The effect of pre-surgical submucosal injection of dexamethasone on postoperative outcomes after mandibular third molar surgical disimpaction at MUHAS- dental clinic.

Abstract

ABSTRACT Background: The impaction of a tooth is described as the failure of the tooth to appear in the mouth at the appropriate time and in the normal position. The surgical extraction of the impacted mandibular M3 molar is among the most performed surgeries by oral and maxillofacial surgeons. This routine procedure is linked to known post-operative complications described as trismus, pain and swelling of the face. To overcome the post-operative complications of third molar surgery, several medical interventions have been tried including drugs like corticosteroids, strong analgesics, and Non-Steroidal Anti-Inflammatory Drugs (NSAID). Despite carrying out the 3rd molar surgical disimpaction procedure on daily basis in our setting, pre-operative injection of submucosal dexamethasone is very rarely practiced despite its benefits noted elsewhere in the world. Moreover, the paucity of information has hindered the development of standardized surgical protocols for managing sequela associated with impacted third molars in our settings. Aim of the study: To assess the effect of presurgical submucosal injection of dexamethasone on postoperative outcomes of surgical disimpaction of a mandibular third molar among patients treated at MUHAS Dental clinic, Oral and Maxillofacial clinic. Materials and methods: This is a randomized case control study conducted at MUHAS- dental clinic. The study population included all adult patient with impacted mandibular third molar treated at MUHAS- Dental clinic. Patient were randomly assigned into two groups (control or case), followed by clinical examination with radiologic studies. Later, face measurements recorded and local anesthesia and submucosal injection of dexamethasone 8 mg for case or tumescent solution infiltration for control was carried out by the principal investigator or his assistant on the mucosa of the site of the surgery. Later, the surgery was carried by a non aware resident in maxillofacial surgery. On day 3 and day 7, patients were assessed for pain, swelling, trismus and comparative measurements were recorded. A level of difficulty was evaluated using a Modified difficulty Index by Shubi singh&kuete for MM3. All the data were encoded and entered into the Microsoft Excel 2022 spreadsheet and analyzed using the SPSS Statistical Package for the Social Sciences version 30. The level of significance was set at P < 0.05. The significance of the differences in measurement between the preoperative and postoperative dexamethasone groups and control was assessed using paired t-test and Wilcoxon signed rank test. Results: Preoperative administration of dexamethasone was found to reduce the sequalae related to surgical disimpaction of mandibular third molar. The pain was reduced through the VAS score pain from day3 with statistical significance (p=0.025<0.05). The patient were experiencing better mouth opening from day 3 and day7. And clinically, the facial edema was reduced considerably on day3 and day7. Using Modified Difficulty level by Shubi Singh&kuete, our surgeries ranged between low and moderate level. Also, during the surgery, minimal postoperative complications like alveolitis, dehiscence, nerve injury were reported. Conclusion and recommendations: The findings of the present study showed that preoperative submucosal injection of dexamethasone is safe, cheap, and easy to apply. It also showed a statistical significant reduction of postoperative pain from day3, with observable reduction in the post operative swelling and better mouth opening. However, more studies with larger sample size and in multiple centers should further be carried. In addition, other studies involving the accessement of inferior alveolar nerve during surgery will also be needed to help in the improvement of patient care. Also, having a standard protocol for surgical disimpaction which is printed and made accessible to clinicians in all dental clinics would help to improve the quality of patient care.