Cryotherapy and topical minocycline as adjunctive measures to control pain after third molar surgery: an exploratory study.

PURPOSE: To assess the impact of cryotherapy or topical minocycline on patients' perceptions of recovery from pain after third molar surgery in an exploratory comparative-effectiveness study. PATIENTS AND METHODS: Subjects aged at least 14 years who were having all 4 third molars removed were enrolled in 3 separate institutional review board-approved studies. Study groups included subjects treated with a passively applied cold wrap for 24 hours postoperatively, subjects treated with topical minocycline during surgery, and subjects enrolled in a nonconcurrent comparison group who had received neither topical minocycline nor directed cryotherapy. Third molar surgery was performed in all cases by trained surgeons using the same protocol. An exact Kruskal-Wallis test was used to compare the distributions of the worst and average pain scores and a Fisher exact test to compare verbal responses from Gracely pain scales among the 3 groups for postsurgical days (PSDs) 1 to 3. RESULTS: This study comprised 51 cryotherapy subjects (2005-2009), 63 minocycline subjects (2003-2004), and 92 comparison-group subjects (2002-2006) who were treated at academic centers and in community practices across the United States (N = 206). Demographic descriptors were similar among all groups. For PSDs 1 through 3 (unadjusted), the highest scores for worst pain (6-7 [out of 7] on Likert-type scale) were reported less frequently in each of the study groups than in subjects in the comparison group, although the numbers of subjects reporting the highest scores were few. The distribution of pain outcomes was significantly different among the 3 groups for worst pain and affective words on PSD 1 (P = .04 for both). However, the small number of subjects who reported the highest pain scores precluded adequate multivariate statistical analyses for all outcomes on PSD 1 to 3. CONCLUSIONS: Data from this exploratory study suggest that adjunctive therapy to decrease postoperative pain-cryotherapy or topical minocycline-might be effective at moderating the patient's highest pain levels after third molar surgery. The topic should be studied further in a multicenter, prospective, randomized trial.

Second molar periodontal inflammatory disease after third molar removal in young adults.

PURPOSE: To assess the prevalence of periodontal inflammatory disease on the distal side of second molars after third molar removal and the association between presurgical and surgical variables and postsurgical periodontal outcomes. PATIENTS AND METHODS: Data before and after surgery from 2 studies approved by an institutional review board were used. In 1 study, 26 subjects had 4 asymptomatic third molars and in the other 49 subjects had at least 1 mandibular third molar with symptoms of pericoronitis. Full-mouth periodontal probing data, 6 sites per tooth, were obtained as a measurement of periodontal status before and after surgery. A probing depth (PD) ≥4 mm on either of the 2 possible probing sites on the distal side of any second molar (D2M) served as an indicator of periodontal inflammatory disease; periodontal health was defined as all D2M PD <4 mm. Cochran-Mantel-Haenszel row mean score tests compared the subjects' postsurgical periodontal status (all D2M PD <4 mm and at least 1 D2M PD ≥4 mm) with respect to age and time intervals, and the Fisher exact test was used to compare ethnicity, gender, and clinical data at surgery. The McNemar test was used to assess the discordance between subjects' pre- and postsurgical periodontal status. The level of significance was set at .05. RESULTS: Of the 75 subjects, 52% were women and 65% were white. The median age at surgery was 23.6 years (interquartile range, 20.9 to 26.6 years). At enrollment, 53 of 75 subjects (71%) had at least 1 D2M PD ≥4 mm. Subjects were significantly more likely to have an improved D2M periodontal status after surgery than a deteriorated status (P < .01). Fewer subjects, 17 of 75 (24%), had at least 1 D2M PD ≥4 mm after surgery. D2M PD ≥4 mm was more likely after surgery if presurgical D2M was PD ≥4 mm (P < .01). Gender, ethnicity, age, presurgical symptoms, and data estimating the extensiveness of surgery were not significantly associated with postsurgical D2M periodontal outcomes. CONCLUSIONS: After third molar removal, periodontal inflammatory disease on the distal of D2Ms was detected significantly less often. None of the variables examined except for presurgical presence of D2M PD ≥4 mm were significantly associated with postsurgical D2M periodontal inflammatory disease.