Effect of Local Dexamethasone on Pain, Swelling, and Trismus After Extraction of Impacted Mesioangular Third Molar

Background: Pain and inflammation are common problems after the third molar surgery. The purpose of this study was to compare the effect of ibuprofen and intra-muscular injection or the intra-socket placement of dexamethasone on pain, swelling, and trismus after the extraction of impacted third molar. Methods: In this triple-blind randomized clinical trial study, 72 eligible patients were randomly divided into four groups of 18 subjects. The groups received dexamethasone powder (4 mg) inside the alveolar socket immediately before flap suturing, injection in the masseter muscle (4 mg/1 mL) immediately after the suture, the ibuprofen tablet from an hour before the surgery (400 mg every 6 hours for 1 day), and placebo. Three parameters of pain severity, swelling, and trismus were evaluated on the second and seventh days after the surgery. Data were analyzed using SPSS 17. Qualitative and quantitative data were expressed as a percentage and mean ± standard deviation, respectively. Chi-square, one-way analysis of variance (ANOVA) and, if necessary, the least significant difference tests were used for inter-group comparison. The findings were significant at P<0.05 Results: Dexamethasone groups had significantly lower pain severity (second and seventh days), swelling (second day), and maximum mouth opening (MMO, alveolar socket: second and seventh days, masseter: second day) in comparison to the other groups (P<0.05). The ibuprofen group had significantly lower levels of pain (second and 7th days) and swelling (second day) in comparison to the control group (P<0.05). There was no significant difference between dexamethasone groups in any measurement for pain, swelling, and MMO. Conclusions: The findings of this study suggest that the intra-oral administration of dexamethasone may have a better effect on pain, swelling, and trismus compared to ibuprofen and has no placebo effect.

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IMPACTED MANDIBULAR THIRD MOLAR SURGERY;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.06.2624 ◽

2014 ◽

Vol 21 (06) ◽

pp. 1272-1278

Author(s):

Muhammad Ilyas Shaikh ◽

Safia Khatoon ◽

Fozia Rajput, ◽

Syed Yousif Ali Shah

Keyword(s):

Social Life ◽

Maxillofacial Surgery ◽

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

Control Group ◽

Random Allocation ◽

Significant Difference ◽

Facial Swelling ◽

And Gender

Objective: The objective of this study was to evaluate the therapeutic effect of dexamethasone in post-operative edema and trismus after impacted third molar surgery. Materials & Methods: It was a prospective randomized control study carried in Department of Oral & Maxillofacial surgery, BADC, Larkana from March 2012 to Feb 2013. Patients age between 20-45 years of either gender; unilateral mandibular impacted third molars (right or left) were included. Patients divided in two groups by using random allocation number. Patients in Group-A were given intramuscular 8 mg dexamethasone 1 hour before surgery and four tablets (2mg) dexamethasone orally immediate postoperatively and 24 hours after surgery. The facial swelling was checked before surgery, after 24 hours (1st day), after 48 hours (2nd day), after 72 hours (3rd day) and on 7th postoperative day Inter-incisor distance was checked on every follow up. Data was analyzed by SPSS version 17. Mean and standard deviation was calculated for age and gender. Mean and SD of facial swelling and mouth opening was calculated before extraction, on 1st, 2nd, 3rd and on 7th post-operative day in both groups. Results: The dexamethasone group showed significant reduction in swellingcompared with control group at all intervals. Dexamethasone resulted in significantly less trismus than controls on day 2 postoperatively, but there was no significant difference among the groups at 7thday. Conclusions: Dexamethasone is effective in minimizing swelling and trismus after removal of impacted lower third molar and improves the social life of individual.

