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Rajendiran S, Krishnan B, Deepthy MS. The Local Route of Administration of Dexamethasone in Impacted Mandibular Third Molar Surgery: A Systematic Review and Meta-analysis of Randomised Controlled Trials and a Critical Narrative Review on the Claimed Advantages of the Local Route. J Maxillofac Oral Surg 2024; 23:56-67. [PMID: 38312984 PMCID: PMC10831005 DOI: 10.1007/s12663-023-02011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction The proponents of local route of Dexamethasone (DXM) administration for impacted mandibular 3rd molar (MM3) surgeries claim advantages over the traditional systemic routes. This systematic review and meta-analysis were aimed to determine whether the route of perioperative administration of DXM influences the inflammatory outcomes of MM3 surgeries. Methodology An electronic database search over a 25 year period of randomised trials of DXM in MM3 surgeries was conducted. The mean differences or standardised mean differences were extracted and pooled using the fixed or random-effects model. Results Of the sixteen selected trials, four were considered for a meta-analysis. There were no statistically significant differences in the inflammatory outcomes between the local and systemic routes of DXM. Conclusion The claimed advantages of the local route of DXM do not appear to be scientifically valid. Clinical trials supported with DXM plasma measurements are needed to confirm the absence of a systemic effect when DXM is administered locally.
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Affiliation(s)
- Saravanan Rajendiran
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), #8, 8th cross street, Bharathi Nagar, Lawspet Post, Puducherry, 605008 India
| | - B. Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), #8, 8th cross street, Bharathi Nagar, Lawspet Post, Puducherry, 605008 India
| | - M. S. Deepthy
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Pimenta RP, Takahashi CM, Barberato-Filho S, McClung DCF, Moraes FDS, de Souza IM, Bergamaschi CDC. Preemptive use of anti-inflammatories and analgesics in oral surgery: a review of systematic reviews. Front Pharmacol 2024; 14:1303382. [PMID: 38328575 PMCID: PMC10847331 DOI: 10.3389/fphar.2023.1303382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
Objectives: This review of systematic reviews evaluated the effectiveness and safety of the preemptive use of anti-inflammatory and analgesic drugs in the management of postoperative pain, edema, and trismus in oral surgery. Materials and methods: The databases searched included the Cochrane Library, MEDLINE, EMBASE, Epistemonikos, Scopus, Web of Science, and Virtual Health Library, up to March 2023. Pairs of reviewers independently selected the studies, extracted the data, and rated their methodological quality using the AMSTAR-2 tool. Results: All of the 19 studies reviewed had at least two critical methodological flaws. Third molar surgery was the most common procedure (n = 15) and the oral route the most frequent approach (n = 14). The use of betamethasone (10, 20, and 60 mg), dexamethasone (4 and 8 mg), methylprednisolone (16, 20, 40, 60, 80, and 125 mg), and prednisolone (10 and 20 mg) by different routes and likewise of celecoxib (200 mg), diclofenac (25, 30, 50, 75, and 100 mg), etoricoxib (120 mg), ibuprofen (400 and 600 mg), ketorolac (30 mg), meloxicam (7.5, 10, and 15 mg), nimesulide (100 mg), and rofecoxib (50 mg) administered by oral, intramuscular, and intravenous routes were found to reduce pain, edema, and trismus in patients undergoing third molar surgery. Data on adverse effects were poorly reported. Conclusion: Further randomized clinical trials should be conducted to confirm these findings, given the wide variety of drugs, doses, and routes of administration used.
