Comparison of the Effects of Dexamethasone Administration on Postoperative Sequelae Before and After “Third Molar" Extraction Surgeries

Author(s): Ehsan Shoohanizad, Milad Parvin*.

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 20 , Issue 3 , 2020

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Graphical Abstract:


Introduction: Impacted third molars (ITMs) surgery, is one of the most common methods in the field of oral and maxillofacial surgical operations. Administration of corticosteroid such as dexamethasone diminishes the postoperative sequelae. The study aimed to compare the impact of dexamethasone administration on pre-operative and post-operative complications in third molar surgery.

Methods: We collected all randomized controlled trial data on the influences of pre-operative and postoperative dexamethasone administration between 2006-2019 on third molar surgery sequelae by searching the keywords: dexamethasone, third molar surgery, wisdom teeth, corticosteroids, oral surgery, maxillofacial surgery, preoperative, postoperative, pain, swelling, and trismus in international databases such as: Web of Science (ISI), PubMed, Scopus, Embase and Cochrane Library.

Results: Twenty-three articles were included in this narrative review. Among them, 22 studies used dexamethasone in particular and 1 study used dexamethasone with amoxicillin. Twenty studies evaluated the prescription of dexamethasone in pre-operative and post-operative routes on pain, trismus and edema following third molars operation. Five studies administered dexamethasone postoperatively and 15 studies administered the drug preoperatively. Two studies evaluated the preoperative and postoperative administration method. Fourteen studies used a 4 mg dexamethasone dose and drug administration was variable. The treatment period in postoperative studies varied between 1 to 7 days.

Conclusion: Dexamethasone appears to be a promising agent in in reduction of post-operative complications following third molar surgery. As a potent anti-inflammatory agent, it has an effective role in pain, trismus and edema reduction distinguished from the routes of administration, dosage and timing, pre or postoperative prescription.

Keywords: Corticosteroid, dexamethasone, third molar surgery, wisdom teeth, trismus, swelling.

