Can Preoperative Intramuscular Single-Dose Dexamethasone Improve Patient-Centered Outcomes Following Third Molar Surgery?

PURPOSE: Because of increased attention focused on administering dexamethasone to treat third molar surgical complications, this study investigated the efficacy of single-dose dexamethasone in managing postoperative complications after impacted third molar surgery. Pain intensity and analgesic intake, patients' discomfort, limitation of oral function, and limitation of daily activities were assessed. MATERIALS AND METHODS: This triple-blinded split-mouth randomized controlled clinical trial included patients 18 to 30 years old who underwent randomized bilateral extractions of impacted mandibular third molars during 2 consecutive sessions. Each patient was given a single-dose intramuscular injection of dexamethasone (0.1 mg/kg) preoperatively in 1 session and a placebo in the other session. Data were collected daily for 7 postoperative days, and 14 patient-centered outcomes were interpreted. A 2-tailed P value less than .05 was considered significant. RESULTS: All 32 patients (100%) enrolled completed the study. When administered dexamethasone, patients reported less pain (P </= .007), took fewer analgesics (P </= .002), reported less swelling (P </= .007), had less difficulty in eating (P </= .024), had less difficulty in enjoying food (P </= .005), had less difficulty in speech (P = .043), had less trismus (P = .005), were absent less from school or work (P </= .016), and had less disruption of daily activity (P </= .042). The differences between the 2 conditions in bleeding, malaise, and sleep disturbance were not significant (P > .05). CONCLUSION: Prophylactic dexamethasone administered intramuscularly before third molar surgery should be recommended as a safe and effective strategy for decreasing pain and discomfort and enhancing oral functions and daily activities, unless contraindicated.