Patient Compliance to Post-extraction Instructions in Prevention of Alveolar Osteitis (Dry Socket): A Cross-sectional Study

Patient Compliance to Post-extraction Instructions in Prevention of Alveolar Osteitis (Dry Socket): A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient Compliance to Post-extraction Instructions in Prevention of Alveolar Osteitis (Dry Socket): A Cross-sectional Study Aniqa Saleem, Nadia Khaleeq, Tanzeel Saleem, Nazneen Khanum, Zohaib khan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7692941/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 21 You are reading this latest preprint version Abstract Background Alveolar osteitis, also known as dry socket, is a common post-extraction complication that can delay healing and cause significant discomfort for patients. While preventive strategies are well documented, patient compliance with post-extraction instructions plays a critical role in reducing their incidence. In Pakistan, especially in Khyber Pakhtunkhwa, limited data exists on patient compliance to post-extraction instructions, making it difficult to assess their impact on postoperative outcomes. The study aims to assess Patient Compliance with post-extraction instructions in the prevention of Alveolar Osteitis and to determine the factors associated with it. Methods We included 303 patients who underwent extractions, either surgical or nonsurgical, at the maxillofacial department of Khyber College of Dentistry, using a non-probability consecutive sampling technique. The post-extraction instructions were provided verbally in accordance with guidelines in the local language. One week later, patients were contacted to gather information about their adherence to post-operative instructions through a questionnaire to assess the level of compliance. Using SPSS v 22, descriptive statistics were reported for all variables. Regression analysis was applied to find the strength of association between the independent variables and the level of compliance and dry socket. Results 51.2% were male and 48.8% were female. A total of 161 (53.1%) patients showed compliance (score 8 and above) with the instructions while 142 (46.9%) showed partial compliance (score 5–7). The regression analysis revealed that higher compliance with post-extraction instructions was associated with a lower odds ratio of developing a dry socket. The higher compliance variables are higher education and above, surgical extraction, impacted tooth and posterior tooth extraction, while the non-compliance variables are employed and self-employed. Regarding compliance with post-extraction instructions in the prevention of dry socket, results are statistically significant with P < 0.05. Conclusion The study found a strong correlation between compliance and factors such as education level, employed, operator status, posterior tooth extraction, impacted tooth and extraction technique. Higher compliance significantly reduced the risk of alveolar osteitis. Enhancing patient education and emphasizing adherence to post extraction instructions can effectively minimize post extraction complication. compliance non-compliance post-extraction instructions dry socket Alveolar osteitis Background Tooth extractions, i-e surgical or non-surgical, is one of the common procedures done in dentistry.( 1 ). It is a stressful event for patients before, during and after treatments( 2 ). Post-extraction instructions are given to each patient to relieve post-operative complications. One of the most common complications is alveolar osteitis, also called Dry Socket.( 3 )( 4 ), the inflammation of alveolar bone( 5 ) develops after 2 to 4 days, characterised by severe pain( 6 ), bad smell (halitosis)( 3 , 7 ), swelling and redness of the gingiva, open socket, not covered by a blood clot and exposed bone. Its occurrence is 1 to 5% in all extraction while in mandibular molar, 38%( 8 ). The reported incidence of dry socket in closed extraction is 0.6% to 5.6% while in open extraction is 24.7%( 9 ). According to dental arch, the incidence of dry socket in Mandible is more common than in the maxilla because of food debris accumulation into socket and presence of dense bone( 10 ). Most cases of dry socket occur in impacted teeth that are mainly mandibular, 3rd molars which are removed surgically ( 4 ). The post-extraction instructions act as a guideline to prevent post-operative complications that is given after surgical procedures ( 11 ). The healing process of the socket is disrupted ( 12 ) When there’s noncompliance towards post-extraction instructions. The primary purpose is to facilitate a more effective healing process of the socket after extraction ( 13 ). When these instructions are followed correctly, patients will have early recovery ( 14 ) and help in promoting wound healing after extractions( 9 , 15 ). To ensure compliance, post-operative instructions should be presented in a clear and understandable manner. Multiple studies indicate that non-compliant patients have a higher incidence of complications such as dry socket, which emphasises the importance of adherence to these instructions for successful recovery and healing ( 14 ). Patients who fully comply with the instructions during follow-up tend to have a satisfactory wound-healing process ( 11 ). Knowledge about post-extraction instructions is also one of the reasons to help in the prevention and management