Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지
DOI QR코드

DOI QR Code

Review of dexamethasone administration for management of complications in postoperative third molar surgery

  • Selvido, Diane Isabel (Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University) ;
  • Bhattarai, Bishwa Prakash (Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University) ;
  • Niyomtham, Nattisa (Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University) ;
  • Riddhabhaya, Apiwat (Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University) ;
  • Vongsawan, Kadkao (Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University) ;
  • Pairuchvej, Verasak (Thai Board of Oral & Maxillofacial Surgery) ;
  • Wongsirichat, Natthamet (Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University)
  • Received : 2020.09.12
  • Accepted : 2021.02.09
  • Published : 2021.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.

Keywords

References

  1. Mutlu I, Abubaker AO, Laskin DM. Narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons after impacted third molar removal. J Oral Maxillofac Surg 2013;71:1500-3. https://doi.org/10.1016/j.joms.2013.04.031
  2. Herrera-Briones FJ, Prados Sanchez E, Reyes Botella C, Vallecillo Capilla M. Update on the use of corticosteroids in third molar surgery: systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:e342-51. https://doi.org/10.1016/j.oooo.2012.02.027
  3. Antunes AA, Avelar RL, Martins Neto EC, Frota R, Dias E. Effect of two routes of administration of dexamethasone on pain, edema, and trismus in impacted lower third molar surgery. Oral Maxillofac Surg 2011;15:217-23. https://doi.org/10.1007/s10006-011-0290-9
  4. Kurihara A, Ohuchi K, Tsurufuji S. Reduction by dexamethasone of chemotactic activity in inflammatory exudates. Eur J Pharmacol 1984;101:11-6. https://doi.org/10.1016/0014-2999(84)90025-6
  5. Messer EJ, Keller JJ. The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surg Oral Med Oral Pathol 1975;40:594-8. https://doi.org/10.1016/0030-4220(75)90369-2
  6. Barnes PJ. Mechanisms and resistance in glucocorticoid control of inflammation. J Steroid Biochem Mol Biol 2010;120:76-85. https://doi.org/10.1016/j.jsbmb.2010.02.018
  7. Simone JL, Jorge WA, Horliana AC, Canaval TG, Tortamano IP. Comparative analysis of preemptive analgesic effect of dexamethasone and diclofenac following third molar surgery. Braz Oral Res 2013;27:266-71. https://doi.org/10.1590/S1806-83242013005000012
  8. Weber CR, Griffin JM. Evaluation of dexamethasone for reducing postoperative edema and inflammatory response after orthogna-thic surgery. J Oral Maxillofac Surg 1994;52:35-9. https://doi.org/10.1016/0278-2391(94)90010-8
  9. Dhanavelu P, Shanmugapriyan S, Ebenezer V, Balakrishnan B, Elumalai M. Dexamethasone for third molar surgery- a review. Int J Pharm Bio Sci 2013;4:9-13.
  10. Stanbury RM, Graham EM. Systemic corticosteroid therapy--side effects and their management. Br J Ophthalmol 1998;82:704-8. https://doi.org/10.1136/bjo.82.6.704
  11. Neupert EA 3rd, Lee JW, Philput CB, Gordon JR. Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal. J Oral Maxillofac Surg 1992;50:1177-82; discussion 1182-3. https://doi.org/10.1016/0278-2391(92)90149-t
  12. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 2013;110:191-200. https://doi.org/10.1093/bja/aes431
  13. Al-Shamiri HM, Shawky M, Hassanein N. Comparative assessment of preoperative versus postoperative dexamethasone on postoperative complications following lower third molar surgical extraction. Int J Dent 2017;2017:1350375. https://doi.org/10.1155/2017/1350375
  14. Takeuchi O, Akira S. Pattern recognition receptors and inflammation. Cell 2010;140:805-20. https://doi.org/10.1016/j.cell.2010.01.022
  15. Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget 2017;9:7204-18. https://doi.org/10.18632/oncotarget.23208
  16. Coulthard P, Esposito M, Renton TF, Worthington HV. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev 2003;(7):CD004345. https://doi.org/10.1002/14651858.cd004345
  17. Amaya F, Izumi Y, Matsuda M, Sasaki M. Tissue injury and related mediators of pain exacerbation. Curr Neuropharmacol 2013;11:592-7. https://doi.org/10.2174/1570159X11311060003
  18. Osunde OD, Adebola RA, Omeje UK. Management of inflammatory complications in third molar surgery: a review of the literature. Afr Health Sci 2011;11:530-7.
