Comment

This paper sets out to assess changes in quality of life during the first week following removal of third molars. Given the number of wisdom teeth removed annually, this is still a relatively under investigated area of clinical practice.¹ A number of oral health specific quality of life measures (questionnaires) have been developed including those specific for third molar removal.² These may become important tools for assessing quality, effectiveness and efficiency of treatment.

One hundred patients were recruited who were to have one lower wisdom tooth removed under local anaesthesia. The patients' quality of life was assessed pre-operatively and then daily by the patient using the oral health impact profile (OHIP–14) and the UK oral health related quality of life measure (OHQoLUK). Patients were asked to complete a logbook each day until reviewed on day 7. Poor quality of life was reflected in a high OHIP score and a low OHQoLUK score.

Of the 100 patients recruited, 93 completed the study. The mean and medium ages were 26 and 24 respectively which mirrors the usual group requiring third molar removal. In the immediate post-operative period, there was a significant decrease in quality of life measured by both questionnaires. By day 7 this had returned to pre-operatively values. The straightforward removal of an upper third molar did not appear to influence quality of life scores. Given that there has been a great deal of debate over specific clinical indications for removal of third molars, it would have been interesting to see if there were any differences in quality of life scores for those patients that satisfied guidelines for removal compared with those that did not. Also to assess the influence of type of impaction, bone removal, and length of operation on quality of life scores. The slight improve-ment in quality of life at day 7 compared with day 0, suggests that some patients' quality of life was affected by third molar problems.

A previous study found that 1 in 2 patients still experienced pain one week postoperatively despite analgesic therapy.¹ This paper provides further evidence of the urgent need to develop better pain control for patients requiring third molar removal.

Where there was no swelling and no trismus, there was often no change in quality of life but this was not always so; about a third reported a reduced quality of life without swelling or trismus. What other factors were responsible for this decrease in quality of life?

The little difference between day 0 and day 7 scores suggests that such influences are short lived. However, deterioration in quality of life was experienced across a broad range of domains (physical, social and psychological) and thus has relevance for counselling and obtaining informed consent for such procedures. Those involved in the construction of patient information leaflets should ensure that quality of life issues are included beyond the traditional ones of pain, swelling, bruising, trismus and possible anaesthesia of lip and tongue.