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Pearce EP, Deas DE, Powell CA, Diogenes A, Kotsakis GA, Mader MJ, Palaiologou A. The impact of intravenous versus submucosal dexamethasone on short-term patient response: A randomized controlled trial. J Periodontol 2024. [PMID: 39382046 DOI: 10.1002/jper.24-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 08/22/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND The purpose of this randomized, cross-over trial was to determine if a preoperative dose of dexamethasone administered submucosally is as effective as intravenous (IV) dexamethasone in reducing pain, swelling, and analgesic consumption after periodontal flap surgery. METHODS Thirty-nine patients planned for two similar flap surgeries under IV sedation were included. Before the first surgery, patients were randomized to receive 8 mg of IV or submucosal dexamethasone. Via the alternate route, 0.9% sodium chloride (placebo) was administered. Dexamethasone was administered via the opposite route during the second surgery. A standardized regimen of 600 mg ibuprofen and 325 mg acetaminophen was used to manage postoperative pain. Patients recorded pain and swelling levels on a 21-point numerical rating scale (NRS-21) and a four-point visual rating scale (VRS-4), as well as analgesic usage via a phone application at 12, 24, 48, 72, and 168 h postoperatively. RESULTS While NRS-21 and VRS-4 data suggest a trend toward decreased pain and swelling with IV administration, there were no significant differences in analgesic usage or pain at any time and a significant difference in swelling only at 72 h in favor of IV administration (p = 0.047). CONCLUSIONS There was no significant difference in pain or analgesic usage following periodontal flap surgery comparing IV and submucosal dexamethasone. A statistically significant difference in swelling between groups at 72 h is likely of limited clinical relevance. Submucosal dexamethasone is an effective way to mitigate pain following periodontal surgery, particularly when IV access for sedation is not required.
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Affiliation(s)
- Ellen P Pearce
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, Texas, USA
| | - David E Deas
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, Texas, USA
| | - Charles A Powell
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, Texas, USA
| | - Anibal Diogenes
- Department of Endodontics, UT Health San Antonio School of Dentistry, San Antonio, Texas, USA
| | - Georgios A Kotsakis
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, New Jersey, USA
| | - Michael J Mader
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Archontia Palaiologou
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, Texas, USA
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Praneetha S, Shenoy V, Christopher P, Gopi G, Manonmani B. Pre-emptive Single Dose of Intramasseteric Administration of Dexamethasone Versus Methylprednisolone in Surgical Extraction of Impacted Mandibular Third Molars: Prospective Split-Mouth, Randomised Triple Blinded Clinical Study. J Maxillofac Oral Surg 2024; 23:424-429. [PMID: 38601237 PMCID: PMC11001828 DOI: 10.1007/s12663-023-02074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/14/2023] [Indexed: 04/12/2024] Open
Abstract
Aim The study aims to contribute in reducing postoperative sequelae and to determine the optimal corticosteroid for reducing postoperative inflammation, pain, swelling, wound healing and quality of life in patients undergoing surgical extraction of impacted mandibular third molars. Materials and Methods The study included 191 patients who presented to the Department of Oral and Maxillofacial Surgery at Thai Moogambigai Dental College and Hospital in Chennai with bilateral impacted mandibular third molars that needed surgical removal. The effects of pre-emptive single dose of dexamethasone and methylprednisolone on pain, oedema, trismus, wound healing, and quality of life after surgical extraction of impacted lower third molars were investigated. Result There was no statistical difference between the two steroids, with both achieving identical levels of wound healing and quality of life. On the third postoperative day, there was a statistically significant difference, with methylprednisolone providing clinically superior results in mouth opening and reduction of swelling. However, by the fifth day, both corticosteroids had exhibited identical improvement. Conclusion Compared to 8 mg of dexamethasone, 40 mg of methylprednisolone administered as a single preemptive dosage in the intrammaseteric region was associated with enhanced quality of life, a reduction in pain and edema, and almost normal mouth opening.
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Affiliation(s)
- Snigdha Praneetha
- Department of Oral and Maxillofacial Surgery, Dr. MGR Educational and Research Institute (Thai Moogambigai Dental College and Hospital), Chennai, India
| | - Vandana Shenoy
- Department of Oral and Maxillofacial Surgery, Dr. MGR Educational and Research Institute (Thai Moogambigai Dental College and Hospital), Chennai, India
| | - Pradeep Christopher
- Department of Oral and Maxillofacial Surgery, Dr. MGR Educational and Research Institute (Thai Moogambigai Dental College and Hospital), Chennai, India
| | - Gayathri Gopi
- Department of Oral and Maxillofacial Surgery, Dr. MGR Educational and Research Institute (Thai Moogambigai Dental College and Hospital), Chennai, India
| | - B. Manonmani
- Department of Oral and Maxillofacial Surgery, Dr. MGR Educational and Research Institute (Thai Moogambigai Dental College and Hospital), Chennai, India
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Rajendiran S, Krishnan B, Deepthy MS. The Local Route of Administration of Dexamethasone in Impacted Mandibular Third Molar Surgery: A Systematic Review and Meta-analysis of Randomised Controlled Trials and a Critical Narrative Review on the Claimed Advantages of the Local Route. J Maxillofac Oral Surg 2024; 23:56-67. [PMID: 38312984 PMCID: PMC10831005 DOI: 10.1007/s12663-023-02011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction The proponents of local route of Dexamethasone (DXM) administration for impacted mandibular 3rd molar (MM3) surgeries claim advantages over the traditional systemic routes. This systematic review and meta-analysis were aimed to determine whether the route of perioperative administration of DXM influences the inflammatory outcomes of MM3 surgeries. Methodology An electronic database search over a 25 year period of randomised trials of DXM in MM3 surgeries was conducted. The mean differences or standardised mean differences were extracted and pooled using the fixed or random-effects model. Results Of the sixteen selected trials, four were considered for a meta-analysis. There were no statistically significant differences in the inflammatory outcomes between the local and systemic routes of DXM. Conclusion The claimed advantages of the local route of DXM do not appear to be scientifically valid. Clinical trials supported with DXM plasma measurements are needed to confirm the absence of a systemic effect when DXM is administered locally.
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Affiliation(s)
- Saravanan Rajendiran
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), #8, 8th cross street, Bharathi Nagar, Lawspet Post, Puducherry, 605008 India
| | - B. Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), #8, 8th cross street, Bharathi Nagar, Lawspet Post, Puducherry, 605008 India
| | - M. S. Deepthy
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Krishna S, Bhaskaran R, Kumar SP, Krishnan M. Efficacy of Oxytetracycline Hydrocortisone-Soaked Gauze Pack on Postoperative Sequelae in Lower Third Molar Surgery: A Prospective Study. Cureus 2024; 16:e52245. [PMID: 38352086 PMCID: PMC10863368 DOI: 10.7759/cureus.52245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Background Though various advancements came into the field of surgery to do the atraumatic procedure, post-operative pain, and swelling are unavoidable complications. Hence, various medicaments are packed in the extracted third molar sockets to prevent these post-operative complications. Aim The study aimed to evaluate the efficacy of oxytetracycline hydrocortisone-soaked gauze in reducing post-operative pain and swelling compared to conventional surgical procedures without any packing in patients undergoing surgical extraction of the impacted mandibular third molars. Materials and methods The study was conducted in the Department of Oral and Maxillofacial Surgery at Saveetha Dental College and Hospitals, Chennai. In this study, 50 patients were randomly included in two groups of 25 participants each. In group A, oxytetracycline hydrocortisone-soaked gauze was placed, and in group B, conventional closure was done without any pack after surgical removal of impacted mandibular third molars. Post-operative pain was assessed on days one, three, and five using a 10-point visual analog scale. Post-operative swelling was assessed on the third and seventh days using a four-point swelling measurement. Data analysis was done using SPSS (IBM Corp. Armonk, NY). A p-value less than 0.05 was considered statistically significant. Independent sample t-test was done to compare the outcomes between the two groups. Results The results demonstrated that group A (Oxytetracycline Hydrocortisone-soaked gauze) showed superior pain reduction compared to group B (conventional closure) at all post-operative intervals (P=0.001). Moreover, group A exhibited reduced swelling, resulting in higher patient satisfaction levels compared to group B on the third post-operative day (P=0.001). Conclusion It can be concluded from the study that there was a significant reduction in post-operative pain and swelling with the use of oxytetracycline hydrocortisone-soaked gauze, as it acts like a local drug delivery system in patients undergoing impacted mandibular third molar surgeries.
