Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient’s Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study

Mandibular third molar surgical extraction, either partially erupted or fully impacted, is the most common surgical procedure in oral and maxillofacial surgery (OMFS). However, this procedure can be associated with many postoperative complications including persistent pain, swelling, trismus, and paresthesia due to nerve injury. This study aimed to identify the correlation of postoperative complications with patient’s age, sex, and surgical difficulty level. This study was a cross-sectional retrospective and single-center research conducted on patients with a history of mandibular third molar surgical extraction in the period between 2017 and 2019 at Dental and Oral Hospital Universitas Airlangga, Surabaya, Indonesia. The researchers assessed the factors of age, sex, and surgical difficulty level regarding postoperative complications on the first day of the surgery and after one week on the 7th day of it. Among 916 respondents, the majority of the sample was females (59%) and the dominant age group (60.9%) was the age group of 21–30 years while the dominant surgical difficulty level was shown by the advanced cases group (77%). The statistical analysis showed that there was a significant correlation between surgical difficulty level and postoperative complications including pain, trismus, and paresthesia on the first-day assessment. On the other hand, age was significantly related to complications like pain, swelling, and trismus on the first-week assessment. Age and surgical difficulty level were the most common risk factors of the mandibular third molar extraction postoperative complications. Dentists should take into consideration that older patients (≥51 years) and patients with complex surgical level are more vulnerable to severe postoperative complications.

The Effect of Oral Ketorolac Compared to Ibuprofen on Edema, Trismus, and Pain After Mandibular Third Molar Surgery

Background: Latent third molar extraction is the most common surgery in dentistry. Common complications of this surgery include pain, swelling, and trismus. To control these side effects, several drugs have been developed and evaluated in various studies. However, the present study is the first one to compare the effects of ibuprofen and ketorolac on pain, swelling, and trismus after molar surgery. Methods: This study was a split-mouth clinical trial. To conduct the trial, 20 candidates were selected from among patients referring to Surgery Department of the Dentistry School at Yazd Shahid Sadoughi University of Medical Sciences for mandibular third molar removal surgery. The patients were divided into two groups after the surgery: one group received ibuprofen, and the other one received ketorolac. Pain, swelling, and trismus were evaluated prior to the surgical procedure, 24 hours later, and one week after the surgery. Data were analyzed by SPSS software version 22 by using Wilcoxon statistical tests and paired t test. Results: Ibuprofen and ketorolac had similar effects on pain relief (P value>0.05). Studying the two groups produced similar results regarding improvement in mouth opening (P value>0.05). Improvement pace of the postoperative swelling was significantly faster in the group receiving ketorolac compared to the one receiving ibuprofen (P value <0.05). Conclusions: It was concluded that ibuprofen and ketorolac had positive and almost similar effects on pain control, edema, and trismus after molar surgery. However, ketorolac was more effective in controlling edema after surgery.

Efficacy of ibuprofen gargle for postoperative pain after mandibular third molar extraction: a phase II, placebo-controlled, double-blind, randomized crossover trial (Preprint)

BACKGROUND Extraction of mandibular third molars is one of the most commonly performed oral surgical procedures, and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management. Oral administration of NSAIDs can produce various adverse events such as gastrointestinal disorders, renal and hepatic dysfunction, and platelet dysfunction. Topical use of analgesics has been proposed as an alternative to oral and injectable medications to safely improve postoperative pain relief. We will conduct a single-center, placebo-controlled, double-blind, randomized crossover trial to assess the pain-relieving effect of an ibuprofen-containing gargle in patients undergoing extraction of mandibular third molars in comparison with a placebo gargle. OBJECTIVE This will be the first clinical study to evaluate the efficacy of ibuprofen gargle for relieving postoperative pain after extraction of mandibular third molars. METHODS This study will be performed at Kobe University Hospital. Participants (n = 40) will be randomized equally to one of two groups. The IP group will receive ibuprofen gargle on postoperative day (POD) 1 and placebo gargle on POD 2. The PI group will receive placebo gargle on POD 1 and ibuprofen gargle on POD 2. Both groups will receive ibuprofen gargle on PODs 3 to 5 at least once daily. The primary objective is to estimate the within-subject difference in a visual analogue scale (VAS) before and 5 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2. The secondary objectives are to estimate the within-subject difference in ΔVAS before and 15 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2, the ΔVAS before and after 5 or 15 minutes of use of ibuprofen gargle on PODs 3 to 5, the overall effectiveness (self-completion, five scales) on PODs 1 to 5, the daily frequency of use (ibuprofen or placebo gargle and analgesics) on PODs 1 to 7, and the occurrence of adverse events. RESULTS The Kobe university Certified Review Board approved the study. The intervention was implemented in May 2021. CONCLUSIONS This trial will provide exploratory evidence of the efficacy and safety of ibuprofen gargle for pain reduction after mandibular third molar extraction. CLINICALTRIAL Japan Registry of Clinical Trials (jRCT) identifier: jRCTs051210022. Registered on 10 May 2021.

Septic arthritis of multiple native joints following tooth extraction

<p>Infection of the distant parts of the body especially the joints after a tooth extraction is uncommon, but when it occurs due to the virulence of the organism or due to the risk factors, it may cause severe joint infection with abscess formation and may limit the movements. We report a case of arthritis of the knee joint along with involvement of other joints following mandibular third molar teeth extraction one week postoperatively. The patient had swelling and limited range of motion of the involved joints, pain over other multiple joints. The patient had two episodes of postoperative septic arthritis following each mandibular third molar extraction. He was diagnosed of having septic arthritis and treated with antibiotics, analgesics, and steroids, that resolved after 3 weeks. </p>