Odontologo

Experience in third molar surgery: an update
W. Jerjes,1 T. Upile,2 F. Nhembe,3 D. Gudka,4 P. Shah,5 S. Abbas,6 E. McCarthy,7 S. Patel,8 J. Mahil9 and C. Hopper10 VERIFIABLE CPD PAPER

IN BRIEF

• There is a relationship between the

RESEARCH

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surgeon’s experience and postoperative complications in third molar surgery. With careful assessment and treatment planning postoperativecomplications may be minimised. Knowledge of general surgical principles is often learned best through direct observation and/or assisting senior colleagues, building upon information gained from written material.

Background The relationship between a surgeon’s experience and the incidence of postoperative complications after third molar surgery is assessed in this prospective clinical study. Previousreports have shown this to be one the most influential factors on surgical outcome. Method In this study, 3,236 patients underwent surgical removal of impacted third molars. All patients included in the study were reviewed and the various postoperative complications were recorded and statistically compared to the surgeon’s grade. Patients’ demographics and pre-operative radiographic findings were alsonoted. Results The surgical procedures were performed by seven specialists and 12 residents. In the group of patients treated by the residents, the incidence of postoperative complications was found to be significant with regards to trismus, infection, alveolar osteitis and paraesthesia of the lingual and inferior alveolar nerves. In the group of patients treated by specialists, the incidence ofpostoperative bleeding was found to be statistically significant. Conclusion There is without doubt a relationship between the surgeon’s experience and the postoperative complication in third molar surgery. The impact of the findings from this study upon the profession, education and research is as yet unrealised. The ethical and moral implications of our findings are discussed. INTRODUCTION
This studyreviews the effect of experience on the outcome of patients undergoing surgical extraction of third molar teeth. This is one of the most common procedures performed in oral and maxillofacial surgery (OMFS). The paradigm may easily be extended to other common operations such as adenoidectomy, tonsillectomy and middle ear surgery (including insertion of grommets). In their entirety they form themajority of the surgical procedures carried out each year in the United Kingdom. The most common indications for the removal of third molar teeth are pain, recurrent swelling and infection. The assessment of a symptomatic patient involves clinical

Senior Clinical Research Fellow, 3,4,5,7,8Senior House Officer, 6Specialist Registrar, 10Consultant Oral & Maxillofacial Surgeon, UCLH Head and Neck Centre,250 Euston Road, London, NW1 2PG; 2Senior Lecturer, Department of Surgery, University College London Medical School, London, NW1 2PG; 9General Practitioner with a special interest, Kent PCT *Correspondence to: Mr Waseem Jerjes Email: waseem_wk1@yahoo.co.uk Online article number E1 Refereed Paper - accepted 26 March 2010 DOI: 10.1038/sj.bdj.2010.581 © British Dental Journal 2010; 209: E1
BRITISHDENTAL JOURNAL

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examination and assessment of a two dimensional radiograph of the tooth to be removed. A decision would be formulated on whether the surgery should take place under local anaesthesia, intravenous sedation or general anaesthesia. Factors including surgical difficulty, anticipated complications, patient’s preference, fear and anxiety and the surgeon’s experience as well as thepublished NICE guidelines should be taken into account before decision making.1 Postoperative complications are a potential risk of any surgical procedure. However, with careful assessment and treatment planning, they may be minimised. This involves appropriate patient preparation, an aseptic technique, meticulous management of the hard and soft tissues, the use of controlled force when applying...