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Vijayakumar G, Sundaram GA, Kumar SP, Krishnan M, Krishna VK, Lakshmanan S. Comparison of the Efficacy of Corticosteroids With Enzymatic Agents in the Postoperative Sequelae for Lower Third Molar Surgery: A Prospective Study. Cureus 2024; 16:e55397. [PMID: 38562319 PMCID: PMC10984366 DOI: 10.7759/cureus.55397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The presence of impacted third molars is a prevalent problem associated with varying degrees of difficulty in extraction and potential consequences, including pain, swelling, and trismus. According to studies, enzymatic combinations, such as bromelain, rutoside, trypsin, and serratiopeptidase, are known to have a very promising role in reducing inflammation and promoting wound healing. This study compared natural enzymatic agents with corticosteroids for postoperative pain, swelling, and trismus in the impacted lower third molar surgery. Objectives The present study aimed to compare the efficacy of prednisolone, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain, and serratiopeptidase in the postoperative sequelae after surgical extraction of impacted mandibular third molars. The primary objective was to assess the difference in swelling between the three groups. The secondary objectives were to assess the difference in postoperative pain and trismus between the three groups. Materials and methods A total of 150 patients who presented to the department of oral and maxillofacial surgery for surgical removal of an impacted mandibular third molar with a moderately difficult score of 5-7 in the Pederson difficulty index were chosen for a prospective study. Patients were categorized into three groups based on the postoperative drug prescribed. In group 1, prednisolone 10 mg was prescribed; in group 2, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was prescribed; and in group 3, serratiopeptidase 15 mg was prescribed. All patients were prescribed a combination drug of aceclofenac 100 mg and paracetamol 325 mg twice daily as a standard analgesic. Swelling, pain, and trismus in each patient were recorded preoperatively and at postoperative day one and day seven. The Friedman test was employed to evaluate the variation in pain levels within the groups over time, while the Kruskal-Wallis test was utilized to investigate the disparity in pain levels between the groups. The difference in swelling and trismus within the groups across the timeline was measured by repeated measures analysis of variance (ANOVA), and the difference in swelling and trismus between the groups was measured by one-way ANOVA. A p-value below 0.05 was deemed to be statistically significant. Results Group 1 showed less swelling, pain, and trismus on both postoperative day one and day seven compared to group 2 and group 3, which was a statistically significant difference (P < 0.05). It was found that swelling, pain, and trismus measurements in postoperative day one and day seven in group 2 were comparatively less than in group 3. Neither group demonstrated any side effects or other complications during the follow-up period. Conclusion It can be concluded that the use of prednisolone postoperatively following surgical removal of the mandibular third molar provided better relief with regard to pain, trismus, and swelling compared to the enzymatic agents. Among enzymatic agents, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was better in reducing pain, trismus, and swelling than serratiopeptidase drug.
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Affiliation(s)
- Goutham Vijayakumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Gidean A Sundaram
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vinod K Krishna
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Saravanan Lakshmanan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Nakao H, Hasegawa S, Tomimatsu M, Sasaki J, Yamamoto S, Watanabe S, Miyabe S, Terasawa F, Miyachi H, Goto M. Three-dimensional imaging evaluation of facial swelling after orthognathic surgery with compression and Kinesio taping therapy: a randomized clinical trial. Ann Med Surg (Lond) 2024; 86:1446-1454. [PMID: 38463074 PMCID: PMC10923312 DOI: 10.1097/ms9.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/04/2024] [Indexed: 03/12/2024] Open
Abstract
Background Postoperative swelling is a common complication of orthognathic surgery. The authors used three-dimensional (3D) image analysis and body surface temperature to determine the effects of compression taping (CT) and Kinesio taping (KT) by the epidermis, dermis, and fascia method (EDF-KT) on postoperative swelling. Materials and methods The authors conducted a prospective, parallel-group, randomized controlled trial. Among the 162 patients diagnosed with jaw deformity and who underwent orthognathic surgery from August 2020 to October 2022, 105 patients (men: 36, women: 69, mean age: 28.27±8.92) underwent Le Fort type I + sagittal split ramus osteotomy (SSRO) or SSRO and were included in this study. Patients were randomly divided into three groups: EDF-KT group (n=31), CT group (n=41), and no tape group (control group, n=30). All taping was performed immediately postoperatively and removed on postoperative day (POD) 5. Three-dimensional images of the participants' faces were obtained preoperatively and at PODs 3, 7, 30, and 90 using a hand-held 3D imaging system and infrared thermography. Results No significant difference was observed in postoperative swelling and postoperative body surface temperature between the groups at each time point. The CT group showed a trend towards reduced swelling on PODs 3 and 7 and a trend toward residual swelling on POD 90. The EDF-KT group showed a trend towards an increase in postoperative body surface temperature. Conclusion CT taping may not be appropriate for postoperative swelling control, suggesting that EDF-KT may affect body surface temperature. Further validation of the efficacy of KT for jaw deformities is needed.
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Affiliation(s)
| | - Shogo Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University Graduate School of Medicine, Nagoya, Japan
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Poorna P, Shetty P, Kalyani V, Shetty S, Upadya M, Mithra P. A comparative evaluation of the effect of addition of 8 mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study. Front Oral Health 2024; 5:1349832. [PMID: 38404531 PMCID: PMC10884295 DOI: 10.3389/froh.2024.1349832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Background Impacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially. Aim To evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars. Methodology A controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures. Results Test group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p < 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p < 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p < 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7. Conclusion The addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.
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Affiliation(s)
- P. Poorna
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Premalatha Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Veerbhadra Kalyani
- Department of Oral Oncosurgery, VTSM Peripheral Cancer Centre, Kalaburagi, India
| | - Sameep Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Madhusudan Upadya
- Department of Emergency Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Amodeo G, Cerbelli E, Pisano A, Minieri L, Scopelliti D. The Influence of Bolus of Methylprednisolone on Postorthognathic Surgery Symptoms: A Controlled Clinical Trial. J Craniofac Surg 2023; 34:2112-2115. [PMID: 37317004 DOI: 10.1097/scs.0000000000009492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Despite improvements in maxillary and mandibular osteotomy, complications still result in around 20%. Post and intraoperative standard therapies, based on the use of betamethasone and tranexamic acid, could help to minimize the onset of side effects. The aim of the study was to compare the role of a supplementary bolus of methylprednisolone rather than the standard therapy in the onset of postoperative symptoms. METHODS The authors enrolled 10 patients, affected by class 2 and 3 Dentoskeletal, submitted to the institution for maxillomandibular repositioning osteotomy between October 2020 and April 2021. Patients were divided into 2 groups as follows: 5 patients (group A ) received standard therapy consisting of the administration of 4 mg of betamethasone, intraoperatively, and 1 g of tranexamic acid in 2 administrations. The remaining 5 patients (group B ) received a supplementary bolus of 20 mg methylprednisolone before the end of the surgery.All patients received, in the postoperative period, 4 mg of betamethasone every 12 hours, for 3 days. Postoperative outcomes were evaluated with a questionnaire evaluating speaking discomfort, pain when swallowing, feeding discomfort, drinking discomfort, swelling, and ache. Each parameter was associated with a numeric rating scale ranging from 0 to 5. RESULTS The authors observed that patients treated with a supplementary bolus of methylprednisolone (group B ) had a statistically significant reduction of all postoperative symptoms as compared with patients of group A (* P < 0.05, ** P <0.01 Fig. 1 ). CONCLUSION The study highlighted that the additional bolus of methylprednisolone improved all of the 6 parameters investigated by the questionnaire submitted to patients, resulting in a faster recovery and improvement of the patient's compliance with surgery. Further studies with a larger population are needed to confirm preliminary results.
