Effectiveness of Bromelain in the Control of Postoperative Pain After Periodontal Surgery: A Crossover Randomized Clinical Trial

Overview

Journal J Adv Periodontol Implant Dent

Specialty Dentistry

Date 2023 Aug 30

PMID 37645550

Authors

Masoumeh Faramarzi

Mehrnoosh Sadighi

Adileh Shirmohamadi

Reza Kazemi

Mahsa Zohdi

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to compare the analgesic effects of Ibuprofen and bromelain after periodontal surgery.

Methods: A double-blinded crossover clinical trial was conducted on 22 patients needing two crown lengthening surgeries without bone surgery or with limited bone surgery on two quadrants of the maxilla, with control and test sides. Each quadrant was randomly assigned to bromelain (500 GUD) or ibuprofen (400 mg). Immediately after the surgery and 6 hours after it, the first dose of the drugs was packaged in the same capsules in A and B. Postoperative pain was evaluated during the first 8 hours and on the following day using a visual analog scale (VAS).

Results: Using the VAS, the Ibuprofen group showed significantly lower mean pain scores than the bromelain group at 4 hours (=0.047). In contrast, there were no significant differences between the two groups at 2, 6, 8, 10, 12, 24, and 48 hours (>0.05).

Conclusion: The effectiveness of bromelain for pain control following periodontal surgery was comparable to that of Ibuprofen. Therefore, bromelain can be an efficient replacement for ibuprofen in managing pain after periodontal surgery, especially in patients with gastric ulceration and increased bleeding tendency.

Citing Articles

Beneficial Effects Induced by a Proprietary Blend of a New Bromelain-Based Polyenzymatic Complex Plus N-Acetylcysteine in Urinary Tract Infections: Results from In Vitro and Ex Vivo Studies.

Recinella L, Pinti M, Libero M, Di Lodovico S, Veschi S, Piro A Antibiotics (Basel). 2024; 13(10).

PMID: 39452251 PMC: 11505172. DOI: 10.3390/antibiotics13100985.

Exploring the Therapeutic Potential of Bromelain: Applications, Benefits, and Mechanisms.

Kansakar U, Trimarco V, Manzi M, Cervi E, Mone P, Santulli G Nutrients. 2024; 16(13).

PMID: 38999808 PMC: 11243481. DOI: 10.3390/nu16132060.

An Evaluation of the Effects of Pineapple-Extract and Bromelain-Based Treatment after Mandibular Third Molar Surgery: A Randomized Three-Arm Clinical Study.

Colletti A, Procchio C, Pisano M, Martelli A, Pellizzato M, Cravotto G Nutrients. 2024; 16(6).

PMID: 38542694 PMC: 10974198. DOI: 10.3390/nu16060784.

Reduction of Post-Surgical Facial Edema Following Bromelain and Coumarin Intake in Traumatology: A Prospective Study with 100 Patients.

Consorti G, Monarchi G, Paglianiti M, Betti E, Balercia P J Clin Med. 2024; 13(4).

PMID: 38398236 PMC: 10889715. DOI: 10.3390/jcm13040922.

References

Pavan R, Jain S, Shraddha , Kumar A . Properties and therapeutic application of bromelain: a review. Biotechnol Res Int. 2013; 2012:976203. PMC: 3529416. DOI: 10.1155/2012/976203. View

ZATUCHNI G, Colombi D . Bromelains therapy for the prevention of episiotomy pain. Obstet Gynecol. 1967; 29(2):275-8. View

Brien S, Lewith G, Walker A, Hicks S, Middleton D . Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid Based Complement Alternat Med. 2005; 1(3):251-257. PMC: 538506. DOI: 10.1093/ecam/neh035. View

Castell J, Friedrich G, Kuhn C, Poppe G . Intestinal absorption of undegraded proteins in men: presence of bromelain in plasma after oral intake. Am J Physiol. 1997; 273(1 Pt 1):G139-46. DOI: 10.1152/ajpgi.1997.273.1.G139. View

Pilatti G, Dos Santos F, Bianchi A, Cavassim R, Tozetto C . The use of celecoxib and dexamethasone for the prevention and control of postoperative pain after periodontal surgery. J Periodontol. 2006; 77(11):1809-14. DOI: 10.1902/jop.2006.060128. View

de la Barrera-Nunez M, Yanez-Vico R, Batista-Cruzado A, Heurtebise-Saavedra J, Castillo-de Oyague R, Torres-Lagares D . Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period. Med Oral Patol Oral Cir Bucal. 2013; 19(2):e157-62. PMC: 4015046. DOI: 10.4317/medoral.19105. View

Schug S . The role of COX-2 inhibitors in the treatment of postoperative pain. J Cardiovasc Pharmacol. 2006; 47 Suppl 1:S82-6. DOI: 10.1097/00005344-200605001-00015. View

Majid O, Al-Mashhadani B . Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2014; 72(6):1043-8. DOI: 10.1016/j.joms.2013.12.035. View

Haas D . An update on analgesics for the management of acute postoperative dental pain. J Can Dent Assoc. 2002; 68(8):476-82. View

10.

MacKay D, Miller A . Nutritional support for wound healing. Altern Med Rev. 2003; 8(4):359-77. View

11.

Vogel R, GROSS J . The effects of nonsteroidal anti-inflammatory analgesics on pain after periodontal surgery. J Am Dent Assoc. 1984; 109(5):731-4. DOI: 10.14219/jada.archive.1984.0181. View

12.

Kumakura S, Yamashita M, Tsurufuji S . Effect of bromelain on kaolin-induced inflammation in rats. Eur J Pharmacol. 1988; 150(3):295-301. DOI: 10.1016/0014-2999(88)90010-6. View

13.

Hotz G, Frank T, Zoller J, Wiebelt H . [Antiphlogistic effect of bromelaine following third molar removal]. Dtsch Zahnarztl Z. 1989; 44(11):830-2. View

14.

Rashwan W . The efficacy of acetaminophen-caffeine compared to Ibuprofen in the control of postoperative pain after periodontal surgery: a crossover pilot study. J Periodontol. 2009; 80(6):945-52. DOI: 10.1902/jop.2009.080637. View

15.

Khan A, Dionne R . The COX-2 inhibitors: new analgesic and anti-inflammatory drugs. Dent Clin North Am. 2002; 46(4):679-90. DOI: 10.1016/s0011-8532(02)00032-0. View

16.

Vogel R, Desjardins P, Major K . Comparison of presurgical and immediate postsurgical ibuprofen on postoperative periodontal pain. J Periodontol. 1992; 63(11):914-8. DOI: 10.1902/jop.1992.63.11.914. View

17.

Taussig S, Yokoyama M, Chinen A, Onari K, Yamakido M . Bromelain: a proteolytic enzyme and its clinical application. A review. Hiroshima J Med Sci. 1975; 24(2-3):185-93. View

18.

Khan A, Maixner W, Feng Lim P . Persistent pain after endodontic therapy. J Am Dent Assoc. 2014; 145(3):270-2. DOI: 10.14219/jada.2013.1. View

19.

Inchingolo F, Tatullo M, Marrelli M, Inchingolo A, Picciariello V, Inchingolo A . Clinical trial with bromelain in third molar exodontia. Eur Rev Med Pharmacol Sci. 2010; 14(9):771-4. View

20.

Humphris G, Morrison T, Lindsay S . The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health. 1995; 12(3):143-50. View