The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery

Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial

Background The surgical removal of mandibular third molars is one of the most common procedures in dentistry. Researchers have extensively studied the treatment of postoperative sequelae such as pain, edema, trismus, and alveolar osteitis throughout the past six decades. Many approaches have been used to address clinical difficulties after third molar surgery, including various flap designs and irrigating solutions. The aim of this study was to compare the effects of three irrigating solutions, hydrocortisone, povidone-iodine, and normal saline, on pain, trismus, and edema following surgical removal of the impacted mandibular third molar. Methodology The study involved 105 participants who required surgical extraction of mandibular third molars. The patients' ages ranged from 18 to 40 years, and they fulfilled the inclusion criteria. Using a simple random sampling technique, they were divided into three groups (group 1: hydrocortisone, group 2: povidone-iodine, group 3: normal saline). The parameters evaluated were edema, pain, and trismus on the second and seventh postoperative days. All data were input into Microsoft Excel (Microsoft® Corp., Redmond, USA) worksheets and analyzed using Stata 17.0 (StataCorp LLC, College Station, USA). The visual analog scale (VAS) score was used to measure postoperative pain, and postoperative swelling was measured using linear measurements from four fixed anatomical points and compared to preoperative values. To assess trismus, the inter-incisal distance was measured in millimeters with a caliper. A p-value of <0.01 was considered statistically significant. Results The mean VAS score for pain in group 1 was lower than the other two groups. The effect of group 1 was significant on the second postoperative day but insignificant on the seventh postoperative day for swelling. The effect of all three groups on trismus was significant on the second and seventh days. Conclusions Hydrocortisone as an irrigating solution showed promising results in managing postoperative swelling in the first 48 hours, but its effect gradually declined by the seventh postoperative day. Additionally, it was effective in controlling postoperative pain and trismus. This suggests that utilizing hydrocortisone as an irrigating solution, compared to povidone-iodine, has been proven to be a significantly effective option in reducing postoperative pain, edema, and trismus resulting from the surgical removal of impacted teeth.

Does Betamethasone Injection Into the Pterygomandibular Space Affect the Postoperative Outcomes of Impacted Lower Third Molar Surgery?

BACKGROUND

Pain, swelling, and trismus are common outcomes following impacted lower third molar surgery.

PURPOSE

The purpose of the study was to evaluate the effect of betamethasone injection into the pterygomandibular space on the aforementioned sequelae of third molar surgery.

STUDY DESIGN, SETTING, AND SAMPLE

A split-mouth, double-blind, randomized clinical trial was conducted on 40 patients with symmetrical bilateral impacted lower third molars. The surgeries were performed at an outpatient clinic under local anesthesia.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

The predictor variable is the steroid treatment. The experimental group received a 1 mL (6 mg) betamethasone injection into the pterygomandibular space, while the control group received a normal saline.

MAIN OUTCOME VARIABLE(S)

The primary outcome variable was postoperative pain assessed using a visual analog scale. The secondary outcome variables were the number of analgesic tablets consumed, facial swelling, and trismus.

COVARIATES

The age and sex of the patients, the direction of impaction, and the duration of surgery were recorded.

ANALYSES

Comparisons between the groups were carried out using an unpaired t test. An analysis of variance test was used to assess intragroup differences. The significance was considered at P ≤ .05.

RESULTS

Of the 265 patients initially screened for study enrollment, the final sample included 40 subjects, with a mean age of 28.3 years (±7.4), 28 (70%) were mal and 12 (30%) were female. There was no significant difference between the two groups concerning postoperative pain or the number of consumed analgesic tablets. However, the betamethasone group exhibited significantly reduced facial swelling and increased mouth opening. On the first postoperative day, the visual analog scale pain score did not significantly differ between the betamethasone group (6.0 ± 1.7) and the control group (6.8 ± 1.4), with a P value of 0.112. On the first postoperative day, facial swelling measured 4.2 ± 1.3 mm in the betamethasone group compared to 6.0 ± 0.9 mm in the control group (P < .001). Mouth opening in the betamethasone group was 30.8 ± 6.7 mm, while in the control group, it measured 21.9 ± 5.5 mm (P < .001).

CONCLUSION AND RELEVANCE

Local betamethasone has no effect on pain after third molar surgery, but facial swelling and trismus are significantly reduced.

