Effect of different factors on patient perception of surgical discomfort in third molar surgery

Reis, Giselle Emilãine da Silva; Calixto, Robson Diego; Petinati, Maria Fernanda Pivetta; Souza, Juliana Feltrin de; Kuchler, Erika Calvano; Costa, Delson João da; Bonotto, Daniel; Rebellato, Nelson Luis Barbosa; Scariot, Rafaela

doi:10.1590/1807-3107bor-2021.vol35.0007

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Original Research, Mouth and Jaw Surgery • Braz. oral. res. 35 • 2021 • https://doi.org/10.1590/1807-3107bor-2021.vol35.0007 copy

Effect of different factors on patient perception of surgical discomfort in third molar surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery.

Keywords:
Surgery, Oral; Molar, Third; Quality of Life; Polymorphism, Genetic

Gene	Polymorphisms	Locus	Change of base	Minor allele frequency/number of individuals assessed*
FKBP5	rs3800373		C/A	C = 0.32867
	rs3800373	6p.21.31	C/A	A = 0.67133
	rs1360780		T/C	T = 0.33611
	rs1360780		T/C	C = 0.66389
SLC6A4	rs1042173		A/C	C = 0.41885
	rs1042173	17q11.2	A/C	A = 0.58115
	rs3813034		A/C	C = 0.32867
	rs3813034		A/C	A = 0.67133
COMT	rs174675	22q11.21	T/C	T = 0.32890
COMT	rs174675	22q11.21	T/C	C = 0.67110

Individual variables			Surgical discomfort	p-value
Individual variables			Med (min–max)	p-value
Sex
	Female	N (117)	1.70 (0–6)	0.001
	Male	N (79)	1.00 (0–4)	0.001
Age (years)
	≥ 23	N (103)	1.40 (0–6)	0.968
	< 23	N (93)	1.40 (0–5)	0.968
BMI
	Underweight	N (5)	1.50 (0–4)	0.845
	Normal weight	N (116)	1.42 (0–6)
	Overweight	N (52)	1.28 (0–4)
	Obesity	N (23)	1.30 (0–5)

Surgical variables			Surgical discomfort	p-value
Surgical variables			Med (min–max)	p-value
Resident's training stage	R1	N (56)	1.42 (0–5)	0.479
	R2	N (69)	1.33 (0–4)
	R3	N (60)	1.55 (0–6)
Surgery duration (minutes)	≥50	N (90	1.15 (0–6)	0.136
Surgery duration (minutes)	<50	N (106)	1.58 (0–5)	0.136
Number of teeth extracted	≥2	N (156)	1.40 (0–6)	0.882
Number of teeth extracted	≤3	N (38)	1.40 (0–4)	0.882
Winter's classification
Teeth 18	Distoangulated	N (25)	1.45 (0–3)	0.997
	Mesioangulated	N (7)	1.20 (0–5)
	Vertical	N (81)	1.58 (0–4)
Teeth 28	Distoangulated	N (15)	1.45 (0–3)	0.059
	Mesioangulated	N (10)	0.75 (0–2)
	Vertical	N (63)	1.40 (0–6)
Teeth 38	Distoangulated	N (9)	1.10 (0–2)	0.839
	Mesioangulated	N (24)	1.65 (0–3)
	Vertical	N (45)	1.48 (0–6)
	Horizontal	N (17)	1.20 (0–3)
	Transalveolar	N (1)	–
Teeth 48	Distoangulated	N (11)	2.15 (0–5)	0.587
	Mesioangulated	N (33)	1.98 (0–4)
	Vertical	N (54)	1.38 (0–5)
	Horizontal	N (19)	1.15 (0–3)
	Transalveolar	N (2)	0.92 (1–1)
Pell & Gregory Classification
Teeth 18	A	N (60)	1.70 (0–4)	0.308
	B	N (23)	1.45 (0–4)
	C	N (29)	1.50 (0–5)
Teeth 28	A	N (46)	1.05 (0–6)	0.126
	B	N (15)	1.60 (0–4)
	C	N (27)	1.50 (0–4)
Teeth 38	IA	N (36)	1.70 (0–6)	0.216
	IB	N (15)	1.40 (0–3)
	IC	N (3)	1.28 (1–1)
	IIA	N (20)	1.40 (0–3)
	IIB	N (13)	1.78 (0–3)
	IIC	N (6)	0.80 (0 - 1)
	IIIB	N (3)	1.15 (0–2)
Teeth 48	IA	N (34)	1.48 (0–4)	0.803
	IB	N (19)	1.30 (2–3)
	IC	N (4)	2.05 (2–3)
	IIA	N (26)	1.42 (0–5)
	IIB	N (27)	1.40 (0–5)
	IIC	N (6)	1.95 (0–3)
	IIIA	N (1)	–
	IIIB	N (3)	1.95 (1–2)
Difficulty level	Easy	N (7)	1,90 (1–3)	0.469
	Medium	N (85)	1,50 (0–6)
	Difficult	N (98)	1,45 (0–5)

OHIP-14	Spearman correlation coefficient	p-value
Functional Limitation	0.087	0.238
Physical disability	0.045	0.546
Psychological discomfort	0.076	0.302
Physical incapacity	0.052	0.480
Psychological disability	0.039	0.596
Social disability	0.113	0.126
Social disadvantage	-0.014	0.849
OHIP-14 general	0.093	0.210

Gene	Polymorphisms	Model		Surgical discomfort	p-value
Gene	Polymorphisms	Model		Med (min–max)	p-value
FKBP5	rs1360780	Additive
			CC	1.20 (0–5)	0.408
			TT	2.23 (0–5)
			CT	1.75 (0–4)
		Dominant
			CC/CT	1.45 (0–5)	0.302
			TT	2.23 (0–5)	0.302
		Recessive
			TT/CT	1.20 (0–5)	0.274
			CC	1.80 (0–5)	0.274
	rs3800373	Additive
			AA	1.15 (0–5)	0.074
			CC	1.15 (0–4)
			AC	1.90 (0–5)
		Dominant
			AA/AC	1.45 (0–5)	0.921
			CC	1.15 (0–4)	0.921
		Recessive
			CC/AC	1.15 (0–5)	0.026
			AA	1.90 (0–5)	0.026
SLC6A4	rs1042173	Additive
			AA	1.15 (0–4)	0.995
			CC	1.30 (0–5)
			AC	1.58 (0–5)
		Dominant
			AA/AC	1.50 (0–5)	0.952
			CC	1.30 (0–5)	0.952
		Recessive
			CC/AC	1.15 (0–4)	0.928
			CC	1.50 (0–5)	0.928
	rs3813034	Additive
			AA	1.45 (0–4)	0.782
			CC	1.20 (0–5)
			AC	1.70 (0–5)
		Dominant
			AA/AC	1.55 (0–5)	0.489
			CC	1.20 (0–5)	0.489
		Recessive
			CC/AC	1.45 (0–4)	0.908
			CC	1.50 (0–5)	0.908
COMT	rs174675	Additive
			CC	1.45 (0–5)	0.468
			CT	1.50 (0–4)
			TT	–

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[1] Corresponding Author: Rafaela Scariot, E-mail: Rafaela_scariot@yahoo.com.br