Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study.

Author(s): Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, Santoro F

Affiliation(s): Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy. gb.grossi@icp.mi.it

Publication date & source: 2007-11, J Oral Maxillofac Surg., 65(11):2218-26.

Publication type: Comparative Study; Randomized Controlled Trial

PURPOSE: The purpose of this study was to evaluate the effect of submucosal administration of dexamethasone sodium phosphate on discomfort after mandibular third molar surgery. PATIENTS AND METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.