The effect of zinc lozenge on pain, oedema, and trismus after impacted third molar surgery: A prospective randomized, double-blinded, placebo-controlled study

Abstract

The postoperative sequelae after third molar surgery include pain, swelling and trismus, Zinc acts as anti-inflammatory agent, can promote wound healing, immune system modulation, tissue repair, and significant reduction in the use of analgesics for oral pain. This study was aimed to evaluate the efficacy of oral zinc lozenge given 30 min before surgery on reducing postoperative sequelae.s: We recruited 70 patients, randomly assigned to two groups: Zinc and Control group, groups received 40mg Zinc lozenge, placebo lozenge 30 min before surgery respectively and every 6h till 72h after surgery. Third molar extraction was performed under local anesthesia. After extraction, pain, swelling, and mouth opening in both groups observed till 72h.Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, was analyzed using Student t test or ANOVA, Chi-square or Mann-Whit­ney U test was performed for non-parametric samples. P < 0.05 was considered as statistically significant: The overall incidence of Pain in the Zinc group was 18% compared to 43% in the Control group (P = .003) Incidence of Pain, swelling, and mouth opening at different time intervals 6h, 24h, 48h and 72h were significantly (P >0.05) better in Zinc group oral zinc lozenge administered 30 minutes preoperatively can significantly reduce complications like pain, swelling, and limited mouth opening after third molar extraction.

Efficacy of Ibuprofen Gargle for Postoperative Pain After Mandibular Third Molar Extraction: Protocol for a Phase II, Placebo-Controlled, Double-Blind, Randomized Crossover Trial

“…Continuous medication with NSAIDs is recommended as the first-line treatment after extraction of mandibular third molars to relieve pain and inflammation. Oral administration of NSAIDs can lead to various adverse effects; therefore, topical NSAIDs are preferred to minimize these side effects [ 9 , 27 , 28 ]. The problem with the administration of NSAIDs thrice a day is that the analgesic effect wears off and postextraction pain recurs.…”

“…In patients with gastrointestinal ulcers or aspirin-induced asthma, acetaminophen may be used as an alternative drug [ 4 ]. NSAIDs, such as celecoxib [ 5 , 6 ], valdecoxib [ 7 ], ibuprofen [ 8 ], flurbiprofen [ 9 ], lornoxicam [ 10 ], etoricoxib [ 11 ], and opioid-containing drugs such as oxycodone [ 12 ] have been studied to identify the optimal analgesics for pain relief in mandibular third molar extractions. In a systematic review of 21 high-quality clinical trials, Weil et al reported that oral paracetamol (acetaminophen) was safe and effective in the treatment of postoperative pain after extraction of embedded mandibular third molars [ 13 ], and in a Cochrane review of 2242 patients, Bailey et al reported that oral ibuprofen was superior to oral paracetamol in the treatment of postoperative pain [ 14 ].…”

“…To address the problems associated with opioid use, Rindal et al [ 17 ] recently published the protocol for a randomized controlled trial of interventions to decrease the prescription of opioids in favor of nonopioid drugs. Additionally, topical use of analgesics has been proposed as an alternative to oral and injectable medications to safely improve postoperative pain relief [ 9 , 18 , 19 ]. Topical administration has also been reported to reduce side effects without reducing the quality of analgesia [ 20 ].…”

Assessment of Patient Characteristics Influencing the Analgesic Effects of Ibuprofen Gargle After Mandibular Third Molar Extractions

“…For patients with gastrointestinal ulcers or aspirin-induced asthma, acetaminophen may serve as an alternative [ 4 ]. Various NSAIDs, including celecoxib [ 5 , 6 ], valdecoxib [ 7 ], ibuprofen [ 8 ], flurbiprofen [ 9 ], and opioid-containing medications such as oxycodone [ 10 ], have been closely evaluated to identify optimal analgesics for pain alleviation in mandibular third molar extractions. A systematic review by Weil et al highlighted the safety and efficacy of oral paracetamol (acetaminophen) in postoperative pain management after embedded mandibular third molar extractions [ 11 ], whereas the Cochrane review by Bailey et al highlighted the superiority of oral ibuprofen over oral paracetamol in this context [ 12 ].…”

“…Rindal et al recently outlined a randomized controlled trial protocol to mitigate opioid-related issues, with a focus on interventions to reduce opioid prescriptions in favor of nonopioid alternatives [ 15 ]. Furthermore, topical analgesic application has emerged as a potentially safer approach to enhance postoperative pain relief [ 16 ]; studies have shown reduced side effects without decreases in analgesic efficacy [ 9 , 17 , 18 ].…”