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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 143-149

The impact of the method of presenting instructions of postoperative care on the quality of life after simple tooth extraction

1 Department of Preventive Dental Science, Taibah University Dental College and Hospital, Al-Madinah Al-Munawwrah, Saudi Arabia
2 Department of Maxillofacial Surgery, Taibah University Dental College and Hospital, Al-Madinah Al-Munawwrah, Saudi Arabia
3 Department of Preventive Dental Science; Department of Maxillofacial Surgery, Taibah University Dental College and Hospital, Al-Madinah Al-Munawwrah, Saudi Arabia
4 Department of Maxillofacial Surgery, Taibah University Dental College and Hospital, Al-Madinah Al-Munawwrah, Saudi Arabia; Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, For Girls, Al-Azhar University, Cairo, Egypt

Date of Submission10-Mar-2021
Date of Decision08-Sep-2021
Date of Acceptance19-Oct-2021
Date of Web Publication30-Dec-2021

Correspondence Address:
Dr. Shadia Abdel-Hameed Elsayed
Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo; College of Dentistry, Taibah University, Almadinah Almunawwarah

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjoralsci.sjoralsci_14_21

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Introduction: The extraction of teeth is a common dental treatment. Healing complications have been reported to be influenced by patients' knowledge and compliance with postoperative instructions.
Aim : The goal of the study was to define the influence of the way postoperative instructions delivering method on reducing morbidity and problems experienced after simple tooth extraction.
Materials and Methods: A single-blind randomized clinical trial was designed at clinics of Oral Maxillofacial Surgery, Taibah University. Patients were distributed to two classes on a random basis. The first group was provided only with verbal instructions (VI) after dental extraction. The second group was given written and verbal (CVWI) instructions. Postoperative pain, swelling, sleep impairment, oral functions, and general activity were reported using an assessment tool for oral health life quality (OHQ).
Results and Discussion: The mean OHQ scores were 14.28 ± 6.36 for VI and 13.46 ± 5.78 for CVWI, which did not indicate a statistical difference (P = 0.50). Of the 100 participants, 51% were mildly affected, whereas 22% were severely affected. Females constituted 51% of the study participants. There was a statistically significant difference between females' mean score values compared to males (15.78 ± 4.5–11.88 ± 6.5) with P = 0.001. About 56% of the participants were nonSaudis and 33% hold a high-school diploma.
Conclusions : There was no difference between the two approaches used to present the postoperative instruction in the postextraction OHQ. Following tooth extraction, female patients experience a significantly greater decline in their OHQ. Translation of written postoperative instructions in more than one language should be available in our institution to improve OHQ during the postextraction period.

Keywords: Patient quality of life, postextraction instruction, postoperative instructions

How to cite this article:
Alsahafi YA, Alolayan AB, Alraddadi W, Alamri A, Aljadani M, Alenazi M, Elsayed SA. The impact of the method of presenting instructions of postoperative care on the quality of life after simple tooth extraction. Saudi J Oral Sci 2021;8:143-9

How to cite this URL:
Alsahafi YA, Alolayan AB, Alraddadi W, Alamri A, Aljadani M, Alenazi M, Elsayed SA. The impact of the method of presenting instructions of postoperative care on the quality of life after simple tooth extraction. Saudi J Oral Sci [serial online] 2021 [cited 2022 Aug 15];8:143-9. Available from: https://www.saudijos.org/text.asp?2021/8/3/143/334292

  Introduction Top

Tooth extraction is a regularly performed dental procedure.[1] Dental caries and periodontal disease are major reasons for extraction in dentistry.[2] The sequela of tooth extraction in literature is well documented, including its effect on the quality of life.[3],[4] A study was done in Nigeria in 2010 has shown that about one-third of patients undergoing simple extraction experience significant deterioration in quality of life, meanly affecting diet and speech.[5] There were also reports of healing complications, pain, and discomfort after dental extraction.[3],[6],[7],[8],[9],[10]

Tooth extraction also involves more serious complications such as dry socket, swelling, trismus, and infection.[11],[12],[13] Their occurrence is uncomfortable for both patients and dentists, as it leads to an extended phase of treatment.[14] There are several factors leading to these complications including patient age, gender, and surgeon experience.[4],[15],[16] Patient awareness and compliance with postoperative instructions have also been reported to influence the occurrence of healing complications.[7],[13],[17],[18],[19]

Rationale of the study

There are limited data regarding the impact of the method of delivering postoperative instructions on problems encountered during healing after (nonsurgical) tooth extraction.[6],[20],[21] The present study aimed to contribute to the current literature by identifying the effect of the way postoperative instructions are delivered at Taibah University Dental clinics, Almadinah Almunawwarah, on reducing morbidity following simple tooth extraction. The hypothesis is that emphasizing the postextraction instructions by giving the patient's both written and verbal instructions (VIs) will improve the understanding and compliance of patients with the instructions, thus improving the quality of life during the postoperative period.

