Effect of Surgical Removal of Impacted Third Molars on Trismus Value

Document Type : Original Article

Authors

1 Department of Oral and Maxillofacial Surgery, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Endodontics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Sciences, Ahvaz, Iran.

3 Department of Operative Group,Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Background and Objective: Surgical extraction of impacted third molars is usually accompanied with inflammatory reactions which result in pain, swelling and trismus. The purpose of this study was to evaluate the effect of different pre-and- inter-surgical variables such as age, gender, temporomandibular disorders (TMD), type of impaction, root morphology and experience of surgeon on the maximum mouth opening after surgical extraction of impacted third molars.
Materials and Methods: In this prospective study we included seventy six patients with impacted lower or upper third molar in this study. Pre-and-per surgical variables were recorded through a questionnaire.  Degree of trismus was evaluated through maximum interincisal mouth opening before and 48 hours after surgery. Data was analyzed using T-paired in SPSS.15 software.
Results: The minimum and maximuminterincisal openings before surgery were, respectively, 22 mm and 65 mm with an average of 47.1 ± 8.5 mm. Two days after operation, the maximum interincisal opening was 62 mm, and the minimum was 8 mm with an average of 28.5 ± 6.2 mm (p<0.05). None of the variables except root morphology had any significant correlation with maximum interincisal opening. However trismus was lower in patients operated with professors (attendants) than postgraduate students (p>0.05). In patients who were treated by postgraduate students was lower than that of undergraduate students (p>0.05). Trismus was high in TMD patients.
Conclusion: Trismus was significantly higher in patients who had third molars with separate and divergent roots.

Keywords


1-Peterson LJ, Ellis E, Hupp JR, Tucker MR .Contemporary oral and maxillofacial surgery. In: Peterson LJ. Principles of management of impacted teeth. 4thed. United States of America: Linda Duncan; 2003.p.184-185.
2-Peterson LJ, Ellis E, Hupp JR, Tucker MR .Contemporary oral and maxillofacial surgery. In: Peterson LJ. Principles of management of impacted teeth. 4thed. United States of America: Linda Duncan; 2003.p.213.
3-Peterson LJ, Ellis E, Hupp JR, Tucker MR .Contemporary oral and maxillofacial surgery. In: Peterson LJ. Postoperative patient management. 4thed. United States of America: Linda Duncan; 2003.p.219.
4-Garcia Garcia A, Gude Sampedro F, Gandara Rey J, Gallas Torreira M. Trismus and pain after removal of impacted lower third molars, J Oral Maxillofa Surg.1997 Nov; 55(11):1223-6.
5-Kim JC, Choi SS, Wang SJ, Kim SG. Minor complications after mandibular third molar surgery: type, incidence, and possible prevention. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Aug;102(2):e4-11. Epub 2006 Jun 27.
6-De Bore MP, Raghoebar GM, Stegenga B, Schoen PJ, Boering G. Complications after mandibular third Molar extraction, Quintessence Int, 1995 Nov, 26(11): 779 –84.
7-Berge TI, Boe OE:. Predictor evaluation of postoperative morbidity after surgical removal of mandibular third molars, Acta Odontal Scand. 1994 Jun, 52(3): 162-9.
8-Akadiri OA, Okoje VN, Arotiba JT. Identification of risk factors for short-term morbidity in third molar surgery. Odontostomatol Trop. 2008 Dec;31(124):5-10.
9-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 May;65(5):901-17.
10-Chiapasco M, Decicco L, Marrone G. Side effects and complications associated with third molar surgery, Oral Surg Oral Med Oral pathol.1993 Oct, 76(4):412-20.
11-Handelman SL, Block PM, Desjardins P, Gatlin L, Simmons L.Removal of impacted third molars by Oral/maxillo facial surgery and general dentistry residents, Spec Care Dentist. 1993 May –Jun, 13(3): 122-6.
12-Berge TI, Gilhuus-Moe OT. Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon. Acta Odontol Scand. 1993 Dec;51(6):389-97.
13-Jerjes W, Upile T, Kafas P, Abbas S, Rob J, McCarthy E, et al. Third molar surgery: the patient's and the clinician's perspective. Int Arch Med. 2009 Oct 24;2(1):32.
14-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 Jul;104(1):e1-6. Epub 2007 May 15.
15-García García A, Gude Sampedro F, Gallas Torrella M, Gándara Vila P, Madriñán-Graña P, Gándara-Rey JM. Trismus and pain after removal of a lower third molar. Effects of raising a mucoperiosteal flap. Med Oral. 2001 Nov-Dec;6(5):391-6.
16-Graziani F, D'Aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial. Int J Oral Maxillofac Surg. 2006 Mar;35(3):241-6. Epub 2005 Sep 26.
17-Baqain ZH, Karaky AA, Sawair F, Khraisat A, Duaibis R, Rajab LD. Frequency estimates and risk factors for postoperative morbidity after third molar removal: a prospective cohort study. J Oral Maxillofac Surg. 2008 Nov;66(11):2276-83.
18-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 May;65(5):901-17.
19-Pedersen A. Interrelation of complints after removal of impacted mandibular third molars, Int J Oral Surg, 1985 Jun; 14(3): 241-4.
20-Oikarinen K, Räsänen A. Complications of third molar surgery among university students. J Am Coll Health. 1991 May;39(6):281-5.
21-Lago-Méndez L, Diniz-Freitas M, Senra-Rivera C, Seoane-Pesqueira G, Gándara-Rey JM, García-García A. Postoperative recovery after removal of a lower third molar: role of trait and dental anxiety. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Dec;108(6):855-60.