Oral surgical procedures under local anaesthesia in day surgery

Local anesthesia results from the prevention of the spread of the action potential so that the sensation cannot be transferred from the stimulus source, such as periodontium and tooth, to the brain. Sodium ions are necessary for a potential action to occur in associated nerve membrane. Local anesthetics work by blocking the entry of sodium ions into their channels. As a result, temporary increase in the permeability of the nerve membrane is prevented [1].

In 1996, Marin described the ambulatory surgery term as an optimal organizational model for multidisciplinary surgical care that permits effective and safe treatment of some patients without having to resort to conventional hospital beds. This concept involves interventions of moderate complexity, performed under general, local or regional anesthesia, which do not require hospitalization after surgery [2].

Day surgery is an expanding field of medical care and an invaluable method for treating patients in many aspects of oral surgery practice. Several medical and dental specialties can benefit from this outpatient treatment approach. In oral surgery, the accepted daily procedure includes tooth extraction, root fragment extraction, orthodontic dental fenestration, removal of small cystic lesions, hard and soft tissue biopsies and frenectomy, extraction of osteosynthesis plaques and wires from the jaws, soft tissue surgery, laser surgery and cryosurgery [3].

A retrospective study was performed to analyze medical records of patients who had been treated at the Istanbul University Department of Maxillofacial and Oral Surgery during the period from January 2010 to July 2013. The aim of this study was to gain insight into the types and frequencies of diagnoses and ambulatory surgical treatments at the Department of Oral Surgery in Istanbul University. We also explored whether there was a significant difference in procedures according to sex, age, and operation side. By learning all these parameters, it is our main goal to find answers to questions such as what we can do in hospital conditions, what we can win, and what operations we can treat.

A total of 10,750 patients admitted to the Istanbul University Department of Oral Surgery from 2010 January to 2013 July were included in the study. The data were collected retrospectively from ambulatory outpatient operation protocols. The data was collected from clinic protocol records. The form for the ambulatory clinic protocols classified the patients according to date of arrival, age, sex, place of residence, and surgical treatments. After data collection, surgical treatments were categorized to facilitate statistical analysis.

Statistical calculations were performed with Number Cruncher Statistical System 2007 Statistical Software (Utah, USA) for Windows. Besides standard descriptive statistical calculations (mean and standard deviation, frequency, percentage), one-way ANOVA was used to compare multiple groups, the post hoc Tukey’s multiple-comparison test was used to compare subgroups, unpaired t-tests were used to compare two groups, and the Chi square test was performed to evaluate qualitative data. Statistical significance was established at p < 0.05.

Records of 10,750 patients treated in the oral ambulatory operation room were examined in this study. Surgically treated patients in a study by Cabov et al. had an age range of 5–88 years, with a median age of 37 years for men and 31 for women. The numbers in the present study did not differ significantly from other reports. Our patients had a similar age range, although women had a mean age of 37.

Syed et al. showed that in both males and females, impacted third molars were more prevalent in the mandibular arch than in the maxilla (49.5% vs. 48.62%). In that study, the male-to-female ratio for impacted third molars was 604: 109 (5.54: 1; p = 0.707). In our study, this surgery was also more common in the mandibular arch (63.16%), and the male-to-female ratio for the impacted third molar operation was 2060: 3762 (49.93, 56.79; p = 0.0001). According to Syed et al., the 20–25-year age group showed the highest prevalence of third molar impaction (64.5%), and the frequency decreased with increasing age. Similarly, in our study, the 21–30-year age group most commonly underwent this procedure, with 3304 patients (60.75%). In other studies, as in ours, the prevalence of impacted third molars was much higher in the mandibular than in the maxillary arch (49.4% vs. 18.4%) [4].

In our study, more women than men underwent surgery, in accordance with previous findings. This could reflect increased prevalence of caries among women. In addition, this may be related to women’s increased interest in aesthetics and health care. Women and men had more operations for impacted wisdom tooth and implants in other countries A study in North India also found that women had more surgeries for impacted teeth more than men [5]. In our study, the number of operations for impacted wisdom teeth was 2060 (49.93%) in men and 3762 (56.79%) in women In Ontario, Canada, the most common day surgery procedure was extractions. In the Dental Clinic of the University of Barcelona, 15.34% of oral surgery treatments were performed on patients younger than 18 years of age. In our study, the number of young patients was significantly lower (7.79%) because most younger patients were scheduled for surgery under general anaesthesia and were therefore not included in this survey. General anaesthesia represents a risk factor for bacteremia following dental exrtractions (BDE), increasing its prevalence and duration [6]. On the other hand, patients subjected to ambulatory surgery should have a very low risk of serious complications, as they are selected according to their general condition (i.e., the absence of serious systemic diseases) [3].