  Materials and Methods Top

The study obtained approval from the Taibah University ethical review committee (TUCD-REC/20191113/WHAlradaddi). Participants were asked to sign an informed consent to give them sufficient information to determine whether to take part in the study. All the data collected were anonymous, and no risk to the participants was involved in the study.

A single-blind randomized controlled trial was performed (participants were asked to sign an informed consent to give them sufficient information to make the decision as to whether to take part in the study but the participants were not be given the real purpose of the study to avoid the bias). Study population included patients seeking simple dental extraction who were selected from the clinics for Oral and Maxillofacial Surgery, College of Dentistry, Taibah University. Patients were randomly allocated to two groups based on how they got the postoperative instructions. The first group (50%) was only be given VI. The second group (50%) was given written and VI (CVWI) (Appendix 1 and 2).

The sample size was determined to be 100 participants using a sample size calculator with confidence level of 95% and population size of 134 (by estimating the number of patients seeking dental extraction over a period of 1 month). Study population included patients seeking simple dental extraction who were selected from the clinics for Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Saudi Arabia.

Inclusion criteria

  • Adult male and female patients with age >14 years old
  • Patients who require nonsurgical tooth extraction
  • Patients who signed the consent and were willing to participate.

Exclusion criteria

  • Cases require surgical extractions
  • Patients with mental disabilities
  • Uncontrolled systematic diseases
  • Patients suffering from visual and/or hearing impairment.

Before the procedure, patient demographic data, the patient's medical, and social history were collected. All participants were followed up for 2 weeks after extraction. On the same day of the extraction, a phone review was performed, and then all patients were clinically followed up at 3, 5, 7, and 15 days following surgery to assess swelling, postoperative pain levels, eating ability, sleep impairment, oral function, and general activity.

A modified version of the Oral Health Impact Profile measuring tool (OHIP-14) questionnaire was used.[22] The study outcome variables were divided into three categories based on the translated health quality questionnaire. All participants' demographic information was included in Section I. Questions on medical history and social habits were addressed in Section II. Section III was modified to include eight questions about postextraction problems [Supplemental Table 1]. The scores ranged from 8 (no problems) to 32 (all problems experienced).

Scores have been divided into four categories: Category I: not affected at all (Score 8); category II: slightly affected (Score 9-16), category III: substantially affected (Score 17–24), and category IV: Severely affected (Score 24–32).

The thickness of the cheek on the operative side was measured with a caliper. The distance between two tips of the caliper arms was measured using a graduated tape. One arm of the caliper was placed in the lingual embrasure between lower first and second mandibular molars, while the other arm was adjusted tangentially to the skin of the cheek parallel to the occlusal plane.

Pain was assessed using a visual analog scale with ratings ranging from 0 to 5. 0 indicates that there is no suffering, 1 denotes a minor pain, 2 denotes weak pain, 3 denotes moderate pain, 4 denotes painful, and 5 denotes unstainable excruciating pain in the first 5 days following extraction. The number of analgesic tablets consumed by patients throughout each follow-up period.

Statistical analysis

Data were collected and analyzed using the 16.0 SPSS statistical software (SPSS Inc. IBM, Chicago, USA). Descriptive statistics were used to summarize data in frequencies and percentages. For parametric data, we used the independent sample t-test to compare the means of both groups. The Mann–Whitney test was used to compare the two groups for nonparametric data. Chi-squared test was used to identify associations. P value was set at P ≤ 0.05.

  Results Top

Out of the 100 patients who participated in this study, 51 (51%) were females and 49 (49%) of them were males. Distributed equally according to how postoperative instructions were given into both groups. Of these, approximately 58 (58%) participants were aged from 25 to 50 years age group, 22 (22%) were aged <25 years, and the remaining 20 (20%) were aged >50 years. Majority of the participants 56 (56%) were non-Saudis and 44 (44%) were Saudis.

The findings showed that most participants 33 (33%) held high school diploma followed by less than high school diploma 28 (28%), followed by bachelor's degree 20 (20%), while 16 (16%) of respondents had no education, and only 3 (3%) had a master degree [Table 1].
Table 1: Characteristics of the study participants (n=100)

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A modified version of the OHIP-14 questionnaire has been used to calculate the Oral health-related quality of life affection scores for every participant. Of the 100 participants, 51 (51%) were little affected (category II) and 22 (22%) were experienced a lot of affection (category III) and only 5 (5%) were very much affected (category IV) whereas 22 (22%) of the participants had complete no affection (category I) [Table 2].
Table 2: Participants distribution in different categories according to the score value of oral health relates quality

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The mean quality score value for VI was 14.28 ± 6.36. For the combined verbal and written instructions, the mean score value was 13.46 ± 5.78 [Table 3]. The difference between the groups studied was not statistically significant (P = 0.50).
Table 3: Mean score values of oral health-related quality of life for the study groups and its statistical analysis based on gender

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The results of mean were compared with independent sample t-test. There was a statistically significant difference between the mean female score of 15.78 ± 4.5 and male score of 11.88 ± 6.5 with a P value of 0.001 [Table 3].

