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Purpose: To assess the impact of symptomatic pericoronitis on health-related quality of life (HRQOL)., Patients and Methods: Healthy subjects with symptomatic pericoronitis were enrolled in an institutional review board-approved study. Each was given a third molar condition-specific HRQOL instrument to assess the impact of pericoronitis in the preceding week. Lifestyle and oral-function outcomes were assessed using a 5-point Likert-type scale, with anchors of "no trouble" (1) and "lots of trouble" (5). Pain outcomes were assessed using a 7-point scale anchored by "no pain" (1) and "worst pain imaginable" (7). Verbal descriptors for sensory perception and unpleasantness of pain were recorded on Gracely scales. The impact of symptomatic pericoronitis on overall health and well-being in the previous 3 months was recorded using the Oral Health Impact Profile (OHIP-14)., Results: The median age of 57 subjects was 23.1 years (interquartile range [IQR], 21.2 to 25.8 years). Forty-nine percent were female, 56% were Caucasian, 21% were Asian, and 16% were African American. Ninety-one percent had at least some college experience. Twenty-eight percent of subjects described their worst pain in the week before enrollment as severe (5-7/7), 40% as moderate (3-4/7), and 32% as none/little (1-2/7). Average pain in the previous week was described as severe (5-7/7) for 4% of subjects, as moderate (3-4/7) for 40%, and as none/little (1-2/7) for 56%. On the Gracely scales, 9% of subjects reported the sensory intensity of pain in the past week as "intense," "very intense," or "extremely intense." Subjects reported "quite a bit/lots" of difficulty (4-5/5) with oral function (23% with eating, 19% with chewing, and 6% with opening) and "quite a bit/lots" of difficulty (4-5/5) with lifestyle (sleeping, social life, and sports/hobby, all at 2%). The median OHIP-14 Severity score was 11/56 (IQR, 5-17). The most frequently reported OHIP-14 items in the 3 months before enrollment were in the pain dimensions. The median Severity score for pain items was 4/8 (IQR, 2-6)., Conclusion: Symptomatic pericoronitis can have adverse outcomes, compromising the quality of life and inflicting pain.

Purpose: This study was conducted to determine if the completeness of the root formation of mandibular third molars prior to removal affected clinical and health-related quality of life (HRQOL) recovery., Patients and Methods: Data from HRQOL responses from patients and clinical outcome data were available after third molar surgery conducted by surgeons in community practice and academic centers. The root development of each mandibular third molar on presurgery panoramic radiographs for these patients was assessed by trained clinician observers. Patients were categorized as those with complete root formation (both mandibular third molars had 100% completely formed roots) or as those with incomplete root formation (at least 1 mandibular third molar not completely formed). The proportion of patients who experienced delayed clinical or HRQOL recovery that exceeded a clinically relevant criterion value were compared for these 2 groups of patients using chi2 statistics. Level of significance was set at 0.05., Results: Both mandibular third molars had 100% completely formed roots in 118 patients; at least 1 mandibular third molar was not completely formed in 218 patients. If patients had a mandibular third molar with roots less than 100% complete, they more likely: were female (65% vs 58%), were less than 25 years old (95% vs 54%), P < .01, and had not finished high school (59% vs 28%), P < .01. For those with incomplete root formation, bone removal for both mandibular third molars was more likely (84% vs 67%), P < .01, and the surgeons' overall estimate of degree of difficulty was greater (14/28 vs 12/28), P = .02. Median surgery time did not differ between groups. The proportion of patients who experienced delayed clinical or HRQOL recovery did not differ between the incomplete and complete root formation groups., Conclusions: Incomplete lower third molar root formation presurgery may not be a predictor of better or worse clinical or HRQOL recovery after surgery. Other clinical, demographic, and health indicators should influence surgeons' recommendations and patients' decisions regarding third molar treatment including surgery.

