Quality of life outcomes after third molar removal in subjects with minor symptoms of pericoronitis.

PURPOSE: Our purpose was to assess the effect of third molar removal on the quality of life in subjects with symptoms of pericoronitis. PATIENTS AND METHODS: Healthy subjects (American Society of Anesthesiologists Classes I and II), aged 18 to 35 years, with minor symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for an institutional review board-approved study. The exclusion criteria were major symptoms of pericoronitis, generalized periodontal disease, body mass index greater than 29 kg/m(2), and antibiotic or tobacco use. The data from patients undergoing surgery to remove all third molars with a follow-up examination after surgery at least 3 months later were included in these analyses. The clinical, demographic, and quality of life data were collected at enrollment and after surgery. At entry, the debris was removed from symptomatic third molar sites; no attempt was made to mechanically remove nonsheddable biofilm. The patients scheduled surgery electively with a recall examination at least 3 months after surgery. RESULTS: The median age of the 60 subjects was 21.9 years (interquartile range 20.2 to 24.7). The median postoperative follow-up was 7.7 months (interquartile range 6.0 to 12.4). The proportion of patients reporting the worst pain as severe decreased from enrollment to after surgery from 32% to 3%. Those responding "none" for the worst pain increased from 10% to 78%. Fifteen percent of subjects reported the pain intensity as "nothing," "faint," or "very weak" at enrollment. This increased to 96% after surgery. One third of patients reported the unpleasantness of pain as "neutral," "slightly unpleasant," or "slightly annoying" at enrollment, which increased to 97% after surgery. Also, 22% and 18% of the patients reported "quite a bit" or "lots of difficulty" with eating desired foods and chewing foods at enrollment, respectively; only 1 patient reported this degree of difficulty at the follow-up examination. In contrast, 42% and 37% of the patients reported no difficulty with eating and chewing at enrollment, which had increased to 95% and 93% at the follow-up examination, respectively. CONCLUSIONS: Removal of the third molars positively influenced the quality of life outcomes in those with minor symptoms of pericoronitis.

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.