Oral and Maxillofacial Surgery Clinics of North America
Therapeutic Agents in Perioperative Third Molar Surgical Procedures
Section snippets
Antibiotic therapy
An ideal prophylactic chemotherapeutic agent reduces the risk of predictive postoperative complications without producing serious side effects or disrupting the surgical procedure. The objective is to make the surgical experience as pleasant as possible. Fewer perioperative adverse effects translate into fewer complaints, fewer postoperative visits, and fewer dissatisfied patients.
Therapeutic agents can be administered prophylactically or empirically. A therapeutic agent provided before a
Steroids
Extraction of third molars, as with any surgical procedure or traumatic insult, results in an intense inflammatory response that consists of edema, erythema, pain, warmth, and loss of function. This response occurs because of mediator release of cytokines, prostaglandins, and histamine from leukocytes, endothelial cells, and mast cells. The increase in osmotic pressure within injured tissue and leakage from capillaries are responsible for the expansion of tissue that occurs with edema [7], [34]
Analgesics
Postoperative pain may be reduced by various interventions (Table 3). Preoperative systemic analgesics reduce pain by inhibition of central and peripheral pain receptors. The peripheral nerves can be blocked by local anesthesia or chemotherapeutic agents [59]. Stimulation of pain receptors after an insult may result in primary or secondary hyperalgia [60], [61]. Primary hyperalgia occurs at the site of the assault immediately after injury and is induced by heat or mechanical stimulation.
Nausea
Regardless of the type of surgical procedure performed, the primary perioperative concern for most patients was the development of nausea and vomiting. In fact, patients surveyed have indicated that they would rather deal with pain postoperatively than nausea and vomiting [70]. The overall prevalence of nausea and vomiting after general anesthesia has been estimated to be 25% to 30%, with 0.18% resulting in retractable nausea and vomiting [70]. The prevalence of nausea and vomiting after
Herbal supplements
The prevalence of herbal supplement consumption in the “third molar extraction population” is not known. Within the United States, 12.1% of the adult population currently uses herbal medication [81], [82]. This number represents a significant increase when compared with 2.5% in 1990 [82]. In a recent survey of patients undergoing cosmetic surgery, twice as many patients reported using herbal supplements when compared with the general population [83]. In patients undergoing various inpatient or
Summary
Surgery is a stressful experience for many patients. Minimizing adverse side effects makes the surgical experience more favorable for patients. This article provides a literature review of various therapeutic agents used to minimize pain, edema, trismus, nausea, vomiting, infection, and adverse medication interactions. The risk factors for each adverse side effect are analyzed. Although the article does not advocate a particular guideline, it provides literature integrating various surgeons'
References (142)
- et al.
The epidemiology of wound infection
Surg Clin North Am
(1980) - et al.
Extra charge and prolongation of stay attributable to nosocomical infections: a prospective interhospital comparison
Am J Med
(1981) Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery
J Oral Maxillofac Surg
(1990)- et al.
Microbial complexes detected in the second/third molar region in patients with asymptomatic third molars
J Oral Maxillofac Surg
(2002) Dry socket and other postoperative complications
Dent Clin North Am
(1971)- et al.
A prospective study of complications related to mandibular third molar surgery
J Oral Maxillofac Surg
(1985) - et al.
Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in private practices
J Am Dent Assoc
(1985) - et al.
The American Association of Oral and Maxillofacial Surgeons age-related third molar study
J Oral Maxillofac Surg
(2005) - et al.
Prophylactic antibiotics for third molar surgery: a supportive opinion
J Oral Maxillofac Surg
(1995) - et al.
