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 Table of Contents  
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 24-29

Qualitative and quantitative evaluation of post-operative sleep following routine dental extraction

1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Inonu University, Malatya, Turkey
2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Harran University, Sanliurfa, Turkey

Date of Submission24-Dec-2019
Date of Acceptance23-Jan-2020
Date of Web Publication11-Mar-2020

Correspondence Address:
Dr. Bahadir Sancar
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Inonu University, Malatya 44280
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_95_19

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Introduction: The aim of this study was to evaluate the quality and quantity of postoperative sleep following routine (nonsurgical) dental extraction. Materials and Methods: Participants with the indication of one- or two-teeth extractions under local anesthesia (n = 274) (experimental group) and the control group without any surgical intervention (n = 50) were included in the study. On the next day of extraction, individuals were asked about their routine day and night sleep durations and the day and night sleep durations following dental extraction, in addition to the Richard–Campbell Sleep Scale. The assessments were made regarding gender, age, one or two teeth, maxilla or mandibular, single- or multi-rooted groups. The control group individuals were asked about routine day and night sleep durations in addition to the Richard–Campbell Sleep Scale, too. Results: No difference was found in terms of the sleep quality between the groups. When the sleep durations were compared, it was observed that the sleep durations on the first night after dental extraction (P < 0.05) and total daily (P < 0.05) sleep durations were decreased. No difference was found in terms of sleep duration when the extractions of single-rooted and multi-rooted teeth were compared. When individuals with two-teeth extractions were compared with individuals with single-tooth extractions, it was seen that the night sleep durations of the individuals with two-teeth extractions were decreased (P = 0.017). Age group comparisons showed statistically significant sleep duration changes before extraction but not for after extractions. Conclusion: As a result, we found that the duration of sleep was reduced, although there was no change in the quality of sleep for the first day when the morbidity was most intense after routine nonsurgical dental extraction. And also, it is found that the duration of sleep decreased as the number of extractions increased.

Keywords: Questionnaire, sleep quality, sleep quantity, tooth extraction

How to cite this article:
Sancar B, Polat ME. Qualitative and quantitative evaluation of post-operative sleep following routine dental extraction. SRM J Res Dent Sci 2020;11:24-9

How to cite this URL:
Sancar B, Polat ME. Qualitative and quantitative evaluation of post-operative sleep following routine dental extraction. SRM J Res Dent Sci [serial online] 2020 [cited 2023 May 31];11:24-9. Available from:

  Introduction Top

Dental extraction is one of the routine dental procedures and is performed only when necessary and usually under local anesthesia. The main indications for dental extraction include dental caries, failed root canal treatments, periodontal diseases, orthodontic requirements, trauma, pericoronitis, and patient request.[1] Dental extraction is a surgical procedure and may give rise to physical and psychological trauma.

Although postoperative discomfort, pain, and labor loss have been well reported in the previous literature[2],[3],[4] for nonsurgical tooth extraction, the quality and quantity of postoperative sleep following routine (nonsurgical) dental extraction has not yet been reported in the literature. In some studies[5],[6],[7] regarding the postoperative healing period of the third molar surgery, it is shown that impaired ability to masticate, limited mouth opening, inability of socialize, maximal mouth opening limitations, and sleep disturbances were the most problematic postoperative complaints. This means that although the surgeons believe that pain would be the main problem in the patients' minds, patients consider the functional handicaps more important.[5],[6],[7]

Especially, complications such as pain and edema adversely affect the individual's physical and psychosocial aspects of daily life, sleep pattern, and quality of sleep.[1] Sleep is a physiological and human needs such as nutrition, respiration, and excretion in an individual's life. Therefore, sleep is found to be an important factor affecting the quality of life, life satisfaction, and physical and psychological state of the person. Sleep, which occupies a large place in human life, is an essential factor in preserving and maintaining an individual's health. In order to be healthy, this physiological need must be met in a regular and balanced way.[8]

