Single-Dose of Submucosal Injection of Dexamethasone Affects the Post Operative Quality of Life After Third Molar Surgery

Efficacy of photobiomodulation therapy on pain, swelling, and trismus following fixation of mandibular fractures

Craniofacial fractures pose complex medical and surgical challenges. Prolonged wound healing complicates surgical reconstruction, highlighting the need for methods to enhance tissue healing. This research evaluated the effects of photobiomodulation (PBM) therapy on edema, trismus, and pain following mandibular fracture surgery. This study was approved by the Kasturba Hospital and Kasturba Medical College Institutional Ethics Committee (IEC: 219/2022). Thirty-two participants were signed up and split into two groups, one receiving PBM. Ten 660 nm LEDs with an energy density of 9 J/cm2, Power density (irradiance) of 50 mW/cm2, and nine 905 nm LEDs with an energy density of 13.5 J/cm2, power density (irradiance) of 75 mW/cm2. With a total power of 235 mW, the total dose was 42.3 J, a spot Size of 3.8 cm2, and pulsed at 156 Hz. The mandibular body and angle area were irradiated from the outer skin surface of the Jaw region. The therapy lasted for 3 min and was given for 4 consecutive days starting from the day after surgery. The present study evaluates pain thresholds using an algometer. The facial swelling was measured at two distinct points, the ear's tragus to the labial commissure (T-LC) and the outer canthus of the eye to the mandible's angle (OC-AM), using a ruler. Mouth opening was measured for trismus using a vernier calliper. There was no significant reduction in pain (-0.34 vs. -0.09; p = 0.079) or edema (T-LC: 2.44 vs. 2.13; p = 0.771, OC-AM 2.31 vs. 0.69; p = 0.185) in the PBM-treated group compared to the control group. However, trismus reduction was significantly better in the PBM group (-3.25 vs. -1.31; p < 0.001). In summary, a specific PBM protocol can effectively reduce trismus during recovery from mandibular fractures, with the potential for future optimization to address pain and edema.

Evaluating quality of life in third molar surgery: a scoping review of the postoperative symptom severity (PoSSe) scale

BACKGROUND

This scoping review evaluated the key dimensions of quality of life impacted by third molar surgery as assessed by the Postoperative Symptom Severity (PoSSe) scale, and their variations across diverse populations and clinical contexts.

MATERIAL AND METHODS

A comprehensive literature search was performed across multiple databases including MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Library, Livivo, LILACS, Web of Science, Scopus, Epistemonikos, and Google Scholar on April 30, 2024, with an update on July 31, 2024. We included analytical observational studies and randomized clinical trials that utilized the PoSSe scale to assess quality of life. There were no restrictions based on language, location, or publication period. Data from eligible studies were extracted and analyzed descriptively.

RESULTS

The search identified 3,438 records, with 31 studies ultimately included. These studies employed the PoSSe scale in various methodological designs to primarily assess quality of life following lower third molar removal. The dimensions most affected were feeding, appearance, and pain, which showed significant correlations with edema, trismus, and analgesic use. Additional influencing factors included gender, tobacco use, surgeon skill level, Pell and Gregory classification, and preemptive analgesia.

CONCLUSIONS

This review has demonstrated the PoSSe scale's effectiveness in evaluating the multifaceted impacts of third molar surgery on patient quality of life, sensitive to differences in surgical techniques, surgeon experience, and patient-specific factors. Future research should explore longitudinal assessments with the PoSSe scale to optimize surgical practices and improve long-term patient outcomes.

Effect of submucosal administration of dexamethasone on postoperative discomfort after third molar surgery

Aim

To compare the impact of submucosal dexamethasone (4 mg) administered after the onset of local anesthesia on postoperative discomfort after third molar surgery and compare the parameters with a control group that did not receive the drug.

Methods

A total of 60 patients indicated for surgical removal of impacted mandibular third molars (mesioangular, Class II or III, and position B or C) were randomly divided into two groups of 30 patients each. After the onset of local anesthesia, the first group (Group A) received a submucosal injection of 4 mg dexamethasone adjacent to the surgical site, and the control group (Group B) received no drug. Pain, swelling, and trismus were recorded at follow-up visits on the 1st, 2nd, and 7th postoperative days. Assessment of postoperative discomfort was performed by evaluating responses through a modified postoperative symptom severity scale questionnaire, which was administered to the patients on the 7th postoperative day.