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Affiliation(s)
- Régis Penha Pimenta
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Silvio Barberato-Filho
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Fabio da Silva Moraes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Hamad SA. Does Betamethasone Injection Into the Pterygomandibular Space Affect the Postoperative Outcomes of Impacted Lower Third Molar Surgery? J Oral Maxillofac Surg 2023; 81:1549-1556. [PMID: 37770014 DOI: 10.1016/j.joms.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Pain, swelling, and trismus are common outcomes following impacted lower third molar surgery. PURPOSE The purpose of the study was to evaluate the effect of betamethasone injection into the pterygomandibular space on the aforementioned sequelae of third molar surgery. STUDY DESIGN, SETTING, AND SAMPLE A split-mouth, double-blind, randomized clinical trial was conducted on 40 patients with symmetrical bilateral impacted lower third molars. The surgeries were performed at an outpatient clinic under local anesthesia. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The predictor variable is the steroid treatment. The experimental group received a 1 mL (6 mg) betamethasone injection into the pterygomandibular space, while the control group received a normal saline. MAIN OUTCOME VARIABLE(S) The primary outcome variable was postoperative pain assessed using a visual analog scale. The secondary outcome variables were the number of analgesic tablets consumed, facial swelling, and trismus. COVARIATES The age and sex of the patients, the direction of impaction, and the duration of surgery were recorded. ANALYSES Comparisons between the groups were carried out using an unpaired t test. An analysis of variance test was used to assess intragroup differences. The significance was considered at P ≤ .05. RESULTS Of the 265 patients initially screened for study enrollment, the final sample included 40 subjects, with a mean age of 28.3 years (±7.4), 28 (70%) were mal and 12 (30%) were female. There was no significant difference between the two groups concerning postoperative pain or the number of consumed analgesic tablets. However, the betamethasone group exhibited significantly reduced facial swelling and increased mouth opening. On the first postoperative day, the visual analog scale pain score did not significantly differ between the betamethasone group (6.0 ± 1.7) and the control group (6.8 ± 1.4), with a P value of 0.112. On the first postoperative day, facial swelling measured 4.2 ± 1.3 mm in the betamethasone group compared to 6.0 ± 0.9 mm in the control group (P < .001). Mouth opening in the betamethasone group was 30.8 ± 6.7 mm, while in the control group, it measured 21.9 ± 5.5 mm (P < .001). CONCLUSION AND RELEVANCE Local betamethasone has no effect on pain after third molar surgery, but facial swelling and trismus are significantly reduced.
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Affiliation(s)
- Shehab Ahmed Hamad
- Assistant Professor of Maxillofacial Surgery, Kurdistan Higher Council of Medical Specialties, Erbil, Iraq.
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Antonelli A, Barone S, Bennardo F, Giudice A. Three-dimensional facial swelling evaluation of pre-operative single-dose of prednisone in third molar surgery: a split-mouth randomized controlled trial. BMC Oral Health 2023; 23:614. [PMID: 37653378 PMCID: PMC10468892 DOI: 10.1186/s12903-023-03334-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Facial swelling, pain, and trismus are the most common postoperative sequelae after mandibular third molar (M3M) surgery. Corticosteroids are the most used drugs to reduce the severity of inflammatory symptoms after M3M surgery. This study aimed to evaluate the effect of a single pre-operative dose of prednisone on pain, trismus, and swelling after M3M surgery. METHODS This study was designed as a split-mouth randomized, controlled, triple-blind trial with two treatment groups, prednisone (PG) and control (CG). All the parameters were assessed before the extraction (T0), two days (T1), and seven days after surgery (T2). Three-dimensional evaluation of facial swelling was performed with Bellus 3D Face App. A visual analogue scale (VAS) was used to assess pain. The maximum incisal distance was recorded with a calibrated rule to evaluate the trismus. The Shapiro-Wilk test was used to evaluate the normal distribution of each variable. To compare the two study groups, the analysis of variance was performed using a two-tailed Student t-test for normal distributions. The level of significance was set at a = 0.05. Statistical analysis was conducted using the software STATA (STATA 11, StataCorp, College Station, TX). RESULTS Thirty-two patients were recruited with a mean age of 23.6 ± 3.7 years, with a male-to-female ratio of 1:3. A total of 64 M3Ms (32 right and 32 left) were randomly assigned to PG or CG. Surgery time recorded a mean value of 15.6 ± 3.7 min, without statistically significant difference between the groups. At T1, PG showed a significantly lower facial swelling compared to CG (PG: 3.3 ± 2.1 mm; CG: 4.2 ± 1.7 mm; p = 0.02). Similar results were recorded comparing the groups one week after surgery (PG: 1.2 ± 1.2; CG: 2.1 ± 1.3; p = 0.0005). All patients reported a decrease in facial swelling from T1 to T2 without differences between the two groups. At T1, the maximum buccal opening was significantly reduced than T0, and no difference between PG (35.6 ± 8.2 mm) and CG (33.7 ± 7.3 mm) (p > 0.05) was shown. Similar results were reported one week after surgery (PG: 33.2 ± 14.4 mm; CG: 33.7 ± 13.1 mm; p > 0.05). PG showed significantly lower pain values compared to CG, both at T1 (PG: 3.1 ± 1.5; CG: 4.6 ± 1.8; p = 0.0006) and T2 (PG: 1.0 ± 0.8; CG: 1.9 ± 1.4; p = 0.0063). CONCLUSION Our results showed that pre-operative low-dose prednisone administration could reduce postoperative sequelae by improving patient comfort after M3M surgery and reducing facial swelling two days and one week after surgical procedures. TRIAL REGISTRATION www. CLINICALTRIALS gov - NCT05830747 retrospectively recorded-Date of registration: 26/04/2023.