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Affiliation(s)
- Giulia Amodeo
- Department of UOC Maxillofacial Surgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
- Smile House Fondazione ETS, Rome, Italy
| | | | - Annalinda Pisano
- Department of UOC Anesthesiology and Reanimation, San Filippo Neri Hospital, ASL Roma1, Rome, Italy
| | - Luciana Minieri
- Department of UOC Maxillofacial Surgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
- Smile House Fondazione ETS, Rome, Italy
- Department of UOC Maxillofacial Surgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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Ruthvik S, Krishnan M, George M, Kumar SP, Lakshmanan S. Efficacy of Dexamethasone Diluted Saline Irrigant on Postoperative Sequelae in Patients Undergoing Lower Third Molar Surgery: A Prospective Clinical Study. Cureus 2023; 15:e45436. [PMID: 37859912 PMCID: PMC10582784 DOI: 10.7759/cureus.45436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
Background Third molar impaction surgery is one of the most common yet challenging procedures done as a part of minor oral surgery. Years of research and improvisation of techniques have been done, yet there are still a lot of postoperative sequelae after surgical removal of the impacted tooth. In our study, we have compared the efficacy of dexamethasone diluted saline solution over plain saline solution used as an irrigant in the reduction of postoperative sequelae for lower third molar surgery. Aim The aim of the study was to evaluate the efficacy of dexamethasone diluted saline solution over plain saline solution in the reduction of postoperative sequelae for lower third molar surgery. Materials and methods The research was conducted at Saveetha Dental College and Hospital in the Department of Oral and Maxillofacial Surgery. The study consisted of 48 individuals, 24 of whom had dexamethasone saline as an irrigant (8 mg of dexamethasone was diluted in 100 ml of plain saline) (Group 1), and 24 in whom plain saline was used as an irrigant (Group 2) in the lower third molar surgery. Patients were evaluated postoperatively for pain and swelling. The postoperative swelling was measured on postoperative day two and day seven. Postoperative pain was measured on day two, day four, and day seven after surgery using a visual analog scale. Data were analyzed using SPSS (IBM Corp., Armonk, NY) with P-values less than 0.05 considered statistically significant. The statistical test used to compare the outcomes between the two groups was the independent samples t-test. Results It was found that study participants in the dexamethasone saline irrigation group reported statistically significantly lesser pain than participants receiving plain saline irrigation on day two (P = 0.001), day four (P = 0.001), and day seven (P = 0.001), respectively. Also, there was a reduction in swelling among participants in the dexamethasone saline irrigation group when compared to the normal saline irrigation group, which was statistically significant (P = 0.001) on day two, while the postoperative swelling was not statistically significant on day seven (P = 0.08) between the two study groups. Conclusion Based on the results obtained, it can be concluded that dexamethasone saline solution (8 mg/100 mL) was more effective as an irrigant in reducing the postoperative sequelae than regular saline solution in the lower third molar surgery.
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Affiliation(s)
- Soorumsetty Ruthvik
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Melvin George
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Saravanan Lakshmanan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Miroshnychenko A, Azab M, Ibrahim S, Roldan Y, Diaz Martinez JP, Tamilselvan D, He L, Urquhart O, Verdugo-Paiva F, Tampi M, Polk DE, Moore PA, Hersh EV, Brignardello-Petersen R, Carrasco-Labra A. Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis. J Am Dent Assoc 2023; 154:727-741.e10. [PMID: 37500235 PMCID: PMC10910594 DOI: 10.1016/j.adaj.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 07/29/2023]
Abstract
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.
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Myers AL, Jeske AH. Provider-directed analgesia for dental pain. Expert Rev Clin Pharmacol 2023; 16:435-451. [PMID: 37083548 DOI: 10.1080/17512433.2023.2206118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Extraction of impacted molar teeth is a common procedure performed by oral surgeons and general dentists, with postoperative pain being a significant adverse event post-surgery. If mismanaged, pain can lead to complications that impact oral and systemic health. The current scourge of the opioid epidemic has ushered in a new era of provider-directed analgesic (PDA) therapy in dentistry. AREAS COVERED This article provides an in-depth review on the major pharmacological and therapeutic properties of established and alternative analgesics used to manage dental pain. EXPERT OPINION Substantial evidence-based literature shows combination of a non-steroidal anti-inflammatory drug (NSAID; e.g. ibuprofen) and acetaminophen provides superior pain relief than single-agent or combination opioid regimens. However, there are clinical scenarios (e.g. severe pain) when short-course opioid prescription is appropriate in select patients, in which a 2-3-day treatment duration is typically sufficient. Alternative agents (e.g. caffeine, gabapentin, phytotherapies), typically in combination with established agents, can mitigate postoperative dental pain. Some evidence suggests preemptive therapies (e.g. corticosteroids, NSAIDs) reduce amounts of postsurgical analgesic consumption and might lessen opioid prescription burden. In summary, this comprehensive review provides an opportune update on the evolving landscape of pharmacotherapy for acute postsurgical dental pain, informing best practices for PDA in the dental setting.
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Affiliation(s)
- Alan L Myers
- Department of Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arthur H Jeske
- Office of the Dean, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Lakhani KS, Joshi S, Pawar S, Nair VS, Korrane V, Salema H, Khan N, Patel J. Evaluation of the Efficacy of Oral and Intramuscular Administration of Dexamethasone on Postoperative Pain, Swelling, and Trismus After Surgical Removal of Impacted Third Molar: A Comparative Split-Mouth Study. Cureus 2023; 15:e38306. [PMID: 37255895 PMCID: PMC10226760 DOI: 10.7759/cureus.38306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/01/2023] Open
Abstract
Context Over the past 60 years, several researchers have conducted extensive studies on the use of dexamethasone to reduce the postoperative complications of lower third molar surgery, namely, pain, edema, and trismus. In this study, we compared the oral and intramuscular methods of dexamethasone administration. Purpose The aim of this research was to assess pain, edema, and trismus in the postoperative period following the surgical removal of the lower third molar using 8 mg of dexamethasone given orally or by intramuscular injection. Method A split-mouth technique was employed for the study, in which each of the two bilaterally impacted mandibular third molars was removed one at a time, separated by at least two weeks. There were 26 participants in this experiment. Two groups were created from the research sample: group A (injection dexamethasone) and group B (tablet dexamethasone). The pain was assessed on the first, second, and third postoperative days. On the first, third, and seventh postoperative days, the parameters, such as edema and trismus, were evaluated. Results As per our study, in terms of edema and trismus, there was less of a statistically significant difference between the two interventions at all time points. While the pain score had a significant difference between both interventions. Conclusion Hence, we conclude that oral dexamethasone is an effective alternative to intramuscular dexamethasone. Oral dexamethasone is comparatively simple, less invasive, painless, and easy for the surgeon and for apprehensive patients, and it offers a cost-effective solution for the suffering often associated with the extraction of impacted lower third molars.
