Postoperative pain relief after periodontal surgery: a comparative evaluation of Diclofenac mouthwash, diclofenac tablets, and benzydamine mouthwash

Abstract

Background: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are frequently prescribed to manage postoperative pain, including following periodontal procedures. However, systemic administration often results in adverse effects such as gastrointestinal discomfort, hepatic toxicity, and hematologic complications. To solve these complications, NSAID delivery via mouthwash can be used. Objective: To compare the efficacy and patient acceptance of diclofenac mouthwash, oral diclofenac tablets, and benzydamine mouthwash in alleviating postoperative pain and inflammation after periodontal flap surgery. Methods: A randomized, controlled, single-blinded study was conducted at the Department of Periodontology, Government Dental College and Hospital, Ahmedabad. Ninety patients with chronic periodontitis, aged between 25–60 years, requiring flap surgery in at least one quadrant, were enrolled and allocated into three groups (n=30 each): Group 1 – Diclofenac Mouthwash, Group 2 – Diclofenac Tablets, Group 3 – Benzydamine Mouthwash. Pain was assessed at baseline, 24, and 72 hours using the Visual Analog Scale (VAS) and Wong-Baker Facial Rating Scale (FRS). Gingival health was evaluated using the Modified Gingival Index (MGI) at baseline and on day 7. Results: All groups showed a reduction in pain perception postoperatively. Topical formulations demonstrated pain relief comparable to oral diclofenac, with fewer reported side effects. The diclofenac mouthwash group showed superior improvement in gingival condition compared to the tablet group. Conclusion: Topical NSAID formulations could be an effective and safer alternative to systemic NSAIDs in managing postoperative pain in periodontal surgery. Diclofenac and benzydamine mouthwashes offer similar analgesic effects as oral diclofenac while potentially enhancing gingival healing and minimizing adverse reactions.

Keywords: Pain, Diclofenac, Analgesic, Mouthwash