Role of Dexamethasone in reducing Postoperative Sequelae following Impacted Mandibular Third Molar Surgery: A Comparative Clinical Study (original) (raw)
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Egyptian dental journal, 2021
Introduction: Corticosteroids are considered anti-inflammatory which considered the essential roles, as well as it reduces edema. Aim: To compare the efficacy of dexamethasone injection submucosally, intra-masseteric and intra-muscular on post-operative swelling, mouth opening and pain following removal of mandibular impacted third molars. Type of Study: prospective randomized comparative clinical study. Methods: The current study included forty-five patients with impacted mandibular third molars were selected to underwent surgical removal of mandibular third molars. Group I, comprised of fifteen patients who received pre-operative sub-mucosal 8 mg dexamethasone injection, Group II, comprised of fifteen patients who received pre-operative Intra-masseteric 8 mg dexamethasone injection and Group III, taking intramuscular dexamethasone injection, Postoperative assessment included: mouth opening, swelling as well as pain at the following intervals; 1 st , 3 rd and 7 th day post-operative. Results: our study showed no statistically significant difference between mean MMO as well as VAS in Group I and II; both showed statistically significant higher mean MMO and VAS than Group III. Significant reduction in pain and swelling in both sub-mucosal, intra-masseteric and intramuscular but a greater immediate effect on trismus was seen in sub-mucosal and intramasseteric routes Conclusion: preoperative administration of dexamethasone has greater post-operative effects. Dexamethasone injected preoperatively was safe and simple effective method to reduce postoperative complications such pain, swelling and trismus.
Egyptian dental journal, 2019
Purpose: The aim of the current study was to compare the efficacy of dexamethasone injection submucosally, intra-masseteric and intramuscular in surgical removal of mandibular third molars on post-operative swelling, mouth opening and pain. Patients and Methods: forty five patients with impacted mandibular third molars were selected to undergo surgical removal of mandibular third molars. Patients were randomly divided into three groups of fifteen each. Group I, taking sub-mucosal dexamethasone injection, Group II, taking Intra-masseteric dexamethasone injection and Group III, taking intramuscular dexamethasone injection, all patients were injected pre-operatively Assessment of swelling, mouth opening, and pain was done at intervals of 1st, 3rd, and 7th post-operative days. Results: our study showed no statistically significant difference between mean MMO as well as VAS in Group I and II; both showed statistically significant higher mean MMO and VAS than Group III. Significant reduction in pain and swelling in both sub-mucosal, intra-masseteric and intra-muscular but a greater immediate effect on trismus was seen in sub-mucosal and intramasseteric routes Conclusion: It can be concluded that pre-operative dexamethasone injection is an effective pharmacological agent to reduce post-surgical third molar removal sequelae such as pain, swelling and trismus.
Preoperative submucosal dexamethasone injection for minimizing postoperative pain, trismus, and oedema associated with impacted mandibular third molar surgery, 2023
To evaluate the relative ability of 4mg dose of preoperative Dexamethasone, administered submucosally, to reduce the postoperative pain, swelling and trismus after third molar surgery. Materials and Methods: The total 40 patient required surgical removal of a single mandibular third molar were included and divided into two groups, the experimental group (20 cases) received intraoperative submucosal injection of 4mg Dexamethasone buccally around the tooth at three points after the onset of anesthesia and the control group (20 cases) received no drugs. The maximum interincisal distance and facial contours were measured at baseline and at post-surgery days 2 and 7. The measurement of pain was done using visual analog scale (VAS). Results: There was a statistically significant reduction in the severity of postoperative edema in the experimental group by the second postoperative day. While both groups saw a reduction in discomfort and trismus, there were no statistically significant differences between them. Conclusion: The findings support submucosal injection of Dexamethasone (4mg) to decrease postoperative edema. Low-dose Dexamethasone injection at the surgical site enhances drug concentration at the injury site without loss owing to diffusion or excretion. The submucosal technique was significantly effective in reduction of postoperative swelling and trismus.
