Drug therapy in the surgical removal of impacted and semi-impacted third molarsAbstract
Aim The aim of this study was to evaluate the variables that can influence dentists on choosing pre- and postoperative drug protocols for impacted and semi-impacted third molar surgeries.
Methods A study carried out by collecting data using a questionnaire set up on the “Google Forms” and sent online to dentists. The questionnaire contained questions about general characteristics and training, professional practice, surgical and pharmacological procedures and postoperative procedures. All Brazilian dentists were eligible to participate. A descriptive analysis of the data was performed, according to the outcomes class of pre- and postoperative medication, and form of administration, and the absolute and relative frequencies of the variables were calculated.
Results A total of 310 forms were answered by professionals, most of them over 40 years old; 53% were male, most were specialists working in private practice, and 50.8% had some training in oral surgery. This was evidenced in the wide range of responses obtained in our study that is a lack of relationship between the dentist’s profile and drug prescriptions. Antibiotics were primarily used postoperatively by more than half of the participants, and few prescribed them preoperatively. The antibiotic prophylaxis was not widely prescribed for this surgery, and amoxicillin proved to be the antibiotic of choice pre- and postoperatively by almost all surveyed dentists. Non-steroidal anti-inflammatory drugs were rarely used preoperatively, although 71.9% of the professionals reported using them postoperatively. Corticosteroids were responsible for 37.7% of preoperative prescriptions, and the preference was for oral administration. Almost all professionals prescribed analgesics in the postoperative period.
Conclusions There was great variability of responses of drug prescriptions in the pre- and postoperative period of third molar surgeries, and no relationship between the dentist’s profile and drug protocols was found.
Keywords:
Drug prescriptions; Molar, third; Surgery, oral; Surveys and questionnaires
Introduction
Removal of impacted or semi-impacted third molars is a commonly performed surgery in dentistry. Frequent indications are pericoronitis, carious lesions, pathological lesions, and root resorption of the adjacent teeth1,2. Given its invasive nature, postoperative complications such as trismus, edema, ecchymosis, infections, and pain may occur, in addition to being associated with a negative impact on the postoperative quality of life3-5. Nonetheless, drug prescription and other pre- and postoperative care measures may reduce these complications3,5,6. Adequate preoperative planning and a safe therapeutic protocol to remove impacted and semi-impacted third molars are essential for a good result, reducing complications6,7, which can be minimized by careful attention to surgical details, including patient preparation, antisepsis, asepsis, tissue management, force control, hemostasis, and adequate postoperative care6,8-10.
Even with all these measures taking into account, some practitioners also prescribe prophylactic systemic antimicrobials to reduce postoperative infection; this practice is widespread in current dentoalveolar surgery4,11. In addition, some authors also believe that oral or intramuscular administration of anti-inflammatory agents can improve postoperative pain, trismus, and edema9,12,13. However, those practices still remain as being a controversial topical.
Regarding the use of pre- and postoperative medication, although there are different protocols in the literature, there is no standardization, leaving the therapeutic choice at the surgeon’s discretion. Professionals make decisions based on their academic background or their know-how; thus, the aim of this study was to evaluate the variables that can influence dentists on choosing pre- and postoperative drug protocols for impacted and semi-impacted third molar surgeries.
Materials and Methods
This study followed principles for reporting as stated by Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations.
Design
This is an observational cross-sectional study carried out by collecting data using an online questionnaire sent to dentists in Brazil. Data were evaluated to assess the influence of the dentist’s profile on choosing the drug protocol to be used.
Ethical Considerations
The study was developed in accordance with Brazilian Resolution no. 466/201214, submitted and approved by the Ethics and Research Committee of the Franciscan University, Santa Maria, Brazil (UFN), and given permit no. 4.418.572. An informed consent was obtained from every participant in the study. All risks and how these were mitigated and the privacy protection under the General Law for the Protection of Personal Data were taking into account and was presented at the free and informed consent form.
Questionnaire Development
An online questionnaire was submitted to Brazilian dentists concerning practices associated with extracting third molars. A pilot study was previously carried out with 40 undergraduate dental students at the UFN. This earlier study was designed to assess the terminology, the sequence of questions, and the overall consistency of the instrument. An open-ended question was added to collect suggestions from participants to improve the questionnaire. After the pilot study, the questions were edited based on the answers until the authors reached a consensus regarding the content.