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Affiliation(s)
- Sai Krishna
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Rajprakash Bhaskaran
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Singh A, Pentapati KC, Kodali MVRM, Smriti K, Patil V, Chowdhary GL, Gadicherla S. Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2023; 2023:7412026. [PMID: 37168455 PMCID: PMC10165033 DOI: 10.1155/2023/7412026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 05/13/2023] Open
Abstract
The corticosteroids have been used for preemptive management of surgical sequelae after mandibular third molar extraction. The aim of this article was to review the efficacy of methylprednisolone versus dexamethasone in the management of postsurgical pain, swelling, and trismus after mandibular third molar surgery. Randomized, double-blinded studies from PubMed, CINAHL, Scopus, DOSS, Cochrane central, and Web of Science were identified by using a search strategy. Randomized controlled trials evaluating the efficacy of use of dexamethasone versus methylprednisolone for mandibular third molar extraction were only considered. The studies involving the use of any other corticosteroid agent were excluded. Outcomes assessed were postoperative pain, the number of rescue analgesics required, swelling, trismus, and adverse events. The search strategy yielded 1046 articles for title and abstract screening, out of which only seven studies were included in the systematic review after full text screening. There was considerable heterogeneity between the studies with regards to the method as well as the parameters assessed. Risk of bias was low in three studies and unclear in other four studies. On pooled analyses, there was no significant difference with respect to pain, rescue analgesics, and swelling in the test and the control group. Forest plot analysis showed that dexamethasone had lesser trismus in early postoperative period (postoperative day 2) as compared to methylprednisolone. None of the included studies reported any adverse effects. Both the corticosteroids have similar efficacy in reducing the postoperative pain and swelling; however, dexamethasone showed statistically significant difference from methylprednisolone in reducing trismus (estimated standardized mean difference of -0.69 mm; 95% CI: -1.01 to -0.38; p < 0.0001) in the early postoperative period. However, due to statistical heterogeneity, quality of the evidence for the review was low to moderate. Hence, more studies with larger study sample and low risk of bias are needed to confirm these results.
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Affiliation(s)
- Anupam Singh
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | | | - Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Vathsala Patil
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Gandham Lekha Chowdhary
- Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
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Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction. J Am Dent Assoc 2022; 153:1154-1170.e60. [DOI: 10.1016/j.adaj.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
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Altaweel AA, El-Hamid Gaber A, Alnaffar MZ, Almowallad AS, Almech MH, Almuwallad AS, Alharbi RK, Arab WA. A novel therapeutic approach for reducing postoperative inflammatory complications after impacted mandibular third molar removal. Medicine (Baltimore) 2022; 101:e30436. [PMID: 36123843 PMCID: PMC9478325 DOI: 10.1097/md.0000000000030436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study was designed to compare effect of combined use of dexamethasone and honey versus each agent alone in controlling complications associated with removal of impacted mandibular third molar. METHODS This randomized clinical study included patients suffering from impacted mandibular wisdom teeth. Patients were divided randomly into 4 groups. Group I, control, group II, received dexamethasone injection preoperatively, group III, received honey locally in the wound after extraction, and group IV, received dexamethasone injection preoperatively and topical honey application. All patients were evaluated preoperatively and postoperatively to assess facial edema, interincisal distance, pain, and total analgesic dose used. RESULTS Significant edema developed in group I than other groups and improved significantly in group II and III on seventh postoperative day, and tenth postoperative day in group I. Insignificant edema developed in group IV. Significant decrease in interincisal distance occurred in all groups on third postoperative day that improved significantly on seventh postoperative days in all groups except group I, it improved on tenth postoperative day. Pain was significantly minimum in group IV than other groups and its maximum degree was in group I. CONCLUSION Both dexamethasone and honey are an effective way of minimizing swelling, pain, and trismus after removal of impacted lower third molars. Both agents either alone or in combination provide simple, safe, painless, and cost-effective method to eliminate postoperative discomfort. However, dexamethasone or honey can decrease complications related to surgical extraction of mandibular third molar, the simultaneous application of both agents is more effective method in this regard.
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Affiliation(s)
- Alaa Abdelqader Altaweel
- Oral & Maxillofacial Surgery, Faculty of Dental Medicine for Boys, Al-Azhar University, Cairo, Egypt
- Consultant of Oral & Maxillofacial Surgery, Nahdicare Clinics, Jeddah, Saudi Arabia
- *Correspondence: Alaa Abdelqader Altaweel, Faculty of Dental Medicine for Boys, Al-Azhar University, AL Mokhaym AL Daem St., Nasr City, Cairo 11751, Egypt (e-mail: )
| | - Abd El-Hamid Gaber
- Clinical Pharmacology, Department of Clinical Pharmacology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mahmoud Z. Alnaffar
- Periodontology and Preventive Dentistry, Vision Colleges, Jeddah, Saudi Arabia
| | | | | | | | | | - Wasan A. Arab
- Dental Intern at Vision Colleges, Jeddah, Saudi Arabia
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Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complication of Impacted Wisdom Removal. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1563513. [PMID: 35368756 PMCID: PMC8970876 DOI: 10.1155/2022/1563513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Introduction. Extraction of impacted molars is commonest operation in oral cavity and associated with complications disturbing patient’s quality of life. Hyaluronic acid is a nontoxic agent recommended for wound management due to its anti-inflammatory effects. Also, methylprednisolone sodium is used to reduce pain and edema. The aim this study was to compare the effect of combined use of corticosteroid and hyaluronic acid versus each agent alone in controlling postextraction complications of impacted mandibular third molars. Materials and Methods. This prospective randomized trial included patients suffering from impacted mandibular third molar. Patients were divided into four groups. Group I, control, and group II received methylprednisolone sodium succinate injection preoperatively, group III received hyaluronic acid applied in extraction socket, and group IV received preoperative methylprednisolone sodium succinate injection and topical hyaluronic acid in the socket. All patients were evaluated preoperatively and postoperative day to assess swelling, pain, mouth opening, and total analgesic dose. Results. Group IV showed insignificant edema along the study period, and other groups showed significant edema on third postoperative day that improved on seventh postoperative in group II and III and tenth postoperative day in group I. Significant decreased mouth opening occurred on second postoperative day in group I, while in other groups, it occurred in third postoperative day. Significant improvement occurred on seventh postoperative day in all groups except in group I which occurred on tenth postoperative day. There was less pain and analgesic dose reported in group IV than other groups. Conclusion. Combined use of methylprednisolone sodium succinate and hyaluronic acid significantly decrease postoperative complications than using each agent alone.
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Stojanović S, Burić N, Tijanić M, Todorović K, Burić K, Burić N, Jovanović M, Bajagić V. The Assessment of Prolonged Inferior Alveolar Nerve Blockade for Postoperative Analgesia in Mandibular Third Molar Surgery by a Perineural Addition of Dexamethasone to 0.5% Ropivacaine: A Randomized Comparison Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031324. [PMID: 35162346 PMCID: PMC8835108 DOI: 10.3390/ijerph19031324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Background: Perineurally adding dexamethasone to local anesthetics could enable postoperative analgesia. Our aim was to investigate the efficacy of 4 mg dexamethasone and 0.5% ropivacaine on the prolonged duration of mandibular anesthesia for postoperative analgesia during third molar surgery. Materials and method: The patients of both sexes, and in the age range of 17 to 50 yrs of age, received the Gow-Gates anesthesia. Group I received 4 mL of plain 0.5% ropivacaine, with perineurally added 1 mL/4 mg of dexamethasone; group II received 4 mL of plain 0.5% ropivacaine with perineurally added 1 mL of 0.9% saline; group III received 4 mL of plain 0.5 bupivacaine with perineurally added 1 mL of 0.9% saline. The prime anesthesia outcome was the duration of conduction anesthesia (DCA); the secondary outcome was the duration of analgesia (DAN) and analgesia before analgesic intake. Results: In 45 randomly selected subjects (mean age 27.06 ± 8.20), DCA was statistically longest in group I (n = 15) (592.50 ± 161.75 min, p = 0.001), collated with groups II (n = 15) and III (n = 15) (307.40 ± 84.71 and 367.07 ± 170.52 min, respectively). DAN was significantly the longest in group I (mean: 654.9 ± 198.4 min, p = 0.001), compared with group II (345.4 ± 88.0 min) and group III (413.7 ± 152.3 min), with insignificant adverse reactions. One-third of the operated patients absented from the use of analgesics. Conclusion: A amount 0.5% ropivacaine with dexamethasone usefully served as an analgesic with a success rate of 93.4% of the given anesthesia.
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Affiliation(s)
- Simona Stojanović
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Nikola Burić
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
- Correspondence: ; Tel.: +381-63-40-63-86
| | - Milos Tijanić
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Kosta Todorović
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Kristina Burić
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Nina Burić
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Marija Jovanović
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Vukadin Bajagić
- School of Medicine, University of Podgorica, 81110 Podgorica, Montenegro;
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Souza GMD, Fernandes IA, Pinheiro MLP, Falci SGM. Comparative Effectiveness of the Homeopathic Preparation Traumeel S in Third Molar Extraction Surgery: A Preliminary Triple-Blind Clinical Trial. HOMEOPATHY 2021; 110:229-235. [PMID: 33765688 DOI: 10.1055/s-0041-1725038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM This preliminary study aimed to evaluate whether a homeopathic preparation (Traumeel S) might be a good option to control post-operative outcomes (pain, edema and trismus) associated with surgical removal of mandibular third molar teeth. The null hypothesis was that Traumeel S is not different from dexamethasone (gold standard) in controlling these post-operative inflammatory complications. METHODS A randomized, "split-mouth", triple-blind clinical trial was conducted. Seventeen healthy patients with a mean age of 20.94 ( ± 5.83) years had their lower asymptomatic bilateral third molars removed. Patients were randomized to receive Traumeel S or dexamethasone pre-operatively by injection into the masseter muscle; each patient acted as his/her own control. At 24, 48, 72 hours and 7 days after the surgery, the pain was evaluated according to a visual analog scale, edema through linear measurements of the face, and trismus through the maximum buccal opening. Wilcoxon statistics or paired t-test were used, and a significance level of 95% was adopted. RESULTS For pain, the results for Traumeel S were not different (p > 0.05) from those of dexamethasone after 24 hours, 72 hours, and 7 days. For edema, the results for Traumeel S were not different (p > 0.05) from those of dexamethasone at all post-operative evaluations. For mouth opening, the results for Traumeel S were not different (p > 0.05) from those of dexamethasone at 72 hours and 7 days after third molar extraction. CONCLUSION With the exception of some early post-operative findings, the null hypothesis is not rejected. Traumeel S might be a good alternative approach to dexamethasone for controlling pain, edema and trismus after third molar removal.