James Hupp, M.T. Edward Ellis In: Contemporary Oral and Maxillofacial Surgery 6th Edition; 718, 2013.
Kim, K.; Brar, P.; Jakubowski, J.; Kaltman, S.; Lopez, E. The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 2009, 107(5), 630-640.
[] [PMID: 19157919]
Cunha-Cruz, J.; Rothen, M.; Spiekerman, C.; Drangsholt, M.; McClellan, L.; Huang, G.J. Recommendations for third molar removal: a practice-based cohort study. Am. J. Public Health, 2014, 104(4), 735-743.
[] [PMID: 24524519]
Jerjes, W.; El-Maaytah, M.; Swinson, B.; Banu, B.; Upile, T.; D’Sa, S.; Al-Khawalde, M.; Chaib, B.; Hopper, C. Experience versus complication rate in third molar surgery. Head Face Med., 2006, 2, 14-14.
[] [PMID: 16725024]
Osunde, O.D.; Adebola, R.A.; Omeje, U.K. Management of inflammatory complications in third molar surgery: a review of the literature. Afr. Health Sci., 2011, 11(3), 530-537.
[PMID: 22275950]
Mavrodi, A.; Ohanyan, A.; Kechagias, N.; Tsekos, A.; Vahtsevanos, K. Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications. Med. Oral Patol. Oral Cir. Bucal, 2015, 20(5), e640-e644.
[] [PMID: 26116843]
Antunes, A.A.; Avelar, R.L.; Martins Neto, E.C.; Frota, R.; Dias, E. Effect of two routes of administration of dexamethasone on pain, edema, and trismus in impacted lower third molar surgery. Oral Maxillofac. Surg., 2011, 15(4), 217-223.
[] [PMID: 21845387]
Khoury, J.N.; Mihailidis, S.; Ghabriel, M.; Townsend, G. Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks. Aust. Dent. J., 2011, 56(2), 112-121.
[] [PMID: 21623801]
Costa, F.W.; Esses, D.F.; de Barros Silva, P.G.; Carvalho, F.S.; Sá, C.D.; Albuquerque, A.F.; Bezerra, T.P.; Ribeiro, T.R.; Sá Roriz Fonteles, C.; Soares, E.C. Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials. Anesth. Prog., 2015, 62(2), 57-63.
[] [PMID: 26061574]
Santosh, P. Impacted Mandibular Third Molars: Review of Literature and a Proposal of a Combined Clinical and Radiological Classification. Ann. Med. Health Sci. Res., 2015, 5(4), 229-234.
[] [PMID: 26229709]
Larsen, M.K.; Kofod, T.; Christiansen, A-E.; Starch-Jensen, T. Different Dosages of Corticosteroid and Routes of Administration in Mandibular Third Molar Surgery: a Systematic Review. J. Oral Maxillofac. Res., 2018, 9(2), e1-e1.
[] [PMID: 30116513]
Sortino, F.; Cicciù, M. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar. Dent Res J (Isfahan), 2011, 8(4), 162-171.
[] [PMID: 22135686]
Ngeow, W.C.; Lim, D. Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery? Adv. Ther., 2016, 33(7), 1105-1139.
[] [PMID: 27287853]
Qasim, A.R.M. A Review of Natural Steroids and their Applications. Int. J. Pharm. Sci. Res., 2013, 4(2), 12.
Vadivelu, N.; Mitra, S.; Schermer, E.; Kodumudi, V.; Kaye, A.D.; Urman, R.D. Preventive analgesia for postoperative pain control: a broader concept. Local Reg. Anesth., 2014, 7, 17-22.
[PMID: 24872720]
Pozzi, A.; Gallelli, L. Pain management for dentists: the role of ibuprofen Annali di stomatologia, 2(3-4 Suppl), 3-24. 2012
Ata-Ali, J.A-A.F.; Peñarrocha-Oltra, D.; Peñarrocha, M. Corticosteroids use in controlling pain, swelling and trismus after lower third molar surgery. J. Clin. Exp. Dent., 2011, 3(5), e469-e475.
Messer, E.J.; Keller, J.J. The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surg. Oral Med. Oral Pathol., 1975, 40(5), 594-598.
[] [PMID: 1059060]
Latt, M.M.; Kiattavorncharoen, S.; Boonsiriseth, K.; Pairuchvej, V.; Wongsirichat, N. The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery. J. Dent. Anesth. Pain Med., 2016, 16(2), 95-102.
[] [PMID: 28879301]
Laureano Filho, J.R.; Maurette, P.E.; Allais, M.; Cotinho, M.; Fernandes, C. Clinical comparative study of the effectiveness of two dosages of Dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Med. Oral Patol. Oral Cir. Bucal, 2008, 13(2), E129-E132.
[PMID: 18223530]
Graziani, F.; D’Aiuto, F.; Arduino, P.G.; 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), 241-246.
[] [PMID: 16188428]
Grossi, G. B.; Maiorana, C.; Garramone, R. A.; Borgonovo, A.; Beretta, M.; Farronato, D.; Santoro, F. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 65(11), 2218-2226. 2007
Majid, O.W.; Mahmood, W.K. Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study. Br. J. Oral Maxillofac. Surg., 2011, 49(8), 647-652.