Participants and Questionnaire Application
The questionnaire was set up on the Google Forms survey software platform and sent to the participants. Before answering the questionnaire, the participants signed the Consent Form. As long as they were officially registered in their councils (Regional Dental Councils), all Brazilian dentists were eligible to participate. These Councils were contacted to collaborate in developing the study, although the new General Law for the Protection of Personal Data (Law no. 13709/2020) prevented them from disclosing and providing the members’ data. Thus, it was a convenience sample, as large as the participants answered the questionnaire.
Hence, the social networks Instagram and Facebook were used to increase the number of participants. A campaign was created to publicize the study, publicizing the questionnaire invitation on the profiles of dentistry professionals in order for it to be disseminated to their followers and other profiles, in addition to publicizing the invitation in discussion groups on Facebook and WhatsApp. Using social networks and email to recruit participants is the best way to obtain a more diverse sample and increase the response rate in online surveys15.
Questionnaire Content
The questionnaire consisted of 22 questions divided into the following topics of interest: participant general characteristics and training (questions 1-4); professional practice (questions 5-9); surgical and pharmacological procedures (questions 10-19); and postoperative procedures (questions 20-22). As a result, a total of 310 forms were completed by dentists throughout Brazil.
Data Analysis
Answers deemed inadequate or unanswered questions were considered lost data. Thus, some questions have a different number of answers than others. Data were analyzed using the SPSS software. A descriptive analysis of the data was performed, according to the outcomes class of pre- and postoperative medication, and form of administration, and the absolute and relative frequencies of the variables were calculated.
Results
Characteristics of the Dentists
The professionals who responded to the survey were mostly over 40 years of age; 53.9% were male and working mainly in southern Brazil. The professionals were mostly dental specialists working in private practice, 50.8% had specific training in oral and maxillofacial surgery, and 86.5% performed third molar surgery, suggesting that this study was aimed at professionals interested in the subject (Table 1).
Preoperative Prescriptions
The questionnaire was divided by medications prescribed in the pre- and postoperative periods of third molar surgeries (Tables 2 and 3). Most professionals do not prescribe antibiotics, and 39.7% assess the surgical situation of the tooth in question before prescribing the drug. Antibiotic prophylaxis is also not used routinely, with only 31.6% of the sample performing this practice. The antibiotic most prescribed by the dentists was amoxicillin, representing 93.83% of the responses (Table 2).
The preoperative prescription of anti-inflammatory drugs also did not show a high prevalence, as only 55.5% of professionals reported routine use of this medication. When asked about corticosteroids, only 37.7% of the sample answered that they use them in their prescriptions, and nearly all respondents prefer oral administration (Table 2).
Postoperative Prescriptions
In the pre- and preoperative periods, amoxicillin was the antibiotic most prescribed by professionals, with a prevalence of 93.11% of responses for patients not allergic to penicillin. Moreover, the vast majority of professionals prescribe antibiotics in the postoperative period, and 37.4% are tooth-dependent on the choice of prescription (Table 3).
Regarding the prescription of anti-inflammatory drugs, we observed dentists prescribed a wide variety of drugs. More than twenty-one drugs were mentioned, with emphasis on ibuprofen (32.7%) and nimesulide (29.2%). It is important to note that, as in the preoperative prescription, dexamethasone appeared as an erroneously suggested prescription of non-steroidal anti-inflammatory drugs, reaching 10.6% of the responses for this item. Still, with regard to prescribing steroidal anti-inflammatory drugs or corticosteroids, only 2.9% of professionals use the intramuscular form of administration.
Most of the responding professionals reported prescribing analgesics in the postoperative period (94.5%), with dipyrone being the drug of choice in 57% of the reports. It is important to note that few practitioners prescribe opioid-type analgesics for this procedure.
Recommendations and Postoperative Complications.
Most of the responding professionals give their patients written postoperative recommendations, and few dentists reported complications after third molar surgeries (Table 4). When asked about which postoperative complication they usually treat, pain is cited as the main one, followed by edema.
