Journal

CLUB
C O M PA R AT I V E A S S E S S M E N T O F P R E O P E R AT I V E V E R S U S
P O S T O P E R AT I V E D E X A M E T H A S O N E O N P O S T O P E R AT I V E
C O M P L I C AT I O N S F O L L O W I N G L O W E R T H I R D M O L A R
SURGICAL EXTRACTION

DR.CHAITANYA AGGARWAL
PG RESIDENT 1ST YEAR
ORAL AND MAXILLOFACIAL SURGERY
Contents
01 ABOUT THE JOURNAL

02 ABOUT THE AUTHOR

03 ABSTRACT

04 INTRODUCTION

05 MATERIALS AND METHODS

06 RESULTS

07 DISCUSSION

08 REFERENCES
 01 ABOUT THE JOURNAL

• International Journal of Dentistry

• Peer Reviewed Journal

• Pubmed Indexed Open Access Journal

• Impact Factor 2.1

• Published By Hindawi

• Year of Publication 2017

 ABOUT THE
02 AUTHOR

• Hashem M. Al-Shamiri 1

• Maha Shawky 2,3

• Nermin Hassanein 4
• 1. Department of Oral and Maxillofacial Surgery Sciences, Alfarabi
Colleges, Riyadh, Saudi Arabia
• 2. Oral and Maxillofacial Surgery Department, Faculty of Dentistry, King
Abdulaziz University, Jeddah, Saudi Arabia
• 3.Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Faculty
of Oral and Dental Medicine, Cairo University, Giza, Egypt
 CRITICS OF AUTHOR
DETAILS

• Qualification details of authors are not mentioned

• Authors are from different institutes

 03

Abstract
 Abstract
• Aim of the study was to evaluate the effect of preoperative versus postoperative administration of oral
Dexamethasone on postoperative complications including pain, edema, and trismus following lower
third molar surgery.
• 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one
hour preoperatively and the other group immediately after surgery. Pain was measured using VAS,
edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening
was measured using a graduated sliding caliper.
• In this study pain and trismus records were similar and statistically nonsignificant in both groups. The
results had proven that preoperative administration was superior when compared to postoperative
administration regarding edema (0.002)
• It was concluded that preoperative oral administration of 8 mg Dexamethasone was superior to the
postoperative administration of the same dose concerning edema after lower third molar surgery.
 CRITICS OF ABSTRACT

• Type of study is not mentioned in the abstract

• Keywords are not mentioned

 04

Introduction
 Introduction
• The surgical extraction of lower third molars is the most frequent intervention in oral surgery which is often

associated with significant postsurgical sequelae like pain, swelling, and limitation in mouth opening (Trismus)

throughout the postoperative course due to the inflammatory response following the surgical injury.

• Surgical removal of lower third molar can vary in difficulty and in the degree of trauma caused to the

surrounding tissue. The greater amount of tissue injury leads to an increased amount of inflammation in the

peri-surgical area.

• Postoperative pain following surgical removal of impacted mandibular third molar is a localized inflammatory

pain of varying intensity. The surgical procedure brings about the release and production of several biochemical

mediators; these mediators involved in the pain process are histamine, bradykinin, and prostaglandins which are

a group of biologically active fatty acids.

• Postsurgical edema is a normal physiological reaction to insult and injury. When body tissues are injured, the

normal physiologic response is inflammation, leading to edema.

Pathophysiology of
Pain
MEDIATORS OF PAIN

• HISTAMINE
• SEROTONIN
• TUMOR NECROSIS FACTOR
• INTERLEUKINS
• PROSTAGLANDINS
• LEUKOTRIENES
• NITRIC OXIDE

Singh, Gurudev & Taliyan, Rajeev & Sharma,

P. (2023). PATHOPHYSIOLOGY OF
NEUROPATHIC PAIN: A SYSTEMIC
REVIEW
 Introduction
• To control postoperative inflammation and symptoms associated, it is necessary to provide an adequate anti-

inflammatory therapy. The use of corticosteroids can decrease the severity of postoperative sequelae in many

patients and therefore decrease morbidity after oral surgery

• Some studies compared the use of Dexamethasone in different formulations one hour before surgery in patients

undergoing extraction of third molars and observed the postoperative edema, trismus, and pain. From this

study, it was concluded that there was no significant difference between the two formulations of

Dexamethasone in surgery of third molars in relation to its use as a preoperative medication to reduce swelling,

trismus, and pain.

• The aim of this study was to evaluate the effect of preoperative versus postoperative administration of oral

Dexamethasone on postoperative discomfort including pain, edema, and trismus following lower third molar

surgery.
 05

Materials and
Methods
• The study was conducted on 24 healthy patients requiring surgical
removal of the mandibular impacted third molar under local
anaesthesia

• 12 were males and 12 were females.

• All patients were subjected to clinical and radiographic examination

with single examiner (periapical and panorex view) and the study
protocol was explained to the patients in detail.

