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Effect of orally administered magnesium on postoperative pain level and trismus after surgical removal of the lower third molars: a randomized, double-blind, placebo-controlled trial

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Abstract

Objectives

Pain and trismus are the most common postoperative complications following a surgical removal of the lower third molar. This randomized, double-blind, placebo-controlled clinical trial evaluated the effect of orally administrated magnesium on postoperative pain and trismus after surgical removal of the lower third molars.

Materials and methods

The study was conducted on 80 participants who were divided into two groups. Each group took different oral forms of magnesium citrate. Participants in both groups had their two lower molars surgically removed. For one randomly selected third molar, participants received either magnesium citrate tablets or lozenges. For the surgical removal of the lower third molar of the opposite side, the participants received either placebo tablets or lozenges. The data were analyzed using the Wilcoxon signed-ranked test, the Mann-Whitney U test, and the Spearman rank-order correlation with the level of significance set at p < 0.05. This manuscript was written in accordance with the Consort recommendation.

Results

The results show a statistically significant lower pain level at all tested times (24 h, 48 h, and 72 h postoperatively) for participants who used magnesium preparations in lozenges (p = 0.012, p = 0.013, and p ≤ 0.001) as well as in tablet form (p ≤ 0.001) compared to placebo. The results also show a statistically significant greater mouth opening ability at all tested times (24 h, 48 h, and 72 h postoperatively) between magnesium preparations and the placebo (p ≤ 0.001).

Conclusion

Orally administered magnesium (either lozenges or tablets) before and after a lower third molar surgical removal significantly reduces pain intensity and the degree of trismus in the postoperative period.

Clinical relevance

Based on the results of the study, oral magnesium could be used in the oral and maxillofacial surgery to reduce postoperative complications after surgical removal of the lower third molars.

Trial registration

This study is registered on http:clinicaltrials.gov under protocol no. NCT03398382.

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References

  1. Marciani RD (2007) Third molar removal: an overview of indications, imaging, evaluation, and assessment of risk. Oral Maxillofac Surg Clin North Am 19:1–13

    PubMed  Google Scholar 

  2. Jokic D, Macan D, Peric B, Tadic M, Biocic J, Danic P, Brajdic D (2013) Ambulatory oral surgery: 1-year experience with 11680 patients from Zagreb district, Croatia. Croat Med J 54:49–54

    PubMed  PubMed Central  Google Scholar 

  3. Garcia Garcia A, Gude Sampedro F, Gandara Rey J, Gallas Torreira M (1997) Trismus and pain after removal of impacted lower third molars. J Oral Maxillofac Surg 55:1223–1236

    PubMed  Google Scholar 

  4. Yuasa H, Sugiura M (2004) Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables. Br J Oral Maxillofac Surg 42:209–214

    PubMed  Google Scholar 

  5. Baqain ZH, Karaky AA, Sawair F, Khraisat A, Duaibis R, Rajab LD (2008) Frequency estimates and risk factors for postoperative morbidity after third molar removal: a prospective cohort study. J Oral Maxillofac Surg 66:2276–2283

    PubMed  Google Scholar 

  6. Coulthard P, Bailey E, Esposito M, Furness S, Renton TF, Worthington HV (2014) Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev:CD004345

  7. Matijevic M, Uzarevic Z, Gvozdic V, Mikelic VM, Leovic D, Macan D (2013) The influence of surgical experience, type of instructions given to patients and patient sex on postoperative pain intensity following lower wisdom tooth surgery. Acta Clin Croat 52:23–28

    PubMed  Google Scholar 

  8. Bortoluzzi MC, Guollo A, Capella DL (2011) Pain levels after third molar surgical removal: an evaluation of predictive variables. J Contemp Dent Pract 12:239–244

    PubMed  Google Scholar 

  9. Colorado-Bonnin M, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2006) Quality of life following lower third molar removal. Int J Oral Maxillofac Surg 35:343–347

    PubMed  Google Scholar 

  10. Snyder M, Shugars DA, White RP, Phillips C (2005) Pain medication as an indicator of interference with lifestyle and oral function during recovery after third molar surgery. J Oral Maxillofac Surg 63:1130–1137

    PubMed  Google Scholar 

  11. Ong CK, Seymour RA (2008) An evidence-based update of the use of analgesics in dentistry. Periodontol 2000(46):143–164

    Google Scholar 

  12. Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO (2005) Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head Face Med 1:11

    PubMed  PubMed Central  Google Scholar 

  13. McGrath C, Comfort MB, Lo EC, Luo Y (2003) Changes in life quality following third molar surgery--the immediate postoperative period. Br Dent J 194:265–268

    PubMed  Google Scholar 

  14. Kirksey MA, Haskins SC, Cheng J, Liu SS (2015) Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One 10:e0137312

    PubMed  PubMed Central  Google Scholar 

  15. Danic P, Salaric I, Macan D (2017) New findings on local tramadol use in Oral surgery. Acta Stomatol Croat 51:336–344