Discussion
Medication use in dentistry still raises numerous doubts, and established protocols are hard to find in the literature. This was evidenced in the wide range of responses obtained in our study, where few standard prescriptions had a high prevalence, showing a great diversity of prescription models, often without formal knowledge required for the practice.
Prescription of antibiotics in third molar surgeries is highly controversial, although most dentists consider that the use of this class of drug is highly recommended in the pre- and postoperative period. Despite current research being increasingly focused on the rational use of antibiotics11,16-19, only 9.7% of the sample do not prescribe the drug in the postoperative period, demonstrating empirical knowledge without a scientific basis for its use. There is also a possibility that the prescription is tooth dependent. Deeb et al.20 reported that 51.6% of dentists prescribe antibiotics preoperatively and 71.4% postoperatively in dental implant surgeries. In this study, the rates were 59.87% preoperatively and 91.71% postoperatively for oral and maxillofacial surgeons. Thus, the present study verified a higher prescription rate for antibiotics, even for professionals with specific training in this field.
The antibiotic most prescribed by the dentists interviewed is amoxicillin, being the drug of choice more than 90% of the time, both preoperatively and postoperatively. This finding corroborates Thornhill et al.19, who evaluated antibiotic prescribing practices by dentists in England and reported that amoxicillin accounted for 64.8% of all antibiotics prescribed. The same authors reported the risk of adverse reactions from antibiotics prescribed by dentists and concluded that amoxicillin is a remarkably safe antibiotic, particularly for patients with no history of penicillin allergy. This drug class is also widely used in Brazil, as the high prevalence in the responses had shown.
Antibiotic prophylaxis is also another possibility of prescription, albeit there is no consensus in the literature. Furthermore, the use of antibiotics is considered to be associated with the risk of developing bacterial resistance and, with the maintenance of the aseptic chain of surgical procedures, the expectation of wound infection rate is very low. Thus, antibiotic prophylaxis must be questioned when not indicated by the American Heart Association guidelines, which only advocate the use of prophylactic antibiotics for patients with valve prostheses, prosthetic material used for valve repair, anterior infective endocarditis, congenital cyanotic heart disease, and heart transplantation with valve insufficiency17,18,21. Nonetheless, even this kind of practice does not seem unanimous in the literature. Glera-Suárez et al.22 observed that most dentists do not perform antibiotic prophylaxis, although Rodríguez Sánchez et al.23 found that 84% of dentists in Italy routinely prescribe prophylactic antibiotics for surgical procedures. In this study, when asked about the use of this protocol, only 12.2% of newly graduated professionals aged between 20 and 30 years perform antibiotic prophylaxis compared to 44.9% of professionals aged between 41 and 50 years, suggesting a trend towards antibiotic prophylaxis in dentists with more years of practice. It is important to emphasize that antibiotic prescriptions must to taking into account consideration the patient’s systemic status and the individual risk of developing a postoperative infection24. There is low-certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction17, and due to the increasing prevalence of bacteria that are resistant to antibiotic treatment, clinicians should evaluate when to prescribe prophylactic antibiotic therapy before a dental extraction for each patient17.
Another class of medication widely used in third molar surgeries is anti-inflammatory drugs. There is a wide range of this class of drugs in Brazil on the market, most with similar efficiency. Hence, the choice for prescription is often based on relative toxicity, cost-effectiveness, convenience, and experience with the drug25. In this study, 32.7% of the dentists reported ibuprofen as the postoperative drug of choice, which corroborates the literature26. The study further reports that in countries such as Germany and Australia, ibuprofen was also the most prescribed non-steroidal anti-inflammatory drug, and this is likely because of its effectiveness in a wide range of inflammatory conditions and low cost.
We found that there may have been doubts about the use of steroid anti-inflammatory drugs and corticosteroids with the professionals interviewed, given that 64% of the sample pointed to dexamethasone as a non-steroidal anti-inflammatory in spite of being a steroidal anti-inflammatory drug. We believe that this is not due to a lack of knowledge about the drug class because when questioned about anti-inflammatory drugs in the preoperative period, the professionals replied to thinking of corticosteroids.
