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Dignam P, Elshafey M, Jeganathan A, Foo M, Park JS, Ratnaweera M. Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review. Int J Dent 2024; 2024:7712829. [PMID: 38756385 PMCID: PMC11098612 DOI: 10.1155/2024/7712829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs. Objectives This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence. Results Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity. Conclusion This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.
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Affiliation(s)
- Peter Dignam
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Mariam Elshafey
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Aparna Jeganathan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Magdalen Foo
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, Australia
- International Research Collaborative—Oral Health and Equity, School of Allied Health, The University of Western Australia, Crawley, Australia
- School of Engineering, Information Technology and Physical Sciences, Federation University Australia, Victoria, Ballarat, Australia
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Starch-Jensen T, Gacic B, Konstantinovic VS, Valls Ontañón A, Sapundzhiev A, Pavlov N, Pechalova P, Szalma J, Mottl R, Tamme T, Tiigimäe-Saar J, Ivask O, Božič V, Jovanovski T, Dovšak T, Țenț PA, Brucoli M, Rocchetti V, Boffano P. Patient's perception of recovery following surgical removal of mandibular third molars. A prospective european multi-center study. J Craniomaxillofac Surg 2023; 51:635-643. [PMID: 37858483 DOI: 10.1016/j.jcms.2023.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Bojan Gacic
- School of Dental Medicine, University of Belgrade, Serbia
| | | | | | - Angel Sapundzhiev
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria
| | - Nikolay Pavlov
- University Hospital "St. Georgi", Clinic of Maxillofacial Surgery, Plovdiv, Bulgaria
| | - Petia Pechalova
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria
| | - József Szalma
- Department of Oral Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Radovan Mottl
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, Hradec Kralove, 500 05, Hradec Kralove, Czech Republic
| | - Tiia Tamme
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Janne Tiigimäe-Saar
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Oksana Ivask
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Veronika Božič
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Trajche Jovanovski
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Tadej Dovšak
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paul Andrei Țenț
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Oradea, Romania
| | - Matteo Brucoli
- Division of Oral and Maxillo-Facial Surgery, Novara University Hospital, Novara, Italy
| | | | - Paolo Boffano
- Division of Dentistry, Vercelli Hospital, Vercelli, Italy
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Li TT, Wei Y, Zhou HS, Xiao QX, Wang C, Xiong LL, Ao J, Wang TH, Yuan H. The Difference of Disease Injury and Postoperative Recovery in the Occupational Characteristics of Thoracolumbar Fracture Patients: A Retrospective Study. Orthop Surg 2022; 14:2059-2072. [PMID: 35913219 PMCID: PMC9483088 DOI: 10.1111/os.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives Understanding the occupational characteristics of patients is not only related to patients' life and health, but also conducive to improving their happiness. However, there were no studies that had been conducted on the relationship between occupation characteristic and postoperative recovery in patients with spinal fractures. The purpose of this study was to explore the relationship between the occupation characteristics of patients with thoracolumbar fracture and the characteristics of disease injury, treatment, and recovery so as to reduce the incidence and improve postoperative rehabilitation. Methods Patients (n = 719) with thoracolumbar fractures were recruited. Patients were grouped according to the characteristic of occupations: unemployed group (n = 299), white‐collar worker group (n = 20), and blue‐collar worker group (n = 400). Data were collected, including the characteristics, injury and treatment information, and the recovery records for 1 year after operation. One‐way ANOVA analysis, χ2 test, and binary logistic regression analysis was used to explore the relationship among these factors. Results Male, high‐falling injuries and single segment injury (mainly T 11, T 12 and L2) were common in patients with thoracolumbar fractures, especially in the blue‐collar worker group (70.8%, 78.3%, and 85.4%). Compared with the unemployed group, the patients in the white‐collar worker group and blue‐collar worker group had a higher proportion of young patients, a higher height and weight, a lesser rate of hypertension or diabetes. One week after injury, 73.4% of patients underwent surgery, with the blue‐collar worker group accounted for the largest proportion. One month after surgery, 77.1% of patients were able to get out of bed, with the white‐collar worker group accounted for the largest proportion. In the postoperative recovery information, patients in the blue‐collar worker group were more likely to have severe low back pain (OR = 2.023, 95% CI: 1.440‐2.284) and pain‐disturbed sleep (OR = 2.287, 95% CI: 1.585‐3.299) than those who in the unemployed group. Conclusions Blue‐collar workers, with a high risk of thoracolumbar fracture, have a higher incidence of low back leg pain and pain‐disturbed sleep in the recovery after thoracolumbar fracture surgery, and this requires more attention.