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The effect of zinc lozenge on pain, oedema, and trismus after impacted third molar surgery: A prospective randomized, double-blinded, placebo-controlled study

Journal of Dental Specialities ◽

10.18231/j.jds.2021.004 ◽

2021 ◽

Vol 9 (1) ◽

pp. 13-18

Author(s):

Tejashree Rajanna ◽

Hemalatha B R

Keyword(s):

Third Molar ◽

Mouth Opening ◽

Controlled Study ◽

Third Molar Surgery ◽

Control Group ◽

Chi Square ◽

Third Molar Extraction ◽

Scale Scores ◽

Immune System Modulation ◽

Molar Extraction

The postoperative sequelae after third molar surgery include pain, swelling and trismus, Zinc acts as anti-inflammatory agent, can promote wound healing, immune system modulation, tissue repair, and significant reduction in the use of analgesics for oral pain. This study was aimed to evaluate the efficacy of oral zinc lozenge given 30 min before surgery on reducing postoperative sequelae.s: We recruited 70 patients, randomly assigned to two groups: Zinc and Control group, groups received 40mg Zinc lozenge, placebo lozenge 30 min before surgery respectively and every 6h till 72h after surgery. Third molar extraction was performed under local anesthesia. After extraction, pain, swelling, and mouth opening in both groups observed till 72h.Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, was analyzed using Student t test or ANOVA, Chi-square or Mann-Whitney U test was performed for non-parametric samples. P < 0.05 was considered as statistically significant: The overall incidence of Pain in the Zinc group was 18% compared to 43% in the Control group (P = .003) Incidence of Pain, swelling, and mouth opening at different time intervals 6h, 24h, 48h and 72h were significantly (P >0.05) better in Zinc group oral zinc lozenge administered 30 minutes preoperatively can significantly reduce complications like pain, swelling, and limited mouth opening after third molar extraction.

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A triple-blind randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories for preemptive action in third molar extractions

Scientific Reports ◽

10.1038/s41598-021-04068-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Gustavo Antonio Correa Momesso ◽

Gustavo Augusto Grossi-Oliveira ◽

William Phillip Pereira Silva ◽

Renan Akira ◽

Fernando Chiba ◽

...

Keyword(s):

Clinical Trial ◽

Pain Perception ◽

Operative Time ◽

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

Analog Scale ◽

Analgesic Effects ◽

Lower Pain ◽

Inflammatory Drugs

AbstractThe aim of this study is to evaluate the preemptive analgesic effects of dexamethasone (DEX) alone or combined with non-steroidal anti-inflammatory drugs (NSAIDs) in third molar surgeries. The subjects were divided into five groups (n = 20 teeth/group); subjects received only 8 mg of dexamethasone 1 h before the surgical procedure (DEX group), or in combination with etodolac (DEX + ETO), ketorolac (DEX + KET), ibuprofen (DEX + IBU), loxoprofen (DEX + LOX). Paracetamol 750 mg was provided as the number of rescue analgesics (NRA). Salivary PGE2 expression was measured preoperatively and at 48 h. Edema and Maximum mouth opening (MMO) were measured postoperatively at 48 h and 7 days. A visual analog scale (VAS) was performed postoperatively at 6, 12, 24, 48, 72 h, and 7 days. Salivary expression of PGE2 showed a decrease only for the DEX group. Edema and MMO and NRA consumption showed no significant differences among the groups (P > 0.05). The VAS showed a significantly lower pain perception at 6 h after the surgery for the DEX + ETO and DEX + KET groups (P < 0.05). The combination of DEX and NSAIDS should be considered for preemptive acute postsurgical pain management in third molar surgery. In some drug associations such as dexamethasone 8 mg + NSAIDS (ETO and KET) in the pre-operative time, only a few rescue analgesics are necessary.

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Pre-emptive low-dose ketamine with local anesthesia reduces postoperative morbidity after third molar surgery: A systematic review and meta-analysis.

Journal Of Oral Research ◽

10.17126/joralres.2020.067 ◽

2020 ◽

Vol 9 (4) ◽

pp. 259-270

Author(s):

Shaimaa Mohsen Refahee ◽

◽

Essam Ahmed Al-Moraissi ◽

Ahmed Saleh Yehya Alkhutari ◽

◽

...

Keyword(s):

Local Anesthesia ◽

Low Dose ◽

Research Question ◽

Grey Literature ◽

Third Molar ◽

Third Molar Surgery ◽

Control Group ◽

Cochrane Central Register ◽

Significant Difference ◽

Quality Evidence

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane’s tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.