Corticosteroid prescription in dental surgeries aims to reduce postoperative sequelae and discomforts27,28. Our study showed a prescription rate of 37.7% of the medication in the preoperative period, while 26.5% of dentists prescribe according to the surgical situation. Although the parenteral use of this drug shows better results27, our data revealed a preference for the oral form of administration (92.9%). Interestingly, 56.4% of the professionals who prescribe corticosteroids in the preoperative period are oral and maxillofacial surgeons, and 51.3% have a master’s degree or PhD.
Pain is the most common symptom to see a dentist. Our study observed that 94.5% of the sample chose dipyrone as their first analgesic option. This can be explained by the low cost and good analgesic response29, although Halling et al.30 reported that dentists do not commonly use this drug in Germany. Other analgesics can be prescribed with more intense pain, albeit they are used with some caution. Dana et al.16 discussed opioid analgesics and the role of dentists in treating dental pain and how their prescriptions can often lead to misuse, abuse, or addiction, even leading to an overdose. In our study, over half of the interviewees did not prescribe this medication, which is in line with the rational use preached by the aforementioned authors.
Surgery to remove third molars is usually accompanied by postoperative discomfort that can be influenced by the surgical approach, although the surgeon’s skills and experience often lead to an uneventful procedure31,32. When respondents were asked about postoperative complications, 93.5% reported having no complications at all. A possible explanation is the professional degree of the participants, as 84.5% of the sample were specialists, masters, or doctors, and more than half were oral and maxillofacial surgeons.
It is well known that surgeons always seek a more comfortable postoperative period for their patients. Some of the dentists provide written post-operative guidelines advising proper care. In our sample, 86.5% reported routinely providing post-operative guidelines, thereby demonstrating concern for the well-being of patients. However, it is important to emphasize that this concern must always be present along with other strategies for better patient comfort. Aloy-Prósper et al.33 evaluated patient adherence to postoperative instructions after third molar surgery and compared verbal and written form versus the effects of a telephone follow-up. The authors concluded that telephone follow-up could promote greater patient adherence to treatment, promoting faster recovery. Most of these individuals are prevented from conducting their daily activities in the first days after surgery. In addition, this procedure is often performed on healthy young people, and the written instructions are a valuable means of increasing patient understanding34. Currently, digital media can be a great tool, even due to the profile of patients who perform third molar extraction.
Despite there may be a search for a Gold Standard drug protocol to manage postoperative complications, our findings show that, apparently, there is no standard followed by the surveyed professionals. Even though the use of medication is often necessary, care with conservative techniques, reduced surgical time, and professional skill also seem to be related to positive postoperative results5,6,8-10,31,32 not to mention that individualized treatments are increasingly necessary. Given the significant variability of the responses, we can conclude that well-performed systematic reviews are needed to establish simpler and easier drug protocols that can be modified in specific situations, and it seems to be evident that there must not be a single type of protocol, as treatments are increasingly individualized.
As a potentials bias, since the study relies on self-reported data from dentists, there is a potential for recall bias or social desirability bias, where respondents may provide answers that reflect what they think is expected rather than their actual practice, leading to underreporting or overreporting of their prescribing habits or complication rates.
Finally, it is necessary to highlight the low adherence of dentists to the study, which made it difficult to have a broader view of the influence of the dentist’s profile on dental procedures. In our study, despite sharing the questionnaire throughout Brazil, we had a higher concentration of responses in the southern region, which can be considered a limitation of the study, added to the low number of questionnaires answered compared to the high number of dentists working in Brazil and the majority of responding professionals are over 40 years of age and predominantly male, which limit the generalizability of the findings. In addition, as a majority of the respondents being specialists, particularly those trained in oral and maxillofacial surgery, the results may not adequately represent the practices and opinions of general practitioners or dentists from other specialties.
There was high variability of responses regarding drug prescriptions in the pre- and postoperative period of third molar surgeries, and there seems to be no relationship between the dentist’s profile in choosing a particular drug protocol.
Acknowledgments
None.
