Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지
DOI QR코드

DOI QR Code

Common risk factors for postoperative pain following the extraction of wisdom teeth

  • Rakhshan, Vahid (Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences)
  • Received : 2014.11.16
  • Accepted : 2014.12.11
  • Published : 2015.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

The extraction of third molars is a common task carried out at dental/surgery clinics. Postoperative pain is one of the two most common complications of this surgery, along with dry socket. Knowledge of the frequent risk factors of this complication is useful in determining high-risk patients, planning treatment, and preparing the patients mentally. Since the risk factors for postoperative pain have never been summarized before while the risk factors for dry socket have been highly debated, this report summarizes the literature regarding the common predictors of postextraction pain. Except for surgical difficulty and the surgeon's experience, the influences of other risk factors (age, gender and oral contraceptive use) were rather inconclusive. The case of a female gender or oral contraceptive effect might mainly be associated with estrogen levels (when it comes to dry socket), which can differ considerably from case to case. Improvement in and unification of statistical and diagnostic methods seem necessary. In addition, each risk factor was actually a combination of various independent variables, which should instead be targeted in more comprehensive studies.

Keywords

References

  1. Nordenram A. Postoperative complications in oral surgery. A study of cases treated during 1980. Swed Dent J 1983;7:109-14.
  2. Heng CK, Badner VM, Clemens DL, Mercer LT, Mercer DW. The relationship of cigarette smoking to postoperative complications from dental extractions among female inmates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:757-62. https://doi.org/10.1016/j.tripleo.2007.04.020
  3. El-Soud NA, El Shenawy H. A randomized double blind clinical study on the efficacy of low level laser therapy in reducing pain after simple third molar extraction. Maced J Med Sci 2010;3:303-6. https://doi.org/10.3889/MJMS.1857-5773.2010.0114
  4. Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg 2003;61:1379-89. https://doi.org/10.1016/j.joms.2003.04.001
  5. Penarrocha M, Sanchis JM, Saez U, Gay C, Bagan JV. Oral hygiene and postoperative pain after mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:260-4. https://doi.org/10.1067/moe.2001.115722
  6. de Santana-Santos T, de Souza-Santos JA, Martins-Filho PR, da Silva LC, de Oliveira E Silva ED, Gomes AC. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables. Med Oral Patol Oral Cir Bucal 2013;18:e65-70.
  7. Calhoun NR. Dry socket and other postoperative complications. Dent Clin North Am 1971;15:337-48.
  8. Muhonen A, Venta I, Ylipaavalniemi P. Factors predisposing to postoperative complications related to wisdom tooth surgery among university students. J Am Coll Health 1997;46:39-42. https://doi.org/10.1080/07448489709595585
  9. Osborn TP, Frederickson G Jr, Small IA, Torgerson TS. A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg 1985;43:767-9. https://doi.org/10.1016/0278-2391(85)90331-3
  10. Lopes V, Mumenya R, Feinmann C, Harris M. Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction. Br J Oral Maxillofac Surg 1995;33:33-5. https://doi.org/10.1016/0266-4356(95)90083-7
  11. Berge TI, Boe OE. Predictor evaluation of postoperative morbidity after surgical removal of mandibular third molars. Acta Odontol Scand 1994;52:162-9. https://doi.org/10.3109/00016359409027591
  12. Capuzzi P, Montebugnoli L, Vaccaro MA. Extraction of impacted third molars. A longitudinal prospective study on factors that affect postoperative recovery. Oral Surg Oral Med Oral Pathol 1994;77:341-3. https://doi.org/10.1016/0030-4220(94)90194-5
  13. Lago-Mendez L, Diniz-Freitas M, Senra-Rivera C, Gude-Sampedro F, Gandara Rey JM, Garcia-Garcia A. Relationships between surgical difficulty and postoperative pain in lower third molar extractions. J Oral Maxillofac Surg 2007;65:979-83. https://doi.org/10.1016/j.joms.2006.06.281
  14. Pedersen A. Interrelation of complaints after removal of impacted mandibular third molars. Int J Oral Surg 1985;14:241-4. https://doi.org/10.1016/S0300-9785(85)80035-1
  15. Haraji A, Rakhshan V. Chlorhexidine gel and less difficult surgeries might reduce post-operative pain, controlling for dry socket, infection and analgesic consumption: a split-mouth controlled randomised clinical trial. J Oral Rehabil 2015;42:209-19. https://doi.org/10.1111/joor.12230
