The aim of this study was to design a scale for measuring the extent and severity of post-surgical complications in third molar surgery. A multi-stage study using a quantitative methodology and qualitative interview strategy was employed. The degree of importance of signs and symptoms in the evaluation of post-surgical complications was initially observed using a self-report questionnaire administered to maxillofacial surgeons and surgical residents at the International Conference of Oral and Maxillofacial Surgeons in 2011. Then, using exploratory factor analysis, the items and components of the scale were established, with internal consistency determined using Cronbach’s alpha. Finally, a group of experts performed a face validity analysis and provided conceptual definitions for the items and components. Thirty-six signs and symptoms were evaluated by 100 respondents, with the most relevant being ‘suppuration’ and ‘abscess’. Factor analysis of the results identified three factors, defined as ‘secondary complication’, ‘soft tissue infection’, and ‘osseous involvement’ (Cronbach’s alpha > 0.7). Finally, a preliminary scale was designed comprised of these three components and 10 items. In this way, a preliminary scale for measuring post-surgical complications was designed to standardize the semiological concepts of post-surgical assessment. This scale will be assessed in a future investigation.
Third molar extraction is the most frequent surgery performed on the oral cavity. The associated post-operative complications have been reported with different frequencies and magnitudes in terms of severity and can occur intraoperatively (socket bleeding, inferior alveolar nerve damage, or oro-antral communication) or post-operatively, due to inflammation (alveolitis, pain, or swelling), infection (post-operative infection), or other causes (dehiscence, haematoma, presence of bone spicules, and others).
A large number of items are used to define post-surgical complications in third molar surgery, and the quantification of signs and symptoms has been recorded using different methods. The existence of various measuring instruments and models means that in most cases they lack validation and reliability studies. This situation may encourage measurement bias, subjectivity in data recording, and a lack of reproducibility of the measurements. Recent systematic reviews have drawn similar conclusions, demonstrating that diagnostic/evaluation criteria and the results of source studies complicate adequate comparisons and homogenization of terminologies. In fact, a recent paper by Dodson highlights the critical nature of the lack of consensus in diagnostic criteria of alveolar osteitis, meaning that combining data may be inappropriate.
A further important aspect to consider is that the use of subjective variables requires psychometric measurement instruments, such as pain scales, which include ordinal levels according to the severity of this sensation. In addition, patient opinion and experience is also relevant during the measurement procedure and should be considered in the process.
These are all sufficient reasons to advocate the application of mathematical models in the creation and validation of measurement instruments in health care that would render clinical practice more objective and predictable.
The aim of this study was to design a preliminary measurement scale for determining the extent and severity of post-surgical complications in third molar extraction surgery.
Materials and methods
A multi-stage study was conducted to create a scale using a quantitative methodology and qualitative interview strategy ( Fig. 1 ).