References
-
1 Pham TAV, Nguyen NH. Periodontal status of the adjacent second molar after impacted mandibular third molar surgical extraction. Contemp Clin Dent. 2019 Apr-Jun;10(2):311-8. doi: 10.4103/ccd.ccd_634_18.
» https://doi.org/10.4103/ccd.ccd_634_18 -
2 Haag DG, Peres KG, Balasubramanian M, Brennan DS. Oral conditions and health-related quality of life: a systematic review. J Dent Res. 2017 Jul;96(8):864-74. doi: 10.1177/0022034517709737.
» https://doi.org/10.1177/0022034517709737 -
3 Al-Shamiri HM, Shawky M, Hassanein N. Comparative assessment of preoperative versus postoperative dexamethasone on postoperative complications following lower third molar surgical extraction. Int J Dent. 2017;2017:1350375. doi: 10.1155/2017/1350375.
» https://doi.org/10.1155/2017/1350375 -
4 Braimah RO, Ndukwe KC, Owotade JF, Aregbesola SB. Impact of oral antibiotics on health-related quality of life after mandibular third molar surgery: an observational study. Niger J Clin Pract. 2017 Sep;20(9):1189-94. doi: 10.4103/1119-3077.183235.
» https://doi.org/10.4103/1119-3077.183235 -
5 Raldi FV, Nascimento RD, Sato FRL, Santos LM, Amorim JBO, Moraes MB. Evaluation of the impact of preoperative use of dexamethasone and cyclobenzaprine in surgical extraction of lower third molars on trismus by electromyographic analysis. Oral Maxillofac Surg. 2019 Dec;23(4):395-405. doi: 10.1007/s10006-019-00776-z.
» https://doi.org/10.1007/s10006-019-00776-z -
6 Rodanant P, Wattanajitseree K, Shrestha B, Wongsirichat N. Pain and quality of life related to suture removal after 3 or 7 days at the extraction sites of impacted lower third molars. J Dent Anesth Pain Med. 2016 Jun;16(2):131-6. doi: 10.17245/jdapm.2016.16.2.131.
» https://doi.org/10.17245/jdapm.2016.16.2.131 -
7 Tojyo I, Nakanishi T, Shintani Y, Okamoto K, Hiraishi Y, Fujita S. Risk of lingual nerve injuries in removal of mandibular third molars: a retrospective case-control study. Maxillofac Plast Reconstr Surg. 2019 Sep;41(1):40. doi: 10.1186/s40902-019-0222-4.
» https://doi.org/10.1186/s40902-019-0222-4 - 8 Modanloo H, Eftekharian H, Arabiun H. Postoperative pain management after impacted third molar surgery with preoperative oral lamotrigine, a randomized, double-blind, placebo-controlled trial. J Dent (Shiraz). 2018 Sep;19(3):189-96.
-
9 Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2014 Jun;72(6):1043-8. doi: 10.1016/j.joms.2013.12.035.
» https://doi.org/10.1016/j.joms.2013.12.035 -
10 Negreiros RM, Biazevic MG, Jorge WA, Michel-Crosato E. Relationship between oral health-related quality of life and the position of the lower third molar: postoperative follow-up. J Oral Maxillofac Surg. 2012 Apr;70(4):779-86. doi: 10.1016/j.joms.2011.09.034. Epub 2011 Dec 16.
» https://doi.org/10.1016/j.joms.2011.09.034 -
11 Marcussen KB, Laulund AS, Jørgensen HL, Pinholt EM. A systematic review on effect of single-dose preoperative antibiotics at surgical osteotomy extraction of lower third molars. J Oral Maxillofac Surg. 2016 Apr;74(4):693-703. doi: 10.1016/j.joms.2015.11.017. Epub 2015.
» https://doi.org/10.1016/j.joms.2015.11.017 -
12 Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg. 2007 Nov;65(11):2218-26. doi: 10.1016/j.joms.2006.11.036.
» https://doi.org/10.1016/j.joms.2006.11.036 -
13 Sabhlok S, Kenjale P, Mony D, Khatri I, Kumar P. Randomized controlled trial to evaluate the efficacy of oral dexamethasone and intramuscular dexamethasone in mandibular third molar surgeries. J Clin Diagn Res. 2015 Nov;9(11):ZC48-51. doi: 10.7860/JCDR/2015/13930.6813.