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Affiliation(s)
- Alessandro Antonelli
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Francesco Bennardo
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
- Department of Health Sciences, Oral Surgery Residency Training Program Director, Dean of the School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Vitor dos Santos Canellas J, Gamboa Ritto F, Tiwana P. Comparative efficacy and safety of different corticosteroids to reduce inflammatory complications after mandibular third molar surgery: a systematic review and network meta-analysis. Br J Oral Maxillofac Surg 2022; 60:1035-1043. [DOI: 10.1016/j.bjoms.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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Vitenson J, Starch-Jensen T, Bruun NH, Larsen MK. The use of advanced platelet-rich fibrin after surgical removal of mandibular third molars: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2022; 51:962-974. [PMID: 35033409 DOI: 10.1016/j.ijom.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/30/2021] [Accepted: 11/25/2021] [Indexed: 12/29/2022]
Abstract
The objective of this systematic review was to test the hypothesis of no difference in recovery following surgical removal of mandibular third molars with the application of advanced platelet-rich fibrin (A-PRF) in the extraction socket compared with alternative biomaterials or natural wound healing. A search of MEDLINE (PubMed), Embase, Cochrane Library, and Scopus was conducted. Human randomized controlled trials published in English up until December 31, 2020 were included. Outcome measures were pain, facial swelling, trismus, soft tissue healing, alveolar osteitis, and quality of life; these were evaluated by descriptive statistics and meta-analysis including 95% confidence intervals (CI). Four studies with a low or moderate risk of bias fulfilled the inclusion criteria. A-PRF resulted in significantly lower pain scores when compared with leucocyte platelet-rich fibrin or natural wound healing after 2 days (-16.8, 95% CI -18.9 to -14.7), 3 days (-12.1, 95% CI -13.4 to -10.7), and 7 days (-1.9, 95% CI -2.9 to -0.9). A-PRF seems to have a negligible effect on facial swelling and trismus and some beneficial effect on soft tissue healing. Alveolar osteitis and quality of life were not assessed. The included studies were characterized by considerable heterogeneity and confounding variables. Thus, the level of evidence appears to be inadequate for clinical recommendations according to the focused question.
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Affiliation(s)
- J Vitenson
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - T Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - N H Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - M K Larsen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
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Fudge JM, Page B, Lee I. Evaluation of Targeted Bupivacaine, Bupivacaine-lidocaine-epinephrine, Dexamethasone, and Meloxicam for Reducing Acute Postoperative Pain in Cats Undergoing Routine Ovariohysterectomy. Top Companion Anim Med 2021; 45:100564. [PMID: 34314884 DOI: 10.1016/j.tcam.2021.100564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/04/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
This study compared bupivacaine (BUP), bupivacaine-lidocaine-epinephrine (BLE), dexamethasone (DEX), and meloxicam (MEL) targeted at specific, potentially painful sites for reducing acute postoperative pain in cats undergoing elective ovariohysterectomy. One hundred fifty-one cats were included in a prospective, randomized, double-blinded clinical trial. Anesthesia consisted of a standardized protocol including buprenorphine, ketamine, dexmedetomidine, and isoflurane. A ventral midline ovariohysterectomy was performed, and cats were administered targeted injections of 0.5% bupivacaine (2 mg/kg); a combined 0.25% bupivacaine (1 mg/kg), 1% lidocaine (2 mg/kg), and 1:100,000 epinephrine (0.005 mg/kg); dexamethasone (0.125 mg/kg); or meloxicam (0.2 mg/kg) intraoperatively at the ovarian suspensory ligaments, uterine body, and incisional subcutaneous tissues. A 0-10 Numeric Pain Rating Scale (NRS) was used to assess cats postoperatively, 1 hour and 3 hours after anesthesia recovery prior to a same day discharge. Pain scores among evaluators were in good agreement with an overall Intraclass Correlation Coefficient (ICC) of 0.7897 (95% Confidence Interval 0.795-0.8313). In all groups, overall pain scores 1-hour post anesthesia recovery were significantly higher than scores 3 hours post anesthesia recovery (P < .0001). Averaged pain scores compared among treatment groups did not differ at 1 hour post recovery. At 3-hours post anesthesia recovery, MEL group cats had significantly lower pain scores than the BLE group (P = .018). Study results indicate that early postoperative pain scores were similar for cats receiving local infiltrations of BUP, BLE, DEX, and MEL as part of a multimodal pain therapy for routine ovariohysterectomies. MEL showed somewhat better results 3 hours post anesthesia recovery, gaining significance over the BLE group.