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Affiliation(s)
- Kinjal S Lakhani
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Samir Joshi
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Sudhir Pawar
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Vivek S Nair
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Vaishali Korrane
- Oral Medicine and Radiology, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Hamza Salema
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Nayla Khan
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Jay Patel
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
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Grissom AC, Hernandez IA, Kirkpatrick TC, Patel SA, Barros JA, Stanley E. Treating Nerve Injury After Endodontic Microsurgery Using Laser Photobiomodulation: A Report of Two Cases. J Endod 2023; 49:597-603. [PMID: 36894023 DOI: 10.1016/j.joen.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/17/2023] [Indexed: 03/09/2023]
Abstract
The purpose of this case report was to inform dentists and dental specialists about a non-invasive, viable treatment option that could aid in the recovery of patients who have experienced iatrogenic nerve injuries. Nerve injury is an inherent risk of many dental procedures, and a complication that can negatively impact a patient's quality of life and activities of daily living. Managing neural injuries presents a challenge for clinicians as there are no standard protocols reported in the literature. While spontaneous healing of these injuries can occur, the duration and degree of healing can vary greatly between individuals. Photobiomodulation (PBM) therapy is used as an adjunct in medicine for functional nerve recovery. Once target tissues are illuminated with a low-level laser during PBM, the light energy is absorbed by the mitochondria causing ATP production, modulation of reactive oxygen species, and the release of nitric oxide. These cellular changes explain why PBM has been shown to aid in cell repair, vasodilation, reduction in inflammation, accelerated healing, and an improvement in postoperative pain. This case report presents two patients with neurosensory alterations after endodontic microsurgery with significant improvement in their condition after PBM treatment using a 940 nm diode laser.
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Affiliation(s)
- Austyn C Grissom
- Department of Endodontics, The University of Texas Health Science Center at Houston School of Dentistry
| | - I Andrea Hernandez
- Department of Endodontics, The University of Texas Health Science Center at Houston School of Dentistry
| | - Timothy C Kirkpatrick
- Department of Endodontics, The University of Texas Health Science Center at Houston School of Dentistry
| | - Shalizeh A Patel
- Department of Restorative Dentistry and Prosthodontics, The University of Texas Health Science Center at Houston School of Dentistry
| | - Juliana A Barros
- Department of Restorative Dentistry and Prosthodontics, The University of Texas Health Science Center at Houston School of Dentistry
| | - Eva Stanley
- Department of Endodontics, The University of Texas Health Science Center at Houston School of Dentistry.
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11
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Singh A, Pentapati KC, Kodali MVRM, Smriti K, Patil V, Chowdhary GL, Gadicherla S. Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2023; 2023:7412026. [PMID: 37168455 PMCID: PMC10165033 DOI: 10.1155/2023/7412026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 05/13/2023] Open
Abstract
The corticosteroids have been used for preemptive management of surgical sequelae after mandibular third molar extraction. The aim of this article was to review the efficacy of methylprednisolone versus dexamethasone in the management of postsurgical pain, swelling, and trismus after mandibular third molar surgery. Randomized, double-blinded studies from PubMed, CINAHL, Scopus, DOSS, Cochrane central, and Web of Science were identified by using a search strategy. Randomized controlled trials evaluating the efficacy of use of dexamethasone versus methylprednisolone for mandibular third molar extraction were only considered. The studies involving the use of any other corticosteroid agent were excluded. Outcomes assessed were postoperative pain, the number of rescue analgesics required, swelling, trismus, and adverse events. The search strategy yielded 1046 articles for title and abstract screening, out of which only seven studies were included in the systematic review after full text screening. There was considerable heterogeneity between the studies with regards to the method as well as the parameters assessed. Risk of bias was low in three studies and unclear in other four studies. On pooled analyses, there was no significant difference with respect to pain, rescue analgesics, and swelling in the test and the control group. Forest plot analysis showed that dexamethasone had lesser trismus in early postoperative period (postoperative day 2) as compared to methylprednisolone. None of the included studies reported any adverse effects. Both the corticosteroids have similar efficacy in reducing the postoperative pain and swelling; however, dexamethasone showed statistically significant difference from methylprednisolone in reducing trismus (estimated standardized mean difference of -0.69 mm; 95% CI: -1.01 to -0.38; p < 0.0001) in the early postoperative period. However, due to statistical heterogeneity, quality of the evidence for the review was low to moderate. Hence, more studies with larger study sample and low risk of bias are needed to confirm these results.
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Affiliation(s)
- Anupam Singh
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | | | - Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Vathsala Patil
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Gandham Lekha Chowdhary
- Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
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12
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Almadhoon HW, Hamdallah A, Abu Eida M, Al-kafarna M, Atallah DA, Abuiriban RW, Asla MM, Abdelsalam A, Awad AA, Nawar AA, Elsayed SM, Almotairy N. Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction. J Am Dent Assoc 2022; 153:1154-1170.e60. [DOI: 10.1016/j.adaj.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
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13
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Aslam‐Pervez B, Carr E. Bilateral ‘kissing’ molars: A case report. Clin Case Rep 2022; 10:e6407. [PMID: 36381048 PMCID: PMC9653165 DOI: 10.1002/ccr3.6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Abstract
‘Kissing molars’, were described by Van Hoof in 1973 as when the occlusal surfaces of impacted molars are united by the same follicular space and the roots point in the opposite direction. There are very few published cases in the literature, and it is an extremely rare form of impaction. This manuscript concerns the diagnosis and management of a rare dentoalveolar clinical and radiographic presentation, which may be encountered by and be of interest to dental practitioners in both primary and secondary care.
