Incidence of alveolar osteitis after mandibular third molar surgery. Can inflammatory cytokines be identified locally?

OBJECTIVES: The aims of the present study were to evaluate the relative incidence of alveolar osteitis (AO) after mandibular third molar surgery, post-operative findings and local expression of bone markers and cytokines. STUDY DESIGN: In 445 patients, unilateral surgical third molars extractions were undertaken (584 teeth). Bone markers and cytokines were explored at the AO side and on the un-operated contralateral side and compared with the levels in samples from a control group of 18 persons without AO. RESULTS: The relative incidence of AO was 4.6%. Patients (n = 27) with AO were invited to participate in the study and 21 (77.8%) did so. Patients with AO had 1-4 extra visits for treatment of AO, the mean follow-up time was 2.6 days for all patients. There were significantly higher levels of bone markers and cytokines in the AO site compared with the un-operated contralateral site, except for Epidermal growth factor (EGF). No significant difference in expression of bone markers and cytokines between the AO and control groups was found. Lower maximum inter-incisor opening (MIO) was correlated with increased Macrophage inflammatory protein 1 alpha. A negative correlation between patients' complaint of trismus and MIO was seen. CONCLUSIONS: The relative incidence of AO was low in our patient group treated with surgical removal of third molars. AO was more frequently seen in female patients. Treatment of AO required up to four extra visits. The study provides some information on the role of cytokines in AO; but further studies are required.

The use of a tetracycline drain reduces alveolar osteitis: a randomized prospective trial of third molar surgery under local anesthetics and without the use of systemic antibiotics.

OBJECTIVES: Our aim was to investigate the effect of an oxytetracycline-impregnated gauze drain on the incidence of alveolar osteitis (AO) and postoperative pain during the first week after mandibular third molar surgery. STUDY DESIGN: Two hundred consecutive patients undergoing third molar surgery under local anesthesia were randomized into a drain group (n = 100), with an oxytetracycline-impregnated drain placed in the extraction socket, and a control group (n = 100). An experienced surgeon performed the surgery. Systemic antibiotics were not used. RESULTS: The incidence of AO was 23% in the control group and 5% in the drain group (P < .001). The risk of developing AO was approximately 6 times higher in the control group, and females had a 2.5 times higher risk compared with males. Patients in the control group had significantly more pain on the day of surgery and on days 4 to 7. The presence of AO was associated with continued use of analgesics (P < .001). No patients experienced postoperative infections or had complications requiring hospitalization. CONCLUSIONS: The present study showed that an oxytetracycline-impregnated drain significantly reduced the incidence of AO after third molar surgery. The described treatment strategy, without the use of systemic antibiotics, seemed efficient in lowering overall postoperative morbidity and downtime after third molar surgery.

Mandibular third molar surgery in 396 patients at a Norwegian university clinic: Morbidity recorded after 1 week utilizing an e-infrastructure for clinical research.

OBJECTIVE: To evaluate morbidity 1 week after mandibular third molar (3M) surgery in the authors' department. MATERIALS AND METHODS: A prospective 1-year clinical study of patients followed up for 1 week after 3M surgery was performed. Consecutive patients of 18 years or older having 3M surgery under local anaesthesia were included. Patients not able to attend a follow-up appointment after 1 week were excluded. Demographic data, indication for surgery and clinical findings were recorded. Outcome variables were days requiring analgesic, days absent from work/school and complications. All data recording was performed utilizing an e-infrastructure for clinical research (InReach, University Health Network, www.uhnsl.com). RESULTS: Three hundred and ninety-six patients were examined 1 week after surgery. Mean number of days requiring analgesics was 3.8 and mean number of days absent from work/school after surgery was 0.6. Minor complications were reported by 7% of patients. Female patients reported more days requiring analgesics compared to male patients. Smokers had a higher odds ratio for being absent ≥ 3 days. Prophylactic removal of 3Ms was associated with fewer days requiring analgesics and days absent from work/school as compared to teeth with local disease. CONCLUSION: Overall morbidity after 3M surgery was low. Compared to patients subjected to therapeutic removal of 3Ms, patients undergoing prophylactic removal seem to have less pain and a faster return to normal activities.