Strategies used to inhibit postoperative swelling following removal of impacted lower third molar

Francesco Sortino, Marco Cicciù, Francesco Sortino, Marco Cicciù

Abstract

Postoperative swelling following different surgical strategies is an area of great interest. The main part of literature on the topic deals with swelling after extraction of low impacted third molar. In this review, we have analyzed publications of the last 20 years with a pubmed search using the following key words: impacted third molar, swelling third molar, wisdom tooth, edema jaw, corticosteroids and extraction third molar, antibiotic prophylaxis and tooth extraction. Attention has often been focused on corticosteroid therapy administered by diverse routes (orally, IV, IM, topically) and at different time schedules (before or after surgery or both). This investigation revealed how the use of different molecules and dosages makes the obtained results hardly comparable. Similar conclusions can be drawn from studies aimed at evaluating the efficacy of antibiotic therapy administered either before or after surgery. A complete review has also to take into account different surgical strategies used including various flaps, no traumatic osteothomy, and primary or secondary closure. The use of pharmacological therapy and application of an ice pack is critical in the postoperative period and has always provided positive results. However, even if it is difficult to come to definite conclusions, due to the variability of the design of studies analyzed, the postoperative discomfort identified with edema, pain and trismus following wisdom tooth removal is influenced by various factors such as the difficulty of the surgical procedure involved, age and gender of the patient, and experience of the surgeon. The pharmacological therapy when performed with corticosteroids seems to improve control of the postoperative swelling related with this kind of surgeries.

Keywords: Antibiotics; corticosteroid; cryotherapy; post-surgery swelling; third molar extraction.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Messer EJ, Keller JJ. The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surg Oral Med Oral Pathol. 1975;40:594–8.
    1. Beirne OR, Hollander B. The effect of methylprednisolone on pain, trismus, and swelling after removal of third molars. Oral Surg Oral Med Oral Pathol. 1986;61:134–8.
    1. Berne RM, Levy MN, Koeppen BM, Stanton BA. Physiology. 5th Ed. New York: Elsevier inc; 2004.
    1. Hupp JR. Wound repair. In: Peterson LJ, Ellis E, Hupp JR, Tucker MR, editors. Contemporary oral and maxillofacialSurgery. 3rd ed. St Louis: Mosby; 1998. pp. 58–60.
    1. Alexander RE, Throndson RT. A review of perioperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:406–15.
    1. Shevel E, Koepp WG, Butow KW. A subjective assessment of pain and swelling following the surgical removal of impacted third molar teeth using different surgical techniques. SADJ. 2001;56:238–41.
    1. Pedersen A. Decadronphosphate in the relief of complaints after third molar surgery. Int J Oral Surg. 1985;14:235–40.
    1. van Gool AV, Ten Bosch JJ, Boering G. Clinical consequences of complaints and complications after removal of the mandibular third molar. Int J Oral Surg. 1977;6:29–37.
    1. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and nonsteroidal anti-inflammatory medication for the management of pain and inflammation after third molar surgery: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:630–40.
    1. Colorado-Bonnin M, Valmaseda-Castelló E, Berini-Aytés L, Gay-Escoda C. Quality of life following lower third molar removal. Int J Oral Maxillofac Surg. 2006;35:343–7.
    1. Grossi GB, Maiorana C, Giarramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effects of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: A prospective study. J Oral Maxillofac Surg. 2007;65:2218–26.
    1. McGrath C, Comfort MB, Lo EC, Luo Y. Changes in life quality following third molar surgery--the immediate postoperative period. Br Dent J. 2003;194:265–8.
    1. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Creminelli L, Santoro F. Assessing postoperative discomfort after third molar surgery: A prospective study. J Oral Maxillofac Surg. 2007;65:901–17.
    1. Slade GD, Foy SP, Shugars DA, Phillips C, White RP., Jr The impact of Third molar symptoms,pain,and swelling on oral health-related quality of life. J Oral Maxillofac Surg. 2004;62:1118–24.
    1. Akadiri OA, Okoje VN, Arotiba JT. Identification of risk factors for short-term morbidity in third molar surgery. Odontostomatol Trop. 2008;31:5–10.
    1. Akadiri OA, Obiechina AE. Assessment of Difficulty in Third Molar Surgery—A Systematic Review. J Oral Maxillofac Surg. 2009;67:771–4.
    1. Curran JB, Kennett S, Young AR. An assessment of the use of prophylactic antibiotics in third molar surgery. Int J Oral Surg. 1974;3:1–6.
    1. Yoshii T, Hamamoto Y, Muraoka S, Furudoi S, Komori T. Differences in postoperative morbidity rates, including infection and dry socket, and differences in the healing process after mandibular third molar surgery in patients receiving 1-day or 3- day prophylaxis with lenampicillin. J Infect Chemother. 2002;8:87–93.
