974 D3000 new imprint Word template Vol 13, No 1 (2025) ISSN 2167-8677 (online) DOI 10.5195/d3000.2025.974 http://dentistry3000.pitt.edu Efficacy of Dexamethasone on Pain and Swelling Following Extraction of Impacted Mandibular Third Molars A Randomized Controlled Trial Saber Mizher College of Den*stry, Tikrit University, Iraq Abstract Objec.ve: Surgical extracFon of impacted mandibular third molars is a common dental pro- cedure associated with significant postoperaFve complicaFons, including pain and swelling. Dexamethasone, a corFcosteroid known for its anF-inflammatory properFes, has been uF- lized to miFgate these postoperaFve sequelae. This study aimed to evaluate the efficacy of submucosal dexamethasone injecFon in reducing postoperaFve pain and swelling compared to a control group receiving normal saline. Material and Methods: A randomized controlled trial was conducted involving 40 paFents scheduled for surgical extracFon of impacted man- dibular third molars. ParFcipants were randomly assigned to two groups: the study group received a submucosal injecFon of 8mg dexamethasone, while the control group received an equivalent volume of normal saline. PostoperaFve pain was assessed using a Numeric RaFng Scale (NRS) at 24 hours, 48 hours, and 7 days post-surgery. Facial swelling was measured at the same intervals using standardized landmarks. Results: The results indicated that the study group experienced significantly less pain at 24 hours (NRS: 4.28 ± 0.71 vs. 5.8 ± 0.87, p=0.001) and 48 hours (NRS: 3.45 ± 0.75 vs. 4.9 ± 0.99, p=0.001) compared to the control group. AddiFonally, facial swelling was significantly reduced in the dexamethasone group at 48 hours (3.01% vs. 6.49%, p=0.001). By the 7th postoperaFve day, both groups showed sim- ilar levels of pain and swelling, indicaFng that the effect of dexamethasone was most pro- nounced in the early postoperaFve period. Conclusion: Submucosal injecFon of dexame- thasone is effecFve in minimizing postoperaFve pain and swelling following the surgical ex- tracFon of impacted mandibular third molars. The findings support the use of dexamethasone as a standard adjuncFve treatment in oral surgery to enhance pa- Fent recovery during the criFcal early postoperaFve phase. Further studies are warranted to explore opFmal dosing and long-term outcomes associated with this intervenFon. Open Access Cita%on: Mizher S. (2025) Efficacy of Dexamethasone on Pain and Swelling Following Extrac%on of Impacted Man- dibular Third Molars: A Randomized Controlled Trial. Den%stry 3000. 1:a001 doi:10.5195/d3000.2025.974 Received: June 28, 2025 Accepted: June 30, 2025 Published: August 21, 2025 Copyright: ©2025 Mizher S. This is an open access ar%cle licensed under a Crea%ve Commons AXribu%on Work 4.0 United States License. Email: xxxxx@esraa.edu.iq Introduc)on Surgical extracFon of impacted mandibular third molars is a common dental procedure that can result in significant postoperaFve complicaFons, including pain, swelling, and trismus. These sequelae can lead to discom- fort, funcFonal impairment, and a prolonged recovery period for paFents. The management of postoperaFve pain and swelling is crucial to improve paFent outcomes and saFsfacFon [1,2]. CorFcosteroids, such as dexamethasone, have been widely used to reduce inflammaFon and alleviate postoperaFve symptoms. Dexame- thasone has potent anF-inflammatory proper- Fes, making it an effecFve agent in reducing swelling and pain. The submucosal route of ad- ministraFon has gained popularity due to its targeted acFon, reduced systemic side effects, and ease of administraFon [3,4]. Despite the growing evidence supporFng the use of dexamethasone in oral surgery, there is a need for further research to establish its effi- cacy in reducing postoperaFve pain and swell- ing following impacted mandibular third molar surgery. The opFmal dosage, Fming, and route of administraFon of dexamethasone remain unclear, and the current literature is limited by the variability in study designs, sample sizes, and outcome measures [5,6]. This randomized controlled trial aims to evalu- ate the efficacy of submucosal dexamethasone injecFon in reducing postoperaFve pain and swelling following surgical extracFon of im- pacted mandibular third molars. The study will compare the outcomes of paFents receiving submucosal dexamethasone injecFon with those receiving a normal saline injecFon. The results of this study will provide valuable Efficacy of Dexamethasone on Pain and Swelling Following ExtracFon of Impacted Mandibular Third Molars Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.974 http://dentistry3000.pitt.edu 2 