Impact of dexamethasone-enhanced anaesthetics on postoperative pain, oedema, and trismus following third molar extraction: a systematic review and meta-analysis.

The extraction of third molars (3Ms) is frequently associated with postoperative inflammation and discomfort. This systematic review aimed to compare the efficacy of combining local anaesthetics with dexamethasone (treatment group) versus local anaesthetics alone (control group) in 3M surgeries. A comprehensive search of PubMed, Cochrane CENTRAL, Virtual Health Library, and Embase was conducted on June 9, 2025, to identify randomized controlled trials (RCTs) assessing outcomes such as pain, oedema, and trismus. Of 300 studies initially identified, nine met inclusion criteria for qualitative synthesis, and eight were included in the meta-analyses. These studies involved 406 patients and 539 3Ms. The treatment group showed significant improvements in postoperative pain, facial oedema (days 1, 3, and 7), trismus (days 3 and 7), anaesthesia onset time, anaesthesia duration, and pain during anaesthetic injection. Overall, the addition of dexamethasone significantly enhanced clinical outcomes compared to anaesthetics alone. However, the certainty of the evidence remains low due to methodological limitations in the included trials. Further high-quality RCTs, rigorously adhering to standardized protocols, are essential to reduce bias and strengthen the reliability of these findings.