelling, pain, and trismus following surgical intervention of zygomaticomaxillary complex fracture. Hence, further research is required to formulate an ideal and cost-effective method in preventing or managing the postoperative morbidities of surgeries in the orofacial region. ...
... In the study, the authors also mentioned that the 3D arrangement of collagen fibers and also preserved the integrity of the dermis. [2,20,21] It is postulated that KT application also reduces the nerve growth factor and B-cell lymphoma-2 immune reactivity, which can be interpreted as a reduction in pain sensation and tissue reconstruction following trauma. These mentioned observations advocate a potential benefit of KT in clinical care. ...
Article
Background and Objectives: Maxillofacial surgery induces alarming facial swelling while treating complex orbital and zygomatic bone fractures for which corticosteroids have been used aggressively causing side effects. This study is aimed to evaluate the efficacy of Kinesiology Tape (KT) in isolated zygomaticomaxillary complex (ZMC) fractures in the reduction of postoperative swelling, pain, and trismus. Methods: This was a prospective study involving thirty patients with isolated ZMC fractures divided into two groups: test and control. Surgery was performed in accordance with the standardized protocol customized for the study. KT was used on the test group. The objective assessment of swelling involving six specific reference points making five lines and pre- and postoperative mouth opening was recorded. The subjective assessment of pain and efficacy of KT was checked at the time of discharge. Results: There was a significant reduction in swelling in the postoperative period in the study group as compared to the control. The study group showed minimum swelling, and the rate of resolving was faster. Subjectively 86.6% of the patients were very satisfied in the study group and did not find any disturbance to the use of KT or difficulty in the neck movement. No significant difference was recorded in trismus and pain in both the groups. Conclusions: The postoperative swelling was significantly lower with application of KT in ZMC fractures. No significant influence was seen on pain and trismus. The subjective assessment of the patients revealed that the mouth opening increased after surgery in the study group which may be due to placebo effect. KT could be a simple, inexpensive, noninvasive approach in management of postoperative morbidity which promises to improve the quality of life.
... These preparations are marketed in India for their anti-inflammatory action and are used in controlling edema, pain and inflammation associated with surgical, obstetrical, dental procedures, accidental trauma, infections or allergic manifestations. [2][3][4][23][24][25][26] We used a drug compendium, which is a commercial publication and is commonly used by prescribers as a source of information on drug formulations available in India. ...
... The analysis of efficacy studies revealed that the superiority of serratiopeptidase alone or of FDCs of serratiopeptidase over existing NSAIDs or other single preparations is questionable. [24,[37][38][39] An earlier study reported that the efficacy of serratiopeptidase alone was not significantly more than that of placebo, ibuprofen or betamethasone in postoperative sequel following removal of impacted 3 rd molar. [37] Similarly, another study revealed that the combination of serratiopeptidase and diclofenac sodium does not cause more reduction in oedema as compared with diclofenac sodium alone in rats. ...
Article
Full-text available
Background and Objectives: Serratiopeptidase is available as an oral preparation. The effectiveness of this enzymatic preparation is questionable. Despite this fact, serratiopeptidase is prescribed for a variety of inflammatory conditions. The study was conducted to determine the availability, cost and rationality of serratiopeptidase preparations available in Indian market. Materials and Methods: Serratiopeptidase preparations were assessed for total number, composition, strength and cost. Data were collected from ‘The Drug Today’ of the years 2009 (October–December) and 2015 (April–June). The rationality of preparations was assessed on validated 6-point scoring criteria. An extensive literature search was made using evidence-based print and electronic databases for the studies on efficacy and safety of serratiopeptidase. Results: A total of 642 serratiopeptidase preparations were available in the year 2009, which increased to 647 in 2015. Eighty percent preparations were fixed-dose combinations (FDCs) with either non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, muscle relaxants or miscellaneous drugs. Of all FDCs, 96% preparations were combinations with one or more NSAIDs. Single drug preparations showed a decline from 19.9 to 12.3%. Serratiopeptidase was available in strengths from 2.5 to 50 mg. The cost of 10 mg dose of serratiopeptidase preparations ranged between Rs. 1.35 and Rs. 8.16. The cost of FDCs was more than that of single non-serratiopeptidase agent. FDCs scored poorly on rationality assessment scale in both years, and an increase in irrational preparations was observed. Conclusion: Too many serratiopeptidase preparations are available. Evidence on their efficacy and safety is lacking. The rationality of available FDCs of serratiopeptidase is poor. The availability of expensive FDCs of unknown efficacy and safety is an important contributory factor for the irrational use of drugs.
... It also is a potential therapeutic agent for the fibrocystic breast disease. It was seen to reduce pain and swelling with no adverse reactions in 25% of patients that received the enzyme treatment (Al-Khateeb and Nusair, 2008). It is also implicated in the management of periodontal inflammatory disorders associated with dental implants as well as those following third molar extraction (Tamimi et al., 2021). ...
... Such fibrinolytic attributes of serratiopeptidase further aid in blood thinning, and thus diminish the risk of stroke and thrombophlebitis. Serratiopeptidase has also been used in surgical pain management in a fixed dose combination with various Non-Steroidal antiinflammatory drugs like paracetamol, diclofenac and aceclofenac (Bhagat et al., 2013;Al-Khateeb and Nusair, 2008). Topical formulations of the enzyme can be used to treat local inflammations better than the non steroidal counterparts (Momeni et al., 2010). ...
Article
Full-text available
Biopharmaceuticals is a rapidly emerging field that explores and employs biological organisms and their products for therapeutic applications. Enzymes are remarkable biocatalysts that accelerate the rate of biochemical reactions manifold. They possess several extraordinary features like immense catalytic potential, high substrate specificity as well as pH and temperature optima. Due to these extraordinary attributes, they find diverse clinical applications. They are being increasingly employed for the treatment of a wide spectrum of diseases, either alone or in combination with other therapies. Functional enzymes can be isolated from plants, animals or microorganisms. Enzymes originally isolated from microbes offer diverse advantages including ease of isolation, high consistency, higher yields, economic feasibility, high stability and candid production via recombinant DNA technology using microbes as host cells. Also the processes of product modification as well as optimization are easier for microbial enzymes as compared to those obtained from animals and plants. Thus microbial enzymes display enthralling features and opportunities, and form an important subclass of modern biopharmaceuticals. In this review, we focus on the curative potential of microbial enzymes including enzybiotics, digestive aids, anti-inflammatory, anti-cancer and fibrinolytic agents. This information will help to highlight and further explore their therapeutic potential which is fast gaining popularity and assisting healthcare.
... The concentration of serratiopeptidase in the plasma was found to vary with body mass. Hence, validated cross over studies and optimization are necessary steps to be taken before recommending and prescribing serratiopeptidase [15]. ...
... Serratiopeptidase is a natural molecule that is being used for decades, hence commonly considered as safe. The safety of this enzyme in different areas of therapeutics is supported by several studies [15,19,22,48,54,72] in which no side effects or adverse events were reported. However, some studies have reported adverse effects of this molecule, but at a rare frequency. ...
Article
Full-text available
Therapeutic applications of enzymes have been widely accepted in clinical practices for decades. Proteolytic enzymes in particular, have been used for the treatment of diseases and disorders. Serratiopeptidase is a proteolytic enzyme having immense applications in therapeutic areas which have been validated by several in vitro, in vivo, and clinical studies as well as through anecdotal evidences. These applications are attributable to its versatile properties including anti-inflammatory, anti-biofilm, analgesic, anti-edemic, and fibrinolytic effects. The significant impact of serratiopeptidase reported needs to be backed by more scientific data. This review encompasses the details of therapeutic applications of serratiopeptidase based on available in vitro, in vivo, and clinical studies. We found some strong evidences regarding the efficacy of serratiopeptidase. However data on safety, tolerability, and its mechanism of action need detailing. This review aims to further explore the available literature on serratiopeptidase as well as provide scientific details for existing applications.
... Serratiopeptidase (EC 3.4.24.40) also known as serrapeptase and serralysin, which is a type of metalloendopeptidase, possess anti-edemic, anti-inflammatory analgesic, fibrinolytic, and anti-atherosclerotic properties and have been directly employed in clinical therapy in regulation of inflammation and pain, and furthermore, serrapeptase is even being used as a health supplement to protect the heart from atherosclerosis, which was achieved by degradation of atherosclerotic plaque and fibrin on the inside of arteries [2]. The anti-inflammatory and analgesic activity of serratiopeptidase is achieved by degrading the inflammationcausing amino acid derivatives such as histamine, serotonin, and bradykinin [3]. ...
Article
Full-text available
Background: Serratiopeptidase is an alkaline metalloendopeptidase, which acquired wide significance because of its therapeutic applications. The present study was undertaken for purification, characterization, and structural elucidation of serratiopeptidase produced from Streptomyces hydrogenans var. MGS13. Result: The crude enzyme was purified by precipitating with ammonium sulfate, dialysis, and Sephadex gel filtration, resulting in 34% recovery with a 12% purification fold. The purified enzyme S.AMP13 was spotted as a single clear hydrolytic band on casein zymogram and whose molecular weight was found to be 32 kDa by SDS-PAGE. The inhibitor and stability studies revealed that this enzyme is metalloprotease, thermostable, and alkaline in nature. The maximum serratiopeptidase activity was observed at 37 °C and pH 9.0. The partial amino acid sequence of the purified enzyme S.AMP13 by LC-MS/MS analysis shows the closest sequence similarities with previously reported alkaline metalloendopeptidases. The amino acid sequence alignment of S.AMP13 shared a conserved C-terminus region with peptidase-M10 serralysin superfamily at amino acid positions 128-147, i.e., ANLSTRATDTVYGFNSTAGR revealed that this enzyme is a serralysin-like protease. The kinetic studies of the purified enzyme revealed a Km of 1 mg/mL for its substrate casein and Vmax of 319 U/mL/min. The 3D structure of the purified enzyme was modeled by using SWISS-MODEL, and the quality of the structure was authenticated by assessing the Ramachandran plot using PROCHECK server, which suggested that the enzyme was stable with good quality. Conclusion: Inhibitor, stability, electrophoretic, and bioinformatic studies suggested that the purified enzyme obtained from S. hydrogenans var. MGS13 is a serralysin-like protease.
... This enzyme is also known by the name of Serralysin, Serratia-protease, or Serrapeptase [10], it has seven cofactors of calcium and, in its active form, one bivalent metal ion (Zn 2 ) [11]. Moreover, it has been used in different therapeutic applications for the treatment of arthritis, sinusitis, carpal tunnel syndrome, chronic bronchitis, atherosclerosis, fibrocystic breast disease, postoperative swelling, and pain due to its anti-inflammatory, analgesic, and anti-edematous effects [10,[12][13][14][15][16][17][18][19][20][21][22]. Several bacteria isolated from different organisms have been used for the production of serratiopeptidase [1,[7][8][9]. ...
Article
Serratiopeptidase, a metalloprotease produced by Serratia marcescens, is produced through a fermentation process using carbohydrates and proteins as carbon and nitrogen sources. However, some byproducts of the silk industry could be an alternative source for serratiopeptidase production. Therefore, the present work is focused on the purification and characterization of a serratiopeptidase produced from the C8 isolate of Serratia marcescens and obtained from a Colombian silkworm hybrid using casein or silkworm pupae. The protease was purified using ultrafiltration, anion-exchange, and size-exclusion chromatography. The purified enzyme showed a molecular weight of ~50 kDa with a purity above 96%, an isoelectric point of ~4.6, optimum pH and temperature of 6 and 50 °C, and stability at 4 °C for one month. The kinetic constants using azocasein as substrate were 0.63 mM (Km), 2,016 μM/min (Vmax), 41.41 s-1 (Kcat), and 6.56 × 107 M-1 s-1 (Kcat/Km). Inhibition by 5 mM EDTA or 1,10-phenanthroline was recovered by adding Zn2+ at the same concentration. Mass spectrometry analysis indicated 94% homology with the sequence of serratiopeptidase produced by the E-15 strain. We purified and characterized a serratiopeptidase produced by the C8 isolate of S. marcescens in a culture medium based on a renewable source from the silk industry.
... (6) A prospective study was conducted by Al Khateeb and Nusair on the use of serratiopeptidase for reduction of postoperative swelling, pain, and trismus after third molar surgery. (7) They concluded that significant reduction in swelling could be achieved with the use of serratiopeptidase. The proteolytic enzyme serratiopeptidase is believed to induce degradation of insoluble protein products like fibrin, biofilm and ...
