Does Intravaneuous Dexamethasone Reduce Pain and Swelling and Improve Mouth Opening After Wisdom Teeth Surgery?

An interesting article titled “Efficacy of intravenous dexamethasone administered preoperatively and postoperatively on pain, swelling, and trismus following third molar surgery. A comparative study” written by Giri et al. appears in the 2019 edition of Oral Surgery (vol. 12, pp. 110-117). The article explores if intravenous dexamethasone given either shortly before or after wisdom teeth surgery has any any effect when compared on the time of administration on pain, swelling, and trismus (mouth opening) experienced in the week after surgery. Previously on this site in a post titled Does Intravaneuous Ibuprofen Reduce Pain After Wisdom Teeth Surgery? it was shown that preoperative intravenous ibuprofen administration significantly reduced the pain experienced after surgery.

In the article by Giri the authors say that dexamethasone is a type of corticosteroid that has a strong anti-inflammatory action. Dexamethasone has a half-life of 36–54 hours and thus is considered to be long lasting. The authors conducted a randomized clinical trial where 100 patients who presented in Bareilly, India having impacted lower wisdom teeth were equally divided into two groups: 1) those receiving pre-operative intravenous 8 mg dexamethasone and 2) those receiving post-operative intravenous 8 mg dexamethasone (group II). All wisdom teeth extractions were performed by the same surgeon under local anesthesia. Pain, swelling, and mouth opening was evaluated at 48 hours and 7 days after surgery. Pain was evaluated using a visual analogue scale from 0 to 10 with increasing pain. Facial swelling was evaluated using a horizontal and vertical guide with a flexible ruler following control points assessed by a using five fixed points on the surgical side of the face and finding an average.

injected medication - Does Intravaneuous Dexamethasone Reduce Pain and Swelling and Improve Mouth Opening After Wisdom Teeth Surgery?
This image is from Adrian Clark on Flickr and has a Creative Commons license

The authors found that there were no statistically significant differences in terms of postoperative facial swelling, pain and mouth opening after wisdom teeth removal at both 48 hours and 7 days after surgery among the two groups. The authors state:

“On the basis of the outcome of this study, the utilisation of intravenous dexamethasone in the management of complications associated with the lower third molar [wisdom teeth] surgery is warranted and could be associated with decreased rate of pain, trismus and swelling regardless of time of administration, that is, pre-operatively or post-operatively.”

The authors speculate that no differences between the two groups given dexamethasone either before or after surgery with regards to pain, swelling, and trismus may be due to dexamethasone’s long half life where they effect of it is going to be for about two days regardless of the time of administration. No side effects of dexamethasone including perineural pruritus were noted in any of the patients. They mention that there are advantageous to a single dose of dexamethasone administered intravenously as opposed to multiple doses or oral administration. For example with oral administration there can be a delayed onset of action and it is possible to create an erratic response due to the pharmacokinetics of the drug. They feel that an intravenous administration provides a more predictable response and patients are more able to comply. If dexamethasone if given for more than a week than signs of steroid toxicity and hypothalamic–pituitary–adrenal axis suppression can occur. Even though the sample size used by the authors had sufficient power to avoid type I and type II statistical errors they do suggest an additional study with a larger sample size.

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