Are antibiotics necessary after lower third molar removal?

Calvo, Adriana Maria; Brozoski, Daniel; Giglio, Fernando Paganeli Machado; Gonçalves, Paulo Zupelari; Sant’Ana, Eduardo; Dionísio, Thiago José; Lauris, José Roberto Pereira; Santos, Carlos

doi:10.1016/j.oooo.2011.10.022

Cited by 38 publications

(45 citation statements)

References 36 publications

(75 reference statements)

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“…Currently, there are still no other randomized clinical trials evaluating the effectiveness of NE using an acute pain control model (22). NE has only been evaluated for its ability to manage chronic pain (19,28).…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, 52 adults (≥18 yrs old) requiring bilateral lower third molars that were similarly positioned (5,21), according to the Pell and Gregory’s classification - classified by panoramic radiograph (22) were screened for participation in this study. Inclusion criteria included a lack of inflammation or infection at the extraction sites and an absence of systemic diseases that could possibly interfere with the study.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions: A double blinded crossover study

Weckwerth

Simoneti²,

Gonçalves³

et al. 2016

Med Oral

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BackgroundUsing a double-blinded randomized crossover design, this study aimed to evaluate acute postoperative pain management, swelling and trismus in 46 volunteers undergoing extractions of the two lower third molars, in similar positions, at two different appointments who consumed a tablet of either NE (naproxen 500 mg + esomepraz ole 20 mg) or only naproxen (500 mg) every 12 hours for 4 days.Material and MethodsParameters were analyzed: self-reported pain intensity using a visual analog scale (VAS) pre- and postoperative mouth opening; incidence, type and severity of adverse reactions; total quantity consumed of rescue medication; and pre- and postoperative swelling.ResultsFemale volunteers reported significantly more postoperative pain at 1, 1.5, 2, 3 and 4hrs after surgery while also taking their first rescue medication at a time significantly earlier when consuming NE when compared to naproxen (3.7hrs and 6.7hrs). Conversely, no differences were found between each drug group in males.ConclusionsIn conclusion, throughout the entire study, pain was mild after using either drug in both men and women with pain scores on average well below 40mm (VAS), although in women naproxen improved acute postoperative pain management when compared to NE. Key words:Oral surgery, third molar, pain, naproxen, esomeprazole, NSAIDs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions: A double blinded crossover study

Weckwerth

Simoneti²,

Gonçalves³

et al. 2016

Med Oral

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“…That is, a single 20 mg dose of piroxicam can be taken orally only once a day to effectively manage pain, inflammation and swelling resulting from third molar extraction. 4,5,6 Moreover, piroxicam is metabolized by CYP2C9, a cytochrome P450 enzyme, creating 5'-hydroxypiroxicam by hydrolysis. This study's objective was to evaluate different concentrations of piroxicam and its major metabolite, 5'-hydroxypiroxicam, in human plasma samples over time using HPLC after liquid-liquid extraction.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,3 Piroxicam, in particular, is a commonly used NSAID which inhibits prostaglandin production, often employed to manage pain, swelling and trismus after oral surgeries. 4,5,6 Cytochrome P4502C9 (CYP2C9) is the main enzyme involved with metabolizing piroxicam to 5'-hydroxypiroxicam. Moreover, urinary excretion of unmetabolized piroxicam is rare.…”

mentioning

confidence: 99%

Effective method for the detection of piroxicam in human plasma using HPLC

et al. 2016

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Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used by the general population to alleviate inflammation and pain after oral surgeries. Piroxicam is among the most commonly used NSAIDs and excels in controlling pain, swelling, trismus and other common symptoms of inflammation. This study aimed to evaluate different concentrations of piroxicam and its major metabolite, 5'-hydroxypiroxicam, in human plasma samples over time using high performance liquid chromatography (HPLC) after liquid-liquid extraction. Briefly, 10 volunteers participated in this study after approval by the Ethics Committee of Bauru School of Dentistry, Universidade de São Paulo -USP, Brazil. Volunteers received a single dose oral of piroxicam (20 mg) and had blood collected at various times following an established protocol. The methodology of liquid-liquid extraction was effective for determining concentrations of piroxicam in plasma using HPLC in 10 out of 10 volunteers while 5'-hydroxypiroxicam was only detected in 2 out of 10 volunteers.

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“…All surgeries were performed between December 2013 and October 2014, after ethical approval. The sample size calculation for the current study was based on the facial edema and trismus parameters from our previous research article 17. Taking into account the facial edema data with 94% power and effect size of 0.7, the number of patients required was 102; considering trismus with 80% power and effect size of 0.56, the number of patients remained 102.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of piroxicam for postoperative pain after lower third molar surgery associated with <em>CYP2C8*3</em> and <em>CYP2C9</em>

Calvo

Zupelari-Gonçalves

Dionísio

et al. 2017

JPR

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ObjectiveNonsteroidal anti-inflammatory drugs (NSAIDs) are metabolized by the cytochrome P450 enzymes (CYPs), predominantly CYP2C8 and CYP2C9. The aim of this study was to evaluate the possible association of polymorphisms in the CYP2C8*3 and CYP2C9 genes with the clinical efficacy of oral piroxicam (20 mg daily for 4 days) after lower third molar surgeries with regard to postoperative pain, swelling, trismus, adverse reactions, need for rescue medication and the volunteer’s overall satisfaction.Materials and methodsFor this purpose, 102 volunteers were genotyped for CYP2C8*3 and CYP2C9 polymorphisms. Briefly, genomic DNA was isolated from saliva collected from volunteers subjected to invasive lower third molar surgeries, and the preoperative, intraoperative and postoperative parameters were collected and analyzed.ResultsAn equal amount of piroxicam sufficiently managed postoperative pain and inflammatory symptoms, with visual analog pain scores typically <40 mm for all genotypes investigated. Furthermore, only two out of 102 volunteers heterozygous for CYP2C8*3 and CYP2C9*3 reported adverse side effects.ConclusionIn general, slow metabolizers of piroxicam, who were volunteers with mutant alleles, were indifferent from normal metabolizers with the wild-type alleles and therefore did not require specialized piroxicam doses to manage postoperative pain and inflammation.

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Are antibiotics necessary after lower third molar removal?

Abstract: This study suggests that antibiotic prescriptions are unnecessary after LTMR when preoperative infections are absent.

Cited by 38 publications

References 36 publications

Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions: A double blinded crossover study

Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions: A double blinded crossover study

Effective method for the detection of piroxicam in human plasma using HPLC

Efficacy of piroxicam for postoperative pain after lower third molar surgery associated with <em>CYP2C8*3</em> and <em>CYP2C9</em>

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