MANAGEMENT OF TRISMUS, PAIN, AND SWELLING FOLLOWING THIRD MOLAR SURGERY USING DEXAMETHASONE: A LITERATURE REVIEW

Background: The surgical extraction of impacted third molars is among the most common procedures in oral and maxillofacial surgery. Postoperative complications such as pain, swelling, and trismus are frequent and can significantly impair patient recovery and quality of life. Dexamethasone, a potent corticosteroid, has been widely used to control these postoperative sequelae. 

Objective: This review aims to evaluate the effectiveness of dexamethasone in managing pain, swelling, and trismus following third molar surgery, with emphasis on dosage, timing, and route of administration. 

Methods: A PRISMA-guided narrative review was conducted. Randomized controlled trials published between 2013 and 2023 were included. Studies evaluating 4 mg or 8 mg dexamethasone administered preoperatively or postoperatively via oral, intravenous (IV), intramuscular (IM), or submucosal routes were considered. Outcomes assessed included postoperative pain, swelling, and trismus. Risk of bias was qualitatively assessed based on randomization, blinding, and completeness of outcome reporting. 

Results: Twenty-one RCTs were included. Preoperative administration of dexamethasone generally provided superior control of postoperative swelling and trismus. Both 4 mg and 8 mg doses were effective, with no consistent evidence favoring higher doses. The submucosal route showed clinical advantages due to localized administration and ease of use, although other routes demonstrated comparable effectiveness in many cases. Pain reduction was less consistent than swelling and trismus outcomes. Dexamethasone was well tolerated, with minimal adverse effects reported, including transient hyperglycemia. 

Conclusion: Single-dose dexamethasone is effective and safe in reducing postoperative swelling and trismus following third molar surgery. Preoperative administration via submucosal injection appears to offer optimal outcomes. Pain control benefits exist but are variable and may require adjunctive analgesics.