Efficacy of Celecoxib in reducing the postoperative pain caused by third molar surgery: A systematic review

Author(s): Parsa Firoozi

Third mandibular molar surgery is the most prevalent oral surgical procedure. The removal of impacted third molars has various postoperative complications including pain. Side effects in this procedure have an unfavorable effect on the quality of life of patients and disrupt patients’ socioeconomic activities after third molar extraction. Also, studies have shown that age and gender do not affect pain caused by third molar surgery. Inflammatory mediators including prostaglandins, leukotrienes, and platelet-activating factors, are released in response to the surgical extraction of the third molar. The production of these inflammatory mediators leads to a raise in vasodilatation of the surgical area, results in some tissue alternations, pain, and edema. Several strategies including pharmacological methods have been demonstrated to reduce complications following third molar surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain relief in third molar surgery. NSAIDs inhibit cyclooxygenase (COX) activity, thus suppressing the production of inflammatory mediators such as prostaglandin E2. COX is divided into Cyclooxygenases COX-1 and COX-2 enzymes. Inhibition of COX-1 causes harms to the gastrointestinal mucosa such as perforation, ulcer, and bleeding. Nowadays, cyclooxygenase-2 inhibitors are gaining popularity due to the lack of damage to the gastrointestinal mucosa. However, they may lead to cardiovascular effects is certain doses. Celecoxib is an anti inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) selectively and only inhibits COX 2, unlike the ordinary NSAIDs. Celecoxib suppresses the production of prostaglandins responsible for pain and does not lead to the aforementioned adverse effects in the gastrointestinal mucosa. Celecoxib appears hazardous in doses of 400 mg or greater based on randomized results. There is no strong evidence to show an increased risk of cardiovascular events at doses of 200 mg or less. This selective NSAID is used to relieve pain caused by rheumatoid arthritis and osteoarthritis. This study is aimed to assess the efficacy of Celecoxib in reducing the postoperative pain caused by third molar surgery.

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