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The comparison of anti-inflammatory
effect in two methods of topical dexamethasone
injection and topical application of ginger
aqua-alcoholic extract after removing mandibular
wisdom teeth
Sahar Zandi (1)
Seyyed Muhammadreza Alavi (2)
Kamran Mirzaie (3)
Ramin Seyedian (4)
Narges Aria (5)
Saman Jokar (6)
(1) Dentistry
faculty, Bushehr University of Medical Sciences,
Bushehr, Iran
(2) Dentistry faculty, Bushehr University of
Medical Sciences, Bushehr, Iran
(3) Department of Social Medicine, Medicine
faculty, Bushehr University of Medical Sciences,
Bushehr, Iran
(4) Department of Pharmacology, Medicine faculty,
Bushehr University of Medical Sciences, Bushehr,
Iran
(5) Department of Oral & Maxillofacial Radiology,
Dentistry faculty, Bushehr University of Medical
Sciences, Bushehr, Iran
(6) Department of Oral & Maxillofacial Surgery,
Dentistry faculty, Bushehr University of Medical
Sciences, Bushehr, Iran
Corresponding Author:
Saman Jokar
Department of Oral & Maxillofacial Surgery,
Dentistry faculty, Bushehr University of Medical
Sciences,
Bushehr, Iran
Tel: +989170412008
Email: saman.jokar@yahoo.com
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Abstract
Introduction:
Removing wisdom tooth is one of the most
damaging facial surgeries encountered.
Dexamethasone is a complex of drugs used
that has many side effects. On the other
hand, ginger has anti-inflammatory properties
without side effects. Therefore, this
study compared anti-inflammatory properties
of two soft tissue injections of dexamethasone
sodium phosphate 1/6 mg, using topical
mucobioadhesive containing ginger extract.
Method: 45
healthy patients were selected without
any systemic diseases with double-sided
wisdom teeth that they intended to have
removed. Two-way teeth of the patients
were removed by a similar procedure by
maxillofacial surgeon. On one side of
2 cm² of mucobioadhesive containing
ginger extract (20%) and on the other
side, dexamethasone phosphate 1/6 mg was
used. The maximal oral opening rate was
measured by the researcher before surgery
and 24 and 72 hours after surgery to evaluate
Trismus.
Results: 45
patients with an average age of 28 years
participated in this study. During the
measurements, the mean of maximum mouth
opening before teeth removal was 47/48
mm. At the side using the mucobioadhesive
containing ginger extract (20%) this value
after 24 hours was 39/57 and after 72
hours was 40 mm. At the side using dexamethasone
phosphate 1/6 mg this value after 24 hours
was 46/42 and after 72 hours was 44/55
mm.
Conclusion: Based
on the statistical data obtained from
this study, it seems that topical administration
of tissue glue containing ginger extract
(20%) and soft tissue injection of dexamethasone
sodium phosphate (1/6 mg) after surgery
both reduced trismus after surgery. But
dexamethasone sodium phosphate was slightly
more successful than the mucobioadhesive
containing ginger extract.
Key words:
third molar removal, trismus, mucobioadhesive,
ginger, dexamethasone sodium phosphate,
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Nowadays, the act of removing wisdom teeth,
whether surgically or non-surgically, is one
of the most commonly used actions by general
and specialized dentists. Many reasons cause
patients and dentists to remove the wisdom teeth.
In this regard, root analysis of second molar
tooth (in case of a false growth pattern of
the tooth (horizontally), the formation of cysts
and tumors with dental origin around the latent
wisdom teeth, which may be benign or malignant
depending on the lesion, jaw bone weakening
by a latent tooth and lacking the mechanical
strength of the jaw bone against impact, and
facing irregularity and mess in the rest of
the jaw teeth can be observed (1). Also, extensive
caries or damage in the pulp of the wisdom teeth
due to the difficulty of working conditions
and performing root canal surgery on these teeth,
as well as weakness, inability of the patient
to cooperate or patient’s desire, is a
preferred decision to remove wisdom teeth. The
prevalence of impacted wisdom teeth in the mandible
has been reported 31/9% in mandibular left third
molar, and 28% in mandibular right third molar.