  19. Majid OW. Submucosal dexamethasone injection improves quality of life measures after third molar surgery: a comparative study. J Oral Maxillofac Surg 2011;69:2289-97. https://doi.org/10.1016/j.joms.2011.01.037
  20. Isik K, Unsal A, Kalayci A, Durmus E. Comparison of three pain scales after impacted third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:715-8. https://doi.org/10.1016/j.tripleo.2011.01.001
  21. Sirintawat N, Sawang K, Chaiyasamut T, Wongsirichat N. Pain measurement in oral and maxillofacial surgery. J Dent Anesth Pain Med 2017;17:253-63. https://doi.org/10.17245/jdapm.2017.17.4.253
  22. Laureano Filho JR, Maurette PE, Allais M, Cotinho M, Fernandes C. Clinical comparative study of the effectiveness of two dosages of dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Med Oral Patol Oral Cir Bucal 2008;13:E129-32.
  23. Gozali P, Boonsiriseth K, Kiattavornchareon S, Khanijou M, Wongsirichat N. Decreased post-operative pain using a sublingual injection of dexamethasone (8 mg) in lower third molar surgery. J Dent Anesth Pain Med 2017;17:47-53. https://doi.org/10.17245/jdapm.2017.17.1.47
  24. Giri KY, Joshi A, Rastogi S, Dandriyal R, Indra B Prasad N, Singh HP, et al. Efficacy of intravenous dexamethasone administered preoperatively and postoperatively on pain, swelling, and trismus following third molar surgery. A comparative study. Oral Surg 2019;12:110-7. https://doi.org/10.1111/ors.12399
  25. Khalida B, Fazal M, Muntaha S, Khan K. Effect of submucosal injection of dexamethasone on post-operative swelling and trismus following impacted mandibular third molar surgery. Pakistan Oral Dent J 2017;37:231-4.
  26. Boonsiriseth K, Klongnoi B, Sirintawat N, Saengsirinavin C, Wongsirichat N. Comparative study of the effect of dexamethasone injection and consumption in lower third molar surgery. Int J Oral Maxillofac Surg 2012;41:244-7. https://doi.org/10.1016/j.ijom.2011.12.011
  27. Kaewkumnert S, Phithaksinsuk K, Changpoo C, Nochit N, Muensaiyat Y, Wilaipornsawai S, et al. Comparison of intraosseous and submucosal dexamethasone injection in mandibular third molar surgery: a split-mouth randomized clinical trial. Int J Oral Maxillofac Surg 2020;49:529-35. https://doi.org/10.1016/j.ijom.2019.10.006
  28. de Santana-Santos T, de Souza-Santos aA, Martins-Filho PR, da Silva LC, de Oliveira E Silva ED, Gomes AC. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables. Med Oral Patol Oral Cir Bucal 2013;18:e65-70. https://doi.org/10.4317/medoral.18039
  29. Rullo R, Addabbo F, Papaccio G, D'Aquino R, Festa VM. Piezoelectric device vs. conventional rotative instruments in impacted third molar surgery: relationships between surgical difficulty and postoperative pain with histological evaluations. J Craniomaxillofac Surg 2013;41:e33-8. https://doi.org/10.1016/j.jcms.2012.07.007
  30. Latt MM, Chewpreecha P, Wongsirichat N. Prediction of difficulty in impacted lower third molars extraction; review literature. Mahidol Dent J 2015;35:281-90.