Purpose: This study was designed to further our understanding of recovery after third molar surgery by using 2 instruments to measure quality of life outcomes, the more global Oral Health Impact Profile (OHIP-14), and the condition-specific Health-Related Quality of Life (HRQOL) instrument., Patients and Methods: Clinical and quality of life data pre- and postsurgery from 63 patients with all 4 third molars below the occlusal plane, treated with topical minocycline during third molar surgery to reduce the incidence of delayed clinical healing, were available for analyses. Each patient was given 2 questionnaires to complete; the more global OHIP-14 and the HRQOL instrument designed to assess recovery after third molar surgery. Prevalence, Extent, and Severity of the OHIP-14 scores were calculated presurgery and for postsurgery days (PSD) 1, 7, 14. The percentage of patients reporting clinically relevant responses detrimental to quality of life from the condition-specific HRQOL instrument were reported for the same time frame., Results: Study patients were most likely female, less than 25 years old, and Caucasian. Most (72%) had bone removed from both lower third molars. Median surgery time was 27 minutes (interquartile range [IQ], 20, 40 minutes.). Median surgeons' estimate of overall difficulty was 14 of a possible 28 (IQ 10, 18), and the median degree of difficulty for lower third molars was 8 of 14 (IQ 6, 10). Few patients (only 10%) had delayed clinical healing. Prevalence for all OHIP-14 items, percent of patients reporting items "fairly often" or "very often," were increased from presurgery on PSD 1 and then decreased on PSD 7 and PSD 14. OHIP-14 Severity scores, the sum of OHIP-14 responses, followed the same pattern as the Prevalence scores. OHIP-14 Severity scores on PSD 1 were 27 (IQ 16, 34), decreasing to 8 (IQ 3, 13) by PSD 7, and 1 (IQ 0, 5) by PSD 14. Recovery for outcomes addressed by both instruments followed a similar pattern and time course. However, each instrument also assessed distinctly different outcomes, adding information that could not be obtained by 1 instrument alone., Conclusion: Complementary instruments to measure quality of life outcomes provide a broader understanding of recovery after third molar surgery.

Purpose: Compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients treated with or without topical minocycline at surgery., Patients and Methods: Sixty-three patients at least 18 years of age with all 4 third molars below the occlusal plane were treated with topical minocycline during third molar surgery. Topical minocycline (1.0 mg in bioresorbable polyglycolide-co-dl-lactide [PGLA] sustained-release microspheres) was placed sequentially in bony defects after removal of lower third molars. Clinical and health-related quality of life (HRQOL) outcomes of these patients postsurgery were compared with those of a nonconcurrent control group (n = 60 patients) who did not receive antibiotics. The control group was selected using the same criteria and treated under the same surgical protocol as the antibiotic group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics., Results: The 63 patients in the minocycline group were treated at 4 clinical centers. The incidence of delayed clinical recovery, defined as a postsurgery visit with treatment, was significantly lower in the minocycline group compared with the control group. In the minocycline group, 10% had 1 postsurgery visit with treatment; no patient had 2 visits. In the control group without antibiotics, 28% had at least 1 postsurgery visit with treatment (P = .01) and 13% had at least 2 postsurgery visits with treatment. Recovery time to "no" or "little trouble" with chewing and mouth opening was significantly improved in the minocycline group (P < .05)., Conclusions: Administration of topical minocycline with third molar surgery may improve clinical and HRQOL recovery in healthy adult patients with all 4 third molars below the occlusal plane, a presenting characteristic that has been suggested as a risk factor for delayed recovery.