    1. Delilbasi C, Saracoglu U, Keskin A. Effects of 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid on the prevention of alveolar osteitis following mandibular third molar extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:301–4.
    1. Kaczmarzyk T, Wichlinski J, Stypulkowska J, Zaleska M, Panas M, Woron J. Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery. Int J Oral Maxillofac Surg. 2007;36:417–22.
    1. Halpern LR, Dodson TB. Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery. J Oral Maxillofac Surg. 2007;65:177–85.
    1. Monaco G, Tavernese L, Agostini R, Marchetti C. Evaluation of Antibiotic Prophylaxis in Reducing Postoperative Infection After Mandibular Third Molar Extraction in Young Patients. J Oral Maxillofac Surg. 2009;67:1467–72.
    1. Martin MV, Kanatas AN, Hardy P. Antibiotic prophylaxis and third molar surgery. Br Dent J. 2005;198:26–30.
    1. Thomas DW, Hill CM. An audit of antibiotic prescribing in third molar surgery. Br J Oral Maxillofac Surg. 1997;35:126–8.
    1. Ataoğlu H, Öz GY, Çandirli C, Kiziloğlu D. Routine antibiotic prophylaxis is not necessary during operations to remove third molars. Br J Oral Maxillofac Surg. 2008;46:133–5.
    1. Salmerón-Escobar JI, Del Amo-Fernández de Velasco A. Antibiotic prophylaxis in Oral and Maxillofacial Surgery. Med Oral Patol Oral Cir Bucal. 2006;11:E 292–6.
    1. Kaziro GS. Metronidazole (Flagyl) and Arnica Montana in the prevention of post-surgical complications, acomparative placebo controlled clinical trial. Br J Oral Maxillofac Surg. 1984;22:42–9.
    1. MacGregor AJ, Addy A. Value of penicillin in the prevention of pain, swelling and trismus following the removal of ectopic mandibular third molars. Int J Oral Surg. 1980;9:166–72.
    1. Bystedt H, Nord CE. Effect of antibiotic treatment on postoperative infections after surgical removal of mandibular third molars. Swed Dent J. 1980;4:27–38.
    1. Lawler B, Sambrook PJ, Goss AN. Antibiotic prophylaxis for dentoalveolar surgery: Is it indicated? Aust Dent J. 2005;50:S54–9.
    1. Stuart E. Lieblich. Postoperative Prophylactic Antibiotic Treatment in Third Molar Surgery—A Necessity? J Oral Maxillofac Surg. 2004;62:9.
    1. Poeschl PW, Eckel D, Poeschl E. Postoperative Prophylactic Antibiotic Treatment in Third Molar Surgery—A Necessity? J Oral Maxillofac Surg. 2004;62:3–8.
    1. Stavropoulos MF, Shugars DA, Phillips C, Conrad SM, Fleuchaus PT, White RP., Jr Impact of topical minocycline with third molar surgery on clinical recovery and Health-Related Quality of Life Outcomes. J Oral Maxillofac Surg. 2006;64:1059–65.
    1. Sekhar CH, Narayanan V, Baig MF. Role of antimicrobials in third molar surgery: Prospective, double blind, randomized, placebo-controlled clinical study. Br J Oral Maxillofac Surg. 2001;39:134–7.
    1. van Eeden SP, Bütow K. Post-operative sequelae of lower third molar removal: A literature review and pilot study on the effect of Covomycin D. SADJ. 2006;61:154–9.
    1. Beirne OR. Evaluation dexamethasone for reduction of postsurgical sequele of third molar removal. J Oral Maxillofac Surg. 1992;50:1182–3.
    1. Patten JR, Patten J, Hutchins MO. Adjunct use of dexamethasone in postoperative dental pain control. Compendium. 1992;13:580–584.
    1. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: Pathophysiologic effects and clinical implications. J Am Coll Surg. 2002;195:694–711.
    1. Goodman LS, Gilman AG. The pharmacologic basis of therapeutics. 11th Ed. New York: Mcgraw-Hill; 2005.
    1. Dionne RA, Gordon SM, Rowan J, Kent A, Brahim JS. Dexamethasone suppresses peripheral prostanoid levels without analgesia in a clinical model of acute inflammation. J Oral Maxillofac Surg. 2003;61:997–1003.
    1. Koerner KR. Steroids in third molar surgery: A review. Gen Dent. 1987;35:459–63.
    1. Peterson LJ. Principles of oral and maxillofacial surgery. Vol. 1. Philadelphia: JB Lippincott; 1992. Principles of management of impacted teeth; p. 117.