Article
Full-text available
Health professionals still prefer to give various drug regimens for patients undergoing surgical removal of mandibular third molar to counteract swelling and pain. The study result help in deciding treatment regimen to be followed after third molar surgeries and suggests better patient comfort level is achieved with use of dexamethasone compared to serratiopeptidase for patients undergoing third molar surgeries. In this study serratiopeptidase and dexamethasone had equal and minimal effect on trismus. Serratiopeptidase can be used as an alternative drug to control inflammation in cases where corticosteroids are contraindicated.
... Postoperative complications such as pain, edema, trismus, bleeding, infection, nerve damage, and fracture may occur after the surgical extraction of the impacted third molar teeth in oral and maxillofacial surgery (5,6). These complications may have a negative impact on the life comfort of the patients postoperatively (6,11). In our study, we evaluated the effectiveness of TENS application to the level of pain which is the most common com- plication that affects the patient comfort at the highest level after the third molar surgery. ...
Article
Full-text available
Background The aim of this study was to assess the therapeutic effects of Transcutaneous Electrical Nerve Stimulation (TENS) on pain after the impacted third molar surgery. Material and Methods The study was carried out on 30 patients attending the outpatient department of the oral and maxillofacial surgery. Both sides’ impacted mandibular third molars were taken into consideration, and a total of 60 impacted third molars were undergone surgical extraction. After the first surgery, patients were given analgesic, antibiotics, and mouthwash as a routine treatment procedure. Following the second surgery, TENS was applied over the painful area of the cheek for patients in addition to routine treatment procedure. Pain was evaluated with Visual Analog Scale (VAS) at the postoperative 6, 8, 24 hours and 2,3,4 and 5 days. The Student t test was applied to compare pain levels between groups. P<0.05 and p<0.001 were considered significant in all statistical analyses. Results The study was carried out in 30 patients 15 (50%) female and 15 (50%) male, aged between 20 and 31 years. The mean age of the patients was 24.60 ± 4.76. There was a statistically significant difference in the evaluation of VAS levels in postoperative 6, 8, 24 hours and 2, 3, 4, and 5 days between the routine treatment group and the TENS application group. Conclusions TENS activates a complex neuronal network to result in a reduction in pain. In conclusion, TENS application was highly effective in pain modulation following the third molar surgery. Therefore, TENS, which is one of the non-pharmacological pain control methods after such surgeries, can be used safely in reducing postoperative pain. Key words:Impacted teeth, third molar, pain, transcutaneous electrical nerve stimulation.
... Diş hekimliği cerrahisinde gömülü üçüncü molar dişlerinin cerrahi çekimlerinden sonra ağrı, ödem, trismus, kanama, enfeksiyon, sinir hasarı ve fraktür gibi postoperatif komplikasyonlar oluşabilmektedir. Bu komplikasyonlar, hastaların postoperatif dönemde yaşam konforlarını oldukça olumsuz etkileyebilmektedirler. 13,14 Bizde çalışmamızda gömülü 3. molar diş cerrahisi sonrasında en çok meydana gelen ve hasta konforunu en yüksek dü- zeyde etkileyen bir komplikasyon olan ağrının düzeyini, hastaların uyku kalitelerini ve ağrı ile uyku kalitesi arasındaki ilişkiyi inceledik. ...
... Indeed, a number of different techniques have been previously used to measure postoperative swelling following third molar surgery, including verbal response scales, mechanical methods (cephalostats, calipers, and registration of reference points or landmarks), ultrasound, photographic techniques, computed tomography, and magnetic resonance imaging [53,54]. Advances in 3D imaging techniques allowed to capture and superimpose facial images and measure alterations in soft tissue position in three dimensions [55]. ...
Article
Full-text available
Objectives This study investigated and compared the effectiveness of a phytotherapeutic drug composed of herbal extracts on postsurgical discomfort after mandibular third molar surgery. Materials and methods Eighty-two patients requiring the surgical removal of a mandibular third molar were randomly assigned to receive placebo (group 1), ibuprofen (group 2), and a phytotherapeutic drug (composed of baicalin, 190 mg; bromelain, 50 mg; escin, 30 mg) (group 3). Drugs were administered after tooth extraction twice a day for 5 days. The primary outcome, pain, was evaluated using a visual analogue scale at 2 h, 6 h, 12 h, 24 h, 48 h, and 7 and 10 days after surgery. The secondary outcomes were the changes in maximum mouth opening and facial contours (mm) between baseline and at 24 h, 72 h, and 7 and 10 days after surgery. Results Compared to the baseline, all treatments demonstrated an improvement in the primary and secondary outcomes. Moreover, compared to groups 1 and 2, patients in group 3 yielded a significant reduction of the postoperative pain score at 12 h (p < 0.001), 24 h (p = 0.010), and 48 h (p = 0.048) after surgery. The mean reduction of the swelling and trismus was similar between groups. Conclusions The results of this study suggest that a postoperative administration of a phytotherapeutic drug was found to be effective in postoperative pain management after the surgical removal of impacted mandibular third molars. Clinical relevance The phytotherapeutic drug composed of herbal extract determined a decrease in the severity of postoperative pain compared to ibuprofen and placebo.
... A number of different techniques have been previously used to measure postoperative swelling, including verbal response scales, mechanical methods (cephalostats, calipers, and registration of reference points or landmarks), ultrasound, photographic techniques, computed tomography and magnetic resonance imaging (28,(30)(31)(32). Advances in 3D imaging techniques have made it possible to capture and superimpose facial images and measure alterations in soft tissue position in three dimensions (33). ...
Article
Full-text available
The purpose of this study was to evaluate and compare the effects of single- and two-dose low-level laser therapies (LLLT) on postoperative swelling, trismus, and pain of patients whose impacted mandibular third molars was extracted in addition measurement volumetrically to the edema with 3dMD face system. Forty-five patients were randomized into three treatment groups, each with 15 patients. Group 1, the control group, received routine management (ice application); Group 2 received a single dose of LLLT immediately after surgery; and Group 3 received two doses of LLLT immediately after surgery and on the second day. In this study, a gallium-aluminum-arsenide (GaAlAs, 0.3 W, 40 s, 4 J/cm2) diode laser device was used. The laser was applied extraorally at the insertion point of the masseter muscle. The trismus, pain level and facial swelling evaluated. 3dMD Face® (3dMD, Atlanta, GA) Photogrammetric System was used to evaluate volumetric changes of the swelling. There were no statistically significant differences detected in average swelling or trismus between the groups. Average visual analog scale (VAS) measurements were not statistically significant at postoperative day 2, but were statistically significant different between the groups at postoperative day 7 (p=0.008). This study demonstrated that although there were beneficial effects of single or two-dose LLLT on swelling, trismus, and pain level, only pain level was significantly decreased at postoperative day 7.
... Serratiopeptidase enzyme was also added in the drug regimen in some patient to prevent swelling. This enzyme is recommended in pain and swelling of bones (Al-Khateeb et al., 2008). It was also observed that 35% of patient who were receiving ossein mineral complex with vitamin D 3 orally in combination, were also receiving vitamin D 3 in injectable form. ...
Article
Aim: The aim and objective of current study is to investigate the best possible regimen for the treatment of osteoarthritis in Pakistani population. Materials and method: An observational, multicentre cross-sectional study was conducted including 179 patients aged from 28 to 80 years. Patients were divided into three treatment protocols. Treatment protocol I patients received non-steroidal anti-inflammatory drugs (NSAIDs) with mineral supplements, Treatment protocol II received NSAIDs with mineral supplements and steroids, and Treatment protocol III received NSAIDs with mineral supplements and Vitamin D 3. A questionnaire was designed and data were collected accordingly. Results: Results indicate that females have high incidence of osteoarthritis. Results also indicate that females receive Treatment protocol I and II more as compared to males. However, they have more vitamin D3 deficiency in comparison to males. Conclusion: The present study concludes that various drug regimens are effective in treatment of osteoarthritis. However, there is not a specific protocol that cures the disorder. Our study also concludes that NSAIDs, with calcium supplementation and vitamin D 3 is a best possible combination to improve the quality of life in Pakistani population.
... The surgical removal of impacted mandibular third molars produces a significant degree of tissue trauma that causes an inflammatory reaction. The latter produces the usual postoperative signs and symptoms such as pain, facial oedema, and limited mouth opening due to muscle spasm (trismus).P (1) P Cytokines are small secreted proteins which mediate and regulate immunity, inflammation, and hematopoietic. They are produced in response to an immune stimulus. ...
Article
Full-text available
Aims: The aim of the study is to assess the blood levels of (interleukin-6) at different intervals of time after surgical removal of impacted lower third molars.. Materials and Methods: The study group comprised 26 patients with impacted lower third molars .All extractions were performed under local anaesthesia using the inferior alveolar nerve block together with vestibular infiltration. A buccal full thickness two sided mucoperiosteal flap was raised. Sterile low-speed straight hand pieces and sterile distilled water were used for ostectomy. After tooth removal the wound was closed with 3-0 black silk suture. Three blood samples were drawn from each patient; one before the operation, the second 2hr. post operation and the third 24hr. post operation. The blood samples were collected through venipunc-ture, serum separated and stored in at-20ºC. Analysis was performed using the Enzyme linked Im-munosourbant assay (ELISA). Results: The level of IL-6, in this study, showed an increase following surgery, in comparison with the level before operation. This increase in the level of Interleukin-6 remained high until 24hr after operation. Conclusion: Interleukin-6 (IL-6) is higher after surgical extraction of lower third molars and remained with high levels to 24hr. after operation.
... Several techniques have been used to measure postoperative swelling including verbal response scales, mechanical methods (cephalostat, calipers, etc.), ultrasound, photographic techniques, computed tomography, and magnetic resonance imaging. [34][35][36][37] We used 3dMD face imaging system to evaluate postoperative swelling because 3dMD system measures changes in soft tissue three dimensionally and provides photo-realistic views and objective evaluation. [38,39] Lack of evidences associated with different doses and application type (extraoral/intraoral) of LLLT on the postoperative indications to minimize pain, swelling, and trismus after surgical removal of mandibular third molar is the limitation of the present study. ...
Article
Full-text available
Purpose: This study aimed to evaluate the effect of a low-level laser therapy (LLLT) on pain, trismus, and swelling of patients whose impacted 3rd molar tooth was extracted compared to placebo or "sham" treatment and measure volumetrically the edema with a three-dimensional (3D) surface imaging device (3dMD face system). Materials and methods: Forty-five patients over 17 years of age were included in the study. Patients were randomized to three groups; Group 1, the control group, received only routine management (ice application) (n = 15); Group 2, received single-dose LLLT immediately after surgery (n = 15); and Group 3, placebo group, received sham therapy immediately after surgery (n = 15). In this study, a gallium-aluminum-arsenide diode laser device was used. The laser was applied extraorally (0.3 W, 40 s, 4 J/cm2). The trismus, pain, and facial swelling were evaluated. A 3D surface imaging device (3dMD Photogrammetric System) was used to evaluate the volumetric changes of the swelling. The 3D morphology of the facial swelling was recorded using this imaging device immediately before surgery, the second day after surgery, and the 7th day after surgery. IBM SPSS statistics 22.0 program was used in the statistical assessment and P < 0.05 was considered statistically significant. Results: There was no statistically significant difference in the edema and trismus between the groups. The pain level in Group 2 was significantly lower than that in Group 3 at all-time points. Furthermore, the pain level in Group 2 was significantly lower than that in Group 1 on day 7. Conclusions: LLLT reduced the intensity of pain following third molar surgery by single dose. The results of this study revealed that LLLT reduced facial swelling, but no significant differences were found among the three groups. In addition, a 3D craniomaxillofacial imaging method provided insight into volume changes after 3rd molar surgery and the evaluation of facial swelling in an objective way.
... Therefore, the use of glucocorticoids was evaluated in dental and maxillo-facial surgery to decrease unwanted postoperative complications [41][42][43][44][45][46]. Several methods of controlling the immediate inflammatory response relating to head and neck surgery have been described and used, including drugs, such as analgesics [47][48][49][50], corticosteroids [51], antibiotics [52], proteolytic enzymes [53], laser treatments [54], and physical therapeutic methods like cryotherapy or manual lymphatic drainage (MLD) [55]. No single treatment method significantly prevents and/or reduces swelling without potential undesirable side effects. ...
