Keywords
Intramuscular Injection
Pain
Post-operative swelling
Surgical extraction
How to Cite
Abstract
Background: Dexamethasone is frequently used for controlling oedema, trismus, and pain following oral surgical procedures and is one of the most researched corticosteroids in oral and maxillofacial surgery.
Objectives: To evaluate the efficacy of a post-operative intramuscular injection of dexamethasone (4 mg) in reducing pain, swelling, and trismus following tooth extraction.
Methods: A non-randomised trial was conducted from 2022 June to 2023 September by department of Oral and Maxillofacial Surgery, Kathmandu Medical College after institutional ethical approval. The participants with no known systemic diseases or drug allergies with age 18-40 years (40 males and 18 females) were enrolled by convenience sampling. Participants were explained about study details and assigned to either a control group or a study group after obtaining informed consent. The control group received an intramuscular 1 ml injection of normal saline solution, while the study group received 1 ml of dexamethasone (4 mg) administered into the deltoid muscle post-operatively. Postoperative pain, swelling, and trismus were assessed and compared between two groups using the Mann-Whitney U test.
Results: Dexamethasone significantly reduced post-operative facial swelling compared to the control group. The reduction in swelling was statistically significant immediately after extraction and continued to show significant differences through Day 2. On Day 7, the difference in swelling between the two groups remained mild but notable. Additionally, dexamethasone was effective in decreasing pain and improving mouth opening.
Conclusion: Intramuscular injection of dexamethasone into the deltoid muscle post-operatively is effective in reducing pain, swelling, and trismus following mandibular third molar extraction.
References
Ata-Ali J, Ata-Ali F, Peñarrocha-Oltra D, Peñarrocha M. Corticosteroids use in controlling pain, swelling and trismus after lower third molar surgery. J Clin Exp Dent. 2011;3(5):e469-75.[Full Text | DOI]
Vegas-Bustamante E, Micó-Llorens J, Gargallo-Albiol J, Satorres-Nieto M, Berini-Aytés L, Gay-Escoda C. Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars. International journal of oral and maxillofacial surgery. 2008 Mar 1;37(3):260-3. [PubMed | Full Text | DOI]
Linenberg WB. The clinical evaluation of dexamethasone in oral surgery. Oral Surgery, Oral Medicine, Oral Pathology. 1965 Jul 1;20(1):6-28. [Full Text | DOI]
Graziani F, D’aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial. International journal of oral and maxillofacial surgery. 2006 Mar 1;35(3):241-6. [PubMed | Full Text | DOI]
Klongnoi B, Kaewpradub P, Boonsiriseth K, Wongsirichat N. Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery. International journal of oral and maxillofacial surgery. 2012 Mar 1;41(3):376-9. [PubMed | Full Text | DOI ]
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. International journal of oral and maxillofacial surgery. 2012 Feb 1;41(2):244-7. [PubMed | Full Text | DOI]
Tavares MG, Machado AP, Motta BG, Borsatto MC, Rosa AL, Xavier SP. Electro-acupuncture efficacy on pain control after mandibular third molar surgery. Brazilian Dental Journal. 2007;18:158-62. [PubMed| Full Text | DOI]
Gozali P, Kiattavornchareon S, Wu M, Wongsirichat N, Suphangul S. Betamethasone and methylprednisolone usage in lower third molar surgery: Review literature. M Dent J. 2015;35:273-80.M Dent J 2015; 35: 273-80. [Full Text]
Latt MM, Kiattavorncharoen S, Boonsiriseth K, Pairuchvej V, Wongsirichat N. The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery. Journal of dental anesthesia and pain medicine. 2016 Jun 1;16(2):95-102. [PubMed | Full Text | DOI].
Bjørnsson GA, Haanaes HR, Skoglund LA. A randomized, double?blind crossover trial of paracetamol 1000 mg four times daily vs ibuprofen 600 mg: effect on swelling and other postoperative events after third molar surgery. British journal of clinical pharmacology. 2003 Apr;55(4):405-12. [PubMed | Full Text | DOI]
Michalek-Sauberer A, Heinzl H, Sator-Katzenschlager SM, Monov G, Knolle E, Kress HG. Perioperative auricular electroacupuncture has no effect on pain and analgesic consumption after third molar tooth extraction. Anesthesia & Analgesia. 2007 Mar 1;104(3):542-7. [PubMed | Full Text | DOI]
Moayedi M, Davis KD. Theories of pain: from specificity to gate control. Journal of neurophysiology. 2013. [PubMed | Full Text | DOI]
Trachsel LA, Munakomi S, Cascella M: Pain Theory. StatPearls Publishing, Treasure Island, FL; 2023. [PubMed | Full Text]
Das J, Sreejith V, Anooj P, Vasudevan A. Use of Corticosteroids in third molar surgery: Review of literature. Universal Research Journal of Dentistry. 2015;5(3):171. [Full Text]
Priyanga R, Balamurugan R, Rajan PS. Comparison of dexamethasone administration through sublingual and intramuscular routes for evaluation of pain, swelling, and trismus after impacted mandibular third molar surgery—a prospective randomized controlled study. Oral and Maxillofacial Surgery. 2022 Mar;26(1):155-9. [PubMed | Full Text | DOI]
Elliott CL, Read GF, Wallace EM. The pharmacokinetics of oral and intramuscular administration of dexamethasone in late pregnancy. Acta obstetricia et gynecologica Scandinavica. 1996 Mar;75(3):213-6. [PubMed | Full Text | DOI]
Mojsa IM, Pokrowiecki R, Lipczynski K, Czerwonka D, Szczeklik K, Zaleska M. Effect of submucosal dexamethasone injection on postoperative pain, oedema, and trismus following mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. International journal of oral and maxillofacial surgery. 2017 Apr 1;46(4):524-30. [PubMed | Full Text | DOI]