Age of Patients and Morbidity Associated With Mandibular Third Molar Surgery

doi:10.14219/jada.archive.1980.0183

The Journal of the American Dental Association

Volume 101, Issue 2, August 1980, Pages 240-245

https://doi.org/10.14219/jada.archive.1980.0183 Get rights and content

Patient’s age has seldom been considered a factor in tooth extraction. The removal of the mandibular third molar may cause operative and postoperative problems. How these problems are affected by the age of the patient indicates to the practitioner an area of concern. This investigation gives information to document the significant relationship of age to morbidity.

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Cited by (269)

Effect of manuka honey socket dressing on postoperative sequelae and complications following third molar extraction: A randomized controlled study
2023, Journal of Cranio-Maxillofacial Surgery
To evaluate the effect of manuka honey on the healing of mandibular third molar extraction sockets.
This was a prospective randomized study at a tertiary health institution in Lagos, Nigeria. All extractions were transalveolar, using the distobuccal bone guttering technique. Participants were randomized into two study groups. Group A underwent intrasocket application of manuka honey, after which sockets were completely closed using the mucosal flap, while participants in group B underwent mucosal flap closure of the socket without application of manuka honey. The primary outcome was healing of the extraction socket at 7 days postoperatively. The secondary outcomes measured were postoperative sequelae, namely pain, swelling, and trismus on postoperative days 1, 3, and 7, and socket healing complications — specifically inflamed socket, infected socket, and alveolar osteitis.
In total, 112 participants completed the study, with 56 participants per group. There were no significant differences in demographic variables between both groups. On the 7th day postoperatively, 26.8% of participants in group B had an unhealed extraction site, compared with 10.3% of participants in group A (p = 0.029).
A significant difference was observed between pre- and postoperative pain scores in both study groups (p = 0.001). A comparison of postoperative mean facial swelling between the two groups showed no statistically significant differences on all the review days (p = 0.66). The difference in postoperative socket healing complication rate between both groups was statistically significant (χ² = 4.747, p = 0.029).
Within the limitations of the study it seems that the application of manuka honey appears to aid earlier healing of the third molar extraction socket, with a significantly lower frequency of complications. Therefore, the application of manuka honey is recommended whenever appropriate.
Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction: A network meta-analysis of randomized clinical trials
2022, Journal of the American Dental Association
The aim of this network meta-analysis was to assess the comparative effects of different dexamethasone (DXM) routes and doses on reducing postoperative sequelae (pain, swelling, trismus) after surgical extraction of impacted mandibular third molars.
Five databases were searched on September 22, 2021, for randomized controlled trials. Risk of bias (ROB) was assessed using the Cochrane ROB 2 tool. Study heterogeneity, publication bias, and quality of evidence were investigated. Network meta-analyses were conducted (P < .05), and the P-score was used to rank comparisons of DXM doses and routes.
Thirty-four eligible studies were included. Eight studies had low ROB, 21 had some concerns, and 5 had high ROB. The certainty of evidence evaluated by the Confidence in Network Meta-Analysis tool indicated low to very low certainty in most comparisons. The results showed that most DXM route and dose combinations were superior to a placebo in reducing the postoperative sequelae 1 day after surgical extraction. The results also showed that a 4-mg DXM submucosal injection substantially reduces pain 3 days after extraction compared with a 4-mg twin-mix or 8-mg intramuscular injection. Overall, it appears that 4 mg DXM submucosal injection or admixed with local anesthetic is effective in reducing postoperative sequelae after surgical extraction.
Within the limitations of this study, the administration of DXM appears to be effective in reducing the postoperative sequelae, especially in the submucosal route. However, no noteworthy differences were found between the investigated DXM route and dose comparisons.
Submucosal DXM injection effectively reduce postoperative sequelae of third-molar extractions.
A Prospective Observational Study on the Variables Affecting the Risk of Inferior Alveolar Nerve Damage During Lower Third Molar Surgery With Nerve/Root Proximity
2022, Journal of Oral and Maxillofacial Surgery
The present study aimed to evaluate which factors were statistically associated with a greater probability of inferior alveolar nerve (IAN) damage during lower third molar surgery.
A prospective observational study was performed at the Oral Surgery Unit of the Umberto I Hospital on 92 patients who underwent surgical extraction of a lower third molar that was radiographically overlapped with the mandibular canal. All surgeries were performed by the same expert surgeon. A principal component analysis and the exact 2-tailed Fisher exact test were used.
