Prevalence of Infected Socket after Surgical Removal of Mandibular Wisdom Tooth

Abstract

Background: The aim of the study was to evaluate the prevalence and the contributing factors of infected socket in post-sur-gical removal of mandibular wisdom tooth. Materials and Methods: The dental records of patients who attended Hospital Universiti Sains Malaysia (HUSM) for surgical removal of mandibular third molars were reviewed. Patients' identification data, medical problem, oral hygiene, smoking status and occurrence of post-operative complication were recorded. From the total of the 342 surgical removals, 256 patients were found to have complete dental record, where 149 were female and the remaining 107 were male the average age of 24.4 years. Results: Out of the 256 patients, postoperative infected socket occurred in 27 patients (10.5%). Other complications were ulcer (n = 8, 3.1%), swelling more than 1 week (n = 11, 4.3%), sensory dysfunction of the inferior alveolar nerve (n = 6, 2.3%), and trismus (n = 10, 3.9%). The risk of infected socket was greater among the patients who had poor hygiene (p = 0.001). There was no significant relationship between the medical problems, age, gender, smoker status and infected socket. Conclusion: Postoperative infection is the most common type of complication and oral hygiene is one of the contribution fac-tors for development of infected socket. KEY WORDS infected socket, post-surgical removal, mandibular wisdom tooth

Full text

International Medical Journal Vol. 21, No. 1, pp. 117 - 119 , February 2014
SHORT COMMUNICATIONS
Prevalence of Infected Socket after Surgical Removal of
Mandibular Wisdom Tooth
Shaifulizan Abdul Rahman, Mohammad Khursheed Alam, Nurul Huda Abdullah,
Ramizu Shaari
ABSTRACT
Background: The aim of the study was to evaluate the prevalence and the contributing factors of infected socket in post-sur-
gical removal of mandibular wisdom tooth.
Materials and Methods: The dental records of patients who attended Hospital Universiti Sains Malaysia (HUSM) for surgical
removal of mandibular third molars were reviewed. Patients' identification data, medical problem, oral hygiene, smoking status
and occurrence of post-operative complication were recorded. From the total of the 342 surgical removals, 256 patients were
found to have complete dental record, where 149 were female and the remaining 107 were male the average age of 24.4 years.
Results: Out of the 256 patients, postoperative infected socket occurred in 27 patients (10.5%). Other complications were
ulcer (n = 8, 3.1%), swelling more than 1 week (n = 11, 4.3%), sensory dysfunction of the inferior alveolar nerve (n = 6, 2.3%),
and trismus (n = 10, 3.9%). The risk of infected socket was greater among the patients who had poor hygiene (p= 0.001). There
was no significant relationship between the medical problems, age, gender, smoker status and infected socket.
Conclusion: Postoperative infection is the most common type of complication and oral hygiene is one of the contribution fac-
tors for development of infected socket.
KEY WORDS
infected socket, post-surgical removal, mandibular wisdom tooth
Received on November 6, 2012 and accepted on May 15, 2013
School of Dental Sciences, Universiti Sains Malaysia
16150 Kubang Kerian, Kelantan, Malaysia
Correspondence to: Shaifulizan Abdul Rahman
(e-mail: shaifulrahman@lycos.com)
117
INTRODUCTION
The third molar teeth are last to erupt and have a relatively high
chance of becoming impacted. In addition, because chewing loads is
an important determinant of mandible and teeth sizes (Macknamara,
1975). It is probable that as an adaptation, individuals born and
brought up in developed nations where diet tends to be relatively
softer will lead to small jaw. Space deficiency is the main underlying
cause of impaction of third molars (Seward et al, 1987). Thus, a high
prevalence impaction of these teeth would be expected nowadays.
Teeth may become impacted when they fail to erupt or develop into
the proper functional location. As such, impacted teeth are consid-
ered non-functional, abnormal, and pathological. Teeth that fail to
attain a functional position may be pathological and should be con-
sidered for removal (Laskin, 1969).
However, surgical will presented with complication such as
infected socket. There are several factors that contributed the infected
socket. There are several factors that contributed to the infected sock-
et such as general health of the patients, professional factor and local
factor. Surgical removal of impacted mandibular third molars should
be carried out well before the age of 24 years. Older patients are at
greater risk of postoperative complications and permanent squeals. A
surgeon's lack of experience could also be major factor in the devel-
opment of operative complications is still controversial (Chiapasco et
al. 1993)
The mouth is alive with bacteria, especially in people with poor
oral hygiene will lead lad to post-operative infected socket. The low
rates of postoperative infection and other complications encouraged
us to continue surgical removal of impacted mandibular third molar
without routine prescription of antibiotics. Previously, Normastura et
al. (2009) assessed mandibular third molar impaction and dental
caries among patients attending HUSM; however, there is no contem-
porary data for Malaysian population. The purpose of this study was
to investigate the post-operative complications after surgical removal
of impacted wisdom among patients attending HUSM. An attempt
was also made to determine the factors associated with infected sock-
et.
MATERIALS AND METHODS
This is a retrospective record review study conducted on 256 den-
tal case notes of patient who had underwent surgical removal of
mandibular third molars in HUSM. This study did not have any age
restriction. Patients with incomplete dental record were excluded
from the study. Patient's age, sex, medical problems and complica-
tions over one week post-operative period were recorded. The age of
patients were further subdivided into 15 to 18 year, 19 to 22 year, 23
to 26 year, 27 to 30 year and 35 to 38 year to find out the most preva-
lent group. The post-operative complications that was looked at was
infection, ulcer, swelling, sensory dysfunction and trismus. Infected
socket is defined by pain at the site of extraction, starting within a
C 2014 Japan International Cultural Exchange Foundation
&Japan Health Sciences University

