Preemptive Effect of Dexamethasone in Third-Molar Surgery: A Meta-Analysis

Abstract

The aim of the present study was to assess the effectiveness of preemptive dexamethasone in surgery of the lower third molars and to compare it with other oral anti-inflammatories. An electronic search was conducted for preemptive effects related to lower third-molar surgery in 3 separate databases. The variables pain, swelling, and trismus were assessed. Meta-analysis was used to calculate the pooled effect measures for mean and standard deviation values (95% confidence interval [CI]). Seven split-mouth clinical trials were selected. Two studies were included in the meta-analysis. Three studies showed a low risk of bias; 2 studies exhibited a moderate risk and 2 a high risk of bias. Dexamethasone was better than nonsteroidal anti-inflammatories for preemptive effectiveness. Meta-analysis for swelling confirmed better results for dexamethasone than for methylprednisolone after 2 days (95% CI = -1.28 to -0.38), 4 days (95% CI = -1.65 to -0.71), 7 days (95% CI = -1.42 to -0.71), and overall (95% CI = -1.25 to -0.72). Dexamethasone was better than methylprednisolone for mouth opening after 4 days (95% CI = 0.18 to 1.07). There is insufficient evidence through meta-analysis to conclude that dexamethasone is better than other nonsteroidal anti-inflammatories or methylprednisolone as a preemptive analgesic. The results of this meta-analysis suggest that dexamethasone is more effective than methylprednisolone for swelling and trismus.

Is bromelain effective in controlling the inflammatory parameters of pain, edema, and trismus after lower third molar surgery? A systematic review and meta‐analysis

“…A significant number of studies support the use of corticosteroids in third molar surgical removal (Alcântara, Falci, Oliveira‐Ferreira, Santos, & Pinheiro, ; Falci, Lima, Martins, Santos, & Pinheiro, ; Lima, Bagordakis, Falci, Dos Santos, & Pinheiro, ); however, few scientific evidences report the anti‐inflammatory efficacy of natural products in this procedure (Kaziro, ; Macedo, Carvalho, Ferreira, & dos Santos‐Pinto, ). As the systematic reviews with meta‐analysis are the top in the hierarchy of the clinical evidence (Izzo, Hoon‐Kim, Radhakrishnan, & Williamson, ), this paper highlights the effect of bromelain in 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.

“…Multiple clinical trials have shown that the effect of corticosteroids in the control of complications after third molar surgery is superior to that of NSAIDs. 11,15,16 Dexamethasone has two mechanisms of action that inhibit the inflammatory process. The first one is a genomic mechanism (slow-acting) that involves the diffusion of corticosteroid molecules through the cell membrane and binding with the cytosolic receptors GR-α and GR-ß for their subsequent transport to the nucleus, where they bind to specific DNA sequences and promote the expression of mRNA and subsequent synthesis of anti-inflammatory proteins.…”

“…In their systematic review, Falci et al, 11 report that preventive use of NSAIDs does not significantly reduce postoperative pain in third molar surgery compared to corticosteroids such as dexamethasone, because of the latter's anti-inflammatory effectiveness. Likewise, they describe that preventive corticosteroid analgesia is based on its mechanism of action, as it affects the initial stage of inflammatory response.…”

“…In this study, the highest degree of postoperative pain intensity was recorded 6 hours after the surgical procedure, resolving almost completely by the seventh day; confirming what has been reported in various studies. 11,17,20 Limitations of this study include the realization that a patient's facial pattern type (mesofacial, dolichofacial and brachifacial) is important in order to standardize facial edema and obtain more accurate results, either by taking photographs or via radiographic analysis. In this study, postoperative and preoperative measurements and their differences were used in order to diminish the effect of this limitation.…”

“…4 The literature recommends 8mg dexamethasone, 1 hour before the surgical procedure. 10,11 These protocols are based on numerous clinical trials; however, there is insufficient scientific evidence to reach a consensus regarding the anti-inflammatory effectiveness of dexamethasone in mandibular third molar surgery, when using the same dose and route at different administration times. Considering the above, the aim of the present research was to compare the antiinflammatory effectiveness of dexamethasone as presurgical and post-surgical therapy in mandibular third molar surgery.…”