The aim of this study was to compare the effect of dexamethasone 8 mg and methylprednisolone 40 mg for the control of pain, swelling, and trismus following the extraction of impacted third molars. Sixteen healthy patients with a mean age of 20.3 (standard deviation 1.25) years received a single oral dose of either drug 1 h prior to each surgical procedure (left and right teeth). At 24, 48, and 72 h and 7 days following surgery, swelling was determined using linear measurements on the face and trismus was determined by maximal mouth opening. Postoperative pain was self-recorded by the patients using a visual analogue scale at 8-h intervals for a period of 72 h. Data analysis involved descriptive statistics and the Wilcoxon, and paired t tests ( P < 0.05). Dexamethasone controlled swelling better than methylprednisolone at all postoperative evaluations ( P < 0.02) and led to greater mouth opening 48 h after surgery ( P = 0.029). No statistically significant difference was found between drugs with regard to pain. In conclusion, pre-emptive dexamethasone 8 mg demonstrated better control of swelling and limited mouth opening in comparison to methylprednisolone 40 mg, with no differences between drugs regarding pain control.
The surgical removal of impacted third molars is an invasive procedure that involves extensive tissue trauma and a considerable postoperative inflammatory response. Although the inflammatory process is necessary for healing, when exacerbated it may cause pain, swelling, and limited mouth opening. Corticosteroids are among the most widely employed preoperative medications administered for the control of such complications.
Corticosteroids act in the initial phase of the inflammatory process by suppressing the production of vasoactive substances, such as prostaglandins and leukotrienes, thereby reducing fluid transudation and consequent oedema. Although these drugs may help control pain, they should be used in combination with an analgesic with a clinically significant effect. The adverse effects of steroids depend on the dose and duration of administration. Prolonged use can delay healing and increase one’s susceptibility to infection, whereas side effects are rare in therapies that employ a single dose or brief duration, such as those often used in oral surgery.
The effectiveness of corticosteroids following oral surgery has been determined by comparing the use of a single dose and placebo, or the comparison of different concentrations of a single drug or different routes of administration. To date, however, there is no consensus on the type, dosage, time, and mode of administration of these drugs. Furthermore, the effect of different types of corticosteroid in the surgical extraction of impacted third molars remains under-investigated.
The aim of the present study was to perform a comparative assessment of the effect of pre-emptive dexamethasone and methylprednisolone at equivalent doses for the postoperative control of pain, swelling, and limited mouth opening following the extraction of impacted third molars.