The Effect of Dexamethasone on Short Term Patient Response: IV vs Oral Administration

There will be two randomized treatment sequences and two study intervention conditions: intravenous dexamethasone with oral placebo, and oral dexamethasone with intravenous placebo. Each participant will receive both intervention conditions and will serve as his or her own control. This cross-over design was selected to reduce between-participant variability in pain perception, inflammatory response, medication use, and healing patterns. The matched placebo blinding approach was selected to preserve blinding while allowing comparison of two different routes of administration. The study intervention consists of a single preoperative dose of dexamethasone administered either intravenously or orally prior to each periodontal flap surgery. Placebo will be administered by the alternate route at each surgical visit to maintain blinding. The intervention duration for each surgical visit is limited to the single preoperative dosing event. Follow-up outcome assessments will occur at 12, 24, 48 and 72 hours after each periodontal surgery. No separate placebo-only or no-treatment control group will be used because the primary study question is whether oral dexamethasone provides comparable short-term patient-centered outcomes to intravenous dexamethasone. Prior periodontal studies have already evaluated dexamethasone compared with placebo or control therapy. In this design, each participant serves as his or her own control by receiving dexamethasone through both routes during two similar surgical procedures.