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Effectiveness of pre-operative oral corticosteroids in reducing pain, trismus and oedema following lower third molar extractions: a systematic review

British Dental Journal (2021)Cite this article

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.

Key points

  • Explores the existing scientific evidence supporting the effectiveness of a single dose of pre-operative corticosteroids to reduce inflammatory sequelae following lower third molar surgery under local anaesthesia.

  • Identifies that existing studies show the use of pre-operative corticosteroids does not provide clinically significant reduction in post-operative pain, oedema or trismus.

  • Recommends further well-designed randomised controlled clinical trials to establish the efficacy of pre-operative oral corticosteroids.

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  1. Peninsula Dental School, University of Plymouth, Research Way, Plymouth, PL6 8BT, UK

    Mohammed Shibl, Kamran Ali & Lorna Burns

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  1. Mohammed Shibl
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Correspondence to Mohammed Shibl.

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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). https://doi.org/10.1038/s41415-021-3165-y

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