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

Adelyn Ai Lyn Lau; Rohana Kumara De Silva; Murray Thomson; Harsha De Silva; Darryl Tong

doi:10.1016/j.joms.2020.09.020

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

J Oral Maxillofac Surg. 2021 Feb;79(2):295-304. doi: 10.1016/j.joms.2020.09.020. Epub 2020 Sep 17.

Authors

Adelyn Ai Lyn Lau¹, Rohana Kumara De Silva², Murray Thomson³, Harsha De Silva⁴, Darryl Tong⁵

Affiliations

¹ Specialist Oral Surgeon - Private Practitioner, Faculty of Dentistry, University of Otago, Department of Oral Diagnostics and Surgical Sciences, Dunedin, New Zealand. Electronic address: Dr.adelynlau@gmail.com.
² Associate Professor, Consultant Oral and Maxillofacial Surgeon, Faculty of Dentistry, University of Otago, Department of Oral Diagnostics and Surgical Sciences, Dunedin, New Zealand.
³ Professor of Dental Epidemiology and Public Health, Faculty of Dentistry, University of Otago, Department of Oral Sciences, Dunedin, New Zealand.
⁴ Senior Lecturer, Consultant Oral and Maxillofacial Surgeon, Faculty of Dentistry, University of Otago, Department of Oral Diagnostics and Surgical Sciences, Dunedin, New Zealand.
⁵ Professor, Consultant Oral and Maxillofacial Surgeon, Head of Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Department of Oral Diagnostics and Surgical Sciences, Dunedin, New Zealand.

PMID: 33058774
DOI: 10.1016/j.joms.2020.09.020

Abstract

Objective: Swelling, pain, and trismus after third molar surgery have a negative impact on patients' quality-of-life in the days following surgery. The study aims to compare the efficacy of submucosal (SM) dexamethasone and intravenous (IV) dexamethasone in reducing these outcomes.

Methods: The single-center study was designed as a randomized, controlled, double-blinded trial with a total of 130 participants evenly allocated into 2 treatment groups. All participants underwent the surgical removal of at least 2 mandibular third molars under intravenous sedation. The outcome variables studied were swelling, pain, and maximum incisal distances. The swelling was measured using a 3-dimensional camera (3dMD Inc, Atlanta, GA). The pain was quantified using a 100 mm visual analog scale (VAS). Maximum incisal distances were measured using a caliper. Participants completed the short-form Oral Health Impact Profile (OHIP-14). The 2 groups were compared using cross-tabulations and chi-square tests for categorical variables and analysis of variance for continuous variables.

Results: The participants had a mean age of 22.6 years, 56.8% females and 12.4% smokers. There were no statistically significant differences in the distribution of study variables between the 2 groups. On day 2, mean facial swelling measurements were 7.3 cm³ in the IV group and 7.8 cm³ in the SM group (P > .05). The mean pain score was 31 in the IV group and 33 in the SM group (P > .05). The mean maximum incisal distances were 33.7 mm in the IV group and 34.5 mm in the SM group (P > .05). Both groups experienced poorer quality-of-life relative to baseline scores and were affected to a similar extent.

Conclusions: There are no differences in swelling, pain, and trismus between submucosal and intravenous dexamethasone in third molar surgery. Submucosal dexamethasone is a straightforward and accessible route of steroid administration in patients having third molar surgery under local anesthesia only.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Dexamethasone / therapeutic use
Edema / etiology
Edema / prevention & control
Female
Humans
Injections
Male
Molar, Third* / surgery
Pain, Postoperative / drug therapy
Pain, Postoperative / prevention & control
Prospective Studies
Tooth Extraction
Tooth, Impacted* / surgery
Trismus
Young Adult

Substances

Dexamethasone