Analgesic effect of Ascorbic Acid versus Aceclofenac on Post-transalveolar Extraction - A case control study

Main Article Content

Nallan CSK Chaitanya
Rajkumar Badam
G Siva Prasad Reddy
AdityaMohan Alwala
Pallerla Srinivas
Nisheeth Saawarn
Chintada Suvarda
Mule Akhila
Parinita Bontala
Pavitra Inamdar
Himabindu Mannava

Keywords

Third molar extraction; IV Vitamin C; Aceclofenac; Post-surgical pain; Trismus; Facial swelling.

Abstract

Background


One of the most important aspects of postsurgical care is finding an efficient way for management of pain. Third molar extractions/ surgical impaction is one of the most frequent surgical procedure in dental offices and it is most often associated with postoperative complications like severe pain, oedema and reduced mouth opening. This present study was aimed to evaluate efficacy of 2 grams IV Vitamin C compared to Aceclofenac 100 mg on postsurgical pain, swelling and trismus after surgical removal of third molars. Material and Methods: A total of 101 patients recruited for the study and they were randomized into two treatment groups; group A (n=51) received 2g IV Vitamin C and group B (n=50) received aceclofenac 100mg. Pain intensity, facial swelling and mouth opening were assessed till day 3 post surgically. Results: Statistical analysis of pain intensity revealed that IV vitamin C performed slightly better but not significantly differed (p>0.05) from aceclofenac group at end of day 3. No significant difference for facial swelling and mouth opening between the two treatment protocols was seen (p>0.05). Conclusion: Our results concluded that both treatment groups were overall similar in analgesic efficacy, postoperative oedema and reduction in mouth opening. It was also determined that 2g IV Vitamin C is well- suited to the treatment of post-operative pain, swelling and trismus following surgical extraction of impacted third molars.