Purpose: This study was designed to examine the impact of delayed clinical healing after third molar surgery on health-related quality-of-life recovery (HRQOL)., Patients and Methods: Recovery data after removal of 4 third molars for patients in an institutional review board-approved, prospective, multi-site, clinical trial were analyzed. Data obtained from patients with a HRQOL instrument, which included domains for lifestyle, oral function, and pain items, assessed recovery for each of 14 days postsurgery. Delayed clinical healing was defined as having at least 1 postsurgery visit with treatment. Prevalence ratios (PR) with 95% confidence intervals were calculated to compare the prevalence of delayed HRQOL recovery between those participants with delayed clinical healing and those without. Sensory intensity and unpleasantness scores from Gracely scale data for each postsurgery day were compared for those patients with and those without delayed clinical healing using the Cochran-Mantel-Haenszel row mean score statistics. The level of significance was set at .05., Results: Recovery data were analyzed for 547 patients. A subset of the patients also completed Gracely scales each day. If a patient had delayed clinical healing, the prevalence of delayed recovery for lifestyle nearly doubled (prevalence ratio (PR), 1.7; 95% CI, 1.3 to 2.3). Similarly, a higher proportion of those with delayed clinical healing also reported delayed oral function recovery (PR, 1.8; 95% CI, 1.4 to 2.3); late symptoms recovery (PR, 2.0; 95% CI, 1.2 to 3.6) and delayed resolution of pain (PR, 1.6; 95% CI, 1.3 to 2.0). Statistically significant average differences existed between those with delayed clinical healing and those without for the sensory intensity of pain and the unpleasantness of pain from postsurgery day 3 through day 14 (P < or = .01)., Conclusion: Delayed clinical healing after third molar surgery significantly increased the prevalence of delayed recovery for lifestyle, oral function, late symptoms, and pain.

Purpose: To compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients predicted to be at risk for delayed recovery, treated with or without intravenous (IV) corticosteroids at surgery., Patients and Methods: Patients at least 18 years of age and with all 4 third molars below the occlusal plane were given IV corticosteroids just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group who did not receive corticosteroids. No antibiotics were administered. The control group was selected using the same criteria and treated under the same surgical protocol as the corticosteroid group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics., Results: Sixty patients were in each cohort. The incidence of delayed clinical recovery, a postsurgery visit with treatment, was higher in the control group compared with the corticosteroid group. In the corticosteroid group, 6 patients (10%) had 1 postsurgery visit with treatment. In the control group without corticosteroids, 17 patients (28%) had at least 1 postsurgery visit with treatment (P = .01). Compared with the control group, nausea tended to bother patients less on postsurgery day 1 (P = .07); sleep was improved on postsurgery days 1 through 4 (P < .05). Though not statistically significant, corticosteroids reduced the patients reported recovery by at least 1 day for pain, lifestyle, and oral function., Conclusion: Administration of IV corticosteroids before third molar surgery without antibiotics does not hamper clinical recovery even when healthy adult patients are predicted to have delayed recovery. Overall, IV corticosteroid administration had a limited, but beneficial effect on HRQOL outcomes.

Purpose: This study was designed to assess the impact of "pain and swelling" associated with third molars on patients' quality of life before surgery., Patients and Methods: The data for these analyses were obtained from a larger ongoing study designed to examine the surgical and medical management of problems associated with third molars. Data from 480 patients with 4 third molars scheduled for removal were used in the analysis. Questionnaires administered presurgery assessed patients' medical and dental history, their reasons for seeking third molar removal, and sociodemographic characteristics. Adverse impacts on oral health-related quality of life were measured using the 14-item Oral Health Impact Profile (OHIP) questionnaire. The primary outcome variable was the percentage of people reporting 1 or more of the 12 non-pain-specific OHIP items "fairly often" or "very often" during the 3 months before enrollment., Results: One third (178 of 480) of patients said they were seeking third molar surgery because of current or previous symptoms of pain/swelling, and 17% reported 1 or more of the 12 non-pain-specific OHIP items. In the multivariate logistic regression model, the odds of one or more impacts was greater for people who presented because of symptoms (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.7 to 4.8), who were aged 25 years or more (OR, 1.9; 95% CI, 1.1-3.3), and who had a self-reported history of tooth loss due to pathology or trauma (OR, 2.9; 95% CI, 1.9 to 5.5)., Conclusions: Adverse impacts on quality of life occurred for 1 in 8 patients seeking third molar surgery, and the odds increased 3-fold for patients who had experienced pain/swelling compared with those who were asymptomatic.

