DOI: 10.4103/sjoralsci.sjoralsci_76_25 ISSN: 2542-7849

Comparative efficacy of preoperative versus postoperative oral dexamethasone in impacted lower third molar surgery: A randomized clinical study

Jaya Sharma, Monica Jain, Bahadur Singh, Kalpana Baijal, Hanu Sharma
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Abstract

Introduction:

Surgical extraction of impacted mandibular third molars is frequently associated with postoperative pain, edema, and trismus, which compromise patient recovery and quality of life. Corticosteroids, particularly dexamethasone, are widely used to mitigate these sequelae; however, the optimal timing of administration remains debated.

Aim:

The present study aimed to evaluate and compare the clinical efficacy of a single 8 mg oral dose of dexamethasone administered either 1 h before or immediately after the surgical extraction of impacted mandibular third molars in reducing postoperative complications.

Materials and Methods:

This randomized clinical trial enrolled 126 healthy patients (18–45 years) requiring removal of impacted mandibular third molars through surgery. Participants were randomly allocated into two groups ( n = 63 each): Group A received 8 mg oral dexamethasone 1 h before surgery, and Group B received the same dose immediately after surgery. Facial edema (primary outcome) was measured by the Gabka and Matsumura method. Secondary outcomes included postoperative pain which was assessed using a Visual Analog Scale (VAS) and maximum mouth opening (measured with a calibrated ruler). Assessments were conducted preoperatively and on the 2 nd , 5 th , and 7 th postoperative days. Data were analyzed using one-way analysis of variance, with P ≤ 0.05 considered statistically significant.

Results and Discussion:

Both the groups reported postoperative pain, swelling, and trismus; however, preoperative dexamethasone administration resulted in significantly lower VAS pain scores, reduced facial edema, and greater mouth opening at all postoperative time points ( P < 0.001). No adverse drug reactions or postoperative complications were observed. These findings demonstrate that achieving adequate steroid levels before surgical trauma leads to a stronger pre-emptive anti-inflammatory effect. Compared with postoperative dosing, preoperative dexamethasone more effectively limits early inflammatory mediator release, resulting in reduced edema, less pain, and better mouth opening. This aligns with existing literature supporting pre-emptive corticosteroid therapy and reinforces that timing of administration plays a crucial role in optimizing patient recovery.

Conclusion:

Preoperative oral administration of 8 mg dexamethasone demonstrates superior efficacy compared with postoperative administration in reducing pain, edema, and trismus following third molar surgery. These findings support the prophylactic use of corticosteroids to improve postoperative recovery and patient comfort.

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