Single-dose IV steroid linked to lower pain in first 24 hours
ROSEMONT, Ill. — A new study in a recent issue of the Journal of Oral and Maxillofacial Surgery (JOMS) reports that a single intravenous (IV) dose of dexamethasone – a commonly used anti-inflammatory steroid – given during wisdom tooth surgery was associated with less pain in the first 24 hours after the procedure, when discomfort typically peaks.
Published in the official peer-reviewed journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS), the study adds to the evidence supporting pain-control plans that prioritize non-opioid options after routine third molar removal.
Researchers found that patients who received IV dexamethasone experienced less pain on the first day after surgery, whether they later took non-opioid pain relievers such as ibuprofen and acetaminophen or an opioid. The lowest pain scores occurred among patients who used non-opioid pain relievers after receiving the steroid.
The results align with national efforts to encourage non‑opioid, multimodal pain‑control plans for routine procedures, particularly for young adults who may receive their first opioid prescription because of third molar removal.
“These findings support the incorporation of intra-operative IV dexamethasone alongside postoperative NSAIDs and acetaminophen as part of a multimodal approach to pain management, potentially reducing the need for opioid prescriptions in routine third molar surgery,” the study’s authors said.
Supported by the multicenter Opioid Analgesic Reduction Study (OARS), the analysis contributes to ongoing work to refine postoperative pain protocols for one of the most common in-office procedures performed by oral and maxillofacial surgeons (OMSs). Effective postoperative pain management remains a critical component of successful wisdom tooth surgery.
Key findings
Researchers asked patients to rate their pain on a 0 to 10 scale (0 = no pain; 10 = worst pain imaginable) in a simple electronic diary during the first few days after surgery. After accounting for differences between patients and procedures, the study showed:
- Patients who received IV dexamethasone during surgery reported less pain on the first postoperative day, whether they were taking non-opioid medicines or an opioid after surgery.
- The group that used non-opioid pain medicine plus the in-surgery steroid reported the lowest pain scores overall across the time points measured.
- Over the full recovery period tracked, the non-opioid-plus-steroid group still had the lowest average pain scores, though the overall difference compared with non-opioids alone was relatively small.
The authors of “Does Intra-Operative IV Dexamethasone Reduce Postoperative Pain More Effectively With Nonopioids or Opioids?” are Ryan Look, DMD; Vincent B. Ziccardi, DDS, MD; and Janine Fredericks-Younger, DMD, all of the Rutgers School of Dental Medicine in Newark, N.J.; Tracy Andrews, MS; and Patricia Greenberg, MS, of Rutgers University in Newark, N.J.; and the OARS Study Group.
Access the full article at JOMS.org/article/S0278-2391(25)00810-9/fulltext.
For more information on wisdom teeth management, visit MyOMS.org/What-We-Do/Wisdom-Teeth-Management.
Learn more
Previous JOMS research supporting non-opioid-focused pain-control strategies after routine third molar removal includes:
- A 2021 scoping review: “Pharmacological and Non-Pharmacological Methods of Postoperative Pain Control Following Oral and Maxillofacial Surgery: A Scoping Review,” found that COX2 inhibitors, antiinflammatory pain relief medications such as celecoxib, may reduce postoperative pain more effectively than NSAIDs such as ibuprofen. Read the abstract at JOMS.org/article/S0278-2391(21)00408-0/abstract.
- A 2021 retrospective study: “A Retrospective Cross-Sectional Study of the Effect of Liposomal Bupivacaine on Postoperative Opioid Prescribing After Third Molar Extraction” reported that patients who received liposomal bupivacaine, a longlasting local anesthetic, required fewer opioid pills after wisdomtooth surgery and were less likely to need a refill. Read the full article at JOMS.org/article/S0278-2391(21)00188-9/fulltext.
In 2025, AAOMS reaffirmed its non-opioid‑first guidance in “Opioid Prescribing: Acute and Postoperative Pain Management,” which recommends ibuprofen – rather than opioids – as the preferred first-line therapy for acute and postsurgical pain.
About the Journal of Oral and Maxillofacial Surgery (JOMS)
The Journal of Oral and Maxillofacial Surgery is published by AAOMS to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The Journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.
About AAOMS
The American Association of Oral and Maxillofacial Surgeons (AAOMS) represents more than 9,000 oral and maxillofacial surgeons in the U.S. AAOMS surgeons specialize in treating diseases, injuries, and defects of the mouth, jaw and face. Learn more at AAOMS.org.
