{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:45:17Z","timestamp":1782740717227,"version":"3.54.5"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical &amp;amp; Exp Dental Res"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Objectives:<\/jats:bold>\n                      To evaluate the clinical effectiveness and safety of adjunctive corticosteroid versus standard treatment alone in facial infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Eligibility criteria:<\/jats:bold>\n                      Included clinical comparative studies (randomized or non\u2010randomized) evaluating adjunctive corticosteroids versus standard care in patients with bacterial facial infections such as odontogenic\/facial space infections, dental abscesses, orbital cellulitis, periorbital cellulitis, and Ludwig's angina.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Information sources:<\/jats:bold>\n                      An unrestricted literature search of five databases was conducted up to December 15, 2025.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Risk of bias:<\/jats:bold>\n                      The quality assessment of the studies was conducted using the Cochrane Risk of Bias Tool (ROBINS\u2010I) for non\u2010randomized and a new risk of bias tool (RoB\u20102) for randomized studies.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Synthesis of results:<\/jats:bold>\n                      Random effects meta\u2010analyses using mean difference (MD) or standardized mean differences (SMDs) were performed, followed by sensitivity analyses, and assessment of the quality of evidence using GRADE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Included studies:<\/jats:bold>\n                      Fifteen comparative studies (three randomized and 12 non\u2010randomized) including 13,905 patients with bacterial facial infections (61.5% male) were included.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Synthesis of results:<\/jats:bold>\n                      Low\u2010certainty evidence showed that the use of adjunctive steroids significantly reduced hospital stay compared with standard treatment alone (10 studies; MD\u2009=\u2009\u22121.61 [\u22123.17, \u22120.05] days;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 99.3%). Low\u2010certainty evidence also showed that pre\u2010treatment CRP was higher in the steroid groups (3 studies; SMD\u2009=\u20090.33 [0.09, 0.58];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Low\u2010certainty evidence indicated no significant difference in the number of surgeries (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.13), while very low\u2010certainty evidence showed no significant differences in intensive care unit admissions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.07) or airway compromise (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.18). Sensitivity and subgroup analyses showed no significant differences by study design, infection type, or risk of bias, confirming robust results; only ethnicity had a significant effect on hospital stay (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0027).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Limitations of evidence:<\/jats:bold>\n                      Certainty of evidence was low to very low for all outcomes, with hospital stay rated low due to methodological limitations, high risk of bias, and the predominance of non\u2010randomized studies.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Interpretation<\/jats:bold>\n                      : The low level of evidence suggests that adjunctive corticosteroids may provide a reduction in hospital length of stay for patients with bacterial facial infections. Further well\u2010designed, randomized, and prospective comparative studies are needed to confirm these findings.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>PROPSERO Registration Number:<\/jats:bold>\n                      (CRD420261329331).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cre2.70377","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T13:52:48Z","timestamp":1778853168000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of Adjunctive Corticosteroid Therapy Versus Standard Treatment Alone in Patients With Bacterial Facial Infections: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1522-2069","authenticated-orcid":false,"given":"Umer","family":"Hussain","sequence":"first","affiliation":[{"name":"Ministry of Health Saudi Arabia Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2198-9435","authenticated-orcid":false,"given":"Wajiha","family":"Abbas","sequence":"additional","affiliation":[{"name":"Balochistan Institute of Child Health Services Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0502-1966","authenticated-orcid":false,"given":"Inayat Ur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Saidu College of Dentistry Swat 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