Impact of topical minocycline with third molar surgery on clinical recovery and health-related quality of life outcomes.

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.

Assessment of oral health-related quality of life before and after third molar 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.

The impact of intravenous corticosteroids with third molar surgery in patients at high risk for delayed health-related quality of life and clinical recovery.

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.

The impact of intravenous antibiotics on health-related quality of life outcomes and clinical recovery after third molar surgery.

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.