Oral Health Group

Natural Adjunct to Post-Operative Management After Third Molar Surgery

June 30, 2017
by Walter Tatch, DDS, FACOMS, Diplomate, ABOMS, Fellow, AACS

Removal of wisdom teeth is one of the most common procedures performed in Oral and Maxillofacial Surgery. The most common postoperative complications of impacted lower third molar extractions are extended pain, trismus and facial swelling. These symptoms slow down the patient’s recovery and influence his or her ability to resume normal daily activities. 1-4

Many articles and publications have suggested different measures to prevent and treat these complications. Among these, the administration of Non-steroidal anti-inflammatory (NSAIDs) is considered to be useful. 5,6 However, a significant number of patients need additional medication to adequately control pain and swelling after third molar surgery. 5,6

In conjunction with NSAIDs, narcotic pain medications are commonly given after third molar surgery. In the United States, 12% of all immediate release opioid analgesic prescriptions are written by dentists. 7 An American Dental Association survey suggested that while a majority of Oral and Maxillofacial Surgeons (74%) preferred patients to use ibuprofen after third molar extraction, 85% also prescribed a post-operative opioid analgesic (most commonly hydrocodone or oxycodone).7 There is a clear need for natural alternatives that could decrease and potentially eliminate the over-prescription of opioids.

Intra-operative and postoperative use of corticosteroids is a pharmacologic approach commonly utilized to reduce postoperative edema. The mechanism of action is believed to be the inhibition of the initial steps of the inflammatory response to surgical injury. 8-10 The effect of oral corticosteroids on post-operative morbidity varies. 11,12 Grossi et al found no significant reduction in post-operative pain from submucosal injection of steroids during the surgical removal of third molars. 1 Other studies have shown that steroids alone do not have a clinically significant analgesic effect 14,15 and in some cases the use of steroids may increase a patient’s reaction to pain by suppressing beta-endorphin levels. 15

To date, the dental profession does not have an effective and natural alternative that reduces swelling and pain, and improves the rate of post-operative recovery. Narcotic pain medications interfere with normal activities such as school and work. The sooner the patient can stop taking narcotic pain medications, the sooner they can return to their normal everyday activities. As well, a decrease in post-operative trismus and swelling is associated with patient satisfaction and comfort.

The VEGA Oral Recovery Kit by StellaLife is based on homeopathic principles and is designed to accelerate healing, reduce swelling, and minimize pain. It contains 14 active ingredients that are monographed in HPUS (Homeopathic Pharmacopeia of United States) and are recognized for their accelerated healing properties. It is an alternative to narcotics and steroids for patients undergoing various dental procedures, including third molar removal.

Arnica Montana is frequently used to reduce swelling and acute inflammation in the setting of post-surgical trauma. Brook M Seeley, et.al published the results of their randomized, double-blind, placebo-controlled study which looked at the effect of Arnica Montana on bruising in facelift surgery. They found that patients taking perioperative Arnica Montana exhibited significantly less ecchymosis. 16 Arnica Montana is believed to increase the flow of blood around bruised tissue causing escaped fluids to be absorbed by the body. The absorption of the fluids reduces the swelling by relieving the pressure on nerve endings.

Calendula has high amounts of flavonoids, plant-based antioxidants that protect cells from being damaged by unstable molecules called free radicals. Calendula appears to fight inflammation, viruses, and bacteria. It also has been shown to help wounds heal faster, possibly by increasing blood flow and oxygen to the affected area, which helps the body grow new tissue. 17-33
The flowers of Chamomile contain 1–2% volatile oils including alpha-bisabolol, alpha-bisabolol oxides A & B, and matricin (usually converted to chamazulene and other flavonoids that possess anti-inflammatory and antiphlogistic properties. 34-37 A study in human volunteers demonstrated that chamomile flavonoids and essential oils penetrate below the skin surface into the deeper skin layers. 38 This is important for their use as topical antiphlogistic (anti-inflammatory) agents. One of chamomile’s anti-inflammatory activities involve the inhibition of LPS-induced prostaglandin E(2) release and attenuation of cyclooxygenase (COX-2) enzyme activity without affecting the constitutive form, COX-1. 39

VEGA Oral Care Recovery Kit by StellaLife has active homeopathic ingredients designed to accelerate healing, reduce pain, swelling and bruising, and provide antimicrobial properties as well as to reduce anxiety. It contains arnica, calendula, and chamomile among other active ingredients. All 14 ingredients work synergistically and give the product its unique properties. The formula also utilizes homaccord, or homeopathic drug that contains several dilutions of the same ingredient. Arnica is represented in three dilutions that will affect the body differently, yet with an overall harmonious effect. VEGA Oral Care Recovery kit may be a natural answer for dental patients recovering after various invasive procedures.

