Effectiveness of Alpha Lipoic Acid on Postoperative Sequelae on Lower third molar surgery -A Randomized control clinical trial
Main Article Content
Keywords
Alpha lipoic acid, impaction surgery, healing, dental , age
Abstract
Introduction: Alpha-lipoic acid (ALA) is a compound found in every cell of the human body produced in mitochondria of cells. ALA is powerful antioxidant, and has anti inflammatory and has excellent wound healing property.Many clinical trials has been done to prove the effect of ALA in particular diseases , including diabetic neuropathy, obesity, schizophrenia, alzheimer’s disease, Multiple sclerosis, abnormalities in pregnancy and organ transplantation. Here in this randomized control trial, we are going to check the effectiveness of alpha lipoic acid and compare it with corticosteroids in post operative swelling and healing in third molar surgery.
Aim: To check the effectiveness of alpha lipoic acid in comparison with corticosteroids in swelling and postoperative healing on patients undergoing third molar surgery.
Materials And Methods: The total number of participants in this study is 200 undergoing third molar impaction surgery (Class 1,Class 2 position B- Mesio angular impaction of third molar). Before study,participants were informed about the study by the principal investigator and gave informed written consent.
Case group is 100 patients subjected with 300 Mg of Alpha lipoic acid for 7 days
Control Group is 100 patients given prednisolone 5 mg (wysolone 5) for 3 days Results: Out of 200 patients, the group which uses alpha lipoic acid has good wound healing when compared to the patient who uses corticosteroids. The inflammation is found to be less in patients who use alpha lipoic acid than corticosteroids.
Conclusion: It can be concluded that steroids can be extremely beneficial, and have serious side effects. ALA has excellent wound healing properties and acts on inflammation similar to corticosteroids but with little or no adverse effects. It’s a good idea to understand the benefits and risks of corticosteroids and replace them with alpha lipoic acid which prevents inflammation and promotes wound healing.
References
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3. Murthi M, Dhasarathan P, Rajendran D. Retrospective Study of the Prevalence of Dry Socket in Patients with Mandibular Third Molar Extraction. WORLD. 2020.
4. McGrath C, Comfort MB, Lo ECM, Luo Y. Changes in life quality following third molar surgery--the immediate postoperative period. Br Dent J. 2003;194: 265–8; discussion 261. doi:10.1038/sj.bdj.4809930
5. Pandian S, Rajamoorthi SN, Gowthaman T, Ravindran C, Teja KV, Janani K. Evaluation of alkaline phosphatase as a biomarker in the healing progression following tooth extraction. BDS. 2022;25. doi:10.4322/bds.2022.e2837
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7. Murugan S, Associate Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College Saveetha Institute of Medical and Technical Sciences Saveetha University Chennai, India. The assessment of need for suturing following maxillary third molar extractions. Int J Dent Oral Sci. 2021; 1775–1779. doi:10.19070/2377-8075-21000351
8. Pradeep, Associate Professor, Department of Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences. Evaluation of postoperative complications after mandibular third molar extraction without suture and its association with age and gender. Int J Dent Oral Sci. 2021; 3832–3838. doi:10.19070/2377-8075-21000785
9. Harini G, Prabu D, Balakrishnan RN. Submucosal Dexamethasone Vs Intramuscular Dexamethasone in Surgical Extraction of Third Molars-A Retrospective Study. Int J Dentistry Oral Sci. 2020;7: 1222–1225.
10. Ramasubbu S, Wahab A. Comparison Of Efficacy Of Oral Bromelain and Serratiopeptidase For The Control OF Postoperative Sequelae Following Third Molar Surgery-A Comparative Study. Int J Dentistry Oral Sci. 2021;8: 2520–2524. Available:
11. Deshpande AA, Hemavathy OR, Krishnan S, Ahmed R. Comparison of effect of intra socket ketamine and tramadol on postoperative pain after mandibular third molar surgery. Natl J Maxillofac Surg. 2022;13: 95–98. doi:10.4103/njms.NJMS_141_20