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Affiliation(s)
| | | | - Inhyung Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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Shibl M, Ali K, Burns L. Effectiveness of pre-operative oral corticosteroids in reducing pain, trismus and oedema following lower third molar extractions: a systematic review. Br Dent J 2021:10.1038/s41415-021-3165-y. [PMID: 34239059 DOI: 10.1038/s41415-021-3165-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022]
Abstract
Aim To determine if a single pre-operative dose of oral corticosteroids would be effective in reducing pain, trismus and oedema following lower third molar surgical extraction. Secondary outcomes of interest were post-operative complications such as infections.Methods Searching was conducted using Embase, Medline, DOSS, CINAHL and CENTRAL for randomised controlled trials. Four studies which compared pre-operative oral corticosteroids to placebo before lower third molar surgical extractions were eligible for inclusion.Results All studies were judged to be at unclear risk of bias. All studies tested the efficacy of 8 mg dexamethasone 60-90 minutes before surgical extractions. While three studies showed improvement in pain visual analogue scale (VAS) scores in the dexamethasone groups, two were not statistically significant. One study found no improvement in pain scores on VAS. One study found no difference in either trismus or oedema. One study reported one occurrence of post-operative alveolar infection in the dexamethasone group and one occurrence of alveolar osteitis in the placebo group.Conclusion While there seems to be an improvement in pain scores on VAS, these results are not clinically significant. Post-operative analgesia plays a more important role clinically.
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Affiliation(s)
- Mohammed Shibl
- Peninsula Dental School, University of Plymouth, Research Way, Plymouth, PL6 8BT, UK.
| | - Kamran Ali
- Peninsula Dental School, University of Plymouth, Research Way, Plymouth, PL6 8BT, UK
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Research Way, Plymouth, PL6 8BT, UK
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Dar-Odeh N, Elsayed S, Babkair H, Abu-Hammad S, Althagafi N, Bahabri R, Eldeen YS, Aljohani W, Abu-Hammad O. What the dental practitioner needs to know about pharmaco-therapeutic modalities of COVID-19 treatment: A review. J Dent Sci 2021; 16:806-816. [PMID: 33230404 PMCID: PMC7674127 DOI: 10.1016/j.jds.2020.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/12/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/PURPOSE Several pharmacotherapeutic methods have been used for the treatment of COVID-19 with varying degrees of success. No definitive treatment or vaccine has been officially approved to-date. This review aimed to highlight COVID-19 pharmacotherapeutic agents that are relevant to dental practice in terms of their clinical indications in COVID-19 and dental practice, as well as their adverse effects as they impact the dental patient. MATERIAL AND METHODS Systematic search was performed using the following keywords combinations: Pharmacotherapy AND COVID-19 OR Pharmacotherapy AND SARS-CoV-2 OR Treatment AND COVID-19. Studies were categorized according to the type of pharmacotherapy used. Pharmacotherapeutic agents were extracted and only those relevant to dental practice were included for review. RESULTS For analysis, a total of 79 clinical trials research articles were included that included COVID-19 pharmacotherapeutic agents relevant to dental practice. Those were analgesics (paracetamol; non-steroidal anti-inflammatory agents); antibiotics (azithromycin, doxycycline, metronidazole); antivirals (penciclovir); and immunomodulatory agents (hydroxychloroquine, corticosteroids). While some COVID-19 drugs are less relevant to dental practice, as antivirals and hydroxychloroquine, their association with long-term adverse effects requires adequate knowledge among dental practitioners. CONCLUSION Many of COVID-19 pharmacotherapeutic agents are used to treat oral diseases particularly orofacial pain and inflammatory conditions. Furthermore, some of these drugs may induce adverse effects that complicate dental treatment. Thorough knowledge of COVID-19 therapy and its dental implications is essential for dental practitioners, and is expected to contribute to a better understanding and effective utilization of these therapeutic agents.
