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The impact of IV corticosteroids on oral health-related quality of life outcomes and clinical recovery after third molar surgery
Oral Abstract Session 3: TMJ/Reconstruction/Pathology/Nerve Repair/Wound Repair/Miscellaneous findings. The patients were followed postoperatively for an average of 18 months and outcome assessment was based upon their subjective experience and the investigators quantitative analysis using the same standardized neurosensory testing. Through this study, it was determined that 14 patients (70%) had significant improvement in neurosensory function, 3 patients (15%) demonstrated moderate improvement, and 2 patients (10%) had only slight improvement. One patient exhibited no clinical improvement due to prolonged delay in seeking treatment subsequent to the injury where the distal nerve could not be localized intraoperatively. Conclusion: Microsurgical repair of lingual nerves can provide significant clinical sensory improvement for patients and is a useful option in treating these affected individuals when implemented soon after injury. References Malden NJ, Maidment YG: Lingual nerve injury subsequent to wisdom teeth removal: A 5-year retrospective audit from a high street dental practice. Br Dent J 193:203, 2002 Pogrel MA: The results of microneurosurgery of the inferior alveolar and lingual nerve. J Oral Maxillofac Surg 5:485, 2002 Zuniga JR, Meyer RA, Gregg JM, et al: The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg 56:2, 1998 Funding Source: Department of Oral and Maxillofacial Surgery, NJDS.
The Impact of IV Corticosteroids on Oral Health-Related Quality of Life Outcomes and Clinical Recovery After Third Molar Surgery Paul S. Tiwana, DDS, MD, University of North Carolina School of Dentistry, Department of OMFS, Chapel Hill, NC 27599-7450 (Foy SP; Shugars DA; Marciani RD; Conrad SM; Phillips C; White RP) Problem: Corticosteroids are given often with third molar surgery to reduce inflammation associated with the procedure. Little data exist to support this practice, and some clinicians fear that corticosteroids may delay healing. Purpose: This clinical trial was designed to compare recovery for oral health-related quality of life (HRQOL) and clinical outcomes after third molar surgery in patients treated with or without IV corticosteroids at surgery. Patients and Methods: Thirty-five patients at least 18 years old and with all third molars below the occlusal plane, were enrolled in a multicenter, IRB approved, prospective clinical trial. Demographic and oral health data were collected prior to surgery, and data about the surgical procedure were collected at surgery. Patients were given IV corticosteroids during surgery (dexamethasone 8 mg or methylprednisolone 40 mg). Patients AAOMS • 2003
were not given antibiotics. Each patient was given an HRQOL instrument to complete at each postsurgery day for 14 days. Data on clinical healing was collected from the patients at each postsurgery visit. Recovery for HRQOL outcomes (pain, early symptoms, lifestyle, oral function, late symptoms) was assessed after surgery. Clinical and HRQOL outcomes of these patients were compared to those of a nonconcurrent control group of 60 patients selected from a database of 630 patients who did not receive corticosteroids, using the same inclusion/exclusion criteria. 1) Both the experimental and the control patients were predicted to be at a higher risk for delayed recovery. 2) Differences between the groups were assessed with CMH statistics. Results: The corticosteroid patients and the control patients were similar in age (both median 20 years), gender (60% versus 63%), ethnicity (Caucasian 87% versus 81%; African American 8% versus 7%), prior third molar symptoms (49% versus 50%), and the surgeon’s estimation of surgical difficulty (14/28 versus 15/28). The experimental group had more patients older than 24 years (27% versus 15%), but fewer patients with bone removed from both lower third molars (78% versus 90%). The experimental group had a shorter surgery time (26 min. versus 30 min.), but both groups had the same percentage of patients whose surgery time exceeded 30 min. (41% versus 40%). Clinical recovery was not delayed by corticosteroid administration. The experimental group tended to have fewer postsurgical treatment visits (14%) compared to the control group (28%), but this trend did not reach statistical significance (P ⫽ .09). Having prior third molar symptoms was associated with a postsurgery visit with treatment for both groups, corticosteroid 4/5 (80%), and control 12/17 (71%). For HRQOL measures the trend was improved recovery for the steroid group for pain, nausea, and sleep on the first 2 postsurgery days, however this was not statistically significant. No differences were found between the groups for other HRQOL measures. Conclusions: If corticosteroids were administered at surgery, to patients predicted to be a higher risk for postsurgery problems, clinical healing was not delayed and oral HRQOL recovery in the first few postsurgery days was improved. References White RP Jr, Shafer DM, Laskin DM, et al: Clinical and health related quality of life outcomes during recovery after third molar surgery. Accepted 9/02 J Oral Maxillofac Surg Phillips C, White RP Jr, Shugars D, et al: Risk factors associated with prolonged recovery and delayed clinical healing after third molar surgery. Submitted J Oral Maxillofac Surg 2002
Funding Source: Oral and Maxillofacial Surgery Foundation, AAOMS, Dental Foundation of NC.
