Effect of Intra-Socket Delivery of Piroxicam on Post-Extraction Dental Pain: A Crossover Randomized Clinical Trial

Post-extraction dental pain is common, often severe, and significantly impacts patient quality of life. NSAIDs like ibuprofen and diclofenac are standard treatments but have limitations, including short half-lives necessitating frequent dosing. Piroxicam, an oxicam class NSAID with a longer half-life and potent anti-inflammatory properties, offers potential advantages. This study evaluates the efficacy of intra-socket delivery of Piroxicam for post-extraction pain management compared to standard oral NSAID regimens.

In this randomized clinical trial, 88 patients underwent bilateral molar extractions. Each received either a 20 mg piroxicam tablet in the socket with gelatin sponge or oral paracetamol (500 mg) and diclofenac (50 mg) for three days. Pain was recorded at 6, 12, 24, 48, and 72 h post-extraction via VAS. A crossover design with a one-week interval was used. Only per-protocol patients were analyzed using nonparametric tests.

Sixty participants completed the study. Pain intensity decreased over time in both groups, but significantly lower pain levels were observed in the piroxicam group at all intervals (p < 0.001). Males in the piroxicam group reported significantly lower pain levels at 12, 24, and 48 h compared to females. Only 36.7% of patients required rescue medication in the piroxicam group, indicating 63.3% efficacy.

A single dose of 20 mg piroxicam administered intra-socket effectively manages post-extraction pain with fewer systemic adverse effects compared to conventional NSAIDs. This method provides a viable alternative for enhancing patient comfort and recovery post-dental extraction.