» https://doi.org/10.7860/JCDR/2015/13930.6813 -
14 Brazilian Ministry of Health. National Health Council. [Resolution No. 466, dated December 12, 2012. Approves the following guidelines and regulatory standards for research involving human subjects; Repeals (RES. 196/96); (RES. 303/00); (RES. 404/08)] [cited 2023 Feb 1]. Available from: https://www.gov.br/conselho-nacional-de-saude/pt-br/atos-normativos/resolucoes/2012/resolucao-no-466.pdf/view Portuguese.
» https://www.gov.br/conselho-nacional-de-saude/pt-br/atos-normativos/resolucoes/2012/resolucao-no-466.pdf/view -
15 Moraes RR, Correa MB, Daneris Â, Queiroz AB, Lopes JP, Lima GS, et al. email vs. Instagram recruitment strategies for online survey research. Braz Dent J. 2021 Jan-Feb;32(1):67-77. doi: 10.1590/0103-6440202104291.
» https://doi.org/10.1590/0103-6440202104291 -
16 Dana R, Azarpazhooh A, Laghapour N, Suda KJ, Okunseri C. Role of dentists in prescribing opioid analgesics and antibiotics: an overview. Dent Clin North Am. 2018 Apr;62(2):279-94. doi: 10.1016/j.cden.2017.11.007.
» https://doi.org/10.1016/j.cden.2017.11.007 -
17 Lodi G, Azzi L, Varoni EM, Pentenero M, Del Fabbro M, Carrassi A, et al. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev. 2021 Feb;2(2):CD003811. doi: 10.1002/14651858.CD003811.pub3.
» https://doi.org/10.1002/14651858.CD003811.pub3 -
18 Oomens MA, Forouzanfar T. Antibiotic prophylaxis in third molar surgery: a review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Dec;114(6):e5-12. doi: 10.1016/j.oooo.2011.10.023.
» https://doi.org/10.1016/j.oooo.2011.10.023 -
19 Thornhill MH, Dayer MJ, Durkin MJ, Lockhart PB, Baddour LM. Oral antibiotic prescribing by NHS dentists in England 2010-2017. Br Dent J. 2019 Dec;227(12):1044-50. doi: 10.1038/s41415-019-1002-3.
» https://doi.org/10.1038/s41415-019-1002-3 -
20 Deeb GR, Soung GY, Best AM, Laskin DM. Antibiotic prescribing habits of oral and maxillofacial surgeons in conjunction with routine dental implant placement. J Oral Maxillofac Surg. 2015 Oct;73(10):1926-31. doi: 10.1016/j.joms.2015.05.024.
» https://doi.org/10.1016/j.joms.2015.05.024 -
21 Dayer M, Thornhill M. Is antibiotic prophylaxis to prevent infective endocarditis worthwhile? J Infect Chemother. 2018 Jan;24(1):18-24. doi: 10.1016/j.jiac.2017.10.006. Epub 2017 Oct 26.
» https://doi.org/10.1016/j.jiac.2017.10.006 -
22 Glera-Suárez P, Soto-Peñaloza D, Peñarrocha-Oltra D, Peñarrocha-Diago M. Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2020 Mar;25(2):e233-e239. doi: 10.4317/medoral.23320.
» https://doi.org/10.4317/medoral.23320 -
23 Rodríguez Sánchez F, Arteagoitia I, Rodríguez Andrés C, Caiazzo A. Antibiotic prophylaxis habits in oral implant surgery among dentists in Italy: a cross-sectional survey. BMC Oral Health. 2019 Dec;19(1):265. doi: 10.1186/s12903-019-0943-x.
» https://doi.org/10.1186/s12903-019-0943-x -
24 Camps-Font O, Sábado-Bundó H, Toledano-Serrabona J, Valmaseda-de-la-Rosa N, Figueiredo R, Valmaseda-Castellón E. Antibiotic prophylaxis in the prevention of dry socket and surgical site infection after lower third molar extraction: a network meta-analysis. Int J Oral Maxillofac Surg. 2024 Jan;53(1):57-67. doi: 10.1016/j.ijom.2023.08.001. Epub 2023 Aug 21.
