Effectiveness of cold therapy in reducing pain, trismus, and oedema after impacted mandibular third molar surgery: a randomized, self-controlled, observer-blind, split-mouth clinical trial

doi:10.1016/j.ijom.2015.10.021

International Journal of Oral and Maxillofacial Surgery

Volume 45, Issue 1, January 2016, Pages 118-123

https://doi.org/10.1016/j.ijom.2015.10.021 Get rights and content

Abstract

Cold therapy is a conventional and widely used modality for reducing pain, trismus, and oedema after dentoalveolar surgeries. However, information reported in the literature on its effectiveness is insufficient and controversial. This study was performed to evaluate the effect of local cold application in reducing pain, trismus, and swelling after impacted mandibular third molar surgery. Thirty patients (seven males and 23 females) with bilateral symmetrical mandibular impacted third molars were enrolled in this randomized, self-controlled, observer-blind clinical trial. The patients were aged between 18 and 30 years. After surgical removal of the tooth on one side (intervention), ice pack therapy was given for 24 h after surgery; for the other side (control), no cold therapy was given. The time interval between the two surgeries was at least 4 weeks. The amount of pain, trismus, and facial swelling was measured on days 2 and 7 postoperative, and patient satisfaction with the cold therapy vs. no cold therapy was assessed. The amount of pain, trismus, and facial swelling, and the extent of patient satisfaction were not significantly different between the intervention and control sides. Cold therapy had no beneficial effects on postoperative sequelae after impacted mandibular third molar surgery.

Section snippets

Materials and methods

The protocol of this investigation was approved by the research ethics committee of the study university and written informed consent was obtained from all of the participants.

Thirty consecutive patients who were referred to the department of the oral and maxillofacial surgery for the extraction of bilateral mandibular impacted third molars were enrolled in this randomized, self-controlled, observer-blind, split-mouth clinical trial. The patients ranged in age from 18 to 30 years (mean age 23.2 ±

Results

A total of 60 impacted teeth were surgically removed in this investigation. The operation time ranged between 17 and 23 min and no unexpected postoperative complication such as nerve damage or infection was observed.

The mean reported pain scores for the intervention and control sides were 3.83 and 4.43, respectively, on postoperative day 2; scores were 0.00 in both groups on postoperative day 7. On statistical analysis, no significant difference was found between the intervention and control

Discussion

The removal of impacted third molars may be associated with certain complications such as infection, inferior alveolar nerve damage, tooth (or root) displacement into adjacent anatomical spaces, and mandibular bone fracture. The incidence of these complications is relatively low and can be minimized by a thorough preoperative evaluation, comprehensive treatment planning, and following the basic surgical principles. On the other hand, problems such as pain, trismus, and oedema occur frequently

Funding

None.

Competing interests

None declared.

Ethical approval

The protocol of this investigation was approved by the Ethics Committee of Hamedan University of Medical Sciences and the trial is registered at irct.ir (number IRCT201410214303N3).

Patient consent

Patient consent was obtained for publication of the photograph (Fig. 1).

Acknowledgement

This study was supported by the Dental Research Centre, Hamedan University of Medical Sciences, Hamedan, Iran.

