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Effects of 15 mg meloxicam administered before odontectomy on pain, facial edema, trismus, and expressions of TNF following odontectomy of impacted mandibular third molar

  • Melisa Ruth ,
  • Cahya Y. Hasan ,
  • Rahardjo ,
  • Rustamadji Rustamadji ,


Objective:To evaluate the effects of 15 mg meloxicam administered 60 minutes before odontectomy on pain, facial edema, trismus and expressions of TNF-α after odontectomy of impacted mandibular third molar.Material and Methods: A total of 24 patients were randomized into treatment groups, each with 12 patients: Group A was administered with 15 mg of meloxicam; and Group B with placebo. Drugs were administered orally 60 minutes prior to surgery. Observation of pain (seen from VAS scores), facial edema (seen from swollen cheeks), trismus (seen from mouth opening) and expressions of TNF-α (measured from saliva by ELISA method), performed before odontectomy, H+1 (24 hours after odontectomy) and H+3 (72 hours after odontectomy).Results: Patients who received 15 mg meloxicam 60 minutes before odontectomy showed less postoperative pain (p=0.000), less facial edema (p=0.000) and lower expressions of TNF-α (p=0.000). No differences were found in mouth opening between the meloxicam group and placebo group (p=0.522). The higher level of TNF-α level will lead to higher level of pain, greater facial edema and causes smaller mouth opening.Conclusion: Oral administration of 15 mg meloxicam 60 minutes prior to odontectomy was found more effective in reducing pain, facial edema and expressions of TNF-α after odontectomy of impacted mandibular third molar compared with placebo.