Based on the abundance of data, it includes
the following types: The mesioangular impacted
teeth (43%), Vertical impaction (38%), distoangular
impaction (6%), horizontal impaction (3%). In
general, tooth extraction toughness (easy to
hard, respectively) is as follows: Vertical,
angle to mesial, horizontal, angle to distal
(2). In general, the most common problems after
removing the wisdom tooth are complications
such as pain, swelling, trismus, and the anesthetic
of the lingual nerve, infection, etc. which
occur due to the trauma to the tissue and the
inflammation caused by it (3, 4). Inflammation
is the natural defense mechanism of the body
to damage or cell death, which is characterized
by redness, warmth, pain and swelling in the
area (5). When tissue damage occurs, a large
amount of histamine, bradykinin, serotonin,
and other chemicals are released in the area.
These substances, in particular, histamine,
cause local vasodilatation, increased blood
flow to the affected area, as well as the permeability
of the capillaries and venules (6-8). Following
this, edema occurs which itself causes the patient’s
unpleasant experience, pain, disability and
possibly greater paresthesia (9). The complications
of removing these teeth and surgical pain that
occurs in 90% of patients with moderate to severe
severity and the effect on the daily activities
of the patient, has turned the removal of pain
and discomfort into one of the important goals
in dentistry. And for many years, science has
sought to find ways to reduce pain (10, 11).
In this context, these strategies include less
manipulation during surgery, maintaining periost
health, taking painkillers, corticosteroid injections,
etc. (12). Nowadays, drugs such as non-steroidal
anti-inflammatory drugs, drug-containing painkillers
and corticosteroids, etc. are available to reduce
pain and side effects (6). The use of corticosteroid
drugs, such as dexamethasone and betamethasone,
is also one of the methods for controlling pain,
swelling and trismus after wisdom teeth surgery
(13, 14). Dexamethasone is a pharmaceutical
and long-acting form of corticosteroids (half-life
of the plasma is 110-120 minutes and the biological
half-life is 36-45 hours). One of the most useful
methods is intraoral injection of dexamethasone,
which has already been reported to have an effect
on pain and edema caused by dental surgery similar
to that of intramuscular injection (15). Therefore,
it has a significant effect on postoperative
pain and edema. Even mucosal injections are
better than muscle injections due to less complications
and equal effects (16).
Despite the benefits mentioned, this drug has
different short-term and long-term complications
(17, 18). The most common side effects of dexamethasone
that appear in the short term include euphoria,
insomnia, decreased or blurred vision, frequent
urination, irritation, excessive thirst, numbness,
mental weakness, pain and swelling, allergy,
infection at the injection site, pain at the
injection site, restlessness, skin rash, redness,
eye sensitivity to light, gastrointestinal ulcer
and the most important complications are seizure,
heart failure, bloody stools, heart rate disorder,
muscle pain and muscle weakness, menstrual disorder,
nausea and vomiting, pain in the back of the
arms, headache, swelling of the legs, etc. (19).
Due to its anti-inflammatory effects, dexamethasone
is one of the most widely used drugs in Iran
and an overdoing process of consuming it has
taken place. (20).
Given the complications, new research suggests
the use of complementary medicine, especially
herbal medicine, as a low-cost treatment with
minimal side effects. Ginger is one of the most
widely used medicinal plants, which has been
introduced in ancient medicine as an anti-inflammatory
herb (21). The antioxidant and anti-inflammatory
properties of ginger are well known and are
influenced by substances such as gingerol in
this plant. Its anti-cancer properties have
also been proven inside the laboratory. In the
process of drying ginger, gingerol is converted
to shogoal (22).
Recent research has proven shogoal’s properties
in preventing Alzheimer’s disease. The
active compounds of this plant, such as zingerone,
shogaol, gingerdion, gingerol have the ability
to inhibit the production of prostaglandins
and nitrite oxide and even interleukins involved
in inflammation. In addition, and more specifically,
the enzymes that produce these inflammatory
mediators are controlled by the active ingredients
of ginger (23).
With regard to the above, and that wisdom teeth
surgery is one of the most commonly used traumatic
dentistry actions that causes a patient significant
inflammation and pain, and on the other hand,
suggested strategies to reduce this distressing
pain are the use of steroidal anti-inflammatory
and non-steroidal anti-inflammatory drugs, which
they themselves cause serious damage, including
digestive, cardiovascular and bone damage; therefore,
considering the anti-inflammatory and analgesic
properties of ginger extract which is a medicinal
herb with high efficiency and low side effects,
it seems that if it is effective, it can replaced
a harmful steroidal drug. Therefore, this study,
by comparing the effect of topical application
of ginger aqua-alcoholic extract with topical
injection of dexamethasone 1/6 mg, intends to
introduce this method, in case of efficiency,
as an alternative to dexamethasone injection.
