COMPARISON OF EFFICACY OF COLD SALINE IRRIGATION, NORMAL SALINE IRRIGATION WITH ORAL ENZYME PREPARATION AND NORMAL SALINE IRRIGATION WITH SUBMUCOSAL DEXAMETHASONE INFILTRATION ON POST OPERATIVE SYMPTOMS AFTER SURGICAL REMOVAL OF IMPACTED MANDIBULAR THIRD MOLAR - A RANDOMIZED CONTROLLED TRIAL

Third molar surgical removal is one of the most common procedures performed by Oral & Maxillofacial surgeons, it is often associated with post operative swelling, pain and trismus which are inflammatory signs and symptoms that cause discomfort and also can have an impact on quality of life

To reduce post operative discomfort, different pharmacological managements have been proposed by various authors;

Normal saline is commonly used as a irrigating solution in third molar surgeries as it decreases the heat generated by surgical drill while contacting bone thus reducing the chance of inflammation and tissue damage

In some studies, surgeons prefer cold saline irrigation  (2-8 degree celsius) and they believe that it is more effective than normal saline irrigation.

Corticosteroids have been used most frequently for post operative management after 3rd molar surgeries, dexamethasone is most commonly used for post operative swelling , pain and trismus the conventional route for dexamethasone drug delivery is through intramuscular and intravenous route ,however these techniques require additional clinical skills and may not be as pleasant to the conscious patient as well.

As an alternative submucosal injection (SM) has been reported to be an effective , convenient and straightforward way of administering dexamethasone

Nonsteroidal Anti-inflammatory drugs have often been prescribed to reduce post operative inflammatory complications caused by third molar surgery, however the side effects associated are numerous primarily gastro intestinal, renal disorders , propensity to cause skin and mucosal reactions.

Hence a natural, effective, and safe remedy that lacks undesirable side effects would offer a better alternative treatment

Bromelain is a proteolytic enzyme derived from stem of pineapple plant( Ananas Comosus) and presents anti-inflammatory anti edemic and anti fibrinolytic  properties , which can be beneficial in post operative management after 3rd molar surgery.