    PubMed  PubMed Central  Google Scholar 

  16. Lopez Carriches C, Martinez Gonzalez JM, Donado Rodriguez M (2006) The use of methylprednisolone versus diclofenac in the treatment of inflammation and trismus after surgical removal of lower third molars. Med Oral Patol Oral Cir Bucal 11:E440–E445

    PubMed  Google Scholar 

  17. Shulman DH, Shipman B, Willis FB (2009) Treating trismus with dynamic splinting: a case report. J Oral Sci 51:141–144

    PubMed  Google Scholar 

  18. Mezitis M, Rallis G, Zachariades N (1989) The normal range of mouth opening. J Oral Maxillofac Surg 47:1028–1029

    PubMed  Google Scholar 

  19. Balakrishnan G, Narendar R, Kavin T, Venkataraman S, Gokulanathan S (2017) Incidence of trismus in transalveolar extraction of lower third molar. J Pharm Bioallied Sci 9:S222–S227

    PubMed  PubMed Central  Google Scholar 

  20. Pathak S, Vashisth S, Mishra S, Singh SP, Sharma S (2014) Grading of extraction and its relationship with post-operative pain and trismus, along with proposed grading for trismus. J Clin Diagn Res 8:ZC09–ZC11

    PubMed  PubMed Central  Google Scholar 

  21. Pedersen A (1985) Interrelation of complaints after removal of impacted mandibular third molars. Int J Oral Surg 14:241–244

    PubMed  Google Scholar 

  22. Konrad M, Schlingmann KP, Gudermann T (2004) Insights into the molecular nature of magnesium homeostasis. Am J Physiol Renal Physiol 286:F599–F605

    PubMed  Google Scholar 

  23. Guerrera MP, Volpe SL, Mao JJ (2009) Therapeutic uses of magnesium. Am Fam Physician 80:157–162

    PubMed  Google Scholar 

  24. Workinger JL, Doyle RP, Bortz J (2018) Challenges in the diagnosis of magnesium status. Nutrients 10(9):1202

    PubMed Central  Google Scholar 

  25. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (1997) Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. The National Academies Collection: Reports funded by National Institutes of Health. Washington, DC

  26. Walker AF, Marakis G, Christie S, Byng M (2003) Mg citrate found more bioavailable than other Mg preparations in a randomised, double-blind study. Magnes Res 16:183–191

    PubMed  Google Scholar 

  27. Wilimzig C, Latz R, Vierling W, Mutschler E, Trnovec T, Nyulassy S (1996) Increase in magnesium plasma level after orally administered trimagnesium dicitrate. Eur J Clin Pharmacol 49:317–323

    PubMed  Google Scholar 

  28. Kara H, Sahin N, Ulusan V, Aydogdu T (2002) Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol 19:52–56

    PubMed  Google Scholar 

  29. Ryu JH, Kang MH, Park KS, Do SH (2008) Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth 100:397–403

    PubMed  Google Scholar 

  30. Schulz-Stubner S, Wettmann G, Reyle-Hahn SM, Rossaint R (2001) Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. Eur J Anaesthesiol 18:723–729

    PubMed  Google Scholar 

  31. Na HS, Ryu JH, Do SH (2011) The role of magnesium in pain. In: Vink R, Nechifor M, editors. Magnesium in the central nervous system [internet]. Adelaide (AU): University of Adelaide Press; 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507245/

  32. Dickenson AH (1995) Spinal cord pharmacology of pain. Br J Anaesth 75:193–200

    PubMed  Google Scholar 

  33. McCartney CJ, Sinha A, Katz J (2004) A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg 98:1385–1400

    PubMed  Google Scholar 

  34. Carlton SM, Zhou S, Coggeshall RE (1998) Evidence for the interaction of glutamate and NK1 receptors in the periphery. Brain Res 790:160–169

    PubMed  Google Scholar 

  35. Borazan H, Kececioglu A, Okesli S, Otelcioglu S (2012) Oral magnesium lozenge reduces postoperative sore throat: a randomized, prospective, placebo-controlled study. Anesthesiology 117:512–518

    PubMed  Google Scholar 

  36. Yousef AA, Al-deeb AE (2013) A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Anaesthesia 68:260–266

    PubMed  Google Scholar 

  37. Jager-Wittenaar H, Dijkstra PU, Vissink A, van Oort RP, Roodenburg JL (2009) Variation in repeated mouth-opening measurements in head and neck cancer patients with and without trismus. Int J Oral Maxillofac Surg 38:26–30

    PubMed  Google Scholar 

  38. Weber C, Dommerich S, Pau HW, Kramp B (2010) Limited mouth opening after primary therapy of head and neck cancer. Oral Maxillofac Surg 14:169–173

    PubMed  Google Scholar 

  39. Bondok RS, Abd El-Hady AM (2006) Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. Br J Anaesth 97:389–392

    PubMed  Google Scholar 

  40. Ghezel-Ahmadi V, Ghezel-Ahmadi D, Schirren J, Tsapopiorgas C, Beck G, Bolukbas S (2019) Perioperative systemic magnesium sulphate to minimize acute and chronic post-thoracotomy pain: a prospective observational study. J Thorac Dis 11:418–426