12. Nesbitt LT Jr. Minimizing complications from systemic glucocorticosteroid use. Dermatol Clin. 1995;13: 925–939
13. Tour S, Menu D. Alpha-lipoic acid (1, 2-Dithiolane-3-pentanoic acid).
14. Alpha-lipoic acid as a biological antioxidant. Free Radical Biology and Medicine. 1995;19: 227–250. doi:10.1016/0891-5849(95)00017-R
15. Schmidt U, Grafen P, Goedde HW. Chemistry and biochemistry ofα-lipoic acid. Angew Chem Int Ed Engl. 1965;4: 846–856. doi:10.1002/anie.196508461 16. Alqahtani SS. The efficiency of alpha-lipoic acid in the treatment of burning mouth syndrome: a systematic review. Eur Rev Med Pharmacol Sci. 2021;25: 6585–6591. doi:10.26355/eurrev_202111_27101
17. Gorąca A, Huk-Kolega H, Piechota A, Kleniewska P, Ciejka E, Skibska B. Lipoic acid - biological activity and therapeutic potential. Pharmacol Rep. 2011;63: 849–858. doi:10.1016/s1734-1140(11)70600-4
18. Han D, Handelman G, Marcocci L, Sen CK, Roy S, Kobuchi H, et al. Lipoic acid increases de novo synthesis of cellular glutathione by improving cystine utilization. Biofactors. 1997;6: 321–338. doi:10.1002/biof.5520060303
19. Afat İM, Akdoğan ET, Gönül O. Effects of Leukocyte- and Platelet-Rich Fibrin Alone and Combined With Hyaluronic Acid on Pain, Edema, and Trismus After Surgical Extraction of Impacted Mandibular Third Molars. J Oral Maxillofac Surg. 2018;76: 926–932. doi:10.1016/j.joms.2017.12.005
20. Ou P, Tritschler HJ, Wolff SP. Thioctic (lipoic) acid: a therapeutic metal-chelating antioxidant? Biochem Pharmacol. 1995;50: 123–126. doi:10.1016/0006-2952(95)00116-h
21. Maglione E, Marrese C, Migliaro E, Marcuccio F, Panico C, Salvati C, et al. Increasing bioavailability of (R)-alpha-lipoic acid to boost antioxidant activity in the treatment of neuropathic pain. Acta Biomed. 2015;86: 226–233.
22. Chen W-L, Kang C-H, Wang S-G, Lee H-M. α-Lipoic acid regulates lipid metabolism through induction of sirtuin 1 (SIRT1) and activation of AMP-activated protein kinase. Diabetologia. 2012;55: 1824–1835. doi:10.1007/s00125-012-2530-4
23. Packer L, Roy S, Sen CK. α-Lipoic Acid: A Metabolic Antioxidant and Potential Redox Modulator of Transcription. In: Sies H, editor. Advances in Pharmacology. Academic Press; 1996. pp. 79–101. doi:10.1016/S1054-3589(08)60980-1
24. Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential. Biochim Biophys Acta. 2009;1790: 1149–1160. doi:10.1016/j.bbagen.2009.07.026
25. Nickander KK, McPhee BR, Low PA, Tritschler H. Alpha-lipoic acid: antioxidant potency against lipid peroxidation of neural tissues in vitro and implications for diabetic neuropathy. Free Radic
Biol Med. 1996;21: 631–639. doi:10.1016/0891-5849(96)00172-4
26. Singh U, Jialal I. Alpha-lipoic acid supplementation and diabetes. Nutr Rev. 2008;66: 646–657. doi:10.1111/j.1753-4887.2008.00118.x
27. Hager K, Kenklies M, McAfoose J, Engel J, Münch G. Alpha-lipoic acid as a new treatment option for Alzheimer’s disease--a 48 months follow-up analysis. J Neural Transm Suppl. 2007; 189–193. doi:10.1007/978-3-211-73574-9_24
28. Agathos E, Tentolouris A, Eleftheriadou I, Katsaouni P, Nemtzas I, Petrou A, et al. Effect of α-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. J Int Med Res. 2018;46: 1779–1790. doi:10.1177/0300060518756540
29. Babbar N, Bhalla K, Nanda S, Mehra S. Inadvertent Use of Oral Corticosteroids Leading to Iatrogenic Cushing Syndrome in an Infant with Down Syndrome. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2020. doi:10.7860/jcdr/2020/43588.13692
30. Chuc NTK, Larsson M, Do NT, Diwan VK, Tomson GB, Falkenberg T. Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. J Clin Epidemiol. 2002;55: 1148–1155. doi:10.1016/s0895-4356(02)00458-4
31. Kang S-H, Choi Y-S, Byun I-Y, Kim M-K. Effect of preoperative prednisolone on clinical postoperative symptoms after surgical extractions of mandibular third molars. Aust Dent J. 2010;55: 462–467. doi:10.1111/j.1834-7819.2010.01271.x
