Glucocorticoids in Oral Surgery

• Glucocorticoids are indicated for prevention of inflammatory manifestations (oedema and trismus)
• Their modest analgesic activity justifies the concomitant prescription of analgesic agents. Combination with an NSAID is not advisable
• Glucocorticoid, by acting on the inflammatory component, may prevent post-operative neuropathic pain
• Analysis of the literature concerning oral surgery does not make it possible to prefer one compound among all those available on the market. For pharmacokinetic reasons (bioavailability, biological half-life), it appears preferable to use prednisone (professional agreement).

Prescribing modalities

• Initial administration must take into account the time to action of glucocorticoids to obtain efficacy before start of the procedure (at least 4 hours before the procedure for an oral dose). Conventionally, it is given in the morning of the day before the procedure (professional agreement).
• The recommended mean daily dose is 1 mg/kg body weight equivalent in prednisone equivalent, OD in a single dose in the morning (professional agreement).
• The optimum duration of treatment is 3 days, with a maximum of 5 days (professional agreement); since this involves short courses of therapy, treatment is discontinued without having to progressively decrease the dose (grade A).
• For all procedures under local or loco-regional anaesthesia, administration by mouth must be preferred; intramuscular injection is not advisable because of the risk of infection related to the injection (professional agreement).

Contraindications

• Prescription of glucocorticoids must take into account their adverse events, their precautions for use and their absolute contraindications (viral diseases and other ongoing infections, uncontrolled psychosis, etc.) and relative (diabetes, immune deficiency, etc.) (professional agreement).

Infection Risk?

• Prescription of glucocorticoids in a short course of therapy does not by itself justify prescription of antibiotics; the cause-effect relationship between use of glucocorticoids in a short course of therapy and an increase in risk of infection is not scientifically established in oral surgery. However, it may reveal a latent infection (tuberculosis, etc.) (professional agreement).

 Reference:

1. Recommendations for prescription of oral anti-inflammatory agents in oral surgery in adults. médecine buccale chirurgie buccal VOL. 14, NO. 3 2008. 
2. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-00132014000300163
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221082/#ref11
4. Das JR, Sreejith V P, Anooj P D, Vasudevan A. Use of Corticosteroids in third molar surgery: Review of literature. Univ Res J Dent [serial online] 2015 [cited 2017 Jul 3];5:171-5. Available from: http://www.urjd.org/text.asp?2015/5/3/171/162800