Assessing postoperative discomfort after third molar surgery: a prospective study.
OBJECTIVE
The purpose of this study was to identify the risk factors for severe discomfort after mandibular third molar surgery and to assess the validity of the Postoperative Symptom Severity (PoSSe) scale.


METHODS
In a 2-year prospective study, a total of 255 unilateral impacted mandibular third molar teeth were surgically removed under local anesthesia by 3 surgeons. Standardized surgical and analgesic protocols were followed. At the review appointment, 1 week after surgery, all patients returned a completed follow-up questionnaire (PoSSe scale) and were evaluated clinically for postoperative pain (number of painkillers taken) and trismus (differences in mouth opening). Sixteen predictive variables were evaluated using stepwise logistic regression analysis to identify the risk factors associated with severe discomfort.


RESULTS
Severe postoperative discomfort was predicted by these independent variables: gender, tobacco use, ramus relationship/space available, and antibiotic prophylaxis. Oral contraceptive use and operation time were not identified as risk factors. The patients' perceptions of the severity of symptoms (PoSSe scale score) was strongly correlated with clinical assessment of trismus (r = 0.54) and pain (r = 0.42).


CONCLUSIONS
The PoSSe scale resulted in a valid and responsive measure of the severity of symptoms after surgical extraction of lower third molars and reflected the clinical severity of the postoperative discomfort. From a patient's perspective, operative factors had little bearing on the quality of life after removal of mandibular third molars.
Grossi
Giovanni Battista
GB
Department of Oral Surgery, School of Dentistry, University of Milan, Milan, Italy. Giovavanni.Grossi@unimi.it
Maiorana
Carlo
C
Garramone
Rocco Alberto
RA
Borgonovo
Andrea
A
Creminelli
Luca
L
Santoro
Franco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008335:Mandibular Condyle / Q000033:anatomy & histology; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016037:Single-Blind Method; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014081:Tooth Extraction / Q000009:adverse effects* / Q000523:psychology; D014095:Tooth, Impacted / Q000601:surgery; D016896:Treatment Outcome; D014313:Trismus / Q000209:etiology / Q000523:psychology
D019980:Amoxicillin-Potassium Clavulanate Combination