Purpose: We sought to compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients treated with or without intravenous antibiotics at surgery., Patients and Methods: Fifty-six patients at least 18 years of age and with all 4 third molars below the occlusal plane, treated at 3 clinical centers, were given intravenous antibiotics just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group (n = 60 patients) who did not receive antibiotics. The control group was selected using the same criteria and treated under the same surgical protocol as the antibiotic group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics., Results: The incidence of delayed clinical recovery defined as a postsurgery visit with treatment was higher in the control group compared with the antibiotic group. In the antibiotic group, 4% had 1 postsurgery visit with treatment; no patient had 2 visits. In the control group without antibiotics, 28% had at least 1 postsurgery visit with treatment (P <.0001) and 13% had at least 2 postsurgery visits with treatment. No statistically significant differences in HRQOL outcomes were found between the 2 groups., Conclusions: Administration of intravenous antibiotics before third molar surgery may improve clinical recovery in healthy adult patients with all 4 third molars below the occlusal plane, a presenting characteristic that has been suggested as a risk factor for delayed recovery. The findings from this exploratory trial indicate that evaluation of the effectiveness of systemic antibiotic administration with third molar surgery in a randomized, multi-intervention, explanatory clinical trial is warranted.

Purpose: We sought to identify the demographic, oral health, and surgical risk factors associated with prolonged recovery after third molar surgery using health-related quality of life (HRQOL) and clinical outcomes., Patients and Methods: HRQOL responses from patients and clinical outcomes were obtained after third molar surgery. Criteria were selected for HRQOL outcomes that separated patients with from those without prolonged recovery. Delayed clinical healing was indicated by a patient having at least 1 postsurgery visit with treatment. Risk assessment models for prolonged HRQOL recovery and delayed clinical healing were developed using stepwise logistic regression analysis., Results: We included 547 subjects with HRQOL and clinical outcome data in this analysis. Age, gender, and occlusal plane position were statistically significantly associated with prolonged recovery for early symptoms, oral function, and pain. Recovery for lifestyle was prolonged only if both lower third molars were below the occlusal plane before surgery. Age, gender, prior symptoms related to the third molars, and the surgeon's perception of difficulty were statistically significant predictors of delayed clinical recovery., Conclusions: Certain demographic and oral health conditions available to the surgeon before surgery, and characteristics of the surgery itself, increase the risk of a prolonged recovery for HRQOL outcomes and delayed clinical outcomes after third molar surgery.

Purpose: The study goal was to assess both clinical and health-related quality of life (HRQOL) outcomes after third molar surgery., Methods: Patients who were having 4 third molars removed were enrolled in a prospective clinical trial. Baseline data were recorded that included demographics, the patient's and surgeon's assessment of third molar conditions, and details of the surgical procedure. After surgery, clinical data were collected that detailed healing and any treatment that was rendered. Each patient was given an HRQOL instrument to complete on each postsurgery day for 14 days; the instrument was designed to assess a patient's perception of recovery in 4 main categories: pain, lifestyle, oral function, and other symptoms related to the procedure., Results: Recovery data were available for 630 of 740 enrolled patients. The median age of the 630 patients was 21 years, and the median operation time was 30 minutes. Recovery for most HRQOL measures occurred within 5 days after surgery. However, recovery from pain to the criterion of "little or none" was delayed relative to other HRQOL measures. Twenty-two percent of patients were treated for delayed healing after surgery., Conclusions: Having both clinical and HRQOL data on recovery after third molar surgery could assist the surgeon when informing prospective patients about what to expect after surgery to remove third molars., (Copyright 2003 American Association of Oral and Maxillofacial Surgeons.)

This study assessed professional satisfaction among 558 California general dentists using the Dentist Satisfaction Survey. Among findings were that dentists were most dissatisfied with the threat of malpractice, level of income, demands of managing the practice, and amount of personal time. Findings have implications for counseling predoctoral students. (Author/DB)