32. Feslihan E, Eroğlu CN. Can Photobiomodulation Therapy Be an Alternative to Methylprednisolone in Reducing Pain, Swelling, and Trismus After Removal of Impacted Third Molars? Photobiomodul Photomed Laser Surg. 2019;37: 700–705. doi:10.1089/photob.2019.4696
33. 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. International Journal of Oral and Maxillofacial Surgery. 2009. pp. 350–355. doi:10.1016/j.ijom.2008.12.013
34. Thorén H, Snäll J, Kormi E, Numminen L, Fäh R, Iizuka T, et al. Does perioperative glucocorticosteroid treatment correlate with disturbance in surgical wound healing after treatment of facial fractures? A retrospective study. J Oral Maxillofac Surg. 2009;67: 1884–1888. doi:10.1016/j.joms.2009.04.089
35. Sanders LLO, de Souza Menezes CE, Chaves Filho AJM, de Almeida Viana G, Fechine FV, Rodrigues de Queiroz MG, et al. α-Lipoic Acid as Adjunctive Treatment for Schizophrenia: An Open-Label Trial. J Clin Psychopharmacol. 2017;37: 697–701. doi:10.1097/JCP.0000000000000800
36. Sammour H, Elkholy A, Rasheedy R, Fadel E. The effect of alpha lipoic acid on uterine wound healing after primary cesarean section: a triple-blind placebo-controlled parallel-group randomized clinical trial. Arch Gynecol Obstet. 2019;299: 665–673. doi:10.1007/s00404-018-5011-2
37. Sharmilabanu S. The Protective Role Of Alpha Lipoic Acid On Organ Damages Induced By Oxidative Stress. World Journal of Pharmacy and
Pharmaceutical Sciences. 2017. pp. 521–529. doi:10.20959/wjpps20176-9274
38. Freimer M. Faculty Opinions recommendation of Oral alpha-lipoic acid to prevent chemotherapy-induced peripheral neuropathy: a randomized, double-blind, placebo-controlled trial. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. 2016. doi:10.3410/f.718216956.793519757
39. Alleva R, Nasole E, Di Donato F, Borghi B, Neuzil J, Tomasetti M. alpha-Lipoic acid supplementation inhibits oxidative damage, accelerating chronic wound healing in patients undergoing hyperbaric oxygen therapy. Biochem Biophys Res Commun. 2005;333: 404–410. doi:10.1016/j.bbrc.2005.05.119
2. Kumar M, Lavanya P. Knowledge about post extraction complications among undergraduate dental students. J Pharm Sci Res. 2016;8: 470–476.
3. Murthi M, Dhasarathan P, Rajendran D. Retrospective Study of the Prevalence of Dry Socket in Patients with Mandibular Third Molar Extraction. WORLD. 2020.
4. McGrath C, Comfort MB, Lo ECM, Luo Y. Changes in life quality following third molar surgery--the immediate postoperative period. Br Dent J. 2003;194: 265–8; discussion 261. doi:10.1038/sj.bdj.4809930
5. Pandian S, Rajamoorthi SN, Gowthaman T, Ravindran C, Teja KV, Janani K. Evaluation of alkaline phosphatase as a biomarker in the healing progression following tooth extraction. BDS. 2022;25. doi:10.4322/bds.2022.e2837
6. Professor, Department of Oral and Maxillofacial surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, No 162, Poonamallee High road, Velappanchavadi, Chennai-77, Tamil Nadu, India. Comparison of the clinical efficacy of two different extraction techniques in the removal of impacted maxillary third molar. Int J Dent Oral Sci. 2021; 2172–2175. doi:10.19070/2377-8075-21000429
7. Murugan S, Associate Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College Saveetha Institute of Medical and Technical Sciences Saveetha University Chennai, India. The assessment of need for suturing following maxillary third molar extractions. Int J Dent Oral Sci. 2021; 1775–1779. doi:10.19070/2377-8075-21000351
8. Pradeep, Associate Professor, Department of Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences. Evaluation of postoperative complications after mandibular third molar extraction without suture and its association with age and gender. Int J Dent Oral Sci. 2021; 3832–3838. doi:10.19070/2377-8075-21000785
9. Harini G, Prabu D, Balakrishnan RN. Submucosal Dexamethasone Vs Intramuscular Dexamethasone in Surgical Extraction of Third Molars-A Retrospective Study. Int J Dentistry Oral Sci. 2020;7: 1222–1225.