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Affiliation(s)
- Ting-Ting Li
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wei
- Gynecology Department, Chengdu Second People's Hospital, Chengdu, China
| | - Hong-Su Zhou
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qiu-Xia Xiao
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chong Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Liu-Lin Xiong
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jun Ao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ting-Hua Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Institue of Neuroscience, Animal Zoology Department, Kunming Medical University, Kunming, China
| | - Hao Yuan
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Institue of Neuroscience, Animal Zoology Department, Kunming Medical University, Kunming, China
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Braimah RO, Ali-Alsuliman D, Al-Sagoor ST, Al-walah AS, Al-makrami R, Taiwo AO, Ibikunle AA. Oral Health-related Quality of Life (OHRQoL) Following Surgical Extraction of Impacted Mandibular Third Molars: Preliminary Observations in a Saudi Arabian Subpopulation. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:7-12. [PMID: 36188062 PMCID: PMC9516752 DOI: 10.4103/jwas.jwas_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/07/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION OHQoL is crucial for the best preoperative assessment and development of suitable indications for mandibular third molar surgical extraction. The current study hopes to report QoL after surgical extraction of impacted mandibular third molars. MATERIALS AND METHODS This was a prospective study conducted in the Department of Oral and Maxillofacial Surgery, between January 2020 and April 2020. After consenting to partake in the study, patients' baseline demographics, indication for seeking third molar removal and laterality of impaction were recorded. All the surgical extractions were performed by the same surgeon. Pain was assessed pre and postoperatively with the numerical pain rating scale while QoL was assessed pre and postoperatively using the validated Arabic version of the 16 item United Kingdom Oral Health Related Quality of Life measure (UK-OHQoL). RESULTS A total of 92 patients were recruited. There are 41 (44.6%) males and 51 (55.4%) females with M:F of 1:1.2. Age range was between 18 and 48 years with a mean of (31.2 ± 6.6) years. Age group 20-29 years constitutes the highest number of patients. Subscales: eating, appearance, sleep, mood and work revealed more percentage complaints (42.9%, 23.4%, 24.7%, 28.6%, and 16.9%, respectively). Regarding mean domain and overall QoL scores, it was observed that there was gradual improvement in mean scores from the Pre-op values and the review periods with best mean QoL reported at POD 14. CONCLUSION Improvement in overall mean QoL scores during the review periods as compared with the preoperative score was observed. Eating, appearance, sleep, mood and work subscales revealed more percentage complaints.
