How Medicines taken before lower wisdom tooth removal can reduce pain, swelling and inflammation after surgery

INTERVENTION: andomized, placebo‐controlled, four‐arm parallel, triple‐blind clinical trial. A total of 60 participants will be randomly allocated to four groups with 15 participants in each group using permuted block randomization. The allocation sequence will be prepared by a researcher who will not participate in medication administration, the surgical procedure, or postoperative assessments and will be concealed in sequentially numbered, sealed, opaque envelopes. The participant, the surgeon, and the researcher responsible for postoperative assessments will remain unaware of the medication administered. The medication preparations will have standardized appearance and packaging to maintain blinding. One hour before surgery, the 15 participants in group 1 will receive a placebo dose orally, the 15 participants in group 2 will receive Dexamethasone 8 milligrams orally, the 15 participants in group 3 will receive Etoricoxib 90 milligrams orally, and the 15 participants in group 4 will receive Amoxicillin 2 grams orally. Each participant will undergo one standardized surgical removal of an impacted mandibular third molar. The procedure will include intraoral and extraoral antisepsis, local anesthesia, creation and elevation of a mucoperiosteal flap, bone removal and tooth sectioning when required, tooth extraction, irrigation of the socket with saline solution, and suturing. The duration of the surgical procedure will be recorded in seconds from the beginning of surgery until completion of suturing. After surgery, all participants will receive Paracetamol 750 milligrams orally every 6 hours during the first 24 hours. From the second through the third postoperative day, Paracetamol 750 milligrams may be used as rescue medication in case of pain, with a minimum interval of 6 hours between doses. All participants will use Chlorhexidine Digluconate 0.12 percent as a mouthwash three times daily for five days. Participants will return on the third and seventh postoperative days for assessment of pain, facial swelling, and mouth opening. Local inflammatory fluid will be collected on the third and seventh postoperative days using sterile periodontal absorbent paper strips maintained at the collection site for 30 seconds for analysis of micro ribonucleic acid expression. Sutures will be removed on the seventh postoperative day, and the total follow‐up period for each participant will be seven days CONDITION: Tooth, Impacted ; Stomatognathic diseases INCLUSION CRITERIA: Patients aged between 18 and 40 years; good systemic health; physical status classification one or two according to the American Society of Anesthesiologists; indication for extraction of an impacted mandibular third molar; third molar classified according to Pell and Gregory as position A and class II, position A and class III, position B and class I, position B and class II, position B and class III, position C and class I, position C and class II, or position C and class III; any tooth angulation according to the Winter classification; absence of clinical signs of local infection or inflammation PRIMARY OUTCOME: To evaluate the effect of preoperative administration of placebo, dexamethasone 8 mg, etoricoxib 90 mg, or amoxicillin 2 g on the relative expression of miR‐1246, miR‐335‐5p, and miR‐193a‐5p in local inflammatory fluid after surgical extraction of an impacted mandibular third molar. Samples will be collected using sterile PerioPaper strips from the distal aspect of the mandibular second molar on postoperative days 3 and 7. Total RNA will be extracted, microRNA‐specific complementary DNA will be synthesized using stem‐loop reverse transcription, and expression will be quantified by reverse transcription quantitative polymerase chain reaction using TaqMan assays. Relative expression values normalized using miR‐16 and let‐7d will be compared among the four intervention groups and between postoperative days 3 and 7 SECONDARY OUTCOME: To evaluate postoperative facial swelling by measuring five facial distances from the angle of the mandible to the tragus, lateral canthus of the eye, nasal border, labial commissure, and soft‐tissue pogonion. Measurements will be obtained using silk thread and a millimeter ruler before surgery and on postoperative days 3 and 7. Distances expressed in millimeters and their postoperative changes from baseline will be compared among the four intervention groups To evaluate postoperative limitation of mouth opening by measuring the maximum interincisal distance with a caliper before surgery and on postoperative days 3 and 7. Measurements expressed in millimeters and the reduction from the preoperative value will be compared among the four intervention groups To evaluate postoperative pain intensity using an 11‐point visual analog scale ranging from 0, corresponding to no pain, to 10, corresponding to the worst possible pain. Pain scores will be recorded at 6, 12, 24, 48, and 72 hours and on postoperative day 7 and will be compared among the four intervention groups To evaluate rescue analgesic consumption by recording the number of paracetamol 750 mg tablets used and the time of each administration from the second through the third postoperative day. The total number of rescue tablets used will be compared among the four intervention groups To evaluate the occurrence of postoperative complications, including surgical site infection, alveolar osteitis, and paresthesia, during postoperative follow‐up. The number and proportion of procedures presenting each complication will be compared among the four intervention groups