Perioperative strategies for third molar surgery.

The removal of third molar teeth is one of the most common procedures performed by oral and maxillofacial surgeons. Third molar extraction is associated with undesirable sequelae and complication. Morbidity is related to pain, swelling, trismus, infection, alveolar osteitis, bleeding, nerve injury, dental injury, jaw fracture, temporomandibular joint dysfunction, lost workdays, and general inconvenience. Many factors and strategies have been studied to minimize the morbidity associated with third molar removal. This article focuses on perioperative strategies that have been suggested to influence the postoperative course after third molar extraction. These include the effect of smoking, chlorhexidine rinses, topical and systemic antibiotic use, and preemptive pharmacotherapies, including corticosteroids, analgesics, and muscle relaxants. Additional factors that may play a role, such as microbial contamination, surgical difficulty, surgeon experience, flap design, extent and closure, presurgical pathology, age, gender, and oral contraceptive use, are not addressed.