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Affiliation(s)
- Ramat Oyebunmi Braimah
- Department of Oral and Maxillofacial Surgery, Najran Regional Specialty Dental Centre, Medical Village Complex, Najran, Kingdom of Saudi Arabia
| | - Dawood Ali-Alsuliman
- Department of Oral and Maxillofacial Surgery, Najran Regional Specialty Dental Centre, Medical Village Complex, Najran, Kingdom of Saudi Arabia
| | - Saeed Turki Al-Sagoor
- Department of Oral and Maxillofacial Surgery, Najran Regional Specialty Dental Centre, Medical Village Complex, Najran, Kingdom of Saudi Arabia
| | - Abdullah Saleh Al-walah
- Department of Oral and Maxillofacial Surgery, Najran Regional Specialty Dental Centre, Medical Village Complex, Najran, Kingdom of Saudi Arabia
| | - Reham Al-makrami
- Department of Oral and Maxillofacial Surgery, Najran Regional Specialty Dental Centre, Medical Village Complex, Najran, Kingdom of Saudi Arabia
| | - Abdulrazaq Olanrewaju Taiwo
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, Usmanu Danfodiyo University, Sokotom, Nigeria
| | - Adebayo Aremu Ibikunle
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Kjærgaard Larsen M, Kofod T, Starch-Jensen T. The Use of Cryotherapy in Conjunction with Surgical Removal of Mandibular Third Molars: a Single-Blinded Randomized Controlled Trial. J Oral Maxillofac Res 2021; 12:e2. [PMID: 35222869 PMCID: PMC8807147 DOI: 10.5037/jomr.2021.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022]
Abstract
Objectives Cryotherapy is frequently used to diminish postoperative sequelae following mandibular third molar surgery. The objective of this single-blinded randomized controlled trial was to assess the therapeutic efficiency of 30 minutes continuous cryotherapy on postoperative sequelae following surgical removal of mandibular third molars compared with no cryotherapy. Material and Methods Thirty patients (14 male and 16 female) including 60 mandibular third molars were randomly allocated to 30 minutes of immediately cryotherapy or no cryotherapy. Outcome measures included pain (visual analogue scale score), maximum mouth opening (trismus) and quality of life (oral health impact profile-14). Outcome measures were assessed preoperatively and one day, three days, seven days and one month following surgical removal of mandibular third molars. Descriptive and generalized estimating equation analyses were made. Level of significance was 0.05. Results No cryotherapy following surgical removal of mandibular third molars revealed a statistically significant lower visual analogue scale score of pain compared to thirty minutes of continuous cryotherapy after one day (P < 0.05). However, no statistically significant difference in trismus or oral health-related quality of life were revealed at any time point compared with no cryotherapy. Conclusions The therapeutic effect of 30 minutes continuous cryotherapy following surgical removal of mandibular third molars seem to be negligible. Thus, further randomized controlled trials assessing a prolonged application period of cryotherapy, alternative devices or use of intermittent cryotherapy are needed before definite conclusions and evidence-based clinical recommendations can be provided.
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Affiliation(s)
| | - Thomas Kofod
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, RigshospitaletDenmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University HospitalDenmark
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PROPHYLACTIC VS. SYMPTOMATIC THIRD MOLAR REMOVAL: EFFECTS ON PATIENT POSTOPERATIVE MORBIDITY. J Evid Based Dent Pract 2021; 21:101582. [DOI: 10.1016/j.jebdp.2021.101582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/22/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
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Steel BJ, Surendran KSB, Braithwaite C, Mehta D, Keith DJW. Current thinking in lower third molar surgery. Br J Oral Maxillofac Surg 2021; 60:257-265. [PMID: 34728107 DOI: 10.1016/j.bjoms.2021.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
The removal of lower third molar teeth is one of the most common surgical procedures performed worldwide, but many concepts in this surgery have been unclear and have engendered different opinions. This paper aims to review current thinking in certain pertinent aspects of this surgery to update the reader on the most current research and synthesise it to make clinical recommendations. Topics covered include preoperative imaging, timing of removal, flap design, lingual retraction, coronectomy, lingual split, closure techniques, and use of antibiotics, steroids, and drains.
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Affiliation(s)
- Ben J Steel
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK.
