Submucosal dexamethasone reduced pain, swelling and trismus following surgical removal of third molars

shutterstock_37849495 -impacted wisdom teeth

Surgical removal of lower third molars is one of the most commonly performed operations.  It is associated with inflammation, pain and limited mouth opening. The aim of this study was evaluate the effectiveness of submucosal injection of dexamethasone on swelling, pain, trismus, neurological complaints and patient satisfaction after third molar surgery.

Adult Patients with Pell and Gregory level B & C third molar impactions were included. The surgical procedure took place under local anaesthesia and patients were randomised to receive 4Mg/ml of dexamethasone submucosally prior to the start of the procedure. Surgery was performed by an experienced surgeon using standardised methods and techniques. All patients received a standardised postoperative analgesic regime (ibuprofen) with no antibiotic prophylaxis.  Facial swelling was measured with a tape, post operative pain with a visual analogue scale and mouth opening with calipers. Neurological assessment was conducted with pinprick test and patients satisfaction using a questionnaire on the 10th postoperative day.

  • 106 patients were randomised with 50 patients from each group contributing to the final analysis.
  • Patients receiving dexamethasone showed significant reduction in pain, swelling, trismus, a tendency to less neurological complaints and improved quality of life compared with the control group.

The authors concluded

Submucosal injection of dexamethasone is more efficient to manage postoperative discomfort after removal of third molars compared to no steroid administration.


The findings of this trial are similar to those of three previous meta-analyses that have show benefits to post-operative effects of third molar surgery from the use of corticosteroids. The most recent meta-analysis by Herrera-Briones  et al (Dental Elf  Sept 3rd 2012) included 28 studies.


Warraich r, Faisal M, Rana M, Shaheen A, Nils-Claudius G,, Ranna M. Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone a randomized observer blind prospective study. (Oral Surg Oral Med Oral Pathol Oral Radiol 2013;-:1-7 – Article in Press)

Dental Elf 3rd Sept 2012 – Perioperative corticosteroid use reduces the degree of trismus and inflammation after third molar removal


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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