of dry socket( 13 ). There is negligible evidence regarding compliance in Pakistan, especially in Khyber Pakhtunkhwa, and inconsistency in following post-extraction instructions. With the above background, this study aims to generate evidence on compliance with post-extraction instructions. The objective of the study was to assess the patient compliance with post-extraction instructions and also determine the factors associated with non-compliance. Methods A cross-sectional study was conducted on patients who underwent tooth extraction at the Oral and Maxillofacial Department of Khyber College of Dentistry from September 2022 to February 2023. A non-probability (consecutive) sampling technique was used for a total of 303 patients, with an anticipated frequency of 73.1%, a 95% confidence level, and a 5% margin of error. Approval was obtained from the IPH&SS ethics committee No.KMU/IPHSS/Ethics/2022/PC/034 of KMU, as well as permission from the local administration. Ethical approval was also granted by the research committee at Khyber College of Dentistry for the collection of data under No. 8152/RRB/KCD. The study included adult males and females aged 18 years and older who underwent surgical or non-surgical extraction of a permanent tooth. The patient will be willing to listen to post-extraction instructions (takes around 8 minutes & max 10 minutes). Patients who were uncooperative, mentally disabled, or unable to understand and follow instructions were excluded from the study. After the approval from the hospital, patients who fulfilled the inclusion criteria were recruited, and informed consent was taken. A total of 303 participants were recruited. At the time of the extraction, demographic information such as age, gender, tooth to be extracted, and type of extraction (surgical or non-surgical) was recorded. At the end of the procedure, the post-extraction instructions were provided verbally in the local language, according to the standard guidelines for oral and maxillofacial surgery. Consent was obtained from all patients to review these guidelines. After one week post-extraction, patients were called for a reminder to follow up to obtain information. Those who didn’t come for the follow-up had data collected through a phone call using a pre-designed questionnaire. The questionnaire consisted of ten questions about compliance; each question had a corresponding score, which quantitatively assessed the level of compliance with post-extraction instructions. It’s a validated tool taken from a study of Amparo Aloy-Prosper( 16 ). The key outcome variable of interest was the level of compliance score (quantified out of 10) according to the validated questionnaire. The collected data were statistically evaluated using SPSS version 22. Descriptive statistics were reported for all variables. Mean and standard deviation were calculated for the continuous variable, and frequency and percentages were calculated for the categorical variables. Regression analysis was applied to find the strength of association between the independent variables and the level of compliance and dry socket. Results The total study sample was 303, in which 51.2% were male and 48.8% were female shown in Table 1 . Table 2 reported the level of compliance reported was 53.1% highly complied (8 to 10 score) and 46.9% partial compliance (5 to 7 score). Posterior teeth 261 (86.1%) were the main extracted teeth. Caries was one of the main reasons for extraction, with most teeth being nonsurgically extracted (89.1%). The mean and standard deviation of the compliance score recorded were 7.71 ± 0.8. Table 3 showed the highest followed instruction was pressing gauze for 30 mints, avoid rinsing, take a soft diet and maintain proper hygiene. Table 4 reported Patients with a higher education and above (OR: 2.6, 95% CI: 1.5–4.7, p < 0.05), surgical extractions (OR: 7.6, 95% CI: 2.6–22.1, p < 0.05), and posterior tooth extraction (OR: 7.2, 95% CI: 1.6–32.0, p < 0.05) have higher odds of compliance in both univariate and multivariate regression but impacted tooth and those who have extractions done by Consultants have higher odds of compliance in only univariate regression. The employed and self-employed in the occupation category reported lower odds of compliance with post-extraction instructions only in the multivariate regression analysis. Table 5 showed the regression analysis for dry socket, showing that an impacted tooth has higher odds of developing dry socket, with a significant P value of < 0.05 in univariate analysis. In multivariate regression, the odds of developing dry socket are higher in surgical extractions and lower in those who demonstrate higher compliance with post-extraction instructions. Discussion This study assessed patient compliance with post extraction instructions aimed at preventing alveolar osteitis in a sample of 303 patients. The findings showed that more than half of the participants demonstrated compliance, with the mean score of 7.71 ± 0.8. The incidence of alveolar osteitis were 5.6%, which is lower than reported in other studies. Compliance were highest for instructions related to gauze compression, soft diet and maintain oral hygiene while the lowest were observed for mouthwash use, antibiotic intake and application of ice packs. The reason for not applying ice wrapped cloth on the face and taking antibiotics that not every patient were treated