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Third Molar Surgery Outcomes: A Randomized Clinical Trial Comparing Submucosal and Intravenous Dexamethasone.

Adelyn Ai Lyn Lau¹, Rohana Kumara De Silva², Murray Thomson³

¹Specialist Oral Surgeon - Private Practitioner, Faculty of Dentistry, University of Otago, Department of Oral Diagnostics and Surgical Sciences, Dunedin, New Zealand.

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons

|October 15, 2020

Summary

Submucosal and intravenous dexamethasone show similar efficacy in reducing swelling, pain, and trismus after third molar surgery. This study highlights submucosal dexamethasone as a viable alternative for pain management.

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Area of Science:

Oral and Maxillofacial Surgery
Pharmacology
Clinical Trials

Background:

Third molar surgery frequently leads to post-operative swelling, pain, and trismus, negatively impacting patient quality of life.
Dexamethasone is often used to manage these post-surgical sequelae.
Comparing different administration routes of dexamethasone is crucial for optimizing patient care.

Purpose of the Study:

To compare the efficacy of submucosal (SM) dexamethasone versus intravenous (IV) dexamethasone in mitigating swelling, pain, and trismus after third molar extraction.
To evaluate the impact of both administration routes on patients' oral health-related quality of life.

Main Methods:

A randomized, controlled, double-blinded trial involving 130 participants undergoing mandibular third molar removal.
Participants were allocated to receive either SM or IV dexamethasone.
Swelling was measured using 3D imaging, pain via a visual analog scale (VAS), and trismus by maximum incisal distances. Quality of life was assessed using the OHIP-14.

Main Results:

No statistically significant differences were observed between the SM and IV dexamethasone groups in terms of facial swelling (7.8 cm³ vs 7.3 cm³), pain scores (33 vs 31 on VAS), or maximum incisal distances (34.5 mm vs 33.7 mm) on day 2.
Both groups reported a similar decline in quality of life compared to baseline.

Conclusions:

Submucosal and intravenous dexamethasone provide comparable outcomes for managing swelling, pain, and trismus following third molar surgery.
Submucosal dexamethasone presents a simple and accessible option for steroid administration, particularly in patients receiving local anesthesia only.