Avaliação clínica e termográfica da resposta inflamatória à remoção de terceiros molares

Abstract

Third molars are dental elements indicated for recurrent extraction in dental services. This surgery generates postoperative complaints such as pain, edema, and limitation of mouth opening, resulting from the inflammatory response. The aim of this study was to compare two different drug protocols to be used during the preoperative period, consisting of different corticoids and with different routes of administration. An observational and longitudinal study was carried out with 30 volunteers who needed the removal of impacted or semi-impacted third molars in the mandible region. Volunteers were equally divided into two groups, with the drug protocol administered in the preoperative phase, one hour before surgery. Two protocols were used: Dexamethasone 8.0 mg orally (VO); and Betamethasone Dipropionate 5mg/mL + Betamethasone Disodium Phosphate 2mg/mL intramuscularly (IM). Postoperative medication was standard for both groups. The volunteers were monitored in the preand postoperative periods (third and seventh days). Local temperature was evaluated in the chin region from the frontal view and the mandibular angle from the profile view.Maximum mouth opening, edema, and pain were evaluated. With regard to the skin temperature response, significant effects were identified for the interaction between the moment in which the evaluations were carried out and the corticoid administered in the following regions of interest and analyzed temperatures: Operated mandibular angle (maximum (F(2, 56)=3.89, p=0.026, ηp2=0.122), mean (F(2.56)=3.47, p=0.038, ηp2=0.110) and minimum (F(2.56)=4.03, p=0.023, ηp2=0.126)) and in the Control Mandibular Angle (maximum (F(2.56)=3.36, p=0.042, ηp2=0.107), and minimum (F(2.56)=3.66, p=0.032, ηp2=0.116 )). The Betamethasone IM group showed an increase in skin temperature on the third postoperative day. On the other hand, the volunteers who used oral Dexamethasone showed a slight reduction in temperature in all regions studied, observed through the absolute temperature. However, in the analysis of the temperature deltas between the operated and control sides, no differences were observed between the groups of different corticoids. As for the variables pain, maximum mouth opening, and edema, only an effect of the moment factor was observed, respectively (F(2.56)=3.51, p=0.037, ηp2=0.111), (F(2.56)=20.858, p<0.001, ηp2=0.427) and (F(2.56)=141.96, p<0.001, ηp2=0.835). In evaluating pain, edema, and maximum mouth opening, a similar behavior tendency was noticed in both drug protocols. During the postoperative period, both patients who used Dexamethasone and those who used Betamethasone preoperatively. It can be concluded that dexamethasone 8.0mg VO and Betamethasone dipropionate 5mg/mL + betamethasone disodium phosphate 2mg/mL IM did not present significant differences in edema, pain, and limitation of mouth opening in the postoperative period when compared, in relation to skin temperature (minimum, mean and maximum), there was a difference when considering the absolute temperature. Considering the results of this study, the fact that Dexamethasone 8.0mg can be administered orally, which provides greater comfort to the patient, Dexamethasone is recommended as a preoperative protocol for the removal of third molars.