There are many factors affecting the sleep quality such as heat, light, anxiety, stress, fear, postoperative pain and complications, hospital environment, surgical procedures, and diseases. Dental extraction and other surgical procedures are psychologically and physically negative experiences for the patient. Patients undergoing surgical procedures are in fear, panic, anxiety, and stress.[8] It has been reported that patients who underwent surgery had poor sleep quality due to postoperative pain and postoperative position limitations.[9] Sleep is important in providing both physical and emotional recovery in the postoperative period. However, sleep quality is very low in the early period after surgery.[10] While sleep disorders can cause delay in recovery after surgery, poor quality of life, and increased complication rates, complications that occur after surgery can bring along sleep disorders. The quality and quantity of sleep in the postoperative period also affects the individual's productivity and contribution to the labor force.[11]

Sleep disturbances are important risk factors that negatively affect daily activities and contribute to the progression of many chronic diseases such as diabetes mellitus, cardiovascular, and other inflammatory disorders.[12],[13],[14],[15] In previous studies, it is shown that healthy sleep behavior supports the immune system through organizing defense mechanism. The causal risk factor of endothelial inflammation glucose intolerance is also associated with sleep curtailment.[16],[17] It is increasingly asked to the dental practitioners that whether they would be able to return their daily routine after extraction, when the effect of the anesthesia would wear off and how long they would feel pain and after extraction complaints. Therefore, it is important to investigate the effect of routine tooth extraction on the quality and quantity of postoperative sleep in the immediate postoperative period.[18]

The idea of this study originated from determining the periods of return to work and education life of individuals after dental extraction. In this study, it was aimed to evaluate the quality and amount of sleep of the patients and to establish an opinion about vehicle utilization and postoperative rest needs of patients undergoing dental extraction in the postoperative period.

  Materials and Methods Top

This prospective study, planned as descriptive and cross-sectional study, was conducted between December 2018 and April 2019 at the department of oral and maxillofacial surgery. This study was initiated after obtaining permission from Inönü University Health Sciences Noninterventional Clinical Trials Ethics Committee and was conducted in accordance with the guidelines on the Helsinki Declaration of Human Rights. This study was conducted on the patients who admitted to the outpatient clinic of the department of oral and maxillofacial surgery with the indication of dental extraction.

Patients with any disease that can comprise a systemic contraindication; those with infection in tooth extraction area; patients requiring open extraction; patients with root fracture during extraction; those who were pregnant or breastfeeding; patients with small child; traveling patients; patients using antibiotic or anti-inflammatory drugs in the past 3 weeks or with alcohol addictions; patients with sleep disorders (sleep apnea, chronic insomnia, etc.,); patients using sleep, depression, and muscle relaxant-type drugs; and patients working night shifts were excluded from the study.

Routine clinical and radiological examinations of the patients included in the study were performed preoperatively. Patients who required one or two teeth extraction from the same jaw were included in the study. All patients were included in the study after giving detailed information about the study and having the patient consent form signed.

A total of 324 individuals, 274 patients (83 men and 191 women) and 50 controls (16 men and 34 women), over 18 years old were included in the study. Of the 324 individuals, 274 were surveyed for sleep quantity and quality on the day after routine (no open extraction) dental extraction and 50 were surveyed for the same aim before the extraction in the control group. In the experimental patient group, one or two teeth extraction sleep evaluations made for all 274 patients. A total of 245 one tooth-extracted patients were compared with 29 two teeth-extracted patients. The survey applied to the experimental group included normal night and day sleep durations, and the day and night sleep durations following dental extraction, in addition to the Richard–Campbell Sleep Scale.

The individuals in the experimental group were divided into three groups in terms of age and were subjected to statistical evaluation. These age groups were evaluated in three groups: 18–25 (n: 97), 26–64 (n: 163), and over 65 (n: 14). In this study, we examined the effect of tooth extraction on sleep, and whether the jaw (maxilla [46%] and mandible [54%]) or tooth morphology (single rooted [13%] and multirooted [87%]) had an effect on sleep.