» https://doi.org/10.1016/j.ijom.2023.08.001 -
25 Hollingworth SA, Chan R, Pham J, Shi S, Ford PJ. Prescribing patterns of analgesics and other medicines by dental practitioners in Australia from 2001 to 2012. Community Dent Oral Epidemiol. 2017 Aug;45(4):303-9. doi: 10.1111/cdoe.12291.
» https://doi.org/10.1111/cdoe.12291 -
26 Cruz AJSD, Santos JS, Pereira Júnior EA, Ruas CM, Mattos FF, Castilho LS, et al. Prescriptions of analgesics and anti-inflammatory drugs in municipalities from a Brazilian Southeast state. Braz Oral Res. 2020 Dec;35:e011. doi: 10.1590/1807-3107bor-2021.vol35.0011.
» https://doi.org/10.1590/1807-3107bor-2021.vol35.0011 -
27 Herrera-Briones FJ, Prados Sánchez E, Reyes Botella C, Vallecillo Capilla M. Update on the use of corticosteroids in third molar surgery: systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Nov;116(5):e342-51. doi: 10.1016/j.oooo.2012.02.027. Epub 2012 Aug 17.
» https://doi.org/10.1016/j.oooo.2012.02.027 -
28 Pansard HB, Prado MC, Marchi GF, Sfreddo CS, Skupien JA. The impact of prior use of corticosteroid to dental extraction on oral health-related quality-of-life and clinical outcomes: a randomized clinical trial. J Oral Maxillofac Surg. 2020 Dec;78(12):2153.e1-2153.e9. doi: 10.1016/j.joms.2020.08.013.
» https://doi.org/10.1016/j.joms.2020.08.013 -
29 Favarini VT, Lima CAA, Silva RA, Sato FRL. Is dipyrone effective as a preemptive analgesic in third molar surgery? A pilot study. Oral Maxillofac Surg. 2018 Mar;22(1):71-5. doi: 10.1007/s10006-018-0669-y.
» https://doi.org/10.1007/s10006-018-0669-y -
30 Halling F, Heymann P, Ziebart T, Neff A. Analgesic prescribing patterns of dental practitioners in Germany. J Craniomaxillofac Surg. 2018 Oct;46(10):1731-6. doi: 10.1016/j.jcms.2018.07.005.
» https://doi.org/10.1016/j.jcms.2018.07.005 -
31 De Marco G, Lanza A, Cristache CM, Capcha EB, Espinoza KI, Rullo R, et al. The influence of flap design on patients' experiencing pain, swelling, and trismus after mandibular third molar surgery: a scoping systematic review. J Appl Oral Sci. 2021 Jun;29:e20200932. doi: 10.1590/1678-7757-2020-0932.
» https://doi.org/10.1590/1678-7757-2020-0932 -
32 Silva BCL, Machado GF, Miranda EFP, Galvão EL, Falci SGM. Envelope or triangular flap for surgical removal of third molars? A systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2020 Aug;49(8):1073-86. doi: 10.1016/j.ijom.2020.01.001.
» https://doi.org/10.1016/j.ijom.2020.01.001 -
33 Aloy-Prósper A, Pellicer-Chover H, Balaguer-Martínez J, Llamas-Monteagudo O, Peñarrocha-Diago M. Patient compliance to postoperative instructions after third molar surgery comparing traditional verbally and written form versus the effect of a postoperative phone call follow-up a: a randomized clinical study. J Clin Exp Dent. 2020 Oct;12(10):e909-e915. doi: 10.4317/jced.56680.
» https://doi.org/10.4317/jced.56680 -
34 Alvira-González J, Gay-Escoda C. Compliance of postoperative instructions following the surgical extraction of impacted lower third molars: a randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2015 Mar;20(2):e224-30. doi: 10.4317/medoral.20121.
» https://doi.org/10.4317/medoral.20121
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Data availability:
Datasets related to this article will be available upon request to the corresponding author.
Edited by
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Editor:
Dr. Altair A. Del Bel Cury
Datasets related to this article will be available upon request to the corresponding author.
