J Oral Maxillofac Surg 69:2731-2738, 2011 Explaining Pain After Lower Third Molar Extraction by Preoperative Pain Assessment Nicola Mobilio, DDS,* Paola Gremigni, PhD,† Mattia Pramstraller, DDS,‡ Renata Vecchiatini, DDS, PhD,§ Giorgio Calura, MD, DDS, and Santo Catapano, MD, DDS¶ Purpose: To evaluate whether preoperative pain sensitivity testing and emotional perception of pain could explain the level of postoperative pain after lower third molar extraction. Patients and Methods: Twenty-three patients (16 women, 7 men) scheduled for lower third molar extraction were enrolled in the study. Patients preoperatively were submitted to a nociceptive stimulus by a cold pressor test (immersion of the hand into ice water). Preoperative pain tolerance (seconds), algosity and unpleasantness (visual analog scale), and dental anxiety (Modified Dental Anxiety Scale) were assessed. The duration of surgery was recorded (minutes). Postoperative pain ratings were taken by self-reported registrations on a 100-mm visual analog scale during the 6 days after surgery. Separate stepwise regression analyses were performed to evaluate the usefulness of preoperative scores in explaining the overall maximum postoperative pain level and postoperative pain rates at different intervals. Results: Preoperative unpleasantness related to the nociceptive stimulus was found to be the best predictor of maximum postoperative pain (adjusted R 2 = 0.39, P = .001). Demographic information (age) and preoperative (dental anxiety, pain tolerance, algosity) and intraoperative (duration of surgery) factors were not correlated with postoperative pain. Conclusions: These results show that a simple preoperative test is useful to identify patients at risk of developing greater pain after third molar surgery. They are characterized by a higher level of reported pain or unpleasantness after exposure to a nociceptive stimulus. This test may be tailored to specific patient needs for postoperative treatment. © 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:2731-2738, 2011 Moderate to severe acute postoperative pain occurs frequently after different surgical procedures and in- volves up to 50% of hospitalized patients and 40% of patients undergoing ambulatory surgery. 1 Despite ma- jor progress in pain management, postoperative pain remains a clinical problem 2 that may extend the re- covery period and predispose patients to expensive, time-consuming complications. 3 An aspect that is far from completely clear is the wide variation in pa- tients’ experiences of pain after similar types of sur- gical injury. 4 It is common to observe that different patients undergoing the same surgical procedure complain differently. This is also true for oral surgery, where third molar extraction is one of the most fre- quent operations, because many people require it at some time in their life. 5 Such surgery is recommended when the third molar presents symptoms, usually pain. However, third molar removal in asymptomatic patients may be advocated as a prophylactic measure. Other indications for third molar removal are related Received from the School of Dentistry, University of Ferrara, Ferrara, Italy. *Research Assistant, Department of Prosthodontics. †Assistant Professor, Department of Psychology, University of Bologna, Bologna, Italy. ‡Research Fellow, Department of Periodontology. §Research Assistant, Department of Oral Surgery and Implantol- ogy. Full Professor, Department of Oral Surgery and Implantology. ¶Associate Professor, Department of Prosthodontics. Address correspondence and reprint requests to Dr Mobilio: Department of Prosthodontics, Dental School, University of Fer- rara, C.so Giovecca, 203, 44121 Ferrara, Italy; e-mail: nicola .mobilio@unife.it © 2011 American Association of Oral and Maxillofacial Surgeons 0278-2391/11/6911-0012$36.00/0 doi:10.1016/j.joms.2011.05.023 2731