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The effect of pre-emptive ibuprofen on post-operative pain after removal of lower third molar teeth: a systematic review

A Correction to this article was published on 24 June 2022

This article has been updated


Objective To investigate the effect of pre-emptive ibuprofen on post-operative pain after lower third molar surgery.

Methods A search for randomised controlled trials was undertaken across the databases Medline, Embase, Cochrane Central and Dentistry and Oral Sciences Source. Citation searching was used to supplement the database search. Inclusion and exclusion criteria were used for independent double screening by two assessors.

Results A total of five randomised controlled trials were included in the review. A risk of bias assessment identified some concerns in four of the included studies. One study was assessed as having low risk of bias. The important outcomes measured were post-operative pain intensity, total pain relief, use of rescue analgesia, time to rescue analgesia and total consumption of rescue analgesia. In two trials, pre-emptive ibuprofen was shown to significantly reduce pain intensity after lower third molar surgery compared with placebo. Two trials showed no significant difference between ibuprofen and placebo groups. Pre-emptive ibuprofen was shown to provide superior pain relief compared with placebo in the one trial measuring this outcome. Where the use of rescue medication was measured as an outcome, two trials showed that pre-emptive ibuprofen was superior to placebo, one trial showed that placebo was superior to ibuprofen and two trials found no significant difference between ibuprofen and placebo groups.

Conclusion Due to the inconsistency of the results, there is insufficient evidence to support the use of pre-emptive ibuprofen for management of post-operative pain after lower third molar surgery. Further research into the effects of pre-emptive analgesia on the surgical pain pathway is required.

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The lead author would like to acknowledge the encouragement and support of their late Father, Patrick Gately, throughout their educational and professional endeavours. They would also like to acknowledge Health Education England for supporting their postgraduate studies. No funding was sought in the writing of this review.

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Authors and Affiliations



F. Gately led the systematic review and drafted the manuscript. K. Ali provided input to the clinical context and relevance of the study. L. Burns provided input on the search strategy, the data analysis and compliance with PRISMA guidelines. All authors were involved in the preparation and editing of the manuscript.

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Correspondence to Fleur Gately.

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The authors of this review have no competing interests to declare. Data availability statement: all data used in this review are contained within the article and supplementary information. Further information is available from the lead author upon request.

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Gately, F., Ali, K. & Burns, L. The effect of pre-emptive ibuprofen on post-operative pain after removal of lower third molar teeth: a systematic review. Evid Based Dent (2022).

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