Article
Full-text available
Background Orthognathic surgery (OGS) is associated with extensive surgical intervention within the soft and hard tissues of the facial region of the skull leading to inflammatory reactions. The presence of postoperative swelling indicates the accumulation of exudate or transudate; both these fluids occur in surgery. Massive swelling is a significant problem, because the tension of tissues intensifies pain sensations. The aim of the study was to evaluate the effectiveness of the kinesio taping method (KT) in patients after orthognathic surgery in the area of the facial skull in terms of eliminating postoperative swelling. Material/methods The study of the impact of kinesiology tape applied after orthognathic surgery to the craniofacial area on the elimination of swelling was performed in sixteen patients who suffered from this complication after bilateral sagittal split osteotomy. Results The swelling was shown to be reduced after KT; within the same study the differences were statistically significant between the left and right sides and for the same side (p<0.05). The application of the lymphatic kinesio taping method led to the reduction of tension in the affected area and restoration of proper lymphatic circulation in the region covered by swelling. This allows for the improvement of the blood and lymph microcirculation and activation of self-healing processes. Conclusions The analysis of the impact of the practical use of the lymphatic KT on complications after orthognathic surgery revealed that it had a beneficial effect on the reduction of swelling. The use of the KT method seems promising because it is simple to carry out, not traumatic, economical and rarely causes undesirable allergies.
... Murugesan et al. [40] carried out a randomized study on 110 patients to evaluate the usefulness of serratiopeptidase compared to dexamethasone in impacted lower third molar surgery. Postoperatively, 1 mg dexamethasone was given thrice daily in the first group and 10 mg serratiopeptidase was given thrice daily in the second group for 3 days. ...
Article
Serratiopeptidase, a proteolytic enzyme derived from Serratia E-15 species enterobacteria, is widely used in medical field for its anti-inflammatory, anti-edemic properties, and analgesic properties. It is being used commonly in various specialties such as orthopedics, otolaryngology, gynecology, surgery, pulmonology, ophthalmology, and dentistry. Research has shown that serratiopeptidase is the most effective anti-inflammatory agent compared to other enzyme preparations. This article reviews the efficacy, safety, and applications of serratiopeptidase in oral surgery. This article also discusses the mechanism of action of serratiopeptidase, its contraindications and complications. From the recently published literature, it is clear that the role of serratiopeptidase as a therapeutic agent in oral and maxillofacial surgery is expanding and they hold a promising future as a broad-spectrum anti-inflammatory drug with minimal side effects and complications. Further, research will broaden their applications in the field of medicine and dentistry.
... S. marcescens strain SRM (MTCC 8708) used in this study was isolated from the flowers of summer squash plants, showing no apparent symptoms of yellow vine disease. Application of Spep as pharmaceutical and insecticidal agent was well studied (8,9,10) . Therefore, the large scale production of Spep is significant for the commercial purpose. ...
Article
Full-text available
Keywords: Serratia marcescens, Pichia pastoris, Serratiopeptidase, cloning, purification, Mass spectroscopy. Serrapeptidase (Spep) produced from Serratia marcescens is a secretary protein devoid of signal peptide. Spep was over expressed in E.Coli as inclusion bodies however the purified fusion protein was enzymatically inactive. To achieve the production of active Spep, in this study, the gene corresponding to Spep (Accession No. KP869847) from the genomic DNA of Serratia marcescens MTCC 8707 was cloned into Pichia pastoris using a modified transfer vector. The expression was induced with methanol and the secreted protein was affinity purified. The yield of the recombinant protein was 0.06 mg/ml with a maximum activity of 30 U/ml. An optimum activity of recombinant Spep was observed at 30oC and pH 8.0. The molecular weight of the purified mature active recombinant protein was 52 kDa. The secreted protein was characterized by mass spectrometric analyses using LC/MS-MS. To the best of our knowledge this is the first report on the production of active form of Spep from S.marcescens of plant origin. This protein may be exploited for the pharmaceutical and insecticidal application.
... LLLT also has an anti-edematous and pain relief effect due to an increased number and diameter of lymph vessels and a decreased blood vessel permeability. At a molecular level, LLLT can increase protein absorption by activating macrophages, modifying hydrostatic and intracapillary pressure and inducing the absorption of interstitial fluids with a consequent reduction of edema [28]. However, laser therapy results are of moderate clinical importance for patients affected by trismus; it has been used for minimizing mouth opening reduction, but only a very small number of patients undergo this type of therapy [29]. ...
Article
Full-text available
(1) Background: Trismus clinically manifests as a reduction of the buccal opening and restricted mouth opening due to different etiologies, but it is often associated with traumatic phenomena. Several treatments have been proposed such as physiotherapy exercises, cryotherapy, laser therapy, hyaluronic acid and platelet-rich fibrin infiltration, but the gold standard is represented by drug therapy based on corticosteroids and NSAIDs, currently the most documented in the scientific literature. Capacitive-resistive electric transfer (Cret) therapy is used to treat musculoskeletal injuries. Cret is a non-invasive electrothermal treatment classified as deep thermo-therapy. (2) Patient: We would like to document a case of particularly traumatic trismus in a 12-year-old patient, not responsive to previous pharmacological therapy and treated with a radiofrequency device called Velvet temporomandibular joint (TMJ). Five capacitive and resistive diathermy sessions with the device were performed. The first four sessions were performed every 4 days and the fifth after 5 days. (3) Result: The maximum opening of the mouth was 10 mm at the initial stage and 38 mm at the end of the six sessions. Pain regressed after the second appointment. (4) Conclusions: Clinical studies with a good number of samples need to be conducted to evaluate the effectiveness of this device which has proved to be an excellent treatment for this refractory case to conventional therapies. Finally, it may be useful to define precise and replicable protocols to make this therapy suitable for patients with TMJ disorders.
... These symptoms should be professionally managed and reduced as much as possible. For that purpose, various therapies, such as corticosteroids, non-steroid anti-inflammatory drugs (NSAIDs), combinations of these agents, and enzymes such as serratiopeptidase, have been suggested [2][3][4][5], and in addition to these pharmacological therapies, cryotherapy, manual lymph drainage, and low-level laser therapy [6][7][8] are also described in the literature. ...
Article
Full-text available
Objectives: We aimed to compare the effects of preoperative single-dose submucosal corticosteroid injection and postoperative elastic therapeutic bandage application with postoperative non-steroid anti-inflammatory drug therapy on postoperative inflammatory symptoms and quality of life following mandibular third molar surgeries. Materials and methods: A single-center, randomized, clinical trial was conducted with 52 patients (36 female, 16 male) who expected severe postoperative sequelae as a result of the extraction of impacted mandibular third molars. The patients were randomized into three groups. In the preoperative submucosal corticosteroid injection group (n = 16), 8 mg/2 ml dexamethasone 21-phosphate was administered near operated sites. In the postoperative therapeutic elastic bandage application group (n = 19), Kinesio tapes were applied to operated sites. Paracetamol 500 mg was prescribed for the patients in the corticosteroid and elastic bandage application groups. In the postoperative non-steroid anti-inflammatory drug group (n = 17), 25 mg dexketoprofen trometamol was prescribed. Maximal mouth opening, swelling, pain, and Oral Health Impaction Profile scores were quantified preoperatively and postoperatively on the second and seventh days. Additionally, all patients were asked to evaluate the postoperative period by the Postoperative Symptom Severity Scale. Results: Analysis of the obtained data revealed that on the second postoperative day, postoperative edema and trismus were significantly lower in the submucosal corticosteroid (p = 0.025, p = 0.03) and therapeutic elastic bandage (p = 0.032, p = 0.014) groups, and the patients in these groups had a more comfortable postoperative period than the group prescribed a postoperative non-steroid anti-inflammatory drug (p = 0.016). Clinical relevance: In oral surgery, postoperative elastic bandage application can provide results similar to those of preoperative submucosal corticosteroid injection with respect to inflammatory symptoms and quality of life. Trial registration: ClinicalTrials.gov Identifier: NCT04200885. Date of Registration: December 2019 (retrospectively registered).
... Another promising area is the use of serratiopeptidase to break down atherosclerotic plaque. Khateeb et al. have demonstrated the role of serratiopeptidase in the management of ortho-dental inflammatory syndrome [64]. Because the enzyme digests non-living tissue and leaves live tissue alone; it may be effective in removing the deposits of fatty substances, cholesterol, cellular waste products, calcium and fibrin on the inside of the arteries. ...
Article
Full-text available
Inflammation remains key event during most of the diseases and physiological imbalance. Acute inflammation defines protective measure by immune system to remove cause and failure of resolution lead to chronic inflammation. Over a period of time, numbers of drugs mostly chemical have been deployed to combat acute and chronic inflammation. In the recent time enzyme based anti-inflammatory, drugs became popular over conventional chemical based. Serratiopeptidase a proteolytic enzyme from trypsin family possess tremendous scope in combating inflammation. Serine protease possesses a higher affinity for cyclooxygenase (COX-I and COX-II) a key enzyme associated with production of different inflammatory mediators including interleukins (IL), prostaglandins (PGs) and thromboxane (TXs) etc. Currently, arthritis, sinusitis, bronchitis, fibrocystic breast disease, and carpal tunnel syndrome, etc. are the leading inflammatory disorders affected entire the globe. In order to conquer inflammation, both acute and chronic world, physician mostly relies on conventional drugs. The most common drugs to combat acute inflammation are Nonsteroidal anti-inflammatory drugs (NSAIDs) alone and or in combination. However, during chronic inflammation, NSAIDs are often used with steroidal drugs such as autoimmune disorders (RA. These drugs possess several limitations such as side effect and ADR etc. In order to overcome these limitations and complications enzyme based drugs (anti-inflammatory) emerged and aiming a new high since last one decade. Serine protease, the largest proteolytic family has been reported for several therapeutic applications, including anti-inflammatory. Serratiopeptidase is a leading enzyme has a very long history in medical as an effective anti-inflammatory drug. Current study emphasizes present scenario and future prospect of serratiopeptidase as an anti-inflammatory drug. The study also illustrates a comparative analysis of conventional drugs and enzyme based therapeutic to combat inflammation.
... The measurements were carried out just before the surgery and at post operative days 1, 2 and 7. Post operative trismus was measured as decrease in mouth opening. (12) The data obtained from this study were analysis included descriptive and analytic methods. For descriptive way, the mean of variance were used. ...
Article
Full-text available
Aims: To compare the efficacy of celebrex 400 mg orally one time daily with paracatamol 1000 mg orally four times daily on reducing post operative oral complication (facial swelling, trismus and pain) after third molar surgery. Materials and Methods: A total of 45 patients (24 females, 21 males) with impacted lower third molars divided into two groups; Group I: Twenty patients treated with paracetamol 1000 mg orally four times daily. Group II: Twenty five patients treated with celebrex 400 mg orally one time daily. Results: The mean age of patients was (29.17 ± 5.0) in group I and (27.1± 4.9) in group II with no significant differences, with a higher percentage of mesioangular impaction 40% among other type of impaction in two groups. Patients in group II suffer from less facial swelling and trismus with a significant differences p ≤ 0.05 compared with group I, but the two groups showed no significant differ-ences in related to pain (p> 0.05) after third molar's surgical removal. Conclusions: Celebrex is more effective than paracetamol with less frequency of administration and longer duration of action in reduc-ing post operative oral complication (swelling and trismus), but with some analgesic effect after surgical removal of lower third molars
... The surgical removal of impacted mandibular third molars produces a significant degree of tissue trauma that causes an inflammatory reaction. The latter produces the usual postoperative signs and symptoms such as pain, facial oedema, and limited mouth opening due to muscle spasm (trismus).P (1) P Cytokines are small secreted proteins which mediate and regulate immunity, inflammation, and hematopoietic. They are produced in response to an immune stimulus. ...
Article
Full-text available
Aims: The aim of the study is to assess the blood levels of (interleukin-6) at different intervals of time after surgical removal of impacted lower third molars.. Materials and Methods: The study group comprised 26 patients with impacted lower third molars .All extractions were performed under local anaesthesia using the inferior alveolar nerve block together with vestibular infiltration. A buccal full thickness two sided mucoperiosteal flap was raised. Sterile low-speed straight hand pieces and sterile distilled water were used for ostectomy. After tooth removal the wound was closed with 3-0 black silk suture. Three blood samples were drawn from each patient; one before the operation, the second 2hr. post operation and the third 24hr. post operation. The blood samples were collected through venipuncture, serum separated and stored in at -20ºC. Analysis was performed using the Enzyme linked Immunosourbant assay ( ELISA). Results: The level of IL-6, in this study, showed an increase following surgery, in comparison with the level before operation. This increase in the level of Interleukin-6 remained high until 24hr after operation. Conclusion: Interleukin-6 (IL-6) is higher after surgical extraction of lower third molars and remained with high levels to 24hr. after operation. Keywords: Third molar surgery, cytokines, interleukin-6
... This enzyme has an inflammatory effect and it is believed to induce degradation of insoluble protein products. [8] It decreases viscosity of the ooze, facilitates draining, and thus alleviates pain by preventing bradykinin release. [9] In maxillary sinus antrotomy, serratiopeptidase is said to significantly reduce buccal swelling. ...