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Affiliation(s)
- Najla Dar-Odeh
- College of Dentistry, Taibah University, Al Madinah, Al Munawara, Saudi Arabia
- School of Dentistry, University of Jordan, Amman, Jordan
| | - Shadia Elsayed
- College of Dentistry, Taibah University, Al Madinah, Al Munawara, Saudi Arabia
- Faculty of Dental Medicine for Girls, Al-Azhar, University, Cairo, Egypt
| | - Hamzah Babkair
- College of Dentistry, Taibah University, Al Madinah, Al Munawara, Saudi Arabia
| | | | - Nebras Althagafi
- College of Dentistry, Taibah University, Al Madinah, Al Munawara, Saudi Arabia
| | - Rayan Bahabri
- College of Dentistry, Taibah University, Al Madinah, Al Munawara, Saudi Arabia
| | | | - Wejdan Aljohani
- College of Dentistry, Taibah University, Al Madinah, Al Munawara, Saudi Arabia
| | - Osama Abu-Hammad
- College of Dentistry, Taibah University, Al Madinah, Al Munawara, Saudi Arabia
- School of Dentistry, University of Jordan, Amman, Jordan
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Larsen MK, Kofod T, Duch K, Starch-Jensen T. Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial. Med Oral Patol Oral Cir Bucal 2021; 26:e156-e163. [PMID: 32701926 PMCID: PMC7980302 DOI: 10.4317/medoral.24094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/10/2020] [Indexed: 11/09/2022] Open
Abstract
Background The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3).
Material and Methods Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval.
Results Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00).
Conclusions The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo. Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.
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Affiliation(s)
- M-K Larsen
- Department of Oral and Maxillofacial Surgery Aalborg University Hospital 18-22 Hobrovej, DK-9000 Aalborg, Denmark
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Singh AK, Dhungel S, Bhattarai K, Roychoudhury A. Do the Benefits of Systemic Corticosteroids Outweigh Adverse Effects During Maxillofacial Trauma Surgery? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2021; 79:1530.e1-1530.e21. [PMID: 33745861 DOI: 10.1016/j.joms.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Perioperative systemic corticosteroids are widely used in maxillofacial trauma surgery to prevent postoperative complications, but potentially perceived benefits are speculative rather than evidence-based. The purpose of our systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically significant outcomes in patients undergoing maxillofacial trauma surgery. METHODS We searched Medline, Embase, CENTRAL, Clinical trial registry, and grey literature as well as references of included trials. Our primary outcomes were facial edema and pain after the surgery. Our secondary outcomes were postoperative nausea and vomiting, neurosensory disturbance, functional recovery, wound infections, and other adverse events. RESULTS Of the 94 trials retrieved, 13 were included (n = 652). Perioperative steroid use was associated with reduced pain and facial edema. We observed a decrease in postoperative nausea and vomiting with the use of systemic corticosteroids (n = 184, OR = 0.53, [0.28, 1.02], I2 = 0%). Four trials reported infections and impaired wound healing associated with steroids (n = 160. OR = 3.37, [1.43. 7.94], I2 = 2%). The 13 trials had an unclear risk of bias. CONCLUSIONS Systemic corticosteroids reduced facial edema and postoperative pain, but impaired wound healing was also reported. The use of systemic steroids in maxillofacial trauma surgery is thus supported only by weak evidence and further research is advocated.
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Affiliation(s)
- Ashutosh Kumar Singh
- Associate Professor, Department of Oral and Maxillofacial Surgery, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal.
| | - Safal Dhungel
- Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal
| | - Kushal Bhattarai
- Assistant Professor, Department of Biochemistry, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal
| | - Ajoy Roychoudhury
- Professor and HOD, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Huang K, Giddins G, Wu LD. Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:2572-2585. [PMID: 31821010 DOI: 10.1177/0363546519888450] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions. PURPOSE To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF. STUDY DESIGN Systematic review and meta-analysis. METHODS Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months). RESULTS Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of -1.3 (95% CI, -1.9 to -0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low. CONCLUSION The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.