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Affiliation(s)
- Bilal Aslam‐Pervez
- Oral and Maxillofacial Surgery, NHS Greater Glasgow and Clyde Queen Elizabeth University Hospital Glasgow UK
| | - Emma Carr
- Oral and Maxillofacial Surgery, NHS Greater Glasgow and Clyde Queen Elizabeth University Hospital Glasgow UK
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14
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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] [What about the content of this article? (0)] [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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Gururaj S, Shankar S, Parveen F, Chidambar C, Bhushan K, Prabhudev C. Assessment of healing and pain response at mandibular third molar extraction sites with and without pre- and postoperative photobiomodulation at red and near-infrared wavelengths: A clinical study. J Pharm Bioallied Sci 2022; 14:S470-S474. [PMID: 36110661 PMCID: PMC9469217 DOI: 10.4103/jpbs.jpbs_675_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022] Open
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Selvido DI, Bhattarai BP, Niyomtham N, Riddhabhaya A, Vongsawan K, Pairuchvej V, Wongsirichat N. Review of dexamethasone administration for management of complications in postoperative third molar surgery. J Korean Assoc Oral Maxillofac Surg 2021; 47:341-350. [PMID: 34713808 PMCID: PMC8564082 DOI: 10.5125/jkaoms.2021.47.5.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Diane Isabel Selvido
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Nattisa Niyomtham
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Apiwat Riddhabhaya
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Kadkao Vongsawan
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | | | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
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17
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Hamadi I, Al-Khanati NM, Kara Beit Z. Comparing the Effect of Facial Compression Bandage to That of Systemic Dexamethasone on Postsurgical Sequels after Extraction of Impacted Mandibular Third Molars: A Split-mouth Randomized Clinical Trial. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The present study aimed to compare the clinical efficiency of facial pressure bandage, to that of intramuscular injection of dexamethasone (8 mg) on postsurgical sequels (swelling, pain, and trismus) of extraction of impacted mandibular third molar.
METHODS: The study implemented a randomized split-mouth design. Patients with symmetrical bilateral impacted molars were eligible for the present trial. Sides were randomly assigned to two groups: pressure bandage group and dexamethasone group. The evaluated postsurgical sequels were extraoral swelling, trismus, and pain after 48 h and 7 days.
RESULTS: The study included 42 impacted third molars (n = 42) in 21 patients with a mean age of 23.4 years. Most participants were females (66.7%). The mean postoperative swelling rates after 48 h and 7 days in pressure bandage group were found to be comparable to those of dexamethasone group. No significant difference was found in the mean rates of postoperative trismus between study groups after 48 h and 7 days. Differences in mean pain level scores between the pressure bandage group and dexamethasone group were statistically insignificant after 48 h and 7 days.
CONCLUSION: The study findings showed that the effect of the pressure bandage was comparable to dexamethasone effect on the postsurgical sequels after surgical extraction of impacted mandibular third molars.
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18
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Gaur S, Marimuthu M, Wahab A, Krishnan N, Ramasubbu S. Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial. J Oral Maxillofac Surg 2021; 80:63-69. [PMID: 34363764 DOI: 10.1016/j.joms.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction. METHODS A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride + 1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride + 1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7. RESULTS The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus. CONCLUSIONS Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.
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Affiliation(s)
- Shivangi Gaur
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Madhulaxmi Marimuthu
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India.
| | - Abdul Wahab
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Navaneetha Krishnan
- Professor, Department of Anesthesia, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Subhashini Ramasubbu
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Selvido DI, Bhattarai BP, Rokaya D, Niyomtham N, Wongsirichat N. Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management. Eur J Dent 2021; 15:588-598. [PMID: 34041732 PMCID: PMC8382502 DOI: 10.1055/s-0041-1725212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.
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Affiliation(s)
- Diane Isabel Selvido
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Dinesh Rokaya
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Nattisa Niyomtham
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
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21
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Vieth MP, Deas DE, Archontia Palaiologou A, Diogenes A, Mader MJ, Mealey BL. Effect of intravenous dexamethasone on postoperative pain and swelling following periodontal flap surgery: A randomized controlled trial of patient-centered outcomes. J Periodontol 2021; 93:237-245. [PMID: 34021915 DOI: 10.1002/jper.21-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND This randomized, crossover trial sought to determine if a preoperative intravenous (IV) dose of dexamethasone reduces pain, swelling, and analgesic usage following periodontal surgery. METHODS Thirty-seven patients planned for two similar periodontal flap surgeries under IV sedation were enrolled. Patients were randomized to receive either 2 mL (8 mg) dexamethasone sodium phosphate or 2 mL of IV solution (placebo) before the first surgery, and 2 mL of the other solution before the second surgery. Postoperative discomfort was managed with a standardized regimen of 600 mg ibuprofen and 325 mg acetaminophen. A smartphone application was used to record self-assessed pain and swelling scores using 21-point numerical (NRS-21) and 4-point verbal (VRS-4) rating scales as well as the number of analgesic medications taken at 12-, 24-, 48-, 72-, 168-, and 336-hours following each surgery. RESULTS IV dexamethasone was associated with a significant reduction in pain at 12, 24, 48, and 72 hours (P <0.05), and swelling at 12, 24, 48, and 168 hours (P < 0.05) postoperatively when compared with placebo based on NRS-21 responses. VRS-4 data showed significant reductions in pain at 12, 72, and 168 hours and swelling at 12, 24, and 168 hours postoperatively with dexamethasone. No significant differences were found in the number of tablets of ibuprofen or acetaminophen between dexamethasone and placebo surgeries. CONCLUSIONS Preoperative, intravenously administered dexamethasone reduces pain and swelling within the first postoperative week following periodontal flap surgery and should be considered a useful adjunct for perioperative management.
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Affiliation(s)
- Michael P Vieth
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | - David E Deas
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | | | - Anibal Diogenes
- Department of Endodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | - Michael J Mader
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Brian L Mealey
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
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22
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Wagner JC, Johnson TM, Gilbert WA. Should periodontists prescribe postoperative oral corticosteroids to control pain and swelling? A systematic review. Clin Adv Periodontics 2021; 12:134-142. [PMID: 33988318 DOI: 10.1002/cap.10169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/08/2021] [Indexed: 11/05/2022]
Abstract
FOCUSED CLINICAL QUESTION In generally healthy patients receiving third molar, periodontal, or dental implant surgery, do postoperative oral corticosteroids effectively limit pain and swelling compared with placebo or alternative medications?
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Affiliation(s)
- Jennah C Wagner
- Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, Georgia
| | - Thomas M Johnson
- Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, Georgia
| | - William A Gilbert
- Department of Periodontics, US Army Dental Health Activity, Joint Base Lewis McChord, Tacoma, Washington
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Sifuentes-Cervantes JS, Carrillo-Morales F, Castro-Núñez J, Cunningham LL, Van Sickels JE. Third molar surgery: Past, present, and the future. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:523-531. [PMID: 34030996 DOI: 10.1016/j.oooo.2021.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
Third molar surgery is the most common ambulatory procedure done by oral and maxillofacial surgeons. Surgical approaches for the removal of third molars have been published since the 20th century. This article reviews the history and development of extraction techniques through a literature review. The literature was selected through a search of an electronic database. Key words for the Medline search were "mandibular/maxillary third molar," "impacted mandibular/maxillary third molar," "mandibular/maxillary third molar flap design," and "mandibular/maxillary third molar incision." The search was restricted to English-language articles. Additionally, a manual search in the major oral surgery journals and books was performed. The aim of this article is to examine the evolution of third molar surgery, recognize pioneering techniques, and compare these techniques to current approaches. Common approaches employed today are discussed and treatment philosophies with thoughts for future therapies are provided.