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Affiliation(s)
- Glaciele Maria de Souza
- Department of Dentistry, Federal University of Vales Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Ighor Andrade Fernandes
- Department of Dentistry, Federal University of Vales Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Marcos Luciano Pimenta Pinheiro
- Division of Pharmacology, Department of Dentistry, Federal University of Vales Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Federal University of Vales Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
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Sugragan C, Sirintawat N, Kiattavornchareon S, Khoo LK, Kc K, Wongsirichat N. Do corticosteroids reduce postoperative pain following third molar intervention? J Dent Anesth Pain Med 2020; 20:281-291. [PMID: 33195806 PMCID: PMC7644360 DOI: 10.17245/jdapm.2020.20.5.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery. Methods The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted. Results Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration. Conclusions Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.
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Affiliation(s)
- Chollathit Sugragan
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Lee Kian Khoo
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kumar Kc
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Agrawal A, Chandel S, Singh N, Tiwari AK, Singh AK, Singh G. The efficacy of intralesional dexamethasone versus intravenous dexamethasone in surgery for impacted third molars: A randomized controlled trial. Natl J Maxillofac Surg 2020; 11:94-97. [PMID: 33041584 PMCID: PMC7518481 DOI: 10.4103/njms.njms_46_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives: A randomized prospective double-blind study was conducted to determine the efficacy of sub-mucosal local infiltration vs. intravenous dexamethasone in reducing postoperative pain, swelling and trismus after surgical removal of impacted mandibular third molars. Materials and Methods: Forty five patients were included in the study and were randomly divided into three groups. Each group consisted of 15 patients for which the first and second groups were given 8 mg of dexamethasone intrlesionally & intravenously respectively, at 30 minutes prior to surgery; the third group served as control. Duration of facial swelling was evaluated subjectively by the patients themselves. Severity of postoperative pain was quantified by counting the number of analgesics taken by the patients during and after surgery (six subsequent days). Postoperative trismus was determined by measuring the maximum incisal opening before surgery and on the seventh day. Results: Results showed that duration of postoperative edema was almost the same in the three test groups. During surgery, the intravenous dexamethasone group showed a significantly lesser pain than the other two groups; the intralesional dexamethasone group showed less marked pain than the control group. Additionally, patients who had taken steroids had a marked increase in the incisal opening postoperatively over the control group. Trismus was significantly reduced in the methylprednisolone group as compared to the dexamethasone group. Conclusion: It is concluded that both preoperative local infiltration and intravenous administration of dexamethasone significantly reduced postoperative pain and trismus after surgical removal of mandibular third molars. An intravenous dexamethasone is more effective in reducing postoperative inflammatory sequelae than its intralesional route.
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Affiliation(s)
- Amiya Agrawal
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Siddhartha Chandel
- Department of Dentistry, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Nishi Singh
- Department of Periodontology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Arunesh Kumar Tiwari
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Akhilesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gaurav Singh
- Department of Oral and Maxillofacial Surgery, Super Speciality Cancer Institute, Lucknow, Uttar Pradesh, India
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Krishna BP, Reddy BP, Yashavanth Kumar DS, Ummar M, Shekhar V, Chandra Tiwari RV. Role of Serratiopeptidase and Dexamethasone in the Control of Postoperative Swelling. Ann Maxillofac Surg 2020; 10:108-113. [PMID: 32855925 PMCID: PMC7433958 DOI: 10.4103/ams.ams_249_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: The present study is designed to evaluate and compare the ability of serratiopeptidase and dexamethasone to control edema following the surgical removal of mandibular third molar. Materials and Methods: Two drugs, dexamethasone and serratiopeptidase, were compared for its efficacy in reducing the postoperative swelling. A total of 100 patients requiring the surgical removal of impacted mandibular third molar were randomly divided into two groups, consisting of 50 patients each. One group was administered 1 mg dexamethasone, one-half h preoperatively and every 8th hourly for 3 days postoperatively. The other group was given 10 mg serratiopeptidase every 8th hourly for 3 days postoperatively. The swelling was measured on 1st, 2nd, 5th, and 7th postoperative days. The results of this study showed that serratiopeptidase was effective in reducing swelling from 2nd to 5th postoperative day, and dexamethasone was effective in reducing swelling from 1st to 2nd postoperative day, further, it also reduced the swelling from 2nd to 5th postoperative day. Results: There was highly significant difference in the facial measurement between serratiopeptidase and dexamethasone group on postoperative day 2 (the mean difference was 62.5 with P < 0.001) and statistically significant difference on postoperative day 1, day 5, and day 7 (P < 0.01). Conclusion: It can be concluded that serratiopeptidase, a proteolytic enzyme and dexamethasone, a long-acting corticosteroid was effective in reducing the swelling, but dexamethasone was more effective than serratiopeptidase in reducing the swelling.
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Affiliation(s)
- B Pramod Krishna
- Department of Oral and Maxillofacial Surgery, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
| | - B Praveen Reddy
- Department of Oral and Maxillofacial Surgery, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - D S Yashavanth Kumar
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India
| | - M Ummar
- Department of OMFS, MES Dental College, Perinthalmanna, Kerala, India
| | | | - Rahul Vinay Chandra Tiwari
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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Marchi D, Santhakumar K, Markham E, Li N, Storbeck KH, Krone N, Cunliffe VT, van Eeden FJM. Bidirectional crosstalk between Hypoxia-Inducible Factor and glucocorticoid signalling in zebrafish larvae. PLoS Genet 2020; 16:e1008757. [PMID: 32379754 PMCID: PMC7237044 DOI: 10.1371/journal.pgen.1008757] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/19/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
In the last decades in vitro studies highlighted the potential for crosstalk between Hypoxia-Inducible Factor-(HIF) and glucocorticoid-(GC) signalling pathways. However, how this interplay precisely occurs in vivo is still debated. Here, we use zebrafish larvae (Danio rerio) to elucidate how and to what degree hypoxic signalling affects the endogenous glucocorticoid pathway and vice versa, in vivo. Firstly, our results demonstrate that in the presence of upregulated HIF signalling, both glucocorticoid receptor (Gr) responsiveness and endogenous cortisol levels are repressed in 5 days post fertilisation larvae. In addition, despite HIF activity being low at normoxia, our data show that it already impedes both glucocorticoid activity and levels. Secondly, we further analysed the in vivo contribution of glucocorticoids to HIF activity. Interestingly, our results show that both glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) play a key role in enhancing it. Finally, we found indications that glucocorticoids promote HIF signalling via multiple routes. Cumulatively, our findings allowed us to suggest a model for how this crosstalk occurs in vivo.
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Affiliation(s)
- Davide Marchi
- The Bateson Centre & Department of Biomedical Science, Firth Court, University of Sheffield, Western Bank, Sheffield, United Kingdom
- * E-mail: (DM); (FJMv)
| | - Kirankumar Santhakumar
- Department of Genetic Engineering, SRM Institute of Science and Technology Kattankulathur, India
| | - Eleanor Markham
- The Bateson Centre & Department of Biomedical Science, Firth Court, University of Sheffield, Western Bank, Sheffield, United Kingdom
| | - Nan Li
- The Bateson Centre & Department of Oncology and Metabolism, School of Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University, Stellenbosch, Matieland, South Africa
| | - Nils Krone
- The Bateson Centre & Department of Oncology and Metabolism, School of Medicine, University of Sheffield, Sheffield, United Kingdom
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Vincent T. Cunliffe
- The Bateson Centre & Department of Biomedical Science, Firth Court, University of Sheffield, Western Bank, Sheffield, United Kingdom
| | - Fredericus J. M. van Eeden
- The Bateson Centre & Department of Biomedical Science, Firth Court, University of Sheffield, Western Bank, Sheffield, United Kingdom
- * E-mail: (DM); (FJMv)
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Comparison of Preemptive Effect of Dexamethasone and Methylprednisolone After Third Molar Surgery: A Split-Mouth Randomized Triple-Blind Clinical Trial. J Maxillofac Oral Surg 2020; 20:264-270. [PMID: 33927496 DOI: 10.1007/s12663-020-01346-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
Abstract
Aim The study aimed to compare the efficacy of methylprednisolone and dexamethasone injected into masseter muscle preoperatively in surgical extraction of lower third molars. Materials and methods This study was carried out on 20 patients who reported to the department of Oral and Maxillofacial surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital Bangalore, requiring surgical removal of bilateral mandibular third molars. The efficacy of corticosteroid was evaluated based on its ability to reduce pain, swelling and trismus following the surgical extraction of impacted lower third molars. Results There was no statistical difference between the two steroids with both of them achieving equal level of pain control. There was a statistically significant difference on the second postoperative day with dexamethasone showing clinically superior result. The difference in oral aperture was found to be statistically significant with dexamethasone showing a decreased reduction in postoperative mouth opening on both second and seventh day. Conclusion This study conclusively proves that patient comfort levels are far better with the use of dexamethasone.
