Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial

Graziani, Filippo; D’Aiuto, Francesco; Arduino, Paolo Giacomo; Tonelli, M; Gabriele, Mario

doi:10.1016/j.ijom.2005.07.010

Cited by 156 publications

(190 citation statements)

References 40 publications

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“…ElHag et al 16 found that 10 mg dexamethasone administered both pre-and postoperatively resulted in a significant reduction in trismus. Graziani et al 17 obtained greater reduction in trismus with alveolar corticosteroid powder than with submucosal injection of the drug. The relatively poor results of hydrocortisone may be related to its short duration of action as the initiation of muscle spasm is a slow process.…”

Section: Discussionmentioning

confidence: 98%

Role of Corticosteroids in reducing Postoperative Swelling, Pain, and Trismus following Surgical Extraction of Impacted Mandibular Third Molars

Raakesh¹,

Veeraraghavan²,

Puthalath³

et al. 2017

IJOCRWEB

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sequelae and improves patient comfort. Dexamethasone 4 mg given intravenously is an effective way of minimizing swelling and trismus after removal of impacted lower third molars. Submucosal hydrocortisone is effective in preventing excess swelling but its role against trismus and pain are questionable. Both modalities offer simple, safe, painless, noninvasive, and cost-effective treatment means to counteract postoperative discomfort.Keywords: Dexamethasone, Hydrocortisone, Impacted mandibular third molars.How to cite this article: Raakesh N, Ravi V, Ushass P, Painatt JM, Kumar VM, Sasikumar P, Subhash AK, Navya P. Source of support: Nil Conflict of interest: None INTRODUCTIONSurgical removal of third molars accounts for a large volume of cases in contemporary oral and maxillofacial surgical practice. It requires meticulous planning and application of surgical skills during both diagnosis and postoperative management. 1Odontectomy of mandibular third molar is generally followed by pain, trismus, and swelling. Pain is subjective and can be influenced by different factors such as age, sex, anxiety, and surgical difficulty. Pain usually begins within 3 hours after surgery and ranges in intensity from moderate to severe. This procedure can also result in significant edema and inflammation in the operative field. Corticosteroids have numerous effects on body function. The normal rate of production of hydrocortisone is 15 to 30 mg/day and it increases up to 300 mg during stress. For inflammation to be suppressed, exogenous hydrocortisone must be administered in doses exceeding the normal physiological amounts of hydrocortisone released. Several researchers have found that hydrocortisone prevents inflammation following oral surgery. Dexamethasone is a synthetic corticosteroid with much greater anti-inflammatory effect. The potency of dexamethasone is about 30 times that of natural corticosteroid.3 Postoperative swelling and edema are due to the conversion of phospholipids into arachidonic acid by ABSTRACTIntroduction: Surgical extraction of impacted mandibular third molar is a common procedure in routine maxillofacial practice. This procedure is generally followed by pain, trismus, and swelling. Various methods have been attempted to reduce these unfavorable postoperative sequelae and to improve patient comfort in postoperative period. Use of steroids is one of the commonly followed practices. In our study, we compare the efficiency of steroids given preoperatively in reducing postoperative sequelae, when given in equivalent steroid doses.

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Section: Discussionmentioning

confidence: 98%

Role of Corticosteroids in reducing Postoperative Swelling, Pain, and Trismus following Surgical Extraction of Impacted Mandibular Third Molars

Raakesh¹,

Veeraraghavan²,

Puthalath³

et al. 2017

IJOCRWEB

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show abstract

“…Corticosteroids block the activity of phospholipase A2, thus inhibiting the release of arachidonic acid from cell membranes and the synthesis of prostaglandins, leukotrienes and thromboxanes [4]. There are numerous studies published on the use of steroids to control the post operative sequel of inflammation [3][4][5][6][7][8][9][10][11][12][14][15][16]. Bodnar [3] stated that corticosteroids can be employed as an adjuvant after oral surgery procedures to reduce the presence of inflammatory mediators and thus lessen fluid transudation and edema.…”

Section: Discussionmentioning

confidence: 99%

A Single Pre Operative Dose of Sub Mucosal Dexamethasone is Effective in Improving Post Operative Quality of Life in the Surgical Management of Impacted Third Molars: A Comparative Randomised Prospective Study

Saravanan

Kannan

John

et al. 2015

J. Maxillofac. Oral Surg.

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Objective The aim of the study was to observe and compare the effects of dexamethasone on pain, swelling and trismus administered as one dose preoperatively sub mucosal (study group 2) versus intramuscular injection (study group 1) keeping control as those who received no dose of steroid in the management of third molar surgery. Materials and methods The group 2 (20 patients) is the study group in which all the patients had single dose of preoperative sub mucosal dexamethasone of 4 mg/2 ml. The group 1 patients (20 patients) received single dose of preoperative intra muscular dexamethasone of 4 mg/2 ml. The control group (20 patients) did not receive steroid in any form. The post operative pain, swelling and trismus were assessed for all the groups. Results The submucosal dexamethasone group showed marked improvement in the mouth opening in the follow ups than the intra muscular dexamethasone group. In those five cases of bilateral impaction, in study groups 1 and 2, the mouth opening was very much significant when sub mucosal dexamethasone was given. ConclusionThe pre operative use of submucosal dexamethasone effectively reduces the post operative pain, swelling and trismus showing statistically significant results. The number of post operative use of analgesic tablets taken by the patients in the study group 2 were less compared to the study group 1 and the control group showing clinically significant results.

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“…Pain was assessed pre-operatively and 30 min, 1, 4, 12 h after surgery and on the 1st, 3rd and 7th postoperative day. This scale was further subdivided into four intervals 0-25 = no pain, 26-50 = mild pain, 51-75 = moderate pain, 76-100 = maximum pain [4,5].…”

Section: Methodsmentioning

confidence: 99%

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane

Shankariah

Neswi

2015

J. Maxillofac. Oral Surg.

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Purpose In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars. Methods Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision. Results The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p \ .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p [ .05) on the 1st, 3rd and 7th post-operative days. Conclusion The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.

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Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial

Cited by 156 publications

References 40 publications

Role of Corticosteroids in reducing Postoperative Swelling, Pain, and Trismus following Surgical Extraction of Impacted Mandibular Third Molars

Role of Corticosteroids in reducing Postoperative Swelling, Pain, and Trismus following Surgical Extraction of Impacted Mandibular Third Molars

A Single Pre Operative Dose of Sub Mucosal Dexamethasone is Effective in Improving Post Operative Quality of Life in the Surgical Management of Impacted Third Molars: A Comparative Randomised Prospective Study

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

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