Patnaik S et al: Effect of cold compression therapy on pain, swelling & trismus ORIGINAL RESEARCH

Effect of Cold Compression Therapy on Pain,

Swelling & Trismus Following Surgical
Removal of Impacted Mandibular Third
Molars: A Clinical Research
Satyabrata Patnaik1, Swati S. Acharya2, Senthil Kumar.S3, Mohammad Akheel4
1- Senior lecturer, Dept. of Oral and maxillofacial surgery, Institute of dental
sciences, Bhubaneswar, Odisha, India. 2- Senior lecturer, Dept. of Correspondence to:
orthodontics, Institute of dental sciences, Bhubaneswar, Odisha , India. 3- Dr. Swati S. Acharya, c/o Dr. K. Acharya, Acharya
Dept. Of Public health dentistry, Sri Ramakrishna Dental College and Bhavan, Near Mangla Mandir, Rajendra Nagar,
Hospital, Coimbatore, Tamil Nadu. 4- Fellow, head & neck surgical oncology, Madhupatna, Cuttack-753010, Odisha, India.
curie manavata cancer centre, Nashik, Maharashtra.

ABSTRACT
Introduction: Dentoalveolar surgery involves some post-operative sequelae comprising of pain, swelling and
dysfunction. Surgical removal of impacted mandibular third molars constitutes a large proportion of minor oral surgical
procedures and generally involves these sequelae. This calls for attention regarding an easier and cost-effective way of
managing these undesirable post-surgical conditions. Aims: This study aims to throw light on the effectiveness of cold
compression therapy on pain, swelling, trismus following removal of impacted mandibular molars. Materials and
methods: 20 consecutive patients, 14 male & 6 female with unilateral impacted mandibular third molars of age ranging
from 17-40 yrs with mean age of 25yrs with mesioangular impacted teeth with variable positions comprised the sample.
Results: The results indicated a statistically significant improvement in values of swelling on the second post-operative
day in the cryotherapy sample than control group. Conclusion: Cold compression therapy proves to be the oldest and
easiest method.
KEYWORDS: Cold compression therapy, cryotherapy, Dentoalveolar surgery
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INTRODUCTION
mean in reducing this post-op sequel. Cold compression
Out of all the surgical procedures performed inside the therapy has been historically proven to be effective in the
oral cavity, the removal of semi-impacted and impacted management of swelling, but to there is a need to
teeth is the most common. The extraction of these quantitate the effectiveness. The primary reason for using
impacted teeth, depending on their localization, may this cold compression therapy in acute injury
prove to be relatively easy or extremely difficult.1 Any management is to reduce the temperature of the injured
dentoalveolar surgery involves post-surgical sequelae. tissue, which further reduces the tissue's metabolic rate
Surgical removal of impacted third molars constitute a and helps the tissue to survive the period after the injury.4
high percentage of minor oral surgical procedures and It is well documented that metabolic rate decreases by
always have pain, swelling, trismus as some of the application of cryotherapy.5
potential sequelae during the healing phase.2 This calls
for attention of clinician for an easier and cost-effective MATERIALS AND METHODS
way of managing these undesirable post-surgical
Patients: 20 consecutive patients, with unilateral
conditions.
impacted mandibular third molars of age ranging from
In the past, there have been reports concerning 17-40 yrs with mean age of 25 yrs,14 male & 6 female,
postoperative swelling, pain, and trismus. And many comprised the sample.
attempts are made to minimize these minor
Mesioangular, impacted teeth with variable positions as
complications, varying from complete rest to
per Pell and Gregory classification that varies from
administration of antibiotics, anti-inflammatory drugs &
position A,B,C & class l,ll,lll comprised the sample
steroids.3
(Example:position A, class ll, mesioangular). The patients
The aim of this study is to highlight the effectiveness of did not have any systemic illness, and they were not
the cold compression therapy as an easy and effective taking any medication that might influence the procedure

How to cite this article:

Patnaik S, Acharya SS, Kumar SS, Akheel M.Effect of Cold Compression Therapy on Pain, Swelling & Trismus Following Surgical Removal of Impacted
Mandibular Third Molars: A Clinical Research. Int J Dent Med Res 2015;1(6):18-21.

