Corticosteroids Can Ease Recovery from Wisdom Tooth Surgery

BUFFALO, N.Y. -- A new meta-analysis of oral surgery studies appears to settle the question of whether corticosteroids ease recovery following wisdom tooth surgery, and the answer is a qualified "yes."

The study found that corticosteroids lessen swelling and jaw stiffness significantly during post-surgery recovery, but have minimal effect on pain.

Results of the study were presented today (April 3, 2008) at a platform session at the 2008 American Academy of Dental Research meeting being held in Dallas, Texas.

"Although a lot of oral and maxillofacial surgeons use corticosteroids routinely in 3rd molar (wisdom tooth) surgery, many academicians argue that their efficacy is still not conclusive," said Michael R. Markiewicz, a predoctoral student in the University at Buffalo School of Dental Medicine and first author on the study.

"There have been many prospective clinical trials assessing corticosteroids' reduction of edema (swelling due to inflammation), trismus (difficulty opening the jaw) and pain, but the effect shown in some of these small studies has been minimal," he said. "This is the reason for performing a meta-analysis. By combining the data of these smaller studies, we made a more powerful study with a large sample size that hopefully better answers this question."

The meta-analysis covered 12 trials that met specific criteria for inclusion into the meta-analysis. Researchers were interested primarily in findings at two points post-surgery: less than 4 days, considered "early," and more than 3 days, considered "late." To standardize the assessments, in most instances they selected results for day 2 and day 7, respectively, to codify for "early" and "late."

Results showed that swelling, as measured on standard computed tomography, in corticosteroid receiving patients was 0.6 millimeters less at early assessment and 0.5 millimeters less at late assessment than controls. Those who received corticosteroids also were able to open their jaws an average of 4.1 millimeters more at "early" assessment and 2.7 millimeters more at "late" assessment than controls. Pain

was somewhat less at "early" assessment in patients who received corticosteroids than in those who did not, but the difference didn't reach statistical significance. There was no difference in pain between groups at the late time point, results showed.

"This study highlights the need for new prospective large scale investigations to adequately assess the optimal type and dose of corticosteroids, as well as the proper time to administer them," said Markiewicz. "In addition, the different anti-inflammatory effects of steroids and NSAIDs (non-steroidal anti-inflammatory drugs) also need to be investigated.

"Regardless, we feel that the present results provide a high level of evidence supporting the use of corticosteroids on patients undergoing extraction of third molars."

Also contributing to the research were Mark F. Brady, Brown University School of Medicine, Providence, R.I.; Eric L. Ding, ScD, Harvard University's School of Public Health, Boston, Mass., and Thomas B. Dodson, D.M.D., M.P.H., Massachusetts General Hospital, Boston, Mass.

The study was supported by the UB Department of Oral and Maxillofacial Surgery's Education and Research Fund, and the Center for Applied Clinical Investigation, Massachusetts General Hospital, Boston, Mass.