Background and Objectives: The purpose of present study is to evaluate and compare the anti-inflammatory properties of combination of bromelain, trypsin and rutoside with the combination of ibuprofen, trypsin and chymotrypsin following surgical removal of lower third molar in terms of reducing postoperative pain, facial swelling and improvement in mouth opening.

Material and Methods: The study was conducted on 230 patients of either sex between the age group of 18-40 years who required removal of impacted lower third molar teeth.

Group 1:- comprising of 115 patients received the drug combination of bromelain 90mg, trypsin 48mg, rutoside 100mg for three times a day for three days.

Group 2:- comprising of 115 patients received ibuprofen 400mg, trypsin-chymotrypsin equivalent to 50,000 units for three times a day for three days.

Measurement of facial swelling, maximal mouth opening were made pre operatively and on the first, third and seventh post operative day. Pain was evaluated from patients response to visual analogue scale (VAS).

Results: Group 1 with Bromelain, trypsin and Rutoside combination showed a significant reduction in pain score when compare with group 2 at all time intervals. However no significant difference was seen in reduction of facial swelling and trismus relief was seen between the two groups. The maximum increase in swelling was seen on S3 baseline (i.e from the corner of the mouth to the angle of the mandible) in both the groups at all time periods.

Conclusion: Bromelain offers superior analgesia when compared to Ibuprofen. Bromelain and other proteolytic enzymes can be considered as an effective alternative to NSAIDs in reducing the postoperative sequelae associated with surgical extraction of third molars and causing less health hazards.

Keywords: Third molar surgery, Postoperative sequelae, Bromelain, Ibuprofen.

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Dr Ankit Choudhary

MBBS MS DNB (ENT), Senior Resident, Institute of Otorhinolaryngology & Head and Neck Surgery, IPGMER Kolkata