Article
Full-text available
Objective: The postoperative symptoms after third molar removal surgery were commonly uneventful. The aim of this study was to compare two proteolytic enzymes from different origin and to prove which enzyme provides a faster healing. One of the proteolytic enzymes involves a combination with a flavonoid. This involves trypsin, bromelain, along with a flavonoid rutin. Another proteolytic enzyme is serratiopeptidase that helps in degradation of insoluble proteins causing reduced swelling in the operated site. Materials and methods: In this study, voluntary subjects of clinically indicated bilateral lower third impaction were selected. The subjects were recommended to undergo extraction of impacted teeth in two sittings, one extraction per visit. In the first sitting, subjects were prescribed trypsin, bromelain, and rutin combination after removal of 48 teeth and in the second sitting subjects were prescribed serratiopeptidase after removal of 38 teeth. There was a time interval of 2-3 weeks in between the sittings. The post findings such as mouth opening, swelling, and pain scale were noted. Results: The results showed that the proteolytic enzyme combination of trypsin, bromelain, and rutin is better than serratiopeptidase. Conclusion: It is recommended that trypsin, bromelain, and rutin combination can be used effectively for postoperative purpose to facilitate wound healing.
... Serratiopeptidase (SRP) is existing in one of the enteric bacilli in the silk worm [1]. It has various actions containing a powerful anti-inflammatory effects, antiedema in addition to bradykinin-decomposing action as soon as improves the action of antibiotic at the infected site [2,3]. SRP mostly used as an anti-inflammatory enzyme-based drug alone or in combination with other medicines in treatment of sinusitis, bronchitis, atherosclerosis and arthritis [4]. ...
Research
Full-text available
Objective: Serratiopeptidase (SRP), an enzyme with great effect in opposing inflammation. Applications of enzyme topically provide advantage of direct entery to the location of action. This study examined the possibility of using topical SRP preparations in the formula of ointments and to assess the topical effect of SRP in facial wound management in rabbits. Material and Method: healthy male rabbits weight,1.25 ± 0.25kg divided into four groups: group one animals received no treatment, group two animals treated with Vaseline only, group three and four were treated by SRP (0.5% and 1%) respectively. Standard incisions were done on submandibular region of all rabbits. Wound healing assessment was determined by histological method. Results: group one and two showed incomplete closure of the wound with poor re-epithelization, while other groups (three and four) demonstrated complete closure of the wound with good re-epithelization. Conclusion: topical application of SRP has ability to improve facial wound healing in rabbits.
... The matter is further complicated by the fact that these drugs are often used in so-called self-medication (self-treatment carried out without medical supervision), which results in their abuse, an exceeding of maximum doses, and a risk of dangerous interactions with other medications taken by patients. Trismus, on the other hand, usually impedes speech and food intake, further reducing the postoperative quality of life in patients [25]. The location of edema in the visible area of the face means that after the surgical extraction of an impacted lower wisdom tooth, patients are often on sick leave and avoid contact with the environment. ...
Article
Full-text available
Non-infectious complications such as post-extraction pain, trismus, and swelling are extremely common after impacted wisdom tooth removal. The aim of the study was to assess the impact of using kinesio tape on the level of the postoperative swelling of soft tissues, trismus, and pain in patients undergoing the surgical extraction of an impacted mandibular third molar. One hundred patients undergoing the surgical extraction of a lower wisdom tooth were randomly divided into two groups: a study group with kinesio taping (KT) (n = 50) and a control group without kinesio taping (NKT) (n = 50). The surgical procedure was performed according to the same repeat-able scheme. Kinesio tape was applied immediately after surgery in the KT group. In both groups, measurements of swelling, trismus, and pain were performed before the surgery and on the third and seventh postprocedural days. Kinesio tape had a significant effect on the decrease in facial swelling on the third day after surgery and a decrease in trismus and pain severity levels on the third and seventh days after surgery. The kinesio tape method is non-invasive, continuously active throughout the entire application period, and requires no additional patient appointments. KT application is an effective method for reducing postoperative edema, pain, and trismus after impacted mandibular wisdom teeth surgery.
... Istnieje wiele możliwości kontroli pozabiegowej odpowiedzi zapalnej włączając użycie leków przeciwbólowych, kortykosteroidów, antybiotyków oraz enzymów proteolitycznych. [6][7][8][9][10] Wspomnieć należy o możliwości zastosowania lasera, krioterapii lub manualnego drenażu limfy. [11][12][13] Żadna z wymienionych metod nie jest w stanie w sposób wyłączny wyeliminować ryzyka wystąpienia obrzęku, bólu bądź szczękościsku z uwzględnieniem niepożądanych skutków ubocznych. ...
Article
Streszczenie Wprowadzenie. Artykuł stanowi kontynuację wcześniejszego opracowania dotyczącego istoty kinesiotapingu w obszarze czaszkowo-żuchwo-wym oraz czaszkowo-twarzowym. Plastrowanie dynamiczne jest jedną z form postępowania fi-zjoterapeutycznego polegającą na aplikowaniu specjalnych taśm w wybranych obszarach ciała. Znajduje zastosowanie w terapii przeciwbólowej, a także przeciwobrzękowej. Może pełnić funkcję stabilizacyjną. Istotną rolę odgrywa w reedukacji wzorców ruchowych, jak również korekcji syste-mu powięziowego. Jest dobrze tolerowany przez pacjentów. Może stanowić izolowaną metodę le-czenia, jak również czynnik wspomagający inne formy terapii. Cel pracy. Celem pracy była ocena zasadno-ści, a zarazem możliwości zastosowania kine-siotapingu u pacjentów z zaburzeniami obszaru czaszkowo-żuchwowego oraz czaszkowo-twa-rzowego. Istota kinesiotapingu w obszarze czaszkowo-żuchwowym oraz czaszkowo-twarzowym – przegląd piśmiennictwa. Część II.
... Methylcobalamin, Acetyl-L-Carnitine, N-Acetyl Cysteine, Vitamin D, and Curcumin improve nerve regeneration in a number of conditions including nerve injuries (crush), nerve repair after transection and neuropathic conditions such as diabetes . Curcumin, Bromelain, and Serratopeptidase decrease the inflammatory response and have demonstrated improved recovery after surgery with less pain and earlier return to activity [61][62][63][64][65][66][67][68][69][70][71][72][73]. ...
... The swelling reaches its maximum after approximately 48 to 72 h after the operation [7,8]. In this period, it is essential to provide adequate pain medication (non-steroidal antirheumatic drugs-NSAIDs [9], corticosteroids [10], or enzymatic drugs [11]) and is highly suggested to provide supportive local therapy, like manual lymph drainage [12], cooling with wet tissues or cryotherapy [2,7,13,14]. ...
Article
Full-text available
Purpose A post-operative cooling method in oral and maxillofacial surgery is the cooling with hilotherapy. The aim of this study was the post-operative comparison of cooling temperatures of 18°C and 22°C. The parameters of this trial were swelling and the post-operative pain levels. Methods This study included 156 patients, divided into two groups among whom a mono-one, bignathic osteotomy or genioplasty was indicated. The post-operative assessment of swelling was performed using a 3D optical scanner. This examination was repeated on post-operative days 1, 2, 3, 7, 14, 30, and 90. The examination on day 90 served as a reference value in respect of swelling and pain. Results Group 1 (18°C, 78 patients) showed an increase in post-operative swelling on the 1st post-OP day of 52.06 ± 35.41ml. The maximum was reached on the 2nd post-OP day with 75.82 ± 38.97ml. On the 30th post-OP day, residual swelling measured 11.60 ± 12.62ml. Group 2 (22 °C, 78 patients) showed an increase in postoperative swelling on the 1st post-OP day of 76.07 ± 63.15ml. The maximum was reached on the 2nd post-OP day with 106.97 ± 69.63 ml. On the 30th post-OP day, residual swelling measured 14.36 ± 32.26ml. The differences between the two groups and between different visits were statistically significant. Conclusion The study results indicate less residual swelling in group 1 on the 30th post-OP day, possible based on the lower cooling temperature. The post-operative pain exhibits a comparable level of pain intensity between the two groups. In overall terms, a subjectively more agreeable treatment was observed in group 1.
... On the other hand, a very strong association has been established between pain and trismus in this setting [25]. Trismus is usually caused by inflammation of the masticatory muscles [26,27] causing a spasm, often secondary to detachment of the mucoperiosteal flap. Other possible causes of trismus include TMJ trauma, direct medial pterygoid muscle trauma incurred during truncal block of the inferior alveolar nerve, and (more rarely) infections [26]. ...
Article
Full-text available
Background: The present study aimed to ascertain whether any significant reduction in patients' postoperative pain and inflammation could be achieved by using sterile physiological solution instead of normal water to irrigate the surgical field and cool the dental bur during third molar extractions. Methods: The study concerned 22 patients (11 females and 11 males) in good general health, who were referred to the Dental Clinic at Padova University hospital for lower third molar extractions. They were randomly assigned to two groups. Only the fluid used to irrigate the surgical field and cool the dental bur differed between the two study groups, being sterile physiological solution for group A, and mains water for group B. Postoperative pain, swelling, trismus and inflammation with high sensitivity CRP where measured and statistically evaluated. The numerosity of our sample was calculated on the grounds of an endpoint based on data in the literature. Results: Eighteen patients needed bilateral extractions, and 4 required only one extraction, so a total of 40 third molars were extracted. A sterile physiological solution was used to irrigate the surgical field in 20 extractions, while water was used in the other 20 cases. Data analysis with Wilcoxon test show no differences between the two groups (p < 0.05). Conclusions: no differences between groups for any of the parameters considered, after third molar extraction procedures undertaken using either sterile physiological solution or water for irrigation and cooling purposes.
... However, most of these techniques did not show beneficial effects. [8][9][10][11][12] Although administration of corticosteroids to control postoperative sequelae is popular, 13 there are serious concerns about their adverse impacts. The most potential side effects of corticosteroids are adrenal suppression, osteonecrosis, impaired wound healing, and increased risk of postoperative infection. ...
Article
Full-text available
Introduction: Periosteal releasing incision (PRI) is nearly always essential to advance the flap sufficiently for a tension-free flap closure in bone augmentation procedures. However, hematoma, swelling, and pain are recognized as the main consequences of PRI with scalpel. The aim of this case series was to investigate the effectiveness of laser-assisted PRI in guided bone regeneration (GBR) procedure. In addition, postoperative hematoma, swelling, and pain and implant success were assessed. Methods: Seventeen patients needed GBR were included in this study. Diode laser (940 nm, 2 W, pulse interval: 1 ms, pulse length: 1 ms, contact mode, 400-μm fiber tip) was used in a contact mode to cut the periosteum to create a tension-free flap. Facial hematoma, swelling, pain, and the number of consumed nonsteroidal anti-inflammatory drugs (NSAIDs) were measured for the six postoperative days. Six months after implant loading, implant success was evaluated. Results: Minimal bleeding was encountered during the procedure. A tension-free primary closure of the flap was achieved in all cases. The clinical healing of the surgical area was uneventful. None of the patients experienced hematoma, ecchymosis, or intense swelling after surgery. The mean value of maximum pain (visual analogue scale - VAS) was 20.59 ± 12.10 mm (mild pain). Patients did not need to use NSAID after four postoperative days. All implants were successful and functional and none of them failed after 6 months of implant loading. Conclusion: This study revealed the effectiveness of laser-assisted PRI in GBR procedure. This technique was accompanied with minimal sequelae at the first postoperative week. All implants were successful and no complication was noted during the course of this study.
... Apical microsurgery promoted the closure of stula, but was not signi cant in the degree of swelling. The appropriate amount of dexamethasone was reported to both reduce swelling and improve the patient's prognosis 13,22 . ...