by surgical extraction, no need of antibiotics, and has no swelling over the face. Education level were significantly associated with compliance while demographic variables such as age and gender showed no significant effect. In this study, education level played an important role in compliance, with highly educated patients demonstrating significantly better adherence compared to low education level of participants. This align with the findings from Blinder et al, who emphasized the importance of reading and comprehension skills, though they reported no direct link between education and compliance( 2 ). A study from Saudi Arabia also revealed that higher education enhance understanding of postoperative instructions and reduces complications ( 17 ). The mean compliance score reported here (7.71 ± 0.8) is comparable to Spanish study by Aloy-Prosper, which reported slightly a higher compliance (7.9 ± 2.1) with written instructions, suggesting that mode of instruction delivery (verbal vs written) may influence patient adherence ( 16 ). Another Spanish study by Gonzalez et al, demonstrated very high compliance with mouthwash use (98.%), whereas in this study, compliance with mouthwash were only 28.7%, reflecting a lack of awareness about its use in local population ( 18 ). The highest compliance were also seen with the instructions such as pressing gauze for 30 minutes, avoiding rinsing for 24 hours, and consuming soft diet while the lower compliance was reported for using mouthwashes and antibiotics, which was consistent with the studies conducted in Nigeria ( 19 ), and Malaysia( 11 ). Verbal instructions were effective in improving recall, as also reported by ET Adebayo. This suggests that simple, clear, and repeated verbal communication can enhance patient understanding especially in sitting with limited literacy ( 20 ). Dry socket incidence in this study were significantly lower (5.6%) compared to studies conducted in Karachi, Pakistan is 19.7% ( 21 ) and India reported 14.1% ( 1 ), reflecting improved patient awareness and oral health practices in our setting. The lower incidence may also showed better patient education, increased acceptability of dental care, or improvements in postoperative instruction delivery. Dry socket in our study were primarily linked to partial compliance, smoking habits, medical history, surgical extractions and posterior tooth extractions. Similar findings were reported in Nigerian study, where poor adherence to instructions increased postoperative complications( 22 ). A multicentre study in Ethiopia also showed a strong link between verbal instructions noncompliance and postoperative complication, reinforcing the importance of effective communication of instructions( 23 ). Overall, our data suggest that while dry socket is multifactorial, compliance remains a key preventive factor. The study revealed the noteworthy demographics, that male patients underwent more extractions, similar to findings from India( 1 ), which attributed this trend to limited self-care among males. Female (housewives) showed lower compliance consistent with findings from Malaysian study ( 11 ) often due to domestic responsibilities. Employed participants reported better compliance than unemployed individuals, due to more proactive nature to take care of themselves. Those who have impacted tooth, surgical extraction, posterior tooth location, and extraction done by consultants showed good compliance with instructions because of more focused towards their oral health. This study underline the importance of tailoring postoperative care strategies to patients’ lifestyle. The study also found that patients easily recalled initial instructions (e-g gauze compression for 30 minutes, avoid rinsing and soft diet), reflecting the emphasizing of key messages immediate post-surgery. Similar observations from Saudi Arabia, where initial instructions recall were highest( 14 ). A major strength of this study is its relatively large sample size (303 participants) and its focus on verbal instructions, which reflects real world practice in low and middle income countries. The use of validated questionnaire allowed for robust quantification of compliance. However, limitations include reliance on self-reported compliance and potential recall bias during follow-ups. Variations in socioeconomic and cultural contexts also limit generalizability. Despite these limitations, the study provide valuable insight in compliance behaviors and their relationship with post-operative complication. Conclusion The current study concluded that compliance with post-extractions instructions was significantly associated with surgical instructions, operator status (consultants), impacted teeth and posterior teeth extractions. Regression analysis revealed that higher compliance was linked to lower odds of developing dry socket, emphasizing the importance of adherence to postoperative guidance. Partial compliance was influenced by factors such as age, gender, smoking, medical history and occupation. Instruction specific analysis showed the highest compliance with maintaining soft diet, placing a gauze pack, avoid rinsing and practicing oral hygiene, while the lowest compliance was with the use of antibiotics, mouthwash, and ice packs for swelling. Abbreviations SPSS statistical package for social sciences OR odds ratio REF reference value Declarations Ethics approval