Int J Dent Med Res | MAR- APR 2015 | VOL 1 | ISSUE 6 18

 Patnaik S et al: Effect of cold compression therapy on pain, swelling & trismus ORIGINAL RESEARCH

or postoperative wound healing, All subjects were

nonsmokers.
A Control group of 5 patients, with same selection
criteria, was also included in the study. After the surgical
removal each patient underwent immediate cold
compression therapy on the treated side with a cool pack
for thirty minutes, followed with every one-half to two
hours when he or she was awake for 24 hrs. No therapy
was performed for the controlled group.
Preoperative Examination: After patient selection and
general physical examination, before surgery, maximum
mouth opening for determination of baseline of trismus
was recorded by measuring the inter-incisal distance
between the maxillary & mandibular central incisors
using a standard millimeter scale device and performed
after 1minute of mouth stretching (Fig 1).
Fig 2: Application of cool packs

Fig1. Swelling was evaluated by measuring the distance between

anatomic landmarks. Fig 3: Application of cool packs

For measurement of swelling the distance from the

attachment of earlobe to skin to the commissure of the lip
and the linear distance from the outer canthus of eye to
the angle of the mandible was measured using a flexible
millimeter tape.
For the measurement of pain visual analogue scale was
used.
Surgical Technique: The patient underwent third molar
extraction while under local anesthesia without any kind
of sedation.The local anesthetic used was lidocaine 2%
solution with 1:80,000 epinephrine.The surgeon
provided nerve block anesthesia of inferior alveolar nerve
.wards incision was used. An osteotomy of the
contiguous bone was performed followed by sectioning
of tooth. Both procedures were performed using a low-
speed straight handpiece under constant irrigation with a
cool sterile physiological saline solution.
Cold Compression Technique: The patients underwent
cold compression therapy on the treated side with cool
packs for 30 minutes and in every one to two hours for
the next 24hrs while awake (Fig 2,3).
RESULTS
The results indicated a statistically significant
improvement in swelling values on the second post-
operative day in the cryotherapy sample than the control
group. However, no significant differences were found in
relation to trismus, significant at 5% (Table 1,2). There is
also statistical difference between both the groups in
relation to pain, significant at 5% (Table 3,4). There is
also statistical difference between both the groups in
relation to swelling, significant at 5% (Table 5,6).
Swelling was evaluated by measuring the distance
between anatomic landmarks (Fig 1,2,3).
DISCUSSION
Cold therapy is commonly employed as the early
treatment in soft-tissue injuries. Its use appears to have
been documented first by Hippocrates (460-377 BC),
who first described its pain-relieving effects
(Hippocrates, 1931 translated by W. H. S. Jones). This
analgesic effect has since been well documented by
Evans, 1981.4 Other effects are less clear. Although the

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 Patnaik S et al: Effect of cold compression therapy on pain, swelling & trismus ORIGINAL RESEARCH

1.6 1.6
1.6
1.45
1.4
1.4

1.2

Mean pain
0.8
0.8 0.7

0.6

0.4

0.2
0 0
0
Pre OP 24 Hrs 48 Hrs 7 Days

Experimental Control

Table 4: Relationship between Crotherapy and Pain among experimental

Table 1: Relationship between Crothrapy and Trismus among
and control group at various intervals
experimental and control group. * Significant at 5 %

4.00 3.78 3.77

3.50
3.50

2.90
3.00
Mean Trismus(cm)

2.50 2.28
2.03
1.90 1.90
2.00

1.50

1.00

0.50

0.00
Pre OP 24 Hrs 48 Hrs 7 Days
Table 5: Relationship between Crothrapy and Swelling among
Experimental Control experimental and control group. * Significant at 5 %
Table 2: Relationship between Crotherapy and Trismus among
experimental and control group at various intervals

11.8411.85
11.6
12
10.5310.35 10.64 10.7
9.83
10

8
Mean Swelling

0
Pre OP 24 Hrs 48 Hrs 7 Days

Experimental Control

Table 3: Relationship between Crothrapy and Pain among experimental Table 6: Relationship between Crotherapy and Swelling among
and control group. * Significant at 5 % experimental and control group at various intervals

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 Patnaik S et al: Effect of cold compression therapy on pain, swelling & trismus
use of cold therapy is widespread, there is little data to
support scientifically any other benefits.
Studies have shown that the body activates the hunting
response5 after only 10 minutes of cryotherapy, at
temperatures which is less than 49F (9.5C). The hunting
response is a cycle of vasoconstriction which decreases
the blood flow and then vasodilation (increased blood
flow) that increases the delivery of Oxygen and nutrient
rich blood to the tissue. Increased blood flow can slow
cell death, limit tissue damage and aid in the removal of
cellular debris and waste products.5
The results indicated in our study showed statistically
significant improvement in swelling values on second
post-operative day in the treated sample, than control
group. There is also a statistical difference between the
two groups in relation to pain.
However, no significant differences were found in
relation to trismus.
CONCLUSION
The cold compression therapy, intervention turned out to
be effective and useful in controlling facial swelling. The
Int J Dent Med Res | MAR- APR 2015 | VOL 1 | ISSUE 6
ORIGINAL RESEARCH
results showed that there was increasd pain values after
surgery on both experimental and control sample
however patients reported a smaller increase in pain in
the cryotherapy treated sample.
a
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Source of Support: Nil
Conflict of Interest: Nil
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