Preprint
Full-text available
The aim of this prospective observational cohort study is to evaluate developing periapical swelling after apical microsurgery and determine potential risk factors. Ninety-eight apical microsurgery patients were selected for this study. Before surgery, bone shadow volume and density of pathological tissue were measured by CBCT. The other variables (age, gender, operative teeth number, fistula, preoperative swelling, drug use and pre-surgery root canal treatments) were assessed during examination. Swelling degree was confirmed by questionnaires for patients on the 1st, 7th, 14th, and 21st days respectively after surgery. Statistical analyses were performed to identify predictors for swelling. Majority of patients reported moderate (45.9%) or severe (34.7%) swelling on day 1, and moderate (44.9%) or mild (45.9%) on day 7. 99% patients had no or mild swelling on day 14. The average swelling level peaked on day 1 postoperatively and gradually decreased. Of statistical significance, age, bone shadow volume and density of pathological tissue acted as predictors of swelling(P<0.05). However, there was no significant difference in gender, tooth number, fistula, preoperative swelling, drug use, or pre-surgery root canal treatments (P > 0.05). We conclude that younger patients with larger shadow volume and density were significantly more likely to develop swelling after apical microsurgery.
... Serratiopeptidase (SRP) is existing in one of the enteric bacilli in the silk worm [1]. It has various actions containing a powerful anti-inflammatory effects, antiedema in addition to bradykinin-decomposing action as soon as improves the action of antibiotic at the infected site [2,3]. SRP mostly used as an anti-inflammatory enzyme-based drug alone or in combination with other medicines in treatment of sinusitis, bronchitis, atherosclerosis and arthritis [4]. ...
Article
Full-text available
Objective: Serratiopeptidase (SRP), an enzyme with great effect in opposing inflammation. Applications of enzyme topically provide advantage of direct entery to the location of action. This study examined the possibility of using topical SRP preparations in the formula of ointments and to assess the topical effect of SRP in facial wound management in rabbits. Material and Method: healthy male rabbits weight,1.25 ± 0.25kg divided into four groups: group one animals received no treatment, group two animals treated with Vaseline only, group three and four were treated by SRP (0.5% and 1%) respectively. Standard incisions were done on submandibular region of all rabbits. Wound healing assessment was determined by histological method. Results: group one and two showed incomplete closure of the wound with poor re-epithelization, while other groups (three and four) demonstrated complete closure of the wound with good re-epithelization. Conclusion: topical application of SRP has ability to improve facial wound healing in rabbits.
... The surgical removal of impacted mandibular third molars produces a significant degree of tissue trauma that causes an inflammatory reaction. The latter produces the usual postoperative signs and symptoms such as pain, facial oedema, and limited mouth opening due to muscle spasm (trismus).P (1) P Cytokines are small secreted proteins which mediate and regulate immunity, inflammation, and hematopoietic. They are produced in response to an immune stimulus. ...
Article
Full-text available
Aims: The aim of the study is to assess the blood levels of (interleukin-6) at different intervals of time after surgical removal of impacted lower third molars.. Materials and Methods: The study group comprised 26 patients with impacted lower third molars .All extractions were performed under local anaesthesia using the inferior alveolar nerve block together with vestibular infiltration. A buccal full thickness two sided mucoperiosteal flap was raised. Sterile low-speed straight hand pieces and sterile distilled water were used for ostectomy. After tooth removal the wound was closed with 3-0 black silk suture. Three blood samples were drawn from each patient; one before the operation, the second 2hr. post operation and the third 24hr. post operation. The blood samples were collected through venipunc-ture, serum separated and stored in at -20ºC. Analysis was performed using the Enzyme linked Im-munosourbant assay ( ELISA). Results: The level of IL-6, in this study, showed an increase following surgery, in comparison with the level before operation. This increase in the level of Interleukin-6 re-mained high until 24hr after operation. Conclusion: Interleukin-6 (IL-6) is higher after surgical extrac-tion of lower third molars and remained with high levels to 24hr. after operation. Keywords: Third molar surgery, cytokines, interleukin-6.
Article
Purpose: The objective of this prospective, double-blind, randomized clinical trial was to compare the effect of 2 dexamethasone dosages on reducing facial swelling after orthognathic surgery through 3-dimensional (3D) photogrammetry. Patients and methods: Patients were classified into group 1 (control group) and group 2 (study group), depending on the administered dexamethasone dosage (5 and 15 mg, respectively). Three-dimensional images were recorded at 5 time points: preoperative (T0) and postoperative at 48 ± 6 hours (T1), 1 week (T2), 1 month (T3), and 6 months (T4). A preliminary study was performed on 5 patients, in whom 3D images were captured at 24, 36, 48, and 60 hours postoperatively to record serial changes in facial swelling. Facial swelling at T1, T2, and T3 and the reduction in swelling at T2 and T3 compared with that at the baseline (T4) were calculated. Possible complications, namely, adrenal suppression, wound dehiscence, wound infection, and postoperative nausea and vomiting were evaluated. Results: In total, 68 patients were enrolled, of whom 25 patients in group 1 and 31 patients in group 2 were eligible for final evaluation. No significant differences were found between the 2 groups at any period. On average, the swelling subsided by 86% at 1 month after the orthognathic surgery. Facial swelling peaked approximately 48 hours after the surgery. The incidence of nausea and vomiting did not differ significantly between the groups. Conclusions: The effect of 5 and 15 mg of dexamethasone on facial swelling reduction as well as on nausea and vomiting after orthognathic surgery was not significantly different.
Article
Background Serratiopeptidase for pain, facial swelling and trismus associated with surgical removal of impacted molar is under investigation. However conclusive evidence on the use of serratiopeptidase is lacking. Hence a systematic review and meta-analysis of randomized controlled studies was carried out. Methods Electronic databases were searched for eligible studies and necessary data extracted. The data were analysed using non-Cochrane mode in RevMan 5.0. 95% confidence interval (95% CI) was used to represent the deviation from the point estimate. The heterogeneity between the studies was assessed using Forest plot visually, I2 statistics and Chi square test with a statistical P value of <0.10 to indicate statistical significance. Random-effect models were used in case of moderate to severe heterogeneity. ResultsFive studies were included for final review. Serratiopeptidase improved trismus better than corticosteroids with the MD, 95% as 4.42 [3.84, 5]. As regards to swelling, no significant difference was observed for serratiopeptidase when compared to corticosteroids. Paucity of studies precludes any conclusion for other outcome measures as well as for other comparator drugs. Conclusion Serratiopeptidase could be used safely and effectively to improve trismus and facial swelling after surgical removal of impacted molar.
Article
Full-text available
Objectives: We are surrounded by a huge amount of data, and it is problematic to assimilate this huge amount of data and convert it into knowledge. This study is intended to provide a guide for compiling an exemplary list of the top articles relevant to third molar surgery according to altmetric analysis. Methods: A bibliographic search (retrospective study) was performed on the Dimensions app with the scheme ("third molar" surgery) in the title, abstract and keyword. The number of citations, altmetric attention score and journal of publication were ranked and analyzed through Microsoft Excel. Tables and graphics were generated to enable data visualization. A graphical illustration of keywords was produced using VOSviewer. Results: A useful list of the top 50 articles was created. There are some notable facts such as the increasing interest in alternative therapies to analgesia for third molar surgery, with a 95% confidence interval (p < 0.05). Some curiosities have been discussed as the increasing interest in surgical methods such as coronectomy and piezosurgery. Conclusions: In addition to the bibliometric analysis, the altmetric analysis is a new, web-based, valuable approach to scientific updating. Both are complementary analyzes. Altmetrics is a great way to update yourself.
Article
Full-text available
Background Serrapeptase is a proteolytic enzyme with many favorable biological properties like anti-inflammatory, analgesic, anti-bacterial, fibrinolytic properties and hence, is widely used in clinical practice for the treatment of many diseases. Although Serrapeptase is widely used, there are very few published papers and the information available about the enzyme is very meagre. Hence this review article compiles all the information about this important enzyme Serrapeptase. MethodsA literature search against various databases and search engines like PubMed, SpringerLink, Scopus etc. was performed. ResultsWe gathered and highlight all the published information regarding the molecular aspects, properties, sources, production, purification, detection, optimizing yield, immobilization, clinical studies, pharmacology, interaction studies, formulation, dosage and safety of the enzyme Serrapeptase. Conclusion Serrapeptase is used in many clinical studies against various diseases for its anti-inflammatory, fibrinolytic and analgesic effects. There is insufficient data regarding the safety of the enzyme as a health supplement. Data about the antiatherosclerotic activity, safety, tolerability, efficacy and mechanism of action of the Serrapeptase are still required.
Article
Purpose An alternative cooling method in oral and maxillofacial surgery is post-operative cooling with hilotherapy. It has not yet been clarified how the development of pain and swelling progresses post-operatively at different cooling temperatures. The aim of this study was the post-operative comparison of cooling temperatures of 18°C and 22°C. The parameters of this trial were swelling and the post-operative development of pain levels. In addition, the need for analgesics and patient satisfaction were documented. Materials and Methods This study included 36 patients, divided into two groups among whom a mono-one or bignathic osteotomy or genioplasty in orthognathic surgery was indicated. After the intervention, hilotherapy was employed directly instead of the conventional cooling method with moist compresses. The post-operative check of swelling during and after hilotherapy was performed using a 3D optical scanner (FaceSCAN3D®). This examination was repeated on post-operative days 1, 2, 3, 7, 14, 30 and 90. In this process, the final examination on day 90 served as a reference value in respect of swelling and pain. Results Group 1 (18°C, 18 patients) showed an increase in post-operative swelling on the 1st post-operative day of 62.22 ± 36.29 ml. The maximum was reached on the 3rd post-operative day with 81.85 ± 40.23 ml. On the 30th post-operative day, residual swelling measured 7.39 ± 15.77 ml (p=0.016). Group 2 (22 °C, 18 patients) showed an increase in postoperative swelling on the 1st post-operative day of 61.69 ± 34.7 ml. The maximum was reached on the 2nd post-operative day with 92.83 ± 48.03 ml. On the 30th post-operative day, residual swelling measured 28.09 ± 19.04 ml (p=0.016). Discussion The study results indicate slightly less residual swelling in group 1 (18°C) on the 30th post-operative day. One possible reason for this, based on the design of the study, could be the lower cooling temperature. The post-operative pain development exhibits a comparable level of pain intensity between the two groups. In overall terms, a subjectively more agreeable treatment was observed in group 1 (18°C).
Article
Background: The aim of this systematic review and meta-analysis was to evaluate the efficacy of cryotherapy in reducing pain, trismus, and facial swelling in patients undergoing third-molar surgery. Types of studies reviewed: The authors searched for randomized clinical trials in PubMed, Web of Science, SCOPUS, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar, and OpenThesis. Eligibility criteria were population: patients submitted to removal of impacted third molars; intervention and comparison: postoperative cryotherapy versus no cold therapy; and outcomes: primary outcome was postoperative pain, and secondary outcomes were facial swelling and trismus. Eligible studies must have reported at least 1 of the outcomes of interest. After extracting data and assessing quality, the authors performed the meta-analyses. Results: The authors included 6 studies in the quantitative synthesis analysis. Differences in pain intensity were found on postoperative day 2 (weighted mean difference, -0.72; 95% confidence interval, -1.45 to 0.01; P = .05) and postoperative day 3 (weighted mean difference, -0.36; 95% confidence interval, -0.59 to -0.13; P = .002). No evidence was found that cryotherapy was effective in reducing trismus and facial swelling. The quality of evidence was graded as low. Conclusions and practical implications: Evidence suggests that cryotherapy may have a small benefit in reducing pain after third-molar surgery, but it is not effective on facial swelling and trismus. Owing to the lack of standardization of cold application, effective evidence-based treatment protocols for cryotherapy after third-molar surgery still need to be established.
Article
Full-text available
Amaç: Bu çalışmanın amacı, gömülü üçüncü molar diş cerrahisinden sonra sistemik ve topikal nonsteroid antiinflamatuar ilaçların postoperatif ağrı ve ödem üzerine etkileri ve ayrıca gastrointestinal yan etkilerin değerlendirilmesidir.Gereç ve Yöntem: Bu klinik çalışmaya, benzer pozisyonda mandibular gömülü üçüncü molar dişe sahip 100 sağlıklı hasta dahil edilmiştir. Operasyon sonrasında hastalar iki gruba ayrıldı, bir gruba Flurbiprofen tablet uygulanırken, diğer gruba da Flurbiprofen 0.25% Oral spray uygulandı. Ağrı, postoperatif olarak Vizüel Ağrı Skalası (VAS) ile değerlendirildi. Ödem ölçümü preoperatif ve postoperatif 2. ve 7. günlerde yapıldı. Mide bulantısı, mide yanması, dispepsi, kusma ve ishal gibi nosteroid anti-inflamatuar ilaç kullanımına bağlı gastrointestinal yan etkiler hastalardan alınan bilgilere göre kaydedildi.Bulgular: Gruplar arasında 6, 8, 12, 24 ve 48. saatler arasında Vizüel Ağrı Skalası düzeyleri açısından istatistiksel olarak anlamlı fark vardı. Sistemik nonsteroidal antienflamatuar ilaç grubunun 2. gündeki ödem ölçümleri lokal topikal nonsteroidal antiinflamatuvar ilaç grubuna göre istatistiksel olarak daha düşük bulundu.Sonuç: Topikal kullanılan nonsteroid anti-inflamatuar ilaçların ağrı ve ödem üzerine etkinlikleri sistemik nonsteroid anti-inflamatuar ilaçlara göre daha düşük olmasına rağmen, daha az gastrointestinal yan etkiye sahip olduğu için tercih edilebilir.