  16. Slade GD, Foy SP, Shugars DA, Phillips C, White RP Jr. The impact of third molar symptoms, pain, and swelling on oral healthrelated quality of life. J Oral Maxillofac Surg 2004;62:1118-24. https://doi.org/10.1016/j.joms.2003.11.014
  17. Bienstock DA, Dodson TB, Perrott DH, Chuang SK. Prognostic factors affecting the duration of disability after third molar removal. J Oral Maxillofac Surg 2011;69:1272-7. https://doi.org/10.1016/j.joms.2010.06.211
  18. Wardle J. Dental pessimism: negative cognitions in fearful dental patients. Behav Res Ther 1984;22:553-6. https://doi.org/10.1016/0005-7967(84)90058-5
  19. Susarla SM, Blaeser BF, Magalnick D. Third molar surgery and associated complications. Oral Maxillofac Surg Clin North Am 2003;15:177-86. https://doi.org/10.1016/S1042-3699(02)00102-4
  20. Haraji A, Rakhshan V, Khamverdi N, Alishahi HK. Effects of intraalveolar placement of 0.2% chlorhexidine bioadhesive gel on dry socket incidence and postsurgical pain: a double-blind split-mouth randomized controlled clinical trial. J Orofac Pain 2013;27:256-62. https://doi.org/10.11607/jop.1142
  21. Blum IR. Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review. Int J Oral Maxillofac Surg 2002;31:309-17. https://doi.org/10.1054/ijom.2002.0263
  22. Bloomer CR. Alveolar osteitis prevention by immediate placement of medicated packing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:282-4. https://doi.org/10.1067/moe.2000.108919
  23. Noroozi AR, Philbert RF. Modern concepts in understanding and management of the "dry socket" syndrome: comprehensive review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:30-5. https://doi.org/10.1016/j.tripleo.2008.05.043
  24. Cardoso CL, Rodrigues MT, Ferreira Junior O, Garlet GP, de Carvalho PS. Clinical concepts of dry socket. J Oral Maxillofac Surg 2010;68:1922-32. https://doi.org/10.1016/j.joms.2009.09.085
  25. Caso A, Hung LK, Beirne OR. Prevention of alveolar osteitis with chlorhexidine: a meta-analytic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:155-9. https://doi.org/10.1016/j.tripleo.2004.05.009
  26. Kolokythas A, Olech E, Miloro M. Alveolar osteitis: a comprehensive review of concepts and controversies. Int J Dent 2010;2010:249073.
  27. White RP Jr, Shugars DA, Shafer DM, Laskin DM, Buckley MJ, Phillips C. Recovery after third molar surgery: clinical and health-related quality of life outcomes. J Oral Maxillofac Surg 2003;61:535-44. https://doi.org/10.1053/joms.2003.50106
  28. Phillips C, White RP Jr, Shugars DA, Zhou X. Risk factors associated with prolonged recovery and delayed healing after third molar surgery. J Oral Maxillofac Surg 2003;61:1436-48. https://doi.org/10.1016/j.joms.2003.08.003
  29. Benediktsdottir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:438-46. https://doi.org/10.1016/j.tripleo.2003.10.018
  30. Halabi D, Escobar J, Munoz C, Uribe S. Logistic regression analysis of risk factors for the development of alveolar osteitis. J Oral Maxillofac Surg 2012;70:1040-4. https://doi.org/10.1016/j.joms.2011.11.024
  31. Haraji A, Rakhshan V. Single-dose intra-alveolar chlorhexidine gel application, easier surgeries, and younger ages are associated with reduced dry socket risk. J Oral Maxillofac Surg 2014;72:259-65. https://doi.org/10.1016/j.joms.2013.09.023
  32. Saez Cuesta Ú, Penarrocha Diago M, Sanchis Bielsa JM, Gay Escoda C. Estudio del postoperatorio de 100 terceros molares mandibulares incluidos, en relacion a la edad, el sexo, el tabaco y la higiene bucal. RCOE Revista del Consejo General de Colegios de Odontologos y Estomatologos de Espana 1999;4:471-5.
  33. Larrazabal C, Garcia B, Penarrocha M, Penarrocha M. Influence of oral hygiene and smoking on pain and swelling after surgical extraction of impacted mandibular third molars. J Oral Maxillofac Surg 2010;68:43-6. https://doi.org/10.1016/j.joms.2009.07.061
  34. Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc 2007;73:325.
  35. Oikarinen K. Postoperative pain after mandibular third-molar surgery. Acta Odontol Scand 1991;49:7-13. https://doi.org/10.3109/00016359109041135
  36. Garcia Garcia A, Gude Sampedro F, Gandara Rey J, Gallas Torreira M. Trismus and pain after removal of impacted lower third molars. J Oral Maxillofac Surg 1997;55:1223-6. https://doi.org/10.1016/S0278-2391(97)90172-5
  37. Yuasa H, Sugiura M. Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables. Br J Oral Maxillofac Surg 2004;42:209-14.
  38. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Creminelli L, Santoro F. Assessing postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg 2007;65:901-17. https://doi.org/10.1016/j.joms.2005.12.046
