Anti-Inflammatory Effectiveness of

Oral Dexamethasone 4 mg on
Mandibular Third Molar Surgeries: A
Split-Mouth Randomized Clinical Trial
alia Mendes de Oliveira, DDS,* Victor Bento Oliveira, DDS,y
Eul

Lana Karine Ara
ujo, DDS,z Tim

oteo Sousa Lopes, DDS,x
Rodrigo Otavio Rego, DDS, MS, PhD,k and
acio da Silva Sampieri, DDS, MS, PhD{
Marcelo Bonif

Purpose: This study aimed to evaluate the anti-inflammatory effect of oral dexamethasone 4 mg in a sin-
gle dose preemptively administered to reduce pain, swelling, and trismus following mandibular third
molar surgeries.
Methods: A split-mouth randomized clinical trial was performed including 22 participants undergoing
surgical removal of bilateral and symmetrically positioned third molars. A total of 44 teeth were allocated
by simple randomization to either the test or nonintervention/control side. Oral dexamethasone 4 mg was
administered on the test side an hour before the surgery. All of the participants were unaware of the medi-
cation studied, and only 1 surgeon, blinded to the medication intake, performed all of the procedures. Anti-
inflammatory effect was evaluated using the clinical parameters of mouth opening, swelling, and rescue
analgesic medication intake to control pain. The statistical analysis was blinded to the allocation groups,
and a significance value P < .05 was adopted for all the tests.
Results: Dexamethasone reduced the mean of rescue analgesic medication intake by 5 times (P = .002).
Facial swelling was lower on the test side by 72h postsurgery in comparison with the control side
(P = .036). No significant difference in mouth opening was found between the groups.
Conclusions: Preemptive use of oral dexamethasone 4 mg proved to be effective in controlling pain and
reducing the need for rescue medication and had a beneficial effect in reducing swelling during a short
postoperative period.
Ó 2021 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 79:981-988, 2021

*Graduate Student, Graduate Program in Dentistry, Faculty of Conflict of Interest Disclosures: The authors declare no conflict of
Pharmacy, Dentistry, and Nursing. Federal University of Cear
a, interest.
Fortaleza, CE, Brazil. Address correspondence and reprint requests to Dr Mendes de
yGraduate Student, Graduate Program in Dentistry, Faculty of Oliveira: Faculty of Pharmacy, Dentistry, and Nursing, Federal Uni-
Pharmacy, Dentistry, and Nursing. Federal University of Cear
a, versity of Cear
a, Rua Alexandre Bara

una 949, Fortaleza, CE 60430-
Fortaleza, CE, Brazil. 160, Brazil; e-mail: eulaliamoliveira@alu.ufc.br
zGraduate Student, Graduate Program in Biotechnology, School Received September 16 2020
of Medicine at Sobral, Federal University of Cear
a, Sobral, CE, Brazil. Accepted January 3 2021
xGraduate Student, Graduate Program in Health Sciences, School Ó 2021 American Association of Oral and Maxillofacial Surgeons
of Medicine at Sobral, Federal University of Cear
a, Sobral, CE, Brazil. 0278-2391/21/00003-3
kAssociate Professor, Department of Dentistry, School of https://doi.org/10.1016/j.joms.2021.01.003
Dentistry at Sobral, Federal University of Cear
a, Sobral, CE, Brazil.
{Assistant Professor, Department of Dentistry, School of
Dentistry at Sobral, Federal University of Cear
a, Sobral, CE, Brazil.