Article
Full-text available
Objective Our study seeks to investigate the effectiveness of kinesio taping (KT) on postoperative morbidity compared to placebo and control groups after impacted third molar surgery. Methodology Sixty patients with impacted mandibular third molar were included in this prospective, randomized, placebo-controlled clinical study. After surgical extraction of the impacted tooth, patients were allocated into three groups (20 patients each): group 1 received KT (kinesio), group 2 received placebo taping (placebo), and group 3 received no taping (control). The groups were compared regarding facial swelling, pain and trismus. Swelling was evaluated using a tape measuring method. Pain was assessed by a visual analog scale and the number of analgesic tablets taken. Trismus was determined by measuring maximum mouth opening. Results In the KT group, all parameters reduced significantly on 2nd and 4th postoperative days compared to other groups; however, placebo and control groups revealed comparable outcomes. On 7th day, all groups showed comparable results. Conclusions The KT application is an effective method for reducing morbidity after impacted mandibular third molar surgery. However, placebo taping is not as effective as proper taping. Placebo taping shows similar results compared to no taping regarding facial swelling percentage, pain and trismus.
Article
Full-text available
Purpose This study aimed to evaluate the anti-inflammatory effect of oral dexamethasone 4 mg in a single dose preemptively administered to reduce pain, swelling, and trismus following mandibular third molar surgeries. Methods A split-mouth randomized clinical trial was performed including twenty-two participants undergoing surgical removal of bilateral and symmetrically positioned third molars. A total of 44 teeth were allocated by simple randomization to either the test or non-intervention/control side. Oral dexamethasone 4 mg was administered on the test side an hour before the surgery. All of the participants were unaware of the medication studied, and only one surgeon, blinded to the medication intake, performed all of the procedures. Anti-inflammatory effect was evaluated using the clinical parameters of mouth opening, swelling, and rescue analgesic medication intake to control pain. The statistical analysis was blinded to the allocation groups and a significance value p <0.05 was adopted for all the tests. Results Dexamethasone reduced the mean of rescue analgesic medication intake by five times (p=0.002). Facial swelling was lower on the test side by 72h post-surgery in comparison with the control side (p=0.036). No significant difference in mouth opening was found between the groups. Conclusion Preemptive use of oral dexamethasone 4 mg proved to be effective in controlling pain and reducing the need for rescue medication, and had a beneficial effect in reducing swelling during a short postoperative period.
Article
To assess the efficacy of Chymotrypsin‐trypsin with Diclofenac versus Diclofenac alone on the post‐operative sequelae of lower third molar disimpactions. A total of 60 patients to undergo lower third molar surgery were divided randomly into 2 equal groups. Group 1 (30 patients) received Chymotrypsin‐trypsin with Diclofenac tablets and conventional treatment while Group 2 (30 patients) received Diclofenac Potassium 50mg and conventional treatment. Pain, facial swelling, and Interincisal opening were measured for each patient on the 1st, 3rd and 7th days postoperatively. In GROUP 1, the mean reduction of VAS Score for Post‐operative Pain was 4.33 to 0.76, whereas GROUP 2 reported decrease of score from 3.06 to 0.93. During the time period of Day 1 to Day 7, GROUP 1 reported mean reduction of swelling score to 0.26 at Day 7, while GROUP 2 reported swelling score of 0.80 at Day 7. For the Interincisal Opening and Trismus, GROUP 1 had mean scores from 0.40 (Day 1) to 1.10 (Day 3) and 0.26 at Day 7, while GROUP 2 had mean scores from 0.63 (Day 1) to 1.20 (day 3) and 0.73 at Day 7. GROUP 1 reported no Adverse symptoms, whereas GROUP 2 showed symptoms on Day 1 and Day 3. Trypsin‐Chymotrypsin in combination with Diclofenac is an effective and superior analgesic when compared to Diclofenac alone in the treatment of post‐operative sequealae of lower third molar surgery with good anti‐inflammatory activity.
Article
Full-text available
Manual lymphatic drainage (MLD) is an unique manual intervention pioneered by Emil and Estrid Vodder. The aim of this study was to investigate whether the application of MLD, in case of surgically removal of impacted third molars, can efficiently diminish postoperative swelling. Material and methods: Sixty patients with mandibular third molars, that required surgical removal, were divided into two equal groups: MLD group (30 patients) and control group (30 patients). Each patient underwent lower third molar extraction. MLD was performed on the neck region, using Vodder's method, once a day-immediately after extraction, until the suture removal. Swelling was evaluated prior to operation, on the first, third and seventh postoperative day with the objective method-a linear measurement. The six landmarks of measurement were as follows: tragus-lip junction, tragus-pogonion, mandibular angle-external corner of eye, mandibular angle-ala nasi, mandibular angle-lip junction, mandibular angle-median point of chin. Results: All lines demonstrated a significant reduction of swelling in the MLD group compared to the control group. Conclusion: MLD is an efficient method for managing postoperative swelling after the removal of impacted third mandibular molars. Manual lymphatic drainage (MLD) techniques are unique manual therapy interventions pioneered by Emil and Estrid Vodder in the 1930s for the treatment of chronic sinusitis and immune disorders. 1 MLD improves lymph flow, microcirculation, tissue oxygenation, and reduces edema and pain. 2 Scientific studies show mixed results regarding the efficacy of the method in treating lymphedema. 3 The theoretical bases for using the therapy are founded on the following concepts 4 : 1) stimulating the lymphatic system via an increase in lymph circulation 2) expediting the removal of biochemical wastes from body tissues 3) enhancing body fluid dynamics, thereby facilitating ede-ma reduction 4) decreasing sympathetic nervous system responses while increasing parasympathetic nervous tone yielding a non-stressed body-framework state Surgical removal of impacted third molars can vary greatly in difficulty. Postoperatively patients develop pain and swelling associated with the surgical sites. Postoperative edema and pain can be minimized by a wide variety of local and systemic treatments. Local cooling with ice-packs, non-steroid anti-inflammatory drugs, corticosteroids, and antibiotics for prophylaxis or treatment are the most common methods. 5
Article
Full-text available
We evaluated an anti-inflammatory enzyme drug Danzen (Serrapeptase: Takeda Chemical Industries, Ltd.) on 70 patients complaining of breast engorgement. These patients were randomly divided into 2 groups, a treatment group and a placebo group. A single observer, unaware of the group the patients were in, assessed the severity of each of the symptoms and signs of breast engorgement before treatment was commenced, and daily for 3 days, during which therapy was administered. Danzen was noted to be superior to placebo for improvement of breast pain, breast swelling and induration and while 85.7% of the patients receiving Danzen had "Moderate to Marked" improvement, only 60.0% of the patients receiving placebo had a similar degree of improvement. "Marked" improvement was found in 22.9% of the treatment group and 2.9% of the placebo group. These differences were statistically significant (P less than 0.05). No adverse reactions were reported with the use of Danzen. Danzen is a safe and effective method for the treatment of breast engorgement.
Article
Full-text available
Among the different mechanisms of bacterial resistance to antimicrobial agents that have been studied, biofilm formation is one of the most widespread. This mechanism is frequently the cause of failure in the treatment of prosthetic device infections, and several attempts have been made to develop molecules and protocols that are able to inhibit biofilm-embedded bacteria. We present data suggesting the possibility that proteolytic enzymes could significantly enhance the activities of antibiotics against biofilms. Antibiotic susceptibility tests on both planktonic and sessile cultures, studies on the dynamics of colonization of 10 biofilm-forming isolates, and then bioluminescence and scanning electron microscopy under seven different experimental conditions showed that serratiopeptidase greatly enhances the activity of ofloxacin on sessile cultures and can inhibit biofilm formation.
Article
Full-text available
The apparent interactions between the mechanisms of action of non-steroidal anti-inflammatory drugs (NSAIDS) and steroids suggest that co-therapy may provide beneficial inflammatory and pain relief in the absence of side effects. The aim of the study was to compare the effect of co-administered dexamethasone and diclofenac potassium (diclofenac K) with diclofenac K alone on the postoperative pain, swelling and trismus after surgical removal of third molars. A prospective randomized double-blind study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Nigeria. A total of 100 patients were randomly allocated to two treatment groups of dexamethasone (prophylactic 8 mg and postoperative 4 mg IV) and diclofenac K (50 mg Oral before and after surgery), and diclofenac K alone (as with first group). The overall analgesic efficacy of the drug combinations was assessed postoperatively by determination of pain intensity using a category rating scale. Facial swelling was measured using a tape measure placed from tragus to gonion to tragus, while interincisal mouth-opening of patients was measured using a vernier calibrated caliper pre-operatively and post-operatively. Co-administration of dexamethasone and diclofenac K was significantly superior to diclofenac alone for the relief of pain (P < 0.05), and facial swelling up to post-operative 48 hour (P < 0.05). However, there was no significant difference for trismus relief between the two medication protocols (P > 0.05). This study illustrates enhanced effects of co-administered dexamethasone and diclofenac K on short-term post-operative pain and swelling, compared to diclofenac potassium alone in third molar surgery.
Article
Full-text available
The purpose of this research was to reduce the polymer concentration and to obtain reasonable viscosity at a lower concentration of pluronic by the addition of a viscosity modifier. A 20% wt/wt pluronic gel was prepared on a weight basis using the cold method. The effect of the amount of tetracycline and Aerosil on gel properties was studied. The gel was evaluated using different parameters: polarizing microscopy, gelation, gel melting, bioadhesivity, viscosity, drug release, and stability of enzyme. An in vivo study was performed to evaluate the clinical efficiency of the liquid crystalline gel. Addition of Aerosil to the gel favored hexagonal phase formation. Viscosity and bioadhesivity increased with an increase in the concentration of Aerosil. Release of tetracycline was sustained as the concentration of Aerosil increased. Various clinical parameters confirmed the acceptability and efficiency of this gel system.
Article
Full-text available
The purpose of this study was to identify the risk factors for severe discomfort after mandibular third molar surgery and to assess the validity of the Postoperative Symptom Severity (PoSSe) scale. In a 2-year prospective study, a total of 255 unilateral impacted mandibular third molar teeth were surgically removed under local anesthesia by 3 surgeons. Standardized surgical and analgesic protocols were followed. At the review appointment, 1 week after surgery, all patients returned a completed follow-up questionnaire (PoSSe scale) and were evaluated clinically for postoperative pain (number of painkillers taken) and trismus (differences in mouth opening). Sixteen predictive variables were evaluated using stepwise logistic regression analysis to identify the risk factors associated with severe discomfort. Severe postoperative discomfort was predicted by these independent variables: gender, tobacco use, ramus relationship/space available, and antibiotic prophylaxis. Oral contraceptive use and operation time were not identified as risk factors. The patients' perceptions of the severity of symptoms (PoSSe scale score) was strongly correlated with clinical assessment of trismus (r = 0.54) and pain (r = 0.42). The PoSSe scale resulted in a valid and responsive measure of the severity of symptoms after surgical extraction of lower third molars and reflected the clinical severity of the postoperative discomfort. From a patient's perspective, operative factors had little bearing on the quality of life after removal of mandibular third molars.
