Comparison of the clinical effects of naproxen sodium and rofecoxib after surgical removal of the impacted third molar

Among today?s oral surgery applications, surgical removal of the impacted third molars is the most frequent operation. Postoperative complications include pain, swelling of the cheek and reduction in the mouth opening. The nonsteroid antiinflammatory drugs which reduce the postoperative pain and inhibit the prostoglandin synthesis to prevent the antiinflammatory reaction, are widely used. The patients usually commence to take these mostly used nonsteroid antiinflammatory drugs after the pain started. On the contrary, the most suitable approach is to take analgesic drugs before the pain starts for prophylaxis purposes.The aim of this double-blind randomised cross-over study is to compare the effects of naproxen sodium and rofecoxib on postoperative pain, swelling and trismus relief following surgical removal of impacted mandibular third molars. The study group consisted of 15 patients (4 male, 11 female mean age 26) who were all systemically healthy. 1 hour before surgical removal of the left or right impacted third molar one of these drugs the patient received and continued for 5 days. Similar regimen was followed for the remaining mandibular third molar, except using another drug.Orthopantomographs were taken to assess the degree of impaction of the impacted mandibular third molars to be removed. Maximal mouth opening ability was measured between the edges of the maxillary and mandibular central incisors with a vernier gauge preoperatively and 48 hour postoperatively. Postoperative pain and side effect of the drugs were recorded by the patients on a specially prepared questionnaire. The intensity of pain was recorded on a four-point descriptive scale as a standard subjective measure.When the results of this study were evaluated, it was found that both of the drugs reduced the postoperative pain significantly, (p<0.01) however, there was no difference between these drugs in reducing the pain (p>0.01). On the other hand, statistically significant difference was found when the average time between the completion of the operation and the first drug taken was evaluated (p<0.01) (naproxen sodium group 8 hours and 17 minutes, rofecoxib group 18 hours and 22 minutes). No difference was found between these two drugs for mouth opening measures statistically significant (p>0.01).The side effects related to the drugs used in this clinical study were all reversible. All of these were disappeared after the patients stopped taking drugs. The numbers of gastrointestinal side effects caused by using naproxen sodium were higher than that of rofecoxib. Remarkably, alveolitis, a side effect of rofecoxib usage in dentistry, was not observed in any of the patient.It was concluded that both naproxen sodium and rofecoxib could be used as analgesic and antiinflammatory drugs after surgical removal of the impacted third molars. Moreover, rofecoxib could be considered as a new, clinically useful analgesic and antiinflammatory drug with well tolerated and a long duration of action and less side effect compared to the other NSAI drugs.Key words: naproxen sodium, rofecoxib, impacted third molar surgery, analgesic effect.