981
982 ANTI-INFLAMMATORY EFFECTIVENESS OF ORAL DEXAMETHASONE 4 MG
Surgical removal of impacted mandibular third molars
is 1 of the most commonly performed procedures in
oral and maxillofacial surgery and is associated with
various postoperative sequelae.1 The severity of post-
surgical events is typically associated with long inter-
ventions and increases with surgical difficulty,
notably when mucoperiosteal flaps, osteotomy, and
sectioning are performed.2 When a meticulous tech-
nique is performed, a substantial inflammatory
response is expected expressed by pain, swelling,
and trismus. These are due to considerable injury in
the hard and soft tissues at the surgical site, which is
highly vascularized and rich in loose connec-
tive tissue.3,4
Effective management of postoperative pain and
inflammation is linked to the success of the proced-
ures and techniques applied; it increases patient satis-
faction and decreases care costs.5 In this sense,
preemptive analgesia for surgical procedures can
help to reduce surgical complications related to
inflammation response and increase patient comfort
in the postoperative period. The principle of preemp-
tive analgesia is to avoid peripheral and central sensiti-
zation when therapeutic interventions are performed,
before injury and pain receptor sensitization, and thus
reduce the total concentration of inflammatory media-
tors in the tissues.6,7
Corticosteroids have been widely used for decades
to control postoperative inflammation and symptoms
associated with third molar surgery.3,8 The postopera-
tive effects of corticosteroids appear to be greater
when they are administered before rather than after
surgery.9 These drugs suppress the first steps of inflam-
mation by activating many anti-inflammatory genes
and repressing proinflammatory genes that are acti-
vated after tissue injury; they also present various
post-transcriptional effects.10 Corticosteroids increase
expression of lipocortin and reduce inflammatory en-
zymes, such as phospholipase A2, thus blocking the
arachidonic acid cycle and production of leukotrienes,
prostacyclins, prostaglandins, and thromboxane A2.11
These effects bring lower concentrations of inflamma-
tory mediators to the tissues, decreasing capillary dila-
tion, exudates, and edema, and avoiding peripheral
nerve sensitization and hyperalgesia.6 Beyond
increasing anti-inflammatory cytokines and inhibitory
proteins, while reducing chemokines, proinflamma-
tory cytokines, and adhesion molecules, corticoste-
roids inhibit lymphocyte activation and migration,
reduce the formation of granulation tissue, and help
limit the continuance of the inflammatory process at
the surgical site.6,10
Dexamethasone is 1 of the most commonly
prescribed steroids in dentoalveolar surgery because
of its dominant glucocorticoid effect, mild sodium
retention, and long half-life.3 Its preemptive
anti-inflammatory effectiveness seems to be better
than that of nonsteroidal anti-inflammatory drugs.12
In temporal evaluations, various randomized clinical
trials have tested dexamethasone in differing concen-
trations and different routes of administration to reveal
beneficial reductions in inflammation (pain, swelling,
and trismus) for up to 7 days after surgery.8,13-15
These primary studies make it possible to conduct a
systematic review and begin to compile information
concerning the best dexamethasone protocols and
dosages in third molar surgery.
Despite the necessity of better-designed trials, the
parenteral administration of dexamethasone in various
dosages has already been well established. Injections
of dexamethasone present benefits in reducing both
facial swelling and pain after third molar extrac-
tion.16-18 For pain control, intramuscular and
extraoral administration appears to provide better
results than submucosal intraoral injection.16 Howev-
er, choosing between 2 routes of administration
should not be linked to the clinical efficacy to reduce
the postoperative sequelae, but to the discomfort dur-
ing administration.19
Studies evaluating the anti-inflammatory effects of
dexamethasone in third molar surgeries when admin-
istered orally are still scarce. The lack of primary
studies evaluating this route of administration makes
comparative analysis (through systematic reviews),
as well as arriving at some decision-making consensus
difficult.9,20 Considering the above, the objective of
this clinical study was to evaluate the effectiveness
of preemptive oral dexamethasone (4 mg) use in a sin-
gle dose, adopting better control of postoperative in-
flammatory events (pain, swelling, and trismus) after
mandibular third molar extraction.
Methods
STUDY DESIGN AND SAMPLE
The reporting of this study follows the Consolidated
Standards of Reporting Trials Statement (CONSORT)
2010.21 The study protocol was approved by the
Ethics Committee of the State University of Acarau Val-
ley, Sobral, Ceara, Brazil, and was conducted in accor-
dance with the Helsinki Declaration of 1975, as revised
in 2013. All patients signed an informed consent form.
The study was registered in the Brazilian Registry of
Clinical Trials at www.ensaiosclinicos.gov.br, under
the identifier RBR-63rw34.
A single-center, split-mouth randomized clinical trial
was conducted for 16 months (July 2018 – October
2019) at the Sobral School of Dentistry, Brazil. Partici-
pants aged from 18 to 30 years old were recruited
