Efficacy of Single-Dose Preoperative Dexamethasone in Managing Pain, Swelling, and Trismus After Impacted Mandibular Third Molar Surgery: A Clinical Study

Introduction: The surgical removal of mandibular third molars is generally followed by complaints of pain, trismus, and swelling. The duration of surgery and the reflection of a mucoperiosteal flap have been shown to affect the intensity and frequency of postoperative complaints. Pain from third molar surgery typically begins within one to three hours after surgery and ranges in intensity from moderate to severe. Numerous analgesics have been used to minimise pain and discomfort following the surgical removal of impacted third molars. Commonly used agents include ibuprofen, diclofenac sodium, paracetamol, or their combinations. Newer drugs, such as selective COX inhibitors, have not been extensively used for minor oral surgical procedures. Aim: To compare the clinical efficacy of celecoxib and diclofenac sodium on pain, swelling, and mouth opening after the surgical removal of impacted mandibular third molars. Materials and Methods: A split-mouth randomised controlled clinical trial was conducted in the Department of Oral and Maxillofacial Surgery at BharatiVidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India. The study duration was six months, from August 2022 to January 2023. A total of 21 subjects (11 males and 10 females) who required surgical extraction of an impacted mandibular third molar were selected. All subjects were randomly allocated to receive one of the following treatments twice a day for five days after surgery: celecoxib 200 mg (n=11) or diclofenac sodium 75 mg (n=10). Pain scores were evaluated using the Visual Analogue Scale (VAS) on postoperative day one, two, and three. Swelling and mouth opening were evaluated on Postoperative Day (POD) two and seven. Intergroup comparison was done using Student’s t-test. Results: The mean age of the study participants was 28±1.5 years, and the mean VAS score for pain evaluation with celecoxib was 6.61, 5.38, and 5.00 on day 1 (p=0.027), 2 (p=0.972), and 3 (p=0.809), respectively. The difference in swelling values for the celecoxib group was significant, while there were no significant differences in the values of mouth opening. Conclusion: It was concluded that celecoxib 200 mg is a better analgesic and anti-inflammatory compared to diclofenac sodium 75 mg. Celecoxib was easily tolerable and comfortable for the patients. There was no significant difference in the values of mouth opening.

Introduction: Surgical removal of mandibular third molars is one of the most frequent clinical tasks conducted by dental surgeons. This surgery is associated with the possibility of delayed and complicated soft-tissue and hard-tissue healing. Local incorporation of bioactive materials (such as growth factors and blood products) has been attempted to promote faster and better healing. Platelet-rich Fibrin (PRF) is the latest development among blood-derived products and is widely used to enhance hard and soft-tissue healing. Aim: To estimate the effect of PRF on soft-tissue and hardtissue healing following the surgical extraction of mandibular third molars. Materials and Methods: This prospective interventional study was carried out in the Department of Oral and Maxillofacial Surgery at Guru Nanak Institute of Dental Science and Research, Kolkata, West Bengal, India. The study was conducted between May 2022 and January 2024. Patients who required extraction of impacted mandibular third molars were divided into two groups (group I and group II) by alternate selection methods. PRF was placed in the empty sockets of group I patients following the surgical extraction of the third molar, while the sockets of group II patients were allowed to heal without PRF. Soft-tissue healing evaluation was performed using the parameters of the healing index on the 3rd, 7th, 14th, and 28th post-extraction days by two blind observers. Hard-tissue healing was evaluated using the Cone Beam Computed Tomography (CBCT) findings on the 1st month and 3rd month postoperatively. Changes in empty socket volume, Bone Density Units (BDU) of the new bone, and the type of new bone were analysed. Statistical analysis was carried out using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 26.0 (Armonk, NY: IBM Corp). A p-value of <0.05 was considered significant. Results: Twenty-six patients were included in the final analysis. They were equally divided into the interventional group (group I, with PRF) and the control group (group II, without PRF). The demographic data and difficulty index of group I were similar to those of group II. The corrected Chi-square test of independence was performed to compare soft-tissue healing. A highly significant association was found on the 3rd postoperative day (p-value=0.03), 14th postoperative day (p-value=0.013), and 28th postoperative day (p-value=0.002), indicating that group I consistently demonstrated improved healing compared to group II. The volume of the empty socket of the extracted third molar was measured using CBCT on the 1st and 3rd postoperative months. In both groups, the volume reduced significantly, but the reduction was more pronounced in group I than in group II (p-value <0.0001). The quality of bone formation (measured by BDUs) was significantly better in group I than in group II (p-value=0.043). However, the type of bone formation was similar for both groups. Conclusion: PRF appears to be beneficial and effective in promoting postoperative soft-tissue and hard-tissue healing following the surgical extraction of mandibular third molars.