  39. Baqain ZH, Karaky AA, Sawair F, Khraisat A, Duaibis R, Rajab LD. Frequency estimates and risk factors for postoperative morbidity after third molar removal: a prospective cohort study. J Oral Maxillofac Surg 2008;66:2276-83. https://doi.org/10.1016/j.joms.2008.06.047
  40. Seymour RA, Meechan JG, Blair GS. An investigation into postoperative pain after third molar surgery under local analgesia. Br J Oral Maxillofac Surg 1985;23:410-8. https://doi.org/10.1016/0266-4356(85)90025-7
  41. de Santana Santos T, Calazans AC, Martins-Filho PR, Silva LC, de Oliveira E Silva ED, Gomes AC. Evaluation of the muscle relaxant cyclobenzaprine after third-molar extraction. J Am Dent Assoc 2011;142:1154-62. https://doi.org/10.14219/jada.archive.2011.0084
  42. Akadiri OA, Fasola AO, Arotiba JT. Evaluation of Pederson index as an instrument for predicting difficulty of third molar surgical extraction. Niger Postgrad Med J 2009;16:105-8.
  43. Pedersen GW. Oral surgery. Philadelphia: Saunders; 1988.
  44. Renton T, Smeeton N, McGurk M. Factors predictive of difficulty of mandibular third molar surgery. Br Dent J 2001;190:607-10.
  45. Yuasa H, Kawai T, Sugiura M. Classification of surgical difficulty in extracting impacted third molars. Br J Oral Maxillofac Surg 2002;40:26-31. https://doi.org/10.1054/bjom.2001.0684
  46. Carvalho RW, do Egito Vasconcelos BC. Assessment of factors associated with surgical difficulty during removal of impacted lower third molars. J Oral Maxillofac Surg 2011;69:2714-21. https://doi.org/10.1016/j.joms.2011.02.097
  47. Conrad SM, Blakey GH, Shugars DA, Marciani RD, Phillips C, White RP Jr. Patients' perception of recovery after third molar surgery. J Oral Maxillofac Surg 1999;57:1288-94. https://doi.org/10.1016/S0278-2391(99)90861-3
  48. Larsen PE. Alveolar osteitis after surgical removal of impacted mandibular third molars. Identification of the patient at risk. Oral Surg Oral Med Oral Pathol 1992;73:393-7. https://doi.org/10.1016/0030-4220(92)90312-E
  49. Meechan JG, Macgregor ID, Rogers SN, Hobson RS, Bate JP, Dennison M. The effect of smoking on immediate post-extraction socket filling with blood and on the incidence of painful socket. Br J Oral Maxillofac Surg 1988;26:402-9. https://doi.org/10.1016/0266-4356(88)90093-9
  50. Johnson WS, Blanton EE. An evaluation of 9-aminoacridine/ Gelfoam to reduce dry socket formation. Oral Surg Oral Med Oral Pathol 1988;66:167-70. https://doi.org/10.1016/0030-4220(88)90086-2
  51. Yoshii T, Hamamoto Y, Muraoka S, Furudoi S, Komori T. Differences in postoperative morbidity rates, including infection and dry socket, and differences in the healing process after mandibular third molar surgery in patients receiving 1-day or 3-day prophylaxis with lenampicillin. J Infect Chemother 2002;8:87-93. https://doi.org/10.1007/s101560200012
  52. Alexander RE. Dental extraction wound management: a case against medicating postextraction sockets. J Oral Maxillofac Surg 2000;58:538-51. https://doi.org/10.1016/S0278-2391(00)90017-X
  53. Brekke JH, Bresner M, Reitman MJ. Effect of surgical trauma and polylactate cubes and granules on the incidence of alveolar osteitis in mandibular third molar extraction wounds. J Can Dent Assoc 1986;52:315-9.
  54. Adkisson SR, Harris PF. A statistical study of alveolar osteitis. U S Armed Forces Med J 1956;7:1749-54.
  55. Berge TI, Gilhuus-Moe OT. Per-and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon. Acta Odontol Scand 1993;51:389-97. https://doi.org/10.3109/00016359309040590
  56. Sisk AL, Hammer WB, Shelton DW, Joy ED Jr. Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 1986;44:855-9. https://doi.org/10.1016/0278-2391(86)90221-1
  57. Eshghpour M, Moradi A, Nejat AH. Dry socket following tooth extraction in an Iranian Dental Center: incidence and risk factors. J Dent Mater Tech 2013;2:86-91.
  58. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009;10:447-85.
  59. Gerdle B, Bjork J, Coster L, Henriksson K, Henriksson C, Bengtsson A. Prevalence of widespread pain and associations with work status: a population study. BMC Musculoskelet Disord 2008;9:102. https://doi.org/10.1186/1471-2474-9-102
  60. Wijnhoven HA, de Vet HC, Picavet HS. Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain 2006;22:717-24. https://doi.org/10.1097/01.ajp.0000210912.95664.53
  61. de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: a population-based study. Pain 2007;129:12-20. https://doi.org/10.1016/j.pain.2006.09.008
  62. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain 2008;9:883-91. https://doi.org/10.1016/j.jpain.2008.05.005
  63. LeResche L. Gender considerations in the epidemiology of chronic pain. Epidemiol Pain 1999;17:43-52.
