Efficacy of Diclofenac in Pain and Inflammation Control Following Third Molar Surgery: A Systematic Review

Abstract

Background: Pain and inflammation following oral surgeries are typically managed with nonsteroidal anti-inflammatory drugs (NSAIDs). The combination of opioid analgesics with NSAIDs has been shown to enhance pain management, particularly in invasive oral surgeries such as third molar extractions. This systematic review evaluates the effectiveness of diclofenac in controlling pain and inflammation after third molar surgery and compares its efficacy with other analgesic treatments. A search of Google Scholar and PubMed databases identified relevant randomized clinical trials published since 2000.

Materials and Methods: This study is a systematic review of randomized clinical trials examining the effects of diclofenac on pain control after third molar surgery. Research articles published from 2000 onwards were sourced from Google Scholar and PubMed. The review focuses on clinical trials that assessed pain levels, mouth opening, and inflammation control in patients receiving diclofenac following third molar extraction.

Results: Analysis of four studies that met the inclusion and exclusion criteria revealed that the average pain intensity at the sixth and twelfth hours post-surgery in the diclofenac group, as measured by the Visual Analog Scale (VAS), were 2.63 and 2.35, respectively. These patients experienced higher pain levels compared to the group receiving alternative analgesics (other than diclofenac) during the same time periods.
Additionally, the average mouth opening in the diclofenac group was 29 mm and 29.82 mm on the second and seventh days after surgery, respectively, compared to a preoperative average of 43 mm. Although there was some reduction in mouth opening in the diclofenac group, it was slightly lower compared to the second group, which received other analgesic medications.

Conclusion: Diclofenac demonstrated a relatively weaker analgesic effect compared to dexamethasone, ketorolac, etoricoxib, and the combination of codeine with diclofenac in managing pain following third molar surgery. However, diclofenac's analgesic efficacy was superior to tramadol. Furthermore, while diclofenac did show some effect on reducing mouth opening post-surgery, its impact was less significant compared to etoricoxib and the combination of diclofenac with codeine.