Systemic Enzymes and their Role in the Reduction of Post-Operative Edema After Surgical Removal of Lower Third Molars: A Randomized Controlled Double-Blind Study

Main Article Content

Abhinav R P
M.P. Santhosh kumar

Keywords

Systemic enzymes, third molar surgery, post-operative complications, pain, edema

Abstract

The most common postoperative complications after surgical removal of impacted mandibular third molar tooth are edema, pain and trismus. Different types of analgesics and anti-inflammatory agents have been employed for reduction of these complications. The aim of the study was to evaluate the effect of systemic enzymes to control post-operative edema, pain and trismus after surgical removal of impacted lower third molars.
The enzyme combination of trypsin, bromelain, rutoside trihydrate was compared with that of serratiopeptidase to control post-operative sequelae following lower third molar surgery. Sixty-eight patients, who required surgical removal of impacted mandibular third molars participated in this study. They were randomly allocated into two groups (n=34 in each group). Group I received 5mg serratiopeptidase orally along with the standard medication and the other group received the enzyme combination with the standard medication. P value <0.05 was considered to be statistically significant,
Five patients were lost to follow-up. The mean swelling measures were found to be non-significant when compared between the two groups (Group I vs. II-54.7 ± 3.4 Vs. 53.2 ± 3.2, p=0.34). Similarly, the differences in mean pain and mouth opening values between the study groups was found to be non-significant (p>0.05).
There was no significant difference in the effect of the enzyme combination of rutoside, trypsin and bromelain when compared to serratiopeptidase in the reduction of post-operative edema, pain and trismus following lower third molar surgery.

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References

1. Srivastava N, Shetty A, Goswami RD, Apparaju V, Bagga V, Kale S. Incidence of distal caries in mandibular second molars due to impacted third molars: Nonintervention strategy of asymptomatic third molars causes harm? A retrospective study. International Journal of Applied and Basic Medical Research. 2017;7(1):15-19.
2. Halpern LR, Dodson TB. Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery?. Journal of Oral and Maxillofacial Surgery. 2007 Feb 1;65(2):177-85.
3. Sortino F, Cicciù M. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar. Dental research journal. 2011 Oct;8(4):162.
4. Markovic A, Todorovic LJ. Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial. International journal of oral and maxillofacial surgery. 2007 Mar 1;36(3):226-9.
5. Shetty V, Mohan A. A prospective, randomized, double-blind, placebo-controlled clinical trial comparing the efficacy of systemic enzyme therapy for edema control in orthognathic surgery using ultrasound scan to measure facial swelling. Journal of Oral and Maxillofacial Surgery. 2013 Jul 1;71(7):1261-7.
6. Chandanwale A, Langade D, Sonawane D, Gavai P. A randomized, clinical trial to evaluate efficacy and tolerability of trypsin: chymotrypsin as compared to serratiopeptidase and trypsin: bromelain: rutoside in wound management. Advances in therapy. 2017 Jan 1;34(1):180-98.
7. Saghaei M. Random allocation software for parallel group randomized trials. BMC medical research methodology. 2004 Dec;4(1):1-6.
8. Janjua OS, Baig Z, Manzoor A, Abbas T. Accuracy of Pederson and modified Parant scale for predicting difficulty level of mandibular third molars. Arch Orofac Sci. 2013 Jan 1;8(1):9-13.
9. Baqain ZH, Karaky AA, Sawair F, Khaisat A, Duaibis R, Rajab LD. Frequency estimates and risk factors for postoperative morbidity after third molar removal: a prospective cohort study. Journal of oral and Maxillofacial Surgery. 2008 Nov 1;66(11):2276-83.
10. Seymour RA, Blair GS, Wyatt FA. Post-operative dental pain and analgesic efficacy. Part I. Br J Oral Surg1983;21: 290–297.
11. Fisher SE, Frame JW, Rout PG, McEntegart DJ. Factors affecting the onset and severity of pain following the surgical removal of unilateral
impacted mandibular third molar teeth. Br Dent J 1988; 164: 351–354.
12. Chopra D, Rehan HS, Mehra P, & Kakkar AK. A randomized, double-blind, placebo-controlled study comparing the efficacy and safety of paracetamol, serratiopeptidase, ibuprofen and betamethasone using the dental impaction pain model. Int J Oral Maxillofac Surg 2009;38:350–355.
13. Al-Khateeb TH, Nusair Y. Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars. Int J Oral Maxillofac Surg 2008;37:264–268.
14. Tamimi Z, Al Habashneh R, Hamad I, Al-Ghazawi M, Kharashgeh H. Efficacy of serratiopeptidase after impacted third molar surgery: a randomized controlled clinical trial. BMC oral health. 2021 Dec;21(1):1-9.
15. de la Barrera-Nunez M, Yanez-Vico R, Batista-Cruzado A, Heurtebise-Saavedra J, Castillo-de Oyague R, Torres-Lagares D. Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period. Med Oral Patol Oral Cir Bucal. 2014 ;19:e157-162.
16. Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2014 ;72:1043-1048.
17. Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO. Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head Face Med 2005 7;1:11.
18. Shah D, Mital K. The Role of Trypsin:Chymotrypsin in Tissue Repair. Adv Ther. 2018;35(1):31-42.
19. Klein G, Kullich W, Schnitker J, Schwann H. Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clin Exp Rheumatol 2006 ;24:25-30.
20. MP SK. Knowledge, Attitude and practices regarding needlestick injuries among dental students. Asian J Pharm Clin Res. 2016;9(4):312-5.
21. SK M. Knowledge, attitude, and practices regarding infection control among undergraduate dental students. Asian J Pharm Clin Res. 2016;9(1):220-4.
22. Ak H. Knowledge and awareness about oral cancer among undergraduate dental students. Asian Journal of Pharmaceutical and Clinical Research. 2016 Jul 1:165-7.
23. Gayathri MM. Knowledge and awareness among patients about dental implants. Journal of Pharmaceutical Sciences and Research. 2016 May 1;8(5):351.
24. Vijayalakshmi B, Kumar MS. Knowledge of students about Local anaesthetics used during oral surgical procedures. Journal of Pharmaceutical Sciences and Research. 2015 Nov 1;7(11):1011.
25. Gayathri MM. Knowledge, Awareness and Attitude among dental students about hepatitis B
infection. Journal of Pharmaceutical Sciences and Research. 2016 Mar 1;8(3):168.
26. Ahamed A, Kumar MS. Knowledge, attitude and perceived confidence in handling medical emergencies among dental students. Journal of Pharmaceutical Sciences and Research. 2016 Jul 1;8(7):645.
27. Kumar S. Knowledge, attitude and practices of dental students toward dental management of patients on antiplatelet therapy. Asian J Pharm Clin Res. 2016;9(30):270-6.
28. MP SK. Local hemostatic agents in the management of bleeding in oral surgery. Asian J Pharm Clin Res. 2016;9(3):35-41.
29. Kumar MP. Newer methods of extraction of teeth. Int J Pharm Bio Sci. 2015;6(3):679-85.