  31. Majid OW, Mahmood WK. Use of dexamethasone to minimise post-operative sequelae after third molar surgery: comparison of five different routes of administration. Oral Surg 2013;6:200-8. https://doi.org/10.1111/ors.12049
  32. Bodh R, Kumari S, Mohanty S, Kumar RD, Diana C. Removal of a deeply impacted ectopic mandibular third molar through a buccal corticotomy in severe trismus-a case report. J Clin Diagn Res 2018;12:ZD04-06. https://doi.org/10.7860/JCDR/2018/29051.11077
  33. Shah SA, Khan I, Shah HS. Effectiveness of submucosal dexamethasone to control postoperative pain & swelling in apicectomy of maxillary anterior teeth. Int J Health Sci (Qassim) 2011;5:156-65.
  34. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 1993;48:961-4. https://doi.org/10.1111/j.1365-2044.1993.tb07474.x
  35. Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO. Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head Face Med 2005;1:11. https://doi.org/10.1186/1746-160X-1-11
  36. Graziani F, D'Aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial. Int J Oral Maxillofac Surg 2006;35:241-6. https://doi.org/10.1016/j.ijom.2005.07.010
  37. Sood P, Ahuja G, Makkar D, Gaba R, Sidana J. Oral health related quality of life: perspectives. Dent J Adv Stud 2014;02:112-7. https://doi.org/10.1055/s-0038-1671996
  38. Tiwana PS, Foy SP, Shugars DA, Marciani RD, Conrad SM, Phillips C, et al. The impact of intravenous corticosteroids with third molar surgery in patients at high risk for delayed healthrelated quality of life and clinical recovery. J Oral Maxillofac Surg 2005;63:55-62. https://doi.org/10.1016/j.joms.2004.01.029
  39. Fokunang C, Fokunang ET, Frederick K, Ngameni B, Ngadjui B. Overview of non-steroidal anti-inflammatory drugs (nsaids) in resource limited countries. MOJ Toxicol 2018;4:5-13. https://doi.org/10.15406/mojt.2018.04.00081
  40. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:630-40. https://doi.org/10.1016/j.tripleo.2008.11.005
  41. Benoliel R, Kahn J, Eliav E. Peripheral painful traumatic trigeminal neuropathies. Oral Dis 2012;18:317-32. https://doi.org/10.1111/j.1601-0825.2011.01883.x
  42. Alcantara CE, Falci SG, Oliveira-Ferreira F, Santos CR, Pinheiro ML. Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: a splitmouth randomized triple-blind clinical trial. Int J Oral Maxillofac Surg 2014;43:93-8. https://doi.org/10.1016/j.ijom.2013.05.016
  43. Gopinath KA, Chakraborty M, Arun V. Comparative evaluation of submucosal and intravenous dexamethasone on postoperative sequelae following third molar surgery: a prospective randomized control study. Int J Oral Care Res 2017;5:191-5. https://doi.org/10.5005/jp-journals-10051-0095
  44. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg 2007;65:2218-26. https://doi.org/10.1016/j.joms.2006.11.036
  45. Schweizer A, Brom R, Glatt M, Bray MA. Leukotrienes reduce nociceptive responses to bradykinin. Eur J Pharmacol 1984;105:105-12. https://doi.org/10.1016/0014-2999(84)90653-8
  46. Lerner UH, Ransjo M, Ljunggren O. Bradykinin stimulates production of prostaglandin E2 and prostacyclin in murine osteoblasts. Bone Miner 1989;5:139-54. https://doi.org/10.1016/0169-6009(89)90092-5
  47. Fernandes IA, de Souza GM, Pinheiro MLP, Falci SGM. Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2019;48:659-68. https://doi.org/10.1016/j.ijom.2018.09.014
  48. Klongnoi B, Kaewpradub P, Boonsiriseth K, Wongsirichat N. Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery. Int J Oral Maxillofac Surg 2012;41:376-9. https://doi.org/10.1016/j.ijom.2011.12.014
  49. Bhargava D, Sreekumar K, Deshpande A. Effects of intra-space injection of Twin mix versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on postoperative sequelae after mandibular impacted third molar surgery: a preliminary clinical comparative study. Oral Maxillofac Surg 2014;18:293-6. https://doi.org/10.1007/s10006-013-0412-7
