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Quality of life following third molar removal under conscious sedation

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      Abstract

      Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient’s QoL during the first postoperative week, especially due to local pain and eating discomfort.

      Key words:Third molar removal, quality of life, sedation.

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      Most cited references 29

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      Who should measure quality of life, the doctor or the patient?

      The extent to which a doctor or health professional can make a valid assessment of a patient's quality of life, anxiety and depression was investigated in a series of cancer patients. Doctors and patients filled out the same forms, viz. the Karnofsky, Spitzer, Linear Analogue Self Assessment Scales and a series of simple scales designed for this study, at the same time. Correlations between the two sets of scores were poor, suggesting that the doctors could not accurately determine what the patients felt. A further study examining the reproducibility of these scales demonstrated considerable variability in results between different doctors. It is concluded that if a reliable and consistent method of measuring quality of life in cancer patients is required, it must come from the patients themselves and not from their doctors and nurses.
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        Individual differences in pain sensitivity: measurement, causation, and consequences.

        Not only are some clinical conditions experienced as more painful than others, but the variability in pain ratings of patients with the same disease or trauma is enormous. Available evidence indicates that to a large extent these differences reflect individual differences in pain sensitivity. Pain sensitivity can be estimated only through the use of well-controlled experimental pain stimuli. Such estimates show substantial heritability but equally important environmental effects. The genetic and environmental factors that influence pain sensitivity differ across pain modalities. For example, genetic factors that influence cold pressor pain have little impact on phasic heat pain and visa versa. Individual differences in pain sensitivity can complicate diagnosis, among other reasons because low sensitivity to pain may delay self-referral. Inclusion of patients with reduced pain sensitivity can attenuate treatment effects in clinical trials, unless controlled for. Measures of pain sensitivity are predictive of acute postoperative pain, and there is preliminary evidence that heightened pain sensitivity increases risk for future chronic pain conditions. At this time, however, it is unclear which experimental pain modalities should be used as predictors for future pain conditions. Careful assessment of each individual's pain sensitivity may become invaluable for the prevention, evaluation, and treatment of pain. Large individual differences in pain sensitivity can complicate diagnosis and pain treatment and can confound clinical trials. Pain sensitivity may also be of great importance for the development of clinical pain. Thus, assessment of pain sensitivity may be relevant for the prevention, evaluation, and treatment of acute and chronic pain.
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          Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions.

          The purpose of this study was to determine the incidence of inferior alveolar nerve (IAN) damage after surgical removal of lower third molars, to identify the causes, and to construct a predictive model to assess the risk of IAN injury. We performed a nonrandomized forward prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in the University of Barcelona Oral Surgery Department. Preoperative, intraoperative, and postoperative data were gathered, and suspected causal factors of IAN damage were identified by using nonparametric tests, the Pearson chi-square test, and the Fisher exact test. Logistic regression predicted the risk of IAN injury. Although only 1.3% of the extractions caused temporary nerve damage, 25% of the lesions were permanent. All of the following significantly increased the risk of IAN damage (P < .05): age, the radiologic relationship between the apices and the mandibular canal, deflection of the root when approaching the mandibular canal, distal ostectomy, the distance of the apices of the third molar to the mandibular canal, ostectomy, crown sectioning, pain during root luxation, primary closure of the wound, prolonged operating time, bleeding, exposure of the nerve, and postoperative ecchymosis. The first 4 factors were included in a predictive logit model. Patient age, ostectomy of the bone distal to the third molar, the radiologic relationship between the roots of the third molar and the mandibular canal, and deflection of the mandibular canal increased the risk of IAN damage. Older patients were at a higher risk for suffering permanent injuries.
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            Author and article information

            Affiliations
            [1 ]Fellow of the Master of Oral Surgery and Implantology. Faculty of Dentistry. University of Barcelona
            [2 ]Professor of Oral Surgery. Professor of the Master of Oral Surgery and Implantology. Faculty of Dentistry. University of Barcelona. UB-IDIBELL Institute Researcher
            [3 ]Professor of Oral and Maxillofacial Surgery. Subdirector of the Master of Oral Surgery and Implantology. Faculty of Dentistry. University of Barcelona. UB-IDIBELL Institute Researcher
            [4 ]Chairman of Oral and Maxillofacial Surgery. Director of the Master of Oral Surgery and Implantology. Faculty of Dentistry. University of Barcelona. UB-IDIBELL Institute Coordinator Researcher. Head of the Oral and Maxillofacial Surgery Department of the Teknon Medical Center, Barcelona
            Author notes
            Feixa Llarga s/n Campus de Bellvitge Pavelló Central 2a planta, 08097 L’Hospitalet de Llobregat Barcelona, Spain , E-mail: eduardvalmaseda@ 123456ub.edu
            Journal
            Med Oral Patol Oral Cir Bucal
            Med Oral Patol Oral Cir Bucal
            Medicina Oral S.L.
            Medicina Oral, Patología Oral y Cirugía Bucal
            Medicina Oral S.L.
            1698-4447
            1698-6946
            November 2012
            28 August 2012
            : 17
            : 6
            : e994-e999
            22926461 3505722 17677 10.4317/medoral.17677
            Copyright: © 2012 Medicina Oral S.L.

            This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Research-Article
            Oral Surgery

            Surgery

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