Use of corticosteroids for acute pain following surgical removal of mandibular third molars

In comparison with placebo, corticosteroid administration offered a trivial decrease in pain at 6 hours and 24 hours following surgical tooth extraction.

This systematic review and meta-analysis aimed to evaluate the impact of corticosteroids on acute post-surgery pain among individuals scheduled to undergo surgical extraction of mandibular third molars.

The research team conducted extensive searches of various databases, encompassing the US clinical trials registry (ClinicalTrials.gov), MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Two reviewers independently assessed titles and abstracts, followed by the identification of potentially eligible trial full texts.

After eliminating duplicate data, the authors performed meta-analyses utilizing random-effects models. With the aid of Version 2 of the Cochrane Risk of Bias tool, the risk of bias was examined. Utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) strategy, the certainty of evidence was determined.

Overall, 40 randomized controlled trials met the eligibility criteria. The findings indicated that, in comparison with placebo, corticosteroids resulted in a minimal drop in pain at both 24 hours after surgical tooth extraction (mean difference, 8.89 points lower; 95% CI, 10.71 to 7.06 points lower; very low certainty) and 6 hours (mean difference, 8.79 points lower; 95% CI, 14.8 to 2.77 points lower; low certainty).

No profound differences were witnessed between corticosteroids and a placebo concerning the occurrence of alveolar osteitis (risk difference, 0%; 95% CI, -3% to 4%; very low certainty) and postsurgery infection (risk difference, 0%; 95% CI, -1% to 1%; low certainty). 

The available evidence, characterized by low and very low certainty, indicates that there is a marginal distinction in terms of postoperative pain severity and adverse effects between corticosteroids given orally, submucosally, or intramuscularly and a placebo in people undergoing molar surgery.