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Moranon P, Chaiyasamut T, Sakdajeyont W, Vorakulpipat C, Klongnoi B, Kiattavornchareon S, Wongsirichat N. Dexamethasone Injection Into Pterygomandibular Space Versus Sublingual Space on Post-Operative Sequalae of Lower Third Molar Intervention. J Clin Med Res 2019; 11:501-508. [PMID: 31236169 PMCID: PMC6575125 DOI: 10.14740/jocmr3844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/04/2019] [Indexed: 11/11/2022] Open
Abstract
Background The surgical removal of lower third molar is still the most common surgical procedure that is done in oral and maxillofacial surgery field and creates the predictable post-operative sequelae such as pain, swelling, stiffness and difficulty in mouth opening. The purpose of this study is to compare pre-operative dexamethasone injection into pterygomandibular space (PGS) and sublingual space (SLS) in lower third molar intervention of post-operative pain, swelling, and limited mouth opening. Methods This study is the split-mouth, randomized crossover clinical trial in 30 healthy patients (mean age 21 years). These patients had similar bilateral lower third molar impactions. The patients were randomly divided into two groups receiving either 8-mg dexamethasone injection into SLS or PGS with the 4-week washout period intervention. Clinical assessment of facial swelling and maximum mouth opening was performed before operation and on day 2 and day 7 after operation. The post-operative pain was also measured by patients' response on pain visual analogue scale (VAS) on the first, second and third day after intervention. Results There is no significant difference between PGS group and SLS group in pain and swelling on the second and seventh day after operation. However, PGS group showed a greater degree of limited mouth opening than SLS group on the second day after operation. Conclusions This study showed that 8-mg dexamethasone injection into PGS or SLS was not different in reduction of pain, swelling, and limited mouth opening. This result suggests that dexamethasone injection into PGS or SLS is similarly effective.
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Affiliation(s)
- Pimrampai Moranon
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Teeranut Chaiyasamut
- Thai Board of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Watus Sakdajeyont
- Thai Board of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Chakorn Vorakulpipat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Boworn Klongnoi
- Thai Board of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Sirichai Kiattavornchareon
- Thai Board of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Natthamet Wongsirichat
- Thai Board of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.,Consultant of Walailak University International College of Dentistry, 19th floor SM Tower, 979/42-46 Phahonyothin Road, Phaya Thai District, Bangkok 10400, Thailand
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Almeida RDA, Lemos C, de Moraes S, Pellizzer E, Vasconcelos B. Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2019; 48:118-131. [DOI: 10.1016/j.ijom.2018.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
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Gümrükçü Z. The effects of piezosurgery and submucosal dexamethasone injection on post-operative complications after third molar surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:182-187. [PMID: 30396027 DOI: 10.1016/j.jormas.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A retrospective clinical study was performed to compare the post-operative effects of the conventional surgery, piezo surgery technique and submucosal dexamethasone injection in lower third molars extractions. METHODS Data from 62 patients, subjected to surgical extraction of lower third molars, were pooled and divided into three groups such as: Conventional Group (22 patients), Piezo Group (20 patients) and Dex Group (conventional surgery + 4 mg/1 mL dexamethasone) (20 patients). Pain, swelling, trismus, analgesic consumption and operation time were comparatively evaluated. RESULTS Pain values were found lower in Dex Group in comparison to Conventional Group at 7th day (P = 0.007). Edema found to be higher in Conventional Group than Dex Group at 2nd day (P = 0.025). Minimally trismus values were found in Dex Group and the difference between the Dex and Conventional Group found to be statistically significant both in 2nd (P = 0.048) and 7th days (P = 0.010). The analgesic consumption in the Conventional Group was found to be higher than Piezo Group at 2nd day (P = 0.002). CONCLUSION The better post-operative values were obtained in the Dex Group. Although longer operative time is considered to be a disadvantage for the piezo technique, piezotome may be preferred for surgical procedures due to its positive results in comparison to the conventional technique.
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Affiliation(s)
- Z Gümrükçü
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Turkey.
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Koç O, Er N. Can Hyaluronidase Be an Alternative Postoperative Anti-edema Agent to Dexamethasone? Preliminary Results of an Animal Study. J Oral Maxillofac Surg 2018; 76:1653-1659. [PMID: 29654778 DOI: 10.1016/j.joms.2018.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/20/2018] [Accepted: 03/11/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Recombinant human hyaluronidase (rHuPH20) is widely used as a spreading factor, which enhances the absorption of subcutaneously injected medicines. The anti-inflammatory and anti-edema effects of the enzyme were demonstrated in previous studies. In the present study, the anti-edema effect of rHuPH20 was compared with that of dexamethasone in a traumatic rat paw edema model. MATERIALS AND METHODS Twenty-four Sprague-Dawley rats (weight 200 to 450 g) were divided into 3 groups: control (group 1), rHuPH20 (group 2), and dexamethasone (group 3). Traumatic edema was induced in the right hind paws of the rats using Feeney's weight-drop model. After edema induction, 0.4 mL of rHuPH20 (100 U/kg = 0.88 μg/kg dose) and 0.4 mL of dexamethasone (0.5 mg/kg dose) were injected into the right hind paws of the rats in groups 2 and 3. The paw volumes were measured before edema induction and at 3, 6, 12, 24, 48, and 72 hours after induction using a plethysmometer. The Mann-Whitney U test was used for the statistical analyses. Probabilities < .05 were accepted as statistically significant. RESULTS The between percentage change in the edema mean values of groups 1 and 3 showed no significant difference at all time points; however, group 2 showed significantly less change in the edema mean values at 3, 6, 12, 24, and 48 hours after edema induction (P < .05) compared with group 1. The change in the edema mean value for group 2 was significantly less than that for group 3 at 3, 6, 12, 24, and 48 hours after edema induction (P < .05). CONCLUSIONS Local rHuPH20 injection more effectively reduced the edema that was induced traumatically in rat paws than did dexamethasone. However, further clinical studies are needed regarding the use of rHuPH20 as a postoperative anti-edema agent in place of dexamethasone.
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Affiliation(s)
- Onur Koç
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey.
| | - Nuray Er
- Doctor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey
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Arora SS, Phull T, Kumar I, Kumar A, Kumar N, Singh H. A comparative study of the effect of two dosages of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective randomized study. Oral Maxillofac Surg 2018; 22:225-230. [PMID: 29752604 DOI: 10.1007/s10006-018-0699-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this clinical study was to evaluate and compare the relative efficacy of two different dosages of dexamethasone, i.e., 4 and 8 mg injected submucosally to reduce postoperative discomfort after mandibular third molar surgery. METHODOLOGY A prospective randomized study was conducted on 45 patients requiring surgical removal of an impacted third molar. Selected patients were divided randomly into three groups of 15 patients each: group I patients received one regimen single dose of 4 mg dexamethasone submucosally, group II received one regimen single dose of 8 mg dexamethasone submucosally, and group III (control group), no dexamethasone was given but only received injection of normal saline submucosally after establishing local anesthesia. The postoperative sequelae were assessed on the second and seventh postoperative day. RESULT As compared to group III, groups I and II showed statistically significant reduction in pain and swelling whereas no statistically significant difference was found between the test groups. CONCLUSION It can be concluded that corticosteroids are effective in curtailing the postoperative edema of lower third molar surgery but have negligible analgesic effect. As no statistically significant difference is found between both the regimes of dexamethasone, i.e., 4 and 8 mg so within the confines of our study, it may be concluded that 4 mg dexamethasone can be given safely to reduce the postoperative edema after the third molar surgery.
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Affiliation(s)
- Srimathy S Arora
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
| | - Tanvi Phull
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
| | - Ish Kumar
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India.
| | - Arun Kumar
- Department of Oral and Maxillofacial Surgery, PGIMER, Chandigarh, India
| | - Nilesh Kumar
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
| | - Hem Singh
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
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Troiano G, Laino L, Cicciù M, Cervino G, Fiorillo L, D'amico C, Zhurakivska K, Lo Muzio L. Comparison of Two Routes of Administration of Dexamethasone to Reduce the Postoperative Sequelae After Third Molar Surgery: A Systematic Review and Meta-Analysis. Open Dent J 2018. [PMID: 29541264 PMCID: PMC5842398 DOI: 10.2174/1874210601812010181] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to compare the clinical efficacy of two routes of dexamethasone administration in reducing the postoperative sequelae after third molar extraction. Electronic databases (PUBMED, SCOPUS and EBSCO library) were screened in order to find both randomized and non-randomized clinical trials that directly compare the submucosal intraoral or the intramuscular extraoral administration of dexamethasone. No restriction about year of publication was imposed. About 340 titles and abstracts were screened independently by two authors. Of these [340 titles], only 4 randomized clinical trials met the inclusion criteria and were included in the meta-analysis. No statistical differences in postoperative pain, swelling and trismus were recorded comparing the intraoral submucosal and the extraoral intramuscular injection of dexamethasone in an extra-oral site.
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Affiliation(s)
- Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Luigi Laino
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Marco Cicciù
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | - Gabriele Cervino
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | - Cesare D'amico
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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Giorgetti APO, Matos RD, Casarin RCV, Pimentel SP, Cirano FR, Ribeiro FV. Preemptive and Postoperative Medication Protocols for Root Coverage Combined with Connective Tissue Graft. Braz Dent J 2018; 29:23-29. [DOI: 10.1590/0103-6440201801452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student’s t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.
