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Efficacy and safety of selective COX-2 inhibitors for pain management after third molar removal: a meta-analysis of randomized clinical trials

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Abstract

Objectives

To compare selective COX-2 inhibitors with ibuprofen in terms of analgesia, rescue medication consumption, and adverse effects after impacted third molar removal.

Materials and methods

Electronic databases were searched. Single dose, double-blind, randomized, and controlled clinical trials comparing the analgesic effect of a selective COX-2 inhibitor versus at least one active control group using ibuprofen after impacted third molar removal were selected.

Results

Twelve studies were included for the qualitative synthesis and eight were included in the meta-analysis. No statistically significant differences were found between selective COX-2 inhibitors and ibuprofen in terms of pain relief after 6, 8, and 12 h. Rescue analgesia use after 24 h was significantly greater in the ibuprofen group than in the selective COX-2 inhibitor group. There were no statistically significant differences in the number of patients presenting one or more adverse events between the two groups, though ibuprofen intake was related with more nausea and vomiting.

Conclusions

No statistically significant differences were found in terms of pain relief 6, 8, and 12 h post-medication between selective COX-2 inhibitors and ibuprofen following totally or partially impacted third molar removal. The patients who consumed selective COX-2 inhibitors needed less rescue analgesia after 24 h. The occurrence of one or more adverse events was similar in both groups, though patients who consumed ibuprofen had more nausea and vomiting.

Clinical relevance

COX-2 inhibitors could be considered a suitable alternative to ibuprofen for pain relief after third molar extraction in patients at risk of developing nausea and vomiting. Also, COX-2 inhibitors seem to slightly reduce the need of rescue medication consumption.

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Acknowledgements

The authors wish to thank Mr. Joe Perkins for English language editing of the manuscript.

Funding

The present research was conducted by the Dental and Maxillofacial Pathology and Therapeutics research group at the IDIBELL Institute (L’Hospitalet de Llobregat, Spain). The present study did not receive any specific funding from public, commercial, or non-profit sectors.

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Albert González-Barnadas, Octavi Camps-Font, Pablo Martín-Fatás, Rui Figueiredo, Cosme Gay-Escoda & Eduard Valmaseda-Castellón

  2. Facultad de Medicina y Ciencias de la Salud, Campus de Bellvitge, Universidad de Barcelona, C/ Feixa Llarga s/n, Pavelló Govern, 2ª planta, Despatx 2.9 08907 - L’Hospitalet de Llobregat, Barcelona, Spain

    Rui Figueiredo

  3. School of Dentistry, University of Barcelona, Barcelona, Spain

    Cosme Gay-Escoda

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  1. Albert González-Barnadas
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Correspondence to Rui Figueiredo.

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Conflict of interest

The authors would like to declare the following interests outside the presented work:

Dr. Albert González-Barnadas has participated as a sub-investigator in clinical trials sponsored by Mundipharma (Cambridge, UK).

Dr. Octavi Camps-Font has participated as a sub-investigator in clinical trials sponsored by Mundipharma (Cambridge, UK) and Menarini Richerche (Florence, Italy).

Dr. Pablo Martín-Fatas declares no conflict of interests.

Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain); personal fees from BioHorizons Ibérica (Madrid, Spain), Inibsa Dental (Lliça de Vall, Spain), Dentsply implants Iberia (Barcelona, Spain), and Araguaney Dental (Barcelona, Spain); and non-financial aid from ADIN Implants (Afula, Israel), and Avinent (Santpedor, Spain) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy).

Dr. Cosme Gay-Escoda has participated as a principal investigator in several randomized clinical trials sponsored by Mundipharma (Cambridge, UK) and Menarini Richerche (Florence, Italy).

Dr. Eduard Valmaseda-Castellón reports personal fees and non-financial support from MozoGrau (Valladolid, Spain); personal fees from BioHorizons Ibérica (Madrid, Spain), Inibsa Dental (Lliça de Vall, Spain), and Dentsply implants Iberia (Barcelona, Spain); and non-financial aid from Avinent (Santpedor, Spain) outside the submitted work. In addition, Dr. Valmaseda-Castellón has also participated as a sub-investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK).

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González-Barnadas, A., Camps-Font, O., Martín-Fatás, P. et al. Efficacy and safety of selective COX-2 inhibitors for pain management after third molar removal: a meta-analysis of randomized clinical trials. Clin Oral Invest 24, 79–96 (2020). https://doi.org/10.1007/s00784-019-02910-3

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