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The Impact of IV Corticosteroids on Oral Health-Related Quality of Life Outcomes and Clinical Recovery After Third Molar Surgery Paul S. Tiwana, DDS, MD, University of North Carolina School of Dentistry, Department of OMFS, Chapel Hill, NC 27599-7450 (Foy SP; Shugars DA; Marciani RD; Conrad SM; Phillips C; White RP) Problem: Corticosteroids are given often with third molar surgery to reduce inflammation associated with the procedure. Little data exist to support this practice, and some clinicians fear that corticosteroids may delay healing. Purpose: This clinical trial was designed to compare recovery for oral health-related quality of life (HRQOL) and clinical outcomes after third molar surgery in patients treated with or without IV corticosteroids at surgery. Patients and Methods: Thirty-five patients at least 18 years old and with all third molars below the occlusal plane, were enrolled in a multicenter, IRB approved, prospective clinical trial. Demographic and oral health data were collected prior to surgery, and data about the surgical procedure were collected at surgery. Patients were given IV corticosteroids during surgery (dexamethasone 8 mg or methylprednisolone 40 mg). Patients AAOMS • 2003
were not given antibiotics. Each patient was given an HRQOL instrument to complete at each postsurgery day for 14 days. Data on clinical healing was collected from the patients at each postsurgery visit. Recovery for HRQOL outcomes (pain, early symptoms, lifestyle, oral function, late symptoms) was assessed after surgery. Clinical and HRQOL outcomes of these patients were compared to those of a nonconcurrent control group of 60 patients selected from a database of 630 patients who did not receive corticosteroids, using the same inclusion/exclusion criteria. 1) Both the experimental and the control patients were predicted to be at a higher risk for delayed recovery. 2) Differences between the groups were assessed with CMH statistics. Results: The corticosteroid patients and the control patients were similar in age (both median 20 years), gender (60% versus 63%), ethnicity (Caucasian 87% versus 81%; African American 8% versus 7%), prior third molar symptoms (49% versus 50%), and the surgeon’s estimation of surgical difficulty (14/28 versus 15/28). The experimental group had more patients older than 24 years (27% versus 15%), but fewer patients with bone removed from both lower third molars (78% versus 90%). The experimental group had a shorter surgery time (26 min. versus 30 min.), but both groups had the same percentage of patients whose surgery time exceeded 30 min. (41% versus 40%). Clinical recovery was not delayed by corticosteroid administration. The experimental group tended to have fewer postsurgical treatment visits (14%) compared to the control group (28%), but this trend did not reach statistical significance (P ⫽ .09). Having prior third molar symptoms was associated with a postsurgery visit with treatment for both groups, corticosteroid 4/5 (80%), and control 12/17 (71%). For HRQOL measures the trend was improved recovery for the steroid group for pain, nausea, and sleep on the first 2 postsurgery days, however this was not statistically significant. No differences were found between the groups for other HRQOL measures. Conclusions: If corticosteroids were administered at surgery, to patients predicted to be a higher risk for postsurgery problems, clinical healing was not delayed and oral HRQOL recovery in the first few postsurgery days was improved. References White RP Jr, Shafer DM, Laskin DM, et al: Clinical and health related quality of life outcomes during recovery after third molar surgery. Accepted 9/02 J Oral Maxillofac Surg Phillips C, White RP Jr, Shugars D, et al: Risk factors associated with prolonged recovery and delayed clinical healing after third molar surgery. Submitted J Oral Maxillofac Surg 2002
Funding Source: Oral and Maxillofacial Surgery Foundation, AAOMS, Dental Foundation of NC.
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