Journal of Dental and Craniofacial Research
Objective of this study was aimed to compare the therapeutic effects of 8 mg dexamethasone intramuscular administered pre-operatively vs post-operatively after the surgical extraction of impacted mandibular third molars, in Al-Qurayyat, Saudi Arabia, population. One hundred and fifty patients who visited the Department of Oral and Maxillofacial Surgery of Gurayat specialized dental center, Al-Qurayyat, Saudi Arabia, were included in the study. The study was conducted from February 2018 to August 2018. 150 patients constituted the study and were randomly divided into two groups. Group A received 8 mg dexamethasone (intramuscular) 1hr pre-operatively. Group B received 8 mg dexamethasone (intramuscular) immediately after the surgery. According to the gender there were 81(54%) males and 69 (46%) females, in both the groups combined. Males to females' ratio was 1.17: 1 in this study. Post-operative 1 st and 3 rd day follow-up showed that there was a significant difference between the two groups in terms of swelling and mouth opening (P=0.000). Overall, Group A showed much better results as far as the post-operative swelling and mouth opening was concerned. There was no statistical difference in the scores when the post-operative pain was evaluated on 1 st , 3 rd and 7 th day (P=0.679, P=0.755, P=0.202). The depth, angulation and the position of the tooth did not affect the study in terms of significance (P=0.626, P=0.874, P=1.000). It was concluded that preoperative administration of single dose of dexamethasone intramuscularly was more effective than the postoperative period, in reducing the swelling and trismus.
International Journal of Oral and Maxillofacial Surgery, 2017
The aim of this study was to investigate the effect of the submucosal injection of 1 ml dexamethasone (4 mg/ml) on pain, swelling, and trismus following the extraction of retained lower third molars. Ninety patients (mean age 23.5 years) were split randomly into three equal study groups (30 patients in each): the 'before' group received dexamethasone 15 min before surgery and placebo 15 min after surgery; the 'after' group received placebo 15 min before surgery and dexamethasone 15 min after surgery; the 'placebo' group received placebo 15 min before surgery and placebo 15 min after surgery. Postoperative pain was recorded by the patients using a visual analogue scale, numerical rating scale, and the McGill Pain Questionnaire at 1, 2, 4, 6, 8, 12, and 24 h after surgery. The patients also recorded the total number of analgesic doses consumed during the 24 h after the procedure. Swelling (determined using linear measurements of the face) and trismus (determined through measurement of maximum mouth opening) were assessed at 48 h, 72 h, and 7 days following surgery. Better control of pain, swelling, and trismus was demonstrated for dexamethasone in comparison to placebo. Postoperative dexamethasone provided better pain control than preoperative dexamethasone. There was no difference in total rescue analgesic intake between the preoperative and postoperative dexamethasone groups.
Oral and maxillofacial surgery, 2018
The aim of this clinical study was to evaluate and compare the relative efficacy of two different dosages of dexamethasone, i.e., 4 and 8 mg injected submucosally to reduce postoperative discomfort after mandibular third molar surgery. A prospective randomized study was conducted on 45 patients requiring surgical removal of an impacted third molar. Selected patients were divided randomly into three groups of 15 patients each: group I patients received one regimen single dose of 4 mg dexamethasone submucosally, group II received one regimen single dose of 8 mg dexamethasone submucosally, and group III (control group), no dexamethasone was given but only received injection of normal saline submucosally after establishing local anesthesia. The postoperative sequelae were assessed on the second and seventh postoperative day. As compared to group III, groups I and II showed statistically significant reduction in pain and swelling whereas no statistically significant difference was found ...