and consent to participate: the Ethical approval for this study was obtained from the “Ethics board of Institute of Public Health and Social Sciences, Khyber Medical University (Reference No.KMU/IPHSS/Ethics/2022/PC/034 of KMU)”. Ethical approval was also granted by the research committee at Khyber College of Dentistry for the collection of data under No. 8152/RRB/KCD. Written informed consent was obtained from all participants prior to their inclusion in the study. Consent for publication: all participants provided consent for publication of anonymized data. Availability of data and materials : the data sets used or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: the authors declare that they have no competing interest. Funding: this research did not receive any specific grant from funding agencies. Clinical trial No: Not applicable Authors' contributions: AS: Concept of the study, data collection, manuscript writing NK: Concept of the study, data cleaning, proofreading of the manuscript TS: Data collection, cleaning and descriptive analysis. NK: Literature review and contribution to the methodology of the manuscript ZoK: Proofreading of manuscript KR: Proofreading of manuscript, supervision of data collection ZeK: Data cleaning, data analysis, Proofreading of manuscript, Acknowledgements: the authors would like to thank Tanzeel, Nazneen, Shiraz and Dr Khalid for reviewing and proofreading of this manuscript. Authors' information (optional): Not applicable References Paul R, Pradeep D, Gurunathan D. Retrospective study on patient compliance following tooth extraction. Indian J Forensic Med Toxicol. 2020;14(4):5522–9. Blinder D, Rotenberg L, Peleg M, Taicher S. 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Tables Table 1 demographics and health status Gender Male 155 51.2% Female 148 48.8% Age Mean and SD 37.8 ± 12.8 Age Categories 18- 37years 153 50.5% 38- 57years 125 41.3% 58 years and above 25 8.3% Education level Nonformal education 121 39.9% Up to Matric 67 22.1% Up to intermediate 31 10.2% Graduate and above 84 27.7% Occupation status Employed and self-employee 120 39.6% Unemployed and retired 23 7.6% Other (Housewife and student) 160 52.8% Smoking status No 297 98% Yes 6 2% Cigarettes per day remove less than 20 cigarettes per day 4 1.3% 20 cigarettes per day 2 .7% More than 20 cigarettes per day 0 0% Medical History no disease 255 84.2% Diabetes 15 5.0% Hypertensive 31 10.2% Other (thyroid problem and Asthma) 2 0.7% Medication no medicines 255 84.2% Diabetic drugs 15 5.0% Antihypertensive 31 10.2% Other (thyroid and Asthma drugs) 2 0.7% Table 2 Oral procedure description Tooth Extraction anterior teeth 42 13.9% posterior teeth 261 86.1% Reason of Extraction Caries 219 72.3% Periodontal diseases 29 9.6% Impacted tooth 17 5.6% Prosthetic Reason 17 5.6% Other (Orthodontic Treatment, Periapical infection, RCT treated, Pericoronitis) 21 6.9% Extraction Technique Non-surgical 270 89.1% Surgical 33 10.9% Operator Status Final year student 80 26.4% Resident (HO) 112 37% Postgraduate (TMO) 100 33% Consultant (MO) 11 3.6% Local anaesthetic cartridges are used less than two cartridges 240 79.2% two or more cartridges 63 20.8% Technique of local anesthesia Infiltration 138 45.5% Mandibular Block 2 0.7% Both 163 53.8% Impacted tooth No 286 94.4% Yes 17 5.6% Level of Compliance Compliance (8–10 score) 161 53.1% Partial compliance (5–7 score) 142 46.9% Table 3 Post-operative instruction compliance assessment Compliance questions Frequency %age 1: Did you keep pressing folded gauze for 30 minutes after extraction? Yes 303 100% No 0 0% 2: Did you avoid rinsing with any liquid for the first 24 hour? Yes 292 96.4% No 11 3.6% 3: Did you take a soft or semi-liquid diet at low or warm temperature? Yes 302 99.7% No 1 0.3% 4: Did you apply ice wrapped in a cloth on the outside of the face where the extraction has been performed? Yes 5 1.7% No 298 98.3% 5: Did you maintain proper oral hygiene? Yes 301 99.3% No 2 0.7% 6: Did you avoid smoking during the postoperative period (7 days after surgery)? Among smokers Yes 5 83.3% No 1 16.7% 7: Did you avoid to take carbonated drinks? Yes 296 97.7% No 7 2.3% 8: Did you take antibiotics according to the recommendations of the surgeon? Yes 146 48.2% No 157 51.8% 9: Did you take analgesics and anti-inflammatories according to the recommendations of the surgeon? Yes 301 99.3% No 2 0.7% 10: Did you perform rinses with Chlorhexidine 0.12% from 24 hours (3 times each day / 10 days) starting the day after surgery? Yes 87 28.7% No 216 71.3% Table 4 Association between the level of compliance and its predictors Variable Outcome: Level of compliance Univariate OR(95%CI) Multivariate OR(95%CI) Gender Male REF value = 1.0 REF value = 1.0 Female 1.0 (0.6–1.6) 1.3(0.6–2.8) Age Category 18–37 REF value = 1.0 REF value = 1.0 38–57 0.6(0.4–0.98) 1.2(0.6–2.2) 58 and above 0.5(0.2–1.2) 1.2(0.4–3.6) Education Category Non formal education REF value = 1.0 REF value = 1.0 Up to matric 1.4(0.7–2.5) 1.5(0.8–3.05) Up to intermediate 2.1(0.9–4.7) 2.1(0.8–5.4) Graduate and above 2.6(1.5–4.7)* 3.1(1.5–6.7)* Occupation category Unemployed and retired REF value = 1.0 REF value = 1.0 Employed and self employed 0.5(0.2–1.3) 0.2(0.08–0.7)* Others(housewife and student) 0.6(0.2–1.5) 0.3(0.1–1.2) Smoking status No REF value = 1.0 REF value = 1.0 yes 0.4 (0.08–2.4) 0.4(0.05–2.6) Operator status Student REF value = 1.0 REF value = 