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Affiliation(s)
- Jose S Sifuentes-Cervantes
- PGY 1, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
| | - Francisco Carrillo-Morales
- Formerly Chief Resident, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Jaime Castro-Núñez
- PGY 3, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico; Research Department, Institución Universitaria Colegios de Colombia, Bogotá, Colombia
| | - Larry L Cunningham
- Professor and Chair, Oral and Maxillofacial Surgery Department, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph E Van Sickels
- Professor and Program Director, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington, KY, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wanithanont P, Chaiyasamut T, Vongsavan K, Bhattarai BP, Pairuchvej V, Kiattavorncharoen S, Wongsirichat N. Comparative efficiency of the preoperative pterygomandibular space injection of two doses of dexamethasone in mandibular third molar surgery. J Dent Anesth Pain Med 2021; 21:29-39. [PMID: 33585682 PMCID: PMC7871183 DOI: 10.17245/jdapm.2021.21.1.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Impacted mandibular third molar removal is one of the most commonly performed oral surgical procedures. This procedure can lead to several postoperative complications, such as trismus, facial swelling, and pain, which occur as a result of the inflammatory responses to surgery. This study compared the efficiency of preoperative injections of 4 mg versus 8 mg dexamethasone into the pterygomandibular space to reduce postoperative sequelae. METHODS This was a randomized, prospective, split-mouth, controlled study, including 52 mandibular third molar surgeries in 26 patients. Each patient was randomized to either the 4 mg or 8 mg dexamethasone injection group. Dexamethasone was injected into the pterygomandibular space after numbness from local anesthesia. Data were collected for trismus, facial swelling, visual analog scale (VAS) pain score, and the number of analgesics taken during the evaluation period. The level of significance was set at P < 0.05. RESULTS Statistically significant differences in postoperative facial swelling (P = 0.031, diff = 1.4 mm) and pain (P = 0.012, diff = 0.020) were found between the 8 mg and 4 mg dexamethasone groups. However, there were no significant differences between the groups for trismus and the total number of analgesics consumed (P > 0.05). CONCLUSION Compared to the 4 mg preoperative dexamethasone injection, the 8 mg preoperative dexamethasone injection into the pterygomandibular space was more effective in reducing postoperative swelling and pain following the surgical removal of the impacted mandibular third molar. However, the difference in trismus could not be evaluated clinically. Therefore, the recommendation of administering the 4 mg dexamethasone preoperative injection is optimal in the third molar surgical procedure.
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Affiliation(s)
- Pavita Wanithanont
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Teeranut Chaiyasamut
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kadkao Vongsavan
- Walailak University International College of Dentistry, Bangkok, Thailand
| | | | - Verasak Pairuchvej
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Sirichai Kiattavorncharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Baumann GP, Robertson W, Guinn A, Curtis K, Morizio K, Jarrell D, Edwards C, Lowry S, Woolridge D, Tolby N. The Effects of Dexamethasone on the Time to Pain Resolution in Dental Periapical Abscess. J Emerg Med 2021; 60:506-11. [PMID: 33483197 DOI: 10.1016/j.jemermed.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dental infections are frequently encountered in the emergency department (ED), with periapical abscesses being among the most painful. Traditional pain management strategies include local anesthetic injections, oral analgesics, and intravenous opioids. OBJECTIVES We sought to identify an alternative pain management strategy with early use of dexamethasone as adjunct to conventional therapies for inflammation and pain at the site of infection. METHODS We conducted a prospective, randomized, double-blind, placebo-controlled study comparing the analgesic effect of dexamethasone and placebo in ED patients with periapical abscess during a 2-year timeframe at two urban academic EDs. Adult patients presenting with physical examination findings consistent with a diagnosis of periapical abscess were randomized to receive oral dexamethasone or an identical placebo. Pain was assessed using the verbal numeric scale in person at discharge and via telephone at 12, 24, 48, and 72 h after discharge from the ED. RESULTS Seventy-three patients were enrolled, with 37 receiving dexamethasone and 36 receiving placebo. Follow-up pain scores were obtained for 52 patients at 12, 24, 48, and 72 h. Ten patients from the dexamethasone group and 11 from placebo group were lost to follow-up. Patients who received dexamethasone reported a greater reduction in pain at 12 h compared with the placebo group (p = 0.029). Changes in pain scores from baseline and at 24, 48, and 72 h were not statistically significant. No adverse events were reported. CONCLUSIONS Single-dose dexamethasone as adjunct to conventional medical management for pain caused by periapical abscess demonstrated a significant reduction in pain 12 h post treatment compared with placebo.
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Al-Moraissi EA, Al-Zendani EA, Al-Selwi AM. Efficacy of Submucosal Injection of Chymotrypsin, Oral Serratiopeptidase or Oral Dexamethasone in Reducing Postoperative Complications Following Impacted Lower Third Molar Surgery: A Prospective, Randomized, Double-Blind, Controlled Clinical Trial. Front Oral Health 2020; 1:575176. [PMID: 35047980 PMCID: PMC8757710 DOI: 10.3389/froh.2020.575176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Aim The study aimed to compare between chymotrypsin, oral serratiopeptidase, and oral dexamethasone following impacted mandibular third molars surgery in respect of postoperative complications. Materials and method: A randomized, double-blind clinical trial was conducted on 60 patients who were candidates for impacted mandibular third molars surgery and randomly allocated into the following 3 groups: submucosal chymotrypsin (5 mg), oral serratiopeptidase (10 mg), and oral dexamethasone (8 mg) (each group = 20). The outcome variables were postoperative pain (via visual analog scale), facial swelling (via tape method) and maximal mouth opening immediately after 2nd, 3rd, and 5th postoperative days. Results: A total of 60 patients underwent randomization and allocation concealment and were included in the current study. All of the subjects tolerated the medicines with no untoward side or adverse effects. There was no statistically significant difference between the three groups in respect of postoperative pain intensity, facial swelling and maximal mouth opening at the immediate first hour, 2nd, 3rd, and 5th postoperative days (P < 0.05). Conclusion: The present randomized clinical trial concluded that preemptive sub-mucosal injection of chymotrypsin yields a comparable effectiveness in decreasing postoperative sequelae following impacted mandibular third molars surgery when compared to oral serratiopeptidase or dexamethasone. This is the first Randomized Clinical Trail that assessed efficacy and safety of sub-mucosal injection of chymotrypsin after impacted mandibular third molars surgery. This trial is registered at clinicaltrials.in.th, number (TCTR20200828006).
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Thamar University, Dhamar, Yemen
- *Correspondence: Essam Ahmed Al-Moraissi
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Sugragan C, Sirintawat N, Kiattavornchareon S, Khoo LK, Kc K, Wongsirichat N. Do corticosteroids reduce postoperative pain following third molar intervention? J Dent Anesth Pain Med 2020; 20:281-291. [PMID: 33195806 PMCID: PMC7644360 DOI: 10.17245/jdapm.2020.20.5.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery. Methods The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted. Results Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration. Conclusions Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.
