Corticosteroids are potent anti-inflammatory hormones used in dental surgery primarily to reduce edema. No study to date has objectively assessed the effect of corticosteroid therapy on oral tissue repair. Despite its known benefits for reducing edema, pain, and trismus, a number of oral surgeons choose not to administer corticosteroids to patients due to concerns of putative negative effects. Using a standardized model of wound healing, this study objectively examined how corticosteroid administration affects oral mucosal inflammation and wound healing.
Wound closure in 63 healthy adults (age range 21-35 years; 31 females) was assessed using a well established mucosal wound model. Three wounds were placed by a periodontist on the hard oral palate under local anesthesia. Wounds were standardized for size, location, depth, and time of placement. Either methylprednisolone (125 mg iv) or placebo was administered using a counterbalanced design just prior to wound placement. This protocol was repeated 4 weeks later using the opposite treatment. Healing rates were determined using daily wound videographs. Gene expression for inflammatory mediators was determined directly in tissue obtained at 0h, 6h, and 24h post-wounding using real-time PCR.
Comparing individuals to themselves, no significant differences in healing rates were observed between placebo and corticosteroid treatments. This remained true within each sex and at different phases of the menstrual cycle (follicular vs. luteal). Corticosteroid therapy resulted in a reduction in gene expression for a variety of inflammatory mediators (e.g. pro-inflammatory cytokines, chemokines, adhesion molecules) at all time points, indicating that corticosteroids had physiological effects in this study.
Corticosteroid administration did not alter oral mucosal healing rates despite obvious reductions in tissue inflammation. These results suggest that clinicians should not be hesitant to administer corticosteroids in dental surgery for fear of immunosuppressive effects in healthy adults.
Keywords: Cytokine, Inflammation, Oral mucosa, Oral surgery and Wound healing
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