  64. Bastos JL, Gigante DP, Peres KG. Toothache prevalence and associated factors: a population based study in southern Brazil. Oral Dis 2008;14:320-6. https://doi.org/10.1111/j.1601-0825.2007.01379.x
  65. Chia YY, Chow LH, Hung CC, Liu K, Ger LP, Wang PN. Gender and pain upon movement are associated with the requirements for postoperative patient-controlled iv analgesia: a prospective survey of 2,298 Chinese patients. Can J Anaesth 2002;49:249-55. https://doi.org/10.1007/BF03020523
  66. Mattila K, Toivonen J, Janhunen L, Rosenberg PH, Hynynen M. Postdischarge symptoms after ambulatory surgery: first-week incidence, intensity, and risk factors. Anesth Analg 2005;101:1643-50.
  67. Taenzer AH, Clark C, Curry CS. Gender affects report of pain and function after arthroscopic anterior cruciate ligament reconstruction. Anesthesiology 2000;93:670-5. https://doi.org/10.1097/00000542-200009000-00015
  68. Rosseland LA, Stubhaug A. Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain 2004;112:248-53. https://doi.org/10.1016/j.pain.2004.08.028
  69. Fillingim RB. Sex, gender, and pain: women and men really are different. Curr Rev Pain 2000;4:24-30. https://doi.org/10.1007/s11916-000-0006-6
  70. Keefe FJ, Lefebvre JC, Egert JR, Affleck G, Sullivan MJ, Caldwell DS. The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain 2000;87:325-34. https://doi.org/10.1016/S0304-3959(00)00296-7
  71. Nakagawa Y, Ishii H, Nomura Y, Watanabe NY, Hoshiba D, Kobayashi K, et al. Third molar position: reliability of panoramic radiography. J Oral Maxillofac Surg 2007;65:1303-8. https://doi.org/10.1016/j.joms.2006.10.028
  72. Abu Younis MH, Abu Hantash RO. Dry socket: frequency, clinical picture, and risk factors in a palestinian dental teaching center. Open Dent J 2011;5:7-12. https://doi.org/10.2174/1874210601105010007
  73. Barbosa-Rebellato NL, Thome AC, Costa-Maciel C, Oliveira J, Scariot R. Factors associated with complications of removal of third molars: a transversal study. Med Oral Patol Oral Cir Bucal 2011;16:e376-80.
  74. Heasman PA, Jacobs DJ. A clinical investigation into the incidence of dry socket. Br J Oral Maxillofac Surg 1984;22:115-22. https://doi.org/10.1016/0266-4356(84)90023-8
  75. Garcia AG, Grana PM, Sampedro FG, Diago MP, Rey JM. Does oral contraceptive use affect the incidence of complications after extraction of a mandibular third molar? Br Dent J 2003;194:453-5. https://doi.org/10.1038/sj.bdj.4810032
  76. Catellani JE, Harvey S, Erickson SH, Cherkin D. Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis). J Am Dent Assoc 1980;101:777-80. https://doi.org/10.14219/jada.archive.1980.0420
  77. Enkling N, Nicolay C, Bayer S, Mericske-Stern R, Utz KH. Investigating interocclusal perception in tactile teeth sensibility using symmetric and asymmetric analysis. Clin Oral Investig 2010;14:683-90. https://doi.org/10.1007/s00784-009-0348-3
  78. Jacobs R, Van Steenberghe D. From osseoperception to implantmediated sensory-motor interactions and related clinical implications. J Oral Rehabil 2006;33:282-92. https://doi.org/10.1111/j.1365-2842.2006.01621.x
  79. Kazemi M, Geramipanah F, Negahdari R, Rakhshan V. Active tactile sensibility of single-tooth implants versus natural dentition: a split-mouth double-blind randomized clinical trial. Clin Implant Dent Relat Res 2014;16:947-55. https://doi.org/10.1111/cid.12053
  80. Goldberg MH, Nemarich AN, Marco WP 2nd. Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in private practice. J Am Dent Assoc 1985;111:277-9. https://doi.org/10.14219/jada.archive.1985.0098
  81. Bruce RA, Frederickson GC, Small GS. Age of patients and morbidity associated with mandibular third molar surgery. J Am Dent Assoc 1980;101:240-5. https://doi.org/10.14219/jada.archive.1980.0183
  82. Precious DS, Mercier P, Payette F. Risks and benefits of extraction of impacted third molars: a critical review of the literature. 2. J Can Dent Assoc 1992;58:845-52.
  83. Akadiri OA, Okoje VN, Arotiba JT. Identification of risk factors for short-term morbidity in third molar surgery. Odontostomatol Trop 2008;31:5-10.
  84. Adeyemo WL, Ogunlewe MO, Ladeinde AL, Hassan OO, Taiwo OA. A comparative study of surgical morbidity associated with mandibular third-molar surgery in young and aging populations. J Contemp Dent Pract 2010;11:E001-8.
  85. Adeyemo WL, Ogunlewe MO, Ladeinde AL, Abib GT, Gbotolorun OM, Olojede OC, et al. Prevalence and surgical morbidity of impacted mandibular third molar removal in the aging population: a retrospective study at the Lagos University Teaching Hospital. Afr J Med Med Sci 2006;35:479-83.

Cited by

  1. Orofacial Pains vol.2017, pp.None, 2015, https://doi.org/10.1155/2017/1915691
  2. Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery vol.28, pp.2, 2015, https://doi.org/10.1097/scs.0000000000003154
  3. Evaluation of the treatment and prognosis of the patients with orofacial pain of unknown cause vol.42, pp.2, 2015, https://doi.org/10.21851/obr.42.02.201806.67
  4. 4% Articaine and 2% Lignocaine for Surgical Removal of Third Molar by Mandibular Nerve Block: A Randomized Clinical Trial for Efficacy and Safety vol.18, pp.3, 2015, https://doi.org/10.1007/s12663-018-1109-0
  5. The Effectiveness of Advanced Platelet-Rich Fibrin in comparison with Leukocyte-Platelet-Rich Fibrin on Outcome after Dentoalveolar Surgery vol.2021, pp.None, 2015, https://doi.org/10.1155/2021/6686857
  6. Injection of Lidocaine Alone versus Lidocaine plus Dexmedetomidine in Impacted Third Molar Extraction Surgery, a Double-Blind Randomized Control Trial for Postoperative Pain Evaluation vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/6623792
  7. Evaluation of post-extraction healing after atraumatic axial tooth extraction using Benex system II versus conventional extraction: Randomized control trial vol.33, pp.8, 2015, https://doi.org/10.1016/j.sdentj.2021.09.002