Objectives: To determine the effectiveness of tube drain compared with conventional suturing on postoperative complications after extraction of impacted mandibular third molars. Study Design: Cross Sectional study (Comparative). Setting: Department of Oral & Maxillofacial Surgery, Institute of Dentistry, LUMHS Jamshoro/Hyderabad. Period: Six months duration from 12-11-2015 to 13-05-2016. Material & Methods: All the patient age from 18 to 45 years irrespective of gender, having mesioangular impacted mandibular third molar were included in the study. Patients were divided into two groups, Group-A and group-B. The severity of pain was recorded by using Visual Analog Scale from 0 no pain to 10 worst pain, degree of swelling was measured by facial size through Amin and Laskin criteria and mouth opening was measured by interincisal distance through ruler. All data was recorded on the 3rd and 7th day by the clinician. Results: Mean age of group A was 31.22+7.21 years, and mean age of group B was 28.34+5.33 years. Male were found slightly more as compared to female. On 3rd day the post-operative pain assessment was almost equal in both groups p-value 0.06 and assessment of post-operative swelling on 3rd day was found with insignificant difference p-value 0.22. Assessment of pain on 7th post-operative day was that the severe pain was found significantly reduced in group B as compared to group A p-value 0.01, swelling was significantly reduced in group B p-value 0.04. While mouth opening was also found significantly more in group B as compared to group A p-value 0.022. Conclusion: After removal of impacted mandibular third molars, incorporating tube drain is very effective as compared to conventional suturing in reducing the facial swelling, trismus and postoperative pain.

Aim: The present study aimed to assess the amount of anxiety felt before and immediately after surgical removal of impacted mandibular third molars. Materials and Methods: Patients' anxiety related to mandibular third molar surgery was prospectively measured before and after the procedure. Each patient level of anxiety was measured using a visual analog scale preoperatively and immediately postoperatively. Patients older than 18 years who were referred to the Oral and Maxillofacial Department of Shiraz University of Medical Sciences, Shiraz, Iran, for surgical removal of mandibular third molars were asked to participate in this study. Data including patient's demographic information, type of the third molar, and severity of surgical removal were recorded. The patient's age and gender and its relation to level anxiety were analyzed. Surgical removal of all third molars was performed by an experienced oral and maxillofacial surgeon under local anesthesia without sedation. Results: Eighty-four patients participated in the present study, of which male participants were 36.7% and female patients were 64.3%. The mean age of participants was 42.07 ± 14.93 years and ranged from 18 to 70 years. The amount of anxiety preoperative compared to postoperative was statistically significant different (P Conclusion: The amount of anxiety related to surgical extraction of mandibular third molars was higher preoperatively than postoperatively, without any relation to the age and gender. Preoperative patients' reassurance and adequate explanation are recommended.