1.0 Resident (HO) 1.4(0.8–2.5) 1.7(0.9–3.1) Postgraduate (TMO) 1.1(0.6–2.1) 1.2(0.6–2.3) Consultant (MO) 5.0 (0.01–24.4)* 3.1(0.5–18.4) Impacted tooth No REF value = 1.0 REF value = 1.0 Yes 7.2(1.6–32.0)* 1.2(0.2–7.6) Extraction technique Non-surgical extraction REF value = 1.0 REF value = 1.0 Surgical extraction 7.6(2.6–22.1)* 6.9(1.8–26.7)* Medical History No disease REF value = 1.0 REF value = 1.0 Diabetes 0.9(0.3–2.7) 1.2(0.4–3.9) Hypertensive 0.5(0.2–1.1) 0.5(0.2–1.3) Other (thyroid and asthma) 0.8(0.05–13.3) 0.3(0.01–8.1) Tooth location Anterior teeth REF value = 1.0 REF value = 1.0 Posterior teeth 2.6(1.3–5.1)* 2.3(0.04-5.0)* Table 5 Association between the dry socket and its predictors Variable Outcome: Dry Socket Univariate OR(95%CI) Multivariate OR(95%CI) Gender Male REF value = 1.0 REF value = 1.0 Female 1.2(0.4–3.2) 0.7(0.1–3.3) Age Categories 18–37 REF value = 1.0 REF value = 1.0 38–57 0.6(0.2–1.8) 1.2(0.3–5.7) 58 and above 1.2(0.2–6.04) 0.5(0.5–39.4) Education categories Non formal education REF value = 1.0 REF value = 1.0 Up to matric 0.6(0.1-3.0) 1.0(0.1–6.5) Up to intermediate 0.6(0.07–5.5) 0.5(0.05–6.1) Graduate and above 2.02(0.7–6.04) 2.9(0.5–15.8) Occupation categories Unemployed and retired REF value = 1.0 REF value = 1.0 Employed and self employed 0.7(0.2-2.0) 0.3(0.06–1.2) Others(housewife and student) 1 1 Smoking status No REF value = 1.0 REF value = 1.0 Yes 1 1 Operator status Student REF value = 1.0 REF value = 1.0 Resident (HO) 0.9(0.2–3.4) 1.1(0.2–5.2) Postgraduate (TMO) 1.2(0.3–4.4) 1.3(0.3–5.8) Consultant (MO) 4.2(0.7–26.4) 5.5(0.4–68.1) Impacted tooth No REF value = 1.0 REF value = 1.0 Yes 4.2(1.1–16.2)* 1.06(0.1–8.2) Extraction technique Non-surgical extraction REF value = 1.0 REF value = 1.0 Surgical extraction 5.2(1.8–15.3) 10.0(1.7–59.4)* Medical history No disease REF value = 1.0 REF value = 1.0 Diabetes 1.4(0.2–12.0) 2.5(0.2–30.6) Hypertensive 3(0.9–9.9) 2.3(0.4–11.7) Other (thyroid and asthma) 1 1 Tooth extraction Anterior teeth REF value = 1.0 REF value = 1.0 Posterior teeth 1 1 Level of compliance Partial compliance (5–7 score) REF value = 1.0 REF value = 1.0 compliance (10 − 8 score) 0.4(0.2–1.3) 0.1(0.04–0.7)* Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Zohaib","middleName":"","lastName":"khan","suffix":""},{"id":538617213,"identity":"2176793d-b697-4d6e-acf5-16160df3ab11","order_by":5,"name":"Khalid Rehman","email":"","orcid":"","institution":"Khyber Medical University","correspondingAuthor":false,"prefix":"","firstName":"Khalid","middleName":"","lastName":"Rehman","suffix":""},{"id":538617216,"identity":"5789bbcf-675f-4716-9dc0-c2e6a027859e","order_by":6,"name":"Zeeshan Kibria","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYJACZiA2YJNgYDjAUJEAFpEAiRCp5QwpWsDKGNuI0CLf3nz4c0HNHWM+6d6HB37OS4s2OMB88DYPwx1jXFoYe46lSc849syMTea4wcHebTm5Gw6wJVvzMDwzw+koiRwzZh62wzZsEmkMB3i3VQC18JhJ8zActsGlhU3+/efPPP8gWg7+nQPSwv8NrxYeCR4Gad62w2YgLYd5G0AO42EDacHpMAmeNDNp3r7DxmwyxxgOyxxLy515mM3Yco7BM5zel28//Pgzz7fDhvNntzF/fFOTnNt3vPnhjTcVdwwbcOnBBKBoYjA4QLwGGCBDyygYBaNgFAxXAACTLlXVq+AXoQAAAABJRU5ErkJggg==","orcid":"","institution":"Khyber Medical University","correspondingAuthor":true,"prefix":"","firstName":"Zeeshan","middleName":"","lastName":"Kibria","suffix":""}],"badges":[],"createdAt":"2025-09-23 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07:22:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1129255,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7692941/v1/ceb4e5f1-1dd9-455e-8339-8c92eb288b96.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePatient Compliance to Post-extraction Instructions in Prevention of Alveolar Osteitis (Dry Socket): A Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eTooth extractions, i-e surgical or non-surgical, is one of the common procedures done in dentistry.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is a stressful event for patients before, during and after treatments(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Post-extraction instructions are given to each patient to relieve post-operative complications. One of the most common complications is alveolar osteitis, also called Dry Socket.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), the inflammation of alveolar bone(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) develops after 2 to 4 days, characterised by severe pain(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), bad smell (halitosis)(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), swelling and redness of the gingiva, open socket, not covered by a blood clot and exposed bone. Its occurrence is 1 to 5% in all extraction while in mandibular molar, 38%(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The reported incidence of dry socket in closed extraction is 0.6% to 5.6% while in open extraction is 24.7%(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). According to dental arch, the incidence of dry socket in Mandible is more common than in the maxilla because of food debris accumulation into socket and presence of dense bone(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Most cases of dry socket occur in impacted teeth that are mainly mandibular, 3rd molars which are removed surgically (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe post-extraction instructions act as a guideline to prevent post-operative complications that is given after surgical procedures (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The healing process of the socket is disrupted (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) When there\u0026rsquo;s noncompliance towards post-extraction instructions. The primary purpose is to facilitate a more effective healing process of the socket after extraction (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). When these instructions are followed correctly, patients will have early recovery (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and help in promoting wound healing after extractions(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). To ensure compliance, post-operative instructions should be presented in a clear and understandable manner. Multiple studies indicate that non-compliant patients have a higher incidence of complications such as dry socket, which emphasises the importance of adherence to these instructions for successful recovery and healing (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Patients who fully comply with the instructions during follow-up tend to have a satisfactory wound-healing process (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Knowledge about post-extraction instructions is also one of the reasons to help in the prevention and management of dry socket(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere is negligible evidence regarding compliance in Pakistan, especially in Khyber Pakhtunkhwa, and inconsistency in following post-extraction instructions. With the above background, this study aims to generate evidence on compliance with post-extraction instructions. The objective of the study was to assess the patient compliance with post-extraction instructions and also determine the factors associated with non-compliance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA cross-sectional study was conducted on patients who underwent tooth extraction at the Oral and Maxillofacial Department of Khyber College of Dentistry from September 2022 to February 2023. A non-probability (consecutive) sampling technique was used for a total of 303 patients, with an anticipated frequency of 73.1%, a 95% confidence level, and a 5% margin of error. Approval was obtained from the IPH\u0026amp;SS ethics committee No.KMU/IPHSS/Ethics/2022/PC/034 of KMU, as well as permission from the local administration. Ethical approval was also granted by the research committee at Khyber College of Dentistry for the collection of data under No. 8152/RRB/KCD.\u003c/p\u003e\u003cp\u003eThe study included adult males and females aged 18 years and older who underwent surgical or non-surgical extraction of a permanent tooth. The patient will be willing to listen to post-extraction instructions (takes around 8 minutes \u0026amp; max 10 minutes). Patients who were uncooperative, mentally disabled, or unable to understand and follow instructions were excluded from the study.\u003c/p\u003e\u003cp\u003eAfter the approval from the hospital, patients who fulfilled the inclusion criteria were recruited, and informed consent was taken. A total of 303 participants were recruited. At the time of the extraction, demographic information such as age, gender, tooth to be extracted, and type of extraction (surgical or non-surgical) was recorded. At the end of the procedure, the post-extraction instructions were provided verbally in the local language, according to the standard guidelines for oral and maxillofacial surgery. Consent was obtained from all patients to review these guidelines. After one week post-extraction, patients were called for a reminder to follow up to obtain information. Those who didn\u0026rsquo;t come for the follow-up had data collected through a phone call using a pre-designed questionnaire. The questionnaire consisted of ten questions about compliance; each question had a corresponding score, which quantitatively assessed the level of compliance with post-extraction instructions. It\u0026rsquo;s a validated tool taken from a study of Amparo Aloy-Prosper(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The key outcome variable of interest was the level of compliance score (quantified out of 10) according to the validated questionnaire. The collected data were statistically evaluated using SPSS version 22. Descriptive statistics were reported for all variables. Mean and standard deviation were calculated for the continuous variable, and frequency and percentages were calculated for the categorical variables. Regression analysis was applied to find the strength of association between the independent variables and the level of compliance and dry socket.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe total study sample was 303, in which 51.2% were male and 48.8% were female shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reported the level of compliance reported was 53.1% highly complied (8 to 10 score) and 46.9% partial compliance (5 to 7 score). Posterior teeth 261 (86.1%) were the main extracted teeth. Caries was one of the main reasons for extraction, with most teeth being nonsurgically extracted (89.1%). The mean and standard deviation of the compliance score recorded were 7.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed the highest followed instruction was pressing gauze for 30 mints, avoid rinsing, take a soft diet and maintain proper hygiene. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e reported Patients with a higher education and above (OR: 2.6, 95% CI: 1.5\u0026ndash;4.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), surgical extractions (OR: 7.6, 95% CI: 2.6\u0026ndash;22.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and posterior tooth extraction (OR: 7.2, 95% CI: 1.6\u0026ndash;32.0, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) have higher odds of compliance in both univariate and multivariate regression but impacted tooth and those who have extractions done by Consultants have higher odds of compliance in only univariate regression. The employed and self-employed in the occupation category reported lower odds of compliance with post-extraction instructions only in the multivariate regression analysis. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e showed the regression analysis for dry socket, showing that an impacted tooth has higher odds of developing dry socket, with a significant P value of \u0026lt;\u0026thinsp;0.05 in univariate analysis. In multivariate regression, the odds of developing dry socket are higher in surgical extractions and lower in those who demonstrate higher compliance with post-extraction instructions.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed patient compliance with post extraction instructions aimed at preventing alveolar osteitis in a sample of 303 patients. The findings showed that more than half of the participants demonstrated compliance, with the mean score of 7.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8. The incidence of alveolar osteitis were 5.6%, which is lower than reported in other studies. Compliance were highest for instructions related to gauze compression, soft diet and maintain oral hygiene while the lowest were observed for mouthwash use, antibiotic intake and application of ice packs. The reason for not applying ice wrapped cloth on the face and taking antibiotics that not every patient were treated by surgical extraction, no need of antibiotics, and has no swelling over the face. Education level were significantly associated with compliance while demographic variables such as age and gender showed no significant effect.\u003c/p\u003e\u003cp\u003eIn this study, education level played an important role in compliance, with highly educated patients demonstrating significantly better adherence compared to low education level of participants. This align with the findings from Blinder et al, who emphasized the importance of reading and comprehension skills, though they reported no direct link between education and compliance(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A study from Saudi Arabia also revealed that higher education enhance understanding of postoperative instructions and reduces complications (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The mean compliance score reported here (7.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8) is comparable to Spanish study by Aloy-Prosper, which reported slightly a higher compliance (7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1) with written instructions, suggesting that mode of instruction delivery (verbal vs written) may influence patient adherence (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Another Spanish study by Gonzalez et al, demonstrated very high compliance with mouthwash use (98.%), whereas in this study, compliance with mouthwash were only 28.7%, reflecting a lack of awareness about its use in local population (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The highest compliance were also seen with the instructions such as pressing gauze for 30 minutes, avoiding rinsing for 24 hours, and consuming soft diet while the lower compliance was reported for using mouthwashes and antibiotics, which was consistent with the studies conducted in Nigeria (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and Malaysia(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Verbal instructions were effective in improving recall, as also reported by ET Adebayo. This suggests that simple, clear, and repeated verbal communication can enhance patient understanding especially in sitting with limited literacy (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDry socket incidence in this study were significantly lower (5.6%) compared to studies conducted in Karachi, Pakistan is 19.7% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and India reported 14.1% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), reflecting improved patient awareness and oral health practices in our setting. The lower incidence may also showed better patient education, increased acceptability of dental care, or improvements in postoperative instruction delivery. Dry socket in our study were primarily linked to partial compliance, smoking habits, medical history, surgical extractions and posterior tooth extractions. Similar findings were reported in Nigerian study, where poor adherence to instructions increased postoperative complications(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). A multicentre study in Ethiopia also showed a strong link between verbal instructions noncompliance and postoperative complication, reinforcing the importance of effective communication of instructions(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Overall, our data suggest that while dry socket is multifactorial, compliance remains a key preventive factor.