title: Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials.
abstract: The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.
authors.affiliation: Adjunct Professor, Division of Oral Radiology, School of Dentistry, Federal University of Ceará, Brazil.
authors.forename: Fábio Wildson Gurgel
authors.initials: FW
authors.lastname: Costa
authors.affiliation: Postgraduate Student, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil.
authors.forename: Diego Felipe Silveira
authors.initials: DF
authors.lastname: Esses
authors.affiliation: Postgraduate Student, Division of Clinical Dentistry, UFC, Fortaleza-CE, Brazil.
authors.forename: Paulo Goberlânio
authors.initials: PG
authors.lastname: de Barros Silva
authors.affiliation: Postgraduate Student, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil.
authors.forename: Francisco Samuel Rodrigues
authors.initials: FS
authors.lastname: Carvalho
authors.affiliation: Postgraduate Student, Division of Oral Surgery, Post-program in Dentistry, Federal University of Ceará, Fortaleza-CE, Brazil.
authors.forename: Carlos Diego Lopes
authors.initials: CD
authors.lastname: Sá
authors.affiliation: Postgraduate Student, Division of Oral Surgery, Post-program in Dentistry, Federal University of Ceará, Fortaleza-CE, Brazil.
authors.forename: Assis Filipe Medeiros
authors.initials: AF
authors.lastname: Albuquerque
authors.affiliation: Professor, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil.
authors.forename: Tácio Pinheiro
authors.initials: TP
authors.lastname: Bezerra
authors.affiliation: Adjunct Professor, Division of Special Needs Dental Patients, UFC, Fortaleza-CE, Brazil.
authors.forename: Thyciana Rodrigues
authors.initials: TR
authors.lastname: Ribeiro
authors.affiliation: Associate Professor, Division of Pediatric Dentistry, UFC, Fortaleza-CE, Brazil.
authors.forename: Cristiane
authors.initials: C
authors.lastname: Sá Roriz Fonteles
authors.affiliation: Full Professor, Division of Oral Surgery, UFC, Fortaleza-CE, Brazil.
authors.forename: Eduardo Costa Studart
authors.initials: EC
authors.lastname: Soares
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D008334:Mandible / Q000601:surgery; D008964:Molar, Third / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control*; D011292:Premedication; D016032:Randomized Controlled Trials as Topic; D014081:Tooth Extraction / Q000009:adverse effects; D014095:Tooth, Impacted / Q000601:surgery
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Analgesia; Meta-analysis; Preemptive; Third molar