07 February 2022

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Third molar surgery: effects of pre and postoperative dexamethasone

Lara Figini

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Reduction of postoperative discomfort after third molar surgery is of interest for all oral and maxillofacial surgeons and their patients. Various drugs have been considered in the attempt to reduce the postoperative inflammatory response associated with lower third molar surgery.  Use of synthetic steroids in oral surgery became increasingly more popular as a function of their beneficial effects for the reduction of post- inflammatory signs and symptoms.  

The aim of the present study was to assess the effects of pre- and postoperative administration of dexamethasone for control of postoperative pain, swelling and trismus  following the removal of impacted third molars.  

Materials and methods  
 The present study consisted of a randomized, triple-blind clinical trial with a split-mouth design. Thirty healthy individuals aged 18 to 22 years old were selected, the inclusion criteria was: orthodontic indication of bilateral upper and lower third molar surgery with similar surgical difficulty between both sides according to the Pell and Gregory classification following clinical and tomographic assessment.   One hour before surgery, all patients received a single dose of dexamethasone (8mg) and nimesulide (100mg) per oral route. Patients were subjected to two surgery ( right and left side) , performed by the same surgeon after 30 days from each other.
A standardized technique was performed in all surgical procedures.
 After the surgery, following  the directions on the sealed envelopes were given dexamethasone to placebo. All the patients were instructed to take one tablet of dipyrone (500mg) in order to control the pain, only if was needed.    
Swelling was assessed using three measurements:  
A.    Tragus / external angle of the eye (Tragus–EA).
B.     Tragus / lateral angle of the mouth (Tragus-LA).
C.     External angle of the eye/gonion (EA-Go).  

Results  
30 patients were included in the present clinical trial, consisting of 25 females (83%) and 5 males (17%), with average age of 20±2 years old.
The Tragus-EA and Tragus-LA measurement showed a significant increase in the dexamethasone group and placebo group starting 48 hours after surgery and then presented a significant reduction until reaching the baseline values 72 hours after surgery.
 The EA-Go and Trismus measurement exhibited significant increases starting 48 hours after surgery in both groups, and significant reductions were observed 72 hours after surgery in the dexamethasone group and on day 7 in the placebo group.
 Sixteen hours after surgery, the pain score was higher in the placebo group.

Conclusions
 Based on the results obtained, one might infer that an additional dose of dexamethasone in the postoperative period reduces pain, swelling and truisms. This drug might be used more easily and decrease post-operative discomfort, resulting in less harm to patients as a function of the reduction of the numbers of analgesics used and in the shortest possible time.  

For additional information: Effects of pre and postoperative dexamethasone for control of pain, swelling and trismus after third molar surgery: a randomized, triple-blind clinical trial.