J Dent Anesth Pain Med.  2017 Mar;17(1):47-53. 10.17245/jdapm.2017.17.1.47.

Decreased post-operative pain using a sublingual injection of dexamethasone (8 mg) in lower third molar surgery

• Gozali P
• Boonsiriseth K
• Kiattavornchareon S
• Khanijou M
• Wongsirichat N

• KMID: 2374723
• DOI: http://doi.org/10.17245/jdapm.2017.17.1.47

Abstract

BACKGROUND
Every patient who undergoes mandibular third molar surgery is concerned about post-operative pain. Indeed, previous researchers have used various methods to treat such pain. This study aimed to assess the effectiveness of sublingual injection of dexamethasone (8 mg) to treat post-operative pain after mandibular third molar surgery. METHOD: This was a randomized, double-blind, split-mouth, clinical trial, involving 48 healthy patients who required surgical removal of two mandibular third molars with similar bilateral positions. All operations were performed by the same experienced surgeon. The patients were randomized into a study group (8 mg dexamethasone injection) and a placebo group (normal saline injection). Both interventions were injected into the sublingual space immediately after local anesthesia, 30 min before the first incision. The study group received an 8 mg dexamethasone injection, while the placebo group received a normal saline injection. The wash period between the patients' two operations was 3 to 4 weeks. Pain was assessed by recording the number of analgesic tablets (rescue drug) consumed, as well as by noting the patients' responses to the visual analog scale (VAS) on the first, second, and third days after surgery.
RESULTS
The study group differed significantly from the placebo group in terms of VAS score and analgesic consumption.
CONCLUSION
Dexamethasone (8 mg), injected sublingually, significantly eased post-operative pain after surgical removal of the mandibular third molar.

Keyword

Dexamethasone; Pain; Postoperative Pain; Sublingual Administration; Tooth, Impacted; Visual Analog Scale

MeSH Terms

Administration, Sublingual
Anesthesia, Local
Dexamethasone*
Humans
Methods
Molar, Third*
Pain, Postoperative
Tablets
Tooth, Impacted
Visual Analog Scale
Dexamethasone
Tablets

Figure

• 

  Fig. 1 Postoperative pain.

• 

  Fig. 2 Analgesic consumption

Reference

1. Boonsiriseth K, Klongnoi B, Sirintawat N, Saengsirinavin C, Wongsirichat N. Comparative study of the effect of dexamethasone injection and consumption in lower third molar surgery. Int J Oral Maxillofac Surg. 2012; 41:244–247.

2. Kitade T, Ohyabu H. Analgesic effects of acupuncture on pain after mandibular wisdom tooth extraction. Acupunct Electrother Res. 2000; 25:109–115.

3. Gozali P, Kiattavornchareon S, Wu M, Wonsirichat N, Suphangul S. Bethamethasone and methylprednisolone usage in lower third molar surgery: Review literature. M Dent J. 2015; 35:273–280.

4. Latt MM, Kiattavornchareon S, Boonsiriseth K, Pairuchvej V, Wongsirichat N. The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery. J Dent Anesth Pain Med. 2016; 16:95–102.

5. Bjornsson GA, Haanes HR, Skoglund L. A randomized, double blind crossover trial of paracetamol 1000 mg four times daily vs ibuprofen 600 mg: effect on swelling and other postoperative events after third molar surgery. Br J Clin Pharmacol. 2003; 55:405–412.

6. Michalek-Sauberer A, Heinzl H, Sator-Katzenchlager SM, Monov G, Knolle E, Kress HG. Perioperative auricular electroacupuncture has no effect on pain and analgesic consumption after third molar tooth extraction. Anesth Analg. 2007; 104:542–547.

7. Gersema L, Baker K. Use of corticosteroids in oral surgery. J Oral Maxillofac Surg. 1992; 50:270–277.

8. Hebel SK. Drug facts and comparisons. St. Louis: Facts and Comparisons;1999. p. 122.

9. Beirne OR, Hollander B. The effect of methylprednisolone on pain, trismus, and swelling after removal third molars. Oral Surg Oral Med Oral Pathol. 1986; 61:134–138.

10. Messer EJ, Keller JJ. The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surg Oral Med Oral Pathol. 1975; 40:594–598.

11. Hargreaves KM, Shmidt EA, Mueller GP, Dionne RA. Dexamethasone alters plasma levels of beta-endorphin and postoperative pain. Clin Pharmacol Ther. 1987; 42:601–607.

12. Mirzai H, Tekin I, Alincak H. Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery: a randomized controlled trial. Spine. 2002; 27:343–346.

13. Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006; 102:263–267.

14. Pell GJ, Gregory BT. Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest. 1933; 39:330–338.

15. Laureano Filho JR, Maurette PE, Allais M, Cotinho M, Fernandes C. Clinical comparative study of the effectiveness of two dosages of dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Med Oral Patol Oral Cir Bucal. 2008; 13:E129–E132.

16. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg. 2007; 65:2218–2226.

17. Graziani F, D'Aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial. Int J Oral Maxillofac Surg. 2006; 35:241–246.

18. Ustun Y, Erdogan O, Esen E, Karsli ED. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96:535–539.

19. Landucci A, Wosny AC, Uetanabaro LC, Moro A, Araujo MR. Efficacy of a single dose of lowlevel laser therapy in reducing pain, swelling, and trismus following third molar extraction surgery. Int J Oral Maxillofac Surg. 2016; 45:392–398.

20. Costa FWG, Soares ECS, Esses DFS, Silva PG, Bezerra TP, Scarparo HC, et al. A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120 mg on inflammatory events following removal of unerupted mandibular third molars. Int J Oral Maxillofac Surg. 2015; 44:1166–1174.

21. Al-Sukhun J, Al-Sukhun S, Penttilä H, Ashammakhi N, Al-Sukhun R. Pre-emptive analgesic effect of low doses of celecoxib is superior to low doses of traditional nonsteroidal anti-inflammatory drugs. J Craniofac Surg. 2012; 23:526–529.

22. Sisk AL, Grover BJ. A comparison of pre-operative and postoperative naproxen sodium for suppression of postoperative pain. J Oral Maxillofac Surg. 1990; 48:674–678.

23. Morse Z, Tump A, Kevelham E. Ibuprofen as a pre-emptive analgesic is as effective as rofecoxibfor mandibular third molar surgery. Odontology. 2006; 94:59–63.

24. Saito K, Kaneko A, Machii K, Ohta H, Ohkura M, Suzuki M. Efficacy and safety of additional 200-mg dose of celecoxib in adult patients with postoperative pain following extraction of impacted third mandibular molar: a multicenter, randomized, double-blind, placebo controlled, phase II study in Japan. Clin Ther. 2012; 34:314–328.

25. Lustenberger FD, Gratz KW, Mutzbauer TS. Efficacy of ibuprofen versus lornoxicam after third molar surgery: a randomized, double-blind, crossover pilot study. Oral Maxillofac Surg. 2011; 15:57–62.

26. Pozos-Guillen A, Martinez-Rider R, Aguirre-Banuelos P, Perez-Urizar J. Pre-emptive analgesic effect of tramadol after mandibular third molar extraction: a pilot study. J Oral Maxillofac Surg. 2007; 65:1315–1320.

27. Zandi M, Amini P, Keshavarz A. Effectiveness of cold therapy in reducing pain, trismus, and oedema after impacted mandibular third molar surgery: a randomized, self-controlled, observer-blind, split-mouth clinical trial. Int J Oral Maxillofac Surg. 2016; 45:118–123.

28. Patten JR, Patten J, Hutchins MO. Adjunct use of dexamethasone in postoperative dental pain control. Compendium. 1992; 13:580. 582. 584 passim.

29. Tavares MG, Machado AP, Motta BG, Borsatto MC, Rosa AL, Xavier SP. Electro-acupuncture efficacy on pain control after mandibular third molar surgery. Braz Dent J. 2007; 18:158–162.

30. Chukwuneke FN, Oji C, Saheeb DB. A comparative study of the effect of using a rubber drain on postoperative discomfort following lower third molar surgery. Int J Oral Maxillofac Surg. 2008; 37:341–344.

31. Osunde OD, Adebola RA, Saheeb DB. A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery. Int J Oral Maxillofac Surg. 2012; 41:1275–1279.

32. Cooper SA. Five studies on ibuprofen for postsurgical dental pain. Am J Med. 1984; 77:70–77.

33. Mojsa IM, Pokrowiecki R, Lipczynski K, Czerwonka D, Szczeklik K, Zaleska M. Effect of submucosal dexamethasone injection on postoperative pain, oedema, and trismus following mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. Int J Oral Maxillofac Surg. 2017; 46:524–530.

34. Neupert EA III, Lee JW, Philput CB, Gordon JR. Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal. J Oral Maxillofac Surg. 1992; 50:1177–1182.

35. Hupp JR. Principles of surgery. In : Peterson LJ, Ellis E, Hupp JR, Tucker MR, editors. Contemporary oral and maxillofacial surgery. 3rd ed. St. Louis: Mosby;1998. p. 56.