without distinction by sex. It was required that the par-
ticipants presented a clear indication for removal of
both mandibular third molars and that their teeth be
OLIVEIRA ET AL
in similar bilateral positions, according to Winter
(1926) and Pell and Gregory (1933) classifications,
with root formation of at least two thirds (stage 8
of Nolla).
Participants were excluded for any of the following
criteria: a history of allergies or exacerbated adverse
reactions to analgesic drugs (NSAIDs and corticoste-
roids), some chronic systemic disease, use of systemic
medications that might potentially interact with the
study drugs, and presenting pathologies associated
with the respective third molars. Patients who did
not strictly follow the prescription and recommenda-
tions, who did not return for subsequent evaluations,
or who presented postsurgical complications, such
as infection, were also excluded.
Data on sex, age, medical and dental history were
collected before surgery. After clinical evaluation, a
panoramic radiography was requested to assess the
position of each third molar, the stage of root forma-
tion, and the level of dental impaction. This completed
the selection process for each patient. The surgeries
were scheduled in separate sessions at intervals sepa-
rated by at least 30 days. All surgeries were performed
in the absence of acute inflammation or active infec-
tion, and the patients could use antibiotics, anti-
inflammatories, or analgesics for up to 7 days before
the procedure. Prior to surgery, patients undergoing
orthodontic treatment were asked to remove the or-
thodontic band of the lower second molars. Recom-
mendations on postoperative care were given at the
end of each procedure, and a standardized pharmaco-
logical prescription was given to each patient.
SAMPLE SIZE
The sample unit adopted in this study (the dental
unit) was 2 teeth per patient. The sample size was
based on a study by Costa et al,22 which demonstrated
lower rescue analgesic medication consumption in a
test group using preemptive etoricoxib 120 mg as
compared to placebos (1.6  1.3 vs 4.0  2.5). It
was judged necessary to evaluate 11 surgical sites
per study group at a 1:1 ratio in order to obtain a sam-
ple with 80% power and a 95% confidence interval for
the alternative hypothesis (www.openepi.com/
SampleSize/SSMean.htm). Further, a loss of 20% of
the sample during the study was considered; thus,
we estimated 14 surgical sites per group.
RANDOMIZATION AND BLINDING
Simple randomization was performed by drawing
envelopes to determine the surgical site that would
be on the test or control side, and the tooth that would
be extracted first. For drawing, the following codes
were adopted: ‘‘A’’ for the right third molar, ‘‘B’’ for
the left third molar, ‘‘X-1’’ for the test side, and ‘‘X-2’’
983
for the control (or no intervention) side. The drawing
was performed in 3 steps in the following order: 1)
Draw the tooth (right or left), 2) Draw the intervention
(test or control) which will be applied to the tooth
selected in step 1, 3) Draw the surgery order (first or
second session) for the tooth selected in step 1.
The patients were unaware of the name or type of
medication being studied; they were only informed
that it was already in the market, and they received
the medication in a plastic container. One surgeon
(M.B.S.S) alone performed all surgeries throughout
the study and remained blind to teeth allocations be-
tween test and control sides, being informed only
about which tooth should be extracted in each ses-
sion. The researcher responsible for statistics (R.O.R)
was also blinded to teeth allocations between the
test and control sides, adopting the same randomiza-
tion codes (‘‘X-1’’ and ‘‘X-2’’) in the analysis.
SURGICAL PROCEDURES AND DRUGS
All surgical procedures were performed using strict
biosafety controls and by only one right-handed sur-
geon with 15 years of experience. For each patient,
the same surgical protocol was performed for both
teeth, aiming to standardize the degree of tissue injury
at both sites. Intraoral and extraoral antisepsis was per-
formed using a chlorhexidine gluconate 0.12% based
mouthwash and a povidone-iodine 2% solution,
respectively. Each extraction was performed under
local anesthesia using a Carpule syringe and a long nee-
dle. At least 2 tubes with 4% solution of articaine and
epinephrine 1:100.000 were used for a truncal block
of the inferior alveolar nerve, infiltration anesthesia
of the buccal and lingual nerves, and in the retro-
molar papilla.
A #5 scalpel blade was used to perform tissue inci-
sions, and a Molt 9 elevator was used to raise the mu-
coperiosteal flap. Initially, a horizontal incision was
made on the crest of the alveolar ridge to the distal
of the second molar, followed by an intrasulcular inci-
sion surrounding the tooth. If a vertical incision was
necessary, an incision was made, preserving the inter-
dental papilla between the second and first molars to-
ward the bottom of the buccal groove.
Then, a peripheral osteotomy was performed with a
#6 carbide bur under high rotation with abundant irri-
gation. If sectioning was necessary, a 702 bur was
used. Tooth luxation was performed using levers,
and the extraction was finished with bone regulariza-
tion, curettage, and irrigation of the tooth socket
with 0.9% saline solution. The suture was performed