day or so of a tooth extraction.
All collected data were analysed using Statistical Package for
Social Sciences (SPSS) version 12.0 statistical software. Age, gender,
medical problems, smoking status, oral hygiene and complication of
surgery were calculated by frequency and percentage. The relation
between gender, medical problems, oral hygiene, smoking and occur-
rence of complications were analysed using Pearson Chi square test.
The relation between the age of patients and occurrence of complica-
tion was analysed using independent t-test.
Ethical clearance was obtained from the Research and Ethics
Committee (Human), Universiti Sains Malaysia. All patients' identifi-
cations and medical conditions data will be kept confidential.
RESULTS
Out of 256 patients, 149 (58.20%) were female and the remaining
107(41.80%) were male, who undergone surgical removal of impact-
ed mandibular third molar at HUSM.
The patients who undergone surgical removal of impacted
mandibular third molar were between 15 to 38 years of age (mean
24.4). The age group in which most extractions were carried out cor-
responds to 23 to 26 years old group.
The complication rate was 24.20% and the most common compli-
cation was infected socket (27 cases; 10.5%). The next common com-
plication was swelling more than 1 week (11 cases; 4.3%).
This was followed by trismus (10 cases; 3.9%), ulcer (8 cases;
3.1%) and sensory dysfunction of the inferior alveolar nerve (6 cases;
2.3%). Total 194 cases (75.80%) were noted to have no complica-
tions.
Table shows the association between the age of patients and
occurrence of complication which was not significantly different (p=
0.8999)
Table 2 shows the association between the patient's oral hygiene
and occurrence of complication which was significantly different (p=
0.001) Therefore, in study, there was no significant association
between smoking status, gender, medical problems and occurrence of
complication.
DISCUSSION
Surgical removal of impacted maxillary 3rd molar is a common
procedure routinely carried out in dental offices. The removed teeth
showed all kind of impacted, so that the procedures varied from sim-
ple extraction to difficult surgery. This study represents the whole
spectrum of the third molar surgery of a dental clinic. Complication
can arise following third molar surgery that could range from infec-
tion, ulcer, swelling, sensory dysfunction and trismus. These compli-
cations are well documented (Kafas et al. 2007). Although attention
to main basic principles of surgery, including proper preparation of
the patient, proper management of hard and soft tissue, asepsis and
haemostasis might definitely lead to reducing the number and severi-
ty of complications, certain unavoidable complication may still
occur.
In this study, the percentage of infected socket after removable of
impacted mandibular third molar is higher than the study done by Al-
Asfour (2009). Complication that were consider are infected socket,
ulcer, swelling, sensory dysfunction, and trismus. However, in Al-
Asfour study (2009), they were only consider post-operative compli-
cation, alveolar osteitis, pain lasting more than 1 week and sensory
dysfunction of the inferior alveolar nerve. The other study done by
118 Rahman S. A. et al.
Figure 1. Sex distribution of sample population Figure 2. Age distribution of sample population
Figure 3. Complications after surgical removal of mandibular
wisdom tooth
Table 1. Association between the age of patients and
occurrence complication
Variable Mean (SD) tstatistic pvalue
Yes No (df)
(Complication) (Complication)
Age 22.56(6.47) 24.56(6.47) 0.127(254) 0.899
Table 2. Association between the patient's oral hygiene,
smoking status, gender, medical problems and
occurrence of complication
Variable Complication X2value pvalue
N(%) (df)
Yes No
Oral Hygiene
Good 0(0) 30(100) 16.056(3) 0.001
Fair 18(14.1) 110(85.9)
Poor 6(28.6) 15(71.4)
Smoking status
Smoker 1(7.1) 13(92.9) 0.252(2) 0.882
Non-Smoker 18(11.1) 144(88.9)
Gender
Male 8(7.5) 99(92.5) 1.873(1) 0.175
Female 19(12.8) 130(7.2)
Medical problem
Yes 5(9.6) 47(90.4) 0.060(1) 0.806
No 22(10.8) 182(89.2)

Blandeau and Danial (2007), they found that there was significant
association was found between post-operative complication and gen-
der. However, in this study, there was no significant relation between
the gender and occurrence of infected socket. In this study also, there
was no significant relationship was found between the age and post-
operative complication. It was supported by Nigerian study (Oginni
et al. 2002)
Conversely, a study done by Benediktsdottir concluded that there
was sex predilection where by female were at higher experiences
post-operative complication (Benediktsdottir et al. 2004). Many stud-
ies reported increased complications among female associated with
oral contraceptive use such as Cohen (1995) and Catellani (1980).
However, consistent with our findings, Heasman and Jacobs (1984)
and Larsen (1992) did not find gender or oral contraceptive use to be
associated with post-operative complication which was found consis-
tent with other findings.
The result of this study found that a positive medical history was
not associated with post-operative complication. However, in study
done by Bui et al. 2003. There was significant relationship between
medical history and post-operative complication. Tobacco uses as a
factor for post-operative complication has been extensively docu-
mented. It is possible that smoking was not a significant risk factor in
this study because of the method of data collection. The information
on smoking was not properly documented in dental case note. In this
study, there was significant relationship between patient's oral
hygiene and post-operative complication.
CONCLUSION
Infected socket is the most common complication compared to
other type of complication that was found in this study. The signifi-
cant contributing factor for infected socket is oral hygiene status of
the patient prior to the surgical removal of mandibular wisdom tooth
as shown to be statistically significant (p< 0.05). However, the prop-
er record keeping of the patient about variable in this study should be
properly considered to get a better result.
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Prevalence of Infected Socket 119