Efficacy and safety of preoperative corticosteroids in third molar surgery: current evidence and proposal for a clinical management protocol

Abstract

Introduction.  Surgical extraction of third molars is commonly associated with postoperative pain, swelling, and trismus, which may negatively affect patient recovery. Preoperative corticosteroids are widely used to control the inflammatory response; however, uncertainty remains regarding the optimal drug, dosage, and route of administration. Objective.  To evaluate the efficacy and safety of preoperative corticosteroid use in third molar surgery and to propose an evidence-based clinical management protocol. Methodology.  A literature review was conducted using PubMed/MEDLINE, Scopus, and the Cochrane Library. Studies published between 2020 and 2025 evaluating preoperative corticosteroid use in third molar surgery were included. After applying inclusion and exclusion criteria, 19 studies, including randomized clinical trials, systematic reviews, and meta-analyses, were selected. Results.  Dexamethasone was the most extensively studied corticosteroid, particularly at single preoperative doses of 4–8 mg. Its use significantly reduced postoperative swelling and trismus, whereas pain control outcomes were less consistent. Submucosal and sublingual administration showed efficacy comparable to systemic routes and greater patient acceptance. No serious adverse events were reported in healthy patients. Conclusion.  Preoperative corticosteroids represent an effective and safe strategy for reducing inflammatory complications after third molar surgery. Dexamethasone at doses of 4–8 mg has the strongest scientific support. However, the heterogeneity of available studies limits protocol standardization; therefore, its use should be individualized according to each patient's clinical characteristics.