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Affiliation(s)
- Kai Huang
- Department of Orthopaedic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Grey Giddins
- Department of Orthopaedic Surgery, Royal United Hospital Bath, Bath, UK
| | - Li-Dong Wu
- Department of Orthopaedic Surgery, The Second Hospital of Medical College, Zhejiang University, Hangzhou, China
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Larsen MK, Kofod T, Duch K, Starch-Jensen T. Short-term Haematological Parameters Following Surgical Removal of Mandibular Third Molars with Different Doses of Methylprednisolone Compared with Placebo. A Randomized Controlled Trial. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e3. [PMID: 32760476 PMCID: PMC7393928 DOI: 10.5037/jomr.2020.11203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/11/2020] [Indexed: 12/27/2022]
Abstract
Objectives To evaluate the influence of a single intraoperative injection of methylprednisolone on short-term haematological parameters following surgical removal of mandibular third molars. Material and Methods Fifty-two patients with indications for surgical removal of bilateral impacted mandibular third molars were included in a randomized, split-mouth and double-blinded study design. Each molar were randomly allocated into one of following four groups: 20 mg methylprednisolone, 30 mg methylprednisolone, 40 mg methylprednisolone and placebo. Peripheral blood samples were obtained before and three days after surgery. Haematological parameters involving haemoglobin, white blood cell count and C-reactive protein (CRP) were evaluated and expressed as mean changes. Level of significance was 0.05. Furthermore, outcomes were correlated for age, sex, smoking and time of surgery. Results There were no significant differences in postoperative haematological parameters with different doses of methylprednisolone compared with placebo. Peripheral blood samples revealed decreased level of haemoglobin and increased level of leucocytes and CRP in each group. Smokers displayed a significant lower level of haemoglobin and CRP compared with non-smokers (P < 0.05) and level of eosinophils decreased significantly with increasing age (P < 0.05). Conclusions This study indicates that a single intraoperative injection of methylprednisolone seems not to cause suppression of short-term haematological parameters compared with placebo following surgical removal of mandibular third molars.
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Affiliation(s)
| | - Thomas Kofod
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen University HospitalDenmark
| | - Kirsten Duch
- Clinical unit of Biostatistics, Aalborg University Hospital, AalborgDenmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University HospitalDenmark
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Couto BPD, Corrêa LQ, de Sousa JEN, Goulart de Carvalho EF, Gonzaga HT, Costa-Cruz JM. Parasitological and immunological aspects of oral and subcutaneous prednisolone treatment in rats experimentally infected with Strongyloides venezuelensis. Acta Trop 2020; 204:105349. [PMID: 31958413 DOI: 10.1016/j.actatropica.2020.105349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Strongyloides venezuelensis is a model to study human strongyloidiasis, which infects wild rodents and shares common antigenic epitopes with Strongyloides stercoralis. This study aimed to evaluate parasitological and immunological parameters of prednisolone immunosuppression protocols in rats (Rattus novergicus) infected with S. venezuelensis. Rats were divided into six groups (n = 36): untreated and uninfected (-) or infected (+); oral treatment and uninfected (o-) or infected (o+); subcutaneous treatment and uninfected (sc-) or infected (sc+). For oral immunosuppression, 5 mg/mL of water diluted prednisolone were given five days before infection, and in the days 8 and 21 (for 5 days). For subcutaneous immunosuppression, 10 mg/kg of prednisolone were given daily. The infection was established by the subcutaneous injection of approximately 3,000 S. venezuelensis filarioid larvae per animal. All animals from the (+) and (o+) groups survived, while four rats from the (sc+) died prior to necropsy date. Parasitological analysis showed higher egg elimination in (o+) in comparison to (+) and (sc+) on 7, 13 and 26 days post infection (d.p.i.).The recovery of parasitic females at day 30 was significantly higher in (o+), compared to (+). The (+) and (o+) groups showed a clear increase in anti-S. venezuelensis IgG, IgG1 and IgG2 from 13th d.p.i. Oral immunosuppression led to a higher number of adult females and increased egg output while maintaining IgG and subclasses antibody levels comparable to the positive control.
