Clinical evaluation of two dexamethasone regimens in the extractions of impacted third molars—a randomized clinical trial

Abstract

The aim of the present study was to compare two therapeutic protocols of dexamethasone for the prevention of postoperative swelling, pain, and other complications after the extraction of impacted third molars, in a prospective, randomized, crossover, double-blinded clinical trial. Fifty patients with symmetrical impaction of third molars were randomly assigned to two different protocols of dexamethasone for each side. Patients underwent two sessions performed at a 21-day interval. In group 1, patients took 8mg of dexamethasone orally 1h before the procedure, and in group 2, 4mg dexamethasone orally 1h before and 24h after the procedure. Surgery duration, volume of local anesthetics, surgical technique, and rescue medication were standardized. Postoperative pain was evaluated using a visual analog scale (VAS) at predefined times: before operation; immediately after; 1, 2, 4, and 12h; and 1, 2, 3, and 7days after operation. The patients were also instructed to take notes of the number of rescue medication tablets taken. Edema and mouth opening were clinically evaluated before surgery and in the postoperative period (second and seventh postoperative days). There were no significant differences between groups for VAS scales (p = 0.5048), but the use of rescue medication was significantly lower in group 1 (p = 0.006). None statistically significant differences (p > 0.05) were observed between groups in any of the time points for all measurements of edema. However, the mouth opening limitation (DIINC) was bigger (p = 0.0069) for group 1 at 2days. Pre-emptive use of different dexamethasone regimens had a beneficial effect against pain, edema, and mouth opening limitation, especially when administered at an 8mg concentration, which suggests that this protocol may also be efficient for more invasive surgery.