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Kim HK, Park YS. Plasma concentration of metformin and dexamethasone after administration through Osseogate. Drug Deliv 2017; 24:437-442. [PMID: 28165808 PMCID: PMC8240976 DOI: 10.1080/10717544.2016.1261380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/13/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Osseogate is a novel drug delivery route through bone marrow involving a modified implant used as the drug delivery system. The purpose of this study was to evaluate the effects of individual drug physicochemical characteristics on the pharmacokinetic behavior when using the Osseogate as administration route. METHODS Implant-mediated drug delivery systems (IMDDS) were installed in a total of 18 rabbits. After complete healing, water-soluble metformin hydrochloride was administered to one group (n = 9) while poorly soluble dexamethasone was administered to the other group (n = 9). The release patterns of each group were monitored for two weeks by measuring the plasma concentration of each drug. RESULTS Both groups showed relative sustained release. However, metformin hydrochloride showed more rapid diffusion and early termination of drug release compared with dexamethasone. CONCLUSIONS The physicochemical properties of drugs significantly affected the release pattern through Osseogate. Further research is required to achieve controlled delivery using this route.
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Affiliation(s)
- Hong-Kyun Kim
- Department of Oral Anatomy, Dental Research Institute and School of Dentistry, Seoul National University Seoul, Seoul, Republic of Korea
| | - Young-Seok Park
- Department of Oral Anatomy, Dental Research Institute and School of Dentistry, Seoul National University Seoul, Seoul, Republic of Korea
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Mojsa I, Pokrowiecki R, Lipczynski K, Czerwonka D, Szczeklik K, Zaleska M. Effect of submucosal dexamethasone injection on postoperative pain, oedema, and trismus following mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. Int J Oral Maxillofac Surg 2017; 46:524-530. [DOI: 10.1016/j.ijom.2016.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 08/14/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
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Boonsiriseth K, Latt MM, Kiattavorncharoen S, Pairuchvej V, Wongsirichat N. Dexamethasone injection into the pterygomandibular space in lower third molar surgery. Int J Oral Maxillofac Surg 2017; 46:899-904. [PMID: 28318872 DOI: 10.1016/j.ijom.2017.02.1266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/26/2016] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
The objective of this study was to evaluate the effects of 8mg dexamethasone injection into the pterygomandibular space on the postoperative sequelae of lower third molar surgery. A prospective, randomized, controlled, split-mouth study was designed involving 62 lower third molar extractions (31 patients). Prior to surgery, the study group received 2ml of 4mg/ml (8mg) dexamethasone injection through the pterygomandibular space following local anaesthesia; the control group received 2ml normal saline injection. Facial swelling, mouth opening, pain on a visual analogue scale (VAS), and the number of analgesics consumed were assessed. Descriptive statistics and the independent-samples t-test were used to compare the two groups at P<0.05. There was a significant reduction in swelling on day 2 postoperative in the dexamethasone group. Mouth opening was also significantly greater on day 2 in the dexamethasone group. The VAS pain score was significantly lower on the day of the operation and first postoperative day in the dexamethasone group, but did not differ significantly between the groups on the other postoperative days. The injection of 8mg dexamethasone into the pterygomandibular space was effective in reducing postoperative swelling, limited mouth opening, and pain following impacted lower third molar extraction.
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Affiliation(s)
- K Boonsiriseth
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - M M Latt
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand; Insein General Hospital, Insein Township, Yangon, Myanmar
| | - S Kiattavorncharoen
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - V Pairuchvej
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - N Wongsirichat
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Abstract
INTRODUCTION The use of corticosteroids to reduce the post-operative sequelae of lower third molar surgery, namely pain, swelling and trismus, has been well studied by many researchers over the past 6 decades. This study reviewed the reported outcome of corticosteroids used in controlling the above sequalae after third molar surgery. MATERIALS AND METHODS A PubMed, Medline, EMBASE and Google search was undertaken of all controlled clinical trials on the effects of corticosteroids on pain, swelling and trismus after lower third molar surgery. The review was limited to studies published over the last 10 years (2006-2015). RESULTS Of the 46 initially retrieved articles, 34 were finally included. Eleven studies compared the effect of 2 similar (but different dose) or different group of corticosteroids. Thirty-one studies reported the effects of corticosteroids on all sequale, 2 reported the outcome on swelling and trismus and another 1 on swelling and pain only. In 16 of the studies, corticosteroid use resulted in significant reductions in pain after third molar removal. Twenty-two out of 29 studies reported reduced swelling against negative control while 18 out of 25 studies reported improved mouth opening. Fourteen studies reported the benefit of corticosteroids on all 3 sequelae, with 71.4% resulted from the use of methylprednisolone. CONCLUSION Although there are some conflicting effects, the results of this analysis shows in general the benefits derived from short-term use of corticosteroids in relation to pain, swelling and trismus following third molar surgical extraction, with no side effects observed. FUNDING This work was supported by the University of Malaya's High Impact Research grant UM.C/625/1/HIR/MOHE/05.
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Affiliation(s)
- Wei Cheong Ngeow
- Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California, San Francisco, 533 Parnassus Avenue, UB08, San Francisco, CA, 94143-0440, USA.
| | - Daniel Lim
- Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Latt MM, 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; 16:95-102. [PMID: 28879301 PMCID: PMC5564088 DOI: 10.17245/jdapm.2016.16.2.95] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 01/03/2023] Open
Abstract
Background Surgery on the lower impacted third molar usually involves trauma in the highly vascularized loose connective tissue area, leading to inflammatory sequelae including postoperative pain, swelling, and general oral dysfunction during the immediate post-operative phase. This study aimed to investigate the effectiveness of preoperative injection of a single dose of 8 mg dexamethasone for postoperative pain control in lower third molar surgery. Methods A controlled, randomized, split-mouth, prospective study involving lower third molar surgery was performed in 31 patients. The randomized sampling group was preoperatively injected, after local anesthesia, with a single dose of dexamethasone (8 mg in 2 ml) through the pterygomandibular space; 2 ml of normal saline (with no dexamethasone) was injected as a placebo. Results The pain VAS score was significantly different on the day of the operation compared to the first post-operative day (P = 0.00 and 0.01, respectively), but it was not significantly different on the third and seventh postoperative day between the control and study groups. There was a significant reduction in swelling on the second postoperative day, and a difference between the second postoperative day and baseline value in the study group (P < 0.05). Trismus was highly significantly different on the second postoperative day and between baseline and second postoperative day between the groups (P = 0.04 and 0.02, respectively). Descriptive statistics and independent-samples t- test were used to assess the significance of differences. Conclusions Injection of 8 mg dexamethasone into the pterygomandibular space effectively reduced the postoperative pain and other postoperative sequalae.
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Affiliation(s)
- Maung Maung Latt
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.,Insein General Hospital, Yangon, Myanmar
| | | | - Kiatanant Boonsiriseth
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Verasak Pairuchvej
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Prashar DV, Pahwa D, Kalia V, Jindal G, Kaur R. A comparative evaluation of the effect of diclofenac sodium with and without per-orally administered methylprednisolone on the sequelae of impacted mandibular third molar removal: A cohort randomized double-blind clinical trial. Indian J Dent 2016; 7:11-6. [PMID: 27134449 PMCID: PMC4836092 DOI: 10.4103/0975-962x.158187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aim and Objectives: This study evaluated the efficacy of oral methylprednisolone and diclofenac sodium on post-operative sequelae after third molar surgery. Settings and Design: A randomized double-blind clinical trial was conducted (with institutional and university approval for dissertation) to evaluate the effect of methylprednisolone with diclofenac sodium (group A) as compared with diclofenac sodium and placebo (group B) on three variables: Pain, swelling and trismus, after third molar surgery. Materials and Methods: Thirty consecutive consenting patients for surgical removal of mandibular impacted third molar were randomly placed into two groups of 15 each (groups A and B). Pain, swelling and trismus were observed by visual analog scale, facial measurements and inter-incisal opening. Scores were recorded after 24 and 72 h and on the seventh post-operative day. Results were subjected to the Chi-square test and independent sample t-test (P = 0.05). Results: Mean difference in pain experienced between the two groups was statistically significant at 24 h (P = 0.015) and 72 h (P = 0.001) and on the seventh day (P = 0.005). Difference in inter-incisal distance was insignificant (P = 0.239) pre-operatively, but significant after 24 h (P = 0.014) and 72 h (P = 0.001) and on the seventh post-operative day (P = 0.001). Mean difference in swelling was highly significant after 24 h (P = 0.001) and 72 h (P = 0.0001) and on the seventh post-operative day (P = 0.047). Conclusions: The combination of oral dose of methylprednisolone (a corticosteroid) diclofenac sodium (a non-steroidal anti-inflammatory drug) was found to be more effective than diclofenac sodium alone on the sequelae of surgical removal of impacted mandibular third molar.
