Patterns of Third-Molar-Pericoronitis-Related Pain: A Morphometrical Observational Retrospective Study

Abstract

Background: Mandibular third molar (M3M) removal and the management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. Pain represents a great symptom for patients affected by pericoronitis and it is the most common indication for third molar removal. The aim of the present article is to search for patterns of pre-operative pain in patients before undergoing third molar surgery and to test for a relation between some patterns of symptoms, such as pain intensity, site of symptomatic tooth, and referred area of pain.

Methods: This retrospective observational study enrolled a total of 86 patients, aged (mean ± SD) 34.54 ± 13.62 years (range 17-78 years), scheduled for outpatient third molar extraction at the Oral Surgery School, Department of Medical Biotechnologies, Policlinico "Le Scotte", University of Siena. Pericoronitis and pain were the symptoms of the patients and the indication of extraction. Inclusion criteria were the presence of partially impacted third molars, confirmed with a preoperative panoramic radiograph, and preoperative pain. Exclusion criteria were known neurological disease (such as previous trigeminal or facial nerve injuries), impaired communicative or cognitive disease, diagnosed diabetes mellitus, and oral surgical intervention within 30 days before data collection. Patients were visited and asked to answer a morphometric analytic questionnaire about their perception of pain referred to the third molar. Analyses were performed on statistical evaluation on age, age ranges, patient gender, prior third molar extraction, site of pericoronitis, pain score (1-10), and pain area. Two-tailed p values of less than 0.05 were considered significant if not otherwise specified.

Results: No correlations were found between age, gender, previous extraction, tooth site (maxillar on mandible), pain score, and pain area. Patterns of third molar pericoronitis pain among 86 patients were reported. A significant correlation was found between pain score and pain area (p = 0.0111, r_s = 0.3131).

Conclusions: Pain intensity has indeed some kind of responsibility in determining the orofacial distribution of pain. The pain area referral patterns of the present article could be considered as a pain model resulting from the pericoronitis of maxillar and mandibular third molars.

Keywords: extraction; headache; pain; pathology; pericoronitis; surgery; third molar.

Figure 1

Frontal view of facial graph with a patient pain referral (x₁ = 3, x₂ = 4, y₁ = 5, y₂ = 7, x-value = 1, y-value = 2) (on the left). Lateral view of facial graph with a patient pain referral (x₁ = 5, x₂ = 7, y₁ = 5, y₂ = 7, x-value = 2, y-value = 2) (on the right). With these values, pain area is 6.

Figure 2

Algebraic formulas for determination of the values.

Figure 3

Pain area distribution on the basis of age range.

Figure 4

Pain score distribution on the basis of age range.

Figure 5

Comparative pain score distribution on the basis of age range and patient gender.

Figure 6

Comparative pain area distribution on the basis of age range and patient gender.

Figure 7

Comparative pain score distribution on the basis of age range and previous extraction.

Figure 8

Comparative pain area distribution on the basis of age range and previous extraction.

Figure 9

Distribution of pain score and pain area on the basis of sex.

Figure 10

Distribution of pain score and pain area on the basis of tooth pain site, maxillar or mandible.

Figure 11

Distribution of pain score and pain area on the basis of previous extraction.

Figure 12

A significant correlation was found between pain score felt by patients and pain area represented on patient’s face (univariate regression analysis p = 0.0111, r_s = 0.3131).

Figure 13

Distribution of pain score on the basis of pain area.