  1. Fragiskos FD. Oral Surgery, Berlin: Springer Verlag; 2007.
  2. p. 31-41, 95-200.
  3. Muhajir I, Yusuf HY, Riawan L. Correlation between
  4. swelling post odontectomy in lower third molar with the
  5. increase of concentration alpha amylase saliva. Int J Sci Res
  6. ;9: 870-873.
  7. Gutiérrez-Corrales A, Campano-Cuevas E, Castillo-Dalí G,
  8. et al. Relationship between salivary biomarkers and postoperative swelling after the extraction of impacted lower third
  9. molars. Int J Oral Maxillofac Surg 2017;46: 243-249.
  10. Orozco-Solís M, García-Ãvalos Y, Pichardo-Ramírez C,
  11. et al. Single dose of diclofenac or meloxicam for control of
  12. pain, facial swelling, and trismus in oral surgery. Med Oral
  13. Patol Oral Cir Bucal 2016;21: e127-34.
  14. Aznar-Arasa L, Harutunin K, Figueiredo R, et al. Effect of
  15. preoperative ibuprofen on pain and swelling after lower
  16. third molar removal: a randomized controlled trial. Int J
  17. Oral Maxillofac Surg 2012;41: 1005-1009.
  18. Albuquerque AFM, Fonteles CSR, do-Val DR, et al. Effect
  19. of pre-emptive analgesia on clinical parameters and tissue
  20. levels Of TNF-α And IL-1β in third molar surgery: a
  21. triple-blind, randomized, placebo controlled study. Int J
  22. Oral Maxillofac Surg 2017;46: 1615-1625.
  23. Veleska-Stevkovska D. Cytokines (IL-1, TNF-α, IL-6)
  24. and oral surgery interventions. Balk J Stom 2010;14:
  25. -132.
  26. Dhingra AK, Chopra B, Dua JS, et al. New insight on
  27. inflammation and its management: a review. J Innov
  28. Pharm Biol Sci 2017;4: 117-126.
  29. Gunaydin C, Bilge SS. Effects of nonsteroidal antiinflammatory drugs at the molecular level. Eurasian J Med
  30. ;50: 116-21.
  31. Euller-Ziegler L, Velicitat P, Bluhmki E, et al. Meloxicam:
  32. a review of its pharmacokinetics, efficacy and tolerability
  33. following intramuscular administration, inflamm. Res
  34. ;50: S5-S9.
  35. Calvo AM, Sakai VT, Giglio FPM, et al. Analgesic and
  36. anti-inflammatory dose–response relationship of 7.5
  37. and 15 mg meloxicam after lower third molar removal:
  38. a double-blind, randomized, crossover study. Int J Oral
  39. Maxillofac Surg 2007;36: 26-31.
  40. Del-Tacca MD, Colucci R, Fornai M, et al. Efficacy and
  41. tolerability of meloxicam, a cox-2 preferential nonsteroidal anti-inflammatory drug, a review. Clin Drug Invest
  42. ;22: 799-818.
  43. De Menezes SA, Cury PR. Effcacy of nimesulide versus
  44. meloxicam in the control of pain, swelling and trismus
  45. following extraction of impacted lower third molar. Int J
  46. Oral Maxillofac Surg 2010;39: 580-584.
  47. Sudarshan RSG, Venkataraghavan K. Management of
  48. postoperative pain and swelling following mandibular
  49. third molar surgery with newer drugs-a comparative study.
  50. Int J Contemp Dent 2011;2: 92-97.
  51. Sener M, Ozgur PZ, Yilmaz I, et al. Comparison of preemptive analgesic effects of a single dose of nonopioid
  52. analgesics for pain management after ambulatory surgery:
  53. a prospective, randomized, single-blind study in turkish
  54. patients. Curr Ther Res Clin Exp 2005;66: 541-551.
  55. Aoki T, Yamaguchi H, Naito H, et al. Premedication with
  56. cyclooxygenase-2 inhibitor meloxicam reduced postoperative
  57. pain in patients after oral surgery. Int J Oral Maxillofac Surg
  58. ;35: 613-617.
  59. Tiigimae-Saar J, Leibur E, Tamme T. The effect of prednisolone on reduction of complaints after impacted third
  60. molar removal. SBDMJ 2010;12: 17-22.
  61. Simone JL, Jorge WA, Horliana ACRT, et al. Comparative
  62. analysis of preemptive analgesic effect of dexamethasone
  63. and diclofenac following third molar surgery. Braz Oral
  64. Res 2013;27: 266-271.
  65. Nazar MN, Puthiriraj V. Analgesics following mandibular
  66. third molar surgery. Int Journal Pharm Clin Res 2014;6:
  67. -19.
  68. Li LC, Hou Q, Guo Y, et al. Inhibitory effect of meloxicam on human polymorphonuclear leukocyte adhesion to
  69. human synovial cell. Yao Xue Xue Bao 2002;37: 103-107.
  70. Davies NM, Skjodt NM. Clinical pharmacokinetics of
  71. meloxicam: a cyclooxygenase-2 preferential nonsteroidal
  72. anti-inflammatory drug. Clin Pharmacokinet 1999;36:
  73. -126.
  74. Auvinet B, Ziller R, Appelboom T, et al Comparison of the
  75. onset and intensity of action of intramuscular meloxicam
  76. and oral meloxicam in patients with acute sciatica. Clin
  77. Therap 1995;17: 1078-1090.
  78. Engelhardt G. Pharmacology of meloxicam, a new
  79. non-steroidal anti-inflammatory drug with an improved
  80. safety profile through preferential inhibition of COX-2.
  81. British J Rheumatol 1996;35: 4-12.
  82. Bekker A, Kloepping C, Collingwood S. Meloxicam in the
  83. management of post-operative pain: Narrative review. J
  84. Anaesthesiol Clin Pharmacol 2018;34: 450-457.
  85. Sirintawat N, Sawang K, Chaiyasamut T, Wongsirichat N.
  86. Pain measurement in oral and maxillofacial surgery. J Dent
  87. Anesth Pain Med 2017;17: 253-263.
  88. Costa FWG, Esses DFS, de-Barros SPG, et al. Does the
  89. preemptive use of oral nonsteroidal anti-inflammatory
  90. drugs reduce postoperative pain in surgical removal of
  91. third molars? a meta-analysis of randomized. Clin Trials
  92. Anesth Prog 2015;62: 57-63.
  93. Yamaguchi A, Sano K. Effectiveness of preemptive
  94. analgesia on postoperative pain following third molar
  95. surgery: review of literatures. Japanese Dent Sci Rev
  96. ;49: 131-138.
  97. Villafuerte-Nuñez AE, Téllez-Anguiano AC, HernándezDíaz O, et al. Facial edema evaluation using digital image
  98. processing. Discrete Dynamics Nature Soc 2013: 1-13.
  99. Bekker A, Kloepping C, Collingwood S. Meloxicam in the
  100. management of post-operative pain: narrative review. J
  101. Anaesthesiol Clin Pharmacol 2018;34: 450-457.
  102. Pochapski MT, Santos FA, de-Andrade ED, et al. Effect
  103. of pretreatment dexamethasone on postendodontic pain.
  104. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
  105. ;108: 790-795.
  106. Deliverska EG, Petkova M. Complications after extraction
  107. of impacted third molars- Literature review. J IMAB
  108. ;22: 1202-1211.
  109. Shugars DA, Gentile MA, Ahmad N, et al. Assessment
  110. of oral health-related quality of life before and after third
  111. molar surgery. J Oral Maxillofac Surg 2006;64: 1721-1730.
  112. Selimović E, Ibrahimagić-Šeper L, Šišić I, et al. Prevention
  113. of trismus with different pharmacological therapies after
  114. surgical extraction of impacted mandibular third molar.
  115. Med Glas (Zenica) 2017;14: 145-151.
  116. Franco-Molina MA, Mendoza-Gamboa E, CoronadoCerda EE, et al. Clinical trial evaluating the effectiveness
  117. of biocompound immunepotent crp in the third-molar
  118. extraction. Biotechnol Biotechnol Equipment 2017;31:
  119. -186.
  120. Mittal S, Bansal V, Garg S, et al. The diagnostic role of
  121. saliva-a review. J Clin Exp Dent 2011;3: e314-320.
  122. Bradley JR. TNF-α mediated inflammatory disease. J
  123. Pathol 2008;214: 149-160.
  124. Fahs F, Bi X, Yu F, et al. Critical review: new insights into
  125. microRNAs in skin wound healing. Int Union Biochem
  126. Molec Biol 2015;67: 889-896.
  127. Xu F, Zhang C, Graves DT. Review article, abnormal cell
  128. responses and role of TNF-α. BioMed Res Int 2013;2013:
  129. -802.
  130. Ritsu M, Kawakami K, Kanno E, et al. Critical role of
  131. tumor necrosis factor-a in the early process of wound healing
  132. in skin. J Dermatol Dermatol Surg 2017;21: 14-19.
  133. Veleska-Stevkovska D. Cytokines (IL-1, TNF-α, IL-6) and
  134. oral surgery interventions. Balk J Stom 2010;14: 124-132.
  135. Verri Jr WA, Cunha TM, Poole S, et al. Cytokine inhibitors
  136. and pain control. Rev Bras Reumatol 2007;47: 341-353.
  137. Pfaffe T, Cooper-White J, Beyerlein P, et al. Diagnostic
  138. Potential of Saliva: Current State And Future Applications.
  139. Clin Chem 2011;57: 675-687.

How to Cite

Ruth, M., Hasan, C. Y., Rahardjo, & Rustamadji, R. (2020). Effects of 15 mg meloxicam administered before odontectomy on pain, facial edema, trismus, and expressions of TNF following odontectomy of impacted mandibular third molar. Journal of Dentomaxillofacial Science, 5(2), 103–109.




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