An interesting article titled “The potential role of patient stress in rates of dental post-extraction complication” written by McDowall appears in the 2014 edition of Oral Surgery (vol. 7, pp. 162-167). The article explores whether stress, alcohol and tobacco use impacts the complication rate experienced after a tooth extraction.
The authors recruited patients for the study who were at least 16 years old and having at least one tooth extracted. The patients were asked to fill out questionnaires incorporating the Global Measure of Perceived Stress Scale (PSS), the Fast Alcohol Screening Test (FAST) and questions related to tobacco use. The PSS consists of fourteen questions designed to determine how stressful the persons life is and higher scores indicated greater perceived stress. The FAST consists of four questions designed to determine the frequency too much alcohol consumption and higher scores indicate to often drinking dangerous amounts of alcohol. A total of 94 patients were interested in the study but data for 68 patients was ultimately used. Among the 68 patients 24 or 35% had a lower wisdom tooth extracted. Two weeks after the extractions each patient was attempted to be contacted by telephone to determine if any complications had occurred. Further during the call each patient was asked to rate the pain experienced following the extraction on a scale of 0 to 10 with increasing pain for higher scores.
Only about 52 of the 68 patients (76%) responded to the follow up phone call. Of the 52 patients who responded to the phone call after the extractions 10 of them (19.2%) reported experiencing a complication. The authors performed cox proportional-hazards regression analysis to determine if higher PSS scores had an impact on the complication rate. The authors found that those with higher log PSS scores and lower FAST scores were more likely to experience a complication. The authors also found those who had higher pain scores were more likely to experience a complication. The use of tobacco did not significantly impact if a complication was experienced or not following tooth removal. The authors state
“The results presented from this exploratory study suggest that stress does have a deleterious effect on complication rates following a dental extraction, controlling for potential confounding variables such as alcohol and tobacco use.”
The authors speculate that the reason alcohol use was inversely associated with the complication rate was due to having patients in the study as a whole being moderate alcohol users and also the possible bactericidal effects of alcohol which could work to prevent dry socket from occurring. As a result of this finding the authors even say that a mouthwash containing alcohol might even be considered for patients as a whole after tooth extraction to protect against complications.
The authors point out that future studies should be conducted. They were not able to explore if different types of tooth extractions such as the tooth extracted and the procedure being performed play a role on the relationship between stress and complications experienced due to having a low number of patients in the study. They also suggest that it may be possible to collect salivary cortisol to measure stress in a future study instead of relying of patients self-reported answers in questionnaires. They suggest that patients with varying amount of stress should be included in such studies along with more robust follow-up techniques to explore complications that occur.