Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
Oral and maxillofacial surgeryThe use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: A review of the literature
Section snippets
Common Postoperative Sequelae and Causes of Postoperative Sequelae After Oral Surgery
Oral surgical procedures can vary in difficulty and in the degree of trauma caused to the surrounding tissue. As the oral and maxillofacial surgeon performs a more invasive or difficult procedure, there will be an increased amount of trauma to the surgical site as well as to the surrounding tissues. The greater amount of tissue injury leads to an increased amount of inflammation in the perisurgical area. Swelling may be particularly significant when the surgery is prolonged and when large
NSAID Use for the Management of Pain and Inflammation After Oral Surgery
NSAIDs decrease inflammation and fever while providing analgesia by inhibiting the cyclooxygenase (COX) enzymes COX-1 and COX-2, important enzymes which are needed for the production of inflammatory mediators such as prostaglandins, prostacyclins, and thromboxanes. Refer to Fig. 1 to review the actions of the COX-1 and COX-2 enzymes.
Preoperative administration of NSAIDs has been investigated to determine efficacy in third molar oral surgery patients. Some of the results of the studies include
Mechanism of Action of Glucocorticoids
The glucocorticoids are synthesized in the cortex of the adrenal gland. Glucocorticoids are corticosteroids with a relatively greater effect on carbohydrate metabolism than on water and electrolyte regulation. Despite the name “glucocorticoid,” they have a very broad range of effects on many metabolic activities. Glucocorticoid receptors are found in virtually every cell of the body and exert a wide range of physiologic actions affecting virtually every organ system.
Glucocorticoids activate
Adverse Effects and Contraindications to Glucocorticoid Use in Oral Surgery
The potential for adverse effects with the use of glucocorticoids depends on the intensity and duration of therapy. A single large dose or a short duration of therapy causes few adverse effects. If therapy with a glucocorticoid is prescribed for >1 week, some signs of steroid toxicity may be seen as well as signs of hypothalamic-pituitary-adrenal (HPA) axis suppression. Adverse effects that are seen with glucocorticoids correlate with the dose and duration of therapy. Some adverse effects that
Review of Literature
Several studies have been conducted to evaluate the efficacy of corticosteroids in reducing the postsurgical sequelae experienced after oral surgical procedures, particularly after the removal of impacted third molar teeth. The literature contains studies that have used methylprednisolone, betamethasone, and dexamethasone at various dosages and routes of administration. A summary of the results of these studies can be viewed in Table III.
Huffman30 in 1977 administered 40 mg and 125 mg doses of
Recommendations for the Appropriate Use of Corticosteroids Following Dentoalveolar Surgery
There are several synthetic analogues of glucocorticoids available to the practitioner. The drugs vary in their glucocorticoid potency, relative mineralocorticoid potency, duration of action, and plasma half-life. Refer to Table IV for a comparison of the most commonly used agents. Plasma half-lives of the various synthetic glucocorticoids vary from 1 h to approximately 4 h. However, plasma half-life is not a good indication of the duration of biologic activity of each steroid. Duration of
Discussion
The use of NSAIDs in managing oral surgical patients has been well described. From the literature available, it is apparent that the combination of another drug with an NSAID is often more effective in controlling postoperative pain and swelling in third molar surgery than an NSAID alone. For example, the combination of diclofenac and prednisolone offers a better therapeutic outcome regarding pain and swelling, as documented in various studies.18, 20, 21 It is important, therefore, that
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