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Affiliation(s)
- Deepti V Prashar
- Department of Oral and Maxillofacial Surgery, Swami Devi Dayal Hospital and Dental College, Panchkula, Haryana, India
| | - Deepti Pahwa
- Department of Oral and Maxillofacial Surgery, B.R.S. Dental College and Hospital, Panchkula, Haryana, India
| | - Vimal Kalia
- Department of Oral and Maxillofacial Surgery, B.R.S. Dental College and Hospital, Panchkula, Haryana, India
| | - Govind Jindal
- Department of Oral and Maxillofacial Surgery, Gian Sagar Dental College and Hospital, Ram Nagar, Rajpura, India
| | - Rupinder Kaur
- Department of Oral and Maxillofacial Surgery, Sukhmani Dental College and Hospital, Derabassi, Punjab, India
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Nandini GD. Eventuality of Dexamethasone Injected Intra-massetrically on Post Operative Sequel Following the Surgical Extraction of Impacted Mandibular Third Molars: A Prospective Study. J Maxillofac Oral Surg 2015; 15:456-460. [PMID: 27833337 DOI: 10.1007/s12663-015-0847-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/18/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objective of the study was to compare the efficacy of dexamethasone given intra-massetrically via intra buccal approach on postoperative sequele after surgical extraction of impacted mandibular third molars. METHODOLOGY Twenty patients, each of who required surgical extraction of a single impacted mandibular third molar under local anesthesia, were randomly set apart to one of the two groups of ten each. The experimental group received dexamethasone 8 mg injected to the masseter muscle intra buccally and the control group did not receive any steroid. Facial swelling and maximal inter-incisal distance were measured by an independent examiner preoperatively, and at 4th h, on the day of surgery, 2 and 7 postoperative days. Pain was measured from the patient's response to a visual analogue scale. RESULTS Patients were of the age range 18-40 years. Dexamethasone group showed significant reduction in swelling and pain compared with the control group at all intervals. Dexamethasone injected into the masseter muscle via intra buccal approach resulted in significantly less trismus than control on day one postoperatively. CONCLUSION Dexamethasone 8 mg given intra-massetrically through intra buccal approach is an effective way of minimizing swelling, trismus, and pain following surgical extraction of impacted mandibular third molars. It offers a simple, safe, painless, non-invasive and cost-effective treatment.
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Affiliation(s)
- G D Nandini
- Department of Oral and Maxillofacial Surgery, Sathyabama University Dental College and Hospital, OMR Road, Chennai, 600119 India
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Eroglu CN, Ataoglu H, Yildirim G, Kiresi D. Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar. Med Oral Patol Oral Cir Bucal 2015; 20:e627-32. [PMID: 26241458 PMCID: PMC4598934 DOI: 10.4317/medoral.20582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/05/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar. MATERIAL AND METHODS The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images. RESULTS Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other. CONCLUSIONS Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling.
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Mansoor J. Pre- and postoperative management techniques. Before and after. Part 2: the removal of third molars. Br Dent J 2015; 218:279-84. [DOI: 10.1038/sj.bdj.2015.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/09/2022]
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Chaudhary PD, 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; 5:21-7. [PMID: 25853044 DOI: 10.1016/j.jobcr.2015.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/07/2015] [Indexed: 10/23/2022] Open
Abstract
AIM To evaluate the preventative effect of intravenous 4 mg of dexamethasone and 8 mg oral dexamethasone on post-operative pain, swelling and trismus after the surgical extraction of mandibular third molars. MATERIALS AND METHODS A randomized clinical trial comprised of 200 patients (control group I intravenous and experimental group II orally) with impacted lower third molars, average age 20.8 years with no local or systemic problems, with bilateral impacted lower third molars, were operated under local anesthesia. Group I was given 4 mg IV and group II was given 8 mg orally of dexamethasone 1 h before procedure. The choice of which side to operate first and the amount of concentration of medication to use was made randomly and double-blindly. Post-operative pain was evaluated using a visual analog scale (VAS) and the degree of swelling was evaluated through facial reference points' variation. The presence of trismus was analyzed through measurement of the interincisal distance (IID). These assessments were obtained before the operation and 24 h, 48 h and 7th POD. RESULTS No significant difference was found in facial swelling and trismus between IV 4 mg injection and oral 8 mg consumption after lower third molar surgery (student t test P > 0.05). The visual analogue scale scores for pain assessment showed no significant difference between IV injection and oral route of dexamethasone (student t test P > 0.05). CONCLUSION Patients can be administered 8 mg oral dexamethasone is as effective as 4 mg intra venous route without much difference in final outcome at any given point of time.
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Affiliation(s)
- Pradeep D Chaudhary
- Professor, Department of Conservative and Endodontics, Bhartiya Vidyapeeth Dental College, Pune, Maharashtra, India
| | - Sanjay Rastogi
- Reader, Department of Oral and Maxillofacial Surgery, Institute of Dental Science - Bareilly, Uttar Pradesh, India
| | - Prashant Gupta
- Reader, Department of Oral and Maxillofacial Surgery, Private Practice, Uttar Pradesh, India
| | - B Niranjanaprasad Indra
- Reader, Department of Oral and Maxillofacial Surgery, Institute of Dental Science - Bareilly, Uttar Pradesh, India
| | - Roy Thomas
- Professor and Consultant, Oral and Maxillofacial Surgery, Private Practice, Kerala, India
| | - Rupshikha Choudhury
- Post Graduate Student, Department of Oral and Maxillofacial Surgery, ITS - Centre for Dental Studies and Research, Murad Nagar, Ghaziabad, Uttar Pradesh, India
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Marques J, Pié-Sánchez J, Figueiredo R, Valmaseda-Castellón E, Gay-Escoda C. Effect of the local administration of betamethasone on pain, swelling and trismus after impacted lower third molar extraction. A randomized, triple blinded, controlled trial. Med Oral Patol Oral Cir Bucal 2014; 19:e49-54. [PMID: 24121915 PMCID: PMC3909432 DOI: 10.4317/medoral.19280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/24/2013] [Indexed: 11/29/2022] Open
Abstract
Objectives: The aim of this study is to compare the analgesic and anti-inflammatory effects of the local postoperative administration of a single 12-mg dose of betamethasone after the surgical removal of impacted lower third molars.
Study Design: A split-mouth, triple-blind, randomized, placebo-controlled clinical trial of 25 patients requiring the surgical removal of symmetrical lower third molars was performed. In the experimental side, a 12-mg dose of betamethasone was administered submucosally after the surgical procedure, while in the control side a placebo (sterile saline solution) was injected in the same area. To assess postoperative pain, visual analogue scales and the consumption of rescue analgesic were used. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening.
Results: There were no significant differences between the two study groups regarding postoperative pain, facial swelling and trismus.
Conclusions: The injection of a single dose of betamethasone does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to placebo.
Key words:Third molar extraction, corticosteroids, betamethasone.
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Affiliation(s)
- José Marques
- Facultat d'Odontologia, Universitat de Barcelona, Campus de Bellvitge, Pavelló de Govern 2a planta, Despatx 2.9, 08907 - L'Hospitalet de Llobregat, Spain,
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Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: a split-mouth randomized triple-blind clinical trial. Int J Oral Maxillofac Surg 2014; 43:93-8. [DOI: 10.1016/j.ijom.2013.05.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 04/20/2013] [Accepted: 05/22/2013] [Indexed: 11/21/2022]
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Koçer G, Yuce E, Tuzuner Oncul A, Dereci O, Koskan O. Effect of the route of administration of methylprednisolone on oedema and trismus in impacted lower third molar surgery. Int J Oral Maxillofac Surg 2013; 43:639-43. [PMID: 24332587 DOI: 10.1016/j.ijom.2013.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/23/2013] [Accepted: 11/01/2013] [Indexed: 10/25/2022]
Abstract
Due to their anatomical position, the surgical removal of impacted third molars results in oedema, pain, and trismus. The purpose of this study was to evaluate the efficacy of supraperiosteal injection of methylprednisolone compared with an oral tablet form and intravenous (i.v.) injection in the prevention of postoperative pain and oedema associated with inflammation. This randomized, prospective, and controlled study included 44 patients. The patients were randomly divided into four groups: group 1 (control; no steroids), group 2 (local injection), group 3 (oral tablets), and group 4 (i.v. injection). On days 2 and 7 following surgery, linear oedema was determined using facial landmarks, and maximal mouth opening was measured. Postoperative mouth opening and swelling were evaluated for each route of methylprednisolone administration and compared. The female (59%) to male (41%) ratio was 1.44; the mean age of the patients was 29.6 years. The level of significance was set at P<0.01 for mouth opening and P<0.05 for oedema. With regard to trismus, all three routes of administration demonstrated better efficacy in comparison to the control. While oral administration and i.v. injection of methylprednisolone achieved similar results, masseter injection provided better results in reducing oedema and trismus when compared to the control following lower third molar surgery.