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Affiliation(s)
- Chollathit Sugragan
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Lee Kian Khoo
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kumar Kc
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Sitthisongkhram K, Niyomtham N, Chaiyasamut T, Pairuchvej V, Kc K, Wongsirichat N. Effectiveness of dexamethasone injection in the pterygomandibular space before and after lower third molar surgery. J Dent Anesth Pain Med 2020; 20:313-323. [PMID: 33195809 PMCID: PMC7644359 DOI: 10.17245/jdapm.2020.20.5.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background Previous studies have investigated the effects of dexamethasone injections into the pterygomandibular space and compared them to those of controls; however, the effects of dexamethasone injections before and after lower third molar surgery on postoperative complications have not been studied. This research investigated the postoperative sequelae of dexamethasone injections before and after surgery into the pterygomandibular space. The aim of this study was to evaluate the effects of preoperative and postoperative injections of 4 mg of dexamethasone into the pterygomandibular space on postoperative pain, facial swelling, and the restriction of mouth opening following lower third molar surgical removal. Methods Twenty-seven participants with bilateral symmetrical lower impacted third molars were included in this study. Each participant was randomly allocated to one of two groups. Group A received injections of 1 ml dexamethasone (4 mg/mL) and 1 mL placebo into the pterygomandibular space before and after surgery, respectively. Group B received the same doses of placebo before surgery and dexamethasone after surgery. Results A significant restriction of mouth opening on the second postoperative day was observed in both groups. Nonetheless, the postoperative restriction of mouth opening, facial swelling, postoperative pain, and analgesic consumption after lower third molar surgical removal were not significantly different in the two groups. Conclusions Regardless of the time of administration, dexamethasone injections into the pterygomandibular space resulted in satisfactory control of the postoperative sequelae of the mandibular third molar surgical removal.
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Affiliation(s)
- Kalaya Sitthisongkhram
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattisa Niyomtham
- International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Teeranut Chaiyasamut
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Verasak Pairuchvej
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kumar Kc
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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French Society of Stomatology, Maxillo-Facial Surgery and Oral Surgery (SFSCMFCO). Electronic address: cabinetruhin@gmail.com. French good practice guidelines regarding third molar removal: Indications, techniques, methods. J Stomatol Oral Maxillofac Surg 2020; 121:418-29. [PMID: 32565265 DOI: 10.1016/j.jormas.2020.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
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Société française de stomatologie, chirurgie maxillofaciale et chirurgie orale (SFSCMFCO). Electronic address: cabinetruhin@gmail.com. [French good practice guidelines regarding third molar removal: Indications, techniques, methods]. J Stomatol Oral Maxillofac Surg 2020; 121:e7-e19. [PMID: 32562779 DOI: 10.1016/j.jormas.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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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. J Oral Maxillofac Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Golob Deeb J, Farris E, Reichert A, Carrico CK, Deeb GR. Effect of postoperative steroids on clinical outcomes and radiographic findings of horizontal alveolar ridge augmentation: A retrospective study. J Periodontol 2019; 91:917-924. [PMID: 31811744 DOI: 10.1002/jper.19-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/17/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of the study was to investigate if the prescription of oral postoperative steroids has an effect on clinical outcomes of horizontal ridge augmentation including implant placement and characteristics of the grafted bone. METHODS A retrospective chart review of 73 horizontal ridge augmentation cases was completed to assess the clinical outcomes, 53 of those cases were further assessed radiographically. Information was gathered regarding surgical technique, grafting materials, postoperative healing, medications used postoperatively, bone growth, and density changes as quantified on a cone-beam computed tomography (CBCT) scan. Statistical analysis was completed to identify whether the use of postoperative oral steroids altered outcomes. RESULTS Steroids were used postoperatively following various horizontal ridge augmentation procedures. The use of tenting screws and resorbable membranes with a combination of osseous allograft and xenograft was used in 73 cases, 53 of which had preoperative and postoperative CBCT scans. Graft exposure occurred in five of the cases (9%), with the majority (n = 4) among those with postoperative steroids, but this was not statistically significant (P-value = 0.6510). Use of steroids was also not significantly associated with the number of courses of antibiotics (P-value > 0.05), but it was significantly associated with increased number of postoperative visits (P-value < 0.05). Among the subset for radiographic analysis (n = 53), there were significant clinical and radiographic dimensional changes in alveolar ridge width with an average horizontal bone gain of 3.6 mm. There were no statistically significant differences found in radiographic linear bone gain or clinical outcomes with the addition of steroids. A marginally statistically significant in the density of grafted bone was found with the addition of steroids (P-value > 0.05). CONCLUSION The prescription of postoperative steroids did not make a significant difference in clinical outcomes, success of implant placement or on radiographic assessment of grafted sites following horizontal alveolar ridge augmentation.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Emily Farris
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Amy Reichert
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - Caroline K Carrico
- Department of Dental Public Health and Policy, Oral Health Research Core, Virginia Commonwealth University, Richmond, VA
| | - George R Deeb
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA
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O’hare PE, Wilson BJ, Loga MG, Ariyawardana A. Effect of submucosal dexamethasone injections in the prevention of postoperative pain, trismus, and oedema associated with mandibular third molar surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2019; 48:1456-69. [DOI: 10.1016/j.ijom.2019.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/19/2022]
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Feslihan E, Eroğlu CN. Can Photobiomodulation Therapy Be an Alternative to Methylprednisolone in Reducing Pain, Swelling, and Trismus After Removal of Impacted Third Molars? Photobiomodul Photomed Laser Surg 2019; 37:700-705. [PMID: 31589558 DOI: 10.1089/photob.2019.4696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background and objective: Studies investigating an alternative to corticosteroids in terms of potential side effects after surgical removal of impacted third molars are still ongoing. Accordingly, the present randomized single-blind study aimed to compare the efficacy of photobiomodulation therapy (PBMT) and methylprednisolone on pain, edema, and trismus after surgical removal of impacted third molars. Methods: The study included 30 healthy patients with bilaterally impacted lower third molars. The side (right or left molar) that would be extracted at first and the treatment (PBMT or corticosteroid) that would be applied to this side were decided by tossing a coin. The time interval between two surgical operations was at least 3 weeks. In the laser group, immediately after the surgical procedure, PBMT was applied extraorally to the insertion point of the masseter muscle for 60 sec with an output power of 0.3 W and an energy density of 6 J/cm2 and then repeated on postoperative days 1 and 2. In the corticosteroid group, 40 mg/2 mL methylprednisolone sodium succinate was injected postoperatively into the masseter muscle with the intrabuccal approach. On postoperative day 1, methylprednisolone injection (20 mg/1 mL) was repeated. Pain was evaluated using the visual analog scale on postoperative days 1, 2, and 7. Edema (in mm) and trismus (in mm) were evaluated preoperatively and on postoperative days 2 and 7. Results: There were no significant differences between the PBMT and methylprednisolone administration in terms of postoperative pain, edema, and trismus. Conclusions: Within the limits of the present study, PBMT was considered an alternative and a useful method for controlling inflammatory complications following impacted wisdom tooth surgery as it exhibited similar clinical efficacy to that of methylprednisolone.