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Comparison of twin mix and revamped twin mix in mandibular third molar surgery - A randomised controlled double blinded study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3231 ◽

2020 ◽

Vol 11 (4) ◽

pp. 5821-5827

Author(s):

Dyna Albert ◽

Sudarssan Subramaniam Gouthaman ◽

Muthusekhar M R

Keyword(s):

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

Mandibular Third Molar ◽

Significant Difference ◽

Facial Swelling ◽

Blinded Study ◽

Mandibular Third Molar Surgery ◽

Randomised Controlled ◽

Double Blinded

Mandibular third molar surgery is one of the most common minor oral surgical procedures performed by oral and maxillofacial surgeons. It is vital to provide the most comfortable postoperative phase to the patient and for this reason dexamethasone, a corticosteroid, is popularly used in various routes. The intraspace injection of dexamethasone mixed with 2% lignocaine and 4% articaine named, Twin Mix and Modified Twin Mix respectively is gaining increasing popularity. 0.5% Centbucridine is a safe alternative to 2% lignocaine with more cardio stable properties. In this study we aimed to evaluate the comparability of Twin Mix(TM) and Revamped Twin Mix(RTM) (mixture of dexamethasone and centbucridine) with respect to its anesthetic properties and its effectiveness in managing postoperative sequelae following mandibular third molar surgery. For this, a randomised controlled double blinded study was conducted among patients reporting to the Out Patient Department of a dental college. The sample size of the population studied was 32, 16 in Group A (RTM) and 16 in Group B (TM). The primary outcomes measured were facial swelling and mouth opening on postoperative day(POD) 1, 3 and 7. The secondary outcomes were VAS score during the surgical procedure, duration and latency of anesthesia. The data were analysed descriptively and using Student’s t Test. Representations were given in graphical and tabular forms. The mean postoperative mouth opening and facial swelling on POD 1, 3 and 7 were comparable and did not show any statistically significant difference. Similarly, the VAS score during procedure, latency and duration of anesthesia were comparable with no statistically significant difference. In conclusion, RTM can be used as an alternative to TM due to its comparable properties.

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A randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories in the lower third molar extractions

10.21203/rs.3.rs-224127/v1 ◽

2021 ◽

Author(s):

Gustavo Antonio Correa Momesso ◽

Gustavo Augusto Grossi Oliveira ◽

William Phillip Pereira Silva ◽

Renan Akira ◽

Fernando Chiba ◽

...

Keyword(s):

Clinical Trial ◽

Pain Perception ◽

Operative Time ◽

Third Molar ◽

Mouth Opening ◽

Third Molar Surgery ◽

Analog Scale ◽

Analgesic Effects ◽

Lower Pain ◽

Inflammatory Drugs

Abstract Objectives The aim of this study is to evaluate the preemptive analgesic effects of dexamethasone (DEX) alone or combined with non-steroidal anti-inflammatory drugs (NSAIDs) in third molar surgeries.Materials and Methods The subjects were divided into five groups (n = 20 teeth/group); subjects received only 8 mg of dexamethasone 1 hour before the surgical procedure (DEX group), or in combination with etodolac (DEX + ETO), ketorolac (DEX + KET), ibuprofen (DEX + IBU), loxoprofen (DEX + LOX). Paracetamol 750 mg was provided as the number of rescue analgesics (NRA). Salivary PGE2 expression was measured preoperatively and at 48 hours. Edema and Maximum mouth opening (MMO) were measured postoperatively at 48h and 7 days. A visual analog scale (VAS) was performed postoperatively at 6, 12, 24, 48, 72 hours, and 7 days.Results Salivary expression of PGE2 showed a decrease only for the DEX group. Edema and MMO and NRA consumption showed no significant differences among the groups (P > 0.05). The VAS showed a significantly lower pain perception at 6 hours after the surgery for the DEX + ETO and DEX + KET groups (P < 0.05).Conclusions The combination of DEX and NSAIDS should be considered for preemptive acute postsurgical pain management in third molar surgery. Clinical Relevance: In some drug associations such as dexamethasone 8 mg + NSAIDS (ETO and KET), and others, the isolated administration of a single dose of dexamethasone in the pre-operative time, only a few rescue analgesics are necessary.

