Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars

• Published in: The Journal of the American Dental Association (1939) Vol. 154; no. 8; pp. 727 - 741.e10
• Main Authors: Miroshnychenko, Anna, Azab, Maria, Ibrahim, Sara, Roldan, Yetiani, Diaz Martinez, Juan Pablo, Tamilselvan, Divyalakshmi, He, Leon, Urquhart, Olivia, Verdugo-Paiva, Francisca, Tampi, Malavika, Polk, Deborah E., Moore, Paul A., Hersh, Elliot V., Brignardello-Petersen, Romina, Carrasco-Labra, Alonso
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.08.2023
• Subjects: Corticosteroids; evidence-based dentistry; postoperative pain; surgical tooth extraction; third molars; L·OVE; GI; RCT; Corticosteroids; evidence-based dentistry; NR; postoperative pain; GRADE; surgical tooth extraction; third molars; SR
• ISSN: 0002-8177; 1943-4723
• DOI: 10.1016/j.adaj.2023.04.018

Corticosteroids are used to manage pain after surgical tooth extractions. The authors assessed the effect of corticosteroids on acute postoperative pain in patients undergoing surgical tooth extractions of mandibular third molars. The authors conducted a systematic review and meta-analysis. The authors searched the Epistemonikos database, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the US clinical trials registry (ClinicalTrials.gov) from inception until April 2023. Pairs of reviewers independently screened titles and abstracts, then full texts of trials were identified as potentially eligible. After duplicate data abstraction, the authors conducted random-effects meta-analyses. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool and certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation approach. Forty randomized controlled trials proved eligible. The evidence suggested that corticosteroids compared with a placebo provided a trivial reduction in pain intensity measured 6 hours (mean difference, 8.79 points lower; 95% CI, 14.8 to 2.77 points lower; low certainty) and 24 hours after surgical tooth extraction (mean difference, 8.89 points lower; 95% CI, 10.71 to 7.06 points lower; very low certainty). The authors found no important difference between corticosteroids and a placebo with regard to incidence of postoperative infection (risk difference, 0%; 95% CI, –1% to 1%; low certainty) and alveolar osteitis (risk difference, 0%; 95% CI, –3% to 4%; very low certainty). Low and very low certainty evidence suggests that there is a trivial difference regarding postoperative pain intensity and adverse effects of corticosteroids administered orally, submucosally, or intramuscularly compared with a placebo in patients undergoing third-molar extractions.