All dental extractions were performed in the clinic of oral and maxillofacial surgery department by the same two physicians following the basic rules of surgery and sterilization. Dental extractions were performed daily with local anesthesia (80 mg/2 ml articaine hydrochloride with 1:80,000 epinephrine) between 8:30 a.m. and 12:00 p.m. in the morning. Patients were called for follow-up the next day without recommending any medication regimen. Those who used any pain medication after dental extraction were excluded from the study.

The data were obtained by asking the average daily sleep duration of the individuals and the sleep durations on the day of the extraction using a questionnaire and applying the Richard–Campbell Sleep Scale. Richard–Campbell Sleep Scale, developed in 1987, is a six-item scale that evaluates sleep depth, sleep latency, awakenings, returnings to sleep, sleep quality, and ambient sound. A score between “0 and 25” indicates a very poor sleep quality, whereas a score between “76 and 100” indicates that the sleep quality is very good.[19] The 6-item scale score assessment, which evaluates the noise level in the environment was excluded from the total score assessment; the total score was assessed on five items.

All the data were entered in the Microsoft Excel Sheet 2010 (Microsoft Corp.) and were analyzed for descriptive statistics using Statistical Package for Social Sciences (SPSS), version 22 (IBM SPSS Statistics, Armonk, NY). Checking the normal distribution of quantitative data was made by the Kolmogorov–Smirnov test, and it was observed that the data were not normally distributed. Nonparametric tests were applied to normal nondispersive data. The nonparametric equivalent of two independent sample tests, the Mann–Whitney U test, and the nonparametric equivalent of ANOVA from the parametric tests, the Kruskal–Wallis tests, were applied to the data and their descriptions were made separately for each test. P < 0.05 was considered statistically significant. In addition, 95% confidence level was used in all tests conducted in the studies.

  Results Top

Demographic data, maximum–minimum sleep durations during the day and maximum–minimum sleep durations at night of the experimental group, are given in [Table 1]. There was no significant difference between the experimental and control groups in terms of sleep according to Richard–Campbell Sleep Scale. Again according to the same scale, no significant difference was found between men and women, between individuals who had single-tooth and two-teeth extraction, and according to whether the extracted tooth was in the mandible or maxilla and whether the extracted tooth was single- or multi-rooted [Table 2]. The spider web diagram for the Richard–Campbell Sleep Scale of the experimental group is given in [Figure 1], and the mean score of the Richard–Campbell Sleep Scale in the experimental group is 55.90 ± 20.8 and in the control group is 56.53 ± 21.08.
Table 1: Demographic variables for the experimental study group (n=274)

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Table 2: Statistical analysis results of whole study

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Figure 1: Richard–Campbell Sleep Scale

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In terms of total sleep and night sleep before and after treatment, it was observed that the effects of the treatment on sleep were significantly reduced in the night sleep durations and daily sleep durations of the experimental group. After evaluating the difference between the single tooth-two teeth groups before and after the treatment, it was observed that the night sleep duration was statistically significantly reduced in the participants who had two teeth extracted (P = 0.017). When the difference between the multi-rooted and single-rooted tooth extraction groups was evaluated in terms of total sleep and night sleep before and after treatment, no difference was observed (P > 0.05). There was no statistically significant difference in terms of total sleep and night sleep before and after treatment between the mandible and maxilla group (P > 0.05) [Table 2].

The age group assessments showed that the total and night sleep durations differ statistically significant among three age groups before extraction (P = 0.031 and P = 0.037), but there were no significant differences found after extraction night and total sleep durations (P > 0.05). Above 65 years' age group showed statistically lower sleep durations than 18–25 years' age group both for total and night sleep before extraction and statistically lower sleep durations than 26–64 years' age group for night sleep before extraction.