Temporary IAN damage occurred in 10 cases (10.9%). Symptoms lasted from 18 to 180 days (73 ± 49.15). IAN damage was more frequent in difficult and long-lasting surgeries, in the presence of many risk factors and in patients with a reduced maximum mouth opening.
Such factors should be accurately evaluated before surgery to assess and discuss the overall surgical risk of IAN damage with the patient especially when they are over the maximum limit of their significant variability range found in the present study, that is, >12 for difficulty index, >2 for number of orthopantomography risk markers and <3.7 cm for maximum mouth opening.
Bibliometric analysis of international publication trends in impacted third molar surgery research (2000–2020)
2021, British Journal of Oral and Maxillofacial Surgery
In scientific fields, various methods of statistical analysis such as bibliometric analysis have been used to determine the effectiveness of journals, research, and articles. The aim of this study was to conduct a bibliometric analysis to systematically and understandably characterise publications on impacted third molar surgery (ITMS) from 2000 to 2020. The articles were retrieved on the same day (1 January 2021) from the Web of Science Core Collection (WoSCC) database of the Web of Science to prevent bias due to daily updates of the databases. A total of 3326 publications from 2000 to 2020 were analysed. The United States of America (USA) had the highest number of publications and h-index value. The highest number of co-citations were of Pell GJ. ITMS research was collected under nine ‘clusters’. In this study, developments, the most influential publications, journals, and countries in the research of ITMS were determined based on the evidence gained through bibliometric analysis.
Five-Years Periodontal Outcomes of Early Removal of Unerupted Third Molars Referred for Orthodontic Purposes
2021, Journal of Oral and Maxillofacial Surgery
The removal of third molars (M3) is one of the most common oral-maxillofacial surgical procedures affecting periodontal tissues of neighboring second molars (M2). The aim of this study was to evaluate the periodontal status of lower M2 following the removal of unerupted lower M3 up to 5 years after removal.
Primary predictor variable in this prospective cohort-study was time [baseline (BL; preoperatively), 6 and 60 months postoperatively]. The primary outcome variable was probing pocket depth (PPD). Clinical attachment level (CAL) was defined as a secondary outcome variable. Plaque index (PlI) and gingival index (GI) were assessed descriptively. All variables were compared using nonparametric tests. M3 were classified as either completely bony or partially bony unerupted. Risk factors (removed M3, type of impaction, mean BL PPD≥4 mm, gender, age) were analyzed (repeated measures ANCOVA). The significance level was set at 0.05.
From originally 91 subjects enrolled in this study, 39 subjects (22 females; mean age: 21.6 ± 2.5 years) contributing 39 M3 completed the study after 5 years. Average BL PPD significantly decreased at 6 (−0.50 ± 0.61 mm, P = .001), 60 months (−0.81 ± 0.56, P < .0001), as well as between 6 and 60 months (−0.31 ± 0.51 mm, P = .030). Corresponding CAL values decreased accordingly (BL–6 months: −0.37 ± 0.59 mm, P = .004; BL–60 months: −0.67 ± 0.55 mm, P < .0001; 6 to 60 months: −0.34 ± 0.48 mm, P = .004). The was confirmed as risk factor for PPD (P = .026) and CAL (P = .042) changes.
Average PPD and CAL of mandibular M2 in young subjects improved 5 years after early removal of unerupted M3 in favor of an initial partially bony unerupted type of impaction.
A retrospective cohort study on reasons to retain third molars
2020, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
There are different reasons for difficult recovery, including continued root development and the fact that the periodontal ligament becomes thinner with age and may even lead to ankylosis of the tooth. Moreover, as the patient ages, the bone becomes densely calcified, and it is therefore less flexible and less likely to bend under the forces of tooth extraction6. The result is that more bone has to be surgically removed to extract an impacted third molar.
The primary goal of this study was to identify and quantify indications for retaining third molars. This retrospective cohort study included 1682 patients (818 male, 864 female; mean age 31 years) who were referred to the University Hospitals Leuven for third molar removal. Eight reasons for retaining the third molars were identified: (1) risk of damaging adjacent structures, (2) compromised health status, (3) adequate space for eruption, (4) third molar serves as abutment tooth, (5) orthodontic reasons, (6) eruption into proper occlusion, (7) symptomless third molars in patients >30 years old, and (8) patient preference. To compare these categories between sex and age groups, a generalized linear model for binary data was fitted with a logit link. A total of 1149 third molars in 548 patients were not extracted. The most frequent reasons for retaining third molar teeth were: eruption into proper occlusion (31.9%), patient preference (31.5%), and symptomless third molars in patients >30 years old (17.5%). Compromised health status and advanced age were often included in the decision regarding whether to retain the third molars. One third of the referred patients had reasons to retain one or more third molars. These findings might facilitate the future development of a consensus statement.

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