Third molar surgery outcomes: a randomized clinical trial comparing submucosal and intravenous dexamethasone

Abstract Objective Swelling, pain and trismus after third molar surgery have a negative impact on patients’ quality of life in the days following surgery. The study aims to compare the efficacy of submucosal (SM) dexamethasone and intravenous (IV) dexamethasone in reducing these outcomes. Methods The single-center study was designed as a randomized, controlled, double-blinded trial with a total of 130 participants evenly allocated into two treatment groups. All participants underwent the surgical removal of at least two mandibular third molars under intravenous sedation. The outcome variables studied were swelling, pain and maximum incisal distances. Swelling was measured using a 3-dimensional camera (3dMD Inc, Atlanta, GA). Pain was quantified using a 100mm visual analogue scale (VAS). Maximum incisal distances were measured using a caliper. Participants completed the short form Oral Health Impact Profile (OHIP-14). The two groups were compared using cross-tabulations and chi-square tests for categorical variables, and analysis of variance for continuous variables. Results The participants had a mean age of 22.6 years, 56.8% female and 12.4% smokers. There were no statistically significant differences in the distribution of study variables between the two groups. On day 2, mean facial swelling measurements were 7.3cm3 in the IV group, and 7.8cm3 in the SM group (P > 0.05). Mean pain score was 31 in the IV group, and 33 in the SM group (P > 0.05). Mean maximm incisal distances were 33.7mm in the IV group, and 34.5mm in the SM group (P > 0.05). Both groups experienced poorer quality-of-life relative to baseline scores, and were affected to a similar extent. Conclusions There are no differences in swelling, pain and trismus between submucosal and intravenous dexamethasone in third molar surgery. Submucosal dexamethasone is a straightforward and accessible route of steroid administration in patients having third molar surgery under local anesthesia only.