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References

1. Friedman JW. The prophylactic extraction of third molars: a public health hazard. Am J Public Health. 2007;97(9):1554-9.
2. Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. The Cochrane database of systematic reviews. 2013(12):Cd004624.
3. American Dental Association. 1999 survey of dental services rendered [unpublished report]. ADA Catalog No. SDSR-1999.
4. Statements by the American Association of Oral and Maxillofacial Surgeons Concerning the Management of Selected Clinical Conditions and Associated Clinical Procedures: The Management of Impacted Third Molar Teeth. Rosemont, Ill: American Association of Oral and Maxillofacial Surgeons; 2007.
5. Friedman JW. Containing the cost of third-molar extractions: a dilemma for health insurance. Public health reports (Washington, DC: 1974). 1983;98(4):376-84.
6. Leonard MS. Removing third molars: a review for the general practitioner. Journal of the American Dental Association. 1992;123(2):77-8, 81-2, 5-6.
7. Colorado-Bonnin M, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Quality of life following lower third molar removal. International journal of oral and maxillofacial surgery. 2006;35(4):343-7.
8. Duarte-Rodrigues L, Miranda EFP, Souza TO, de Paiva HN, Falci SGM, Galvao EL. Third molar removal and its impact on quality of life: systematic review and meta-analysis. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation. 2018;27(10):2477-89.
9. van Wijk A, Kieffer JM, Lindeboom JH. Effect of third molar surgery on oral health-related quality of life in the first postoperative week using Dutch version of Oral Health Impact Profile-14. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons. 2009;67(5):1026-31.
10. Zuniga JR, Phillips CL, Shugars D, Lyon JA, Peroutka SJ, Swarbrick J, et al. Analgesic safety and efficacy of diclofenac sodium softgels on postoperative third molar extraction pain. Journal of Oral and Maxillofacial Surgery. 2004;62(7):806-15.
11. Roelofse JA, Van der Bijl P, Joubert JJ. Analgesic and anti-inflammatory efficacy of tenoxicam and diclofenac sodium after third molar surgery. Anesth Prog. 1996;43(4):103-7.
12. Gobetti JD. Controlling dental pain. Journal of the American Dental Association 1992;123:47–52.
13. Derry C, Derry S, Moore RA, McQuay HJ. Single dose oral ibuprofen for acute postoperative pain in adults. The Cochrane database of systematic reviews. 2009(3):Cd001548.
14. Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five-parallel-group, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain. 2011;152(3):632-42.
15. Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. The Cochrane database of systematic reviews. 2013(6):Cd010210.
16. Chunduri NS, Kollu T, Goteki VR, et al. Efficacy of aceclofenac and diclofenac sodium for relief of postoperative pain after third molar surgery: a randomised open label comparative study. J Pharmacol Pharmacother 2013;4(2):144-5.
17. Jyothsna K, Deshpande N, Vijayalakshmi G. Efficacy and safety of diclofenac sodium and aceclofenac in controlling post extraction dental pain: a randomised open label comparative study. J Pharmacol Toxicol 2011:41-7.
18. Chunduri NS, Kollu T, Goteki VR, Mallela KK, Madasu K. Efficacy of aceclofenac and diclofenac sodium for relief of postoperative pain after third molar surgery: A randomised open label comparative study. J Pharmacol Pharmacother. 2013;4(2):144-5.
19. Chaitanya NC, Muthukrishnan A, Krishnaprasad CMS, Sanjuprasanna G, Pillay P, Mounika B. An Insight and Update on the Analgesic Properties of Vitamin C. Journal of pharmacy & bioallied sciences. 2018;10(3):119-25.
20. Catani MV, Savini I, Rossi A, Melino G, Avigliano L. Biological role of vitamin C in keratinocytes. Nutrition reviews. 2005;63(3):81-90.
21. Popovich D, McAlhany A, Adewumi AO, Barnes MM. Scurvy: forgotten but definitely not gone. Journal of pediatric health care: official publication of National Association of Pediatric Nurse Associates & Practitioners. 2009;23(6):405-15.
22. Schencking M, Vollbracht C, Weiss G, Lebert J, Biller A, Goyvaerts B, et al. Intravenous vitamin C in the treatment of shingles: results of a multicenter prospective cohort study. Medical science monitor: international medical journal of experimental and clinical research. 2012;18(4):Cr215-24.
23. Chen JY, Chu CC, So EC, Hsing CH, Hu ML. Treatment of postherpetic neuralgia with intravenous administration of vitamin C. Anesthesia and analgesia. 2006;103(6):1616-7.
24. Jensen NH. [Reduced pain from osteoarthritis in hip joint or knee joint during treatment with calcium ascorbate. A randomized, placebo-controlled cross-over trial in general practice]. Ugeskrift for laeger. 2003;165(25):2563-6.
25. Carr AC, Vissers MCM, Cook JS. The effect of intravenous vitamin C on cancer- and chemotherapy-related fatigue and quality of life. Front Oncol. 2014;4(283):1–7.
26. Cameron E, Campbell A. The orthomolecular treatment of cancer. II. Clinical trial of high-dose ascorbic acid supplements in advanced human cancer. Chem Biol Interact. 1974;9(4):285–315.
27. Jeon Y, Park JS, Moon S, Yeo J. Effect of Intravenous High Dose Vitamin C on Postoperative Pain and Morphine Use after Laparoscopic Colectomy: A Randomized Controlled Trial. Pain Research and Management. 2016;2016:6.
28. Amin MM, Laskin DM. Prophylactic use of indomethacin for prevention of postsurgical complications after removal of impacted third molars. Oral surgery, oral medicine and oral pathology. 1983;55(5):448-51.
29. Deliverska EG, Petkova M. Complications after extraction of impacted third molars- literature review. J Of IMAB. 2016;22(3):1202-11.
30. Contar CM, de Oliveira P, Kanegusuku K, Berticelli RD, Azevedo-Alanis LR, Machado MA. Complications in third molar removal: a retrospective study of 588 patients. Medicina oral, patologia oral y cirugia bucal. 2010;15(1):e74-8.
31. Carr AC, McCall C. The role of vitamin C in the treatment of pain: new insights. Journal of translational medicine. 2017;15(1):77.
32. Jyosthna K, Deshpande N, Vijayalakshmi G. Efficacy and safety of Diclofenac sodium and Aceclofenac in controlling Post extraction dental pain: A randomized open label comparative study. Journal of Pharmacology and Toxicology. 2011;6:541-47.
33. Benediktsdottir I, Wenzel A, Petersen J et al. Mandibular- third molar removal: risk indicators for extended operation time, postoperative pain and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:438-46.
34. Yasin MF, Tawfiq NO. Aceclofenac efficacy on pain, trismus and swelling after surgical removal of impacted wisdom teeth. Int J Enhanced Research in Medicines & Dental care. 2017;4(3):25-31.
35. Jatin K, Lata J, Singh TPA. Comparative study on the efficacy of rofecoxib and ibuprofen in controlling post-operative sequelae following third molar surgeries. J Maxillofac O Surg. 2007;6(1):17–21.
36. 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 medicine. 2005;1:11.
37. Stephenson CM, Levin RD, Spector T, Lis CG. Phase I clinical trial to evaluate the safety, tolerability, and pharmacokinetics of high-dose intravenous ascorbic acid in patients with advanced cancer. Cancer Chemother Pharmacol 2013;72:139–46.
38. Mikirova N, Casciari J, Riordan N, Hunninghake R. Clinical experience with intravenous administration of ascorbic acid: achievable levels in blood for different states of inflammation and disease in cancer patients. Journal of translational medicine. 2013;11:191.