using 3.0 silk and was removed 1 week after surgery.
The surgery time was counted in minutes from the
beginning of anesthesia to the end of the suture.
984 ANTI-INFLAMMATORY EFFECTIVENESS OF ORAL DEXAMETHASONE 4 MG
All patients were instructed to rest in the postoper-
ative period and to follow a liquid and cold diet for the
first 24 hours, to maintain adequate oral hygiene, and
to contact the surgeon in case of any complications,
such as heavy bleeding, extreme pain, and signs of
infection (fever and suppuration). All patients
received a standardized pharmacological prescription,
and all of them were to take nimesulide 100 mg at 12-
hour intervals for 3 days. Sodium dipyrone 500 mg was
used as a rescue analgesic medication, and the patients
were to take a pill at 6-hour intervals only if they felt
pain and considered it necessary to take the drug to
control it. They were also told to count how many pills
of sodium dipyrone were taken over a 72 hours period.
OUTCOME MEASURES
The primary outcomes assessed in this study were
postoperative inflammatory events (pain, swelling,
and trismus) being compared to the patient’s initial
preoperative status for each surgical site. The anal-
gesic effect of dexamethasone in pain control was as-
sessed using the total number of rescue medication
pills taken over 72h. Facial swelling and trismus
were evaluated at 3 different moments, immediate
postoperative, at 72 hours, and at 7 days after surgery.
For assessing pain, the Visual Numeric Scale (VNS) was
applied every time the patient took a pill, but most pa-
tients did not use the tool correctly, so the assessment
was removed from the study.
The swelling was evaluated using 3 measurements
between fixed anatomical points; from the external
corner of the eye to the angle of the mandible (MA-
ECE), from the tragus to the labial commissure (TRA-
LC), and from the tragus to the soft pogonion (TRA-
SP). These points were marked with a pen and the dis-
tance between them was measured in centimeters
with the aid of dental floss and transferred to a flexible
ruler. Trismus was assessed with a manual caliper posi-
tioned between the incisal edges of the upper and
lower incisors to measure the interincisal distance in
millimeters when the patient was at the maximum
mouth opening.
STATISTICAL ANALYSIS
Quantitative data (rescue analgesic medication
intake, trismus, facial swelling, and duration of sur-
gery) were expressed as means and standard devia-
tions and compared using the paired t test
(parametric) or Wilcoxon test (nonparametric). The
Shapiro–Wilk test was used to verify the normality of
the data. A difference of P < .05 was considered statis-
tically significant. The data analysis was performed us-
ing SPSS V.25 (SPSS, IBM).
Results
A total of 44 patients were recruited, 16 were
excluded for not meeting the eligibility criteria, and
56 surgical sites were randomized between the test
group and the control group. The exclusion of a surgi-
cal site (test or control) during some phase of the
research resulted in the consequent exclusion of the
contralateral site; thus, there was a loss of 12 surgical
sites, as described in the flowchart (Fig 1). The final
study sample consisted of 44 surgical sites (22 pa-
tients) from 15 males (68.2%) and 7 females (31.8%),
with a mean age of 23.05  3.78 years old. The
mean difference for surgery durations between test
and control sites was not statistically significant.
All surgeries were performed free of trans operative
accidents, and no drug side effects were reported. At
the end of the follow-up period, no cases of infection
or alveolar osteitis were reported among the patients
included in the final sample. Only 1 patient, who
was excluded at the beginning of the study for taking
nonprescribed medication, presented alveolar osteitis.
This case was resolved with curettage and irrigation of
the tooth socket under local anesthesia, followed by a
new suture, 0.12% chlorhexidine based mouthwash
for 7 days, and an anti-inflammatory prescription.
The average rescue analgesic medication intake in
the control group was approximately 5 times higher
than in the test group (Table 1). There was no statisti-
cal difference in the maximum mouth opening aver-
ages between the groups at any postoperative
moment evaluated as compared to the patient’s preop-
erative status (Table 2). Both groups presented an in-
crease in all swelling measures during the
postoperative period. However, there was a statistical
difference between groups only for the TRA-LC mea-
sure at 72h postoperative period (Table 3).
Discussion
The presence of inflammatory mediators, released
after surgical trauma, results in postoperative pain
through sensitization of nerve fibers, edema by an
accumulation of exudate in the surrounding tissues,
and trismus by inflammation in the muscles. These ef-
fects are postoperative events and depend on many
factors related to the difficulty of the surgical proced-
ure, the surgical technique used, and the severity of
the impaction, and they are often unpredictable.14 Pre-
emptive administration of corticosteroids is
commonly used to reduce postoperative morbidity.6
Although their use is well accepted in the field of
dentistry and well described in the literature, there is
still no consensus for use in third molar surgery, and
many differences between administration routes, dos-
ages, and associations.
OLIVEIRA ET AL 985