Results

The difference in subjective pain values and the mean number of analgesics consumed was not significant between the groups. The difference in postoperative swelling was statistically significant on the 1st, 2nd (P < 0.0001), and 7th postoperative days (P = 0.0152). The difference in postoperative trismus was highly significant on 1st and 2nd postoperative days (P < 0.0001). The difference in the mean total quality of life (QOL) score, Eating, Appearance, Daily activity subscale (P < 0.0001), and Social Isolation subscale (P = 0.0002) was statistically significant between both groups.

Conclusion

It was found that the administration of submucosal dexamethasone resulted in significantly lesser postoperative swelling and trismus and better QOL outcomes.

The Predictive Value of Cold Pack Test for Pain After Third Molar Surgery

BACKGROUND

Early identification of patients who are prone to postoperative pain may provide individualization of postoperative analgesia strategies.

PURPOSE

The aim of the study was to investigate whether the cold pack test is associated with postoperative pain levels after mandibular third molar surgery.

STUDY DESIGN, SETTING, SAMPLE

This prospective cohort study included healthy male patients admitted to Department of Oral and Maxillofacial Surgery of a tertiary health-care center between June 2022 and December 2022 and scheduled for lower third molar extraction. Those who had used any analgesic within the past 10 days or had a history of intolerance/allergy to analgesics were excluded.

PREDICTOR VARIABLE

The primary predictor variable was pain tolerance, measured using the endurance test score. Subjects were grouped into two categories, low tolerance test score (withdrew the hand from the cold pack in <240 seconds) and high tolerance test score (maintained the hand on the cold pack for 240 seconds).

MAIN OUTCOME VARIABLES

The primary outcome variable was pain measured by the patients from 0 to 10 with the visual analog scale, and the secondary outcome variables were the amount of ibuprofen and paracetamol consumed in the postoperative period. Pain measurements and ibuprofen consumption were recorded at 0-2, 8, 16, 24, 32, 40, 48, 56, 64, 72, 80, 88, and 96 hours (0-2 interval of the first 2 hours immediately after surgery).

COVARIATES

Age, classification and position of mandibular third molar were utilized as covariates.

ANALYSES

The relationship between pain tolerance and postoperative pain was analyzed using the Mann-Whitney U test and the Fisher exact test. Statistical analysis was performed using the SPSS version 28.0 software.

RESULTS

A total of 30 male patients with a mean age of 22.5 ± 4.8 years were included in our study. In the group with low pain tolerance, the pain scores at the first 2 hours, 32, and 48 hours after the operation (4.55 ± 3.59, 2.91 ± 2.59, 2.91 ± 2.43, respectively) were found to be significantly higher than the group with high pain tolerance (2.00 ± 2.67, 0.95 ± 1.68, 0.95 ± 1.39, respectively) (P < .05). In the first 2 hours after the operation, the amount of ibuprofen consumed was also significantly higher in the group with low pain tolerance compared to the other group, and 81.8% of this group felt the need to consume ibuprofen (P < .05).

CONCLUSIONS AND RELEVANCE

The cold pack test, a more practical version of quantitative sensory testing, is useful in identifying male patients at risk of developing greater pain after third molar surgery. It can be helpful to provide effective analgesia in male patients with different pain tolerance thresholds.

Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis

BACKGROUND

Corticosteroids are used to manage pain after surgical tooth extractions. The authors assessed the effect of corticosteroids on acute postoperative pain in patients undergoing surgical tooth extractions of mandibular third molars.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic review and meta-analysis. The authors searched the Epistemonikos database, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the US clinical trials registry (ClinicalTrials.gov) from inception until April 2023. Pairs of reviewers independently screened titles and abstracts, then full texts of trials were identified as potentially eligible. After duplicate data abstraction, the authors conducted random-effects meta-analyses. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool and certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Forty randomized controlled trials proved eligible. The evidence suggested that corticosteroids compared with a placebo provided a trivial reduction in pain intensity measured 6 hours (mean difference, 8.79 points lower; 95% CI, 14.8 to 2.77 points lower; low certainty) and 24 hours after surgical tooth extraction (mean difference, 8.89 points lower; 95% CI, 10.71 to 7.06 points lower; very low certainty). The authors found no important difference between corticosteroids and a placebo with regard to incidence of postoperative infection (risk difference, 0%; 95% CI, -1% to 1%; low certainty) and alveolar osteitis (risk difference, 0%; 95% CI, -3% to 4%; very low certainty).

PRACTICAL IMPLICATIONS

Low and very low certainty evidence suggests that there is a trivial difference regarding postoperative pain intensity and adverse effects of corticosteroids administered orally, submucosally, or intramuscularly compared with a placebo in patients undergoing third-molar extractions.