To assesses the efficacy of low-level laser therapy (LLLT) over dexamethasone in reducing postoperative edema and trismus following surgical removal of mandibular third molars. A single-center, parallel group, randomized, prospective, single-blind clinical trial on 50 patients between the age 18-40years, requiring surgical extraction of mandibular third molars classified as mesioangular, class II and position B impactions, was selected for the study. The selected patients were randomly divided into two groups:Group 1, n = 25, Soft Tissue Diode laser was applied intra-orally and extra-orally at the insertion of the masseter.Group 2, n = 25, 8mg of Dexamethasone was given intravenously preoperatively.Trismus and edema were calculated preoperatively and on the 1st and 5th postoperative day. The collected data were subjected to statistical analysis using student's t test. Trismus (4.61 ± 0.26cm [p = 0.0001]) in the LLLT group was significantly less than the dexamethasone group (trismus: 3.82 ± 0.73cm). Edema at different anatomic locations in the LLLT group was also significantly less than the dexamethasone group (Angle-tragus [p = 0.0008], angle-canthus [p = 0.0021], angle-ala [p = 0.0258], angle-commissure [p = 0.0168], angle-mentus [p = 0.0227]). This study demonstrates that LLLT was beneficial in reduction in edema and trismus compared to dexamethasone following surgical extraction of third molars.

Introduction Surgical removal of an impacted third molar is one of the most common oral surgical procedures performed in dental offices. The postoperative phase is often associated with severe inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to manage postoperative discomfort. NSAIDs have been associated with gastrointestinal bleeding, renal function disturbances, and platelet count reductions. Thus, the present study demonstrates the utility of aescin in managing postoperative discomfort after the surgical removal of impacted mandibular third molars. This study aimed to correlate and compare the impact of aescin and diclofenac on salivary PGE2 levels and serum C-reactive protein levels after surgical extraction of the mandibular third molar. The study will also evaluate and compare the effectiveness of individual drug therapy in managing postoperative pain, swelling and mouth opening. Methods The planned study is a single-center, double-blind, randomized, parallel, prospective clinical trial. Each patient will be prescribed either diclofenac sodium 150 mg/day or aescin (escin) 120 mg/day to be taken orally in divided doses for five days after surgically removing the impacted mandibular third molar. Pain will be assessed using a visual analog scale. Facial swelling and mouth opening will be recorded using a metric scale with standardized reference points. ELISA (enzyme-linked immunosorbent assay (ELISA) will be employed to measure salivary Prostaglandin E2 and serum C–reactive protein levels. All parameters will be recorded preoperatively (T0) on the second postoperative day (T1) and fifth postoperative day (T2). Conclusion The proposed study is expected to show a clinically acceptable response to the administration of aescin for the management of postoperative discomfort compared to diclofenac sodium after third molar surgery. The proposed study is expected to positively manipulate the levels of salivary Prostaglandin E2 and serum C–reactive protein, which are reliable inflammatory markers. The outcome of this study may provide an efficacious and safe alternative to conventional nonsteroidal anti-inflammatory drugs for managing postoperative discomfort following third molar surgery.

Introduction Oral and maxillofacial surgeons frequently perform the removal of impacted mandibular third molars. The success of this surgical intervention depends on meticulous surgical technique and the use of appropriate irrigants to minimize complications in the postoperative period. Aim The aim of this study was to evaluate the efficacy of four different irrigation solutions (povidone-iodine, metronidazole, chlorhexidine gluconate (CHX), and normal saline)on postoperative sequelae like pain, trismus, swelling, and alveolar osteitisfollowing surgical extraction of the impacted mandibular third molars. Materials and methods The current research was a randomized study carried out at Saveetha Dental College and Hospital in Chennai, India, from December 2022 to March 2023.The study population consisted of 112 participants who were referred to the Oral and Maxillofacial Surgery for the surgical removal of impacted mandibular third molars. The population was divided into four groups, with 28in each group. They were categorized as A, B, C, and D based on the final irrigation solution used after surgical removal of the impacted teeth. In group A, patients received 0.5% povidone-iodine as the final irrigation solution; group B received 1% metronidazole; group C received 0.12% chlorhexidine gluconate (CHX); and group D received 0.9% normal saline.Patients were examined on the first and seventh postoperative days to assess pain, swelling, trismus, and alveolar osteitis. The results were analyzed with SPSSStatistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) software for Windows (MicrosoftCorporation, Redmond, Washington, United States). A p-value less than 0.05 was considered statistically significant. Results Group B experienced significantly less pain than groups A, C, and D on the first and seventh postoperative days (p<0.05). The facial swelling was significantly less on the first and seventh postoperative day in groupB compared to groups A, B, and D (p<0.05). There was no statistically significant variation observed in trismus (mouth opening) across the groups on both the first postoperative and seventh postoperative days. The presence of alveolar osteitis was seen in groups A, C, and D, but no instances were reported in group B. Conclusion It can be concluded that among the four irrigation solutions used in the lower third molar surgery,metronidazole irrigation solution yielded the best results in terms of less pain, swelling, and alveolar osteitis followed by chlorhexidine.There was no difference between povidone-iodine irrigation and normal saline irrigation on the postoperative sequelae. Postoperative trismus does not depend on the irrigation solutionused in the third molar surgery.