FIGURE 1. Flowchart of the study participants, according to CONSORT.

Oliveira et al. Anti-Inflammatory Effectiveness of Oral Dexamethasone 4 mg . J Oral Maxillofac Surg 2021.

As to oral dexamethasone, the scientific literature
has reported dosages of 4 mg and 8 mg as main proto-
cols. Larger doses of 12 mg have also been studied,23
and a 6 mg dosage was reported,24 but (possibly due
to unavailability in the market) this dosage is not
currently being studied. Studies have evaluated the
preemptive clinical effectiveness of the 4 mg and
8 mg dosages, concluding that for postoperative pain
control up to 48h, the regimens do present a statistical
difference. However, the amount of rescue analgesic

Table 1. CHARACTERISTICS OF THE STUDY PATIENTS (N = 22) AND COMPARISON OF SURGERY DURATIONS (MIN),
AND RESCUE ANALGESIC MEDICATION INTAKE (PILLS) AT 72H (MEAN ± SD)

Variable Test Side Control Side P-value

Surgery duration 34.86  19.0 33  15.3 .516*

Rescue analgesic medication 0.77  1.02 3.95  4.18 .002yz
* –Paired Test T.
y –Wilcoxon Test.
z P < .05.
Oliveira et al. Anti-Inflammatory Effectiveness of Oral Dexamethasone 4 mg . J Oral Maxillofac Surg 2021.
986 ANTI-INFLAMMATORY EFFECTIVENESS OF ORAL DEXAMETHASONE 4 MG