Article
Background. Swelling, pain and trismus are undesirable consequences of impacted mandibular third-molar extraction. The authors conducted a study to evaluate the effectiveness of cryotherapy, the therapeutic use of cold, in reducing undersirable consequences after surgery. Methods. Fourteen patients aged 20 to 28 years comprised the sample. The authors extracted two impacted mandibular third molars at different times from each patient. Immediately after surgery. the patient underwent cryotherapy on one side for 30 minutes every one and one-half hours for 48 hours when he or she was awake. The patient did not receive cryotherapy on the other side. The authors performed clinical examinations to measure trismus and swelling before surgery, immediately after surgery and 24 and 48 hours after surgery. Results. The authors compared both sides for differences in swelling, pain and trismus in each patient. The results showed significant statistical differences in two of the five points that were used to measure the swelling (Wilcoxon nonparametric signed rank test of linear distances between the angle of the mandible to the pogonion and to the tragus). They found statistical differences between the two sides in relation to the pain; however, they found no significant differences in relation to trismus. Conclusions. Cryotherapy was effective in reducing swelling and pain in this sample. Despite playing no role in the reduction of trismus, cryotherapy was effective in reducing swelling and pain in this sample, and the authors still recommend it be used. Clinical Implications. Cryotherapy is helpful after third-molar extraction. Further studies need to be conducted that use larger samples of patients and other types of therapy, such as low-level laser therapy.
Article
Objective: To compare the short-term efficacy and tolerability of an oral enzyme therapy with the NSAID diclofenac in patients with symptomatic osteoarthritis of the knee (gonarthritis). Methods: In a double-blind clinical trial, 73 patients with painful gonarthritis were randomised to receive 3 weeks of treatment with an oral enzyme preparation (Phlogenzym®) containing bromelain, trypsin and rutin (n = 36), or the NSAID diclofenac (n = 37). Efficacy was primarily evaluated using the Lequesne index (measuring pain and function of the affected knee). Other investigations included assessment of pain symptoms using a visual analogue scale (VAS), global assessment of efficacy and tolerability (by both patients and one physician), and various laboratory parameters. Patients were evaluated at baseline, at weekly intervals throughout the 3-week treatment period, and at 7 weeks (i.e. 4 weeks after discontinuing therapy). Results: The Lequesne index improved continuously in both groups: from 13.56 at baseline to 3.10 after 3 weeks (end of therapy) to 2.05 at 7 weeks (follow-up) in the enzyme group, and from 14.04 to 3.50 to 2.24, respectively, in the diclofenac group. Statistical evaluation showed the treatment groups to be equivalent; the lower bound of the 95% confidence interval of the Mann-Whitney estimator was above 0.44 (the limit for equivalence) at all time points. Global assessment of efficacy and tolerability of the drugs was ‘very good’ or ‘good’ for the majority patients. Conclusions: Short-term evaluation indicates that oral enzymes may be considered an effective and safe alternative to NSAIDs such as diclofenac in the treatment of painful gonarthritis.
Article
To quantitatively analyze cellular elements in mucopurulent nasal secretions from patients with chronic paranasal sinusitis, we studied five mucus-liquefying agents--dithiothreitol (DTT), ethylenediaminetetraacetic acid tetrasodium salt, propylene glycol, serratio peptidase and urea--with Hanks' balanced salt solution used as a control. Agents were compared for the number of cells, the mucus-liquefying effect and the staining characteristic of cells in cytocentrifuge-prepared smears. The results indicated that the treatment of nasal secretions with 10 mM DTT provides more clear and detailed cytological preparations for quantitative cytology of nasal secretions.
Article
The efficacy and tolerability of Serratia peptidase were evaluated in a multicentre, double-blind, placebo-controlled study of 193 subjects suffering from acute or chronic ear, nose or throat disorders. Treatment lasted 7-8 days, with the drug or placebo being administered at a rate of two tablets three times a day. After 3-4 days' treatment, significant symptom regression was observed in peptidase-treated patients. There was also a significant reduction in symptoms after 7-8 days for patients in both treatment groups but the response was more marked in those patients receiving the active drug. Statistical comparison between the two groups confirmed the greater efficacy and rapid action of the peptidase against all the symptoms examined at both stages. Tolerance was found to be very good and similar for both groups. It is concluded that Serratia peptidase has anti-inflammatory, anti-oedemic and fibrinolytic activity and acts rapidly on localized inflammation.
Article
Using a quantitative standardized procedure, the swelling of the ankle produced by supination trauma was measured. In the 66 patients with fresh rupture of the lateral ligament treated surgically at our Department between December 1986 and April 1987, a prospective study of the effect of serrapeptase (Aniflazym) on post-operative swelling and pain was carried out in 3 randomized groups of patients. In the group receiving the test substance, the swelling had decreased by 50% on the third post-operative day, while in the other two control groups (elevation of the leg, bed rest, with and without the application of ice) no reduction in swelling had occurred at that time. The difference is statistically significant (p = 0.013). Decreasing pain correlated for the most part with the reduction in swelling. Thus, the patients receiving the test substance more rapidly became pain-free than did the control groups. On the basis of these results, serrapeptase would appear to be an effective preparation for the post-operative reduction of swelling, in comparison with the classical conservative measures, for example, the application of ice.
Article
A multi-centre, double-blind, placebo-controlled trial was carried out to investigate the clinical efficacy of the anti-inflammatory enzyme serrapeptase in a total of 174 patients who underwent Caldwell-Luc antrotomy for chronic empyema. Eighty-eight patients received 10 mg serrapeptase 3 times on the day before operation, once on the night of the operation and 3 times daily for 5 days after operation; the other 86 received placebo. Changes in buccal swelling after operation were observed as a parameter of the response to treatment. The degree of swelling in the serrapeptase-treated patients was significantly less than that in the placebo-treated patients at every point of observation after operation up to the 5th day (p less than 0.01 to p less than 0.05). Maximal swelling throughout all the post-operative points of observation was also significantly smaller in size in the serrapeptase-treated group than in the placebo-treated group. No side-effects were reported.
Article
The effect of soft-laser application on postoperative pain and swelling was evaluated in a double-blind, crossover study. Twenty-five healthy adults with bilateral identically impacted lower third molars were selected for this study. The teeth were removed in two separate operations. Laser treatment was tested in comparison with placebo laser, with a 40-mW, 830-nm Biophoton laser (Roenvig Dental, Denmark). All surgical procedures and measurements were done by the same surgeon. The following features were statistically analyzed: swelling, trismus, and subjective registration of pain on a visual analog scale. No statistically significant differences were observed in comparison of the experimental side with the placebo side. It may be concluded that soft-laser treatment has no beneficial effect on swelling, trismus, and pain after third molar surgery.
Article
This study was designed to compare the efficacy and safety of seaprose S and serratio-peptidase in the treatment of venous inflammatory disease. Forty patients entered the study (11 males, 29 females), mean age 54.3 years (range 30-77), mean weight 74.8 kg (range 51-96), with superficial thrombophlebitis. The trial was conducted following a controlled, between patients, randomized experimental design. Seaprose S was administered as 30 mg tablets at a daily dosage of 90 mg (one tab t.i.d.), and serratio-peptidase as 5 mg tablets, at a dose of 30 mg per day (two tabs t.i.d.), both orally, for 14 days. Twenty patients received seaprose S and 20 serratio-peptidase. The findings indicate that seaprose S was more effective and better tolerated than serratio-peptidase. Although the group of patients assigned to seaprose S had considerably more severe initial symptoms, by the end of treatment spontaneous pain was reduced 68.7% from the baseline mean score (from 3.2 to 1.0), as compared with a 63.3% reduction in the serratio-peptidase group (from 3.0 to 1.1). Pain on pressure was reduced 61.1% with seaprose S (from 3.6 to 1.4), compared to 57.6% with the reference treatment (from 3.3 to 1.4). Edema was reduced respectively 75% (from 1.6 to 0.4) and 56.2% (from 1.6 to 0.7); erythema diminished 72.4% (from 2.9 to 0.8) and 58.3% (from 2.4 to 1.0); nighttime cramps were 61.1% less (from 1.8 to 0.7) compared with 52.9% (from 1.7 to 0.8); hemorrhagic suffusion was 53.3% less (from 1.5 to 0.7) compared with 41.7% (from 1.2 to 0.7); cutaneous dystrophy was reduced by 11.1% (from 1.8 to 1.6) and 7.7% (from 1.3 to 1.2). At the end of the treatment with seaprose S efficacy was assessed as good or excellent in 85% of the cases, compared with 65% for serratio-peptidase. Seaprose S caused no adverse reactions. During serratio-peptidase treatment one patient reported diarrhea, requiring temporary dosage reduction and specific treatment. It can thus be confirmed that seaprose S was effective and well tolerated in patients with inflammatory venous diseases.
Article
The anti-inflammatory effect and adrenal suppressive side effect of methylprednisolone sodium succinate (MP) on the postoperative sequelae of third molar surgery were evaluated using objective methods in a double-blind, crossover study. Twenty patients who were to undergo surgical removal of bilateral, symmetrically placed lower third molars were studied. Each patient was given 125 mg MP intravenously before surgery on one side, and a placebo before surgery on the opposite side on a random basis. Ultrasonographic and computed tomographic examinations were performed to determine the amount of facial edema. Trismus was evaluated by measuring maximal interincisal opening, and pain was evaluated by recording the number of standard analgesic tablets used on the day of surgery and the first postoperative day. Hypothalamic-pituitary-adrenal (HPA) axis function was tested by measuring basal plasma cortisol (hydrocortisone) levels preoperatively and postoperatively. The adrenocorticotropic hormone (ACTH) stimulation test also was performed before and after administration of MP, to evaluate adrenal function. Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the MP group. Plasma cortisol levels showed a nonsignificant decrease in both the MP- and placebo-treated groups. The ACTH stimulation test indicated normal HPA axis function before and after MP administration. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted. Eighteen patients (90%) indicated a preference for the overall postoperative course when MP was used. In the absence of contraindications for corticosteroid administration, preoperative use of MP appears to be a safe and effective method of reducing postoperative complications in third molar surgery.
Article
This study was planned to assess the response of serratiopeptidase in patients with carpal tunnel syndrome (CTS). Twenty patients with CTS were evaluated clinically. After baseline electrophysiological studies, these patients were given serratiopeptidase 10 mg twice daily with initial short course of nimesulide. Clinical and electrophysiological reassessment was done after 6 weeks. Mean age was 43.9 years with male to female ratio of 1:2.33. Sixty five percent cases showed significant clinical improvement which was supported by significant improvement in electrophysiological parameters. Recurrence was reported in four cases. No significant side effect was observed. Serratiopeptidase therapy may proved to be a useful alternative mode of conservative treatment. Larger study may be further helpful to establish the role of serratiopeptidase in CTS.
Article
The study goal was to assess both clinical and health-related quality of life (HRQOL) outcomes after third molar surgery. Patients who were having 4 third molars removed were enrolled in a prospective clinical trial. Baseline data were recorded that included demographics, the patient's and surgeon's assessment of third molar conditions, and details of the surgical procedure. After surgery, clinical data were collected that detailed healing and any treatment that was rendered. Each patient was given an HRQOL instrument to complete on each postsurgery day for 14 days; the instrument was designed to assess a patient's perception of recovery in 4 main categories: pain, lifestyle, oral function, and other symptoms related to the procedure. Recovery data were available for 630 of 740 enrolled patients. The median age of the 630 patients was 21 years, and the median operation time was 30 minutes. Recovery for most HRQOL measures occurred within 5 days after surgery. However, recovery from pain to the criterion of "little or none" was delayed relative to other HRQOL measures. Twenty-two percent of patients were treated for delayed healing after surgery. Having both clinical and HRQOL data on recovery after third molar surgery could assist the surgeon when informing prospective patients about what to expect after surgery to remove third molars.
Article
The proteolytic enzyme serrapeptase (SER) is widely used in clinical practice in Japan. We investigated the effect of SER on sputum properties and symptoms in patients with chronic airway diseases. This study was an open-labelled trial with a non-treatment control group. Patients were randomly assigned to oral treatment with (n = 15) and without (n = 14) SER 30 mg/day for 4 weeks. Patients collected sputum samples for about 4 h in the morning on the day the trial began and 4 weeks later. We measured the amount of sputum by weighing. Part of each sputum sample was weighed and then completely dried and reweighed. The percentage solid component, viscosity and elasticity of the sputum were measured. Mucociliary transportability index was measured using ciliated bovine trachea ex vivo. Sputum smears were also prepared to count sputum neutrophils. Patients' symptoms were assessed by a questionnaire that used a visual analogue scale. After 4 weeks of SER treatment, sputum weight in the morning, percentage solid component, viscosity and elasticity of sputum, sputum neutrophil count, frequency of coughing and frequency of expectoration significantly decreased. The mean mucociliary transportability index increased from 13.3 +/- 1.8 to 24.4 +/- 2.5 (P = 0.0103). SER may exert a beneficial effect on mucus clearance by reducing neutrophil numbers and altering the viscoelasticity of sputum in patients with chronic airway diseases.