| | - Krisna S B Surendran
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
| | - Christopher Braithwaite
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
| | - Darpan Mehta
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
| | - David J W Keith
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
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Siracusa R, Monaco F, D’Amico R, Genovese T, Cordaro M, Interdonato L, Gugliandolo E, Peritore AF, Crupi R, Cuzzocrea S, Impellizzeri D, Fusco R, Di Paola R. Epigallocatechin-3-Gallate Modulates Postoperative Pain by Regulating Biochemical and Molecular Pathways. Int J Mol Sci 2021; 22:ijms22136879. [PMID: 34206850 PMCID: PMC8268037 DOI: 10.3390/ijms22136879] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Treating postoperative (PO) pain is a clinical challenge. Inadequate PO pain management can lead to worse outcomes, for example chronic post-surgical pain. Therefore, acquiring new information on the PO pain mechanism would increase the therapeutic options available. In this paper, we evaluated the role of a natural substance, epigallocatechin-3-gallate (EGCG), on pain and neuroinflammation induced by a surgical procedure in an animal model of PO pain. We performed an incision of the hind paw and EGCG was administered for five days. Mechanical allodynia, thermal hyperalgesia, and motor dysfunction were assessed 24 h, and three and five days after surgery. At the same time points, animals were sacrificed, and sera and lumbar spinal cord tissues were harvested for molecular analysis. EGCG administration significantly alleviated hyperalgesia and allodynia, and reduced motor disfunction. From the molecular point of view, EGCG reduced the activation of the WNT pathway, reducing WNT3a, cysteine-rich domain frizzled (FZ)1 and FZ8 expressions, and both cytosolic and nuclear β-catenin expression, and the noncanonical β-catenin–independent signaling pathways, reducing the activation of the NMDA receptor subtype NR2B (pNR2B), pPKC and cAMP response element-binding protein (pCREB) expressions at all time points. Additionally, EGCG reduced spinal astrocytes and microglia activation, cytokines overexpression and nuclear factor kappa-light-chain-enhancer of activated B cells (NFkB) pathway, downregulating inducible nitric oxide synthase (iNOS) activation, cyclooxygenase 2 (COX-2) expression, and prostaglandin E2 (PGE2) levels. Thus, EGCG administration managing the WNT/β-catenin signaling pathways modulates PO pain related neurochemical and inflammatory alterations.
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Affiliation(s)
- Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
| | - Francesco Monaco
- Department of Biomedical, Dental and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy; (F.M.); (M.C.)
| | - Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
| | - Tiziana Genovese
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
| | - Marika Cordaro
- Department of Biomedical, Dental and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy; (F.M.); (M.C.)
| | - Livia Interdonato
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
| | - Enrico Gugliandolo
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy; (E.G.); (R.C.)
| | - Alessio Filippo Peritore
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
| | - Rosalia Crupi
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy; (E.G.); (R.C.)
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
- Correspondence: ; Tel.: +39-090-676-5208
| | - Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
| | - Rosanna Di Paola
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98168 Messina, Italy; (R.S.); (R.D.); (T.G.); (L.I.); (A.F.P.); (S.C.); (R.F.); (R.D.P.)
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Effects of Curcumin and Its Different Formulations in Preclinical and Clinical Studies of Peripheral Neuropathic and Postoperative Pain: A Comprehensive Review. Int J Mol Sci 2021; 22:ijms22094666. [PMID: 33925121 PMCID: PMC8125634 DOI: 10.3390/ijms22094666] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Lesion or disease of the somatosensory system leads to the development of neuropathic pain. Peripheral neuropathic pain encompasses damage or injury of the peripheral nervous system. On the other hand, 10–15% of individuals suffer from acute postoperative pain followed by persistent pain after undergoing surgeries. Antidepressants, anticonvulsants, baclofen, and clonidine are used to treat peripheral neuropathy, whereas opioids are used to treat postoperative pain. The negative effects associated with these drugs emphasize the search for alternative therapeutics with better efficacy and fewer side effects. Curcumin, a polyphenol isolated from the roots of Curcuma longa, possesses antibacterial, antioxidant, and anti-inflammatory properties. Furthermore, the low bioavailability and fast metabolism of curcumin have led to the advent of various curcumin formulations. The present review provides a comprehensive analysis on the effects of curcumin and its formulations in preclinical and clinical studies of neuropathic and postoperative pain. Based on the positive outcomes from both preclinical and clinical studies, curcumin holds the promise of mitigating or preventing neuropathic and postoperative pain conditions. However, more clinical studies with improved curcumin formulations are required to involve its use as adjuvant to neuropathic and postoperative drugs.
