The supraperiosteal route of dexamethasone should be considered for dental surgery

We think it is a very interesting thought to inject dexamethasone directly into an intraoral wound in the attempt to create an antiinflammatory effect on the tissues. Three studies that evaluate supraperiosteal injections around a tooth to compare the efficacy of this technique versus placebo injections are presented by the contributor. Although antiinflammatory effects were achieved in all 3 studies compared with placebo, none of the studies demonstrated superiority of this technique over systemic administration of dexamethasone intravenously or intramuscularly.

We feel that more important than the route of administration of the drug is the timing for the drug to exert its function. Dexamethasone, like other glucocorticoids, is a drug which binds to cell membrane receptors and is then transported to the nucleus, where it subsequently alters the transcription of genes that cause inflammation. Because of this complex mechanism, it often takes hours for many steroids to begin exerting their effects. Therefore, it is crucial that the drug be administered before the tissue insult to time the effects in a favorable manner. Steroids injected systemically will get to the site of action quickly, perhaps not as quickly or concentrated as direct injection into the wound, but additional investigation needs to be performed to assess the level of the drug at the site of action when administered via various routes and the possible advantages/disadvantages. Also, it is well established that the conventional manner in which steroids have been administered for their antiinflammatory effects (oral, IV, or IM) have minimal impact on wound healing or incidence of infection, which is not the case for local infiltration.

If the thought is that injecting steroids directly into a wound is superior because it results in less negative systemic effects of the drug, we do not agree with this premise. The drug, although initially injected locally, will eventually be absorbed into the circulation to create systemic effects. The difference between the various routes of administration remains to be determined.

Thank you very much for the contribution and the inquiry. We look forward to any other letters.