Influence of Immediate Post-Extraction Irrigation with Chlorhexidine Rinse on Post-Operative Pain and Incidence of Alveolar Osteitis of Impacted Mandibular Third Molars

Pain and alveolar osteitis are significant and common post-operative complications after extraction of third molars. The purpose of this study is to determine if post-extraction irrigation with 0.12% chlorhexidine gluconate rinse will impact on post-operative pain and on the incidence of alveolar osteitis.

A split-mouth double-blinded randomized control study was conducted with patients of the UIC Oral and Maxillofacial Surgery Clinic. The patients were enrolled based on symmetry of mandibular third molar impaction and age.  Patients were required to be over the age of 18 and have symmetrically impacted third molars, determined by a panoramic radiograph. One mandibular third molar extraction site was chosen to be the experimental side in each patient.  The experimental side was evenly distributed between left and right to nullify the effect of the hand dominance of the surgeon. After extraction of the third molars, the control extraction site was irrigated with normal saline, while the experimental extraction site was irrigated with 1:10 dilution of 0.12% chlorhexidine gluconate to saline. Patients returned at post-operative day three (POD3) and post-operative day seven (POD7) for evaluation.  A pain analog score, as well as clinical evaluation, were used to determine healing of extraction sites.

Twenty-five patients completed the study between February 2014 and February 2015.  A two-tailed t-test for matched groups (each patient served as their own control) was used to compare the pain levels on each post-operative day. On POD3, 15 of the 25 patients reported a decrease in pain on the experimental side, whereas 3 patients reported the same level of pain on each side. On POD7, 12 of the 25 patients reported a decrease in pain on the experimental side; 10 patients reported the same level of pain between sides. The average pain level on a scale of 1-10 based on the visual analog scale was computed for each group.  On POD3, the control group had an average pain level of 4.3 and the experimental group had an average pain level of 3.6. On POD7, the control group had an average pain level of 2.4 and the experimental group had an average pain level of 1.9.  On POD3 the difference in pain levels between the experimental and control groups showed no statistical significance with a p value of 0.065. On POD7 the difference in pain levels were statistically significant with a p value of 0.02.  In regards to the incidence of alveolar osteitis this was very low for statistical analysis, with only three cases.  One patient experienced bilateral AO and the other only at the control site

This study shows that irrigation with chlorhexidine reduces the amount of pain at one week status-post surgery.  There was a trend of decrease in early post-operative pain, however, this proved not to be statistically significant.  This study has given one method to aid in reduction of post-operative pain in extraction sites.  At this time no difference has been elucidated regarding incidence of alveolar osteitis.  More research in the area of strength of the chlorhexidine gluconate irrigation and dosage would be beneficial.  

 

Caso A., Hung LK., Beirne OR. Prevention of alveolar osteitis with chlorhexidine; a meta-analytic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:155-9

Larsen PE. The effect of a chlorhexidine rinse on the incidence of alveolar osteitis following the surgical removal of impacted mandibular third molars. J Oral Maxillofac Surg. 1991;49:932-7