title: Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effect of submucosal administration of dexamethasone sodium phosphate on discomfort after mandibular third molar surgery.
  
  
  METHODS
  Sixty-one consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly placed into 3 groups. After the onset of local anesthesia, the experimental groups received dexamethasone at 2 different doses (4 or 8 mg) as submucosal injection, and the control group received no drug. Standardized surgical and analgesic protocols were followed. Maximum interincisal distance and facial contours were measured at baseline and at postsurgery days 2 and 7. Pain was objectively measured by counting the number of analgesic tablets required. The patients' perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale).
  
  
  RESULTS
  On the second postoperative day, facial edema showed a statistically significant reduction in both dexamethasone 4-mg and dexamethasone 8-mg groups compared with the control group, but no statistically significant differences were observed between the 2 dosage regimens of dexamethasone. By contrast, there was no statistically significant difference between all groups when postoperative swelling was evaluated at day 7 (P > .50). The treatment group had a limited and nonsignificant effect on pain and trismus when compared with the control group at the 2 times of evaluation.
  
  
  CONCLUSIONS
  Parenteral use of dexamethasone 4 mg, given as an intraoral injection at the time of surgery, is effective in the prevention of postoperative edema. Increasing the dose to 8 mg provides no further benefit.
authors.affiliation: Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy. gb.grossi@icp.mi.it
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Grossi
authors.forename: Carlo
authors.initials: C
authors.lastname: Maiorana
authors.forename: Rocco Alberto
authors.initials: RA
authors.lastname: Garramone
authors.forename: Andrea
authors.initials: A
authors.lastname: Borgonovo
authors.forename: Mario
authors.initials: M
authors.lastname: Beretta
authors.forename: Davide
authors.initials: D
authors.lastname: Farronato
authors.forename: Franco
authors.initials: F
authors.lastname: Santoro
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000772:Anesthesia, Local; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004487:Edema / Q000517:prevention & control; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008334:Mandible / Q000601:surgery; D008964:Molar, Third / Q000601:surgery*; D009061:Mouth Mucosa; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000601:surgery; D014313:Trismus / Q000517:prevention & control
chemical_list: D018712:Analgesics, Non-Narcotic; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D000082:Acetaminophen; D003907:Dexamethasone