days and were asked to report on any of the days in between if necessary. There were two methods: mandibular third molar surgery with or without ostectomy.
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Original research paper
Postoperative complaints following impacted mandibular third molar surgery in lie-Ife, Nigeria FO Oginni, VI Ugboko, E Assam, EO Ogunbodede
tion, impaction type and method of impacted tooth removal.
Stirnma'ry
,.
An investigationinto the pattern' of corpplaintslodged by patients after impacted mandibular third molar surgery was done in aj\JfgeriaO teaching hospital OVera period of 3 years. One hundred and twenty seven records were retrieved. Perico" ronitis (T1.2%},pLllpitis(17.6%)and periodontitis (11.2%)were the rea" sons for surgery. No /third rpolar surgery was done for prophylactic or orthodontic reaSOns.Sixty-one complaints were lodged by 49 (38.6%)patients on day 1, and 37 complaints by 35 patients 00 day
Although the findings of this retrospective study are limited their comparability, they suggest the need for an appraisal of pain management in patients undergoing mandibular third molar surgery in our hospital. Consequently, there should be a reduction in complaint rate thereby making selective review appointment on the first postoperative day feasible. S Afr Dent J 2002; 57: 264-268,
.
Introduction
7. These corpplaints were verified The removal of impacted lower third by the findings of the exaf'!"jiningclimolars is one of the commonest dentonician. Pain, swelling and trismus~veolar--sur-gical proC€KmreSundertakwere the commonest complaints. en in dental practice.! In the UK, priA significant association (P:;= vate sector expenditure on this proce0.042) was found between dure is reportedly second only to that patients' complaints on the first of cardiac surgery.2 postoperative day and the drug The literature is replete with comcombina.tio~given. Sironilarl~, there plaints lodged by patients after this was a significantrelationship (p:;= procedure. Pain, swelling and trismus 0.0055}betw~en the type of analconstitute the commonest problems gesics pre§cribed and the preswhile other rare complaints include enceof postoperative pain.No sigparaesthesia and bleeding.3-5Garcia et nificant relationship was~owever a/.5 reported that although 79.8% of fou~d b~twee~ the c?mplalnts aod patients age, Indicationfor extrac-
FO Oginni, VI Ugboko, E Assam, Department
patients had pain on the first post?pe.rative day, more than 40% had pam till the fifth day postoperatively. In a related study, Middlehurst et a/.6 found a strong correlation between pain and swelling in nearly 87% of their patients. The severity of these complaints has been associated with the age of patients,' number of teeth extracted, reason for surgery and surgical technique employed.6,s Morbidity has been reported to increase with increasing age, duration of surgery' and symptomatic teeth (with pre-extraction pathology).5 While the need for postoperative review of these p 0.05 pathology in all the patients in this study may be responsible for the dif* Combined for analysis ference observed and the failure to draw an association. Previous studiess have identified a years. However, contrary to the distinct confirmed. Of these cases 2.4% develhigh prevalence of complaints with female preponderance noted by Earl,' oped dry sockets as opposed to 1% in Garcia et aU and Alkhateeb et al,llthis disto-angular impactions, but no such Goldberg et al.'5 study.IS association was found in this series. study reports an almost equal gender An analysis of the pattern of analgesic The small sample size of disto-angular predilection similar to Middlehurst et prescription (ibuprofen and paracetaimpactions and the presence of preal.'5 study" mol) and postoperative pain shows a existing infection in all our patients Unlike in the Caucasoid population significant relationship between the may be responsible for the observawhere prophylactic extractions account two factors (P = 0.0078). Patients who tion. Similarly, the method of surgery for about 50% of third molar extracreceived ibuprofen (400 mg) with or showed no significant relationship tions,2.12.13 none of our patients had an without peri-operative (5 cc) intramuswith the patients' complaints, contrary extraction for prophylactic or orthocular analgin had fewer complaints of dontic reasons. This is in line with the to previous reports of increasing morpain compared with patients who bidity with bone removal.. low prevalence of third molar received paracetamol (1 000 mg). This The pattern of drug prescription varimpactions in this locality.14 Periis in agreement with previous studies ied. The choice of drug combination coronitis (70.0%) and pulpitis (17.9%) that have proved the potency of were the commonest indications for was usually informed by the extent of ibuprofen in the control of postoperasurgery, a finding comparable with that tive pain in third molar surgery,I9-21 the surgery, level of difficulty, patients' underlying health status and the of Amaratunga and Chandarasekara.15 especially when compared with paracetamol.22 propensity for infection. A significant Based on the ,findings of the examining association existed (P = 0.042) between clinician, we have observed a mean Trismus constituted 14.8% of the comthe drugs given and the patients' comcomplication rate of 29.3%.In the UK plaints reported. Greenfield and plaints on day 1 only. More patients where third molar surgeries are done Moore23 have convincingly attributed who had group A drugs (Le. antibiotic, more frequently, an overall complicathis to a voluntary act of patients in analgesic and anti-inflammatories) tion rate of 10% has been reported,'..17 order to avoid pain. almost a third of our rate. Plausible reahad complaints on day 1 than the other Although postoperative haemorrhage groups. Possibly, their procedures sons for this contrast include the presis not commonly reported in literature, were more traumatic, hence the drug ence of pre-existing inflammation and Goldberg et al.lsfound it in 0.6% of their the use of local anaesthesia in all our combination employed and the consecases; 5 of our patients (3.9.%) presentcases. Furthermore, in a situation quent pattern of complaints recorded. ed with postoperative haemorrhage. It could be inferred that such patients where most procedures are done under All cases were due to poor compliance would be more likely to develop postgeneral anaesthesia,9 it can be assumed with postoperative instructions. that a theatre environment would be operative complaints despite the drug combination used. As expected, paraesthesia was a very less prone to contamination. rare complaint (0.8%) as a result of the The benefits of traditional follow-up On day 1, 49 patients (36.6%) had combuccal guttering approach in our cenappointments for patients undergoing plaints. Similarly to other reports,J-
