Sublingual ketorolac and sublingual piroxicam are equally effective for postoperative pain, trismus, and swelling management in lower third molar removal.
OBJECTIVE
Lower third molar removal provides a clinical model for studying analgesic drugs. The present study's aim was to compare the clinical efficacy of sublingual ketorolac and sublingual piroxicam in managing pain, trismus and swelling after lower third molar extraction in adult volunteers.


METHODS
In this double-blinded, randomized, crossover investigation, 47 volunteers received for 4 days ketorolac sublingually (10 mg 4 times daily) and piroxicam sublingually (20 mg once daily) during 2 separate appointments after lower third molar extraction of symmetrically positioned lower third molars. A surgeon evaluated objective parameters (surgery duration, mouth opening, rescue analgesic medication, and facial swelling) and volunteers documented subjective parameters (postoperative pain and global evaluation), comparing postoperative results for a total of 7 days after surgery. The means of the objective and subjective parameters were compared for statistical significance (P < .05).


RESULTS
Volunteers reported low pain scores during the postoperative period when treated with either sublingual ketorolac or piroxicam. Also, volunteers ingested similar amounts of analgesic rescue medication (paracetamol) when they received either drug sublingually (P > .05). Additionally, values for mouth openings measured just before surgery and immediately after suture removal 7 days later were similar among volunteers (P > .05), and the type of nonsteroidal antiinflammatory drug (NSAID) used in this study showed no significant differences between swellings on the second or seventh days after surgery (P > .05).


CONCLUSIONS
Pain, trismus, and swelling after lower third molar extraction, independent of surgical difficulty, were successfully controlled by sublingual ketorolac (10 mg 4 times daily) or sublingual piroxicam (20 mg once daily), and no significant differences were observed between the NSAIDs evaluated.
Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
Paulo A K
PA
Trindade
Fernando P M
FP
Giglio
Bella L
BL
Colombini-Ishikiriama
Adriana M
AM
Calvo
Karin Cristina S
KC
Modena
Debora A
DA
Ribeiro
Thiago J
TJ
Dionísio
Daniel T
DT
Brozoski
José Roberto P
JR
Lauris
Flávio Augusto C
FA
Faria
Carlos F
CF
Santos
D000704:Analysis of Variance; D018592:Cross-Over Studies; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D004311:Double-Blind Method; D004487:Edema / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage*; D008297:Male; D008334:Mandible / Q000601:surgery; D008964:Molar, Third / Q000601:surgery*; D010027:Osteotomy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010894:Piroxicam / Q000008:administration & dosage*; D014095:Tooth, Impacted / Q000601:surgery*; D016896:Treatment Outcome; D014313:Trismus / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
D016861:Cyclooxygenase Inhibitors; D010894:Piroxicam; D020910:Ketorolac