Comparison of Clinical Efficacy of Bromelain with Paracetamol on Postoperative Sequelae after Surgical Removal of Impacted Mandibular Third Molar: A Split-mouth Randomised Clinical Study

Abstract

Introduction: The most frequent oral and maxillofacial surgical operation carried out in an outpatient setting is the surgical extraction of impacted mandibular third molars. The removal of impacted mandibular third molars involves surgical trauma in a highly vascularised area, which causes inflammatory changes referred to as “sequelae,” including pain, swelling, and trismus. These symptoms gradually appear, peaking two days after the extraction. To limit these postsurgical inflammatory complications, surgeons have advised the patients to use proteolytic enzymes, such as bromelain, along with routine antibiotics, analgesics, and corticosteroids. Aim: To compare the clinical efficacy of bromelain with that of paracetamol on pain, swelling, and trismus after the surgical removal of bilateral impacted mandibular third molars with similar difficulty indices. Materials and Methods: The present study was a split-mouth randomised clinical trial conducted at the Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India, over a period of six months from August 2022 to January 2023. Twenty subjects requiring surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly assigned to receive one of the following treatments for five days after surgery: Cap. bromelain 500 mg-BD 24 hours preoperatively and continued until the 4th day postoperatively (n=10, Group A) or Tab. paracetamol 500 mg-TDS (n=10, Group B). Pain scores were evaluated using the Visual Analog Scale (VAS) on postoperative days 1, 2, and 3. Swelling and mouth opening were assessed on postoperative days 2 and 7. Intergroup comparison was done using Student’s t-test. Results: The mean VAS scores for pain evaluation were 6.60, 5.80, and 5.20 for bromelain on days 1 (p=0.001), 2 (p=0.001), and 3 (p=0.001), respectively. The difference between the swelling values for the bromelain group was significant, while there were no significant differences in the values of trismus. Conclusion: It was concluded that bromelain is a better analgesic and anti-inflammatory drug compared to paracetamol. There were no significant differences in the values of trismus.