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Is Injectable Platelet-Rich Fibrin Really Effective in Reducing Expected Side Effects of Removing Impacted Third Molar Surgery?
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The normality of the distribution of the study data was assessed using the Kolmogorov-Smirnov test. Depending on whether the data exhibited a normal distribution or not, the data were analyzed using either the paired t-test or the Wilcoxon test. A P value < .05 was considered statistically significant.
The study included 35 patients with a mean age of 19.97 ± 2.07 years. The i-PRF side significant success in postoperative edema measurements. There was a statistically significant difference observed between the control side and the i-PRF side on the second day (control: 9.74 ± 0.57 mm, i-PRF: 9.46 ± 0.51 mm) and seventh day (control: 9.33 ± 0.59 mm, i-PRF: 9.12 ± 0.50 mm) in lateral canthus-angulus measurements (P: .01 and P: .04, respectively). Additionally, on the second day, there was a statistically significant difference in tragus-commisura measurements (control: 11.53 ± 0.62 mm, i-PRF: 11.31 ± 0.58 mm) with a P value of .02. There was no significant difference observed between the sides in terms of postoperative pain (P > .05). However, analgesic consumption in the i-PRF side was significantly lower at the sixth hour (control: 1.8 ± 0.58 dose, i-PRF: 1.14 ± 0.35 dose), 24th hour (control: 1.77 ± 0.54 dose, i-PRF: 1.14 ± 0.35 dose), and second day (control: 1.8 ± 0.47 dose, i-PRF: 1.4 ± 0.73 dose) postoperatively (P: .000, P: .000, and P: .012). Mouth opening was significantly lower in the i-PRF side on the second day (control: 27.88 ± 6.48 mm, i-PRF: 25.51 ± 5.56 mm) (P: .025). However, i-PRF had no significant effect on postoperative quality of life (P > .05).
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This is a single blinded, randomized clinical trial to assess and compare the effect of dexamethasone, icepack and ketoprofen on the postoperative pain, swelling and trismus following surgical removal of impacted lower third molar (ILTM).
Consecutive patients who require surgical extraction of ILTM with a modified Pederson difficulty index score of 5-6 were recruited. Ninety patients were randomly allocated into 3 groups. Group A received 100mg of ketoprofen and group C received 8mg of dexamethasone per-oral 1hr preoperatively. Subjects in group B used a pre-standardized ice pack held against the skin over the angle of the mandible for 6 hours postoperatively. Swelling, trismus and pain were recorded on postoperative day 1, 2 and 7.
A total of 78 subjects with mean age of 27.8 ± 4.9 years comprising of 59.0% males completed the study. There were no statistically significant difference found in the sociodemographics. Subjects in the dexamethasone group showed a significant reduction in pain on postoperative day 1 and 2, and in swelling on all postoperative days in review.
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Citation Excerpt :
In a similar literature review, Collins (2008) found insufficient evidence that cold therapy improved clinical outcomes in soft tissue injuries. Zandi et al. (2016) and Van der Westhuijzen et al. (2005) studied the effects of cold therapy on pain, trismus, and swelling but found no differences between the experimental and control groups. However, Shin et al. (2009) and Mahshidfar et al. (2016) concluded that cold therapy was cost-effective and an effective technique.
Cold therapy is one of the most common nonpharmacologic pain treatments. Despite the existence of many studies about cold therapy, few have examined the effects of cold therapy after abdominal surgery.
The purpose of the study was to investigate the effect of cold therapy applied to the incision area after abdominal surgery on postoperative pain and analgesic use.
This study was a randomized controlled trial
The sample included 60 patients (30 control, 30 experimental) undergoing abdominal surgery. Researchers recorded information from a patient information form, a visual analogue scale (VAS), a pain evaluation form, and the vital signs recording form.
There was no statistically significant difference in pain level between the experimental and control groups as measured by VAS at postoperative hour 1 (p > .05). Furthermore, no statistically significant difference in VAS pain levels between groups was observed at postoperative hours 1, 2, and 8 prior to application of cold therapy (p > .05). Then, when cold therapy was applied at hours 1, 2 and 8, the pain level decreased significantly in the experimental group (p =.001). Pain also decreased in the control group between hours 1 and 8, but this decrease was not as great as that in the experimental group (p = .024).
Both groups had decreased pain levels, and the decrease in the experimental group was greater than in the control group but cold therapy had no statistically significant effect on analgesics use.

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^☆: The trial is registered at irct.ir, number IRCT201410214303N3.

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Clinical PaperOral SurgeryEffectiveness of cold therapy in reducing pain, trismus, and oedema after impacted mandibular third molar surgery: a randomized, self-controlled, observer-blind, split-mouth clinical trial☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Funding

Competing interests

Ethical approval

Patient consent

Acknowledgement

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Arthroplasty

J Arthroplasty

Arch Phys Med Rehabil

Int J Oral Maxillofac Surg

J Am Dent Assoc

Br J Oral Maxillofac Surg

Clinical Paper
Oral Surgery
Effectiveness of cold therapy in reducing pain, trismus, and oedema after impacted mandibular third molar surgery: a randomized, self-controlled, observer-blind, split-mouth clinical trial☆