Preoperative submucosal dexamethasone injection for minimizing postoperative pain, trismus, and oedema associated with impacted mandibular third molar surgery
Abstract
Aim: 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. Keywords: Dexamethasone; Third molar; Pain; Trismus; Edema.
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7. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effect of Submucosal Injection of Dexamethasone on Postoperative Discomfort After Third Molar Surgery: A Prospective Study. J Oral Maxillofac Surg. 2007;65(11):2218–26.
8. Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: Postoperative complications and their risk factors. J Can Dent Assoc (Tor). 2007;73(4):325.
9. Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin. 2007;19(1):117–28.
10. Chukwuneke F, Onyejiaka N. Management of postoperative morbidity after third molar surgery: a review of the literature. Niger J Med. 2007;16(2):107–12.
11. Mobilio N, Vecchiatini R, Vasquez M, Calura G, Catapano S. Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars: A randomized prospective study. J Dent Res Dent Clin Dent Prospects. 2017;11(3):156–60.
12. Phillips C, White Jr RP, Shugars DA, Zhou X. Risk factors associated with prolonged recovery and delayed healing after third molar surgery. J Oral Maxillofac Surg. 2003;61(12):1436–48.
13. Petersen JK, Hansson F, Strid S. The effect of an ibuprofen-codeine combination for the treatment of patients with pain after removal of lower third molars. J oral Maxillofac Surg. 1993;51(6):637–40.
14. Hyrkäs T, Ylipaavalniemi P, Oikarinen VJ, Paakkari I. A comparison of diclofenac with and without single-dose intravenous steroid to prevent postoperative pain after third molar removal. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 1993;51(6):634–6.
15. Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J oral Maxillofac Surg. 1995;53(1):2–7.
16. Dionne RA, Gordon SM, Rowan J, Kent A, Brahim JS. Dexamethasone suppresses peripheral prostanoid levels without analgesia in a clinical model of acute inflammation. J oral Maxillofac Surg. 2003;61(9):997–1003.
17. Milles M, Desjardins PJ. Reduction of postoperative facial swelling by low-dose methylprednisolone: an experimental study. J oral Maxillofac Surg. 1993;51(9):987–91.
18. Neupert III EA, Lee JW, Philput CB, Gordon JR. Evaluation of Dexamethasone for reduction of postsurgical sequelae of third molar removal. J oral Maxillofac Surg. 1992;50(11):1177–82.
19. Messer E.J, Keller J.J, The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surgery, Oral Medicine, Oral Pathology. 1975;40, (5): 594-598.
20. Graziani F, D’aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative Dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial. Int J Oral Maxillofac Surg. 2006;35(3):241–6.
21. Esen E, Taşar F, Akhan O. Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery. J oral Maxillofac Surg. 1999;57(10):1201–6.
22. Gersema L, Baker K. Use of corticosteroids in oral surgery. J oral Maxillofac Surg. 1992;50(3):270–7.
23. Troullos ES, Hargreaves KM, Butler DP, Dionne RA. Comparison of nonsteroidal anti-inflammatory drugs, ibuprofen and flurbiprofen, with methylprednisolone and placebo for acute pain, swelling, and trismus. J oral Maxillofac Surg. 1990;48(9):945–52.
24. Sekhar CH, Narayanan V, Baig MF. Role of antimicrobials in third molar surgery: prospective, double blind, randomized, placebo-controlled clinical study. Br J Oral Maxillofac Surg. 2001;39(2):134–7.
25. Montgomery MT, Hogg JP, Roberts DL, Redding SW. The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery. J oral Maxillofac Surg. 1990;48(2):179–87.
2. Hupp JR. Principles of Management of Impacted Teeth. Contemp Oral Maxillofac Surg. 2014;3:143–67.
3. Hupp JR, Tucker MR, Ellis E. Contemporary oral and maxillofacial surgery. 5th edition. Br Dent J 205, 109 (2008).
4. Elsey MJ, Rock WP. Influence of orthodontic treatment on development of third molars. Br J Oral Maxillofac Surg. 2000;38(4):350–3.
