Third molar surgery outcomes: a comparison between submucosal and intravenous dexamethasone
ObjectiveTo compare the efficacy of submucosal (SM) dexamethasone and intravenous (IV) dexamethasone in reducing postoperative facial swelling, pain and trismus after third molar surgery, and its impact on quality of life. MethodsThe study was designed as a randomised, controlled, observer-, surgeon- and participant-blinded single-centre equivalence trial with two parallel groups. There were 61 participants in the IV group and 64 participants in the SM group. The IV group received 2ml intravenous saline and 8mg/2ml submucosal dexamethasone. The SM group received 8mg/2ml intravenous dexamethasone and 2 ml saline submucosal injection. Facial swelling was measured using a contactless stereophotogrammetry 3-dimensional facial camera (3dMD Inc, Atlanta, GA). These images were superimposed and analysed to calculate the volumetric difference in facial swelling. Pain was measured using a 100mm visual analogue scale (VAS). Maximum incisal distances were measured using a linear calliper. All measurements were taken immediately before the surgery and on postoperative days 2 and 7. Data were collected from participants by means of self-reported questionnaires. This study used the oral health impact profile (OHIP)-14 and a third-molar-specific oral-health-related quality of life (OHRQoL) instrument to assess changes to quality of life. Demographic and clinical characteristics of the participants were cross-tabulated and analysed by analysis of variance (ANOVA) or Pearson Chi-Square, as appropriate. P values of <0.05 were considered statistically significant. ResultsOn day 2, the IV and SM group had a mean facial swelling of 7.3 cm3 and 7.8 cm3, respectively. On day 7, the swelling had reduced to 2.9 cm3 in the IV group, and 2.6 cm3 in the SM group. Mean pain scores did not differ between treatment groups on either postoperative days. Trismus was most severe on postoperative day 2 in both groups. The amount of trismus observed at both postoperative follow-up time points was similar between the groups. There were no statistically significant differences between the two groups. Both groups experienced poorer quality of life following third molar surgery. The degree of impact on quality of life was comparable between the treatment groups. ConclusionsThere are no differences in postoperative adverse outcomes between submucosal and intravenous administration of dexamethasone in third molar surgery. Submucosal dexamethasone is a straightforward, accessible and viable route of delivery of steroid administration in patients who choose to have third molar surgery under local anaesthesia only.
Advisor: De Silva, Rohana; De Silva, Harsha; Tong, Darryl; Thomson, Murray
Degree Name: Doctor of Clinical Dentistry
Degree Discipline: Oral Diagnostics and Surgical Sciences
Publisher: University of Otago
Keywords: Third molar surgery; Steroids; Dexamethasone; Swelling; Pain; Trismus; Quality of life; wisdom teeth; 3d camera; 3DMD; intravenous; submucosal
Research Type: Thesis