Aim To assess prevention and reduction of trismus after surgically extracted impacted mandibular third molars with individual and combined therapy with corticosteroids and anti-inflammatory analgesics. Methods The research included 60 randomly selected patients (3 groups) attended to the Dental Oral Surgery of the Public Institution Healthcare Center Zenica during the period January-December 2008. Patients of both genders, 18-45 years of age, were presented without pain and other inflammatory symptoms at the time of surgery. According to a scheme established in the research protocol, two medications were administered orally: methylprednisolone (corticosteroid) 32 mg and meloxicam (non-steroidal anti-inflammatory analgesic, NSAID) 15 mg as a single drug, or a combination of both drugs. The level of trismus is assessed on the basis of differences of preoperative and postoperative values of interincisal spaces when fully opening the mouth on the second and the seventh post-operative day. The differences between groups of patients were evaluated by means of Tukey’s HSD test. Results On the second and on the seventh post-operative day significantly better results were registered in the group that received only corticosteroids and in the group that received both, corticosteroids and NSAIDs compared to the group that received only NSAIDs. A tendency of trismus reduction was present in all patient groups for the second and seventh day after surgery. Conclusion Prevention and control of postoperative trismus after surgical extraction of impacted mandibular third molars with combined therapy is effective and superior comparing to individual therapy with meloxicam-or methylprednisolone alone.
Costa M, Pazzini C, Pantuzo M, Jorge M, Marques L. Is there justification for prophylactic extraction of third molars? A systematic review. Braz Oral Res. 2013. p. 183–8.
2.
Lee C, Zhang S, Leung Y, Tsang C, Chu C. Patients’ satisfaction and prevalence of complications on surgical extraction of third molar. Patient Prefer Adherence. 2015. p. 257–63.
3.
Jiang Q, Qiu Y, Yang C, Chen M, Zhang Z. Piezoelectric versus conventional rotary techniques for impacted third molar extraction: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2015. p. 1685.
4.
Adeyemo W, James O, Ogunlewe M, Ladeinde A, Taiwo O. Indications for extraction of third molars: a review of 1763 cases. Niger Postgrad Med J. 2008. p. 42–6.
5.
Carrasco-Labra A, Brignardello-Petersen R, Yanine N, Araya I, Guyatt G. Secondary versus primary closure techniques for the prevention of postoperative complications following removal of impacted mandibular third molars: a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg. 2012. p. 441–57.
6.
Coulthard P, Bailey E, Esposito M, Furness S, Worthington H. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev. 2014.
7.
Ghaeminia H. Coronectomy may be a way of managing impacted third molars. Evid Based Dent. 2013. p. 57–8.
8.
Gelesko S, Long L, Faulk J, Phillips C, Dicus C, White R. Cryotherapy and topical minocycline as adjunctive measures to control pain after third molar surgery: an exploratory study. J Oral Maxillofac Surg. 2011. p. 324–32.
9.
Msagati F, Simon E, Owibingire S. Pattern of occurrence and treatment of impacted teeth at the Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Oral Health. 2013. p. 13–37.
10.
Osunde O, Saheeb B, Bassey G. Indications and risk factors for complications of lower third molar surgery in a nigerian teaching hospital. Ann Med Health Sci Res. 2014. p. 938–42.
11.
Chaudhary P, Rastogi S, Gupta P, Indra N, B, Choudhury T. Pre-emptive effect of dexamethasone injection and consumption on post-operative swelling, pain, and trismus after third molar surgery. A prospective, double blind and randomized study. J Oral Biol Craniofac Res. 2015. p. 21–7.
12.
Beirne O. Corticosteroids decrease pain, swelling and trismus. Evid Based Dent. 2013. p. 111.
13.
Selimović E. The effect of corticosteroids and nonsteroidal anti-inflammatory analgesics in the postoperative recovery of impacted mandibular third molars. 2009.
14.
Bamgbose B, Akinwande J, Adeyemo W, Ladeinde A, Arotiba G, Ogunlewe M. Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head Face Med. 2005. p. 11.
15.