A pilot study involving a case series utilized the VEGA Oral Care Recovery Kit for post-operative management. This series of cases involved nine patients, two males and seven females aged 17-21. All patients received the following standard medications: two grams of Amoxicillin–1 hour pre-operatively, followed by Amoxicillin 500 mg–three times daily for five days. All patients received 15 tablets of narcotic pain medication Norco (5/325 mg Hydrocodone/Tylenol) to be used postoperatively as needed for pain (Table I).

Table 1
Average # of Norco pills taken

Patient-reported outcome measures were recorded. The number of narcotic analgesic tablets taken were used to evaluate post-operative pain. Post-operative pain was rated daily using a 100-point visual analog scale (VAS) anchored by verbal descriptors “no pain”(0) and “very severe pain” (100) (Graph 1).

Graph 1
Summary of Norco pills required over the course of seven days after surgery by each patient.

Graph 2
Dental Health ranked by patients daily for seven days after surgery.

After surgery, each patient was given the health related quality of life (HRQOL) instrument in a diary as described by Shugars et al. 40 HRQOL data was collected from the patients daily for seven days post-operatively. 11-15

In this series of case reports patients recovered 1-2 days more quickly when compared with the average patient in other studies who received oral or submucosal corticosteroids. 41-44 This study was limited in scope (nine patients) and there were no controls.

Based on this series of case reports, some testable hypotheses for further studies of the effectiveness of VEGA Oral Recovery Kit (Fig. 3) after surgical removal of impacted third molars were generated. The Vega Kit may provide a natural alternative to steroids and narcotic pain meds while accelerating healing in patients undergoing various dental procedures.

Fig. 1
Pre-op panorex of patient who has impacted wisdom teeth that are symptomatic. VEGA Recovery Kit was started three days pre-op and continued for seven days post-op. All patients were also given prescriptions for Amoxicillin and Norco to take during the post-operative course.

Fig. 2
Seven days post-op picture shows accelerated healing, no edema or erythema and barely visible incision lines. Patients reported no discomfort on the post-op visit.

Fig. 3
StellaLife VEGA Oral Care Recovery Kit.

Fig. 4
StellaLife VEGA Oral Care Gel

Fig. 5
StellaLife VEGA Oral Care Rinse.

StellaLife VEGA Oral Care Recovery Kit is a revolutionary new technology that has been clinically proven to accelerate healing, relieve pain and reduce swelling in dental patients’ after both surgical and non-surgical procedures. The Kit consists of Gel, Spray and Rinse, all chemical-free. Uses include, but are not limited to, wisdom teeth extraction, dental implants, bone and tissues grafting, osseous surgery, SRP, mucositis, aphthous ulcers, dry socket and denture sores. StellaLife products line encompasses a broad spectrum of applications, ranging from recovery to maintenance, and from the treatment of oral inflammatory conditions to pain management.

StellaLife VEGA Oral Care Gel is a revolutionary new technology that has been clinically proven to accelerate healing, relieve pain and reduce swelling in dental patients’ after both surgical and non-surgical procedures. Doctors have found it effective in management of mucositis, aphthous ulcers, cold sores, sores associated with dentures, dry sockets and following dental surgical and nonsurgical procedures. The Gel is ideal for in-office application immediately after treatment or at post-operative visits. The patient-applied Gel in combination with Rinse was found to work well in open wounds and accelerate healing by both primary and secondary intention.

VEGA Oral Care Rinse is an all-natural, antimicrobial product that promotes healthy gums, hydrates the oral cavity, maintains oral health and freshens breath. Independent antimicrobial studies confirmed its efficacy against Strep mutans, Actinomyces v, Strep pyogenes, P. gingivitis, and Bacteroides fragilis. Clinical reports showed antifungal properties and efficacy in treatment of mucositis in conjunction with VEGA Oral Gel. The Rinse supports healthy healing following oral surgery and periodontal treatment. It is highly recommended as part of daily oral hygiene. The great tasting VEGA Rinse will not stain teeth, or cause any other unpleasant side effects such as altered taste, burning sensation or sensitivity. OH

Oral Health welcomes this original article.

Dr. Tatch is affiliated with StellaLife.

