A review of perioperative corticosteroid use in dentoalveolar surgery.
OBJECTIVE
Dental surgeons are often advised to use corticosteroids during and after third molar removal and other dentoalveolar surgery to reduce postsurgical edema, but recommendations for use are rarely accompanied by definitive guidance regarding the type of steroid, dosage, or duration of administration. Many regimens in use appear to be based on anecdotal information from articles in the 1960s and 1970s and might be subtherapeutic. Few regimens have been updated with data from more recent studies, and well-designed comparison studies are lacking.


METHODS
In this article, the literature from the past 30 years is reviewed, meaningful findings are highlighted, and available data are used as a basis for formulating interim clinical recommendations for corticosteroid use pending the emergence of more evidence-based data. A meta-analysis of data was not performed.


RESULTS
Recent data suggest that perioperative corticosteroid regimens should be administered in higher doses and for longer durations than recommended in the past and should be started before surgery for optimum benefit.


CONCLUSIONS
Based on the literature review, interim recommendations for the use of corticosteroids are proposed, including dosages and regimens that appear rational for oral, intramuscular, or intravenous corticosteroid administration before and after extractions and other dentoalveolar surgery. These largely empiric recommendations might require adjustment when evidence-based data become available in future studies. There is a great need for well-designed clinical research to further evaluate protocols for corticosteroid use.
Alexander
R E
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Baylor College of Dentistry, Texas A&M University System Health Science Center, Dallas 75266-0677, USA.
Throndson
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D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000075202:Contraindications; D004363:Drug Utilization; D004487:Edema / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D019647:Oral Surgical Procedures / Q000009:adverse effects; D019239:Practice Patterns, Dentists'; D013810:Therapeutic Equivalency
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal