Risk Factors for Inflammatory Complications Following Third Molar Surgery in Adults

Prognostic factors affecting the duration of disability after third molar removal

PURPOSE

The purposes of this investigation were 1) to estimate the duration of disability after third molar removal and 2) to identify factors associated with prolonged recovery.

MATERIALS AND METHODS

This was a prospective cohort study composed of subjects enrolled in the American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study. The predictor variables were grouped as follows: demographic, health status, anatomic, pathologic, medications, and complications. The outcome variable was the duration of postoperative disability measured as the number of days the subject reported inability to perform normal daily activities after third molar removal. Bivariate and multiple linear regression analyses were used. The level of statistical significance was P < .05.

RESULTS

The study sample included 4,004 subjects who had 8,748 third molars removed. The mean duration of postoperative disability was 1.4 ± 1.8 days (range, 0-26; median, 1 day). In the multiple linear regression model, age, female gender, number of third molars removed, mandibular third molar removal, full-bony impaction, sum of antibiotics or pain medications, and complications were associated with prolonged recovery (P < .05). Erupted third molars, periodontal disease or other preoperative pathology, and use of chlorhexidine were associated with earlier return to normal daily activities (P < .05).

CONCLUSION

The study results suggest that third molar removal is associated with a mean delay in returning to normal activities of less than 2 days. Several factors were statistically associated with time to return to normal activities.

Recovery after third-molar surgery: the effects of age and sex

INTRODUCTION

In this study, we assessed the effects of age and sex on quality-of-life recovery after third-molar surgery.

METHODS

Healthy subjects scheduled for removal of third molars were recruited at multiple sites for this study. Each patient was given a condition-specific instrument to be completed each postsurgery day for 14 days. Lifestyle and oral-function recovery were assessed by using a 5-point Likert-type scale. Recovery was defined as the number of days until the patient reported no or little trouble. Recovery from pain was defined as the number of days until no medications were taken. For each quality-of-life item, a Cox regression analysis was performed to assess the effects of age and sex on recovery after controlling for surgical-procedure variables.

RESULTS

Nine hundred fifty-eight subjects treated at 9 academic centers and 12 community practices were enrolled. Except for ability to open the mouth, recovery for all quality-of-life items for those 21 years or older significantly (P < 0.02) lagged behind recovery for younger subjects. Recovery for female subjects was significantly longer than for male subjects for all outcomes (P < 0.01).

CONCLUSIONS

Patients older than 21 and those who are female should be informed before removal of all 4 third molars that their oral function, lifestyle, and pain recovery will be prolonged compared with those who are younger and male.

Risk indicators of postoperative complications following surgical extraction of lower third molars

OBJECTIVE

The aim of this prospective clinical trial was to evaluate the incidence of postoperative complications following surgical extraction of lower third molars (L8) and the risk factors and clinical variables associated with these complications.

SUBJECTS AND METHODS

Three-hundred and twenty-seven consecutive patients (128 men and 199 women, mean age = 23.1 ± 3.9 years, range: 18-40) were recruited to this study. The L8 of all the patients were surgically extracted. Immediate and late complications like pain, swelling, trismus, paresthesia, bleeding, dry socket, infection and fracture were assessed 3 and 7-14 days, respectively, following the surgery.

RESULTS

The most frequent immediate and late complications were slight pain, swelling, and trismus. Thirty-nine (11.9%) patients reported dry socket and 10 (0.3%) reversible sensory nerve complications. More immediate and late complications were experienced by females (p = 0.000 and 0.016, respectively). Older subjects reported more late complications. Frequent immediate and late complications were associated with preexisting pericoronitis, longer duration of operation, extraction of two molars, flaps with vertical incision, extractions with bone removal, extractions without tooth sectioning and distoangular impactions (p ≤ 0.05). Linear regression analysis showed that the above factors were able to predict postoperative complications.

CONCLUSION

The most frequent immediate and late complications were slight pain, swelling, and trismus. Preoperative complaints, angulation of the impacted molars, duration of surgery, type of surgical flap, the need for bone removal and tooth sectioning could predict and had an impact on the incidence of postoperative complications following L8 removal. Females and older patients were likely to have more postoperative complications following surgical extraction of L8.