Evaluation of effect of submucosal administration of depomedrol in management of postoperative sequelae in mandibular fractures: A randomized clinical trial study

Introduction:

The mandible is a commonly fractured bone in the face, a fact related to its prominent and exposed position. Open reduction and internal fixation (ORIF) of mandibular fractures has been associated with trauma to the surgical site and the surrounding tissues.

Purpose:

The purpose of this study is to evaluate the effects of immediate postoperative submucosal depomedrol administration on postoperative pain, edema, and trismus after ORIF for mandibular fractures.

Materials and Methods:

We conducted a prospective, randomized, controlled, double-blind study of forty patients who required ORIF for mandibular fractures under general anesthesia. The patients were divided into two groups, an experimental group who received immediate postoperative submucosal 40 mg of depomedrol injection through the surgical incision site, and a control group who did not receive any drug. Pain was assessed using a Visual Analog Scale score and the frequency of analgesic consumption at various postoperative intervals. The maximum interincisal distance and facial measurements were compared before surgery and at 24, 48, 72 h, and 7 days after surgery.

Results:

Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the depomedrol group. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted.

Conclusion:

The results of our study suggest that submucosal administration of depomedrol injection after ORIF for mandibular fractures is effective in reducing postoperative pain, edema, and trismus.

Review of dexamethasone administration for management of complications in postoperative third molar surgery

Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.

Quality of Life of Patients after Kinesio Tape Applications Following Impacted Mandibular Third Molar Surgeries

Today, extraction of the impacted third molar is the most common procedure performed in oral surgery departments. One of the methods currently investigated—in terms reducing the severity of non-infectious complications and decreasing Quality of Life following third molar surgeries—is Kinesio Taping (KT). The aim of the study was to evaluate the impact of Kinesio Tape application on Quality of Life. A total of 100 asymptomatic patients with impacted third lower molar were included. The study participants were randomly divided into two groups: a study group with the application of KT (n = 50) and a control group (without KT) (n = 50). Removal of the impacted third lower molar was performed in each patient in a standardized fashion. For assessment of Quality of Life, the modified University of Washington Quality of Life Questionnaire (UW-QoL v4) was used. Patients with Kinesio Tape application scored higher in all domains. Statistically significant differences between the two groups were found in the following domains: “Activity”, “Mood”, “Health-related QoL during the past 7 days” and “Overall QoL during the past 7 days”. There were no significant differences in significant problems and important issues between groups. Kinesio Taping has a significant impact on Quality of Life after impacted third molar removal. It should be considered as one of the noninvasive methods to reduce postoperative non-infectious complications.

Objective and subjective comparison of submucosal and intravenous routes of single-dose preoperative dexamethasone for mandibular third molar surgery-a prospective randomized observer-blind study

PURPOSE

Adjuvant corticosteroid administration through local routes has gained popularity due to ease of technique, lesser morbidity and presumed advantage of achieving therapeutic dosage at the site. To evaluate this, present study has compared submucosal route with an intravenous route control using single-dose preoperative dexamethasone. The study investigated objective facial measurements, mouth opening and compared them with subjective scores on a visual analogue scale and quality of life (QOL) recovery questionnaire.

MATERIALS AND METHODS

This was a prospective, randomized, open-label study with blinded end-point assessment of submucosal and intravenous routes of single preoperative dexamethasone administration, in patients undergoing mandibular third molar surgery. Patients were randomly divided into two groups and received 8 mg DX as either submucosal or intravenous injection 5 min after administration of local anaesthesia. Data was collected at 2nd and 7th post-op intervals. Statistical analysis was done keeping a P value < 0.05 as significant.

RESULTS

Thirty patients were evaluated in the study. SM route behaved similarly to IV route in producing changes in facial measurements [P = 0.533], mouth opening [P = 0.533] and pain [VAS] scores [P = 0.533] at early and late intervals. Questionnaire subscale scores were not significantly different between groups, but total mean score was significant [P = 0.050] with a measure of variance 17.54 in group IV compared with 39.54 of group SM showing that subjectively, IV route brought better recovery.

CONCLUSION AND CLINICAL RELEVANCE

Submucosal route can be an effective less invasive, painless, straightforward alternative to systemic administration of corticosteroid for improving QOL recovery in mandibular third molar surgery.

Comparison of the effect of therapeutic elastic bandage, submucosal dexamethasone, or dexketoprofen trometamol on inflammatory symptoms and quality of life following third molar surgery: a randomized clinical trial

OBJECTIVES

We aimed to compare the effects of preoperative single-dose submucosal corticosteroid injection and postoperative elastic therapeutic bandage application with postoperative non-steroid anti-inflammatory drug therapy on postoperative inflammatory symptoms and quality of life following mandibular third molar surgeries.