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Larsen MK, Kofod T, Duch K, Starch-Jensen T. Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial. Med Oral Patol Oral Cir Bucal 2021; 26:e156-e163. [PMID: 32701926 PMCID: PMC7980302 DOI: 10.4317/medoral.24094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/10/2020] [Indexed: 11/09/2022] Open
Abstract
Background The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3).
Material and Methods Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval.
Results Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00).
Conclusions The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo. Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.
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Affiliation(s)
- M-K Larsen
- Department of Oral and Maxillofacial Surgery Aalborg University Hospital 18-22 Hobrovej, DK-9000 Aalborg, Denmark
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Hounsome J, Pilkington G, Mahon J, Boland A, Beale S, Kotas E, Renton T, Dickson R. Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-116. [PMID: 32589125 PMCID: PMC7336222 DOI: 10.3310/hta24300] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment options for people with impacted third molars are removal or retention with standard care. If there are pathological changes, the current National Institute for Health and Care Excellence guidance states that the impacted third molar should be removed. OBJECTIVE The objective of this study was to appraise the clinical effectiveness and cost-effectiveness of the prophylactic removal of impacted mandibular third molars compared with retention of, and standard care for, impacted third molars. METHODS Five electronic databases were searched (1999 to 29 April 2016) to identify relevant evidence [The Cochrane Library (searched 4 April 2016 and 29 April 2016), MEDLINE (searched 4 April 2016 and 29 April 2016), EMBASE (searched 4 April 2016 and 29 April 2016), EconLit (searched 4 April 2016 and 29 April 2016) and NHS Economic Evaluation Database (searched 4 April 2016)]. Studies that compared the prophylactic removal of impacted mandibular third molars with retention and standard care or studies that assessed the outcomes from either approach were included. The clinical outcomes considered were pathology associated with retention, post-operative complications following extraction and adverse effects of treatment. Cost-effectiveness outcomes included UK costs and health-related quality-of-life measures. In addition, the assessment group constructed a de novo economic model to compare the cost-effectiveness of a prophylactic removal strategy with that of retention and standard care. RESULTS The clinical review identified four cohort studies and nine systematic reviews. In the two studies that reported on surgical complications, no serious complications were reported. Pathological changes due to retention of asymptomatic impacted mandibular third molars were reported by three studies. In these studies, the extraction rate for retained impacted mandibular third molars varied from 5.5% to 31.4%; this variation can be explained by the differing follow-up periods (i.e. 1 and 5 years). The findings from this review are consistent with the findings from previous systematic reviews. Two published cost-effectiveness studies were identified. The authors of both studies concluded that, to their knowledge, there is currently no economic evidence to support the prophylactic removal of impacted mandibular third molars. The results generated by the assessment group's lifetime economic model indicated that the incremental cost-effectiveness ratio per quality-adjusted life-year gained for the comparison of a prophylactic removal strategy with a retention and standard care strategy is £11,741 for people aged 20 years with asymptomatic impacted mandibular third molars. The incremental cost per person associated with prophylactic extraction is £55.71, with an incremental quality-adjusted life-year gain of 0.005 per person. The base-case incremental cost-effectiveness ratio per quality-adjusted life-year gained was found to be robust when a range of sensitivity and scenario analyses were carried out. LIMITATIONS Limitations of the study included that no head-to-head trials comparing the effectiveness of prophylactic removal of impacted mandibular third molars with retention and standard care were identified with the assessment group model that was built on observational data. Utility data on impacted mandibular third molars and their symptoms are lacking. CONCLUSIONS The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy. FUTURE WORK Effectiveness evidence is lacking. Head-to-head trials comparing the prophylactic removal of trouble-free impacted mandibular third molars with retention and watchful waiting are required. If this is not possible, routine clinical data, using common definitions and outcome reporting methods, should be collected. STUDY REGISTRATION This study is registered as PROSPERO CRD42016037776. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Juliet Hounsome
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Gerlinde Pilkington
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - James Mahon
