21 November 2023

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Is administering corticosteroids after wisdom tooth extractions useful for reducing pain and complications?

Lara Figini

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In the dental sector, more than 10 million teeth are extracted worldwide every year. Among the most common complications that occur following tooth extractions are pain, swelling and trismus, conditions that can significantly compromise the patient's quality of life in the immediate post-operative period. Analgesics and anti-inflammatory drugs prescribed postoperatively should relieve pain, reduce swelling and trismus, and improve healing without unwanted adverse effects.

Among the drugs that exert both analgesic and anti-inflammatory effects there are corticosteroids, which can be divided into 2 main groups: glucocorticoids and mineralocorticoids. In particular, glucocorticoids (or corticosteroids) are used for the management of post-operative complications after dental extractions due to their notable anti-inflammatory effects and can typically be administered orally, intramuscularly and submucosally.

Materials and methods

In a systematic review, published in the Journal of the American Dental Association, the authors evaluated the effect of corticosteroids on acute post-operative pain in patients undergoing mandibular third molar extraction surgery.

The literature search was conducted using the following databases: Medline, Embase, Cochrane Central, Controlled Trials Registry, and US Clinical Trials Registry (ClinicalTrials.gov) through April 2023. Two reviewers independently screened titles and abstracts of relevant articles, then full texts, after which studies were identified as potentially eligible. After data extraction, the authors conducted the random effects meta-analysis. Risk of bias was assessed using Cochrane Risk of Bias version 2 and certainty of the evidence was determined using GRADE.

Results

Forty randomized controlled trials were eligible and included in the final review. The evidence suggested that corticosteroids compared to placebo provided an insignificant reduction in pain intensity measured at 6 hours and 24 hours after surgical extraction of third molars. The authors found no important differences between cases treated with corticosteroids and those treated with placebo regarding the incidence of post-operative infections and the incidence of alveolar osteitis.

Conclusions

From the data of this review, which must be confirmed in other similar studies and reviews, it can be concluded that there is an insignificant difference regarding the intensity of post-operative pain and adverse effects when administering corticosteroids orally, submucosa or intramuscularly compared to a placebo in patients undergoing third molar extractions.