Submucosal Dexamethasone Injection Improves Quality of Life Measures After Third Molar Surgery: A Comparative Study

Purpose: The purpose of the present study was to compare the effect of submucosal versus intramuscular administration of dexamethasone sodium phosphate on patients' quality of life after surgical removal of impacted lower third molars. Patients and Methods: A randomized, non-blind, clinical trial was planned. The sample was composed of patients requiring extraction under local anesthesia of a single partial bony impacted mandibular third molar with Class II or III and position B or C, according to the Pell and Gregory classification. The patients were randomly distributed into 1 of 3 groups: submucosal dexamethasone, intramuscular dexamethasone, and a control group that received no steroid. A modified translated questionnaire was used to assess the patients' perception regarding different quality of life dimensions. In addition, the objective measurements of facial pain, swelling, and trismus were performed on days 1, 3, and 7 postoperatively. Results: A total of 33 subjects requiring surgical removal of a single impacted mandibular third molar under local anesthesia were included in the present study. Both dexamethasone groups showed a significant reduction in swelling and pain compared with the control group at all intervals (P < .05). Submucosal dexamethasone provided significant improvement in trismus compared with the control group on day 1 postoperatively (P = .026). Both dexamethasone groups showed a highly significant difference in the effect on quality of life and the duration of effect in all subscale scores (P < .01) except for the speech and appearance subscales. The effect was comparable between the 2 treated groups in all parameters. The effect of the 2 routes of dexamethasone was also comparable for all parameters. Conclusions: Submucosal injection of dexamethasone 4 mg is an effective therapeutic strategy for improving the quality of life after surgical removal of impacted lower third molars with a comparable effect on postoperative sequelae to intramuscular injection. It offers a simple, safe, painless, noninvasive, and cost effective therapeutic option for moderate and severe cases. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:2289-2297, 2011