The Comparative Effects of Dexamethasone, Nanocurcumin, and Coenzyme Q10 Against Lumbar Laminectomy-Induced Epidural Fibrosis in a Rat Model

BACKGROUND

One of the major problems in neurosurgical procedures is fibrosis formation. Therefore, the prevention of fibrosis is an important issue in spinal cord injury that needs to be addressed. No approved therapy has yet been found, and epidural fibrosis (EF) is a huge treatment challenge. In this regard, new drugs that can effectively prevent EF are still being considered. Hence, this study aimed to investigate the effects of dexamethasone (DEX), nanocurcumin (Nano-CUR), and coenzyme Q10 (CoQ10) on the prevention of EF in a rat laminectomy model.

METHODS

Thirty-five Sprague-Dawley male rats were randomly divided into 5 groups: sham group, laminectomy group, laminectomy + DEX group, in which 0.5 ml DEX (8 mg/ml) was applied locally on the laminectomy area, laminectomy + Nano-CUR group, in which 100 mg/kg Nano-CUR was administered intraperitoneally once a day for 7 days, and laminectomy + CoQ10 group, in which 30 mg/kg CoQ10 was administered once daily intraperitoneally for 7 days. After 4 weeks, the vertebral columns were removed from L1 and L3 and prepared for histopathological assays.

RESULTS

The local administration of DEX could not improve the histological parameters, and EF was induced by laminectomy after 4 weeks. On the other hand, Nano-CUR could ameliorate EF at the laminectomy site compared to the laminectomy group, but the difference was not statistically significant. CoQ10 significantly reduced EF (P < 0.05), collagen density (P < 0.01), and inflammation in the arachnoid layer (P < 0.01).

CONCLUSIONS

Our findings showed that Nano-CUR and CoQ10 had the potential to be used for treatment of EF.

Intra-socket application of Hyaluronic acid reduces pain and swelling following wisdom teeth removal

Background: Hyaluronic acid (HA) has the potential to promote wound healing. Pain and swelling with trismus are common sequalae post wisdom teeth removal. This study aims to investigate the effectiveness of intra-socket HA solution to reduce these uncomfortable post-operative events. Materials and methods: 30 patients underwent bilateral extractions of mandibular wisdom teeth for this study. Intra-socket application of 0.7 ml 20 mg/2 ml HA solution (Hyalgun) with Gel foam as a scaffold in study site versus Gel foam only on control site was conducted via a split mouth study design. Data collection of five facial reference points for swelling and maximum mouth opening was recorded during the pre-operative period and post-operative 2nd and 7th day. The VAS pain score at post-op 1st, 2nd and 3rd day and the number of analgesics for the 7-day post-operative duration were evaluated. Results: The HA group demonstrated statistically significant less swelling, trismus and analgesia consumption on the 2 and 7 days after surgery. VAS scores on day 1, 2 and 3 after surgery (P = 0.05) were significantly less in the HA group compared to the control group. Conclusion: The application of intra-socket HA has a positive effect for reducing postoperative pain and swelling with trismus after the lower third molar intervention (LTMI).

Effectiveness of dexamethasone or adrenaline with lignocaine 2% for prolonging inferior alveolar nerve block: a randomized controlled trial

Objectives

Inferior alveolar nerve block (IANB) is commonly used for mandibular dentoalveolar surgery. The objective of this study was to evaluate and compare the effectiveness of coadministration of dexamethasone (4 mg/mL) or adrenaline (0.01 mg/mL) as an adjuvant with lignocaine 2% in IANB during third molar surgery (TMS).

Patients and Methods This double-blind, randomized controlled trial was conducted between March and August 2020. The investigators screened patients needing elective TMS under local anesthesia. Based on strict inclusion and exclusion criteria, patients were enrolled in this study. These patients were assigned randomly into two study groups dexamethasone group (DXN) or adrenaline group (ADN). Outcome variables were postoperative edema, trismus, visual analogue scale (VAS), perioperative analgesia, onset time, and duration of IANB.

Results

Eighty-three patients were enrolled in this study, of whom 23 (27.7%) were eliminated or excluded during follow-up. This study thus included data from 60 samples. Mean age was 32.28±11.74 years, including 28 females (46.7%) in the ADN (16 patients, 57.1%) and DXN (12 patients, 42.9%) groups. The duration of action for DXN (mean±standard deviation [SD], 40207±03401 hours; standard error [SE], 00600 hours; log-rank P=0.001) and for ADN (mean±SD, 15834±02452 hours; SE, 00442 hours; log-rank P=0.001) were found. Similarly, time at which 1st analgesic consume and total number of nonsteroidal antiinflammatory drugs need to rescue postoperative analgesia was found statistically significant between study groups (t (58)=–11.95; confidence interval, –22541 to –14353; P=0.001). Early-hours VAS was also significantly different between the study groups.