  50. Sabhlok S, Kenjale P, Mony D, Khatri I, Kumar P. Randomized controlled trial to evaluate the efficacy of oral dexamethasone and intramuscular dexamethasone in mandibular third molar surgeries. J Clin Diagn Res 2015;9:ZC48-51. https://doi.org/10.7860/JCDR/2015/13930.6813
  51. de Sousa Santos JA, da Silva LC, de Santana Santos T, Menezes Junior LR, de Assuncao Oliveira AC, Brandao JR. Comparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery. J Craniomaxillofac Surg 2012;40:694-700. https://doi.org/10.1016/j.jcms.2012.01.001
  52. Nandini GD. Eventuality of dexamethasone injected intra-massetrically on post operative sequel following the surgical extraction of impacted mandibular third molars: a prospective study. J Maxillofac Oral Surg 2016;15:456-60. https://doi.org/10.1007/s12663-015-0847-5
  53. Arora SS, Phull T, Kumar I, Kumar A, Kumar N, Singh H. A comparative study of the effect of two dosages of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective randomized study. Oral Maxillofac Surg 2018;22:225-30. https://doi.org/10.1007/s10006-018-0699-5
  54. Troiano G, Laino L, Cicciu M, Cervino G, Fiorillo L, D'amico C, et al. Comparison of two routes of administration of dexamethasone to reduce the postoperative sequelae after third molar surgery: a systematic review and meta-analysis. Open Dent J 2018;12:181-8. https://doi.org/10.2174/1874210601812010181
  55. Moraschini V, Hidalgo R, Porto Barboza Ed. Effect of submucosal injection of dexamethasone after third molar surgery: a metaanalysis of randomized controlled trials. Int J Oral Maxillofac Surg 2016;45:232-40. https://doi.org/10.1016/j.ijom.2015.09.008
  56. Deo SP. Single-dose of submucosal injection of dexamethasone affects the post operative quality of life after third molar surgery. J Maxillofac Oral Surg 2016;15:367-75. https://doi.org/10.1007/s12663-015-0846-6
  57. Warraich R, Faisal M, Rana M, Shaheen A, Gellrich NC, Rana M. Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone - a randomized observer blind prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:16-22. https://doi.org/10.1016/j.oooo.2012.12.007
  58. Moore PA, Brar P, Smiga ER, Costello BJ. Preemptive rofecoxib and dexamethasone for prevention of pain and trismus following third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:E1-7. https://doi.org/10.1016/j.tripleo.2004.08.028
  59. Al-Dajani M. Can preoperative intramuscular single-dose dexamethasone improve patient-centered outcomes following third molar surgery? J Oral Maxillofac Surg 2017;75:1616-26. https://doi.org/10.1016/j.joms.2017.03.037
  60. Vivek GK, Vaibhav N, Shafath A, Imran M. Efficacy of intravenous, intramassetric, and submucosal routes of dexamethasone administration after impacted third molar surgery: a randomized, comparative clinical study. J Adv Clin Res Insights 2017;4:3-7. https://doi.org/10.15713/ins.jcri.146
  61. Latt MM, Kiattavorncharoen S, Boonsiriseth K, Pairuchvej V, Wongsirichat N. The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery. J Dent Anesth Pain Med 2016;16:95-102. https://doi.org/10.17245/jdapm.2016.16.2.95
  62. Moranon P, Chaiyasamut T, Sakdajeyont W, Vorakulpipat C, Klongnoi B, Kiattavornchareon S, et al. Dexamethasone injection into pterygomandibular space versus sublingual space on postoperative sequalae of lower third molar intervention. J Clin Med Res 2019;11:501-8. https://doi.org/10.14740/jocmr3844
  63. Majid OW, Mahmood WK. Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study. Br J Oral Maxillofac Surg 2011;49:647-52. https://doi.org/10.1016/j.bjoms.2010.09.021
