EFFECT OF SUBMUCOSAL AND INTRAMUSCULAR DEXAMETHASONE ON POSTOPERATIVE SEQUELAE AFTER MANDIBULAR THIRD MOLAR SURGERY: A COMPARATIVE STUDY
Main Article Content
Keywords
Third molar surgery, Dexamethasone, Submucosal, Intramuscular
Abstract
Background:
Surgical extraction of impacted mandibular third molars is commonly associated with postoperative pain, swelling, and trismus. Dexamethasone, a corticosteroid, is often used to reduce these sequelae, but the comparative efficacy of different administration routes remains underexplored.
Objective:
To compare the effectiveness of intramuscular and submucosal dexamethasone with a control group in managing postoperative complications following mandibular third molar surgery.
Materials and Methods:
A prospective, randomized clinical study was conducted at Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow. 90 patients with mesioangular Class II Position B mandibular third molar impactions were randomly divided into three groups: Group A received 8 mg dexamethasone intramuscularly (deltoid), Group B received 8 mg submucosally at the surgical site, Group C received no dexamethasone (control). Postoperative parameters including pain (Visual Analog Scale), swelling (facial measurements), and trismus (interincisal distance) were evaluated on postoperative days 1, 3, and 7. Data were analyzed using ANOVA and post-hoc Tukey test, with p < 0.05 considered statistically significant.
Results:
On day 1, mean pain scores were lowest in Group B (3.0 ± 1.1), followed by Group A (3.9 ± 1.2), and highest in Group C (5.2 ± 1.0), (p = 0.001). Maximum swelling on day 3 was observed in Group C (6.7 ± 1.3 mm) versus Group A (5.1 ± 1.0 mm) and Group B (4.3 ± 0.8 mm), (p = 0.002). Trismus reduction was significantly better in Group B by day 7 (interincisal opening: 40.1 ± 2.5 mm) compared to Group A (37.8 ± 2.9 mm) and Group C (35.4 ± 3.1 mm), (p = 0.003).
Conclusion:
Submucosal dexamethasone was more effective than intramuscular injection and no steroid treatment in reducing postoperative complications after mandibular third molar surgery, making it a preferable route for clinical practice.
References
2. Majid OW. Submucosal dexamethasone injection improves quality of life measures after third molar surgery: a comparative study. J Oral Maxillofac Surg. 2011;69(9):2289-97. doi:10.1016/j.joms.2011.01.037. PMID: 21514710
3. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, Santoro F. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg. 2007;65(11):2218-26. doi:10.1016/j.joms.2006.11.036. PMID: 17954317
4. 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(3):376-9. doi:10.1016/j.ijom.2011.12.014. PMID: 22209181
5. 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(2):E129-32. PMID: 18223530
6. Deo SP. Effect of submucosal injection of dexamethasone on post-operative sequelae of third molar surgery. JNMA J Nepal Med Assoc. 2011;51(182):72-8. PMID: 22916516
7. 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(2):244-7. doi:10.1016/j.ijom.2011.12.011. PMID: 22209180
8. 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 post-operative sequelae after mandibular impacted third molar surgery: a preliminary clinical comparative study. Oral Maxillofac Surg. 2014;18(3):293-6. doi:10.1007/s10006-013-0412-7. PMID: 23512235
9. Kara IM, Polat S, Inci MF, Gümüş C. Analgesic and anti-inflammatory effects of oxaprozin and naproxen sodium after removal of impacted lower third molars: a randomized, double-blind, placebo-controlled crossover study. J Oral Maxillofac Surg. 2010;68(5):1018-24. doi:10.1016/j.joms.2009.09.094. PMID: 20206429
10. Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2014;72(6):1043-8. doi:10.1016/j.joms.2013.12.035. PMID: 24589242
11. Al-Khateeb TH, Nusair Y. Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars. Int J Oral Maxillofac Surg. 2008;37(3):264-8. doi:10.1016/j.ijom.2007.11.011. PMID: 18272344
12. 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(1):16-22. doi:10.1016/j.oooo.2012.12.007. PMID: 23453611
13. Buyukkurt MC, Gungormus M, Kaya O. The effect of a single dose prednisolone with and without diclofenac on pain, trismus, and swelling after removal of mandibular third molars. J Oral Maxillofac Surg. 2006;64(12):1761-6. doi:10.1016/j.joms.2005.11.107. PMID: 17113442
14. Sandhu A, Sandhu S, Kaur T. Comparison of two different flap designs in the surgical removal of bilateral impacted mandibular third molars. Int J Oral Maxillofac Surg. 2010;39(11):1091-6. doi:10.1016/j.ijom.2010.07.003. PMID: 20727713
15. Hindy AM, Ismaiel ME, Fayed N. Modified lingual split technique versus conventional buccal technique in odontectomy of impacted mandibular third molars. Egypt Dent J. 1995;41(2):1137-44. PMID: 9497650
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Ajay Kumar Kushwaha
Assistant Professor, Department of Oral and Maxillofacial Surgery, Chandra Dental College and Hospital, Barabanki, Uttar Pradesh, India
Dr. Gaurav Singh
Professor, Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Science, Lucknow, Uttar Pradesh, India
Dr. Ashok Gupta
Associate Professor, Department of Forensic Medicine and Toxicology, Career Institute of Medical
Sciences and Hospital, Lucknow, Uttar Pradesh, India