Conclusion

A single injection of dexamethasone prolongs the duration of action of lignocaine 2% IANB. Additionally, it can be used in cases where adrenaline is contraindicated.

Sub-mucosal dexamethasone for post-operative pain and oedema control in lower third molar surgery

Background:

Surgical excision of the problematic mandibular third molars causes substantial tissue damage and an inflammatory response. Discomfort and edema are common postoperative signs and symptoms caused by the latter. To find out whether dexamethasone may help with the edema and pain that come along with the surgical removal of impacted mandibular third molars, researchers have performed clinical studies.

Methods:

Twenty individuals with bilaterally affected mandibular third molars who were scheduled for extraction participated in a prospective trial. At two separate sessions, teeth were raised and cut after buccal ostectomy. Since the surgical operation on the left foot, both patients were administered a mixture of 4 mg dexamethasone submucosal injection and antibiotics for 3 days. On the 1^st, 3^rd, and 7^th postoperative days, edema and pain were assessed.

Results:

At the 1^st, 3^rd, and 7^th postoperative days, there was a clinically meaningful decrease in the level of edema and discomfort in both arms.

Conclusions:

The current report offers empirical proof that administering a 4 mg dexamethasone submucosal injection during surgery greatly reduced post-surgical edema and discomfort.

Anesthetic efficacies of buccal with palatal injection versus buccal with intra-septal injection in permanent maxillary first molars of pediatric patients

The high success rate of dental treatment is dependent on the cooperation of pediatric patients during procedures. Dental treatment often causes pain, particularly in children. The factors in providing treatment to pediatric patients include the characteristics and location of the tooth, profoundness of the anesthesia including the type of local anesthetic, and cooperation of the patient. Previous studies have examined several techniques to successfully achieve profound pulpal anesthesia in maxillary permanent teeth. The dentist should select the injection technique to be used based on patient needs. In children, either buccal with palatal injections or buccal with intra-septal injections may be used to anesthetize the permanent maxillary first molar. Buccal with palatal injections are commonly used prior to routine maxillary dental procedures. Currently, there are only a few studies on the employment of buccal with intra-septal injections to anesthetize permanent maxillary first molars in pediatric patients. This review will focus on efficacy of buccal with palatal versus buccal with intra-septal pulpal anesthesia of the permanent maxillary first molars in pediatric patients and aim to determine which technique should be used during routine dental procedures.

Review of dexamethasone administration for management of complications in postoperative third molar surgery

Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.

Comparing the Effect of Facial Compression Bandage to That of Systemic Dexamethasone on Postsurgical Sequels after Extraction of Impacted Mandibular Third Molars: A Split-mouth Randomized Clinical Trial

AIM: The present study aimed to compare the clinical efficiency of facial pressure bandage, to that of intramuscular injection of dexamethasone (8 mg) on postsurgical sequels (swelling, pain, and trismus) of extraction of impacted mandibular third molar. METHODS: The study implemented a randomized split-mouth design. Patients with symmetrical bilateral impacted molars were eligible for the present trial. Sides were randomly assigned to two groups: pressure bandage group and dexamethasone group. The evaluated postsurgical sequels were extraoral swelling, trismus, and pain after 48 h and 7 days. RESULTS: The study included 42 impacted third molars (n = 42) in 21 patients with a mean age of 23.4 years. Most participants were females (66.7%). The mean postoperative swelling rates after 48 h and 7 days in pressure bandage group were found to be comparable to those of dexamethasone group. No significant difference was found in the mean rates of postoperative trismus between study groups after 48 h and 7 days. Differences in mean pain level scores between the pressure bandage group and dexamethasone group were statistically insignificant after 48 h and 7 days. CONCLUSION: The study findings showed that the effect of the pressure bandage was comparable to dexamethasone effect on the postsurgical sequels after surgical extraction of impacted mandibular third molars.

Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial

Background

Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain.

Methods

A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7.

Results

The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001).

Conclusion

The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery.

Trial registration: NCT04889781 (https://clinicaltrials.gov/), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1

Alternatives to opioids for acute pain management after dental procedures: A Department of Veterans Affairs consensus paper

BACKGROUND

Opioid misuse is a widespread public health problem, and opioids are often prescribed in the dental environment. These recommendations provide alternatives to opioids to reduce or eliminate dental procedure-related acute pain.

