In a healthy adult (age 18‑50) without diabetes, peptic ulcer disease, infection, chronic immunosuppression, or pregnancy, does a single peri‑operative dose of dexamethasone reduce pain and swelling after wisdom‑tooth extraction?

Dexamethasone for Wisdom Tooth Extraction

Yes, a single perioperative dose of dexamethasone (8 mg) significantly reduces both pain and swelling after wisdom tooth extraction in healthy adults and should be administered routinely unless contraindicated.

Optimal Dosing and Timing

Administer 8 mg of dexamethasone intramuscularly or intravenously 1 hour before surgery for maximal benefit. 1

• Pre-operative administration (1 hour before incision) provides superior control of swelling, pain, and trismus compared to immediate postoperative dosing 1
• The 8 mg dose is the standard effective dose for third molar extraction, with no additional benefit from higher doses (12 mg showed equivalent efficacy to 4 mg in one study) 2
• Both oral and parenteral routes are effective, though intramuscular or intravenous administration is preferred for reliability 3, 4

Expected Clinical Benefits

Pain reduction: Dexamethasone significantly reduces pain at 4 hours postoperatively and can eliminate the need for opioid analgesia in the immediate postoperative period 3

Swelling control: Marked reduction in facial edema, particularly evident on postoperative day 2, with pre-operative dexamethasone reducing swelling measurements by approximately 13 mm compared to postoperative administration 1

Trismus improvement: Patients receiving pre-operative dexamethasone demonstrate significantly better mouth opening (45.69±6.06 mm vs 38.69±4.40 mm) on postoperative day 2 1

Additional benefits: Significant reduction in postoperative nausea and vomiting 3

Integration with Multimodal Analgesia

Combine dexamethasone with scheduled paracetamol (acetaminophen) and NSAIDs for optimal pain control. 5, 6

• This multimodal approach provides superior analgesia compared to any single agent 5
• NSAIDs (such as diclofenac 50-100 mg every 8 hours) do not increase bleeding risk based on multiple meta-analyses 5, 6
• The combination of dexamethasone with basic analgesics reduces the need for rescue opioids 7

Safety Profile in Healthy Adults

A single 8 mg dose of dexamethasone is safe with minimal side effects in healthy adults. 8

• The primary side effect is a transient physiological rise in blood glucose levels, which is clinically insignificant in non-diabetic patients 8
• No increased risk of postoperative infection or wound complications with single-dose administration 8
• Studies specifically in third molar extraction show no adverse events with 8 mg dosing 3, 9, 1

Absolute Contraindications

Do not administer dexamethasone to patients with:

• Diabetes mellitus or impaired glucose-insulin regulation 5
• Active systemic infection 5
• Endocrine disorders already receiving exogenous steroids 5
• Pregnancy (excluded from your patient population but worth noting) 5
• Peptic ulcer disease (excluded from your patient population) 5

Route of Administration Options

All three routes are effective, choose based on clinical setting: 4

• Intramuscular or intravenous: 8 mg administered 1 hour pre-operatively (preferred for reliability) 1
• Oral: 8 mg administered 1 hour pre-operatively (effective but absorption may vary) 3
• Local administration: 4-10 mg as endo-alveolar powder or sub-mucosal injection (effective but less practical) 4

Comparison with Other Corticosteroids

Dexamethasone 8 mg is superior to methylprednisolone 40 mg for swelling and trismus control. 9

• Dexamethasone controlled swelling better at all postoperative time points (24,48,72 hours, and 7 days) 9
• Dexamethasone resulted in greater mouth opening at 48 hours postoperatively 9
• No difference between the two drugs for pain control 9
• Dexamethasone's extended half-life and potent anti-inflammatory effects make it the preferred corticosteroid 1

Common Pitfalls to Avoid

Timing error: Administering dexamethasone immediately after surgery rather than pre-operatively reduces its effectiveness by approximately 30% for swelling control 1

Dose confusion: Using doses lower than 8 mg may provide suboptimal benefit, while doses higher than 8 mg offer no additional advantage 2

Omitting multimodal analgesia: Relying on dexamethasone alone without scheduled NSAIDs and paracetamol results in inferior pain control 5, 6

Inappropriate patient selection: Failing to screen for diabetes or active infection before administration 5