Revisit incidence of complications after impacted mandibular third molar extraction: A nationwide population-based cohort study.

Ya-Wei Chen,Oscar Kuang-Sheng Lee,Lin-Yang Chi,Essam Al-Moraissi

doi:10.1371/journal.pone.0246625

Abstract

Most of complications after impacted mandibular third molar (iLM3) extraction surgeries are transient and resolved spontaneously within one or two weeks, but some of them are more complicated and required further treatments to alleviate the symptoms. The aim of study is to revisit incidence and predictors of complications after iLM3 surgery by reviewing previous literature and investigating a population-based data. From Taiwan National Health Insurance Research Database, records of 16,609 patients who had received iLM3 extraction under ambulatory settings were retrieved for analysis. Outcomes of interest included dry socket (DS), prolonged temporomandibular joint symptoms (TMD), and surgical site infection (SSI), which necessitated additional appointments to manage. Odds ratios of having those complications between different variables were analyzed. The incidence rates of DS, TMD, and SSI were 3.6%, 0.41%, 0.17%, respectively; while they ranged from 0.33–19.14% (DS), 0–4.17% (TMD), and 0.2–5.17% (SSI) in previous studies. Logistic regression revealed DS significantly correlated with complexity of odontectomy (2.5-fold of risk) and history of gingivitis or pericoronitis (1.3-fold of risk). More TMD was found in female than male patients (0.5% versus 0.3%). However, no factors associated with SSI was found; neither did we find aging as a risk in association with any of above complications. Compared to previous studies, our data supports that surgical intervention should be considered in iLM3 with risk of gingivitis or pericoronitis to reduce the occurrence of DS. The original information in this article, which provides a “real-world” evidence, along with the organizing data we summarized from previous article, can serve as a reference for clinicians in assessing the complication risks before treatment of iLM3.

Highlights

Third molar is the most commonly seen impacted tooth in the mouth, with a higher occurrence rate in the lower jaw than the upper jaw [1]
In the new White Paper released by the American Association of Oral and Maxillofacial Surgeons (AAOMS) in 2017, they advocated third molars that are associated with disease or at higher risk of developing disease should be surgically extracted [9]
The characteristic symptom of dry socket (DS) is increasing postoperative pain surrounding the extraction wound with the onset of 2 to 4 days after dental surgery, accompanying with the signs of intra-alveolar blood clot disintegration and yellow-gray necrotic tissue layer covering the surface [19, 20]

Summary

Introduction

Third molar is the most commonly seen impacted tooth in the mouth, with a higher occurrence rate in the lower jaw than the upper jaw [1]. Incidence of complications after impacted lower third molar surgery pathology-free impacted third molars as a preventive manner has always been a debate between clinicians for a long time [2, 3]. In the new White Paper released by the American Association of Oral and Maxillofacial Surgeons (AAOMS) in 2017, they advocated third molars that are associated with disease or at higher risk of developing disease should be surgically extracted [9]. Suggestions have been made to surgically remove asymptomatic or pathology-free impacted third molars prior to the development of pathology at the time when the post-surgical healing is optimal and with a lower risk of complications [10]

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Conclusion