    1. Hooley JR, Francis FH. Bethamethasone in traumatic oral surgery. J Oral Surg. 1969;27:398–403.
    1. Milles M, Desjardins PJ. Reduction of postoperative facial swelling by low-dose methylprednisolone. J Oral Maxillofac Surg. 1993;51:987–91.
    1. Tiwana PS, Foy SP, Shugars DA, Marciani RD, Conrad SM, Phillips C, et al. The impact of intravenous corticosteroids with third molar surgery in patients at high risk for delayed health-delated quality of life and clinical recovery. J Oral Maxillofac Surg. 2005;63:55–62.
    1. Esen E, Tasar F, Akhan O. Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery. J Oral Maxillofac Surg. 1999;57:1201–6.
    1. Bystedt H, Nordenram A. Effect of methylprednisolone on complications after removal of impacted mandibular third molars. Swed Dent J. 1985;9:65–9.
    1. ElHag M, Coghlan K, Christmas P, Harvey W, Harris M. The anti-inflammatory effects of dexamethasone and therapeutic ultrasound in oral surgery. Br J Oral Maxillofac Surg. 1985;23:17–23.
    1. Schaberg SJ, Stuller CB, Edwards SM. Effect of methilprednisolone on swelling after orthognathic surgery. J Oral Maxillofac Surg. 1984;42:356–61.
    1. Ustün Y, Erdogan Ö, Esen E, Deniz E. Comparison of the effects of two doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:535–9.
    1. Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J Oral Maxillofac Surg. 1995;53:2–7.
    1. Laureano Filho JR, Maurette PE, Allais M, Cotinho M, Fernandes C. Clinical comparative study of the effectiveness of two dosages of Dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars. Med Oral Patol Oral Cir Bucal. 2008;13:E129–32.
    1. Neuppert EA, Lee JW, Philput CB, Gordon JR. Evaluation of dexamethasone for reduction of post-surgical seqelae of third molar removal. J Oral Maxillofac Surg. 1992;50:1977–82.
    1. Markiewicz MR, Brady MF, Ding EL, Dodson TB. Corticosteroids Reduce Postoperative Morbidity After Third Molar Surgery: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2008;66:1881–94.
    1. Buyukkurt MC, Gungormus M, Kaya O. The effect a single dose prednisolone with and without diclofenac of pain, trismus, and swelling after removal of mandibular third molar. J Oral Maxillofac Surg. 2006;64:1761–6.
    1. Vegas-Bustamante E, Micó-Llorens J, Gargallo-Albiol J, Satorres-Nieto M, Berini-Aytés L, Gay-Escoda C. Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars. Int J Oral Maxillofac Surg. 2008;37:260–3.
    1. Montgomery MT, Hoggs JP, Robers DL, Redding SW. The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery. J Oral Maxillofac Surg. 1990;48:179–87.
    1. Graziani F, D’Aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal.A splitmouth randomized double-masked clinical trial. Int J Oral Maxillofac Surg. 2006;35:241–6.
    1. Suarez-Cunqueiro MM, Gutwald R, Reichman J, Otero-Cepeda XL, Schmelzeisen R. Marginal flap versus paramarginal flap in impacted third molar surgery: A prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:403–8.
    1. Kirk DG, Liston PN, Tong DC, Love RM. Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e1–6.
    1. Szmyd L. Impacted teeth. Dent Clin North Am. 1971;15:299–318.
    1. Monaco G, Daprile G, Tavernese L, Corinaldesi G, Marchetti C. Mandibular Third Molar Removal in Young Patients: An Evaluation of 2 Different Flap Designs. J Oral Maxillofac Surg. 2009;67:15–21.
    1. Pasqualini D, Cocero N, Castella A, Mela L, Bracco P. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars:a comparative study. Int J Oral Maxillofac Surg. 2005;34:52–7.
    1. Dubois DD, Pizer ME, Chinnis RJ. Comparison of primary and secondany closure techniques after removal of impacted mandibular 3rd molars. J Oral Maxillofac Surg. 1982;4:631–4.
    1. Holland CS, Hinole MO. The influence of closure or dressing of third molar sockets on post-operative swelling and pain. Br J Oral Maxillofac Surg. 1984;22:65–71.
    1. de Brabander EC, Cattaneo G. The effect of surgical drain together with a secondary closure technique on postoperative trismus, swelling and pain after mandibular 3rd molar surgery. Int J Oral Maxillofac Surg. 1988;17:119–21.
    1. Waite PD, Cherala S. Surgical outcomes for suture-less surgery in 366 impacted third molar patients. J Oral Maxillofac Surg. 2006;64:669–73.