  Discussion Top

An updated 14-item OHIP has been used in this study to evaluate the oral health-related quality of life (OHQ) reported by patients following nonsurgical extraction. The patients were assigned to two groups according to the postoperative instruction presentation method. The participants were assigned randomly to the test group where combined written and VIs were given and control group where the patients received only VIs.

The postoperative extraction period is very important in determine healing sequence of every surgical wound and the surgeons emphasize that this time is as important as the goodness of surgery itself.[11],[16],[23] It is well-documented in the literature that tooth extraction is associated with deterioration in quality of life.[20],[24] Patient required to adhere completely to the postoperative instruction given to avoid possible complications such as dry sockets which may be precipitated due to patient negligence or misunderstanding of the instruction given.[17],[25],[26]

This study found that 78% of the participants who have undergone nonsurgical tooth extraction confirmed that their OHQ was affected. The majority of these (51%) claimed, that they were slightly affected and (22%) reported that they were quite very much affected. These findings are consistent with the findings of Adeyemo's study in which he stated in his analysis that 94% of the participants reported a deterioration in their OHQ.[5]

The present analysis revealed that there is no significant difference between the two groups. Patients in the studied group who received combined verbal and written instructions did not show statistically significant lower score of health quality affection than patients receiving only VIs. The mean score value for the control group who received VIs was 14.28 ± 6.36 while for the study group who received combined verbal and written instructions, the mean score value was 13.46 ± 5.78 [Table 3]. This result is contrary to findings in a similar study by Gheisari in India, where he concluded that the mode of delivering postoperative instructions affected pain intensity and general patient satisfaction. Patients who received VIs reported the most intense pain and the least satisfaction, and patients who received verbal and written instructions were the most satisfied.[4]

The explanation of this occurrence may be due to the regional cultural context of our study population setting where our institution in Almadinah Almunawwarah serves residents who speak different languages and originate from various countries such as Pakistan, Afghanistan, India, Malaysia, Uzbekistan, Egypt, and others. This therefore requires the translation of the written postoperative instruction into various languages and this has not happened in our institution because only the Arabic and English versions of the written postoperative instructions are available and distributed and so this may affect our results.[27],[28]

Findings from this study also showed that female patients have higher mean scores than males. Females scored 15.78 ± 4.5 mean value of their health quality affection while males scored 11.88 ± 6.5. Independent sample t-test was used to compare the mean. There was statistically significant difference between the mean score values with P = 0.001. A study carried out by Al-Khateeb and Alnahar, supports our findings. In his study, he concluded that female gender predominance in pain reporting after extraction.[29]

The study's limitations included the small sample size, due to the use of convenience sampling that restricts the extent to which the outcomes can be generalized. A larger-scale study could be conducted in the future to evaluate the effect of the difference between verbal and combined postoperative instructions for more complex surgical procedures.

  Conclusion Top

Within the limitation of the study, it has been found that there was no difference between the two approaches used to present the postoperative instruction on the postextraction quality of life affection scores. Female patients experience more deterioration in quality of life after tooth extraction than males. The study recommends translation of the written postoperative instruction should be available in more than one language to improve the quality of life scores during the healing period after extraction.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  Appendices Top

Appendix 1: Postoperative instructions


  • Bite firmly on the gauze for at least 30 minutes and not to chew on the gauze. Hold the gauze in place without opening or closing the mouth. Talking should be kept to a minimum for 2 to 3 h
  • If the bleeding is more than a slight ooze, reapply a small piece of gauze directly over the area of the extraction. Hold this second gauze pack in place for as long as 1 h to gain control of bleeding
  • Avoid smoking for the first 12 h
  • Do not suck on a straw when drinking
  • Do not spit during the first 12 h after surgery
  • No strenuous exercise should be performed for the first 12 to 24 h after extraction
  • If you are worried about the bleeding, you should call to get additional advice. Prolonged oozing, bright red bleeding, or large clots in your mouth are indications for a return visit.

Pain and Discomfort

  • Expect a certain amount of discomfort after the procedure
  • Take ibuprofen or acetaminophen postoperatively
  • The first dose of analgesic medication should be taken before the effects of the local anesthetic subside
  • Be warned that taking too much of narcotic medications will result in drowsiness and an increased chance of gastric upset
  • Avoid taking narcotic pain medications on an empty stomach.


  • Food in the first 12 h should be soft and cool.

Oral Hygiene

  • Keeping your teeth and the whole mouth clean will results in a more rapid healing
  • Postoperatively on the day of surgery you may gently brush the teeth that are away from the area of surgery in the usual fashion
  • Avoid brushing the teeth immediately adjacent to the extraction site
  • The next day, begin gentle rinses with dilute saltwater. The water should be warm but not hot enough to burn the tissue.


  • Moderate amount of swelling is expected
  • Do not be concerned or frightened by swelling because it will resolve within a few days

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  [Table 1], [Table 2], [Table 3]


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