Introduction: The most frequent oral and maxillofacial surgical operation carried out in an outpatient setting is the surgical extraction of impacted mandibular third molars. The removal of impacted mandibular third molars involves surgical trauma in a highly vascularised area, which causes inflammatory changes referred to as “sequelae,” including pain, swelling, and trismus. These symptoms gradually appear, peaking two days after the extraction. To limit these postsurgical inflammatory complications, surgeons have advised the patients to use proteolytic enzymes, such as bromelain, along with routine antibiotics, analgesics, and corticosteroids. Aim: To compare the clinical efficacy of bromelain with that of paracetamol on pain, swelling, and trismus after the surgical removal of bilateral impacted mandibular third molars with similar difficulty indices. Materials and Methods: The present study was a split-mouth randomised clinical trial conducted at the Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India, over a period of six months from August 2022 to January 2023. Twenty subjects requiring surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly assigned to receive one of the following treatments for five days after surgery: Cap. bromelain 500 mg-BD 24 hours preoperatively and continued until the 4th day postoperatively (n=10, Group A) or Tab. paracetamol 500 mg-TDS (n=10, Group B). Pain scores were evaluated using the Visual Analog Scale (VAS) on postoperative days 1, 2, and 3. Swelling and mouth opening were assessed on postoperative days 2 and 7. Intergroup comparison was done using Student’s t-test. Results: The mean VAS scores for pain evaluation were 6.60, 5.80, and 5.20 for bromelain on days 1 (p=0.001), 2 (p=0.001), and 3 (p=0.001), respectively. The difference between the swelling values for the bromelain group was significant, while there were no significant differences in the values of trismus. Conclusion: It was concluded that bromelain is a better analgesic and anti-inflammatory drug compared to paracetamol. There were no significant differences in the values of trismus.

Surgical removal of an impacted third molar is one of the most common oral surgical procedures performed in dental offices. The postoperative phase is often associated with severe inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to manage postoperative discomfort. NSAIDs have been associated with gastrointestinal bleeding, renal function disturbances, and platelet count reductions. Thus, the present study demonstrates the utility of aescin in managing postoperative discomfort after the surgical removal of impacted mandibular third molars.This study aimed to correlate and compare the impact of aescin and diclofenac on salivary PGE2 levels and serum C-reactive protein levels after surgical extraction of the mandibular third molar. The study will also evaluate and compare the effectiveness of individual drug therapy in managing postoperative pain, swelling and mouth opening. The planned study is a single-center, double-blind, randomized, parallel, prospective clinical trial. Each patient will be prescribed either diclofenac sodium 150 mg/day or aescin (escin) 120 mg/day to be taken orally in divided doses for five days after surgically removing the impacted mandibular third molar.Pain will be assessed using a visual analog scale. Facial swelling and mouth opening will be recorded using a metric scale with standardized reference points. ELISA (enzyme-linked immunosorbent assay (ELISA) will be employed to measure salivary Prostaglandin E2 and serum C-reactive protein levels. All parameters will be recorded preoperatively (T0) on the second postoperative day (T1) and fifth postoperative day (T2). The proposed study is expected to show a clinically acceptable response to the administration of aescin for the management of postoperative discomfort compared to diclofenac sodium after third molar surgery.The proposed study is expected to positively manipulate the levels of salivary Prostaglandin E2 and serum C-reactive protein, which are reliable inflammatory markers.The outcome of this study may provide an efficacious and safe alternative to conventional nonsteroidal anti-inflammatory drugs for managing postoperative discomfort following third molar surgery.