- Coldingham Analytical Services, Berwickshire, UK
| | - Angela Boland
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sophie Beale
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Eleanor Kotas
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Tara Renton
- Oral Surgery, Dental Hospital, King's College London, London, UK
| | - Rumona Dickson
- Liverpoool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
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Qiao F, Huang X, Li B, Dong R, Huang X, Sun J. A Validated Model to Predict Postoperative Symptom Severity After Mandibular Third Molar Removal. J Oral Maxillofac Surg 2020; 78:893-901. [PMID: 32151651 DOI: 10.1016/j.joms.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE The individualized prediction of postoperative symptom severity is essential for selecting interventions after mandibular third molar (M3M) removal. The purpose of the present study was to develop and validate a nomogram for personal prediction of postoperative symptom severity. MATERIALS AND METHODS A prospective cohort study was performed in the Stomatology Hospital of Tianjin Medical University. The sample was divided into training and testing data sets by time. The demographic, anatomic, radiographic, and operative variables were recorded. The self-reported postoperative symptom severity was recorded and defined as the primary outcome variable. Stepwise forward algorithms were applied to informative predictors based on Akaike's information criterion. Multivariable logistic regression analysis was used to develop the nomogram. An independent testing data set was used to validate the nomogram. Receiver operating characteristic curves and the Hosmer-Lemeshow test were used to assess model performance. P < .05 was considered to indicate statistical significance. RESULTS The sample included 321 subjects who had undergone M3M removal. An independent validation data set included 103 consecutive patients. The median operation time was 15.0 minutes (interquartile range, 8.3 to 21.6 minutes) in the training data set (n = 218). Patients with serious postoperative symptoms accounted for 48.6 and 47.6% of the training and testing data sets, respectively. Gender, age, smoking status, operation time, Pell-Gregory ramus classification, and preoperative symptoms were identified as predictors and assembled into the nomogram. The area under curve demonstrated adequate discrimination in the validation data set (0.69; 95% confidence interval, 0.59 to 0.80). The nomogram was well calibrated, with a Hosmer-Lemeshow χ2 statistic of 6.33 (P = .78) in the testing data set. The confusion matrix was also summarized, and the accuracy was 63.3 and 65.1% in the training and testing data set, respectively. CONCLUSIONS The present study has proposed an effective nomogram with potential application in facilitating the individualized prediction of postoperative symptom severity after M3M removal.
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Affiliation(s)
- Feng Qiao
- Associate Chief Physician, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China.
| | - Xiaohuan Huang
- Graduate Student, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
| | - Bolong Li
- Graduate Student, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
| | - Rui Dong
- Attending Surgeon, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
| | - Xin Huang
- Resident Physician, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
| | - Jun Sun
- Resident Physician, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
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Avellaneda-Gimeno V, Figueiredo R, Valmaseda-Castellón E. Quality of life after upper third molar removal: A prospective longitudinal study. Med Oral Patol Oral Cir Bucal 2017; 22:e759-e766. [PMID: 29053650 PMCID: PMC5813995 DOI: 10.4317/medoral.21781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/11/2017] [Indexed: 12/03/2022] Open
Abstract
Background Third molar extraction is a very common procedure in Dentistry. The aim of this study was to evaluate the quality of life (QoL) and satisfaction of patients undergoing extraction of an upper third molar under local anesthesia. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after surgery and its relationship with pre- and intraoperative factors. Material and Methods A prospective longitudinal cohort study was made. Fifty-five patients received a questionnaire assessing social and working isolation, eating and speaking ability, diet modifications, sleep impairment, physical appearance, discomfort at suture removal and overall satisfaction. Pain was registered daily on a VAS scale. A descriptive and bivariate analysis of the data was performed. Results Forty-seven patients were included. Pain decreased lineally across the 7 days, and relief was significant between days 2 and 3. Intraoperative complications were significantly associated with pain. The complication that showed the highest pain score was the tuberosity fracture. Conclusions Upper third molar removal significantly affects the patient’s quality of life, particularly during the first 2 days after extraction. Key words:Quality of life, upper third molar, extraction, complications.