Table 2. COMPARISON OF MAXIMUM MOUTH

route with either parenteral route, 4 mg dexametha-
OPENING (MM) IN THE DIFFERENT EVALUATION sone was more effective when administered parenter-
PERIODS (MEAN ± SD) ally.14 As to the duration of the drug’s effects, the
parenteral route seems to achieve greater effects
Period Test Side Control Side P value
than oral administration.9
Regarding effects on swelling and pain, one trial has
Initial 44.09  4.30 44.23  5.20 .914
IP 33.82  7.55 32.73  6.58 .490
shown that intravenous and intramuscular dexameth-
72h 33.00  6.88 34.64  7.02 .297 asone (4 mg) presents improvements over the oral
7 days 39.05  6.82 39.77  6.03 .711 route. Although the differences between the 3 groups
were not significant.28 It is important to understand
Abbreviation: IP, Immediate postoperative. that the intravenous route presents 100% drug
Oliveira et al. Anti-Inflammatory Effectiveness of Oral Dexameth- bioavailability to the circulation, which is reduced in
asone 4 mg . J Oral Maxillofac Surg 2021.
oral administration due to amounts lost during enteral
absorption.29 However, in the same study, the effect of
oral dexamethasone on trismus was somewhat better
medication, the facial edema measures, and the limita- than the parenteral routes and related to the extended
tion of the mouth opening were all significantly higher drug delivery time.28 These differences between dos-
in the 4 mg groups.25,26 Another study showed that ages and routes of administration may have been found
when doses of 12 mg and 4 mg were compared at because Kim et al30 had reported that the use of corti-
24h and 48h after surgery, both regimens presented costeroids is effective in various outcome scenarios.
the same therapeutic effect with no statistical differ- However, this depends on both dosage and duration.
ences for pain, trismus, or edema.23 A higher administered dose and a longer administra-
Clinical trials comparing the dexamethasone 8 mg tion period lead to more satisfying results, justifying
administration have found that the oral and parenteral the variability reported in the literature.
routes (extraoral intramuscular and intraoral submu- In the present study, the oral administration route
cosa injections) bring beneficial effects against pain, was chosen for its ease of applicability. The dosage
edema, and trismus after lower third molar surgery. choice of 4 mg (compared to a control group) repre-
However, statistical differences between routes were sents a dosage that is still little addressed in the litera-
not observed.14,27 In contrast, if comparing the oral ture. Thus, as most studies on oral administration of
dexamethasone (alone or in combination) compare
4 mg doses with other drugs, and given the absence
of a control or placebo group, discussing the relative
Table 3. COMPARISON OF FACIAL SWELLING BE-
TWEEN ANATOMIC FIXED POINTS OF THE FACE (CM) results becomes challenging.
FOR THE DIFFERENT PERIODS EVALUATED (MEAN ± SD) Inflammatory response after surgery is influenced
by factors such as surgical difficulty and individual
Measure Period Test Side Control Side P value characteristics. The split-mouth design adopted in
this study is a suitable model for inflammatory studies
MA-ECE Initial 10.74  5.52 10.80  6.10 .943*
because it allows improvements in results reliability
IP 10.99  5.87 10.99  5.73 .753y
72h 10.88  619 11.29  6.56 .516y
since each patient serves as their own control with
7 days 10.80  6.10 10.85  5.39 .585* symmetric conditions that minimize individual vari-
TRA-LC Initial 11.87  6.50 12.06  6.16 .375* ability.2,31 The study also standardized the surgical
IP 12.09  6.65 12.34  5.36 .210y techniques at both surgical sites for each patient.
72h 12.11  6.72 12.46  5.92 .121y Further, to conduct all of the procedures, a single
7 days 11.95  6.46 12.23  5.92 .103y experienced surgeon was established. These are
TRA-SP Initial 14.68  8.21 14.69  7.22 .920* important variables for uniformity since the tech-
IP 14.87  7.61 15.05  6.21 .067* niques used and the surgeon’s expertise are also fac-
72h 14.87  7.65 15.16  6.71 .036*z tors that relate to postoperative morbidity.32
7 days 14.75  7.86 14.91  6.18 .154*z Another strength of this study was the method used
Abbreviations: MA-ECE, From the external corner of the eye to evaluate the inflammatory events, such as the num-
to the mandible angle; TRA-LC, From the tragus to the labial ber of rescue medications used when assessing the
commissure; TRA-SP, From the tragus to the soft pogonion; analgesic potential and pain control of dexametha-
IP, Immediate postoperative.
sone. Measurement of the distance between anatom-
* Paired Test T.
y Wilcoxon Test. ical fixed points to assess trismus and facial edema at
z P < .05. similar time intervals and already established methods
Oliveira et al. Anti-Inflammatory Effectiveness of Oral Dexameth- of assessing mouth opening were also useful. Differ-
asone 4 mg . J Oral Maxillofac Surg 2021. ences between studies regarding temporal evaluations
OLIVEIRA ET AL
of facial swelling have already been reported.33 Thus,
in this study, it was decided to evaluate the outcome
for 72 hours due to the peak swelling occurring in
that period.
The findings of the present study should also be
viewed considering its limitations. The lack of a pla-
cebo drug in the control group prevented patient
blinding and may have compromised the results ob-
tained concerning the analgesic potential of the tested
drug. Another source of bias was the lack of strict stan-
dardization for the third molar position, which relates
to surgery difficulty.
In conclusion, this study observed the beneficial ef-
fects of preoperative administration of dexamethasone
4 mg in a single dose to reduce inflammatory events af-
ter lower third molar surgery. Preemptive analgesia
with oral dexamethasone 4 mg proved to be effective
in controlling postoperative pain by reducing the con-
sumption of analgesic medication and allowing less
edema in the short postsurgical period. These findings
may contribute to the better pharmacological manage-
ment of patients undergoing third molar surgery, espe-
cially in the clinical routines of countries (eg low-
income and middle-income countries) where the
parenteral route administration of anti-inflammatory
drugs is rarely used. It can also be suggested that pre-
emptive use of dexamethasone may reduce the
amount of sodium dipyrone ingested and the risk of
adverse effects resulting from its consumption.
Acknowledgments
Eul
alia Mendes de Oliveira and Victor Bento Oliveira shared the
first authorship. The Coordination for the Improvement of Higher
Education Personnel (CAPES), Ministry of Education, Brazil, and
the Ceara State Scientific and Technological Foundation (FUNCAP),
Brazil, sponsored the research scholarships.
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