METHODS

A multidisciplinary working group developed these clinical recommendations to specifically address procedure-related acute pain. These recommendations, which are based on published peer-reviewed research and guidelines, include therapies used before, during, and after dental procedures. When evidence is not definitive, the best practices, which are based on experts' consensus, are included. The recommendations are not intended to be exhaustive.

RESULTS

These recommendations are a summary of the evidence and best practices for opioid alternatives to treat acute pain related to dental procedures.

CONCLUSIONS

Dental providers should prioritize opioid stewardship when managing procedure-related pain with strategies such as thorough preprocedure pain assessment, minimally invasive techniques, preemptive analgesia, intraprocedure pain management, and appropriately selected postprocedure pharmacologic therapy.

PRACTICAL IMPLICATIONS

These recommendations are a concise resource for clinical providers. It is important to address patients' procedure-related pain, using nonopioids whenever possible. Alternatives are outlined, allowing providers to make informed decisions.

Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management

Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.

Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial

Background

The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3).

Material and Methods

Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval.

Results

Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00).

Conclusions

The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo.

Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.

Comparative efficiency of the preoperative pterygomandibular space injection of two doses of dexamethasone in mandibular third molar surgery

BACKGROUND

Impacted mandibular third molar removal is one of the most commonly performed oral surgical procedures. This procedure can lead to several postoperative complications, such as trismus, facial swelling, and pain, which occur as a result of the inflammatory responses to surgery. This study compared the efficiency of preoperative injections of 4 mg versus 8 mg dexamethasone into the pterygomandibular space to reduce postoperative sequelae.

METHODS

This was a randomized, prospective, split-mouth, controlled study, including 52 mandibular third molar surgeries in 26 patients. Each patient was randomized to either the 4 mg or 8 mg dexamethasone injection group. Dexamethasone was injected into the pterygomandibular space after numbness from local anesthesia. Data were collected for trismus, facial swelling, visual analog scale (VAS) pain score, and the number of analgesics taken during the evaluation period. The level of significance was set at P < 0.05.

RESULTS

Statistically significant differences in postoperative facial swelling (P = 0.031, diff = 1.4 mm) and pain (P = 0.012, diff = 0.020) were found between the 8 mg and 4 mg dexamethasone groups. However, there were no significant differences between the groups for trismus and the total number of analgesics consumed (P > 0.05).

CONCLUSION

Compared to the 4 mg preoperative dexamethasone injection, the 8 mg preoperative dexamethasone injection into the pterygomandibular space was more effective in reducing postoperative swelling and pain following the surgical removal of the impacted mandibular third molar. However, the difference in trismus could not be evaluated clinically. Therefore, the recommendation of administering the 4 mg dexamethasone preoperative injection is optimal in the third molar surgical procedure.

Effectiveness of dexamethasone injection in the pterygomandibular space before and after lower third molar surgery

Background

Previous studies have investigated the effects of dexamethasone injections into the pterygomandibular space and compared them to those of controls; however, the effects of dexamethasone injections before and after lower third molar surgery on postoperative complications have not been studied. This research investigated the postoperative sequelae of dexamethasone injections before and after surgery into the pterygomandibular space. The aim of this study was to evaluate the effects of preoperative and postoperative injections of 4 mg of dexamethasone into the pterygomandibular space on postoperative pain, facial swelling, and the restriction of mouth opening following lower third molar surgical removal.

Methods

Twenty-seven participants with bilateral symmetrical lower impacted third molars were included in this study. Each participant was randomly allocated to one of two groups. Group A received injections of 1 ml dexamethasone (4 mg/mL) and 1 mL placebo into the pterygomandibular space before and after surgery, respectively. Group B received the same doses of placebo before surgery and dexamethasone after surgery.

Results

A significant restriction of mouth opening on the second postoperative day was observed in both groups. Nonetheless, the postoperative restriction of mouth opening, facial swelling, postoperative pain, and analgesic consumption after lower third molar surgical removal were not significantly different in the two groups.

Conclusions

Regardless of the time of administration, dexamethasone injections into the pterygomandibular space resulted in satisfactory control of the postoperative sequelae of the mandibular third molar surgical removal.