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Affiliation(s)
- V Avellaneda-Gimeno
- Facultat d'Odontologia, Campus de Bellvitge, Universitat de Barcelona (UB), Pavelló de Govern; 2 planta, Despatx 2.9, C/ Feixa Llarga s/n, E-08907 L'Hospitalet de Llobregat,
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Single-Dose of Submucosal Injection of Dexamethasone Affects the Post Operative Quality of Life After Third Molar Surgery. J Maxillofac Oral Surg 2015; 15:367-375. [PMID: 27752209 DOI: 10.1007/s12663-015-0846-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/18/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Third molar surgery (TMS) became a routine, safe office procedure with generally predictable outcomes and relative low cost. It affects quality of life (QOL) of patients by causing considerable pain, swelling and trismus; by changing what people eat, their speech in the first few days after surgery. The purpose of the present study was to improve QOL of patient after lower TMS by injecting single dose 8 mg submucosal dexamethasone. MATERIALS AND METHODS Forty healthy adult subjects of either gender underwent surgical removal of the lower impacted third molar under local anaesthesia and after being randomly assigned to receive either 8 mg dexamethasone submucosal injection or normal saline injection in proximity to surgical site. STATISTICAL ANALYSIS USED Chi-square test, Mann-Whitney U test (Z), t student and unpaired t test, and Fisher extract test were used for calculation of data. RESULTS Facial swelling, trismus showed significant reduction immediate postoperative day in dexamethasone groups. Patient perception postoperative pain on VAS score was not significant. PoSSe statistics, only three out of seven subscales showed a statistically significant difference between groups viz., Eating subscale, Appearance subscale, Sickness subscale but over all improvement in QOL was observed. CONCLUSIONS Submucosal dexamethasone effectively reduces postoperative sequelae and improves postoperative QOL after TMS.
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Almpani K, Kolokitha OE. Role of third molars in orthodontics. World J Clin Cases 2015; 3:132-140. [PMID: 25685759 PMCID: PMC4317606 DOI: 10.12998/wjcc.v3.i2.132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/10/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
The role of third molars in the oral cavity has been extensively studied over the years. Literature includes numerous diagnostic and treatment alternatives regarding the third molars. However, an issue that has not been discussed at the same level is their involvement in orthodontic therapy. The aim of this study is to present a review of the contemporary literature regarding the most broadly discussed aspects of the multifactorial role of third molars in orthodontics and which are of general dental interest too.
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Antinociceptive effects of curcumin in a rat model of postoperative pain. Sci Rep 2014; 4:4932. [PMID: 24816565 PMCID: PMC4017214 DOI: 10.1038/srep04932] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/24/2014] [Indexed: 12/21/2022] Open
Abstract
Curcumin is a principal ingredient of traditional Chinese medicine, Curcuma Longa, which possesses a variety of pharmacological activities including pain relief. Preclinical studies have demonstrated that curcumin has antinociceptive effects for inflammatory and neuropathic pain. This study examined the effects of curcumin in a rat model of postoperative pain. A surgical incision on the right hind paw induced a sustained mechanical hyperalgesia that lasted for 5 days. Acute curcumin treatment (10-40 mg/kg, p.o) significantly and dose dependently reversed mechanical hyperalgesia. In addition, repeated curcumin treatment significantly facilitated the recovery from surgery. In contrast, repeated treatment with curcumin before surgery did not impact the postoperative pain threshold and recovery rate. All the doses of curcumin did not significantly alter the spontaneous locomotor activity. Combined, these results suggested that curcumin could alleviate postoperative pain and promote recovery from the surgery, although there was no significant preventive value. This study extends previous findings and supports the application of curcumin alone or as an adjunct therapy for the management of peri-operative pain.
