Assessment of Oral Health–Related Quality of Life Before and After Third Molar Surgery

doi:10.1016/j.joms.2006.03.052

Journal of Oral and Maxillofacial Surgery

Volume 64, Issue 12, December 2006, Pages 1721-1730

https://doi.org/10.1016/j.joms.2006.03.052 Get rights and content

Purpose

This study was designed to further our understanding of recovery after third molar surgery by using 2 instruments to measure quality of life outcomes, the more global Oral Health Impact Profile (OHIP-14), and the condition-specific Health-Related Quality of Life (HRQOL) instrument.

Patients and Methods

Clinical and quality of life data pre- and postsurgery from 63 patients with all 4 third molars below the occlusal plane, treated with topical minocycline during third molar surgery to reduce the incidence of delayed clinical healing, were available for analyses. Each patient was given 2 questionnaires to complete; the more global OHIP-14 and the HRQOL instrument designed to assess recovery after third molar surgery. Prevalence, Extent, and Severity of the OHIP-14 scores were calculated presurgery and for postsurgery days (PSD) 1, 7, 14. The percentage of patients reporting clinically relevant responses detrimental to quality of life from the condition-specific HRQOL instrument were reported for the same time frame.

Results

Study patients were most likely female, less than 25 years old, and Caucasian. Most (72%) had bone removed from both lower third molars. Median surgery time was 27 minutes (interquartile range [IQ], 20, 40 minutes.). Median surgeons’ estimate of overall difficulty was 14 of a possible 28 (IQ 10, 18), and the median degree of difficulty for lower third molars was 8 of 14 (IQ 6, 10). Few patients (only 10%) had delayed clinical healing. Prevalence for all OHIP-14 items, percent of patients reporting items “fairly often” or “very often,” were increased from presurgery on PSD 1 and then decreased on PSD 7 and PSD 14. OHIP-14 Severity scores, the sum of OHIP-14 responses, followed the same pattern as the Prevalence scores. OHIP-14 Severity scores on PSD 1 were 27 (IQ 16, 34), decreasing to 8 (IQ 3, 13) by PSD 7, and 1 (IQ 0, 5) by PSD 14. Recovery for outcomes addressed by both instruments followed a similar pattern and time course. However, each instrument also assessed distinctly different outcomes, adding information that could not be obtained by 1 instrument alone.

Conclusion

Complementary instruments to measure quality of life outcomes provide a broader understanding of recovery after third molar surgery.

Section snippets

Patients and Methods

For our analyses, pre- and postsurgery data were available from 63 patients treated in a prospective, Institutional Review Board–approved, clinical trial at 2 community practices and 2 academic centers. Based on the data reported by Phillips et al,¹² the study patients were predicted to be at higher risk for delayed clinical and health-related quality of life recovery. Patients were treated at surgery with topical minocycline (1 mg) in sustained release microspheres placed in lower third molar

Results

All 63 enrolled patients having 4 third molars removed completed the OHIP-14 and the HRQOL questionnaires. A majority of study patients were female, 85% were less than 25 years old, and 87% were Caucasian (Table 1). Over half were educated beyond high school.

Forty percent reported prior third molar symptoms of pain and swelling sufficient to seek third molar removal (Table 2). Most (72%) had bone removal from both lower third molars. Median surgery time was 27 minutes, interquartile range (IQ

Discussion

The most pertinent clinical finding from this study was that recovery following third molar surgery was rapid when assessed by any of the patient-reported indicators of quality of life. Results were similar no matter which instrument was used to measure recovery. By PSD 14 few patients reported an impact on quality of life that could be attributed to third molar surgery. Five percent or less reported any item on OHIP-14 “fairly often” or “very often” (Table 3). With the exception of the 8%

Acknowledgment

The authors thank the surgeons and their patients who volunteered to provide data for this analysis. The authors also thank Debora Price for helping manage data for this project.

References (22)

G.D. Slade et al.
The impact of third molar symptoms, pain and swelling, on oral health related quality of life
J Oral Maxillofac Surg
(2004)
C. McGrath et al.
Patient-centered outcome measures in oral surgery: Validity and sensitivity
Br J Oral Maxillofac Surg
(2003)
C. McGrath et al.
Can third molar surgery improve quality of life?A 6-month cohort study
J Oral Maxillofac Surg
(2003)
D.A. Shugars et al.
Developing a measure of patient perceptions of short-term outcomes of third molar surgery
J Oral Maxillofac Surg
(1996)
S.M. Conrad et al.
Patients’ perception of recovery after third molar surgery
J Oral Maxillofac Surg
(1999)
R.P. White et al.
Recovery after third molar surgery: Clinical and health related quality of life outcomes
J Oral Maxillofac Surg
(2003)
R.H. Gracely et al.
The descriptor scale: Applying psychophysical principles to clinical pain assessment
Pain
(1988)
C. Phillips et al.
Risk factors associated with prolonged recovery and delayed clinical healing after third molar surgery
J Oral Maxillofac Surg
(2003)
A. Ruvo et al.
Delayed clinical recovery and health related quality of life outcomes after third molar surgery
J Oral Maxillofac Surg
(2005)
S.P. Foy et al.
Outcomes following third molar surgery with intravenous antibiotics in patients at risk for delayed recovery
J Oral Maxillofac Surg
(2004)

M.F. Stavropoulos et al.

The impact of topical minocycline with third molar surgery on clinical recovery and health related quality of life outcomes

J Oral Maxillofac Surg

(2006)

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: Supported by the Dental Foundation of North Carolina, the Oral and Maxillofacial Surgery Foundation, and the American Association of Oral and Maxillofacial Surgeons.

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Basic and patient-oriented researchAssessment of Oral Health–Related Quality of Life Before and After Third Molar Surgery

Purpose

Patients and Methods

Results

Conclusion

Section snippets

Patients and Methods

Results

Discussion

Acknowledgment

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Pain

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Basic and patient-oriented research
Assessment of Oral Health–Related Quality of Life Before and After Third Molar Surgery