Comparative Evaluation of Dexamethasone and Methylprednisolone for Pain, Swelling, and Trismus After Mandibular Third Molar Surgery: A Prospective Randomized Clinical Study

Abstract

Introduction: Impacted third molars, commonly known as wisdom teeth, frequently require surgical removal due to various pathological and therapeutic reasons. These include infection, periodontal disease, pericoronitis, pain, caries prevention, adjacent tooth resorption, orthodontic and prosthetic considerations, mandibular fracture prevention, cysts and tumors, orthognathic surgery interference, transplant use, and prophylactic measures. The goal of third molar extraction is to minimize postoperative complications. This study aims to compare the effects of dexamethasone and methylprednisolone on postoperative pain, swelling, and trismus following mandibular third molar extraction. Materials and Methods: Sixty adult patients scheduled for mandibular third molar extraction at the Department of Oral and Maxillofacial Surgery were enrolled in this open-label, prospective, randomized clinical study. Patients were randomly assigned to two groups of 30 each. Group A received an 8 mg dexamethasone injection, while Group B received a 40 mg methylprednisolone injection, both administered submucosally one hour prior to surgery. Preoperative measurements included maximum interincisal distance and facial measurements using a Vernier-calibrated sliding caliper and a flexible measuring tape. Standard surgical procedures were followed, and patients were given postoperative care instructions and medications. Results: The study found that trismus was significantly lower in Group A (dexamethasone) compared to Group B (methylprednisolone) on days 2, 7, and 14 postoperatively. Group A also exhibited significantly reduced facial swelling over the same period. However, there was no significant difference in the Visual Analog Scale (VAS) pain scores between the two groups at any time point. Conclusion: Submucosal injection of 8 mg dexamethasone effectively reduces swelling and trismus after mandibular third molar extraction compared to 40 mg methylprednisolone. However, both drugs were equally effective in controlling postoperative pain. Dexamethasone offers a simple, safe, and cost-effective option for managing postoperative edema and related complications. Further studies with larger sample sizes are recommended for more definitive results.