Original Research Article http://doi.org/10.18231/j.ijohd.2019.047 International Journal of Oral Health Dentistry, October-December, 2019;5(4):208-211 208 Comparative analysis for presurgical use of steroidal and nonsteroidal anti-inflammatory medication in gingivectomy procedure Sumant Kumar Singh 1 , Amit Kumar Srivastava 2* , Manoj Kumar 3 , Arpita Srivastava 4 , Harish Tiwari 5 1 Assistant Professor, 2 Associate Professor, 3 Professor, 4,5 Lecturer, 1-3 Dept. of Dental Surgery, 5 Dept. of Community Medicine, 1-3,5 Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, 4 Purvanchal Institute of Dental Sciences, Gorakhpur, Uttar Pradesh, India *Corresponding Author: Amit Kumar Srivastava Email: amit.radc@gmail.com Abstract Aims: The aim of this study was to evaluate the role of Dexamethasone (Steroidal anti-inflammatory drug) and Ibuprofen (Nonsteroidal anti-inflammatory drug) in controlling postoperative pain and swelling following gingivectomy procedure when administered preoperatively. Materials and Methods: It was triple blind placebo controlled clinical trial in which total of 60 patients were randomly allocated for external bevel gingivectomy. All patients were divided in three groups as follows: In Group A: Tab Dexamethasone 4mg, Group B:Tab Ibuprofen 400mg and in Group C: Placebo tab orally given to the patients 30 minutes before gingivectomy procedure. Pain intensity were evaluated using visual analog scale(VAS) at 6hr, 12hr, 24hr, day 2 and on day3 postgingivectomy period and swelling scores at day 1,day 2 and on day 3 postgingivectomy period using visual scoring system. The data collected were statistically analysed using one way analysis of variance (ANOVA) test. Result & Conclusion: At 6hr and 12hr postgingivectomy period pain intensity was almost same with Group A (Dexamethasone) and Group B (Ibuprofen) and was maximum with Placebo group. At 24hr, day 2 and day 3 postgingivectomy period, the pain intensity was least with Dexamethasone group followed by Ibuprofen then Placebo group. It was found that at day 1 postgingivectomy period swelling was significantly less with Dexamethasone group followed by Ibuprofen group then Placebo group. The present study showed that Dexamethasone is better than Ibuprofen in controlling pain and edema following gingivectomy procedure. Keywords: Steroidal anti-inflammatory drugs (SAIDs), Nonsteroidal anti-inflammatory drugs (NSAIDs), Central sensitization, Peripheral sensitization, Cyclooxygenase pathway, Phospholipase enzyme. Introduction Preemptive analgesia is defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from injury. 1,2 As a consequence preemptive analgesia can reduce immediate postoperative pain and also prevent the development of chronic pain by decreasing the altered central sensory response. 3 Local tissue damage causing release of chemical mediators (hydroxyl ion, noradrenalin, bradykinin, histamine, potassium ion, prostaglandin, cytokines and leukotrienes) are responsible for peripheral sensitization which increase the excitability of dorsal horn neurons followed by central sensitization. Once central sensitization established, patients respond poorly to analgesics. 4 The concept of preemptive analgesia to minimize postoperative pain by preventing central sensitization even before surgery. After establishment of central sensitization due to surgical tissue damage, postoperative hyperesthesia is protracted and it takes additional time for improvement. However if preemptive analgesia provided before surgery, central sensitization suppressed and postoperative hyperesthesia does not occur. A variety of anti-inflammatory medications administered preoperatively such as nonsteroidal anti-inflammatory drugs (NSAIDs) or steroidal anti-inflammatory drugs (SAIDs) are found to reduce postoperative pain intensity. 5 The NSAIDs act by blocking the cyclooxygenase (COX) pathway, producing effects on arachidonic acid metabolism and on the inhibition of synthesis of certain metabolites, such as Prostaglandins (PGs). The SAIDS defined as corticosteroids have a higher activity than NSAIDs due to blockade of A2 phospholipase enzyme, thereby reducing not only the release of PGs, but also other chemical mediators like leukotriens and thromboxanes. 6 The aim of this study was to evaluate the role of Dexamethasone and Ibuprofen when administered orally 30 minutes before gingivectomy in controlling postoperative pain and swelling. Materials and Methods This triple blind placebo controlled clinical trial was carried out in the out patient Dept. of Periodontics, Purvanchal Institute of Dental Sciences, Gorakhpur and Dental Surgery Department, B.R.D. Medical College, Gorakhpur. All patients were explained about the study and an informed consents were obtained from them. Ethical committee clearance was obtained before starting of the study. Subject selection Patient with both sexes, age group ranging between 18-45 years with good general health and oral hygiene habit were selected for the study. Subject were not taken any systemic antibiotic since last 6 months before the commencement of the study. Patient with moderate to advanced periodontal destruction with suprabony pocket more than 5mm in depth or gingival enlargement in which the bottom of the pocket not apical to the mucogingival junction were included in the study. Study design A total of 60 patients were selected for the external bevel gingivectomy. The patients were randomly divided into