The removal of lower third molars is one of the commonest surgical procedures. The effective management of post operative pain is an important consideration and it has been suggested that preoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) may be more effective than post operative administration. The aim of this study was therefore to compare the analgesic and anti-inflammatory effects of preoperative and postoperative administration of ibuprofen after the surgical removal of impacted lower third molars.

What did they do

Patients aged 18-45 who required the surgical removal of an impacted lower third molar were randomised to receive either 600 mg of ibuprofen orally 1 h before the surgical procedure, followed by placebo just after the end of the operation ( test group), or had placebo was given 1 h before the extraction, and 600 mg of ibuprofen administered when surgery had been completed ( control group). Pain was assessed every 2 or 4 h within the first 14 h, and then the patient measured pain intensity every 8 h between 24 and 64 h post surgery using a visual analogue scale(VAS). Facial swelling and trismus were recorded at 48 h and 7 days. Use of rescue medication was recorded.

 What did they find

• Of the 120 enrolled ( 60 in each arm), 11 were lost to follow up ( 7 in test group, 4 in the control)
• There were no significant differences between the two study groups regarding postoperative pain, rescue analgesics consumption, facial swelling and trismus.
• There was a slightly higher need for rescue analgesics in the experimental group.

They concluded

The preoperative intake of ibuprofen does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to the postoperative administration of the same drug.

Aznar-Arasa L, Harutunian K, Figueiredo R, Valmaseda-Castellón E, Gay-Escoda C. Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial. Int J Oral Maxillofac Surg. 2012 Apr 19. [Epub ahead of print] PubMed PMID: 22521671.

Relevant reviews

The third molar model is regularly used in studies for analgesics so consequently there is a large literature available;  a number of reviews and a  Cochrane protocol are higlighted below:-

Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD008659. DOI: 10.1002/14651858.CD008659.pub2.

Yong SL, Walsh T, Coulthard P. Protective analgesia for postoperative pain following third molar surgery (Protocol). Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD008692. DOI: 10.1002/14651858.CD008692.

Weil K, Hooper L, Afzal Z, Esposito M, Worthington HV, van Wijk AJ, Coulthard P. Paracetamol for pain relief after surgical removal of lower wisdom teeth.Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004487. Review. PubMed PMID:17636762.

 Barden J, Edwards JE, McQuay HJ, Wiffen PJ, Moore RA. Relative efficacy of oral analgesics after third molar extraction. Br Dent J. 2004 Oct 9;197(7):407-11; discussion 397. Review. PubMed PMID: 15475903.

 Barden J, Edwards JE, McQuay HJ, Andrew Moore R. Pain and analgesic response after third molar extraction and other postsurgical pain. Pain. 2004Jan;107(1-2):86-90. PubMed PMID: 14715393.