title: Cryotherapy and topical minocycline as adjunctive measures to control pain after third molar surgery: an exploratory study.
abstract: OBJECTIVE
  To assess the impact of cryotherapy or topical minocycline on patients' perceptions of recovery from pain after third molar surgery in an exploratory comparative-effectiveness study.
  
  
  METHODS
  Subjects aged at least 14 years who were having all 4 third molars removed were enrolled in 3 separate institutional review board-approved studies. Study groups included subjects treated with a passively applied cold wrap for 24 hours postoperatively, subjects treated with topical minocycline during surgery, and subjects enrolled in a nonconcurrent comparison group who had received neither topical minocycline nor directed cryotherapy. Third molar surgery was performed in all cases by trained surgeons using the same protocol. An exact Kruskal-Wallis test was used to compare the distributions of the worst and average pain scores and a Fisher exact test to compare verbal responses from Gracely pain scales among the 3 groups for postsurgical days (PSDs) 1 to 3.
  
  
  RESULTS
  This study comprised 51 cryotherapy subjects (2005-2009), 63 minocycline subjects (2003-2004), and 92 comparison-group subjects (2002-2006) who were treated at academic centers and in community practices across the United States (N = 206). Demographic descriptors were similar among all groups. For PSDs 1 through 3 (unadjusted), the highest scores for worst pain (6-7 [out of 7] on Likert-type scale) were reported less frequently in each of the study groups than in subjects in the comparison group, although the numbers of subjects reporting the highest scores were few. The distribution of pain outcomes was significantly different among the 3 groups for worst pain and affective words on PSD 1 (P = .04 for both). However, the small number of subjects who reported the highest pain scores precluded adequate multivariate statistical analyses for all outcomes on PSD 1 to 3.
  
  
  CONCLUSIONS
  Data from this exploratory study suggest that adjunctive therapy to decrease postoperative pain-cryotherapy or topical minocycline-might be effective at moderating the patient's highest pain levels after third molar surgery. The topic should be studied further in a multicenter, prospective, randomized trial.
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Dentistry, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Savannah
authors.initials: S
authors.lastname: Gelesko
authors.forename: Leann
authors.initials: L
authors.lastname: Long
authors.forename: Jan
authors.initials: J
authors.lastname: Faulk
authors.forename: Ceib
authors.initials: C
authors.lastname: Phillips
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dicus
authors.forename: Raymond P
authors.initials: RP
authors.lastname: White
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000379:methods*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008911:Minocycline / Q000008:administration & dosage / Q000627:therapeutic use*; D008964:Molar, Third / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D014081:Tooth Extraction / Q000379:methods*; D055815:Young Adult
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents; D008911:Minocycline