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A telephone survey was used to assess adequacy of pain control after third molar removal in a series of three audits. After each audit, factors contributing to failure to control pain adequately and poor patient compliance with our analgesic regimen were identified. Changes in practice were then introduced to remedy areas of weakness and improve outcome. Despite an apparently sound protocol for the prescription of analgesics for patients having third molar surgery, the first audit revealed that 53% of patients experienced moderate to severe pain. After the introduction of written patient instructions to clarify the use of post-operative analgesics, the second audit demonstrated that 86% had their pain managed successfully. After subsequently increasing the post-operative Ibuprofen doses from 400 mg to 600 mg, the third audit showed that 96% of patients had satisfactory pain control. The use of clinical audit with an evidence-based analgesic regimen and clear, written patient instruction has improved post-operative pain control.
Clinical Relevance: This paper demonstrates the usefulness of clinical audit for the monitoring and improvement of pain control and analgesic prescribing regimens following oral surgery, which in turn may improve patient experience and outcome.
Article
The surgical removal of mandibular third molars is known to cause post-operative pain.1 The predictability of pain after third molar surgery has resulted in this surgical procedure being used in analgesic studies as a model of acute inflammatory pain.2,3 For a patient undergoing this frequently performed procedure, a satisfactory outcome should include acceptable pain control – the prevention or complete relief of pain, although challenging, is the goal of responsible clinicians.
It is known that patients suffering from acute dental pain self-medicate with a variety of analgesics4 which may be inappropriate for some. Excessive consumption has also been reported.5,6 Wishing to avoid similar problems in post-operative patients following third molar removal, the Department of Oral Surgery of King's College Hospital Foundation Trust introduced a protocol which determined that all patients undergoing the surgical removal of teeth would be prescribed pre-operative and post-operative analgesics. Senior clinicians believed this to represent sound clinical practice in a busy department staffed by many clinicians where wide variation in prescribing might otherwise result. Arrangements were made for appropriate analgesics to be dispensed from locally held stocks.
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