Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction

Abstract

Aim. To evaluate the effect of preoperative versus postoperative administration of oral Dexamethasone on postoperative complications including pain, edema, and trismus following lower third molar surgery. Methods. 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one hour preoperatively and the other group immediately after surgery. Pain was measured using VAS, edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening was measured using a graduated sliding caliper. Results. In this study pain and trismus records were similar and statistically nonsignificant in both groups. The results had proven that preoperative administration was superior when compared to postoperative administration regarding edema (0.002). Conclusions. Preoperative oral administration of 8 mg Dexamethasone was superior to the postoperative administration of the same dose concerning edema after lower third molar surgery.

Comparison of the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery: A randomized clinical trial.

“…These results are similar to those reported by Graziani et al, 24 Lima et al, 16 and Al-Shamiri et al, 25 which showed that pre-surgical oral administration of 8mg dexamethasone produced a significantly greater reduction in swelling compared to postoperative administration after the first hour, and on the first and third post-surgical days.…”

“…Inhibition of phospholipase A2 reduces arachidonic acid release, decreasing the levels of vasoactive substances: prostaglandins and leukotrienes. 4,6 These results differ with Al-Shamiri et al, 25 as their study showed that preoperative dexamethasone medication increased its analgesic effect, according to the VAS, and achieved significantly higher efficacy on the third day (2.6mm ± 1.5mm), compared to the group that received postoperative dexamethasone (3.2mm ± 1.5mm); p=0.008. Similarly, Boonsiriseth et al, 28 reported a similar analgesic effect on the first day after immediate post-surgical administration of intramuscular (20.8mm ± 21.3mm) and oral (22.4mm ± 24mm) dexamethasone, increasing progressively until the seventh postoperative day (2.2mm ± 5.5mm and 4.7mm ± 1.21mm; respectively); p>0.05.…”

“…However, these differences were not significant, coinciding with the clinical trials conducted by Moore et al, 29 which showed that the group that received preoperative rofecoxib and intraoperative dexamethasone had a mouth opening reduction of only 23.7%, compared to the placebo group, which showed a 43.2% reduction; p>0.05. Al-Shamiri et al, 25 reported that the group of post-surgical dexamethasone recorded higher mouth opening levels on the second day evaluation (34.6mm±8.2mm), compared to the preoperatively medicated group (32.2mm ± 5.7mm); p=0.412.…”

Efectividad antiinflamatoria de la dexametasona más complejo b en la cirugía de terceras molares inferiores. Un ensayo clínico controlado aleatorizado paralelo a doble ciego

“…El tercer molar mandibular es el diente impactado más comúnmente encontrado en los seres humanos [1][2][3][4][5][6] y a menudo es tratado con una exodoncia quirúrgica, convirtiéndose así en una de las intervenciones más frecuentes en cirugía oral 1,[7][8][9][10][11][12][13][14] . Se sabe que cada cirugía conlleva riesgos y que la exodoncia quirúrgica de terceros molares se relaciona a menudo con secuelas posquirúrgicas importantes 1,[7][8][9][10][11][12][13]15,16 . Esta exodoncia varía en dificultad y en el grado de trauma causado a los tejidos circundantes.…”

“…Esta exodoncia varía en dificultad y en el grado de trauma causado a los tejidos circundantes. Por ello se requiere un conocimiento confiable de la profundidad y angulación de estas piezas dentales y su relación con las estructuras vitales circundantes, así como el manejo profesional de las complicaciones quirúrgicas asociadas 1,[7][8][9]11,13,15,17 .…”