[] [PMID: 21035237]
Deo, S.P. Effect of submucosal injection of dexamethasone on post-operative sequelae of third molar surgery. JNMA J. Nepal Med. Assoc., 2011, 51(182), 72-78.
[] [PMID: 22916516]
Boonsiriseth, K.; Klongnoi, B.; Sirintawat, N.; Saengsirinavin, C.; Wongsirichat, N. Comparative study of the effect of dexamethasone injection and consumption in lower third molar surgery. Int. J. Oral Maxillofac. Surg., 2012, 41(2), 244-247.
[] [PMID: 22209180]
Klongnoi, B.; Kaewpradub, P.; Boonsiriseth, K.; Wongsirichat, N. Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery. Int. J. Oral Maxillofac. Surg., 2012, 41(3), 376-379.
[] [PMID: 22209181]
Bortoluzzi, M.C.; Capella, D.L.; Barbieri, T.; Pagliarini, M.; Cavalieri, T.; Manfro, R. A single dose of amoxicillin and dexamethasone for prevention of postoperative complications in third molar surgery: a randomized, double-blind, placebo controlled clinical trial. J. Clin. Med. Res., 2013, 5(1), 26-33.
[] [PMID: 23390473]
Majid, O.W.; Mahmood, W.K. Use of dexamethasone to minimise post-operative sequelae after third molar surgery: comparison of five different routes of administration. Oral Surg., 2013, 6(4), 200-208.
Nair, R.B.; Rahman, N.M.; Ummar, M.; Hafiz, K.A.; Issac, J.K.; Sameer, K.M. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J. Contemp. Dent. Pract., 2013, 14(3), 401-404.
[] [PMID: 24171980]
Warraich, R.; Faisal, M.; Rana, M.; Shaheen, A.; Gellrich, N.C.; Rana, M. Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone - a randomized observer blind prospective study. Oral Surg. Oral Med. Oral Pathol. Oral Radiol., 2013, 116(1), 16-22.
[] [PMID: 23453611]
Ehsan, A.; Ali Bukhari, S.G. Ashar; Manzoor, A.; Junaid, M. Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar. J. Coll. Physicians Surg. Pak., 2014, 24(7), 489-492.
[PMID: 25052972]
Agostinho, C.N.; da Silva, V.C.; Maia Filho, E.M.; Cruz, M.L.; Bastos, E.G. The efficacy of 2 different doses of dexamethasone to control postoperative swelling, trismus, and pain after third molar extractions. Gen. Dent., 2014, 62(6), e1-e5.
[PMID: 25369393]
Lt , Col V Effectiveness Of Submucosal V/S Intramuscular Dexamethasone In Mandibular Third Molar Surgeries. International Journal of Medical Science and Clinical invention., 2(1) 2015
Chaudhary, P.D.; Rastogi, S.; Gupta, P.; Niranjanaprasad Indra, B.; Thomas, R.; Choudhury, R. Pre-emptive effect of dexamethasone injection and consumption on post-operative swelling, pain, and trismus after third molar surgery. A prospective, double blind and randomized study. J. Oral Biol. Craniofac. Res., 2015, 5(1), 21-27.
[] [PMID: 25853044]
Arjun Gopinath, M.C.; Arun, V. Comparative Evaluation of Submucosal and Intravenous Dexamethasone on Postoperative Sequelae following Third Molar Surgery: A Prospective Randomized Control Study. Int. J. Oral Care Res., 2017, 5(3), 191-195. [IJOCR]
Al-Shamiri, H.M.; Shawky, M.; Hassanein, N. Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction. Int. J. Dent., 2017, 2017, 1350375-1350375.
[] [PMID: 28487738]
Brignardello-Petersen, R. Submucosal dexamethasone reduces pain, swelling, and trismus after impacted third-molar extraction. Journal of the American Dental Association (1939), 148(5) 2017
Gozali, P.; Boonsiriseth, K.; Kiattavornchareon, S.; Khanijou, M.; Wongsirichat, N. Decreased post-operative pain using a sublingual injection of dexamethasone (8 mg) in lower third molar surgery. J. Dent. Anesth. Pain Med., 2017, 17(1), 47-53.
[] [PMID: 28879328]
Shir Afkan Saeed, M.M. Razavi Mahshid, azemi Parisa. Clinical Evaluation of Dexamethasone Pills on Side Effects of Mandibular Third Molars Surgery Journal of Research in Medical and Dental Sciencce, 2018, 6(1), 98-106. [JRMDS]
Syed, K.; AlQahtani, F.; Mohammad, A.; Abdullah, I.; Qahtani, H.; Hameed, M. Assessment of pain, swelling and trismus following impacted third molar surgery using injection dexamethasone submucosally: A prospective, randomized, crossover clinical study. J. Int. Oral Health, 2017, 9(3), 116-121.

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Article Details

Year: 2020
Page: [356 - 364]
Pages: 9
DOI: 10.2174/1871530319666190722120405
Price: $65

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