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Affiliation(s)
- G Koçer
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Süleyman Demirel, Isparta, Turkey.
| | - E Yuce
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Süleyman Demirel, Isparta, Turkey
| | - A Tuzuner Oncul
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ankara, Ankara, Turkey
| | - O Dereci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Osman Gazi, Eskişehir, Turkey
| | - O Koskan
- Department of Biometry, Faculty of Agriculture, University of Süleyman Demirel, Isparta, Turkey
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Buyukkurt CM, Gungormus M, Kaya O, Tozoğlu S. The effect of a single dose of prednisolone on pain, trismus and swelling after removal of third mandibular molars. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/1568569053749921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Selvaraj L, Hanumantha Rao S, Lankupalli AS. Comparison of Efficacy of Methylprednisolone Injection into Masseter Muscle Versus Gluteal Muscle for Surgical Removal of Impacted Lower Third Molar. J Maxillofac Oral Surg 2013. [PMID: 26225017 DOI: 10.1007/s12663-013-0562-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To compare the efficacy, advantages and disadvantages of the use of preoperative injection of methylprednisolone into masseter muscle versus gluteal muscle to minimize postoperative swelling after the surgical removal of lower third molar. MATERIALS AND METHODS A prospective randomized study was planned comprising of 10 subjects, undergoing elective surgery for bilateral impacted lower third molar removal with similar severity index. The subjects were randomly assigned into two groups-group I who received intrabuccal masseteric injection and group II who received gluteal injection of 40 mg of methylprednisolone after inferior alveolar nerve and long buccal nerve block (prior to the surgical removal of the impacted lower third molars). We evaluated the postoperative pain, trismus, swelling, advantages and disadvantages of the injection techniques. Statistical analysis was done using student t test. RESULTS Ten patients of mean age 27 ± 6 years were selected for the study including six males and four females. The mean age was 27 years (SD 6). The differences in measurements of preoperative and postoperative pain, swelling and mouth opening between group I and group II were not statistically significant. CONCLUSION The study evidently proves that there is no statistically significant difference between the intrabuccal approach of masseteric injection and gluteal injection of methylprednisolone in terms of pain, swelling and trismus following surgical removal of impacted lower third molars. However, the intrabuccal approach of masseteric injection was found to be more convenient when compared to gluteal injection, for the surgeon as well as the patient. It also has an additional advantage of being a painless steroidal injection on an anesthetized injection site.
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Affiliation(s)
- Loganathan Selvaraj
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, No-162, Ponnamalle High Road, Chennai, 600077 Tamil Nadu India
| | - Srinivasan Hanumantha Rao
- Department of Oral and Maxillofacial Surgery, Priyadarshini Dental College and Hospital, Thiruvallur, India
| | - Arathy S Lankupalli
- Department of Oral and Maxillofacial Medicine, Saveetha Dental College and Hospital, No-162, Ponnamalle High Road, Chennai, 600077 Tamil Nadu India
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Abstract
Glucocorticosteroids are a product of the adrenal cortex and perform a staggering number of physiological effects essential for life. Their clinical use is largely predicated on their anti-inflammatory and immunosuppressive properties, but they also have notable efficacy in the prophylaxis of postoperative nausea and vomiting. This article reviews the basic functions of glucocorticoids and their clinical use in dental practice.
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Nair RB, Rahman NMM, Ummar M, Hafiz KAA, Issac JK, Sameer KM. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Contemp Dent Pract 2013; 14:401-404. [PMID: 24171980 DOI: 10.5005/jp-journals-10024-1335] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To evaluate the relative ability of 4 mg dose of intraoperative dexamethasone, administered submucosally, to reduce the postoperative discomfort after third molar surgery. MATERIALS AND METHODS A total of 100 patients requiring surgical removal of a single mandibular third molar were included. The experimental group (50) received dexamethasone 4 mg as submucosal injection and control group (50) received no drugs. The maximum interincisal distance and facial contours were measured at baseline and at postsurgery days 2 and 7. The measurement of pain was done using visual analog scale (VAS). RESULTS None of the patients developed wound infection or any serious postoperative complications. Postoperative edema tended to be less severe on the second postoperative day in the experimental group and the result was statistically significant. There were no significant differences in the reduction of pain and trismus between the two groups studied. CONCLUSION Submucosal administration of dexamethasone sodium phosphate (4 mg) results in reduction of postoperative edema, comparable with or greater than other routes of administration. Presumably, a higher effective drug concentration at the site of injury without loss due to distribution to other compartments may be achieved, and the submucosal route is convenient for both the surgeon and the patient. CLINICAL SIGNIFICANCE Submucosal route of administration of dexamethasone (4 mg) is effective in reducing postoperative discomfort after third molar surgeries.
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Affiliation(s)
- Rakesh B Nair
- Senior Lecturer, Department of Maxillofacial Surgery, MES Dental College, Perinthalmanna, Malappuram, Kerala, India, e-mail:
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Arakeri G, Rai KK, Shivakumar HR, Jayade B. A randomized clinical trial to compare the efficacy of submucosal aprotinin injection and intravenous dexamethasone in reducing pain and swelling after third molar surgery: a prospective study. J Maxillofac Oral Surg 2013; 12:73-9. [PMID: 24431817 PMCID: PMC3589511 DOI: 10.1007/s12663-012-0364-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/01/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare two different groups of drugs, aprotinin and dexamethasone for its efficacy in reducing post operative swelling and pain after third molar surgery. METHODS Fifty consecutive patients requiring surgical removal of single mandibular third molar (class II position B) under local anesthesia were randomly divided into two groups, each group consisting of 25 patients. One group was administered 8 mg dexamethasone through intravenous route pre-operatively. The other group received 1 ml of Aprotinin through submucosal route in operating area after the onset of local anesthesia. Swelling was assessed by measuring facial contours at baseline and at 1st, 3rd and 7th post-operative days. Pain was measured on the 1st, 3rd and 7th post-operative days using visual analog scale. Based on statistical analysis (paired t test and Wilcoxon's signed ranking test), the results showed statistically significant difference in post operative swelling and pain on 3rd postoperative day in dexamethasone group as compared to aprotinin group. RESULTS The results of present study showed a similar reduction in the severity of pain and swelling at the aprotinin and dexamethasone sites on 1st and 7th postoperative day. It was also noticed that the aprotinin promoted a greater reduction of swelling and pain on 3rd postoperative day. CONCLUSION It appeared that, benefits of aprotinin against the risks of dexamethasone and its efficacy in controlling pain and swelling after third molar surgery makes aprotinin to be a valuable alternative to dexamethasone.
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Affiliation(s)
- Gururaj Arakeri
- />PB’s Indian Academy of Craniofacial Research (PBIACR), Gangashri Nilaya, Basaveshwara Nagar, Shahapur, Yadgir, 585223 Karnataka India
- />Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Raichur, Karnataka India
| | - Kirthi Kumar Rai
- />Department of Oral Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka India
| | - H. R. Shivakumar
- />Department of Oral Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka India
| | - Bhushan Jayade
- />Department of Oral Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka India
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Warraich R, Faisal M, Rana M, Shaheen A, Gellrich NC, 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; 116:16-22. [PMID: 23453611 DOI: 10.1016/j.oooo.2012.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/14/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical removal of impacted lower third molar is still the most frequent procedure done by Oral and Maxillofacial surgeons and is often associated with pain, swelling and trismus. These postoperative sequelae can cause distress to the patient as a result of tissue trauma and affect the patient's quality of life after surgery. Use of antiseptic mouthwashes, drains, muscle relaxants, cryotherapy, antibiotics, corticosteroids and physiotherapy seems to decrease postoperative discomfort. Among them corticosteroids are well-known adjuncts to surgery for suppressing tissue mediators of inflammation, thereby reducing transudation of fluids and lessening edema. The rationale of this study is to determine the effectiveness of submucosal injection of dexamethasone in reducing postoperative discomfort after third molar surgery. PATIENTS AND METHODS 100 patients requiring surgical removal of third molar under local anesthesia were randomly divided into 2 groups, group I receiving 4 mg dexamethasone as submucosal injection and the control group II received no steroid administration. Facial swelling was quantified by anatomical facial landmarks. Furthermore, pain and patient satisfaction, as well as neurological score and the degree of mouth opening were observed from each patient. RESULTS Patients receiving dexamethasone showed significant reduction in pain, swelling, trismus, a tendency to less neurological complaints and improved quality of life compared with the control group. CONCLUSIONS Submucosal injection of dexamethasone is more efficient to manage postoperative discomfort after removal of third molars compared to no steroid administration.
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Affiliation(s)
- Riaz Warraich
- Department of Oral and Maxillofacial Surgery, King Edward University, Lahore, Pakistan
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Sortino F, Cicciù M. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar. Dent Res J (Isfahan) 2012; 8:162-71. [PMID: 22135686 PMCID: PMC3221082 DOI: 10.4103/1735-3327.86031] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Postoperative swelling following different surgical strategies is an area of great interest. The main part of literature on the topic deals with swelling after extraction of low impacted third molar. In this review, we have analyzed publications of the last 20 years with a pubmed search using the following key words: impacted third molar, swelling third molar, wisdom tooth, edema jaw, corticosteroids and extraction third molar, antibiotic prophylaxis and tooth extraction. Attention has often been focused on corticosteroid therapy administered by diverse routes (orally, IV, IM, topically) and at different time schedules (before or after surgery or both). This investigation revealed how the use of different molecules and dosages makes the obtained results hardly comparable. Similar conclusions can be drawn from studies aimed at evaluating the efficacy of antibiotic therapy administered either before or after surgery. A complete review has also to take into account different surgical strategies used including various flaps, no traumatic osteothomy, and primary or secondary closure. The use of pharmacological therapy and application of an ice pack is critical in the postoperative period and has always provided positive results. However, even if it is difficult to come to definite conclusions, due to the variability of the design of studies analyzed, the postoperative discomfort identified with edema, pain and trismus following wisdom tooth removal is influenced by various factors such as the difficulty of the surgical procedure involved, age and gender of the patient, and experience of the surgeon. The pharmacological therapy when performed with corticosteroids seems to improve control of the postoperative swelling related with this kind of surgeries.
