Third Molar Surgery Outcomes: A Randomized Clinical Trial Comparing Submucosal and Intravenous Dexamethasone

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 2 treatment groups. All participants underwent the surgical removal of at least 2 mandibular third molars under intravenous sedation. The outcome variables studied were swelling, pain, and maximum incisal distances. The swelling was measured using a 3-dimensional camera (3dMD Inc, Atlanta, GA). The pain was quantified using a 100 mm visual analog scale (VAS). Maximum incisal distances were measured using a caliper. Participants completed the short-form Oral Health Impact Profile (OHIP-14). The 2 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% females and 12.4% smokers. There were no statistically significant differences in the distribution of study variables between the 2 groups. On day 2, mean facial swelling measurements were 7.3 cm(3) in the IV group and 7.8 cm(3) in the SM group (P>.05). The mean pain score was 31 in the IV group and 33 in the SM group (P>.05). The mean maximum incisal distances were 33.7 mm in the IV group and 34.5 mm in the SM group (P>.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. (C) 2020 American Association of Oral and Maxillofacial Surgeons