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The study was designed to determine the effectiveness of single pre-operative submucosal injection of dexamethasone in reducing post operative swelling and trismus after surgical removal of impacted mandibular molar when compared with control. This randomized control study was carried out at Islamic International Dental Hospital from September 2015 to April 2016 on 60 patients requiring the surgical removal of impacted mandibular third molar. All patients were divided randomly into two equal groups that is group A (Experimental) and group B (Control). Baseline and post operative data were recorded by measuring facial width, inter incisal distance of the upper and lower right central incisor. Data were analyzed through SPSS version 17. Patient's age in group-A and group B at the time of surgery ranged from 17 to 44 years (29.67+-7.6) and 17 to 41 years(27.87+-6.43) respectively.

There were 57% males and 43% females in group-A. Group-B had 70% males and 30% females. Experimental group showed a significant reduction in swelling (p < 0.001) and trismus (p 0.05) while on 2nd postoperative day it was statistically significant (p 0.05). On second postoperative day, trismus was statistically significant (p


2ndpost-###10.57 +- 0.692###10.91 +-0.565###p


2ndpost-###12.83 +-0.779###12.02 +- 0.554###p


2ndpost-###22.97+- 5.196###30.93+- 3.321###p<



Dexamethasone is delivered for third molar surgeries by either oral, intravenous, intramuscular in masseter, gluteal or deltoid region, sub mucosal injec- tion, endo alveolar powder.17 Submucosal route was used in the current study because it is simple, painless, non invasive, convenient for surgeon and the patient and offers cost effective method.5 No special skill is required to give a submucosal injection as essential for intramuscular and intravenous injection.9 Moreover, the third molar surgery is done under local anesthesia so it is convenient to administer the submucosal dexamethasone painlessly at the site of surgery which gives submucosal route an advantage over IV and IM routes of administration.6,9

Various studies have been done to compare the outcome after the administration of 4mg and 8mg doses of dexamethasone. Grossi GB et al found no difference in post operative discomfort between two different doses of dexamethasone i.e. 4mg and 8mg administrated submucosally.16 In the current study, 4mg dexamethasone was used because it is considered that sub therapeutic dose of dexamethasone has less morbidity due to minimal systemic absorption and therefore minimal immunosuppression, resulting in significant reduction in post operative discomfort.1

Different studies use measurement of the distance between the incisal edges of the upper and lower incisors at maximum aperture to quantify trismus.18,19,20,21

In present study we also used the same method for measuring inter incisal distance. The method employed for the measurement of swelling in present study was selected because it is valid easy and inexpensive. Recent large multicenter trial indicated that symptoms reach a maximum at day 1 or day 2 postoperatively and generally resolve by day 7. In the current study, second post operative day was used to assess facial width and trismus.2

In current study, submucosal injection of dexamethasone of 4 mg administered pre operatively showed significant decrease in edema(p [?] 0.001) and trismus (p [?] 0.001) on 2nd post-operative day (48 hours after the surgical procedure) in comparison to the control group. Waraich et al, in their study showed that sub mucosal injection of 4 mg is effective in controlling post-operative discomfort after third molar surgery.6

Saravanan et al, in their study also reported that all the patients in the sub mucosal group had better comfort particularly in terms of mouth opening compared to both study group i.e. intramuscular group and control group. Between the intramuscular groups and Sub mucosal group, those who underwent bilateral impactions, had improved quality of life when given submucosal dexamethasone.22 The study by Majid et al proved that 4 mg dexamethasone showed significant decrease in swelling (p< 0.05).9 Similarly Deo found that with use of submucosal dexamethasone there is significant decrease in swelling and trismus.23 Ehsan et al compared the effect of submucosal dexamethasone with the control group and found statistically significant reduction of swelling and trismus on 2nd postoperative (p< 0.05). All of the above mentioned studies support current study findings.1

It has been reported by various studies that the post-operative sequelae after the removal of impacted third molar are also influenced by various factors such as age, gender, depth and position of tooth and surgeon experience. Since this study was conducted on mesioangular class II position B mandibular third molar impaction and surgery was performed by single operator so the depth and position of tooth and surgeon experience does not have any impact on the results. Another important factor that can also affect the post-operative sequelae especially the degree of facial swelling is the duration of operating time which in turn related to the difficulties in extraction.6,24 In present study the duration of surgery was almost same for both the groups.


It was concluded that pre-operative single sub therapeutic dose of submucosal of dexamethasone will help in reducing the post-operative discomfort. However current study had some limitations as only mesioangular class II position B mandibular third molar impaction were included. Further studies are required with other types of impactions and then their results should be compared to determine the effectiveness of submucosal dexamethasone injection. Age of the patient should be standardized along with the gender, angulation and depth of impaction to attain more accurate results.


1 Ehsan A, Bukhari SGA, Ashar AM, Junaid M. Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar. J Coll Physicians Surg Pak. 2014; 24(7):489-92.

2 Channar Ka, Kumar N, Ul Hassan Q, Memon Ab. Dexamethasone In Control Of Post-Operative Sequelae After Extraction Of Mandibular Impacted Third Molars. MC. 2013; 19: 63-66.

3 Laureano Filho JR, Maurette PE, Allais M, Cotinho M, Fernandes C. Clinical comparative study of the effectiveness of two dosages of dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Med Oral Patol Oral Cir Bucal 2008; 13: 129-32.

4 Antunes AA, Avelar RL, Martins Neto EC, Frota R, Dias E. Effect of two routes of administration of dexamethasone on pain, edema, and trismus in impacted lower third molar surgery. Oral and maxillofacial surgery. 2011; 15(4):217-23.

5 Majid OW. Submucosal dexamethasone injection improves quality of life measures after third molar surgery: a comparative study. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons. 2011; 69(9):2289-97.

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17 Prakash Dhanavelu S, Vijay Ebenezer, Balakrishnan And M Elumalai Dexamethasone For Third Molar Surgery- A Review Int J Pharm Bio Sci. 2013;4(4):9-13.

18 Zandi M. Comparison of corticosteroids and rubber drain for reduction of sequelae after third molar surgery. Oral Maxillofac Surg. 2008; 12:29-33.

19 Moore PA, Brar P, Smiga ER, Costello BJ. Preemptive rofecoxib and dexamethasone for prevention of pain and trismus following third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2005;99:1-7.

20 Lopez-Carriches C, Martinez Gonzalez JM, Donado-Rodriguez 11. M. Analgesic efficacy of diclofenac versus methylprednisolone in the control of postoperative pain after surgical removal of lower third molars. Med Oral Patol Oral Cir Bucal. 2005;10:432-39.

21 Buyukkurt MC, Gungormus M, Kaya O. The effect of a single dose prednisolone with and without diclofenac on pain, trismus, and swelling after removal of mandibular third molars. J Oral Maxillofac Surg. 2006 ; 64:1761-66.

22 Saravanan, K., Kannan, R., John, R.R., Nantha Kumar, C. A single pre operative dose of sub mucosal dexamethasone is effective in improving post operative quality of life in the surgical management of impacted third molars: a comparative randomised prospective study. J Oral Maxillofac Surg. 2016;15:67-71.

23 Deo SP. Effect of submucosal injection of dexamethasone on post-operative sequelae of third molar surgery. JNMA; journal of the Nepal Medical Association. 2011; 51(182):72-78.

24 Haug RH, Perrott DH, Gonzalez ML, Talwar RM. The American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study. Journal of Oral and Maxillofacial Surgery. 2005;63(8):1106-14.
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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Date:Jun 30, 2017

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