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Effect of submucosal injection of ketorolac versus dexamethasone on postoperative pain after third molar surgery: a randomized clinical trial

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00177-z ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Dariush Hasheminia ◽

Reyhaneh Faghihian ◽

Farhad Mardani

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Third Molar ◽

Study Groups ◽

Third Molar Surgery ◽

Control Group ◽

Impacted Third Molar ◽

Significant Difference ◽

The Mean ◽

The Difference

Abstract Background One of the most common dentoalveolar surgeries is the removal of impacted third molars. Moderate to severe pain is predictable after these surgeries, usually leaving the patient in need of an effective analgesic for at least 24 h. Corticosteroids and NSAIDs are well-known medications used to reduce pain. This prospective, randomized clinical trial aimed to assess the effectiveness of two types of analgesics, ketorolac and dexamethasone, on pain experienced after unilateral impacted third molar surgery. The analgesics were injected sublingually after profound anesthesia was confirmed in 60 healthy adult patients. During this study, the patients were divided into three groups. The patients in group K received 1 mL of ketorolac (30 mg), while the patients in group D received 1 mL of dexamethasone (4 mg) sublingually. The patients in group C (the control group) received 1 mL of normal saline solution as a placebo. Results The mean pain scores reported by the patients in groups K and D were significantly lower than group C (P = 0.002 and P < 0.001, respectively). However, the difference between groups D and K was not significant (P = 0.158). The mean number of analgesics taken by patients in groups K and D 24 h after surgery was significantly lower than the control group (P < 0.05). At 48 and 72 h postoperatively, however, the difference was not significant between the study groups (P > 0.05). The mean time of the first analgesic taken by the patients in groups K and D was 200.94 and 214.74 min after surgery, respectively. Exhibiting a significant difference, it was 132.65 min for the patients in group C (P = 0.003). Conclusions Under this study’s limitations, preoperative sublingual injection of ketorolac and dexamethasone were similarly effective in pain control after impacted third molar surgery.

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Success Rate of Obturation of Root Canals by Different Techniques in Primary Molars: A Comparative Clinical Study

Current Dentistry ◽

10.2174/2542579x02999200503032916 ◽

2020 ◽

Vol 2 (1) ◽

pp. 36-44

Author(s):

Satyawan G. Damle ◽

Ritika Bansal ◽

Dhanashree D. Sakhare

Keyword(s):

Success Rate ◽

Study Groups ◽

Primary Molars ◽

Control Group ◽

Second Primary ◽

Chi Square ◽

Exact Test ◽

Root Canals ◽

Significant Difference ◽

Comparative Clinical Study

Objective: To compare the success rate of different obturation procedures in primary mandibular second molars clinically and also by digital radiovisiography. Methods: A total of 40 children aged between 4-8 years with deeply carious mandibular second primary molars indicated for single session pulpectomy were selected. Canals were obturated with Metapex. The 3 study groups (Endodontic plugger, Handheld lentulospiral, Navi Tip syringe) were compared with the control group (reamer) both clinically and radiovisiographically. The data collected were statistically analyzed using Pearson’s Chi-square and Fisher’s exact test. Results: The use of Navi tip syringe led to the least number of voids followed by Endodontic plugger and Reamer and the highest number of voids was reported with Lentulospiral. Navitip presented maximum number of optimally filled cases followed by Endodontic plugger and Lentulospiral and least number of optimally filled cases with reamer. However, there was no statistically significant difference (p>0.05) in any of the groups with clinical (pain and tenderness to percussion) and radiographic parameters (presence or absence of voids and length of obturation). Conclusion: Within the limitations of the present study, though the clinical outcome was statistically insignificant, Navitip syringe exhibited encouraging results and is a promising option for obturation in primary teeth.

