Perioperative corticosteroid use reduces the degree of trismus and inflammation after third molar removal

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The surgical removal of third molars is a common procedure that results in varying degrees of inflammation, pain and limited mouth opening.  Non-steroidal anti-inflammatories, steroids and opiates are often prescribed to alleviate these problems.  This review aims to assess the impact of steroids on outcomes following third molars removal.

Searches of the PubMed, Scopus, Med- line, and Cochrane databases were undertaken from randomised controlled trials (RCT) in English relating to steroid use and third molars.  Trails that compared perioperative steroids given in any formulation, dose, or route with either placebo or no treatment were included.

28 studies (1 meta-analysis and 27 randomized control trial studies) were included.  The studies were classified according to the active principles, doses, and administration routes used for the treatment. No meta-analysis was conducted and a qualitative summary of the finding presented.

The authors concluded

  • The use of corticosteroids in conjunction with third molar extractions reduces the degree of trismus and inflammation
  • Superior effects appear to be obtained by using parenteral rather than oral administration.
  • Postoperative effects appear to be greater when corticosteroids are administered before rather than after surgery.
  • Further comparative studies are required using different corticosteroids doses, and administration routes so as to establish the most effective regimen for controlling pain, trismus, and inflammation after third molar extraction

Comments

 A previous review by Markiewicz et al (2008) looking at corticosteroid use in third molar surgery included 12 studies and included a meta-analysis. They concluded:-

 this study suggest that perioperative administration of corticosteroids produces a mild to moderate reduction in edema and improvement in range of motion after third molar removal.

In 2010 Dan et al published a review of corticosteroids in oral and orthognathic surgery  concluding that:-

 findings suggest that the administration of corticosteroids in oral surgery decreases edema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.

 Links

Herrera-Briones FJ, Prados Sánchez E, Reyes Botella C, Vallecillo Capilla M. Update on the use of corticosteroids in third molar surgery: systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Aug 16. [Epub ahead of print] PubMed PMID: 22902498.

Markiewicz MR, Brady MF, Ding EL, Dodson TB. Corticosteroids reduce postoperative morbidity after third molar surgery: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2008 Sep;66(9):1881-94. Review. PubMed PMID: 18718396.

Dan AE, Thygesen TH, Pinholt EM. Corticosteroid administration in oral and orthognathic surgery: a systematic review of the literature and meta-analysis. J  Oral Maxillofac Surg. 2010 Sep;68(9):2207-20. Epub 2010 Jun 29. Review. PubMed PMID: 20591548.

 

 

 

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