insights into the effecFveness of submucosal dexamethasone injecFon in managing postop- eraFve pain and swelling, ulFmately contrib- uFng to improved paFent care and outcomes in oral surgery. Material and Methods Study Design: This randomized controlled trial was conducted from November 4, 2022, to De- cember 15, 2022. The study was approved by the insFtuFonal review board, and informed consent was obtained from all parFcipants. Par.cipants: A total of 40 paFents aged 17 to 40 years, requiring surgical extracFon of im- pacted mandibular third molars, were enrolled in the study. PaFents were randomly assigned to two groups: the study group (n=20) received a submucosal injecFon of 8 mg dexame- thasone, while the control group (n=20) re- ceived an equivalent volume of normal saline (Normon, Spain). Inclusion criteria included pa- Fents with fully impacted mandibular third molars, while exclusion criteria included those with systemic diseases, allergies to corFcoster- oids, or pregnant women [7,8]. Surgical Procedure: All surgical extracFons were performed under local anesthesia using 20 mg/ml lidocaine with 0.0125 mg/ml epi- nephrine. A full-thickness two-sided flap was created using a No. 15 blade and scalpel handle No. 3. Flap reflecFon was achieved with a peri- osteal elevator, followed by bone removal us- ing a low-speed surgical handpiece and normal saline irrigaFon. The impacted tooth was ex- tracted, and the flap was reposiFoned and su- tured [9,10]. Interven.on: Immediately afer the surgical procedure, the study group received a submu- cosal injecFon of 8 mg dexamethasone (Cas- pian Tamin, Iran) at the surgical site, while the control group received an equivalent volume of normal saline. The injecFons were adminis- tered using a dental syringe (Dental Syringe, Pakistan) to ensure accurate delivery. Outcome Measures: PostoperaFve pain was assessed using a Numeric RaFng Scale (NRS) at 24 hours, 48 hours, and 7 days post-surgery. PaFents were instructed to rate their pain in- tensity on a scale from 0 (no pain) to 10 (worst pain imaginable). Facial swelling was measured at baseline, 48 hours, and 7 days postopera- Fvely using standardized landmarks on the face. Data Analysis: Data were analyzed using SPSS sofware (version 25). DescripFve staFsFcs were calculated for demographic data. Com- parisons between groups for pain scores and swelling measurements were performed using independent t-tests and ANOVA, with a signifi- cance level set at p < 0.05. The results were presented as mean ± standard deviaFon (SD) [11,12]. Results Summary of Findings The results of this study indicate that submu- cosal dexamethasone injecFon is effecFve in reducing both postoperaFve pain and swelling following the surgical extracFon of impacted mandibular third molars. The most significant benefits were observed within the first 48 hours post-surgery, with both pain and swell- ing returning to similar levels by the 7th post- operaFve day. These findings support the use of submucosal dexamethasone as a standard adjuncFve treatment in oral surgery to en- hance paFent recovery during the criFcal early postoperaFve phase. Demographic Data A total of 40 paFents were enrolled in the study, with 20 paFents in the study group re- ceiving submucosal dexamethasone injecFon and 20 paFents in the control group receiving normal saline. The mean age of the paFents was 28.85 years, with a standard deviaFon of ±6.95 years. The sex distribuFon showed that in the control and intervenFon groups 12 par- Fcipants were male and eight were female, with no significant difference between the groups (p ≥ 0.05). Pain Assessment PostoperaFve pain scores were assessed using the Numeric RaFng Scale (NRS) at 24 hours, 48 hours, and 7 days post-surgery. At 24 hours postoperaFvely, the study group reported sig- nificantly lower pain scores compared to the control group (4.28 ± 0.71 vs. 5.8 ± 0.87, p=0.001). Similarly, at 48 hours, the pain scores remained significantly lower in the study group (3.45 ± 0.75 vs. 4.9 ± 0.99, p=0.001). By the 7th postoperaFve day, the pain scores in both groups were comparable, with no staFsFcally significant difference (0.2 ± 0.41 vs. 0.43 ± 0.31, p=0.069). Swelling Assessment Facial swelling was measured at baseline, 48 hours, and 7 days postoperaFvely. At 48 hours, the study group exhibited significantly less swelling compared to the control group (3.01% vs. 6.49%, p=0.001). By the 7th postoperaFve day, the swelling in both groups was similar, with no staFsFcally significant difference (1.05% vs. 1.26%, p=0.16). Adverse Effects No serious adverse effects were reported in ei- ther group during