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Affiliation(s)
- Erkan Feslihan
- Tekirdag Oral and Dental Health Hospital, Tekirdag, Turkey
| | - Cennet Neslihan Eroğlu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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Nagori S, Jose A, Roy I, Chattopadhyay P, Roychoudhury A. Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2019; 48:787-800. [DOI: 10.1016/j.ijom.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/10/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022]
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Raldi FV, Nascimento RD, Sato FRL, Santos LM, Amorim JBO, de Moraes MB. Evaluation of the impact of preoperative use of dexamethasone and cyclobenzaprine in surgical extraction of lower third molars on trismus by electromyographic analysis. Oral Maxillofac Surg 2019; 23:395-405. [PMID: 31119419 DOI: 10.1007/s10006-019-00776-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 05/02/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to evaluate the influence of cyclobenzaprine and dexamethasone on the electrical activity of the masticatory muscles in patients who had undergone lower third molar surgery. METHODS Thirty bilateral impacted lower third molars with indication of extraction were randomised into three groups: the control group, the dexamethasone, and the cyclobenzaprine group. To obtain muscular electrical activity and mouth opening, an electromyographic device was used at mandibular rest and maximum voluntary contraction and compared pre- and post-operatively. RESULTS During muscle contraction, no significant difference was observed in the electromyographic records on the non-operated side. On the operated side, there was a reduction in electrical activity for both drugs pre-operatively and immediately post-operatively compared to the control group. All pharmacological agents promoted a higher mouth opening compared to control group. CONCLUSION The results suggest that dexamethasone and cyclobenzaprine may be useful as an adjuvant in the prevention of motor dysfunctions in third molar surgery.
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Affiliation(s)
- Fernando Vagner Raldi
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - Rodrigo Dias Nascimento
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - Fábio Ricardo Loureiro Sato
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil. .,Department of Oral and Maxillofacial Surgery, College of Dentistry, State University of São Paulo - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, SP, 12245-000, Brazil.
| | - Lucio Murillo Santos
- Department of Bioscience and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - José Benedito Oliveira Amorim
- Department of Bioscience and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
| | - Michelle Bianchi de Moraes
- Department of Surgery and Oral Diagnoses, College of Dentistry, State University of São Paulo - UNESP, São José dos Campos, Brazil
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dos Santos Alves J, de Freitas Alves B, de Figueiredo Costa A, Carneiro B, de Sousa L, Gondim D. Cranial nerve injuries in Le Fort I osteotomy: a systematic review. Int J Oral Maxillofac Surg 2019; 48:601-611. [DOI: 10.1016/j.ijom.2018.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022]
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Liu S, Zhao H, Wang Y, Zhao H, Ma C. Oral Bromelain for the Control of Facial Swelling, Trismus, and Pain After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 77:1566-1574. [PMID: 30986376 DOI: 10.1016/j.joms.2019.02.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/30/2019] [Accepted: 02/28/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether bromelain can decrease trismus, pain, and facial swelling in patients undergoing impacted third molar surgery. MATERIALS AND METHODS Three databases were searched to identify relevant studies through November 1, 2017. Randomized controlled trials (RCTs) that compared the effect of bromelain versus placebo after mandibular third molar surgery were included. The main outcome measures, pain, facial swelling, and trismus, were assessed in the early stage (2 to 3 days) and the late stage (7 days) after surgery. Standardized mean differences (SMDs) and weighted mean differences (WMDs) were calculated using fixed-effect models. All statistical analyses were implemented using Review Manager 5.3. RESULT Six RCTs were included in this meta-analysis. The pooled results suggested that bromelain appears to be effective for decreasing facial swelling in the early and late stages after surgery (early-stage SMD, -0.24; 95% confidence interval [CI], -0.46 to -0.02; P = .03; late-stage SMD, -0.54; 95% CI, -0.84 to -0.24; P = .0004). Bromelain alleviated postoperative pain 7 days after surgery (SMD, -0.54; 95% CI, -0.87 to -0.20; P = .002), but there was no significant difference in pain levels at the early stage. For trismus, analyses showed that bromelain had no apparent effect on early or late trismus. CONCLUSION Bromelain conferred moderate relief of postoperative discomfort after third molar surgery.
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Affiliation(s)
- Shaopeng Liu
- Resident, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Haoming Zhao
- Resident, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Ye Wang
- Resident, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Huaqiang Zhao
- Professor, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Chuan Ma
- Lecturer, College of Stomatology, Shandong University, Jinan, Shandong Province, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Almeida RDA, Lemos C, de Moraes S, Pellizzer E, Vasconcelos B. Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2019; 48:118-131. [DOI: 10.1016/j.ijom.2018.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
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Abstract
In this review we describe the evidence base for postoperative analgesia after maxillofacial surgery. We discuss the implications of poorly managed pain, risk factors for the development of severe pain, and pharmacological and non-pharmacological analgesic strategies to manage it.
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Affiliation(s)
- S W Evans
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH
| | - R A McCahon
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH.
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Larsen MK, Kofod T, Christiansen AE, Starch-Jensen T. Different Dosages of Corticosteroid and Routes of Administration in Mandibular Third Molar Surgery: a Systematic Review. J Oral Maxillofac Res 2018; 9:e1. [PMID: 30116513 PMCID: PMC6090248 DOI: 10.5037/jomr.2018.9201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
Abstract
Objectives The objective of the present systematic review was to test the hypothesis of no difference in facial swelling, pain and trismus after surgical removal of mandibular third molar with different dosages of corticosteroids and administration routes. Material and Methods A MEDLINE (PubMed), Embase database and Cochrane Library search in combination with a hand-search of relevant journals was conducted by including randomized controlled trials published in English until 1st December 2017. Results Seven studies fulfilled the inclusion criteria. Considerable variation in the included studies prevented meta-analysis from being performed. Preoperative submucosal injection of corticosteroids significantly diminishes facial swelling, pain and trismus compared with placebo. However, different dosages of corticosteroid and administration routes reveal contrary results indicating that administration of a higher dosage of corticosteroids do not necessarily cause a further decrease in facial swelling, pain and trismus. Conclusions Consequently, the optimal dosage of corticosteroids and administration route for diminishing postsurgical morbidity and improve quality of life after surgical removal of mandibular third molar is presently unknown. Therefore, further well-designed randomized clinical trials including a standardised protocol, patient-reported outcome measures and three-dimensional analysis of facial swelling is needed.
