Effect of dexamethasone, ketoprofen and cold compress on postoperative sequelae in mandibular third molar surgery: A randomized clinical trial

Purpose: This is a single blinded, randomized clinical trial to assess and compare the effect of dexamethasone, icepack and ketoprofen on the postoperative pain, swelling and trismus following surgical removal of impacted lower third molar (ILTM). Methodology: Consecutive patients who require surgical extraction of ILTM with a modified Pederson difficulty index score of 5-6 were recruited. Ninety patients were randomly allocated into 3 groups. Group A received 100mg of ketoprofen and group C received 8mg of dexamethasone per-oral 1hr preoperatively. Subjects in group B used a pre-standardized ice pack held against the skin over the angle of the mandible for 6 hours postoperatively. Swelling, trismus and pain were recorded on postoperative day 1, 2 and 7. Result: A total of 78 subjects with mean age of 27.8 ± 4.9 years comprising of 59.0% males completed the study. There were no statistically significant difference found in the sociodemographics. Subjects in the dexamethasone group showed a significant reduction in pain on postoperative day 1 and 2, and in swelling on all postoperative days in review. Conclusion: Oral dexamethasone showed superior reduction in postoperative pain and swelling after ILTM surgery. It also offers an effective, painless, easy route of administration and single dose safety profile. However, icepack provides a low-cost option and may be of importance in low resource settings or in patients allergic to dexamethasone.