Delayed-onset infections after lower third molar surgery: a Hungarian case-control study.

OBJECTIVE: Delayed-onset infection is defined as infectious swelling and trismus accompanied by pain or the presence of suppuration starting approximately 30 days after surgery. This study aimed to describe the occurrence and potential predisposing factors of delayed-onset infection. STUDY DESIGN: A retrospective case-control study of 223 lower third molar surgeries was performed. Participants were selected from among 1102 outpatients who underwent surgery between January 2013 and June 2018 at Semmelweis University. The inclusion criterion for the case group was inflammation of the operated area after suture removal. Patients in the control group were healthy nonsmokers <26 years old who healed without complication. Statistical analysis was performed using the Shapiro-Wilk test, the Mann-Whitney U test, and Fisher's exact test. RESULTS: Complications occurred only in patients <26 years old approximately 29.5 days after surgery. A significantly higher risk was observed for younger age, total soft tissue coverage, deeper impaction, lower Nolla stage (P < .001), mesioangular direction (P = .002), and full bone coverage (P < .05). Distal space was inversely correlated with complications (P < .001). CONCLUSIONS: Lower Nolla stage, total soft tissue coverage, lack of distal space, deeper impaction, or mesioangular tilt may promote delayed-onset infection. Follow-up of at-risk patients and the maintenance of oral hygiene are recommended.

[Incidence and case-control study of delayed-onset infection after lower third molar surgery]. / Az alsó bölcsességfogak mutéti eltávolítását követo késoi posztoperatív gyulladás (delayed-onset infection) vizsgálata.

INTRODUCTION AND AIM: Delayed-onset infection was defined as an infectious swelling and trismus accompained by pain or the presence of suppuration starting after the discharge of the patient, generally a week after surgery. Our aim was to describe incidence and possible risk factors of delayed-onset infection after lower wisdoom tooth removal. MATERIAL AND METHODS: Retrospective study of 851 lower third molar surgeries, performed between January 2013 and August 2017 at Semmelweis University Faculty of Dentistry, Department of Oro-Maxillofacial Surgery and Stomatology, has been done. The teeth were removed by 2 surgeons. Under age of 26, a case-control study comprising a total of 150 lower third molar surgeries were done to indentify possible risk factors. RESULTS: 10 delayed-onset wound infections were recorded after suture removal (1.17% of the patients). The mean time elapsing from surgery to delayed-onset infection was 30 days. Lower third molars with total soft tissue coverage, a bigger amount of bone coverage, a lack of distal space (Pell-Gregory class III), deeper impaction (Pell-Gregory classes B, C) or mesioangular tilt are associated with the development of this complication (p<0.05). Female sex and young age seem to be risk factors, too. CONCLUSION: Patients with risk factors should be warned that infection may still occur several weeks after surgery. The clinicians should observe these patients longer and emphasize keeping their wound clean for a prolonged period. Orv Hetil. 2018; 159(31): 1278-1283.