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Affiliation(s)
- Marie Kjærgaard Larsen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Thomas Kofod
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen University Hospital, CopenhagenDenmark
| | - Ann-Eva Christiansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
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Lim D, Ngeow WC. In reply. J Oral Maxillofac Surg 2018; 76:1141-2. [PMID: 29596795 DOI: 10.1016/j.joms.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/22/2022]
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Cho H, Lynham AJ, Hsu E. Postoperative interventions to reduce inflammatory complications after third molar surgery: review of the current evidence. Aust Dent J 2017; 62:412-419. [DOI: 10.1111/adj.12526] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 12/26/2022]
Affiliation(s)
- H Cho
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - AJ Lynham
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - E Hsu
- Maxillofacial Unit; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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Lim D, Ngeow WC. A Comparative Study on the Efficacy of Submucosal Injection of Dexamethasone Versus Methylprednisolone in Reducing Postoperative Sequelae After Third Molar Surgery. J Oral Maxillofac Surg 2017; 75:2278-86. [PMID: 28666096 DOI: 10.1016/j.joms.2017.05.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the efficacy of preoperative submucosal injection of 4 mg of dexamethasone versus 40 mg of methylprednisolone in reducing postoperative sequelae after surgical removal of impacted mandibular third molars. PATIENTS AND METHODS This prospective, randomized, double-blind study included 65 patients who required surgical removal of impacted mandibular third molars with Class II or position B impaction (Pell and Gregory classification). Patients were randomly assigned to 1 of 3 groups: dexamethasone, methylprednisolone, or placebo (control). Surgery was performed with patients under local anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on postoperative day 1, 2, 5, and 7 to measure postoperative facial swelling by use of 2 linear measurements: interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Wound healing also was assessed on postoperative day 7. Descriptive and multivariate statistics were computed, and significance was set at P < .05. RESULTS Both methylprednisolone and dexamethasone significantly reduced swelling and trismus (P < .05, Kruskal-Wallis test), whereas the methylprednisolone group had significantly less pain (P < .05, Kruskal-Wallis test) and consumed a lower amount of analgesics (P < .05, χ2 test) during the early postoperative days. CONCLUSIONS The study findings suggest that a single preoperative dose of dexamethasone versus methylprednisolone was equally effective in reducing postoperative swelling and trismus. Pain control by these corticosteroids, however, was variable.
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Maeda S, Honda Y, Tanimura H, Tomoyasu Y, Higuchi H, Murata N, Egusa M, Miyawaki T. Clinical Analysis of Analgesics and Steroids Use for Extraction of Teeth in Patients with Intellectual Disability Under General Anesthesia. Open Dent J 2017; 11:181-186. [PMID: 28567142 PMCID: PMC5418919 DOI: 10.2174/1874210601711010181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 11/22/2022] Open
Abstract
Background: The extraction of lower wisdom teeth is often performed under general anesthesia in patients with intellectual disabilities. However, the choice of analgesics has not yet been investigated. Objective: To analyze the use of analgesics during general anesthesia for extraction including lower wisdom teeth in patients with intellectual disabilities. Methods: This research is a retrospective observational study. The study population was composed of all patients presenting for extraction of lower wisdom teeth under ambulatory general anesthesia in the clinic of Special Needs Dentistry in Okayama University Hospital from April 2011 to March 2016. The distribution of the combination of analgesics and the relationship between the use of analgesics and the type of extraction were investigated. Results: One hundred and twelve cases were enrolled in this study. Intravenous injections of flurbiprofen, acetaminophen and betamethasone were used in 96 (85.7%), 12 (10.7%) and 26 cases (23.2%), respectively. Flurbiprofen is a non-steroid anti-inflammatory drugs (NSAIDs). Acetaminophen is an old analgesic, but an injection of acetaminophen is new, which was released in 2013 in Japan. And betamethasone is not an analgesic, but a steroid. Betamethasone was used in combination with other analgesics, and was used at a higher dose in a case in which four wisdom teeth were extracted. Conclusion: Flurbiprofen was the main analgesic used for extraction of wisdom teeth under general anesthesia in patients with intellectual disabilities. Betamethasone was used to support flurbiprofen or acetaminophen for extractions of multiple wisdom teeth, with the aim of controlling swelling rather than relieving pain.
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Affiliation(s)
- Shigeru Maeda
- Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan
| | - Yuka Honda
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Tanimura
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yumiko Tomoyasu
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Higuchi
- Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan
| | - Naomichi Murata
- Special Needs Dentistry, Okayama University Hospital, Okayama, Japan
| | - Masahiko Egusa
- Special Needs Dentistry, Okayama University Hospital, Okayama, Japan
| | - Takuya Miyawaki
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Salem N, Salem MY, Elmaghrabi MM, Elawady MA, Elawady MA, Sabry D, Shamaa A, Elkasapy AHH, Ibrhim N, Elamir A. Does vitamin C have the ability to augment the therapeutic effect of bone marrow-derived mesenchymal stem cells on spinal cord injury? Neural Regen Res 2017; 12:2050-2058. [PMID: 29323045 PMCID: PMC5784354 DOI: 10.4103/1673-5374.221163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Methylprednisolone (MP) is currently the only drug confirmed to exhibit a neuroprotective effect on acute spinal cord injury (SCI). Vitamin C (VC) is a natural water-soluble antioxidant that exerts neuroprotective effects through eliminating free radical damage to nerve cells. Bone marrow mesenchymal stem cells (BMMSCs), as multipotent stem cells, are promising candidates in SCI repair. To evaluate the therapeutic effects of MP, VC and BMMSCs on traumatic SCI, 80 adult male rats were randomly divided into seven groups: control, SCI (SCI induction by weight-drop method), MP (SCI induction, followed by administration of 30 mg/kg MP via the tail vein, once every other 6 hours, for five times), VC (SCI induction, followed by intraperitoneal administration of 100 mg/kg VC once a day, for 28 days), MP + VC (SCI induction, followed by administration of MP and VC as the former), BMMSCs (SCI induction, followed by injection of 3 × 106 BMMSCs at the injury site), and BMMSCs + VC (SCI induction, followed by BMMSCs injection and VC administration as the former). Locomotor recovery was assessed using the Basso Mouse Scale. Injured spinal cord tissue was evaluated using hematoxylin-eosin staining and immunohistochemical staining. Expression of transforming growth factor-beta, tumor necrosis factor-alpha, and matrix metalloproteinase-2 genes was determined using real-time quantitative PCR. BMMSCs intervention better promoted recovery of nerve function of rats with SCI, mitigated nerve cell damage, and decreased expression of transforming growth factor-beta, tumor necrosis factor-alpha, and matrix metalloproteinase-2 genes than MP and/or VC. More importantly, BMMSCs in combination with VC induced more obvious improvements. These results suggest that VC can enhance the neuroprotective effects of BMMSCs against SCI.
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Affiliation(s)
- Nesrine Salem
- Department of Histology and Cell Biology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Mohamed Y Salem
- Department of Histology and Cell Biology, Faculty of Medicine, Banha University, Banha, Egypt
| | | | - Moataz A Elawady
- Department of Neurosurgery, Faculty of Medicine, Banha University, Banha, Egypt
| | - Mona A Elawady
- Department of Community Medicine, Faculty of Medicine, Banha University, Banha, Egypt
| | - Dina Sabry
- Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ashraf Shamaa
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | | | - Noha Ibrhim
- Department of Medical Physiology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Azza Elamir
- Department of Medical Biochemistry, Faculty of Medicine, El Fayoum University, Egyptian, Egypt
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