ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title For Patients Undergoing Open-Flap Debridement Surgery, There is No Significant Difference Between Dexamethasone and NSAIDs For Reducing Patient Perceived Pain
Clinical Question In adults undergoing periodontal surgery, what is the effect of dexamethasone on patient perceived pain as compared to traditional non-steroidal anti-inflammatories?
Clinical Bottom Line Dexamethasone and NSAIDs are equally effective in reducing patient perceived pain following periodontal open flap debridement surgeries.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20367520Steffens/201015 adult patients receiving periodontal surgeryRandomized double masked cross-over controlled clinical trial
Key results8mg dexamethasone and 120mg etoricoxib taken 1 hour prior to surgery were equally effective at reducing post-operative pain following open-flap debridement. Pain reduction in these groups was more significant than placebo at 4,5,6,7 and 8 hours after surgery.
#2) 17076604Pilatti/200620 adult patients receiving flap surgeries for periodontitisRandomized double masked cross-over controlled clinical trial
Key resultsThe Celecoxib group produced significantly less pain at 1, 2,3 4, 6, 7 hours post-operatively than placebo. Dexamethasone produced significantly less pain at the 3-hour mark only (compared to placebo). No statistical significant differences were found between Celecoxib and Dexamethasone.
Evidence Search ("dexamethasone"[MeSH Terms] OR "dexamethasone"[All Fields]) AND ("anti-inflammatory agents, non-steroidal"[Pharmacological Action] OR "anti-inflammatory agents, non-steroidal"[MeSH Terms] OR ("anti-inflammatory"[All Fields] AND "agents"[All Fields] AND "non-steroidal"[All Fields]) OR "non-steroidal anti-inflammatory agents"[All Fields] OR "nsaids"[All Fields]) AND periodontal[All Fields] AND ("surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgery"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields]) AND ("pain"[MeSH Terms] OR "pain"[All Fields])
Comments on
The Evidence
The Steffens et al. study had small sample size (15 patients) as did the Pilatti et. al study (20 patients). The authors state that the control group had a low overall pain intensity in both studies, which probably contributed to small differences in pain intensity between control and intervention. The low dose of dexamethasone (4mg) in the Pilatti et. al. study may explain insignificant difference between placebo and steroid group. Therefore, Steffens et al increased steroid dose to 8mg in their study. Surgical approach in both studies was open-flap debridement, which is traditionally associated with low post-operative pain. Patients routinely experience varying levels of pain due to influence from dental anxiety and stress. Studies with a greater sample size are necessary. Studies on patients undergoing more intense periodontal surgery such as mucogingival surgery or bone-resective surgeries should be done to determine effects on pain management with dexamethasone vs. NSAIDS.
Applicability If a regimen of 8mg dexamethasone (Steffens et al.) instead of 4mg regimen (Pilatti et al.) is used, steroidal and non-steroidal treatment of post-operative pain following open flap debridement surgeries can be more effective than a placebo.
Specialty/Discipline (Periodontics)
Keywords Periodontal surgery, pain, dexamethasone, NSAIDs, Perio Surg, Periodontal Surgery, APF, apically positioned flap, open flap debridement, open(-) flap curettage, gum surg(ery)
ID# 2956
Date of submission: 10/21/2015spacer
E-mail rockeyk@livemail.uthscsa.edu
Author Kelsey Rockey, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Guy Huyhn-Ba, DDS
Faculty mentor/Co-author e-mail HuynhBa@uthscsa.edu
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