Oral and Maxillofacial Surgery
Oral hygiene and postoperative pain after mandibular third molar surgery*

https://doi.org/10.1067/moe.2001.115722Get rights and content

Abstract

Objective: The purpose of this study was to evaluate the association between oral hygiene before surgery and pain, inflammation, and trismus after the surgical removal of 190 impacted lower third molars. Study Design: Patient hygiene was assessed by the simplified oral hygiene index. The maximum active interincisal oral opening was determined before surgery by using a millimeter scale, from the upper incisive edge to the lower incisive edge. Pain and inflammation were in turn recorded in written form by each patient 2, 6, and 12 hours after the operation and every day thereafter for 7 days. Results: Maximum postoperative pain was recorded 6 hours after extraction, with peak inflammation after 24 hours. The patients with the poorest oral hygiene reported higher pain levels throughout the postoperative period and more analgesic consumption in the first 48 hours. In contrast, oral hygiene appeared to exert no influence on either trismus or inflammation. Conclusions: Poor oral hygiene before the surgical removal of 190 impacted lower third molars is correlated with greater postoperative pain. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:260-4)

Section snippets

Study sample

A total of 190 healthy subjects with impacted third molars (79 partially erupted, 85 submucosal, and 26 intraosseous teeth) volunteered to participate in the study. There were 127 females and 63 males, with a mean age of 25.9 years. The inclusion criteria were as follows: healthy patients seen in the outpatient clinic of Valencia University Dental School (Spain) who voluntarily agreed to participate in the study and presented with an impacted third molar (extraction with the raising of a

Results

Good oral hygiene before the extraction of the impacted third molar was observed in 61% of patients, with regular and poor hygiene in 29% and 10%, respectively. The surgical difficulty (based on Winter’s distance) was similar in all groups (P =.834). There were no significant differences with respect to the initial interincisal opening of the groups (P =.247). Of note, however, is the observation that the group with the poorest hygiene was made up mostly of males (P =.000) and exhibited a

Discussion

Some studies have shown preoperative chlorhexidine mouthrinse to reduce the incidence of dry socket in simple extractions19 and in extractions of lower third molars.20, 21, 22, 23 Rango and Szkutnik23 recommended that the patient use a 0.12% chlorhexidine mouthrinse solution before and after third molar surgery. Larsen21 recommended using chlorhexidine mouthrinse 1 week before the operation. Fotos et al25 reported a decrease in postoperative patient discomfort after introducing a collagen

References (26)

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*

Reprint requests: M. Peñarrocha-Diago, Clínica Odontológica, c/ Gascó Oliag 1, 46021–Valencia, Spain

a

Assistant Professor of Oral Surgery; Director, Master of Surgery and Implantology, Valencia University Medical and Dental School, Valencia, Spain.

b

Associate Professor of Oral Surgery, Valencia University Medical and Dental School, Valencia, Spain.

c

Dentist and Master of Surgery and Implantology, Valencia University Medical and Dental School, Valencia, Spain.

d

Professor and Chairman of Oral and Maxillofacial Surgery; Director, Master of Surgery and Implantology, Barcelona University Medical and Dental School, Barcelona, Spain.

e

Professor and Chairman of Oral Medicine, Valencia University Medical and Dental School, Valencia, Spain

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