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      In Search of a Better Option: Dexamethasone Versus Methylprednisolone in Third Molar Impaction Surgery

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          Abstract

          Background:

          Post-surgical complications like pain, swelling, impaired function cause transient morbidity for the patients leading to refrainment of the treatment. Various preemptive drugs are prescribed to prevent patients from such unpleasant situations. Both dexamethasone and methyl prednisolone can be used for this purpose in surgery of third molar impactions.

          Materials and Methods:

          This was a split-mouth study consisting 25 patients having Pell and Gregory’s Class II position B bilateral impactions. About 8 mg dexamethasone and 40 mg methyl prednisolone were prescribed randomly 1 hour prior to the surgery. Pain, swelling and trismus were noted on 1 st, 2 nd, 3 rd and 7 th day following surgery. Wilcoxon test was used to assess the significance between the parameters.

          Results:

          Reduction in swelling and trismus was found to be significantly more with dexamethasone than methyl prednisolone. However, no statistical significant difference was found in post-operative pain.

          Conclusion:

          Dexamethasone can be used as a potent preemptive drug for controlling post-operative complications in the removal of third molar impactions.

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          Most cited references15

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          The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature.

          The use of medication to relieve pain and inflammation after removal of third molars has been explored thoroughly in the literature. Narcotic analgesics, nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids, and combinations of these all have a role in the postoperative management of pain and swelling within this group of patients. This article addresses the use of NSAIDs and corticosteroids after third molar surgery, along with a review of the literature, which is incorporated to provide practitioners helpful, quick, and reliable information regarding patients undergoing third molar surgery.
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            A review of perioperative corticosteroid use in dentoalveolar surgery.

            Dental surgeons are often advised to use corticosteroids during and after third molar removal and other dentoalveolar surgery to reduce postsurgical edema, but recommendations for use are rarely accompanied by definitive guidance regarding the type of steroid, dosage, or duration of administration. Many regimens in use appear to be based on anecdotal information from articles in the 1960s and 1970s and might be subtherapeutic. Few regimens have been updated with data from more recent studies, and well-designed comparison studies are lacking. In this article, the literature from the past 30 years is reviewed, meaningful findings are highlighted, and available data are used as a basis for formulating interim clinical recommendations for corticosteroid use pending the emergence of more evidence-based data. A meta-analysis of data was not performed. Recent data suggest that perioperative corticosteroid regimens should be administered in higher doses and for longer durations than recommended in the past and should be started before surgery for optimum benefit. Based on the literature review, interim recommendations for the use of corticosteroids are proposed, including dosages and regimens that appear rational for oral, intramuscular, or intravenous corticosteroid administration before and after extractions and other dentoalveolar surgery. These largely empiric recommendations might require adjustment when evidence-based data become available in future studies. There is a great need for well-designed clinical research to further evaluate protocols for corticosteroid use.
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              Dexamethasone reduces pain and swelling following extraction of third molar teeth.

              Extraction of multiple third molar teeth can cause significant postoperative pain, swelling and trismus, which may result in delayed hospital discharge. We have examined the effect of a single prophylactic dose of oral dexamethasone 8 mg on these complications, in a randomised double-blind study of 50 adult patients. The number of extractions performed and the operative approach were standardised. Dexamethasone resulted in a significant reduction in pain 4 h postoperatively, and eliminated the need for opioid analgesia in the postoperative period. The incidence of severe swelling was also reduced significantly, but there was no effect on trismus. Postoperative nausea and vomiting were significantly lower in the dexamethasone group. We conclude that the use of prophylactic oral dexamethasone is useful in reducing postoperative analgesia requirements in this group of patients, and may facilitate surgery performed on a day case basis.
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                Author and article information

                Journal
                J Int Oral Health
                J Int Oral Health
                JIOH
                Journal of International Oral Health : JIOH
                Dentmedpub Research and Printing Co (India )
                0976-7428
                0976-1799
                Nov-Dec 2014
                : 6
                : 6
                : 14-17
                Affiliations
                [1 ]Professor and Head, Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences, Bhilai, Chattisgarh, India
                [2 ]Assistant Professor, Department of Periodontology, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
                [3 ]Professor and Head, Department of Periodontology, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
                [4 ]Senior Lecturer, Department of Periodontology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
                [5 ]Reader, Department of Conservative Dentistry and Endodontics, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India.
                Author notes
                Correspondence: Dr. Kumar S. Department of Periodontology, Karnavati School of Dentistry, Gandhinagar, Gujarat, India. Email: drsantoshkumar2004@ 123456gmail.com
                Article
                JIOH-6-14
                4295447
                25628476
                24433247-d477-414f-a9dc-fd2549e70f54
                Copyright: © J. Int Oral Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 March 2014
                : 09 June 2014
                Categories
                Original Research

                dexamethasone,methylprednisolone,third molar,trismus
                dexamethasone, methylprednisolone, third molar, trismus

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