Short-Term Perception of Recovery after Surgical Removal of Impacted Third Molar
Abstract
Background: The surgical removal of third molars, or wisdom teeth, is a common oral and maxillofacial procedure that often presents postoperative challenges such as pain, swelling, and restricted jaw function. While clinical recovery parameters are well-documented, patient-perceived recovery progress remains variable and influenced by multiple factors.
Objective: This study aims to assess the subjective experiences of patients undergoing third molar extraction, focusing on perceived pain levels, postoperative swelling, functional recovery, and complications during the first postoperative week.
Methods: A three-month observational study was conducted at the Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, BIU, Bareilly. The study included 45 healthy adult patients (aged 18-35 years) who underwent surgical third molar extraction. Data collection involved patient-reported outcomes assessed at 24 hours, 72 hours, and 7 days postoperatively. Parameters included pain levels (measured using the Visual Analogue Scale), difficulty in mouth opening, swelling, and complications. A structured questionnaire was used to evaluate the impact of surgery on daily activities, social interactions, and overall quality of life.
Results: The majority of patients reported significant postoperative discomfort, with peak pain occurring within the first 24 hours (VAS score of 6). Swelling was most pronounced on the second postoperative day before gradually subsiding. Functional limitations, such as restricted mouth opening and chewing difficulties, were most evident during the first three days but improved over the study period. A small proportion of patients reported delayed healing and temporary difficulty in mouth opening as complications. Despite these challenges, most patients rated their overall recovery experience as positive, with effective pain management contributing to satisfactory outcomes.
Conclusion: Third molar extraction significantly affects patients’ quality of life during the early postoperative phase, with pain, swelling, and functional impairment being primary concerns. However, patient education, effective analgesic use, and proper postoperative care can enhance recovery experiences. The findings highlight the need for individualized patient management strategies to improve overall satisfaction and optimize postoperative recovery.
References
McGrath C, Comfort MB, Lo EC, Luo Y. Changes in life quality following third molar surgery–the immediate postoperative period. British dental journal. 2003 Mar;194(5):265-8. doi: https://doi.org/10.1038/sj.bdj.4809930
White Jr RP, Shugars DA, Shafer DM, Laskin DM, Buckley MJ, Phillips C. Recovery after third molar surgery: clinical and health-related quality of life outcomes. Journal of oral and maxillofacial surgery. 2003 May 1;61(5):535-44. doi: https://doi.org/10.1053/joms.2003.50106
Colorado-Bonnin M, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Quality of life following lower third molar removal. International journal of oral and maxillofacial surgery. 2006 Apr 1;35(4):343-7. doi: https://doi.org/10.1016/j.ijom.2005.08.008
Sato FR, Asprino L, de Araújo DE, de Moraes M. Short-term outcome of postoperative patient recovery perception after surgical removal of third molars. Journal of Oral and Maxillofacial Surgery. 2009 May 1;67(5):1083-91. doi: https://doi.org/10.1016/j.joms.2008.09.032
Avellaneda-Gimeno V, Figueiredo R, Valmaseda-Castellón E. Quality of life after upper third molar removal: A prospective longitudinal study. Medicina oral, patologia oral y cirugia bucal. 2017 Nov;22(6):e759-66. doi: https://doi.org/10.4317/medoral.21781
Abramovitz I, Zakopay E, Zini A, Chweidan H, Balakirski D, Protter NE, Almoznino G. Pre-operative oral health-related quality of life in patients attending surgical removal of mandibular third molar teeth. InHealthcare 2021 Jan;16(9):85-96. doi: https://doi.org/10.3390/healthcare9010085
Doni BR, Srinivasan A, Issrani R, Agrawal R, Patil SR, Alam MK. The effect of pain and swelling related to third molars on oral health-related quality of life. Pesquisa Brasileira em Odontopediatria e Clínica Integrada. 2021 Apr 2;21: e0190-7 doi: http://dx.doi.org/10.1590/pboci.2021.056
Hallab L, Azzouzi A, Chami B. Quality of life after extraction of mandibular wisdom teeth: A systematic review. Annals of Medicine and Surgery. 2022 Sep 1;81:104387-404. doi: https://doi.org/10.1016/j.amsu.2022.104387
Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatology international. 1985;5(4):145-8; doi: https://doi.org/10.1007/bf00541514
Howe GL. Some complications of tooth extraction: lectures delivered at the Royal College of Surgeons of England on 27th April 1961. Annals of The Royal College of Surgeons of England. 1962 May;30(5):309-23; https://pmc.ncbi.nlm.nih.gov/articles/PMC2414205/
Bhujbal R, Veerabhadrappa SK, Yadav S, Chappi M, Patil V. Evaluation of platelet-rich fibrin and platelet-rich plasma in impacted mandibular third molar extraction socket healing and bone regeneration: A split-mouth comparative study. European J Gen Dent. 2020;9(02):96-102. doi: https://doi.org/10.4103/ejgd.ejgd_133_19
Shugars DA, Benson K, White RP Jr, Simpson KN, Bader JD. Developing a measure of patient perceptions of short-term outcomes of third molar surgery. J Oral Maxillofac Surg. 1996;54(12):1402-8. doi: https://doi.org/10.1016/s0278-2391(96)90253-0
Savin J, Ogden GR. Third molar surgery—a preliminary report on aspects affecting quality of life in the early postoperative period. Br J Oral Maxillofac Surg. 1997;35(4):246-53. doi: https://doi.org/10.1016/s0266-4356(97)90042-5
White RP Jr, Shugars DA, Shafer DM, Laskin DM, Buckley MJ, Phillips C. Recovery after third molar surgery: clinical and health-related quality of life outcomes. J Oral Maxillofac Surg. 2003;61(5):535-44. doi: https://doi.org/10.1053/joms.2003.50106
Conrad SM, Blakey GH, Shugars DA, Marciani RD, Phillips C, White RP Jr. Patients' perception of recovery after third molar surgery. J Oral Maxillofac Surg. 1999;57(11):1288-94. doi: https://doi.org/10.1016/s0278-2391(99)90861-3
Lindsay SJ, Humphris GM, Barnby GJ. Expectations and preferences for treatment: a comparison between anxious and non-anxious dental patients. Int Dent J. 1987;37(4):215-26. Doi: https://doi.org/10.1038/sj.bdj.4806218
Fraser HM, Hampson SE. The relative importance of dental appearance and care to dental anxiety. Community Dent Oral Epidemiol. 1986;14(4):205-8.
Earl P. Patients' expectations and experiences of third molar surgery. J R Soc Med. 1994;87(11):690-1. doi: https://doi.org/10.1016/s0278-2391(99)90861-3
Winter GB. Principles of Exodontia as Applied to the Impacted Third Molar. St. Louis: American Medical Book Co.; 1926.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63(S11):S240-52. doi: https://doi.org/10.1002/acr.20543
Moore JR, Gilby MC. The collar technique for impacted third molars. Br J Oral Surg. 1973;10(3):256-61.
Bello SA, Olaitan AA, Ladeinde AL. A randomized controlled clinical trial of two different regimens of dexamethasone therapy in the prevention of complications following third molar surgery. J Oral Maxillofac Surg. 2011;69(11):e273-7.