• Written Consent was obtained

INCLUSION CRITERIA INCLUSION CRITERIA INCLUSION CRITERIA

Freedom of any Freedom of any recent anti- Freedom from allergy to

systemic diseases inflammatory drug intake the drugs used in the
that could interfere or being under long term study.
with wound healing treatment with
medicaments that will
obscure the assessment
 • After designating a specific number for each case, they were randomly distributed into two
groups using a research randomization program in the computer (group A and group B) of 12
patients in each.

Patients in group A were given 8 mg (2 tablets Patients in group B were given 8 mg

of 4 mg) Dexamethasone (Dexamethasone (2 tablets of 4 mg) (Dexamethasone Tablets
Tablets USP, 4 mg, Roxane Laboratories, Inc., USP, 4 mg, Roxane Laboratories, Inc.,
Columbus, OH, USA) orally 1 hour before the Columbus, OH, USA) orally immediately after
surgery completion of the surgery.

• Preoperative facial measurements were taken in three planes using

a tape measuring method;
• the first plane was from tragus of the ear to the corner of the mouth
• the second plane form the gonion to corner of the mouth
• the third plane from the outer canthus of the eye to the gonion
• The preoperative sum of the three measurements was considered as the baseline for that side.
Then the mean was recorded for these three records. These facial measurements were
repeated at the 2nd, 5th, and 7th days postoperatively.
 Methodology
• The maximum interincisal distance was recorded both preoperatively and at the 2nd, 5th, and 7th days

postoperatively using a graduated sliding caliper for measuring the interincisal distance between the

mesioincisal angle of upper central incisor and that of lower incisor at maximum mouth opening taking them as

a baseline for measurements.

• Trismus was recorded as the difference in interincisal distance at maximum opening before and after the

operation.

• Pain measurements were recorded using a visual analogue scale (VAS), which consists of plan horizontal 10

mm long line starting from “No Pain” at one end (0) point and the “Worst Pain” at the other end at (10) point,

and patients were asked to mark each scale according to their pain at a given time at night the day of the

surgery and two days postoperatively both in the morning and at night.
 Methodology
• Data were analyzed using PASW Statistics 18.0 (Predictive Analytics Software) for windows (SPSS: An IBM

Company, Chicago, IL, USA). Numerical data were presented as mean and standard deviation values, where

Student’s and paired -tests were used for parametric numerical data, but Mann–Whitney U test and Wilcoxon

signed-rank test were used for nonparametric numerical data.

• Qualitative data were presented as frequencies and percentages; Chi-square test was used between the two

groups. The significance level was set at p<0.05

 06

Results
The radiographic analysis of the angulation (p value,
0.779) and depth (p value, 0.751) of the impacted teeth according
to Winter’s classification showed no statistically
significant difference between types of impaction in the two
groups.

The mean of the duration of operation in group (A) was

48.3 minutes, while the values were 44.6 minutes in group
B, with no statistically significant difference (p value, 0.292)

For edema, through all periods, group B showed statistically

significant higher mean% increase in edema measurement
than group A (p value, 0.003)

For trismus, only after 7 days, group B showed statistically

significant higher mean% reduction in maximum interincisal
opening value than group A (p value, 0.021)

With regard to pain, at the 3rd day in the morning and

night, group A showed statistically significant higher mean%
decrease in VAS than group B (p value on morning, 0.008;
p value on night, 0.009)
 07

Discussion
 • Prostaglandins are inhibited by the disruption of the arachidonic acid cascade. Lipocortin, an endogenous proteins
by steroids, blocks the activity of phospholipase A2, thus influencing the synthesis of prostaglandins.
• All routes of administration of corticosteroids have given significant improvement in pain and swelling unless
otherwise when the Dexamethasone is contraindicated.
• Dexamethasone was chosen because of its higher potency, lower sodium-retaining ability, and longer half-life.
• The normal daily output of cortisol is 15–25mg/day, but upto 300mg of cortisol can be released in a time of crisis,
and the 8mg Dexamethasone is nearly equivalent to this amount of released cortisol.

Edema was at a maximum on the second postoperative

day in the two groups. This swelling was reduced gradually
but lasted for 2–5 days.The edema subsided almost
completely after one week in both groups, particularly in
group A.
Trismus reaches a maximum on Day 1 or Day 2
postoperatively and generally resolve by Day 7 .
After 7 days, group B showed statistically
significantly higher mean% reduction in maximum
interincisal opening value than group A ,may be
attributed to the fact that the swelling or edema in
group A is almost absent, thus allowing more free
movement and increased opening of the jaws.
This study showed a statistically significant decrease in
mean VAS (Pain) by time in group A compared to
group B at the 3rd day after surgery.This
difference may be attributed to the fact that, in
group A, the Dexamethasone acts early in the
inflammatory area, thus decreasing the production
of inflammatory mediators.
 08

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