National Journal of Maxillofacial Surgery, 2020
Objectives: A randomized prospective double-blind study was conducted to determine the efficacy of sub-mucosal local infiltration vs. intravenous dexamethasone in reducing postoperative pain, swelling and trismus after surgical removal of impacted mandibular third molars. Materials and Methods: Forty five patients were included in the study and were randomly divided into three groups. Each group consisted of 15 patients for which the first and second groups were given 8 mg of dexamethasone intrlesionally & intravenously respectively, at 30 minutes prior to surgery; the third group served as control. Duration of facial swelling was evaluated subjectively by the patients themselves. Severity of postoperative pain was quantified by counting the number of analgesics taken by the patients during and after surgery (six subsequent days). Postoperative trismus was determined by measuring the maximum incisal opening before surgery and on the seventh day. Results: Results showed that duration of postoperative edema was almost the same in the three test groups. During surgery, the intravenous dexamethasone group showed a significantly lesser pain than the other two groups; the intralesional dexamethasone group showed less marked pain than the control group. Additionally, patients who had taken steroids had a marked increase in the incisal opening postoperatively over the control group. Trismus was significantly reduced in the methylprednisolone group as compared to the dexamethasone group. Conclusion: It is concluded that both preoperative local infiltration and intravenous administration of dexamethasone significantly reduced postoperative pain and trismus after surgical removal of mandibular third molars. An intravenous dexamethasone is more effective in reducing postoperative inflammatory sequelae than its intralesional route.
Oral Surgery, 2018
Aim: To demonstrate the preventative therapeutic effect of preoperative and post-operative intravenous 8 mg of dexamethasone on post-operative pain, swelling and trismus after the surgical extraction of mandibular third molars. Materials and methods: A randomised clinical trial was conducted on of 100 healthy participants (group I pre-operative and group II postoperative) with unilateral impacted lower third molars, average age 27.7 AE 9.7 years with no local or systemic problems were operated under local anaesthesia. Group I received 8 mg intravenous 1 hour preoperatively and group II received 8 mg intravenous dose of dexamethasone at the end of procedure. Post-operative pain was evaluated using a visual analogue scale (VAS) and the degree of swelling was evaluated through facial reference point variation. The presence of trismus was analysed through measurement of the inter-incisal distance (IID). These assessments were obtained before the operation and 48 hour and 7 th post-operative day. Results: No significant differences were observed in facial swelling and trismus among pre-operative and post-operative IV 8 mg doses after the surgery (student t-test; P > 0.05). The visual analogue scale scores for pain assessment showed no clinically or statistically significant differences in both groups (student t test; P > 0.05). Conclusions: Pre-operative administration of 8 mg intravenous dexamethasone is as effective as 8 mg IV post-operative dexamethasone with no clinically or statistically significant differences in the final outcomes of the third molar surgery. Clinical Significance This study demonstrates that the steroids can be used pre-operatively and post-operatively for the third molar surgery safely without any statistical difference. However, the steroids should be used judiciously and its use depends on the case selection and preference of the practitioner.
Journal of Oral and Maxillofacial Surgery, 2007
The purpose of this study was to evaluate the effect of submucosal administration of dexamethasone sodium phosphate on discomfort after mandibular third molar surgery.Sixty-one consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly placed into 3 groups. After the onset of local anesthesia, the experimental groups received dexamethasone at 2 different doses (4 or 8 mg) as submucosal injection, and the control group received no drug. Standardized surgical and analgesic protocols were followed. Maximum interincisal distance and facial contours were measured at baseline and at postsurgery days 2 and 7. Pain was objectively measured by counting the number of analgesic tablets required. The patients’ perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale).On the second postoperative day, facial edema showed a statistically significant reduction in both dexamethasone 4-mg and dexamethasone 8-mg groups compared with the control group, but no statistically significant differences were observed between the 2 dosage regimens of dexamethasone. By contrast, there was no statistically significant difference between all groups when postoperative swelling was evaluated at day 7 (P > .50). The treatment group had a limited and nonsignificant effect on pain and trismus when compared with the control group at the 2 times of evaluation.Parenteral use of dexamethasone 4 mg, given as an intraoral injection at the time of surgery, is effective in the prevention of postoperative edema. Increasing the dose to 8 mg provides no further benefit.