MATERIALS AND METHODS

A single-center, randomized, clinical trial was conducted with 52 patients (36 female, 16 male) who expected severe postoperative sequelae as a result of the extraction of impacted mandibular third molars. The patients were randomized into three groups. In the preoperative submucosal corticosteroid injection group (n = 16), 8 mg/2 ml dexamethasone 21-phosphate was administered near operated sites. In the postoperative therapeutic elastic bandage application group (n = 19), Kinesio tapes were applied to operated sites. Paracetamol 500 mg was prescribed for the patients in the corticosteroid and elastic bandage application groups. In the postoperative non-steroid anti-inflammatory drug group (n = 17), 25 mg dexketoprofen trometamol was prescribed. Maximal mouth opening, swelling, pain, and Oral Health Impaction Profile scores were quantified preoperatively and postoperatively on the second and seventh days. Additionally, all patients were asked to evaluate the postoperative period by the Postoperative Symptom Severity Scale.

RESULTS

Analysis of the obtained data revealed that on the second postoperative day, postoperative edema and trismus were significantly lower in the submucosal corticosteroid (p = 0.025, p = 0.03) and therapeutic elastic bandage (p = 0.032, p = 0.014) groups, and the patients in these groups had a more comfortable postoperative period than the group prescribed a postoperative non-steroid anti-inflammatory drug (p = 0.016).

CLINICAL RELEVANCE

In oral surgery, postoperative elastic bandage application can provide results similar to those of preoperative submucosal corticosteroid injection with respect to inflammatory symptoms and quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04200885. Date of Registration: December 2019 (retrospectively registered).

The effects of piezosurgery and submucosal dexamethasone injection on post-operative complications after third molar surgery

BACKGROUND

A retrospective clinical study was performed to compare the post-operative effects of the conventional surgery, piezo surgery technique and submucosal dexamethasone injection in lower third molars extractions.

METHODS

Data from 62 patients, subjected to surgical extraction of lower third molars, were pooled and divided into three groups such as: Conventional Group (22 patients), Piezo Group (20 patients) and Dex Group (conventional surgery + 4 mg/1 mL dexamethasone) (20 patients). Pain, swelling, trismus, analgesic consumption and operation time were comparatively evaluated.

RESULTS

Pain values were found lower in Dex Group in comparison to Conventional Group at 7th day (P = 0.007). Edema found to be higher in Conventional Group than Dex Group at 2nd day (P = 0.025). Minimally trismus values were found in Dex Group and the difference between the Dex and Conventional Group found to be statistically significant both in 2nd (P = 0.048) and 7th days (P = 0.010). The analgesic consumption in the Conventional Group was found to be higher than Piezo Group at 2nd day (P = 0.002).

CONCLUSION

The better post-operative values were obtained in the Dex Group. Although longer operative time is considered to be a disadvantage for the piezo technique, piezotome may be preferred for surgical procedures due to its positive results in comparison to the conventional technique.

Third molar removal and its impact on quality of life: systematic review and meta-analysis

OBJECTIVE

The purpose of this systematic review was to assess the impact of third molar removal on patient's quality of life.

METHODS

To address the study purpose, investigators designed and implemented a systematic review. The primary outcome variable was the quality of life after third molar extraction. An electronic search was conducted through March, 2017, on the PUBMED, Virtual Health Library (VHL), Web of Science, and OVID, to identify relevant literatures. Research studies (randomized or non-randomized clinical trials) were included that evaluated the quality of life in individuals before and after third molar extraction, using validated measures of oral health-related quality of life with quantitative approach, besides procedures performed under local anesthesia. The R software was used to measure the mean difference on the quality of life between the preoperative period and follow-up days.

RESULTS

A total of 1141 studies were identified. Of this total, 13 articles were selected in the present systematic review, of which six studies were included in the meta-analysis. All of these 13 articles used the OHIP-14, and 4 of this 13 used OHQoLUK-16 to evaluate the quality of life. Regarding quality assessment, four of the 13 included studies in this review received a maximum score of 9 points, according to the Newcastle-Ottawa (NOS). The OHIP-14 mean score on the first postoperative day was 17.57 (95% CI 11.84-23.30, I² = 96%) higher than the preoperative period. On the seventh postoperative day, the quality of life assessed by OHIP-14 got worse again.

CONCLUSION

This systematic review revealed that the highest negative impact on quality of life of individuals submitted to third molar surgery was observed on the first postoperative day, decreasing over the follow-up period.