Sublingual piroxicam and ketorolac efficacy after lower third molar removal

The sublingual administration of drugs determines a faster absorption as compared with the oral route. As a consequence, an earlier plasma peak develops, which is interesting for non-steroidal anti-inflammatory drugs (NSAIDs) aimed to control pain, trismus and swelling after lower third molar removal. Objectives: The aim of this work was to compare the clinical efficacy of two NSAIDs, piroxicam and ketorolac, administered sublingually for pain, trismus and swelling control after lower third molar removal. Methods: The study population comprised 47 volunteers aged 18 years or over, with two similarly positioned lower third molars. This was a double-blind study, randomized and crossover study. The same surgeon performed all surgeries and postoperative controls. The NSAIDs administration protocol was 20 mg sublingual piroxicam once daily or 10 mg sublingual ketorolac four times daily during 4 days. Objective and subjective parameters were recorded for comparison of postoperative courses. Data were analyzed by paired t-test, Wilcoxon test or two-way ANOVA followed by the Tukey test for multiple comparisons. Statistical significance was established at 5%. Results: Regardless of the need of bone removal, pain values recorded by the volunteers during the postoperative period were very low (generally below 20 mm on a visual analogue scale ranging from 0 to 100 mm) without a statistically significant difference between both NSAIDs. Volunteers showed the same ability of mouth opening on the 2nd and 7th postoperative days when medicated with either piroxicam or ketorolac. Both NSAIDs provided the same swelling control on the 2nd and 7th postoperative days. Side effects such as somnolence and gastric discomfort were reported with a very low incidence and considered of mild intensity by the volunteers. Conclusion: Our data suggest that sublingual piroxicam and ketorolac are equally effective for pain, trismus and swelling control after lower third molar removal. Financial support: FAPESP (process #2006/56215-1).