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Affiliation(s)
- Francesco Sortino
- Department of Oral Surgery, University of Catania, Azienda Policlinico, Via Santa Sofia, Catania, Italy
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Majid OW. Submucosal dexamethasone injection improves quality of life measures after third molar surgery: a comparative study. J Oral Maxillofac Surg 2011; 69:2289-97. [PMID: 21514710 DOI: 10.1016/j.joms.2011.01.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 01/08/2011] [Accepted: 01/28/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the present study was to compare the effect of submucosal versus intramuscular administration of dexamethasone sodium phosphate on patients' quality of life after surgical removal of impacted lower third molars. PATIENTS AND METHODS A randomized, non-blind, clinical trial was planned. The sample was composed of patients requiring extraction under local anesthesia of a single partial bony impacted mandibular third molar with Class II or III and position B or C, according to the Pell and Gregory classification. The patients were randomly distributed into 1 of 3 groups: submucosal dexamethasone, intramuscular dexamethasone, and a control group that received no steroid. A modified translated questionnaire was used to assess the patients' perception regarding different quality of life dimensions. In addition, the objective measurements of facial pain, swelling, and trismus were performed on days 1, 3, and 7 postoperatively. RESULTS A total of 33 subjects requiring surgical removal of a single impacted mandibular third molar under local anesthesia were included in the present study. Both dexamethasone groups showed a significant reduction in swelling and pain compared with the control group at all intervals (P < .05). Submucosal dexamethasone provided significant improvement in trismus compared with the control group on day 1 postoperatively (P = .026). Both dexamethasone groups showed a highly significant difference in the effect on quality of life and the duration of effect in all subscale scores (P < .01) except for the "speech" and "appearance" subscales. The effect was comparable between the 2 treated groups in all parameters. The effect of the 2 routes of dexamethasone was also comparable for all parameters. CONCLUSIONS Submucosal injection of dexamethasone 4 mg is an effective therapeutic strategy for improving the quality of life after surgical removal of impacted lower third molars with a comparable effect on postoperative sequelae to intramuscular injection. It offers a simple, safe, painless, noninvasive, and cost effective therapeutic option for moderate and severe cases.
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Affiliation(s)
- Omer Waleed Majid
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Mosul, Mosul, Nineveh, Iraq.
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Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study. Br J Oral Maxillofac Surg 2010; 49:647-52. [PMID: 21035237 DOI: 10.1016/j.bjoms.2010.09.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 09/27/2010] [Indexed: 11/22/2022]
Abstract
We compared the effects of dexamethasone sodium phosphate given submucosally and intramuscularly on postoperative complications after removal of impacted lower third molars in a preliminary randomised prospective clinical trial. Thirty patients, each of whom required removal of a single impacted mandibular third molar under local anaesthesia, were randomly allocated to one of 3 groups of 10 each. The 2 experimental groups were given dexamethasone 4 mg submucosally or intramuscularly, and the control group had no steroid. Facial swelling and maximal interincisal distance were measured by an independent examiner at baseline (preoperatively), and at 1, 3, and 7 days postoperatively. Pain was measured by counting the number of rescue analgesic tablets taken, and from the patients' response to a visual analogue scale (VAS). The mean age of the 16 men and 14 women was 27 years (range 20-48). Both dexamethasone groups showed significant reductions in swelling (p<0.001) and in pain (p<0.05) compared with the control group at all intervals. Submucosal dexamethasone resulted in significantly less trismus than controls on day 1 postoperatively (p=0.04), but there were no significant differences among the groups at the other times. The effects of the two routes of dexamethasone were comparable for all variables. There were no cases of alveolar osteitis or wound infection. Dexamethasone 4 mg given submucosally is an effective way of minimising swelling, trismus, and pain after removal of impacted lower third molars, and is comparable with the intramuscular route. It offers a simple, safe, painless, non-invasive, and cost-effective treatment in moderate and severe cases.
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Dan AEB, Thygesen TH, Pinholt EM. Corticosteroid administration in oral and orthognathic surgery: a systematic review of the literature and meta-analysis. J Oral Maxillofac Surg 2010; 68:2207-20. [PMID: 20591548 DOI: 10.1016/j.joms.2010.04.019] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 04/10/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This study evaluated the effect of corticosteroid (CS) administration on edema, analgesia, and neuroregeneration in conjunction with surgical dental extraction, orthognathic surgery, and the risk of developing side effects. MATERIALS AND METHODS A systematic search of the literature was made. The primary predictor variable was CS administration and the outcome variables were edema, pain, and infection. A meta-analysis was performed. The risk of other side effects was evaluated through a simple review. RESULTS In oral surgery, most clinical trials showed a significant decrease in edema (P < .0001) after CS, and local injection of methylprednisolone > or =25 mg was expected to result in a significant decrease in edema. Regarding the analgesic effect, several clinical trials showed a decrease in pain after CS (P < .0001). Further, CS administration resulted in a slightly higher risk of infection (relative risk, 1.0041), but with a P value of .89. CS could be administered with no increased risk of infection. In orthognathic surgery, methylprednisolone > or =85 mg administered intravenously seemed sufficient to produce a significant decrease in edema, and several trials pointed toward a neuroregeneration effect, but no statistical analysis could be performed. Regarding the risk of other side effects, in oral surgery, a minimal risk of chronic adrenal suppression was seen; in orthognathic surgery, an elevated risk of avascular osteonecrosis, steroid-induced psychosis, and adrenal suppression was seen. There were no reports of decreased healing. CONCLUSION These findings suggest that the administration of CS in oral surgery decreases edema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.
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Affiliation(s)
- Anne E B Dan
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Garg AK. Pharmacological Agents in Implant Dentistry. IMPLANT DENT 2010. [DOI: 10.1016/b978-0-323-05566-6.00010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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A randomized, double-blind, placebo-controlled study comparing the efficacy and safety of paracetamol, serratiopeptidase, ibuprofen and betamethasone using the dental impaction pain model. Int J Oral Maxillofac Surg 2009; 38:350-5. [DOI: 10.1016/j.ijom.2008.12.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 06/09/2008] [Accepted: 12/16/2008] [Indexed: 11/18/2022]
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Corticosteroids Reduce Postoperative Morbidity After Third Molar Surgery: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2008; 66:1881-94. [DOI: 10.1016/j.joms.2008.04.022] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/19/2008] [Accepted: 04/14/2008] [Indexed: 11/21/2022]
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Zandi M. Comparison of corticosteroids and rubber drain for reduction of sequelae after third molar surgery. Oral Maxillofac Surg 2008; 12:29-33. [PMID: 18600358 DOI: 10.1007/s10006-008-0096-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION For reducing edema, trismus, and pain after impacted tooth surgery, some protocols are proposed but their relative effectiveness is controversial. PURPOSE The goal of this study was to evaluate and compare the effects of corticosteroids and rubber drain on the postoperative complications of impacted molar surgery. PATIENTS AND METHODS This study was carried out on 22 patients with bilateral symmetrical mandibular impacted third molars. For surgical removal of impacted teeth on one side of these patients, either rubber drain (11 cases) or perioperative corticosteroids (11 cases) were used (study group). The contralateral impacted teeth were removed routinely without using any drug or drain (control group). Facial edema, trismus, and pain perception of the study and control groups were recorded on the second and seventh postoperative days. RESULTS AND DISCUSSION This study showed that perioperative steroids reduce the trismus, facial swelling, and the severity of pain after third molar surgery. This study also revealed that the use of the drain reduces facial pain and trismus but has no effect on the facial swelling after impacted tooth surgery. Comparing the steroid and drain groups, we found that perioperative corticosteroids are more effective than the surgical drain in reducing postoperative pain and edema, but their effects on trismus are similar.
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Affiliation(s)
- Mohammad Zandi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hamedan University of Medical Sciences, Shahid Fahmideh Street, Hamedan, Iran.
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Vegas-Bustamante E, Micó-Llorens J, Gargallo-Albiol J, Satorres-Nieto M, Berini-Aytés L, Gay-Escoda C. Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars. Int J Oral Maxillofac Surg 2008; 37:260-3. [PMID: 18296027 DOI: 10.1016/j.ijom.2007.07.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 06/01/2007] [Accepted: 07/13/2007] [Indexed: 11/16/2022]
Abstract
The aim of this study was to demonstrate the efficacy of methylprednisolone, as a single 40-mg dose, injected into the masseter muscle upon completion of extraction of impacted lower third molars. A prospective, randomized cross-over study was made of 35 healthy patients. The difficulty of extraction was similar in all cases. The study group received 40 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound. The control group received no intramuscular corticoid. Evaluations were made of postoperative pain, trismus and swelling. Oral aperture was measured, along with the following distances for the assessment of swelling: tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye, before and 2 and 7 days after surgery. The patients administered methylprednisolone showed superior results after surgery in terms of oral aperture, pain and all the facial swelling parameters, with statistically significant differences versus the controls (p<0.05). The results obtained show that 40 mg of methylprednisolone injected into the masseter muscle in the immediate postoperative period reduces swelling, trismus and pain.
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Affiliation(s)
- E Vegas-Bustamante
- Oral Surgery and Orofacial Implantology, School of Dentistry of the University of Barcelona, Spain
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