    1. Cerqueira PR, Vasconcelos BC, Bessa-Nogueira RV. Comparative study of the effect of a tube drain in impacted lower third molar surgery. J Oral Maxillofac Surg. 2004;62:57–61.
    1. Chukwuneke FN, Oji C, Saheeb DB. A comparative study of the effect of using a rubber drain on postoperative discomfort following lower third molar surgery. Int J Oral Maxillofac Surg. 2008;37:341–4.
    1. Rakprasitkul S, Pairuchvej V. Mandibular third molar surgery with primary closure and tube drain. Int J Oral Maxillofac Surg. 1997;26:187–190.
    1. Ordulu M, Aktas I, Yalcin S, Azak AN, Evlioğlu G, Disçi R, et al. Comparative study of the effect of tube drainage versus methylprednisolone after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e96–100.
    1. Sortino F, Pedullà E, Masoli V. The Piezoelectric and Rotatory Osteotomy Technique in Impacted Third Molar Surgery: Comparison of Postoperative Recovery. J Oral Maxillofac Surg. 2008;66:2444–8.
    1. Shearer J, McManners J. Comparison between the use of an ultrasonic tip and a microhead handpiece in periradicular surgery: A prospective randomised trial. Br J Oral Maxillofac Surg. 2009;47:386–8.
    1. Robiony M, Polini F, Costa F, Sembronio S, Zerman N, Politi M. Endoscopically assisted intraoral vertical ramus osteotomy and piezoelectric surgery in mandibular prognathism. Int J Oral Maxillofac Surg. 2007;36:267–9.
    1. Lee JM, Warren MP, Mason SM. Effects of ice on nerve conduction velocity. Physiotherapy. 1978;64:2–6.
    1. Price R, Lehmann JF, Boswell-Bessette S, Burleigh A, deLateur BJ. Influence of cryotherapy on spasticity at the human ankle. Arch Phys Med Rehabil. 1993;74:300–4.
    1. Curl WW, Smith BP, Marr A, Rosencrance E, Holden M, Smith TL. The effect of contusion and cryotherapy on skeletal muscle microcirculation. J Sports Med Phys Fitness. 1997;37:279–86.
    1. Thermann H, Krettek C, Hufner T, Schratt HE, Albrecht K, Tscherne H. Management of calcaneal fractures in adults: conservative versus operative treatment. Clin Orthop Relat Res. 1998;353:107–24.
    1. van der Westhuijzen AJ, Becker PJ, Morkel J, Roelse JA. A randomized observer blind comparison of bilateral facial ice pack therapy with no ice therapy following third molar surgery. Int J Oral Maxillofac Surg. 2005;34:281–6.
    1. Lehmann JF. Therapeutic Heat and Cold. Baltimore: Williams and Wilkins; 1990. pp. 590–632.
    1. Sortino F, Messina G, Pulvirenti G. Evaluation of postoperative mucosa and skin temperature after surgery for impacted third molar. Minerva Stomatol. 2003;52:393–9.
    1. Oosterveld FG, Rasker JJ, Jacobs JW, Overmars HJ. The effect of local heat and cold therapy on the intraarticular and skin surface temperature of the knee. Arthritis Rheum. 1992;35:146–51.
    1. Weston M, Taber C, Casagranda L, Cornwall M. Changes in local blood volume during cold gel application to traumatized ankles. J Orthop Sports Phys Ther. 1994;19:197–9.
    1. Laureano Filho JR, de Oliveira e Silva ED, Batista CL, Gouveia FM. The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction. J Am Dent Assoc. 2005;136:774–8.
    1. Greenstein G. Therapeutic efficacy of cold therapy after intraoral surgical procedures: A letterature review. J Periodontol. 2007;78:790–800.
    1. Moore RJ, Watts JJ, Hood JA, Burrit DJ. Intraoral temperature variation over 24 hours. Eur J Orthod. 1999;21:249–61.
    1. Nusair YM. Local application of ice bags did not affect postoperative facial swelling after oral surgery in rabbits. Br J Maxillofac Surg. 2007;45:48–50.
    1. Markovic A, Todorovic Lj. Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: A clinical trial. Int J Oral Maxillofac Surg. 2007;36:226–9.
    1. Bahn SL. Glucocorticosteroids in dentistry. J Am Dent Assoc. 1982;105:476–81.
    1. Esen E, Tasar F, Akhan O. Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery. J Oral Maxillofac Surg. 1999;57:1201–6.
    1. Barron RP, Benoliel R, Zeltser R, Eliav E, Nahlieli O, Gracely RH. Effect of dexamethasone and dipyrone on lingual and inferior alveolar nerve hypersensitivity following third molar extractions: Preliminary report. J Orofac Pain. 2004;18:62–8.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться