• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.105-111
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• 2017

Background: Dental fear is usually associated with hemodynamic changes. Fear of pain during the surgical removal of a lower impacted third molar might cause patients anxiety, thereby leading to avoidance of any future dental therapy. This study aimed to determine the effect of experiencing a surgical impacted-tooth removal on the pain perception-related anxiety and hemodynamic status. Method: Twenty-seven healthy patients aged 15-30 years (mean age, 24 years), for whom surgical removal of bilateral lower third molars was advised, were included. This prospective, randomized, controlled, split-mouth study involved operations on both sides of the mandibular arch, with a 1-month washout period in between. Blood pressure and heart rate were measured before the surgical procedure, during and after the injection, preoperatively, and postoperatively. Pain perception was evaluated using a 100-mm visual analog scale during the injection, preoperatively, and postoperatively after the numbness disappeared. Differences in the blood pressure, heart rate, and pain perception between the two appointments were analyzed using the paired t-test. For all statistical analyses, SPSS version 11.5 was used. Results: The mean pain perception values during the injection and preoperatively showed no significant differences between the two appointments (P > 0.05); however, significant differences in the blood pressure and heart rate were noted before the surgical procedure; preoperatively, the blood pressure alone showed a significant difference (P < 0.05). Conclusion: There was a significant decrease in the blood pressure and heart rate preoperatively; hence, experiencing a surgical impacted-tooth removal can reduce the subsequent preoperative anxiety in healthy patients.

• Journal of Korean Dental Science
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• v.9 no.1
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• pp.42-48
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• 2016

Prophylactic removal of impacted third molars is a common procedure in dentistry, but the necessity of routine extraction is still controversial. When impacted third molars caused severe apical root resorption of the second molars, orthodontic traction of the third molars after extraction of the damaged second molars could minimize alveolar bone defect and preserve the patient's natural teeth. By well-planned orthodontic treatment, functional occlusion was established avoiding extraction of the impacted teeth and eliminating the possibility of a large bone defect after extraction.

• Imaging Science in Dentistry
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• v.44 no.2
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• pp.171-175
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• 2014

One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.1
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• pp.29-37
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• 2022

Background: Pain, edema, and trismus are predictable sequelae for surgical extraction of impacted mandibular third molars (M3M). The present study aimed to compare the anti-phlogistic potential of bromelain and aceclofenac in the reduction of post-surgical sequalae in the extraction of impacted M3M. Method: A randomized controlled, triple-blinded clinical study included 72 patients scheduled for surgical removal of impacted M3M under local anesthesia. Randomization was performed and subjects were equally allocated to groups A (control) and B (study), who intended to receive aceclofenac and bromelain, respectively. The primary outcome variables were pain, edema, and trismus evaluated on postoperative days 2 and 7 and compared with baseline values. The secondary variables evaluated were the quantity of rescue analgesics required and the frequency of adverse effects in both groups for 7 postoperative (PO) days. Data were analyzed with a level of significance of P < 0.05. Results: Group B demonstrated a significant decrease in the severity of edema and trismus compared to group A on both PO days 2 and 7 (P < 0.001). Bromelain demonstrated similar analgesic efficacy with an insignificant difference compared to aceclofenac (P > 0.05). Conclusion: The present study showed that the efficacy of bromelain was comparable to that of aceclofenac in reducing inflammatory complications following surgical removal of impacted M3M. Bromelain can be considered a safe and potent alternative to routinely used aceclofenac when addressing inflammatory outcomes after surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.375-380
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• 2007

The purpose of this study is to understand anxiety in patients undergoing third molar extraction and care patients of third molar extraction. The subjects in the study were Sixty-three patients who visited the department of dentistry at Pusan Paik Hospital from May 2006 to September 2006 and who underwent third molar extraction. Patients' anxiety(state anxiety and trait anxiety) to use Spielberger's state-trait anxiety inventory(STAI) were measured. They were asked to fill out STAI question paper immediately before third molar extraction(pre-extraction) and on the day after the extraction(post-extraction). And visual analog scale(VAS) to measure patient's postoperative pain on the day after extraction(postextraction day) was used. Then Differences in anxiety before and after extraction, between men and women, between the first and second extraction, with impacted versus non impacted third molar extraction, between extraction time and anxiety, and between postoperative pain and anxiety were evaluated. The anxiety status of patients undergoing third molar extraction could be quantitatively evaluated using the STAI-KYZ. There were significant difference before and after third molar extraction. Especially women and patients of more severe postoperative pain was more anxious. We need to alleviate patient's anxiety(especially women) and to control postoperative pain throughout the tooth removal process.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.575-582
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• 2021

Background: The aim of this randomized, triple-blind trial was to determine the anesthetic, analgesic, and hemodynamic effects of articaine and bupivacaine in the extraction of impacted mandibular third molar teeth. Methods: Twenty-six patients who underwent removal of bilaterally symmetric mandibular third molars were randomly assigned to articaine and bupivacaine groups in a split-mouth design. The onset of anesthetic action, intraoperative comfort, total amount of solution used, duration of postoperative anesthesia and analgesia, rescue analgesic use, postoperative pain, intraoperative bleeding, and hemodynamic parameters were evaluated. Results: In the articaine group, the onset of anesthetic activity was faster, intraoperative comfort was greater, and effective anesthesia required less local anesthetic solution. The bupivacaine group showed a significantly longer duration of postoperative anesthesia and analgesia, in addition to lower visual analog scale values at 6 and 48 hours postoperatively. There were no significant differences between the two solutions regarding rescue analgesic medication use, intraoperative bleeding, or hemodynamics. Conclusion: Articaine showed greater clinical efficacy than bupivacaine in intraoperative anesthesia, achieving faster onset of anesthetic action and greater patient comfort while also requiring less reinforcement during surgery. However, bupivacaine was superior in terms of postoperative anesthesia, reducing postoperative pain due to its residual anesthetic and analgesic effects. Both anesthetic solutions led to similar hemodynamics at low doses in mandibular third molar surgery

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.5
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• pp.313-323
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• 2020

Background: Previous studies have investigated the effects of dexamethasone injections into the pterygomandibular space and compared them to those of controls; however, the effects of dexamethasone injections before and after lower third molar surgery on postoperative complications have not been studied. This research investigated the postoperative sequelae of dexamethasone injections before and after surgery into the pterygomandibular space. The aim of this study was to evaluate the effects of preoperative and postoperative injections of 4 mg of dexamethasone into the pterygomandibular space on postoperative pain, facial swelling, and the restriction of mouth opening following lower third molar surgical removal. Methods: Twenty-seven participants with bilateral symmetrical lower impacted third molars were included in this study. Each participant was randomly allocated to one of two groups. Group A received injections of 1 ml dexamethasone (4 mg/mL) and 1 mL placebo into the pterygomandibular space before and after surgery, respectively. Group B received the same doses of placebo before surgery and dexamethasone after surgery. Results: A significant restriction of mouth opening on the second postoperative day was observed in both groups. Nonetheless, the postoperative restriction of mouth opening, facial swelling, postoperative pain, and analgesic consumption after lower third molar surgical removal were not significantly different in the two groups. Conclusions: Regardless of the time of administration, dexamethasone injections into the pterygomandibular space resulted in satisfactory control of the postoperative sequelae of the mandibular third molar surgical removal.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.1
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• pp.69-77
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• 2001

PURPOSE : The Purpose of this study was to investigate the anti-inflammatory effect on combination dosage of dexamethasone and naproxen after removal of impacted 3rd molars. We evaluated postoperative pain, swelling, and mouth opening limitation quantitatively. PATIENTS AND METHODS : Removal of an impacted lower third molar was done under local anesthesia with 2% lidocaine to 239 healthy patients. We randomly gave experimental group 1.5mg dexamethasone and 200mg naproxen three times a day for postoperative 2days, and also gave control group 200mg naproxen alone three times a day for postoperative 2days. Swelling and pain were measured by visual analogue scale (VAS). Mouth opening limitation was measured by maximum interincisal opening length. We estimated these measurements in the first and second postoperative days. Differences between experimental and control group were investigated considering age, sex, BMI(body mass index), impacted type, surgical site(right or left), and operation time by independent student T-test. RESULTS : In general, swelling, pain, and mouth opening limitations were significantly reduced (p<0.01) by combination dose of dexamethasone and naproxen in postoperative one day. But there was no difference in pain on the second postoperative day. As variables being considered, in the postoperative pain, there was significant difference between experimental group and control group in only male, little bony removal group, left side extraction group. In case of postoperative swelling, there was no significant differences in male, adolescence, long operating time group (over 20 minutes), medium BMI group and right side extraction group. In case of postoperative mouth opening limitation, there was significant difference between only female and long operating time group (over 20 minutes). CONCLUSION : Variables being considered, postoperative swelling was more reduced by the combination dose of naproxen and dexamethasone than that of naproxen alone after removal of impacted 3rd molars. But there was varoius results in pain and mouth opening limitation.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.2
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• pp.131-136
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• 2016

Background: This study aimed to evaluate the patient's pain and quality of life after suture removal at either 3 or 7 days following the bilateral surgical extraction of impacted lower third molars. Methods: This study was a prospective, randomized controlled clinical trial carried out in 30 patients, who acted as their own control. Each patient required the bilaterally impacted mandibular third molars to be extracted. The impacted teeth were removed and the wound margins were approximated and sutured with black braided silk. The suture material was removed on day 3 on one side and on day 7 on the other. Each participant was asked to complete a questionnaire after the removal of the suture material on each designated day. Results: Regarding overall clinical symptoms, the mean VAS scores of male and female participants on day 3 were not significantly different from those on day 7. A significant difference was found in female participants, in that overall daily activity was better on day 7. There were significant differences in the ability to smile and laugh in both sexes and the ability to chew in the male participants was better on day 7. Conclusions: There were no significant differences in the patient's pain and quality of life between suture removal on day 3 or on day 7 following surgery to remove impacted lower third molars.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.505-509
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• 2009

Purpose: To evaluate the properties of antibiotic and NSAIDs administration before extract of the impacted mandibular third molar. Materials & Methods: No patient showed any sign of pain, inflammation, or swelling at the time of removal. A group of 50 patients was classified in Group 1(preemptive and oral medication was carried out for 3 days postoperatively, N=23) and Group 2(oral medication was carried out for 3 days postoperatively, N=27) subgroups. Clinical and radiologic factors were recorded for each case, and the rationale for assigning the patients to the groups was strictly random. The surgical technique was the same in all cases, and the follow-up period was 1 week. Parameters that were evaluated were infection, swelling, pain and differences in mouth opening. Results: We could not find any significant difference between the 2 groups regarding the evaluated parameters. Conclusion: The results of our study show that antibiotic and NSAIDs administration before the removal of lower third molars does not contribute to a decrease infection, swelling, pain or increase mouth opening. Therefore antibiotic and NSAIDs administration before the removal of lower third molars is not recommended for routine use.