Facial expression drawings and the full cup test: valid tools for the measurement of swelling after dental surgery

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Abstract

Assessment of postoperative swelling is subjective and depends on the patient's opinion. The aim of this study was to evaluate the validity of facial expression drawings and the full cup test and to compare their performance with that of other scales in measuring postoperative swelling. Fifty patients who had one of several procedures were included. All patients were asked to fill in a form for six days postoperatively (including the day of operation) that contained four scales to rate the amount of swelling: facial expression drawings, the full cup test, the visual analogue scale (VAS), and the verbal rating scale (VRS). Seven patients did not know how to use some of the scales. However, all patients successfully used the facial expression drawings. There was a significant difference between the scale that patients found easiest to use and the others (p< 0.008). Fourteen patients selected facial expression drawings and five the VRS. The results showed that the correlations between the scales were good (p < 0.01). Facial expression drawings and the full cup test are valid tools and could be used to assess postoperative swelling interchangeably with other scales for rating swelling, and some patients found facial expression drawings were the easiest to use.

Introduction

Dental operations lead to a lot of discomfort from postoperative complications, and swelling with its subsequent release of inflammatory cytokines leads to increased permeability of vessels and accumulation of inflammatory exudate.1, 2 We aimed to reduce the incidence and severity of swelling, and to do this we evaluated the effectiveness of our strategies. Among the subjective measurement scales, the visual analogue scale (VAS) is the most commonly used1, 3, 4, 5 while the verbal rating scale (VRS) is less popular.6, 7

The facial expression drawings and full cup test have been suggested as ways to establish self-reported evaluations of pain that are reliable and valid.8, 9 As far as we know this paper is the first to assess them in the evaluation of swelling after dental operations. Our primary purpose was to evaluate their validity as scales for the patients to assess the amount of swelling and compare them with other scales. Our second aim was to find out which rating scale the patients found easiest to assess the degree of swelling.

Section snippets

Patients and methods

We studied patients who presented to the Department of the Oral Surgery, The Left Specialized Dental Centre, Mosul, Iraq, for evaluation and management of different but related dental problems. The ethics committee of the Iraqi Ministry of Health approved the study, and all the patients provided written informed consent.

Inclusion criteria were patients having any dental operations that required reflection of a flap and removal of bone. Exclusion criteria were: patients with any medical problems

Results

Of the 50 patients enrolled only 47 returned the forms, 29 of whom were female and 18 male. Their mean (SD) age was 29 (12) years, range 10-65.

Seven patients did not know how to use some of the scales (one, five, and five for VRS, VAS, and full cup test, respectively). However, they all used the facial expression drawing correctly.

Only 40 patients successfully used all the scales, and the difference in ease of use was significant (p< 0.008). Twenty-one patients found all the scales easy to use,

Discussion

The extent of swelling is one of the chief indicators of the patient’s comfort during the postoperative period.5 Photography and computed tomography (CT) have been proposed as objective methods to measure postoperative swelling.10 However, they are neither cost-effective nor time saving. Stereophotographic techniques11 are probably the most sophisticated described to date, but are too complex for clinical use.5 Craniometrics using flexible tape has been used in many studies12, 13, 14 but is

Conclusion

Any of the four scales could be used to detect swelling after oral surgical operations, and most patients found the facial expression drawings the easiest to use. Although some patients found the full cup test difficult, we concluded that both it and facial expression drawings are valid ways to assess swelling interchangeably with other scales.

Conflict of interest

We have no conflicts of interest.

Ethics statement/confirmation of patients’ permission

The ethics committee of the Ministry of Health approved the study. All patients gave their informed consent.

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    © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.