1. Grossi GB, Maiorana C, et.al. Effect of Submucosal injection of Dextamethasone on Postoperative discomfort after third molar surgery: A prospective study. JOMS 2007, 65: 2218-2226.
2. Savin J, Ogden GR: Third molar surgery- A preliminary report on aspects affecting quality of life in the early postoperative period. Br J oral Maxillofac Surg 35:246,1997
3. McGrath C, Comfort MB , et al: Changes in life quality following third molar surgery – The immediate postoperative period. Br Dent J 194:265, 2003.
4. Ogden GR, Bissias E, at al: Quality of life following third molar removal: A patient versus professional perspective. Br Dent J 185: 407,1998.
5. Troullous ES, Hargreaves KM et al: Comparison of NSAID drugs , ibuprophen and flurbiprofen, with methylprednisalone and placebo for acute pain, swelling and trismus. J Orol Maxillofac Surg. 1990;48:945-952.
6. Moore PA, Brar P, et al: Preemptive rofecoxib and dexamethasone for prevention of pain and trismus following third molar surgery. OOO, 2005; 99 E1-7.
7. Denisco RC, Kenna GA, O’Neil MG, Kulich RJ, Moore PA, Kane WT, et al. Prevention of prescription opioid abuse: the role of the dentist. J Am Dent Assoc. 2011;142:800-10.
8. Hooley JR, Bradley PB, Haines M. Plasma cortisol levels following short term betamethasone therapy for oral surgical procedures. Trans Int Conf Oral Surg 4:188,1973
9. Hirschman JV. Some principles of systemic glucocorticoid therapy . Clin Exp Dermatol 11:27,1986.
10. Seymour RA, Walton JG. Pain control after third molar surgery. Int J Oral Surg 13:457, 1984.
11. Bystedt H, Norderman A. Effect of methylprednisalone on complications after removal of impacted mandibular third molars. Swed Dent J 9: 65,1985.
12. Edilby G, Canniff J, Harris M. A double–blind placebo-controlled trial of the effects of dexamethasone on postoperative swelling [abstract]. J Dent Res 61:556, 1982.
13. Miles M, Desjardins PJ. Reduction of postoperative facial swelling by low-dose methylprednisalone. J Oral Maxillofac Surg51: 987, 1993.
14. Dionne RA, Gordon SM, Rowan J, et al. Dexamethasone suppresses peripheral prostanoid levels without analgesia in a clinical model of acute inflammation. JOMS 61: 997, 2003.
15. Hargreaves KM, Shmidt EA, Mueller GP, et al. Dexamethasone alters plasma levels of beta-endorphin and postoperative pain. Clin Pharmacol Ther 42:601, 1987.
16. Seeley BM, Denton AB, et.al. Arch Facial Plast Surg. 2006;8(1) : 54-59.
17. Akhtar N, Zaman SU, Khan BA, Amir MN, Ebrahimzadeh MA. Calendula extract: effects on mechanical parameters of human skin. Acta Pol Pharm. 2011;68(5):693-701.
18. Alnuqaydan AM, Lenehan CE, Hughes RR, Sanderson BJ. Extracts from Calendula officinalis offer in vitro protection agains H2O2 induced oxidative stress cell killing of human skin cells. Phytother Res. 2015;29(1):120-4.
19. Barajas-Farias LM et al. A dual and opposite effect of Calendula officinalis flower extract: chemoprotector and promoter in rat hepatocarcinogenesis model. PLanta Med. 2006;72(3):217-21.
20. Basch E, Bent S, Foppa I, et al. Marigold (Calendula officinalis):An evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother. 2006;6(3-4):135-59.
21. Duran V, Matic M, Jovanovc M, et al. Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers. Int J Tissue React. 2005;27(3):101-6.
22. Fronza M, Heinzmann B, Hamburger M, Laufer S, Merfort I. Determination of the wound healing effect of Calendula extracts using the scratch assay with 3T3 fibroblasts. J Ethnopharm acol. 2009 Dec 10;126(3):463-7.
23. Hematology/Oncology Clinics of North America. Dietary supplement use in cancer care: Help or harm. Hematology/Oncology Clinics of North America. 2008;22(4).
24. Jimenez-Medina E, Garcia-Lora A, Paco L, Algarra I, Collado A, Garrido F. A new extract of the plant Calendula officinalis produces a dual in vitro effect: cytotoxic anti-tumor activity and lymphocyte activation. BMC Cancer. 2006;6:119.
25. Kassab S, Cummings M, Berkovitz S, van Haselen R, Fisher P. Homeopathic medicines for adverse effects of cancer treatments. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD004845.
26. McQuestion M. Evidence-based skin care management in radiation therapy: clinical update. Semin Oncol Nurs. 2011;27(2):e1-17.
27. Panahi Y, Sharif MR, Sharif A, et al. A randomized comparative trial on the therapeutic efficacy of topical aloe vera and Calendula officinalis on diaper dermatitis in children. Scientific World
Journal. 2012;2012:810234.
28. Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004 Apr 15;22(8):1447-53.
29. Saini P, Al-Shibani N, Sun J, et al. Effects of Calendula officinalis on human gingival fibroblasts. Homeopathy. 2012;101(2):92-8.
30. Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics. 2003 May;111(5 Pt 1):e574-9.
31. Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med. 2001;155(7):796-799.
32. Sharp L, Finnila K, Hohansson H, Abrahamsson M, Hatschek T, Bergenmar M. No differences between Calendula cream and aqueous cream in the prevention of acute radiation skin reactions—results from a randomised blinded trial. Eur J Oncol Nurs. 2013; 17(4):429-35.
33. Ullman D. The Consumer’s Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:254-255;334.
34. Lemberkovics E, Kéry A, Marczal G, Simándi B, Szöke E. Phytochemical evaluation of essential oils, medicinal plants and their preparations. Acta Pharm Hung. 1998;68:141–149.
35. Carnat A, Carnat AP, Fraisse D, Ricoux L, Lamaison JL. The aromatic and polyphenolic composition of Roman camomile tea. Fitoterapia. 2004;75:32–38.
36. Sakai H, Misawa M. Effect of sodium azulene sulfonate on capsaicin-induced pharyngitis in rats. Basic Clin Pharmacol Toxicol. 2005;96:54–55.
37. Peña D, Montes de Oca N, Rojas S. Anti-inflammatory and anti- diarrheic activity of Isocarpha cubana Blake. Pharmacologyonline. 2006;3:744–749.
38. Merfort I, Heilmann J, Hagedorn-Leweke U, Lippold BC. In vivo skin penetration studies of camomile flavones. Pharmazie. 1994;49:509–511.
39. Srivastava JK, Pandey M, Gupta S. Chamomile, a novel and selective Cox-2 inhibitor with anti-inflammatory activity. Life Sci. 2009;85:663–669.
40. Shugars DA, et al. Developing a measure of patient perceptions of short-term outcomes of third molar surgery. JOMS 1996, 54: 1402-1408.
41. Kim, JC, Choi, SS, Wang, SJ. et al. Minor complications after mandibular third molar surgery: Type, incidence, and possible prevention. OOO, 2006;102:e4.
42. Bouloux, GF, and Punnia-Moorthy A. Bupivicaine versus lidocaine for third molar surgery: A double-blind, randomized , crossover study.JOMS. 1999; 57:510
43. Esen, E, Tasar, F, Akhan O. Determination of anti-inflammatory effects of methylprednisalone on the sequelae of third molar surgery. =JOMS. 1999;57: 1201.
44. Nayyar MS, and Yates C. Bupivicaine as preemptive analgesia in third molar surgery: Randomised controlled trial. Br J Oral Maxillofacial Surg. 2006;44:501

