And for full bony third molars, I administer [redacted] dexamethasone IV at induction and schedule ibuprofen [redacted] q6h with cold compress in the first 24 hours. Are you seeing better day‑2 edema control with an additional [redacted] PO dex at 24 hours, or do you prefer a short taper?
On my full bony lowers, I’ll add a single PO dex “at 24 hours” only if I had to do a lot of buccal troughing; otherwise the IV at induction plus q6h ibuprofen and ice has been enough and I skip the taper. Small caveat: I avoid multi‑day tapers unless there’s significant trismus risk because I’ve seen sleep/mood hiccups out of proportion to the benefit. Are you seeing rebound swelling when you skip the 24‑hour dose?
For day‑2 control, I’ve had better results giving the extra PO dex the morning of POD1 (around 8–9 a.m.) rather than exactly at “24 hours”, with food, and I skip a taper unless it was a marathon case (>45 min or wide envelope flap)… Curious if you’ve seen any change in trismus using a morning dose after your “IV at induction” + q6h ibuprofen protocol.
Instead of another systemic dose, I’ll place dex submucosally at closure; paired with your q6h ibuprofen and ice the first day, it keeps the POD2 puff down better than a taper in my hands. I still give the IV “at induction” like you, and only add more if I did a wide flap or tuberosity work. @rebecca_r88 have you tried the submucosal route on those heavy trough cases?
I use a symptom-trigger for the extra steroid: if the cheek is ‘worse on waking than at bedtime’ on POD1, they take a single dose with breakfast and plenty of water; otherwise I skip it. Curious if you tie yours to trismus or purely swelling, @Casey. I avoid the add-on in reflux or snorers and push head-of-bed elevation.
I reserve the day‑1 morning dose for long ops or bilateral full‑bony cases and otherwise skip a taper. Piggybacking @amyjohns76’s timing, I keep it before 10 a.m. to avoid sleep issues and avoid the extra dose in diabetics or reflux patients — are you seeing any insomnia or glucose bumps when you add it?