Basic and patient-oriented research
Severe Third Molar Complications Including Death—Lessons from 100 Cases Requiring Hospitalization

https://doi.org/10.1016/j.joms.2007.04.014Get rights and content

Purpose

In this study we investigated patients that were hospitalized due to third molar (M3) complications. Specifically we analyzed frequency, age distribution, and outcome with respect to the M3 clinical status.

Patients and Methods

We set up a prospective cohort study and included 100 subjects admitted for management of acute M3-associated complications. The clinical status of the M3 was defined as 1) prophylactic M3 removal, 2) therapeutic (nonelective) M3 removal, or 3) M3 present at the time of admission. Outcome variables were clinical infection markers (C-reactive protein, leukocyte counts) and economic parameters (treatment costs, length of hospital stay, and days of disability). Nonparametric tests were used for comparison of subpopulations (surgical vs nonsurgical, prophylaxis-related vs nonprophylaxis-related).

Results

One third of the 100 patients were age 40 or older. Overall 80 severe infections, 11 mandibular fractures, 3 nerve injuries, 5 tooth/root luxations, and 1 postoperative hemorrhage were noticed. Twenty-seven complications resulted from prophylactic surgery, 44 from nonelective removal, and 29 from pericoronitis. Postoperatively, a 77-year-old male patient hospitalized with nonelective removal sustained fatal myocardial infarction. Treatment costs were 260,086 € (mean 2,608 €/case); total days of disability were 1,534. The postsurgical complications showed higher C-reactive protein values compared with pericoronitis-induced complications.

Conclusions

Within the catchment area of our institution, the majority of complications requiring hospitalization resulted from diseased third molars or their removal. Side effects of observational strategies such as the shifting of complications to higher ages deserve future attention.

Section snippets

Study Design and Sample

In this study, we used a prospective case series design in which all consecutive patients were enrolled who were admitted from general dental practitioners, oral surgeons, and maxillofacial surgeons for management of acute complications associated with M3. The patients were included in the study due to acute complications requiring urgent hospital treatment according to the German Appropriateness Evaluation Protocol (G-AEP) criteria for patient hospitalization, forwarded by the German Hospital

Patients and Diagnoses

The sample of 100 consecutive patients was enrolled within 3 years and 6 months. The patients requiring hospital treatment due to severe M3-associated complications represents 2.3% of the total number of patients hospitalized at our institution during this time interval. The catchment area of our hospital amounts to a population of roughly 2,600,000 which represents about 65% of the inhabitants of the county of “Rheinland Pfalz.”

Although there was a preponderance of young adults in this cohort,

Discussion

It was the lack of adequate data on M3-associated severe complications that prompted our prospective observational study in 2003. Meanwhile, we enrolled 100 cases in this sample which provides the basis to further analyze the clinical and economic variables with respect to the status of M3.

As in our previous report20 and in accordance with the data of Berge17, 18 we found a 2:1 preponderance of patients hospitalized due to complications arising from M3 removal versus those hospitalized due to

Cited by (41)

  • French good practice guidelines regarding third molar removal: Indications, techniques, methods

    2020, Journal of Stomatology, Oral and Maxillofacial Surgery
    Citation Excerpt :

    The most common post-surgery complications are: pain, oedema and trismus. Bleeding, infection, alveolitis, nerve lesions and more rarely mandibular fracture or an introduction of the tooth in the mouth floor, the maxillary sinus or the infra-temporal fossa may also occur [59–64]. Immediate or differed post-surgery analgesic care must be a constant concern of the surgeon [65–68].

  • Value in Oral and Maxillofacial Surgery: A Systematic Review of Economic Analyses

    2017, Journal of Oral and Maxillofacial Surgery
    Citation Excerpt :

    There were no CEAs pertaining to anesthesia, airway, and pain control. There were 16 studies on dentoalveolar surgery with publication dates ranging from 1990 to 2014, with 7 studies published in 2010 or later.27-42 Of the 16 studies, 6 originated from the United States.

View all citing articles on Scopus
View full text