45
patients
referred
to
the
Bushehr
faculty
of
Dentistry
clinic
in
2017
who
had
double
mandibular
wisdom
teeth
and
were
referred
to
have
a
simple
tooth
extraction
(without
surgery)
or
extraction
with
surgical
procedures.
The
similarity
of
the
two
mandibular
teeth
was
determined
by
an
expert
Oral
&
Maxillofacial
radiologist
through
panoramic
radiography
images
and
based
on
the
indications
in
the
radiology
images
and
the
classifications
available
in
the
reference
books
as
well
as
by
a
clinical
examination
by
a
Oral
&
Maxillofacial
surgeon
to
make
sure
that
the
angle
of
tooth
placement
in
the
jaw,
the
amount
of
bone
and
soft
tissue
on
the
tooth,
as
well
as
the
condition
of
the
tooth
is
similar
to
that
of
the
Ramos
anterior
border.
The
tooth
extraction
toughness
was
determined
by
the
Winter’s
&
Terence
guidelines
and
the
Pell-Gregory
criteria
(24).
Patients
underwent
injections
of
two
carpule
of
lidocaine
anesthetics
using
the
method
of
inferior
alveolar
nerve
block
and
long
buccal,
then
teeth
were
removed
by
maxillofacial
surgeon
and
under
the
mucoperiosteal
flap
cutting
procedure
(if
surgery
was
required)
or
by
simple
dragging.
Then,
with
a
random
choice
based
on
random
numbers,
4
cm²
of
bioadhesive
containing
20%
ginger
extract
was
placed
in
the
extracted
cavity,
or
1/8
ml
dexamethasone
1/6
mg
was
injected
there.
Criteria
for
entering
the
study:
The
patient
has
a
double-sided
dental
wisdom
in
the
lower
jaw
(according
to
the
angle
of
tooth
placement
in
the
jaw,
the
amount
of
bone
and
soft
tissue
on
the
tooth,
the
condition
of
the
tooth
relative
to
the
Ramos
anterior
border),
and
has
a
tendency
to
cooperate
and
has
no
prohibition
of
dental
surgery
and
allergy
to
ginger.
The
mentioned
tooth
do
not
have
any
pathological
lesions
in
the
root
zone
in
clinical
and
radiographic
examinations.
Failure
to
perform
any
other
surgery
for
at
least
two
weeks.
Criteria
for
exiting
the
study:
Systemic
diseases,
including
kidney
or
liver,
bleeding
problems
such
as
hemophilia,
neutropenia,
blood
platelet
deficiency,
etc.,
previous
or
current
stomach
ulcers,
any
heart
disease,
known
allergies,
allergies
or
individual
reactions
to
each
of
the
medicines
used
or
the
medicines
that
are
likely
to
be
used
in
the
study
(Ginger,
Lidocaine
anesthesia,
Acetaminophen
Codeine
300,
Gelofen
400,
Amoxicillin
500,
and
Metronidazole
250
mg),
pregnancy
and
lactation,
the
use
of
analgesic
or
anti-inflammatory
drugs
24
hours
before
the
study,
taking
any
anti-inflammatory
or
analgesic
medicine
etc.,
except
for
the
prescribed
analgesic
substance
(acetaminophen
Codeine
300
mg),
having
pain
and
other
inflammatory
symptoms
including
swelling,
high
blood
pressure,
any
deviations
and
inability
to
open
the
full
mouth
before
the
study,
smoking
or
consuming
other
tobacco
products
less
than
a
week
before
the
study,
smoking
or
consuming
other
tobacco
products
up
to
two
weeks
after
surgery,
alcohol
consumption.
The
amount
of
opening
the
patient’s
mouth
before
surgery
(Trismus
Status
Review)
was
measured
and
recorded
using
a
tool
named
“Caliper”
in
each
side,
24
hours
and
72
hours
after
surgery.
The
method
of
data
collection
and
statistical
analysis
The
method
of
collecting
information
in
this
study
field
and
its
tool
was
a
questionnaire,
observation
and
checklist.
Descriptive
statistics,
abundance
(percentage)
and
mean
(standard
deviation,
mean,
and
range)
were
used
to
analyze
the
data,
and
for
the
inflation
situation,
the
McNemar
test
was
used
at
a
significant
level
of
0.05
and
using
SPSS
V.19
statistical
software.
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