Effect of Local Dexamethasone on Pain, Swelling, and Trismus After Extraction of Impacted Mesioangular Third Molar

Pain and inflammation are common problems after the third molar surgery. The purpose of this study was to compare the effect of ibuprofen and intra-muscular injection or the intra-socket placement of dexamethasone on pain, swelling, and trismus after the extraction of impacted third molar.

In this triple-blind randomized clinical trial study, 72 eligible patients were randomly divided into four groups of 18 subjects. The groups received dexamethasone powder (4 mg) inside the alveolar socket immediately before flap suturing, injection in the masseter muscle (4 mg/1 mL) immediately after the suture, the ibuprofen tablet from an hour before the surgery (400 mg every 6 hours for 1 day), and placebo. Three parameters of pain severity, swelling, and trismus were evaluated on the second and seventh days after the surgery. Data were analyzed using SPSS 17. Qualitative and quantitative data were expressed as a percentage and mean ± standard deviation, respectively. Chi-square, one-way analysis of variance (ANOVA) and, if necessary, the least significant difference tests were used for intergroup comparison. The findings were significant at P<0.05

Dexamethasone groups had significantly lower pain severity (second and seventh days), swelling (second day), and maximum mouth opening (MMO, alveolar socket: second and seventh days, masseter: second day) in comparison to the other groups (P<0.05). The ibuprofen group had significantly lower levels of pain (second and 7th days) and swelling (second day) in comparison to the control group (P<0.05). There was no significant difference between dexamethasone groups in any measurement for pain, swelling, and MMO.

The findings of this study suggest that the intra-oral administration of dexamethasone may have a better effect on pain, swelling, and trismus compared to ibuprofen and has no placebo effect.