  Discussion Top

Today, individuals should have more information about decisions concerning their health. Informing patients about their recovery time, possible complications, and procedure's possibility of adversely affecting their lifestyles on the days after the procedure are likely to increase the patient and physician satisfaction.[20] In our study, we aimed to evaluate the sleep durations and sleep quality of the patients after dental extraction, which is a surgical procedure. It is known that people who sleep less are more likely to have an accident when driving,[21] they are exposed to more stress while working during the day,[22] and to have problems with concentration, anxiety, and depression[23] than people who sleep well. This will result in reduced productivity and cost increases, as well as safety problems and occupational risks.[24] Routine dental extraction is often regarded by dentists as an easy and safe procedure. However, serious but rare complications may occur, such as the passage of tooth or tooth fragments into anatomical cavities and even into the lungs. Dentists are aware that such complications may occur and obtain informed consent from the patient. However, they do not expect any negative consequences for a complication such as sleep disturbance that may occur as a result of routine tooth extraction and the conditions that may be caused by it.

Developed in 1987, Richard–Campbell Sleep Scale is a six-item scale that evaluates sleep depth, sleep latency, awakenings, returnings to sleep, sleep quality, and ambient sound. Each item is evaluated on the chart between 0 and 100 by the visual analog scale technique. A score between “0 and 25” indicates a very poor sleep, whereas a score between “76 and 100” indicates a very good sleep. The total score of the scale was assessed in five items; the sixth item assessing the noise level in the environment was excluded from the total score assessment. As the score increases, sleep quality of the patients increases too.[19] We found that there was no significant change in the quality of sleep in accordance with the Richard–Campbell Sleep Scale. Adeyemo et al.[18] reported that 12.5% of the patients who underwent dental extraction had problem in falling asleep and 14.1% of the patients was interrupted with the night sleep. These questions are related to the quality of sleep, and as a result, they state that there is no sleep deterioration in dental extractions performed without the need for open surgery.

Cebi[11] found in his study that the highest value of pain following impacted third molar surgery was found to be between the 6th and 8th hour of the 1st day and this value started to decrease after the 1st day. In a study evaluating the pain after simple tooth extraction, it was stated that the most intense pain was experienced on the evening of extraction.[25] In our study, we evaluated the quality and quantity of sleep by applying our questionnaire after the 1st day and night when the patients were most disturbed. We carried out our questionnaire following the day of the extraction, considering the complaints of the individuals such as pain, sensitivity, and inability to chew effectively could affect the quality and quantity of sleep. According to the study of Colorado-Bonnin et al.[26] evaluating the quality of life after the extraction of the lower wisdom teeth, it was stated that sleep disorders and daytime sleepiness may be caused by both sleep interruptions caused by extrusion-related discomfort and postoperative drug treatment. Therefore, no medication was prescribed to individuals after extraction.

The individuals included in our study were over the age of 18 years, with an average age of 35.36 years. Hirshkowitz et al.,[27] in their study, recommended a sleep time of 7–9 h for individuals in this age group. In our study, the mean night sleep time was determined to be 7.41 h, whereas mean total sleep time was 8.13 h. It was found that the average sleep time in the first night was 6.99 h and the total daily sleep time was 7.48 h, after the tooth extraction procedure. This decrease in total daily sleep and night sleep amounts was significant. Again, we evaluated that the patients who had two teeth extracted had less sleep compared to the patients who had one tooth extraction.

According to our results, the night and total sleep durations after the tooth extraction decreases, there was no statistically significant difference between night and total sleep time after tooth extraction. The higher intensity of pain among women reflects the observation that women experience pain differently than men.[28],[29] We did not find any difference between the men and women groups in terms of both quality and quantity of sleep.

  Conclusion Top

In our study, we found that although the sleep quality of the individuals did not change after the tooth extraction, the amount of sleep decreased. The sleep duration decreases as the number of tooth extractions increase. Individuals should be informed about the loss of workforce, machine, and driving skills that may be caused by insufficient sleep. Further studies are needed on this subject.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2]


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