Introduction Surgical removal of an impacted third molar is one of the most common oral surgical procedures performed in dental offices. The postoperative phase is often associated with severe inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to manage postoperative discomfort. NSAIDs have been associated with gastrointestinal bleeding, renal function disturbances, and platelet count reductions. Thus, the present study demonstrates the utility of aescin in managing postoperative discomfort after the surgical removal of impacted mandibular third molars. This study aimed to correlate salivary PGE2 levels and serum C-reactive protein levels with subjective and objective symptoms after surgical extraction of the mandibular third molar and their relationship with drug therapy. Methods The planned study is a single-center, double-blind, randomized, parallel, prospective clinical trial. Each patient will be prescribed either diclofenac sodium 150 mg/day or aescin (escin) 120 mg/day to be taken orally in divided doses for five days after surgically removing the impacted mandibular third molar. Pain will be assessed using a visual analog scale. Facial swelling and mouth opening will be recorded using a metric scale with standardized reference points. ELISA (enzyme-linked immunosorbent assay (ELISA) will be employed to measure salivary Prostaglandin E2 and serum C–reactive protein levels. All parameters will be recorded preoperatively (T0) on the second postoperative day (T1) and fifth postoperative day (T2). Conclusion The proposed study is expected to show a favorable response to the administration of aescin for the management of postoperative discomfort compared to diclofenac sodium after third molar surgery. The proposed study is expected to positively manipulate the levels of salivary Prostaglandin E2 and serum C–reactive protein, which are reliable inflammatory markers. The outcome of this study may provide an efficacious and safe alternative to conventional nonsteroidal anti-inflammatory drugs for managing postoperative discomfort following third molar surgery.

A prospective randomized double-blind study was conducted to assess the latency and duration of pterygomandibular nerve block with a mixture of 1.8 ml 2% lignocaine with 1:200,000 epinephrine and 1 ml of 4 mg dexamethasone and its impact on postoperative sequelae of surgical extraction of impacted mandibular third molars. The study was conducted as a prospective randomized double-blind clinical trial on 20 patients with bilateral impaction of mandibular third molars. A total of 40 interventions were included for the study, 20 with 2% lignocaine with 1:200,000 epinephrine (study group C, control) and 20 with the twin-mix (study group T, twin-mix), with a gap of 1 month between two interventions in a single patient. After injection of the anesthetic solution, the time to anesthetic effect, duration of anesthesia, and the need to re-anesthetize the surgical site were recorded. A 10-point visual analog scale (VAS) was used to assess the overall pain intensity while injecting the study drug, during surgery, and in the postoperative period. pH of the test anesthetic solutions was also determined using a pH meter. Twin-mix was found to be more basic than 2% lignocaine with 1:200,000 epinephrine. Mean VAS value for the pain/sting on local anesthetic injection/block was less in study group T. Time of onset of the local anesthetic was significantly less for the study group T, 51 ± 17.5 s when compared with patients in study group C (P less than 0.0001). The duration of soft tissue anesthesia was longer for all the patients in the study group T. On comparative evaluation between study group C and study group T, patients in the control group had more sever swelling and reduction in mouth opening in the postoperative period. The addition of dexamethasone to lignocaine and its administration as an intra-space injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.