Article
The aim of this study was to compare the effects of intravenous administration of 1.5 mg/kg and 3 mg/kg of methylprednisolone sodium succinate (MP) on pain, swelling, and trismus after third molar surgery. Twenty-six healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, cross-over study. Either 1.5 mg/kg or 3 mg/kg of MP was administered by intravenous route one hour prior to the first operation. At the second operation the other dose was applied. Trismus was determined by measuring maximum interincisal opening and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analogue scale and recording the number of pain pills taken. There was no statistically significant difference in trismus, facial swelling, and pain between the two groups. No clinical benefit of the higher dose of MP was demonstrated.
Article
There is uncertainty over whether the patient group in which acute pain studies are conducted (pain model) has any influence on the estimate of analgesic efficacy. Data from four recently updated systematic reviews of aspirin 600/650 mg, paracetamol 600/650 mg, paracetamol 1000 mg and ibuprofen 400 mg were used to investigate the influence of pain model. Area under the pain relief versus time curve equivalent to at least 50% maximum pain relief over 6 h was used as the outcome measure. Event rates with treatment and placebo, and relative benefit (RB) and number needed to treat (NNT) were used as outputs from the meta-analyses. The event rate with placebo was systematically statistically lower for dental than postsurgical pain for all four treatments. Event rates with analgesics, RB and NNT were infrequently different between the pain models. Systematic difference in the estimate of analgesic efficacy between dental and postsurgical pain models remains unproven, and, on balance, no major difference is likely.
Article
This paper is intended as an investigation of the relationship between preoperative findings and short-term outcome in third molar surgery. We assessed 153 consecutive surgical extractions of mandibular third molars performed in 140 patients between April 1998 and March 2001. Fifty-four (35%) of the 153 extractions were performed in male subjects and 99 (65%) in female subjects. The median age was 27 years. The amount of facial swelling varied depending on age and sex. Severe pain was associated with depth and preoperative index of difficulty. Average pain was associated with preoperative index of difficulty. In conclusion, we consider that the short-term outcomes of third molar operations (swelling and pain) differ depending on patients' characteristics (age and sex) and preoperative index of difficulty. Further mega-trial studies of the association between preoperative findings and short-term outcome will help to elucidate the true nature and magnitude of the association.
Article
This study was designed to assess the impact of "pain and swelling" associated with third molars on patients' quality of life before surgery. The data for these analyses were obtained from a larger ongoing study designed to examine the surgical and medical management of problems associated with third molars. Data from 480 patients with 4 third molars scheduled for removal were used in the analysis. Questionnaires administered presurgery assessed patients' medical and dental history, their reasons for seeking third molar removal, and sociodemographic characteristics. Adverse impacts on oral health-related quality of life were measured using the 14-item Oral Health Impact Profile (OHIP) questionnaire. The primary outcome variable was the percentage of people reporting 1 or more of the 12 non-pain-specific OHIP items "fairly often" or "very often" during the 3 months before enrollment. One third (178 of 480) of patients said they were seeking third molar surgery because of current or previous symptoms of pain/swelling, and 17% reported 1 or more of the 12 non-pain-specific OHIP items. In the multivariate logistic regression model, the odds of one or more impacts was greater for people who presented because of symptoms (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.7 to 4.8), who were aged 25 years or more (OR, 1.9; 95% CI, 1.1-3.3), and who had a self-reported history of tooth loss due to pathology or trauma (OR, 2.9; 95% CI, 1.9 to 5.5). Adverse impacts on quality of life occurred for 1 in 8 patients seeking third molar surgery, and the odds increased 3-fold for patients who had experienced pain/swelling compared with those who were asymptomatic.
Article
Swelling, pain and trismus are undesirable consequences of impacted mandibular third-molar extraction. The authors conducted a study to evaluate the effectiveness of cryotherapy, the therapeutic use of cold, in reducing undesirable consequences after surgery. Fourteen patients aged 20 to 28 years comprised the sample. The authors extracted two impacted mandibular third molars at different times from each patient. Immediately after surgery, the patient underwent cryotherapy on one side for 30 minutes every one and one-half hours for 48 hours when he or she was awake. The patient did not receive cryotherapy on the other side. The authors performed clinical examinations to measure trismus and swelling before surgery, immediately after surgery and 24 and 48 hours after surgery. The authors compared both sides for differences in swelling, pain and trismus in each patient. The results showed significant statistical differences in two of the five points that were used to measure the swelling (Wilcoxon nonparametric signed rank test of linear distances between the angle of the mandible to the pogonion and to the tragus). They found statistical differences between the two sides in relation to the pain; however, they found no significant differences in relation to trismus. Cryotherapy was effective in reducing swelling and pain in this sample. Despite playing no role in the reduction of trismus, cryotherapy was effective in reducing swelling and pain in this sample, and the authors still recommend it be used. Cryotherapy is helpful after third-molar extraction. Further studies need to be conducted that use larger samples of patients and other types of therapy, such as low-level laser therapy.
Article
The effect of endo-alveolar and sub-mucosal administration of dexamethasone sodium phosphate to prevent inflammatory sequelae after surgical removal of lower third molars was studied. Forty-three patients underwent bilateral extractions of lower third molars and were randomly assigned to receive either dexamethasone 4 mg (group A) or 10 mg (group B) as endo-alveolar powder or 10 mg as sub-mucosal injection (group C) unilaterally. The controlateral site served as control and did not receive any steroid administration. Facial edema, trismus and pain perception were evaluated at the 2nd and 7th postoperative day. A multivariate analysis revealed that treatment and ostectomy time were both significantly positively associated with the degree of postoperative trismus and edema. Other baseline classification variables (e.g., molar classification) were also predictive of the degree of change in all clinical parameters. Test sites treated (any steroid application) showed greater reductions in all clinical parameters recorded compared to control. No statistically significant differences were observed between the three test groups. Both sub-mucosal and endo-alveolar administration of dexamethasone are effective in reducing postoperative sequelae of surgical removal of lower wisdom teeth.
Article
Infection around an implanted orthopaedic device is a devastating complication, and the treatment of infections involving slime-forming bacteria is especially difficult. The purpose of the present study was to evaluate the effectiveness of a proteolytic enzyme, serratiopeptidase, in the eradication of a periprosthetic infection in an in vivo animal model. In sixty Sprague-Dawley rats, the medullary canal of the right femur was drilled through the intercondylar notch and was inoculated with a Staphylococcus epidermidis strain (ATCC 35984) with a high slime-producing capacity. The cavity was filled with polymethylmethacrylate cement, and a Kirschner wire that had contact with the knee joint was inserted. None of the animals received any treatment for two weeks. Twenty rats were killed at two weeks after the inoculation in order to determine if the infection had become established. The remaining forty rats were randomized into two groups. One group received serratiopeptidase enzyme injections into the knee joint in addition to antibiotic therapy for four weeks, and the other group received intra-articular saline solution injections together with the same antibiotic therapy. The animals from both groups were killed two weeks after the end of therapy (on Day 56). The knee specimens were evaluated bacteriologically and histologically to determine the prevalence of persistent infection and the effects of the enzyme on local tissue. At two weeks, inoculated bacteria grew on culture of specimens from twelve (63.2%) of nineteen animals in the no-treatment group. Microbiological testing suggested that infection persisted in only one (5.6%) of eighteen animals in the serratiopeptidase-and-antibiotic group, whereas it was present in six (37.5%) of sixteen animals in the antibiotic-only group (p = 0.001). Histological evaluation showed similar results (kappa = 0.92). Serratiopeptidase was effective for eradicating infection caused by biofilm-forming bacteria in this experimental animal model. The antibiofilm property of the enzyme may enhance antibiotic efficacy in the treatment of staphylococcal infections.
Article
The aim of this prospective study was to ascertain the incidence of minor complications after mandibular third molar surgery and to predict the risk of skin ecchymosis or mucosa petechiae related to the usage of an absorbable gelatin sponge. One hundred and four patients subjected to surgical extraction of horizontally impacted lower third molars were selected and investigated by means of questionnaires and clinical examinations. The independent sample t test was used for numeric variables. The chi-square test was used for logistic variables to determine the association between variables, and thereafter stepwise logistical regression was used. The older group (> or = 30 years old), with deeply impacted teeth, and long operation times (> or = 10 minutes) were shown to have significantly higher swelling than the other groups (P < .05). The patients who had deeply impacted teeth or long operation times were shown to have significantly higher VAS scores compared to short operation times (P < .05). The use of an absorbable gelatin sponge in the extraction socket significantly decreased postoperative swelling, mucosal petechiae, and skin ecchymosis (P < .05). The clinical variables related to postoperative bleeding disorder, pain, and trismus were identified. The insertion of an absorbable gelatin sponge into the extraction socket was found to be a very useful method to prevent postoperative bleeding problems.
Article
Impacted third molar extraction causes considerable swelling in the days immediately following surgery. The aim of the present investigation was to evaluate the efficacy of methylprednisolone as a single 40-mg intramuscular dose in controlling the complications of impacted lower third molar surgical removal. Thirty-five patients were evaluated within the framework of a consecutive sampling and double-blind study with intrasubject measurements. Extraction comprised ostectomy with tooth sectioning of both lower third molars under local anesthesia. The study group received 40 mg of methylprednisolone injected into the gluteal region, while the controls received no such medication. In each individual one molar was randomly assigned to the study group and the other to the control series - with extraction of the two teeth being spaced 1 month apart. Evaluations were made of postoperative pain, trismus and swelling, and measurements were obtained for oral aperture and various distances (tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye) before surgery and 2-7 days after extraction. Statistical correlations were made based on the Student t-test for the comparison of means of related samples. A statistically and clinically significant association was observed 2 days after surgery between methylprednisolone administration and increased oral aperture and diminished facial swelling. Likewise, less pain was recorded in the study group 6 h after surgery. The results confirm the efficacy of methylprednisolone in providing a more comfortable postoperative course after surgical extraction of impacted lower third molars.
Article
The purpose of this study was to evaluate the effect of a single intramuscular dose of prednisolone and the prednisolone-diclofenac combination on postoperative pain, trismus, and edema after the removal of third molars. Forty-five patients who were to undergo surgical removal of lower third molars were studied. Patients were divided into 3 groups. In the first group, each patient was given 25 mg prednisolone intramuscularly immediately after surgery. In the second group, each patient was given 25 mg prednisolone and diclofenac intramuscularly immediately after surgery, and in the third group, each patient was given sterile saline solution as control group. Postoperative pain was evaluated by visual analogue scale on the day of surgery. Facial swelling and trismus were evaluated on postoperative days 2 and 7. ANOVA was used to analyze these data. Statistical analysis of the data indicated the prednisolone-diclofenac combination suppressed pain intensity in comparison with control (P < .05) at the 6-hour observation. Both the prednisolone and prednisolone-diclofenac combinations suppressed pain at the seventh postoperative hour in comparison with the control (P < .05). The prednisolone-diclofenac combination group also had a smaller loss of opening at postoperative days 2 and 7 in comparison with both the prednisolone and control groups (P < .05). Postoperative swelling was less in both the prednisolone and prednisolone-diclofenac combination groups, as compared with the control group (P < .05) at postoperative day 2. The prednisolone-diclofenac combination group also had a smaller swelling at postoperative day 7 in comparison with both the prednisolone and control groups (P < .05). It was determined that the combination of a single dose of prednisolone and diclofenac is well-suited to the treatment of postoperative pain, trismus, and swelling after dental surgical procedures and should be used when extensive postoperative swelling of soft tissue is anticipated.
Effects of co-Effect of serrapeptase on postoperative pain, swelling and trismus 44
  • Bamgbose
  • Bo
  • Ja Akinwande
  • Adeyemo Wl
  • Al Ladeinde
  • Arotiba Gt
  • Ogunlewe
  • Mo
Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO. Effects of co-Effect of serrapeptase on postoperative pain, swelling and trismus 44: 515–524.
Effects of cotion: a preliminary study
  • Bo Bamgbose
  • Ja Akinwande
  • Wl Adeyemo
  • Al Ladeinde
  • Gt Arotiba
  • Mo Ogunlewe
Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO. Effects of cotion: a preliminary study. J Am Dent Assoc 2005: 136: 774–778.
Address: Dr. Taiseer Al-Khateeb Division of Oral & Maxillofacial Surgery Faculty of Dentistry
Br J Oral Maxillofac Surg 2004: 42: 209-214. Address: Dr. Taiseer Al-Khateeb Division of Oral & Maxillofacial Surgery Faculty of Dentistry Jordan University of Science & Technology P.O. Box 3030
Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery
  • Ustun