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Affiliation(s)
- Bruna Patricia do Couto
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Luísa Queiroz Corrêa
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - José Eduardo Neto de Sousa
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Edson Fernando Goulart de Carvalho
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Henrique Tomaz Gonzaga
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Julia Maria Costa-Cruz
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil.
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Shoohanizad E, Parvin M. Comparison of the Effects of Dexamethasone Administration on Postoperative Sequelae Before and After “Third Molar" Extraction Surgeries. Endocr Metab Immune Disord Drug Targets 2020; 20:356-364. [DOI: 10.2174/1871530319666190722120405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/22/2022]
Abstract
Introduction:
Impacted third molars (ITMs) surgery, is one of the most common methods in
the field of oral and maxillofacial surgical operations. Administration of corticosteroid such as dexamethasone
diminishes the postoperative sequelae. The study aimed to compare the impact of dexamethasone
administration on pre-operative and post-operative complications in third molar surgery.
Methods:
We collected all randomized controlled trial data on the influences of pre-operative and postoperative
dexamethasone administration between 2006-2019 on third molar surgery sequelae by
searching the keywords: dexamethasone, third molar surgery, wisdom teeth, corticosteroids, oral surgery,
maxillofacial surgery, preoperative, postoperative, pain, swelling, and trismus in international
databases such as: Web of Science (ISI), PubMed, Scopus, Embase and Cochrane Library.
Results:
Twenty-three articles were included in this narrative review. Among them, 22 studies used
dexamethasone in particular and 1 study used dexamethasone with amoxicillin. Twenty studies evaluated
the prescription of dexamethasone in pre-operative and post-operative routes on pain, trismus and
edema following third molars operation. Five studies administered dexamethasone postoperatively and
15 studies administered the drug preoperatively. Two studies evaluated the preoperative and postoperative
administration method. Fourteen studies used a 4 mg dexamethasone dose and drug administration
was variable. The treatment period in postoperative studies varied between 1 to 7 days.
Conclusion:
Dexamethasone appears to be a promising agent in in reduction of post-operative complications
following third molar surgery. As a potent anti-inflammatory agent, it has an effective role in
pain, trismus and edema reduction distinguished from the routes of administration, dosage and timing,
pre or postoperative prescription.
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Affiliation(s)
- Ehsan Shoohanizad
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Parvin
- Assistant Professor, Oral and Maxillofacial Surgery Department, School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
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Larsen MK, Kofod T, Starch-Jensen T. Therapeutic efficacy of cryotherapy on facial swelling, pain, trismus and quality of life after surgical removal of mandibular third molars: A systematic review. J Oral Rehabil 2019; 46:563-573. [PMID: 30869171 DOI: 10.1111/joor.12789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/13/2019] [Accepted: 03/09/2019] [Indexed: 11/27/2022]
Abstract
The objective was to test the hypothesis of no difference in facial swelling, pain, trismus and immediate quality of life after surgical removal of mandibular third molars, with or without post-operative cryotherapy. A MEDLINE (PubMed), EMBASE database and Cochrane library search in combination with a hand search of relevant journals were conducted by including human randomised controlled trials published in English until 17 July 2018. The search identified 37 titles. Six studies with low or unclear risk of bias fulfilled the inclusion criteria. Intermittent cryotherapy for 30 minutes during the first post-operative days significantly diminished facial swelling, pain and trismus compared with no cryotherapy. Patient's satisfaction and perception of recovery were significantly increased with cryotherapy. Therapeutic efficacy of intermittent cryotherapy on post-operative facial swelling, pain and trismus seems to be improved compared with continuous cryotherapy. Considerable variations in study design, diversity of used evaluation methods, outcome measures and various methodological confounding factors posed serious restrictions to review the literature in a quantitative systematic manner. Thus, conclusions drawn from the results of this systematic review should be interpreted with caution. Further well-designed randomised controlled trials including standardised protocol, larger patient sample, blinded outcome assessors, patient-reported outcome measures and three-dimensional volumetric analysis of facial swelling are required before evidence-based recommendations can be provided.
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Affiliation(s)
| | - Thomas Kofod
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
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