Effect of Submucosal Injection of Dexamethasone on Postoperative Discomfort After Third Molar Surgery: A Prospective Study

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Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 11, Pages 2218-2226 (November 2007)

Effect of Submucosal Injection of Dexamethasone on Postoperative Discomfort After Third Molar Surgery: A Prospective Study

Giovanni Battista Grossi, DMD, DDS, MD⁎, Carlo Maiorana, DDS, MD‹, Rocco Alberto Garramone, DDS, MD·, Andrea Borgonovo, DMD, MD?, Mario Beretta, DDS∥, Davide Farronato, DDS?, Franco Santoro, DDS, MD#

Purpose
The purpose of this study was to evaluate the effect of submucosal administration of dexamethasone sodium phosphate on discomfort after mandibular third molar surgery.

Patients and Methods
Sixty-one consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly placed into 3 groups. After the onset of local anesthesia, the experimental groups received dexamethasone at 2 different doses (4 or 8 mg) as submucosal injection, and the control group received no drug. Standardized surgical and analgesic protocols were followed. Maximum interincisal distance and facial contours were measured at baseline and at postsurgery days 2 and 7. Pain was objectively measured by counting the number of analgesic tablets required. The patientsÌ perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale).

Results
On the second postoperative day, facial edema showed a statistically significant reduction in both dexamethasone 4-mg and dexamethasone 8-mg groups compared with the control group, but no statistically significant differences were observed between the 2 dosage regimens of dexamethasone. By contrast, there was no statistically significant difference between all groups when postoperative swelling was evaluated at day 7 (P > .50). The treatment group had a limited and nonsignificant effect on pain and trismus when compared with the control group at the 2 times of evaluation.

Conclusions
Parenteral use of dexamethasone 4 mg, given as an intraoral injection at the time of surgery, is effective in the prevention of postoperative edema. Increasing the dose to 8 mg provides no further benefit.

⁎ Clinical Assistant Professor, Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy.

‹ Associate Professor, Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy.

· Resident, Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy.

? Resident, Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy.

∥ Resident, Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy.

? Resident, Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy.

# Department Head, Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy.

Address correspondence and reprint requests to Dr Grossi: Department of Oral Surgery, School of Dentistry, Istituti Clinici di Perfezionamento, Via Commenda no. 10, Milano 20122, Italy

© 2007 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.