JADA+ Clinical Scan: Submucosal dexamethasone reduces pain, swelling, and trismus after impacted third-molar extraction
June 19, 2017
By Romina Brignardello-Petersen, DDS, MSc, PhD
Mojsa IM, 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(4):524-530. http://dx.doi.org/10.1016/j.ijom.2016.11.006.
The main clinical concerns of patients undergoing third-molar extraction are postoperative pain, swelling, and trismus. Oral health care professionals performing extractions look for strategies to decrease these complications.
The researchers conducted this randomized clinical trial to determine the effectiveness of submucosal dexamethasone before or after surgery in reducing pain, swelling, and trismus in patients undergoing impacted third-molar extractions,* as part of an orthodontic treatment plan. The researchers recruited 90 participants††
and assigned them to receive either submucosal dexamethasone before or after surgery or a placebo.‡
Participants who received dexamethasone after the surgery had a mean pain score ranging from 0 through 1 on a 0 through 10 scale, with higher scores representing more pain; participants who received preoperative dexamethasone had a mean pain score ranging from 1 through 3; and patients who received placebo had a mean pain score ranging from 1 through 4.§
Participants who received the placebo had statistically significant more swelling (up to 3 days after surgery) and trismus (up to 7 days after surgery) than participants who received dexamethasone before or after surgery. However, there were no statistical differences in swelling and trismus between participants who received dexamethasone before or after the surgery. No infections or adverse events were reported.
Strengths and limitations.
This randomized clinical trial had a low risk of bias. The random allocation of patients to the groups and scheduled blinding were performed appropriately. This resulted in groups that were balanced regarding prognostic factors that could have influenced the outcomes at the beginning of the study. The participants and the clinicians performing the procedures and measuring the outcomes were blinded, making it likely that the prognostic balance was maintained. There were no losses to follow-up. Therefore, we are confident that the observed differences between the groups were due to the intervention. One limitation is how the results were reported. Researchers used graphs to show the results, and it was hard to make conclusions about the actual differences between groups and to determine whether such differences were not only statistically significant but also important to patients. In addition, to make the results more applicable to clinical practice, the swelling and trismus measurements could have been supplemented with the patients' perspectives.
* Inclusion criteria were participants with a partially or totally impacted third molar with no inflammation around the tooth.
† 64.4% female; median age, 23.5 years, range 18 to 42 years.
‡ Group 1: 1 milliliter of dexamethasone (4 milligrams per mL) 15 minutes before the surgery plus 1 mL of placebo 15 minutes after the surgery; group 2: 1 mL of the placebo 15 minutes before the surgery plus 1 mL of dexamethasone 15 minutes after the surgery; group 3: 1 mL of the placebo 15 minutes before plus 1 mL of the placebo 15 minutes after the surgery.
§ Differences between postoperative dexamethasone and the other groups were statistically significant, and the differences between preoperative dexamethasone and placebo were not. Pain was measured up to 24 hours.
Dr. Brignardello-Petersen did not report any disclosures.