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Kim CW, Kim SG, Park SW, Chee YJ. Evaluation of masseter muscle electromyography after surgical extraction of third molar. Oral Maxillofac Surg 2014; 19:13-8. [PMID: 24535133 DOI: 10.1007/s10006-014-0442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/23/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to evaluate the results of electromyographies (EMGs) of the masseter muscle after mandibular third molar surgery and to determine the relationships between clinical variables and EMG results. PATIENTS AND METHODS Seventy patients were included in the study. The parameters of the patients' masseter muscles were measured using EMG prior to operation and 7 and 21 days post-operation. Clinical variables were also recorded before and after the third molar surgeries. RESULTS When the masseter muscle EMG results from the tooth-extracted side were compared with those from the non-extracted (control) side, significant differences in the areas of voltage, power spectral densities and median frequencies (p = 0.011, 0.017 and 0.041, respectively) were found 7 days postoperatively. Additionally, there were significant associations between some clinical variables (i.e. postoperative swelling, bone reduction and pericoronitis) and the EMG results 7 days postoperatively, (p < 0.05). However, there were no significant differences 21 days postoperatively. CONCLUSION This study revealed that the postoperative changes in EMG activities were transient. Although there have been controversies about the reliability of EMG, this study showed that some EMG variables could be used to evaluate postoperative changes in masseter muscle activity.
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Affiliation(s)
- Chan-Woo Kim
- Department of Oral and Maxillofacial Surgery, Collage of Dentistry, Gangneung-Wonju National University, Jibyun-dong, Gangneung, Gangwon-do, 210-702, Republic of Korea
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Summary of the Third Molar Clinical Trials: report of the AAOMS Task Force for Third Molar Summary. J Oral Maxillofac Surg 2012; 70:2238-48. [PMID: 22907112 DOI: 10.1016/j.joms.2012.06.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 06/22/2012] [Indexed: 01/18/2023]
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Phillips C, White RP. How predictable is the position of third molars over time? J Oral Maxillofac Surg 2012; 70:S11-4. [PMID: 22705213 DOI: 10.1016/j.joms.2012.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to review contemporaneous longitudinal studies focused on changes in the position of third molars. MATERIALS AND METHODS A systematic search of the National Library of Medicine (PubMed, http://www.pubmed.gov) and the Cochrane Central Register of Controlled Trials (http://www.mrw.interscience.wiley.com/cochrane) was conducted to identify eligible articles. The inclusion criteria were 1) longitudinal assessment (retrospective or prospective); 2) published in English; and 3) full text available online or at the University of North Carolina Health Sciences Library. RESULTS Five studies met the inclusion criteria. The status of third molars with respect to eruption/angulation was operationalized in multiple ways, making any comparison of the frequency of changes in position difficult. The major findings of each study are reviewed. CONCLUSIONS Few longitudinal data exist on the changes over time of impacted third molars. Impacted teeth that remain static, with no changes in position or angulation over time, are rare.
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Affiliation(s)
- Ceib Phillips
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599, USA.
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Pitak-Arnnop P, Pausch NC. Female and older adult patients (age ≥ 21 Years) had slower recovery after third-molar surgery compared with males and younger adults in a US study. J Evid Based Dent Pract 2011; 11:196-9. [PMID: 22078833 DOI: 10.1016/j.jebdp.2011.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Recovery after third-molar surgery: the effects of age and sex. Phillips C, Gelesko S, Proffit WR, White RP Jr. Am J Orthod Dentofacial Orthop 2010;138(6):700.e1-8 REVIEWERS Poramate Pitak-Arnnop, DDS, PGDipClinSc (OMS), MSc, PhD, DSc Niels Christian Pausch, MD, DMD, PhD. PURPOSE/QUESTION To assess the effects of age and gender on quality-of-life recovery after third-molar surgery in patients treated in either community practices or academic centers. SOURCE OF FUNDING The Oral and Maxillofacial Surgery Foundation, the American Association of Oral and Maxillofacial Surgeons, and the Dental Foundation of North America. TYPE OF STUDY/DESIGN Cohort study. LEVEL OF EVIDENCE Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE Not applicable.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Scientific Unit for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany.
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Kandasamy S. Evaluation and management of asymptomatic third molars: Watchful monitoring is a low-risk alternative to extraction. Am J Orthod Dentofacial Orthop 2011; 140:11-7. [DOI: 10.1016/j.ajodo.2011.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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