Trypsin, bromelain and rutoside in dental pathologies-synergistic action and qualitative metanalysis of investigator-initiated studies
Keywords:Inflammation, Pain, Swelling, Enzymes, Flavonoids
Inflammation, which manifests as pain and swelling, forms the basis of various dental pathologies like dental caries and pulpitis. Inflammation is also associated with tissue injury in cases of surgical processes like tooth extraction, root canal treatment or third molar extraction. Various drugs which help reducing inflammation are used in the treatment of dental pathologies. In this article, the mechanism of action of trypsin, bromelain and rutoside is mapped to show the clinical benefit. To demonstrate comparative benefit of trypsin, bromelain, and rutoside combination, a literature search was carried out for real-world investigator-initiated studies. A qualitative analysis of these studies was carried out. All 7 studies, identified in literature, controlled clinical studies comparing efficacy and safety of combination of trypsin, bromelain, and rutoside with that of non-steroidal anti-inflammatory drugs like diclofenac, versus other anti-inflammatory enzymes like trypsin-chymotrypsin combination or serratiopeptidase. All studies have demonstrated efficacy benefit of combination of trypsin, bromelain and rutoside. Importance and place of trypsin-bromelain-rutoside combination in therapy of dental pathologies, is further emphasized based on the results of this review.
Renton T. Dental (odontogenic) pain. Rev Pain. 2011;5(1):2-7.
Daftary G, Shah A, Divekar G, John J, Patil N, Khemnar B. Systemic therapy with bromelain- trypsin-rutoside combination in inflammation: A narrative review of the pharmacodynamics. Natl J Physiol Pharm Pharmacol. 2022;12(11):1.
Wala LJ, Choudhary A, Reddy BC. Clinical evaluation of anti-inflammatory properties of combination of bromelain, trypsin and rutoside with combination of ibuprofen, trypsin and chymotrypsin following third molar extraction-a comparative study. J Med Sci Clin Res. 2020;8(2):464-8.
Menon VD, Muthusekhar MR. Effectiveness of Anti-Inflammatory Properties Of Combination Of Bromelain, Trypsin And Rutoside With Combination Of Diclofenac And Serratiopeptidase Following Surgical Removal Of Impacted Mandibular Third Molar-A Randomised Double Blinded Clinical Trial. Int J Dentistry Oral Sci. 2021;8(9):4217-21.
Kumar ST, Prasanna RA, Kirubanandan JR, Elaveyini U, Devi SP, Balasubramaniam M. Postoperative healing after surgical removal of mandibular third molar: A comparative study between two proteolytic enzymes. J Pharm Bioallied Sci. 2020;12(1):S289.
Islam MA, Rahman MA, Hossain S, Rahman Q B. Comparative evaluation of anti-inflammatory effect of bromelain-trypsin combination versus diclofenac sodium after surgical removal of mandibular third molar teeth. UpDCJ. 2020;10(1):16-20.
Ksh. SC, Dilip KR, Raghuveer HP, Shobha ES, Prashanth NT, Vinod R. A double blinded comparative evaluation of the therapeutic efficacy of combination of (trypsin, bromelain, rutoside) with diclofenac sodium and placebo in impacted mandibular third molar surgery-A clinical study. Int J Recent Sci Res. 2017;8(11):21820-3
Gokkulakrishnan S, Balaji RA, Satyabhushan, Kannaiyah V, Manikandan G, Premkumar JB et al. Comparison of efficacy of combination of proteolytic enzymes with diclofenac sodium versus diclofenac sodium alone in patients undergoing surgical extraction of moderately difficult impacted mandibular third molars. Int J Current Res. 2016:8(10):39842-5
Vishal KT, Priya S, Sinha DK, Kumar C. Effect of Bromelain, Rutoside and Trypsin Combination on Postoperative Pain, Swelling and Trismus After Surgical Third Molar Extraction. J West Bengal Univ Health Sci. 2021;1(3):18-25.
Anderson K, Hamm RL. Factors that impair wound healing. J Am Coll Clin Wound Spec. 2012;4(4):84-91.
Fowler C. Do nonsteroidal anti-inflammatory drugs impair tissue healing? JAAPA. 2018;31(8):1-5.
Su WH, Cheng MH, Lee WL, Tsou TS, Chang WH, Chen CS et al. Nonsteroidal anti-inflammatory drugs for wounds: pain relief or excessive scar formation? Mediat Inflamm. 2010;2010.
Barsom S, Sasse-Rollenhagen K, Betrmann A. Erfolgreiche Prostatitisbehandlung mit hydrolytischen Enzymen. (Effects of simultaneously administered Hydrolytic enzymes on Antibiotic serum levels). Erfahrungsheilkunde. 1982;31:2.
Tinozzi S, Venegoni A. Effect of bromelain on serum and tissue levels of amoxycillin. Drug Exp Clin Res. 1978;1:39-44.