Clinical articles
The impact of intravenous corticosteroids with third molar surgery in patients at high risk for delayed health-related quality of life and clinical recovery

https://doi.org/10.1016/j.joms.2004.01.029Get rights and content

Purpose

To compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients predicted to be at risk for delayed recovery, treated with or without intravenous (IV) corticosteroids at surgery.

Patients and methods

Patients at least 18 years of age and with all 4 third molars below the occlusal plane were given IV corticosteroids just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group who did not receive corticosteroids. No antibiotics were administered. The control group was selected using the same criteria and treated under the same surgical protocol as the corticosteroid group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics.

Results

Sixty patients were in each cohort. The incidence of delayed clinical recovery, a postsurgery visit with treatment, was higher in the control group compared with the corticosteroid group. In the corticosteroid group, 6 patients (10%) had 1 postsurgery visit with treatment. In the control group without corticosteroids, 17 patients (28%) had at least 1 postsurgery visit with treatment (P = .01). Compared with the control group, nausea tended to bother patients less on postsurgery day 1 (P = .07); sleep was improved on postsurgery days 1 through 4 (P < .05). Though not statistically significant, corticosteroids reduced the patients’ reported recovery by at least 1 day for pain, lifestyle, and oral function.

Conclusion

Administration of IV corticosteroids before third molar surgery without antibiotics does not hamper clinical recovery even when healthy adult patients are predicted to have delayed recovery. Overall, IV corticosteroid administration had a limited, but beneficial effect on HRQOL outcomes.

Section snippets

Patients and methods

A prospective clinical trial conducted at multiple clinical centers was designed to compare the effectiveness of IV corticosteroids without antibiotics on outcomes after third molar surgery in patients expected to be at higher risk for delayed recovery. The group of patients (CSG) receiving IV corticosteroids at surgery was compared with a nonconcurrent control group of patients (CTG) who did not receive corticosteroids or antibiotics selected by the same inclusion/exclusion criteria. Neither

Results

Sixty patients with 4 third molars scheduled for removal were enrolled in the CSG and treated by 8 surgeons at 2 academic centers and 1 community practice. All patients received IV corticosteroids just before surgery without the administration of antibiotics. Thirty-seven patients received dexamethasone sodium phosphate 8 mg and 23 patients methlyprednisolone sodium succinate 40 mg. In the CTG, 60 patients were enrolled and treated by 22 surgeons at 3 academic centers and 9 community practices.

Discussion

The principal finding of this study was that a single IV dose of a glucocorticosteroid administered just before third molar surgery with no antibiotics given concurrently had no detrimental impact on wound healing in patients predicted to be at higher risk for delayed clinical recovery. In addition, from the patients’ perspective, corticosteroids had a beneficial but minimal impact on recovery for HRQOL domains. Recovery for 7 of 10 outcomes for lifestyle, oral function, and pain were improved

Acknowledgment

The authors offer a special thanks to the surgeons and their patients who volunteered to provide data for this analysis. The authors thank Debora Price, Lyna Rogers, and Terri Horton for assistance in managing data for this project.

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Research grant support was received from the Dental Foundation of North Carolina, Oral and Maxillofacial Surgery Foundation, and the American Association of Oral and Maxillofacial Surgeons.

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