Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial

J Oral Maxillofac Surg. 2014 Jun;72(6):1043-8. doi: 10.1016/j.joms.2013.12.035. Epub 2014 Jan 16.


Purpose: The purpose of the present study was to compare the effect of oral bromelain (4 × 250 mg) versus oral diclofenac sodium (4 × 25 mg) on pain, swelling, trismus, and quality of life (QOL) after surgical removal of impacted lower third molars.

Patients and methods: A randomized, double-blind, placebo-controlled study was planned. The sample included patients requiring extraction under local anesthesia of a single partial bony impacted mandibular third molar. The patients were randomly distributed into 1 of 3 groups: bromelain, diclofenac, and placebo. Treatment started 1 day before surgery and continued for 4 days. The predictor variable was the type of the drug given to the patients. The outcome variables were pain, swelling, and trismus, which were measured at 1, 3, and 7 days postoperatively. The other study variables included QOL measures to assess the patients' perception regarding the effect of surgery on their well-being and daily activities. A validated questionnaire was used to measure QOL. The data were analyzed using analysis of variance, multiple measures analysis of variance, or Pearson's χ(2) test, as appropriate. P < .05 was considered significant.

Results: A total of 45 subjects requiring surgical removal of a single impacted mandibular third molar under local anesthesia were included in the present study. The bromelain and diclofenac groups both showed a significant reduction in pain compared with the placebo group at all intervals (P < .05). Diclofenac also resulted in a significant reduction of swelling at 3 and 7 days, and bromelain resulted in an insignificant reduction. A nonsignificant reduction in trismus occurred in both treatment groups compared with the placebo group. Both treatment groups also showed a significant difference in the effect on QOL in most subscales and total scores (P < .05). The effect was comparable between the 2 treatment groups for all parameters and at all intervals.

Conclusions: The results of our study have shown that oral bromelain is an effective therapy to improve the QOL after surgical removal of impacted lower third molars, with an effect on the postoperative sequelae comparable to that of preemptive diclofenac sodium.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Administration, Oral
  • Adolescent
  • Adult
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Attitude to Health
  • Bromelains / administration & dosage
  • Bromelains / therapeutic use*
  • Diclofenac / administration & dosage
  • Diclofenac / therapeutic use
  • Double-Blind Method
  • Edema / prevention & control*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mandible / surgery
  • Molar, Third / surgery*
  • Pain, Postoperative / prevention & control*
  • Placebos
  • Postoperative Complications / prevention & control
  • Premedication*
  • Prospective Studies
  • Quality of Life*
  • Tooth Extraction* / adverse effects
  • Tooth Extraction* / psychology
  • Tooth, Impacted / prevention & control
  • Tooth, Impacted / surgery
  • Treatment Outcome
  • Trismus / prevention & control
  • Young Adult


  • Anti-Inflammatory Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Placebos
  • Diclofenac
  • Bromelains