Effect of antiseptic gels in the microbiologic colonization of the suture threads after oral surgery

Three different bioadhesive gels were evaluated in a double-blind randomized clinical trial in which microbial growth in the suture thread was assessed following post-surgical application of the aforementioned gels. Also assessed in this trial were, the intensity of post-surgical pain as well as the degree of healing of the patients’ surgical wounds. A total of 21 patients (with 42 wisdom teeth) participated in this trial. Chlorhexidine gel, chlorhexidine-chitosan gel, and hyaluronic acid gel were evaluated, with a neutral water-based gel serving as the control agent. The aerobic and facultative anaerobic bacterial recovery on blood agar was lower in the placebo group than in the experimental groups. The most significant difference (p = 0.04) was observed in the chlorhexidine-chitosan group. in which the growth of Blood Agar and Mitis Salivarius Agar was significantly higher than in the placebo group. The intensity of post-surgical pain was very similar among all the groups. Significantly better healing rates were observed in the patients treated with chlorhexidine-chitosan gel when compared with those who used the placebo gel (p = 0.03), and in particular when compared with those patients who used hyaluronic acid gel (p = 0.01). Through our microbiological analyses, we were able to conclude that none of the bioadhesive gels tested resulted in beneficial reductions in the bacterial/fungal populations. However, the healing rates of patients who were treated with chlorhexidine-chitosan were better than those of the patients who used either the placebo gel or the hyaluronic acid gel.

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

Introduction:

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

Methods:

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

Results:

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

Conclusion:

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

Dexamethasone Injection Into Pterygomandibular Space Versus Sublingual Space on Post-Operative Sequalae of Lower Third Molar Intervention

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.

The efficacy of curcumin in managing acute inflammation pain on the post-surgical removal of impacted third molars patients: A randomised controlled trial

Curcumin is a turmeric-contained active ingredient that has been proven to be effective in treating pain and inflammation due to its analgesic as well as anti-inflammation potential. Odontectomy, on the other hand, has been well known for its post-procedure acute inflammation pain. The aim of the current study was to evaluate the efficacy of curcuminoid in treating acute inflammation post-operative pain in the post-surgical removal of impacted third molars patients. Ninety (44 males; 46 females) participants were recruited in this randomised controlled trial and randomly assigned to the control group (those who consumed mefenamic acid) or the experimental group (those who consumed curcumin). Numeric rating scale (NRS) was used as an evaluation tool to evaluate the intensity of the pain experienced by the participants. Pain evaluation was performed immediately after anaesthesia effect disappeared (T₀ ) and an hour after participant took their first (T₁ ), second (T₂ ) and third (T₃ ) course of drugs. All data were collected and analysed using Wilcoxon-Mann-Whitney test. The current study showed that participants in both groups experienced significantly (P < .01) less pain compared to their initial pain level. In addition, when the two groups were compared, it was revealed that those in the treatment group experienced even significantly (P < .01) less pain compared to those in the control group. It can be concluded that curcumin is effective in treating acute inflammation pain in the post-surgical removal of impacted third molars patients.

4% lidocaine versus 4% articaine for inferior alveolar nerve block in impacted lower third molar surgery

Background

No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars.

Method

This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded.

Results

The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences.

Conclusion

The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.

Decreased post-operative pain using a sublingual injection of dexamethasone (8 mg) in lower third molar surgery

Background

Every patient who undergoes mandibular third molar surgery is concerned about post-operative pain. Indeed, previous researchers have used various methods to treat such pain. This study aimed to assess the effectiveness of sublingual injection of dexamethasone (8 mg) to treat post-operative pain after mandibular third molar surgery.

Method

This was a randomized, double-blind, split-mouth, clinical trial, involving 48 healthy patients who required surgical removal of two mandibular third molars with similar bilateral positions. All operations were performed by the same experienced surgeon. The patients were randomized into a study group (8 mg dexamethasone injection) and a placebo group (normal saline injection). Both interventions were injected into the sublingual space immediately after local anesthesia, 30 min before the first incision. The study group received an 8 mg dexamethasone injection, while the placebo group received a normal saline injection. The wash period between the patients' two operations was 3 to 4 weeks. Pain was assessed by recording the number of analgesic tablets (rescue drug) consumed, as well as by noting the patients' responses to the visual analog scale (VAS) on the first, second, and third days after surgery.

Results

The study group differed significantly from the placebo group in terms of VAS score and analgesic consumption.

Conclusion

Dexamethasone (8 mg), injected sublingually, significantly eased post-operative pain after surgical removal of the mandibular third molar.