▋ Introduction

When the body experiences trauma, the wound releases large amounts of histamine, leading to inflammatory responses characterized by redness, swelling, heat, and pain—this is a natural physiological mechanism. Steroids can inhibit leukocyte migration, thereby reducing postoperative inflammation and edema.

▋ Patients Requiring Caution When Using Steroids

Poorly controlled hypertension
Diabetes mellitus
Active peptic ulcer
Osteoporosis
Cataracts
Pregnancy
Immunocompromised patients
HSV (patients with active viral infection)

Systemic steroids should be used cautiously in these populations to avoid potential side effects.

▋ Risks of Long-Term Use

Long-term or high-dose use of steroids may lead to the following side effects: obesity, fluid and sodium retention, hyperglycemia, increased risk of osteoporosis, and higher susceptibility to infections.

Short-term use of steroids can significantly reduce postoperative pain and swelling in maxillofacial surgery without causing notable side effects. Studies have shown that oral administration of 8 mg dexamethasone has a duration of action of up to 66 hours, effectively reducing swelling during the first 1–3 postoperative days.

▋ Key Considerations for Steroid Use

Type of medication
Potency and dosage
Route of administration
Duration of administration

(Please refer to page 5 of the image for a summary of steroids currently available in Taiwan.)

▋ Summary

Based on the literature review and the author’s clinical recommendations:

Oral dexamethasone is recommended for postoperative swelling control during the first 1–3 days.
Procedures more prone to swelling include: deep third molar extraction, extensive GBR and open-window sinus lift, and multiple dental implant placement surgeries.
Steroids are generally not necessary for single implant placement or minor surgical procedures.
A minimum dose of 4 mg is required to achieve a noticeable anti-edema effect.
Most studies recommend a total dose of 8 mg administered preoperatively or postoperatively.

Reference
Efficacy of corticosteroid versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2019;48:118–131.
https://doi.org/10.1016/j.ijom.2018.05.023