About the Author
Dr. Walter Tatch has been a board certified Oral and Maxillofacial Surgeon for over 13 years. He is a graduate of University of California at San Francisco and University of Illinois at Chicago. Dr Tatch is a Fellow of American Association of Oral and Maxillofacial Surgeons, American College of Oral and Maxillofacial Surgeons, American and International Associations of Oral and Maxillofacial Surgeons. He is also a member of numerous professional organizations including ADA, CDA, American Academy of Cosmetic Surgery.

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2 Comments » for Natural Adjunct to Post-Operative Management After Third Molar Surgery
  1. Thomas Kaus says:

    Evidence based dentistry relies on sound evidence and practitioners that know how to evaluate clinical research. In case of homeopathy the verdict is clear. Modern medicine and dentistry have moved on. Is it worth looking at it again and again? Should we maintain an open mind? Edzard Ernst’s and Michael Baum’s commentary in the American Journal of Medicine is a good starting point for clinicians that are unsure whether homeopathy might be a useful adjunct:
    Their commentary is best summarized as follows:
    “We think that a belief in homeopathy exceeds the tolerance of an open mind. We should start from the premise that homeopathy cannot work and that positive evidence reflects publication bias or design flaws until proved otherwise.”
    Homeopathy has no place in modern dentistry or in a modern dental office. Samuel Hahnemann invented homeopathy in the late 18th century long before we discovered antibiotics and long before Canada and the ODA were founded! The ODA’s goal was “to help bring Ontario’s dental practices out of the dark ages” (http://150.oda.ca). Let’s all move on and not backwards in time! Dear editors of Oral Health – it is the year 2017! Canada and the ODA celebrated 150 years and homeopathy is not part of modern evidence based dentistry.

  2. Richard Lindzon says:

    Thank-you Thomas. Well stated.

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