Side effects and complications associated with third molar surgery
Oral Surg Oral Med Oral Pathol
(1993)
Prophylactic use of phenoxymethylpenicillin and tinidazole in mandibular third molar surgery: a comparative placebo controlled clinical trial
Br J Oral Maxillofac Surg
Tinidazole or pivampicillin in third molar surgery
Int J Oral Maxillofac Surg
Complications following removal of impacted third molars
J Oral Maxillofac Surg
Neomycin-baciteracin cones in impacted third molar sockets
Int J Oral Maxillofac Surg
An assessment of the use of prophylactic antibiotics in third molar surgery
Int J Oral Surg
The effect of chlorhexidine rinse on the incidence of alveolar osteitis following the surgical removal of impacted mandibular third molars
J Oral Maxillofac Surg
The effect of smoking on immediate post-extraction socket filling with blood and the incidence of painful socket
Br J Oral Maxillofac Surg
Metronidazole two or three times daily: a comparative controlled clinical trial of the efficacy of two different dosing schedules of metronidazole for chemoprophylaxis following third molar surgery
Br J Oral Maxillofac Surg
The effect of methylprednisolone on pain, trismus and swelling after removal of third molar
Oral Surg Oral Med Oral Pathol
The use of intraoral dexamethasone after extraction of mandibular third molars
Oral Surg Oral Med Oral Pathol
Adrenocorticosteroids in medical emergencies
Med Clin North Am
The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery
J Oral Maxillofac Surg
Glucocorticosteroids in dentistry
J Am Dent Assoc
Reduction of postoperative facial swelling by low-dose methylprednisolone
J Oral Maxillofac Surg
Determination of the anti-inflammatory effects of methylprednisolone on sequelae of third molar surgery
J Oral Maxillofac Surg
Evaluation of methylprednisolone and flurbiprofen for inhibition for the postoperative inflammatory response
Oral Surg Oral Med Oral Pathol
A review of perioperative corticosteroid use in dentoalveolar surgery
Oral Surg Oral Med Oral Pathol
Acute adrenal insufficiency: recognition, management and prevention
Urol Clin North Am
Preoperative nonsteroidal anti-inflammatory agents: review of the literature
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Peripheral and central mechanism of cutaneous hyperalgesia
Prog Neurobiol
Ibuprofen given pre- and post-operatively for the relief of pain
Int J Oral Maxillofac Surg
Evaluation of preoperative ibuprofen for postoperative pain after removal of third molars
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Prophylactic use of indomethacin for prevention of post surgical complications after removal of impacted third molars
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Analgesic efficacy and tolerability of oxycodone 5mg/ibuprofen 400 mg compared with those of oxycodone 5 mg/acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain: a randomized, double-blind placebo-controlled, single-dose parallel-group study in a dental pain model
Clin Ther
Outcomes after same-day surgery: a review of 1180 cases at a major teaching hospital
J Oral Maxillofac Surg
The prophylactic treatment of postoperative nausea and vomiting in oral and maxillofacial surgery
J Oral Maxillofac Surg
Practical solutions for difficult problems: II. Drug cost analysis data in anesthesia
Anesthesiol Clin North Am
Herbal medication: current trends in anesthesiology practice a hospital survey
J Clin Anesth
The clinical evaluation of dexamethasone in oral surgery
Oral Surg Oral Med Oral Pathol
Betamethasone in dentistry
Oral Surg Oral Med Oral Pathol
Double-blind study of prednisolone and papase as inhibitors of complications after oral surgery
J Am Dent Assoc
The use of dexamethasone after extraction of mandibular third molars
Oral Surg
The anti-inflammatory effects of dexamethasone and therapeutic ultrasound in oral surgery
Br J Oral Maxillofac Surg
Comparison of the effects of 2 doses of methylprednisolone on pain, swelling and trismus after third molar surgery
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Current guidelines for antibiotic prophylaxis of surgical wounds
Am Fam Physician
Preoperative antibiotic prophylaxis
N Engl J Med
Prevention of bacterial endocarditis: recommendations by the American heart association
J Am Dent Assoc
Prophylactic use of antibiotic for procedures after total joint replacement
J Bone Joint Surg Am
The contributions of infection control to a century of surgical progress
Ann Surg
The effective period of preventive antibiotic action in experimental incisions and dermal lesions
Surgery
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Is Injectable Platelet-Rich Fibrin Really Effective in Reducing Expected Side Effects of Removing Impacted Third Molar Surgery?
2024, Journal of Oral and Maxillofacial SurgeryPhotobiomodulation Therapy Improves Postoperative Pain and Edema in Third Molar Surgeries: A Randomized, Comparative, Double-Blind, and Prospective Clinical Trial
2022, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :PBM therapy causes cellular changes that promote cell viability, proliferation, and tissue healing.8,18,41 The use of PBM therapy has been reported in the literature as an adjunctive therapy to control the signs and symptoms in the postoperative period of third molar surgery.5-8,18 The results of this clinical trial have demonstrated that PBM therapy using a diode laser (GaAlAs) at 810 nm with an energy of 6 J/point improved pain and edema control in the postoperative third molar retained extractions (Fig. 2, 3, 5, 6).
Effects of co-administered dexamethasone and nimesulide on pain, swelling, and trismus following third molar surgery: a randomized, triple-blind, controlled clinical trial
2017, International Journal of Oral and Maxillofacial SurgeryCitation Excerpt :This allows the patient to describe their discomfort more objectively. Furthermore, the change in pain on treatment can also be assessed with the use of this ruler.17 Patients were instructed to record their pain score at 30 min after surgery and then at 2, 4, 6, 8, 12, 16, 24, 48, and 72 h postoperative.
Amoxicillin to prevent post extraction of third molars infection: Randomized clinical trial
2016, Revista Espanola de Cirugia Oral y MaxilofacialEfficacy of antibiotic prophylaxis on postoperative inflammatory complications in Chinese patients having impacted mandibular third molars removed: A split-mouth, double-blind, self-controlled, clinical trial
2015, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Pasupathy and Alexander13 also failed to show any advantage in the routine use of prophylactic antibiotics. Because we knew of few if any standard clinical trials on this topic in China, we designed this split-mouth, double-blind, self-controlled, clinical trial to identify whether antibiotics have an effect on postoperative inflammatory complications after extraction of impacted mandibular third molars in Chinese patients, similar to that of Mehrabi et al.14 The second question was which antibiotics could be used to prevent and reduce the incidence of postoperative inflammatory complications?