Micó-Llorens J, Satorres-Nieto M, Gargallo-Albiol J, Arnabat-Domínguez J, Berini-Aytés L, Gay-Escoda C. EEfficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction. Eur J Clin Pharmacol. 2006. p. 693–8.
16.
Lopez Carriches C, Gonzalez M, J, Rodriguez D, M. The use of methylprednisolone versus diclofenac in the treatment of inflammation and trismus after surgical removal of lower third molars. Med Oral Patol Oral Cir Bucal. 2006. p. 440–5.
17.
Buyukkurt M, Gungormus M, Kaya O. The effect of a single dose prednisolone with and without diclofenac on pain, trismus, and swelling after removal of mandibular third molars. J Oral Maxillofac Surg. 2006. p. 1761–6.
18.
Bjornsson G, Bjornland T, Skoglund L. Reproducibility of postoperative courses after surgical removal of symmetrically impacted wisdom teeth. Methods Find Exp Clin Pharmacol. 1995. p. 345–56.
19.
Atkinson H, Currie J, Moodie J, Carson S, Evans S, Worthington J, et al. Combination paracetamol and ibuprofen for pain relief after oral surgery: a dose ranging study. Eur J Clin Pharmacol. 2015. p. 579–87.
20.
Akbulut N, Üstüner E, Atakan C, Çölok G. Comparison of the effect of naproxen, etodolac and diclofenac on postoperative sequels following third molar surgery: a randomised, double-blind, crossover study. Med Oral Patol Oral Cir Bucal. 2014. p. 149–56.
21.
Herrera-Briones F, Sánchez P, E, Botella R, C, Capilla V, et al. Update on the use of corticosteroids in third molar surgery: systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013. p. 342–51.
22.
Hatgreaves K, Costello A. Glucocorticoids suppress levels of immunoreactive bradykinin in inflamed tissue as evaluated by microidialysis probes. Clin Pharmacol Ther. 1990. p. 168–78.
23.
Marques J, Pié-Sánchez J, Figueiredo R, Valmaseda-Castellón E, Gay-Escoda C. Effect of the local administration of betamethasone on pain, swelling and trismus after impacted lower third molar extraction. A randomized, triple blinded, controlled trial. Med Oral Patol Oral Cir Bucal. 2014. p. 49–54.
24.
Li C, Men Y, Li L. Discrepancies on dexamethasone for trismus after third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014. p. 253.
25.
Ngeow W, Lim D. Do Corticosteroids still have a role in the management of third molar surgery? Adv Ther. 2016. p. 1105–39.
26.
Dodson T. Corticosteroid administration in oral and orthognathic surgery. Evid Based Dent. 2011. p. 49–50.
27.
Ehsan A, Bukhari A, Ashar S, Manzoor A, Junaid M. Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar. J Coll Physicians Surg Pak. 2014. p. 489–92.
28.
Warraich R, Faisal M, Rana M, Shaheen A, Gellrich N, Rana. Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone -a randomized observer blind prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013. p. 16–22.
29.
Jain N, John R. Anesthetic efficacy of 4% articaine versus 2% lignocaine during the surgical removal of the third molar: A comparative prospective study. Anesth Essays Res. 2016. p. 356–61.
30.
Alexander R, Throndson R. A review of perioperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000. p. 406–15.
31.
Morse Z, Tump A, Kevelham E. Ibuprofen as a preemptive analgesic is as effective as rofecoxib for mandibular third molar surgery. Odontology. 2006. p. 59–63.
32.
Sotto-Maior B, Senna P, De Souza P, Assis N. Corticosteroids or cyclooxygenase 2-selective inhibitor medication for the management of pain and swelling after third-molar surgery. J Craniofac Surg. 2011. p. 758–62.
33.
Berge T. Visual analogue scale assessment of postoperative swelling. A study of clinical inflammatory variables subsequent to third-molar surgery. Acta Odontol Scand. 1988. p. 233–40.
34.
Pedersen A. Interrelation of complaints after removal of impacted mandibular third molars. Int J Oral Surg. 1985. p. 241–4.
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