MATERIALS AND METHODS
This study was performed from January 2015 to January 2016 including 312 healthy participants with American Society of Anesthesiologists physical status class 1 or 2, who underwent surgical removal of the mandibular third molars by an oral and maxillofacial surgery specialist at the Wonkwang University.
After the administration of local anesthetics (2% lidocaine containing a vasoconstrictor), an enveloped flap was raised. A surgical straight handpiece was used for bone removal and/or tooth separation. The indicated third molar was completely removed with minimal trauma to the adjacent second molar. After bone removal, an absorbable collagen sponge was inserted to prevent delayed postoperative bleeding, and one or two sutures were placed. In all patients, intraoperative pain was controlled with additional local anesthesia. After the surgery, first-generation cephalosporins and acetaminophen or tramadol analgesics were administered orally for three days. The postoperative instructions provided to the patients were: 1) bite on the gauze; 2) apply an ice pack immediately after the surgery; 3) re-visit on postoperative day 1 or 2 for dressing; and 4) re-visit for suture removal after one postoperative week.
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At the follow-up, the patients were asked whether or not they had pain, and it was checked if pain was experienced upon probing of the extraction socket or the adjacent tooth. The patient was diagnosed with dry socket when the bone was exposed, either whole or in part. A hypersensitive response to percussion or mobility of the adjacent tooth (second molar) was examined to detect pain in the adjacent tooth.
Patients diagnosed with dry socket were treated conservatively until the pain disappeared. Patients with pain in the adjacent tooth were instructed to avoid biting with the opposing teeth while chewing and to control teeth clenching and bruxism. In addition, all patients were instructed to re-visit until the pain was relieved.
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Patient data were retrospectively collected from medical records. Patients who did not attend more than one follow-up after surgical extraction of the mandibular third molar, such as the follow-up for dressing or suture removal, were excluded from the study.
Based on the cause of pain, the patients were classified into groups A, B, and C and others. Group A included patients with dry socket alone; group B included patients with pain in the adjacent tooth alone; group C included patients with both dry socket and pain in the adjacent tooth (Fig. 1 and and2);2); others included patients with moderate pain but no bone exposure or pain in the adjacent tooth. In patients who attended more than two follow-ups, the duration of symptoms was recorded from the first episode (symptom onset) to the last episode. In addition, patients whose symptoms persisted for more than two days were categorized under the complete improvement, improvement, maintenance, deterioration, or complete deterioration group.
The study was approved by the Institutional Review Board (IRB) of the Wonkwang University Dental Hospital (IRB number: WKDIRB 201907-01) and was performed in accordance with relevant guidelines and regulations. The statistical significance was assessed at the 95% confidence level with a cross-analysis, an independent sample t-test, and a variance analysis to determine the differences in sex and age distribution and duration of symptoms among the groups.
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