Introduction: Corticosteroids are considered anti-inflammatory which considered the essential roles, as well as it reduces edema. (1) Aim: To compare the efficacy of dexamethasone injection submucosally, intra-masseteric and intra-muscular on post-operative swelling, mouth opening and pain following removal of mandibular impacted third molars. Type of Study: prospective randomized comparative clinical study. Methods: The current study included forty-five patients with impacted mandibular third molars were selected to underwent surgical removal of mandibular third molars. Group I, comprised of fifteen patients who received pre-operative sub-mucosal 8 mg dexamethasone injection, Group II, comprised of fifteen patients who received pre-operative Intra-masseteric 8 mg dexamethasone injection and Group III, taking intramuscular dexamethasone injection, Postoperative assessment included: mouth opening, swelling as well as pain at the following intervals; 1st, 3rd and 7th day post-operative. Results: our study showed no statistically significant difference between mean MMO as well as VAS in Group I and II; both showed statistically significant higher mean MMO and VAS than Group III. Significant reduction in pain and swelling in both sub-mucosal, intra-masseteric and intra-muscular but a greater immediate effect on trismus was seen in sub-mucosal and intramasseteric routes Discussion: preoperative administration of dexamethasone has greater post-operative effects. Dexamethasone injected preoperatively was safe and simple effective method to reduce postoperative complications such pain, swelling and trismus.

To estimate the effects of flap design on wound dehiscence and the postoperative side effects after the extraction of bilateral impacted mandibular third molars. Materials and methods: This study was designed as a randomized, clinical trial composed of a sample of subjects =>18 years of age who required surgical extraction of the mandibular third molars. The predictor variable was flap type. A 3-cornered flap was used on one side and a modified triangular flap was used on the other. The primary outcome variable was wound dehiscence. The secondary outcome variables were pain, swelling, and trismus. Other variables were demographic and operative. Descriptive, bivariate statistics were computed. Significance was set at P < 0.05. Results: Forty patients who required removal of bilateral impacted third molars were included. There were no significant differences regarding wound dehiscence and postoperative side effects between the 2 flap techniques. Conclusion: Both flap designs obtained similar short-term outcomes in mandibular third molar surgery.

Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling, and mouth opening after surgical removal of impacted third molars: a randomized, controlled clinical trial

To compare the Ward’s Flap Versus Modified Ward’s flap in relation to access, healing &amp; postoperative complications in surgical extraction of mandibular third molar impaction. Study Design: Comparative Cross Sectional. Setting: Department of Oral &amp; Maxillofacial Surgery LUMHS Jamshoro/Hyderabad: Period: March 2017 to November 2017. Materials and Methods: The history, clinical examination and radiographs (OPG and periapical) had done by team of researchers and recorded on proforma. After selection of patient into either group (Group A=Wards Flap, Group B Modified Wards), the surgical extraction was carried out under local anesthesia. For group A, a standard full thickness mucoperiosteal flap (ward’s flap) was raised. The incision was given mesial to the impacted lower third molar. For group B, a standard full thickness mucoperiosteal flap (Modified ward’s flap) was given mesial to second molar. At the end of the surgery, the flap design used for the extraction of impacted lower third molar tooth and the duration of each operation (from the first extraction maneuver to the completion of the last suture), Pain, Swelling and Trismus13 were recorded on the proforma. Every patient was called for follow up on the 3rd day and 7th day. Results: Mean age was found 27.93 years, with range of minimum 20 years and maximum 35 years. Male were found in the majority 72.3%. Majority of the cases 51.5% were found with class B, in class A 37.5% and 10.9% were found with class C. According to the impaction position 50% cases were in class I, and 50% cases were in class II. Preoperative pain measurement was done according VAS, 71.9% patients were found with mild pain, 9.4% were with moderate pain while 18.8% patients were without pain. Modified Wards flap showed good efficacy regarding duration of third molar extraction as compare to Ward’s flap P-value 0.018. Modified ward’s flap had showed less postoperative pain as compare to ward’s flap p-value 0.022. No significant difference was found between both groups on 3rd and 7th postoperative day in Mouth opening. Conclusion: This study concluded that both ward’s flap and modified ward’s flaps showed good efficacy, while duration of surgery and postoperative pain were significantly less in the modified ward’s flaps as compare to ward’s flap. More large sample size studies are required to evaluate more accurate findings.