5. Pahkala R, Pahkala A, Laine T. Eruption pattern of permanent teeth in a rural community in northeastern Finland. Acta Odontol Scand. 1991;49(6):341–9.
6. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Creminelli L, Santoro F. Assessing Postoperative Discomfort After Third Molar Surgery: A Prospective Study. J Oral Maxillofac Surg. 2007;65(5):901–17.
7. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effect of Submucosal Injection of Dexamethasone on Postoperative Discomfort After Third Molar Surgery: A Prospective Study. J Oral Maxillofac Surg. 2007;65(11):2218–26.
8. Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: Postoperative complications and their risk factors. J Can Dent Assoc (Tor). 2007;73(4):325.
9. Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin. 2007;19(1):117–28.
10. Chukwuneke F, Onyejiaka N. Management of postoperative morbidity after third molar surgery: a review of the literature. Niger J Med. 2007;16(2):107–12.
11. Mobilio N, Vecchiatini R, Vasquez M, Calura G, Catapano S. Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars: A randomized prospective study. J Dent Res Dent Clin Dent Prospects. 2017;11(3):156–60.
12. Phillips C, White Jr RP, Shugars DA, Zhou X. Risk factors associated with prolonged recovery and delayed healing after third molar surgery. J Oral Maxillofac Surg. 2003;61(12):1436–48.
13. Petersen JK, Hansson F, Strid S. The effect of an ibuprofen-codeine combination for the treatment of patients with pain after removal of lower third molars. J oral Maxillofac Surg. 1993;51(6):637–40.
14. Hyrkäs T, Ylipaavalniemi P, Oikarinen VJ, Paakkari I. A comparison of diclofenac with and without single-dose intravenous steroid to prevent postoperative pain after third molar removal. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 1993;51(6):634–6.
15. Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J oral Maxillofac Surg. 1995;53(1):2–7.
16. Dionne RA, Gordon SM, Rowan J, Kent A, Brahim JS. Dexamethasone suppresses peripheral prostanoid levels without analgesia in a clinical model of acute inflammation. J oral Maxillofac Surg. 2003;61(9):997–1003.
17. Milles M, Desjardins PJ. Reduction of postoperative facial swelling by low-dose methylprednisolone: an experimental study. J oral Maxillofac Surg. 1993;51(9):987–91.
18. Neupert III EA, Lee JW, Philput CB, Gordon JR. Evaluation of Dexamethasone for reduction of postsurgical sequelae of third molar removal. J oral Maxillofac Surg. 1992;50(11):1177–82.
19. Messer E.J, Keller J.J, The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surgery, Oral Medicine, Oral Pathology. 1975;40, (5): 594-598.
20. Graziani F, D’aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative Dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial. Int J Oral Maxillofac Surg. 2006;35(3):241–6.
21. Esen E, Taşar F, Akhan O. Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery. J oral Maxillofac Surg. 1999;57(10):1201–6.
22. Gersema L, Baker K. Use of corticosteroids in oral surgery. J oral Maxillofac Surg. 1992;50(3):270–7.
23. Troullos ES, Hargreaves KM, Butler DP, Dionne RA. Comparison of nonsteroidal anti-inflammatory drugs, ibuprofen and flurbiprofen, with methylprednisolone and placebo for acute pain, swelling, and trismus. J oral Maxillofac Surg. 1990;48(9):945–52.
24. Sekhar CH, Narayanan V, Baig MF. Role of antimicrobials in third molar surgery: prospective, double blind, randomized, placebo-controlled clinical study. Br J Oral Maxillofac Surg. 2001;39(2):134–7.
25. Montgomery MT, Hogg JP, Roberts DL, Redding SW. The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery. J oral Maxillofac Surg. 1990;48(2):179–87.
| Files | ||
| Issue | Vol 9, No 3 (Summer 2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v9i3.12695 | |
| Keywords | ||
| Dexamethasone; Third molar; Pain; Trismus; Edema. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Fatah G, Mahmood Faris B. Preoperative submucosal dexamethasone injection for minimizing postoperative pain, trismus, and oedema associated with impacted mandibular third molar surgery. J Craniomaxillofac Res. 2023;9(3):128-134.