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Facial Profile Shape, Malocclusion and Palatal Morphology in Malay Obstructive Sleep Apnea Patients

The Angle Orthodontist ◽

10.2319/011509-26.1 ◽

2010 ◽

Vol 80 (1) ◽

pp. 37-42 ◽

Cited By ~ 11

Author(s):

S. M. Banabilh ◽

A. R. Samsudin ◽

A. H. Suzina ◽

Sidek Dinsuhaimi

Keyword(s):

Obstructive Sleep Apnea ◽

Null Hypothesis ◽

Control Group ◽

Class Ii Malocclusion ◽

Chi Square ◽

Facial Profile ◽

Obstructive Sleep ◽

Significant Difference ◽

Chi Square Test ◽

The Mean

Abstract Objective: To test the null hypothesis that there is no difference in facial profile shape, malocclusion class, or palatal morphology in Malay adults with and without obstructive sleep apnea (OSA). Materials and Methods: Subjects were 120 adult Malays aged 18 to 65 years (mean ± standard deviation [SD], 33.2 ± 13.31) divided into two groups of 60. Both groups underwent clinical examination and limited channel polysomnography (PSG). The mean OSA and control values were subjected to t-test and the chi square test. Results: Physical examination showed that 61.7% of the OSA patients were obese, and 41.7% of those obese patients had severe OSA. The mean body mass index (BMI) was significantly greater for the OSA group (33.2 kg/m2 ± 6.5) than for the control group (22.7 kg/m2 ± 3.5; P < .001). The mean neck size and systolic blood pressure were greater for the OSA group (43.6 cm ± 6.02; 129.1 mm Hg ± 17.55) than for the control group (35.6 cm ± 3.52; 114.1 mm Hg ± 13.67; P < .001). Clinical examination showed that the most frequent findings among OSA groups when compared with the control group were convex profiles (71.7%), Class II malocclusion (51.7%), and V palatal shape (53.3%), respectively; the chi square test revealed a significant difference in terms of facial profile and malocclusion class (P < .05), but no significant difference in palatal shape was found. Conclusion: The null hypothesis is rejected. A convex facial profile and Class II malocclusion were significantly more common in the OSA group. The V palatal shape was a frequent finding in the OSA group.

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Effects of Relationship Enrichment Training on Improving Marital Satisfaction of Infertile Couples: A Randomized Control Trial

Current Women s Health Reviews ◽

10.2174/1573404817666210111141202 ◽

2021 ◽

Vol 17 ◽

Author(s):

Seyedeh Zahra Masoumi ◽

Khodayar Oshvandi ◽

Masoumeh Rostami-Moez ◽

Arezoo Shayan ◽

Farideh Kazemi

Keyword(s):

Marital Satisfaction ◽

Intervention Group ◽

Analysis Of Covariance ◽

Control Group ◽

Chi Square ◽

Significance Level ◽

Significant Difference ◽

The Mean ◽

Infertile Couples ◽

Relationship Enrichment

Background: Infertility can cause low marital satisfaction. Marital satisfaction has an important effect on infertile couples’ health. Objective: This study aimed to assess the effect of relationship enrichment training on improving the marital satisfaction of infertile couples. Methods: This randomized clinical trial was conducted on 50 infertile couples in the infertility center of Fatemieh Hospital in Hamadan, Iran in 2018. Participants were matched for demographic characteristics and randomly assigned to intervention and control groups (each group had 25 couples). Informed consent was obtained from all participants. The Enrich Marital Satisfaction questionnaire and demographic information were used to collect data before the study and two months after the intervention. Two trained midwifery students taught only the intervention group the relationship enrichment topics in seven sessions (each session = 90 minutes). The data were analyzed by SPSS Statistics version 21 using analysis of covariance, independent t-test, chi-square, and Mann–Whitney. The significance level was set at p ≤ 0.05. Results: There was no significant difference in demographic and obstetric information between the two groups (p >0.05). The mean of marital satisfaction in the intervention group significantly increased among women and men from 151.00 ±28.61 to 154.88 ±22.62 and from 152.56 ±27.33 to 159.24 ±22.14, respectively, (p <0.001). Conversely, the mean of marital satisfaction decreased among women and men from 158.13 ±13.86 to 146.25 ±19.53 and from 164.25 ±17.00 to 153.17 ±27.50 in the control group (p=0.02). Conclusion: Relationship enrichment training can be effective in promoting the marital satisfaction of infertile couples. Registration number: The National Center for Strategic Research in medical education, No. 960185.

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