    PubMed  PubMed Central  Google Scholar 

  41. Taheri A, Haryalchi K, Mansour Ghanaie M, Habibi Arejan N (2015) Effect of low-dose (single-dose) magnesium sulfate on postoperative analgesia in hysterectomy patients receiving balanced general anesthesia. Anesthesiol Res Pract 2015:306145

    PubMed  PubMed Central  Google Scholar 

  42. Ryu JH, Sohn IS, Do SH (2009) Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate. Br J Anaesth 103:490–495

    PubMed  Google Scholar 

  43. Seyhan TO, Tugrul M, Sungur MO, Kayacan S, Telci L, Pembeci K, Akpir K (2006) Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. Br J Anaesth 96:247–252

    PubMed  Google Scholar 

  44. Oguzhan N, Gunday I, Turan A (2008) Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag 4:105–110

    PubMed  Google Scholar 

  45. Vlok R, Melhuish TM, Chong C, Ryan T, White LD (2017) Adjuncts to local anaesthetics in tonsillectomy: a systematic review and meta-analysis. J Anesth 31:608–616

    PubMed  Google Scholar 

  46. Shetty KP, Satish SV, Kilaru KR, Sardar P, Luke AM (2015) Comparison of anesthetic efficacy between lidocaine with and without magnesium sulfate USP 50% for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. J Endod 41:431–433

    PubMed  Google Scholar 

  47. Sirvinskas E, Laurinaitis R (2002) Use of magnesium sulfate in anesthesiology. Medicina (Kaunas) 38:695–698

    Google Scholar 

  48. Potter JD, Robertson SP, Johnson JD (1981) Magnesium and the regulation of muscle contraction. Fed Proc 40:2653–6265

    PubMed  Google Scholar 

  49. Ceneviva GD, Thomas NJ, Kees-Folts D (2003) Magnesium sulfate for control of muscle rigidity and spasms and avoidance of mechanical ventilation in pediatric tetanus. Pediatr Crit Care Med 4:480–484

    PubMed  Google Scholar 

  50. Sonna LA, Hirshman CA, Croxton TL (1996) Role of calcium channel blockade in relaxation of tracheal smooth muscle by extracellular Mg2+. Am J Phys 271:L251–L257

    Google Scholar 

  51. Eby GA (2006) Rescue treatment and prevention of asthma using magnesium throat lozenges: hypothesis for a mouth-lung biologically closed electric circuit. Med Hypotheses 67:1136–1141

    PubMed  Google Scholar 

  52. D'Angelo EK, Singer HA, Rembold CM (1992) Magnesium relaxes arterial smooth muscle by decreasing intracellular Ca2+ without changing intracellular Mg2+. J Clin Invest 89:1988–1994

    PubMed  PubMed Central  Google Scholar 

  53. Chiu HY, Yeh TH, Huang YC, Chen PY (2016) Effects of intravenous and oral magnesium on reducing migraine: a meta-analysis of randomized controlled trials. Pain Physician 19:E97–E112

    PubMed  Google Scholar 

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Funding

This study was funded by the researcher himself.

Author information

Authors and Affiliations

  1. Department of Maxillofacial Surgery, Study of Dental Medicine, School of Medicine, Clinical Hospital Centre, University of Split, Spinciceva 1, 21000, Split, Croatia

    Daniel Jerkovic

  2. Department of Restorative Dental Medicine and Endodontics, Study of Dental Medicine, School of Medicine, University of Split, Split, Croatia

    Antonija Tadin

  3. Department for Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, Split, Croatia

    Lidia Gavic

  4. School of Dental Medicine, University of Zagreb, Zagreb, Croatia

    Nada Zorica Vladislavic & Nino Grgic

  5. Department of Maxillofacial and Oral Surgery, School of Dental Medicine, University of Zagreb, University Hospital Dubrava, Zagreb, Croatia

    Darko Macan

Authors
  1. Daniel Jerkovic
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  2. Antonija Tadin
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  3. Lidia Gavic
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  4. Nada Zorica Vladislavic
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  5. Nino Grgic
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  6. Darko Macan
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Contributions

All authors contributed to the data collection and analysis, the writing of this article, and the approval of the final version for publication.

Corresponding author

Correspondence to Daniel Jerkovic.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The protocol of the study was reviewed and approved by the Ethics Committee of the School of Dental Medicine, Zagreb, Croatia (No. 05-PA-15-3/2017). The study was conducted by the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All participants gave their informed consent before they were included in the study.

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Jerkovic, D., Tadin, A., Gavic, L. et al. Effect of orally administered magnesium on postoperative pain level and trismus after surgical removal of the lower third molars: a randomized, double-blind, placebo-controlled trial. Clin Oral Invest 24, 4649–4659 (2020). https://doi.org/10.1007/s00784-020-03335-z

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