10. Ramasubbu S, Wahab A. Comparison Of Efficacy Of Oral Bromelain and Serratiopeptidase For The Control OF Postoperative Sequelae Following Third Molar Surgery-A Comparative Study. Int J Dentistry Oral Sci. 2021;8: 2520–2524. Available:
11. Deshpande AA, Hemavathy OR, Krishnan S, Ahmed R. Comparison of effect of intra socket ketamine and tramadol on postoperative pain after mandibular third molar surgery. Natl J Maxillofac Surg. 2022;13: 95–98. doi:10.4103/njms.NJMS_141_20
12. Nesbitt LT Jr. Minimizing complications from systemic glucocorticosteroid use. Dermatol Clin. 1995;13: 925–939
13. Tour S, Menu D. Alpha-lipoic acid (1, 2-Dithiolane-3-pentanoic acid).
14. Alpha-lipoic acid as a biological antioxidant. Free Radical Biology and Medicine. 1995;19: 227–250. doi:10.1016/0891-5849(95)00017-R
15. Schmidt U, Grafen P, Goedde HW. Chemistry and biochemistry ofα-lipoic acid. Angew Chem Int Ed Engl. 1965;4: 846–856. doi:10.1002/anie.196508461 16. Alqahtani SS. The efficiency of alpha-lipoic acid in the treatment of burning mouth syndrome: a systematic review. Eur Rev Med Pharmacol Sci. 2021;25: 6585–6591. doi:10.26355/eurrev_202111_27101
17. Gorąca A, Huk-Kolega H, Piechota A, Kleniewska P, Ciejka E, Skibska B. Lipoic acid - biological activity and therapeutic potential. Pharmacol Rep. 2011;63: 849–858. doi:10.1016/s1734-1140(11)70600-4
18. Han D, Handelman G, Marcocci L, Sen CK, Roy S, Kobuchi H, et al. Lipoic acid increases de novo synthesis of cellular glutathione by improving cystine utilization. Biofactors. 1997;6: 321–338. doi:10.1002/biof.5520060303
19. Afat İM, Akdoğan ET, Gönül O. Effects of Leukocyte- and Platelet-Rich Fibrin Alone and Combined With Hyaluronic Acid on Pain, Edema, and Trismus After Surgical Extraction of Impacted Mandibular Third Molars. J Oral Maxillofac Surg. 2018;76: 926–932. doi:10.1016/j.joms.2017.12.005
20. Ou P, Tritschler HJ, Wolff SP. Thioctic (lipoic) acid: a therapeutic metal-chelating antioxidant? Biochem Pharmacol. 1995;50: 123–126. doi:10.1016/0006-2952(95)00116-h
21. Maglione E, Marrese C, Migliaro E, Marcuccio F, Panico C, Salvati C, et al. Increasing bioavailability of (R)-alpha-lipoic acid to boost antioxidant activity in the treatment of neuropathic pain. Acta Biomed. 2015;86: 226–233.