  64. Chaudhary PD, Rastogi S, Gupta P, Niranjanaprasad Indra B, Thomas R, Choudhury R. Pre-emptive effect of dexamethasone injection and consumption on post-operative swelling, pain, and trismus after third molar surgery. A prospective, double blind and randomized study. J Oral Biol Craniofac Res 2015;5:21-7. https://doi.org/10.1016/j.jobcr.2015.02.001
  65. Ngeow WC, Lim D. Do corticosteroids still have a role in the management of third molar surgery? Adv Ther 2016;33:1105-39. https://doi.org/10.1007/s12325-016-0357-y
  66. Latif Shah K, Saud Al Lbad A, Al Anazi YM, Ahmad Al Khalaf Y, Mohammed Balto M, Jaafar Albahrani Z. Comparison of therapeutic effects of 8 mg dexamethasone intramuscular administered pre-operatively vs. post operatively after the surgical extraction of impacted mandibular third molars. Dent Craniofac Res 2018;03:9. https://doi.org/10.21767/2576-392x.100025
  67. Nunez-Diaz D, Chumpitaz-Cerrate V, Chavez-Rimache L, Cruz LGS. Comparison of the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery: a randomized clinical trial. J Oral Res 2020;8:463-70. https://doi.org/10.17126/joralres.2019.0
  68. Markiewicz MR, Brady MF, Ding EL, Dodson TB. Corticosteroids reduce postoperative morbidity after third molar surgery: a systematic review and meta-analysis. J Oral Maxillofac Surg 2008;66:1881-94. https://doi.org/10.1016/j.joms.2008.04.022
  69. Mehra P, Reebye U, Nadershah M, Cottrell D. Efficacy of antiinflammatory drugs in third molar surgery: a randomized clinical trial. Int J Oral Maxillofac Surg 2013;42:835-42. https://doi.org/10.1016/j.ijom.2013.02.017
  70. Lima CAA, Favarini VT, Torres AM, da Silva RA, Sato FRL. Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial. Oral Maxillofac Surg 2017;21:321-26. https://doi.org/10.1007/s10006-017-0635-0
  71. Sitthisongkhram K, Niyomtham N, Chaiyasamut T, Pairuchvej V, Kc K, Wongsirichat N. Effectiveness of dexamethasone injection in the pterygomandibular space before and after lower third molar surgery. J Dent Anesth Pain Med 2020;20:313-23. https://doi.org/10.17245/jdapm.2020.20.5.313
  72. Darawade DA, Kumar S, Mehta R, Sharma AR, Reddy GS. In search of a better option: dexamethasone versus methylprednisolone in third molar impaction surgery. J Int Oral Health 2014;6:14-7.
  73. Lim D, Ngeow WC. A comparative study on the efficacy of submucosal injection of dexamethasone versus methylprednisolone in reducing postoperative sequelae after third molar surgery. J Oral Maxillofac Surg 2017;75:2278-86. https://doi.org/10.1016/j.joms.2017.05.033
  74. Garcia AG, Sampedro FG, Rey JG, Vila PG, Martin MS. PellGregory classification is unreliable as a predictor of difficulty in extracting impacted lower third molars. Br J Oral Maxillofac Surg 2000;38:585-7. https://doi.org/10.1054/bjom.2000.0535
  75. Capuzzi P, Montebugnoli L, Vaccaro MA. Extraction of impacted third molars. A longitudinal prospective study on factors that affect postoperative recovery. Oral Surg Oral Med Oral Pathol 1994;77:341-3. https://doi.org/10.1016/0030-4220(94)90194-5
  76. Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG. Prevention and management of glucocorticoid-induced side effects: a comprehensive review: gastrointestinal and endocrinologic side effects. J Am Acad Dermatol 2017;76:11-6. https://doi.org/10.1016/j.jaad.2016.02.1239
  77. Bebawy JF. Perioperative steroids for peritumoral intracranial edema: a review of mechanisms, efficacy, and side effects. J Neurosurg Anesthesiol 2012;24:173-7. https://doi.org/10.1097/ANA.0b013e3182578bb5
  78. Laino L, Menditti D, Lo Muzio L, Laino G, Lauritano F, Cicciu M. Extraoral surgical approach of ectopic mandibular third molar to the lower border of mandible. J Craniofac Surg 2015;26:e256-60. https://doi.org/10.1097/SCS.0000000000001541