the study period. Minor side effects, such as transient nausea and dizziness, were noted in a few paFents but were not sig- nificantly different between the groups. Discussion The findings of this randomized controlled trial demonstrate that submucosal dexamethasone injecFon significantly reduces postoperaFve pain and swelling following the surgical extracFon of impacted mandibular third mo- lars. The study revealed that paFents receiving dexamethasone reported lower pain scores at 24 and 48 hours postoperaFvely compared to the control group, with a notable reducFon in facial swelling at 48 hours. These results align with previous studies that have highlighted the efficacy of corFcosteroids in managing postop- eraFve inflammaFon and discomfort [13,14]. CorFcosteroids, parFcularly dexamethasone, are known for their potent anF-inflammatory properFes. They inhibit the release of inflam- matory mediators, such as prostaglandins and leukotrienes, which play a crucial role in the development of pain and swelling following surgical trauma [15]. The significant reducFon in pain and swelling observed in this study sup- ports the findings of Moraschini et al. (2016), who conducted a meta-analysis indicaFng that dexamethasone administraFon [1], parFcu- larly via the submucosal route, effecFvely miF- gates postoperaFve symptoms afer third mo- lar surgery [16,17]. Conversely, some studies have reported mixed results regarding the efficacy of dexame- thasone. For instance, Klongnoi et al. (2012) found no significant difference in pain reduc- Fon when comparing dexamethasone to pla- cebo in certain paFent populaFons. This dis- crepancy may be ajributed to variaFons in study design, paFent demographics, and the Fming of dexamethasone administraFon. This study's focus on the submucosal route may ex- plain the more favorable outcomes, as this method allows for localized delivery of the medicaFon, maximizing its anF-inflammatory effects while minimizing systemic exposure [18]. These results also indicate that the benefits of dexamethasone are most pronounced in the early postoperaFve period, with pain and swelling levels converging by the seventh day. This finding is consistent with the pharmacoki- neFcs of dexamethasone, which has a half-life of approximately 36 to 54 hours, suggesFng that its effects diminish as the drug is metabo- lized [19,20]. These findings contribute to the growing body of evidence supporFng the use of corFcosteroids in oral surgery and highlight the importance of opFmizing postoperaFve care to enhance paFent recovery. Conclusions This randomized controlled trial demonstrates that submucosal dexamethasone injecFon is an effecFve intervenFon for minimizing post- operaFve pain and swelling following the sur- gical extracFon of impacted mandibular third molars. The results indicate that paFents re- ceiving dexamethasone experienced signifi- cantly lower pain scores at 24- and 48-hours post-surgery, as well as reduced facial swelling Efficacy of Dexamethasone on Pain and Swelling Following ExtracFon of Impacted Mandibular Third Molars Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.974 http://dentistry3000.pitt.edu 3 at the 48-hour mark compared to the control group receiving normal saline. The findings support the use of submucosal dexamethasone as a standard adjuncFve treat- ment in oral surgery, parFcularly during the criFcal early postoperaFve period when pa- Fents are most vulnerable to discomfort and inflammaFon. The localized administraFon of dexamethasone not only enhances its efficacy but also minimizes potenFal systemic side ef- fects, making it a favorable opFon for manag- ing postoperaFve sequelae. Considering these results, it is recommended that dental practitioners consider incorporat- ing submucosal dexamethasone injections into their postoperative care protocols for patients undergoing third molar extractions. Further re- search is reasonable to explore optimal dosing strategies, timing of administration, and long- term outcomes associated with this interven- tion. Overall, the use of submucosal dexame- thasone injection represents a valuable ad- vancement in enhancing patient recovery and improving the quality of care in oral and maxil- lofacial surgery. References 1) Moraschini V, Hidalgo R, Porto Barboza E. Ef- fect of submucosal injection of dexamethasone af- ter third molar surgery: a meta-analysis of ran- domized controlled trials. Int J Oral Maxillofac Surg. 2016; 45(2):232-40. 2) Klongnoi B, Kaewpradub P, Boonsiriseth K, Wongsirichat N. Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery. 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