22. Chen W-L, Kang C-H, Wang S-G, Lee H-M. α-Lipoic acid regulates lipid metabolism through induction of sirtuin 1 (SIRT1) and activation of AMP-activated protein kinase. Diabetologia. 2012;55: 1824–1835. doi:10.1007/s00125-012-2530-4
23. Packer L, Roy S, Sen CK. α-Lipoic Acid: A Metabolic Antioxidant and Potential Redox Modulator of Transcription. In: Sies H, editor. Advances in Pharmacology. Academic Press; 1996. pp. 79–101. doi:10.1016/S1054-3589(08)60980-1
24. Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential. Biochim Biophys Acta. 2009;1790: 1149–1160. doi:10.1016/j.bbagen.2009.07.026
25. Nickander KK, McPhee BR, Low PA, Tritschler H. Alpha-lipoic acid: antioxidant potency against lipid peroxidation of neural tissues in vitro and implications for diabetic neuropathy. Free Radic
Biol Med. 1996;21: 631–639. doi:10.1016/0891-5849(96)00172-4
26. Singh U, Jialal I. Alpha-lipoic acid supplementation and diabetes. Nutr Rev. 2008;66: 646–657. doi:10.1111/j.1753-4887.2008.00118.x
27. Hager K, Kenklies M, McAfoose J, Engel J, Münch G. Alpha-lipoic acid as a new treatment option for Alzheimer’s disease--a 48 months follow-up analysis. J Neural Transm Suppl. 2007; 189–193. doi:10.1007/978-3-211-73574-9_24
28. Agathos E, Tentolouris A, Eleftheriadou I, Katsaouni P, Nemtzas I, Petrou A, et al. Effect of α-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. J Int Med Res. 2018;46: 1779–1790. doi:10.1177/0300060518756540
29. Babbar N, Bhalla K, Nanda S, Mehra S. Inadvertent Use of Oral Corticosteroids Leading to Iatrogenic Cushing Syndrome in an Infant with Down Syndrome. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2020. doi:10.7860/jcdr/2020/43588.13692
30. Chuc NTK, Larsson M, Do NT, Diwan VK, Tomson GB, Falkenberg T. Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. J Clin Epidemiol. 2002;55: 1148–1155. doi:10.1016/s0895-4356(02)00458-4
31. Kang S-H, Choi Y-S, Byun I-Y, Kim M-K. Effect of preoperative prednisolone on clinical postoperative symptoms after surgical extractions of mandibular third molars. Aust Dent J. 2010;55: 462–467. doi:10.1111/j.1834-7819.2010.01271.x
32. Feslihan E, Eroğlu CN. Can Photobiomodulation Therapy Be an Alternative to Methylprednisolone in Reducing Pain, Swelling, and Trismus After Removal of Impacted Third Molars? Photobiomodul Photomed Laser Surg. 2019;37: 700–705. doi:10.1089/photob.2019.4696
33. 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. International Journal of Oral and Maxillofacial Surgery. 2009. pp. 350–355. doi:10.1016/j.ijom.2008.12.013
34. Thorén H, Snäll J, Kormi E, Numminen L, Fäh R, Iizuka T, et al. Does perioperative glucocorticosteroid treatment correlate with disturbance in surgical wound healing after treatment of facial fractures? A retrospective study. J Oral Maxillofac Surg. 2009;67: 1884–1888. doi:10.1016/j.joms.2009.04.089
35. Sanders LLO, de Souza Menezes CE, Chaves Filho AJM, de Almeida Viana G, Fechine FV, Rodrigues de Queiroz MG, et al. α-Lipoic Acid as Adjunctive Treatment for Schizophrenia: An Open-Label Trial. J Clin Psychopharmacol. 2017;37: 697–701. doi:10.1097/JCP.0000000000000800
36. Sammour H, Elkholy A, Rasheedy R, Fadel E. The effect of alpha lipoic acid on uterine wound healing after primary cesarean section: a triple-blind placebo-controlled parallel-group randomized clinical trial. Arch Gynecol Obstet. 2019;299: 665–673. doi:10.1007/s00404-018-5011-2
37. Sharmilabanu S. The Protective Role Of Alpha Lipoic Acid On Organ Damages Induced By Oxidative Stress. World Journal of Pharmacy and
Pharmaceutical Sciences. 2017. pp. 521–529. doi:10.20959/wjpps20176-9274
38. Freimer M. Faculty Opinions recommendation of Oral alpha-lipoic acid to prevent chemotherapy-induced peripheral neuropathy: a randomized, double-blind, placebo-controlled trial. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. 2016. doi:10.3410/f.718216956.793519757
39. Alleva R, Nasole E, Di Donato F, Borghi B, Neuzil J, Tomasetti M. alpha-Lipoic acid supplementation inhibits oxidative damage, accelerating chronic wound healing in patients undergoing hyperbaric oxygen therapy. Biochem Biophys Res Commun. 2005;333: 404–410. doi:10.1016/j.bbrc.2005.05.119
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May 13, 2023
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Vedha vivigdha A, Santhosh Kumar, Senthil Murugan P, Murugesan, & Alladi Sneha. (2023). Effectiveness of Alpha Lipoic Acid on Postoperative Sequelae on Lower third molar surgery -A Randomized control clinical trial. Journal of Population Therapeutics and Clinical Pharmacology, 30(10), 371–382. https://doi.org/10.47750/jptcp.2023.30.10.041
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