\u003c/p\u003e\u003cp\u003eThe study revealed the noteworthy demographics, that male patients underwent more extractions, similar to findings from India(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), which attributed this trend to limited self-care among males. Female (housewives) showed lower compliance consistent with findings from Malaysian study (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) often due to domestic responsibilities. Employed participants reported better compliance than unemployed individuals, due to more proactive nature to take care of themselves. Those who have impacted tooth, surgical extraction, posterior tooth location, and extraction done by consultants showed good compliance with instructions because of more focused towards their oral health. This study underline the importance of tailoring postoperative care strategies to patients\u0026rsquo; lifestyle. The study also found that patients easily recalled initial instructions (e-g gauze compression for 30 minutes, avoid rinsing and soft diet), reflecting the emphasizing of key messages immediate post-surgery. Similar observations from Saudi Arabia, where initial instructions recall were highest(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA major strength of this study is its relatively large sample size (303 participants) and its focus on verbal instructions, which reflects real world practice in low and middle income countries. The use of validated questionnaire allowed for robust quantification of compliance. However, limitations include reliance on self-reported compliance and potential recall bias during follow-ups. Variations in socioeconomic and cultural contexts also limit generalizability. Despite these limitations, the study provide valuable insight in compliance behaviors and their relationship with post-operative complication.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe current study concluded that compliance with post-extractions instructions was significantly associated with surgical instructions, operator status (consultants), impacted teeth and posterior teeth extractions. Regression analysis revealed that higher compliance was linked to lower odds of developing dry socket, emphasizing the importance of adherence to postoperative guidance. Partial compliance was influenced by factors such as age, gender, smoking, medical history and occupation. Instruction specific analysis showed the highest compliance with maintaining soft diet, placing a gauze pack, avoid rinsing and practicing oral hygiene, while the lowest compliance was with the use of antibiotics, mouthwash, and ice packs for swelling.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSPSS statistical package for social sciences\u003c/p\u003e\u003cp\u003eOR odds ratio\u003c/p\u003e\u003cp\u003eREF reference value\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e the Ethical approval for this study was obtained from the \u0026ldquo;Ethics board of Institute of Public Health and Social Sciences, Khyber Medical University (Reference No.KMU/IPHSS/Ethics/2022/PC/034 of KMU)\u0026rdquo;. Ethical approval was also granted by the research committee at Khyber College of Dentistry for the collection of data under No. 8152/RRB/KCD. Written informed consent was obtained from all participants prior to their inclusion in the study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eall participants provided consent for publication of anonymized data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: the data sets used or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e the authors declare that they have no competing interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e this research did not receive any specific grant from funding agencies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial No:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAS: Concept of the study, data collection, manuscript writing\u003c/p\u003e\n\u003cp\u003eNK: Concept of the study, data cleaning, proofreading of the manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTS: Data collection, cleaning and descriptive analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNK: Literature review and contribution to the methodology of the manuscript\u003c/p\u003e\n\u003cp\u003eZoK: Proofreading of manuscript\u003c/p\u003e\n\u003cp\u003eKR: Proofreading of manuscript, supervision of data collection\u003c/p\u003e\n\u003cp\u003eZeK: Data cleaning, data analysis, Proofreading of manuscript,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e the authors would like to thank Tanzeel, Nazneen, Shiraz and Dr Khalid for reviewing and proofreading of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information (optional): Not applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePaul R, Pradeep D, Gurunathan D. Retrospective study on patient compliance following tooth extraction. Indian J Forensic Med Toxicol. 2020;14(4):5522\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlinder D, Rotenberg L, Peleg M, Taicher S. Clinical paper: Patient compliance to instructions after oral surgical procedures. 2001;216\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhitab U, Khan A, Shah SM. Clinical Characteristics and Treatment of Dry Socket \u0026ndash;A Study. Pakistan Oral Dent J. 2012;32(01):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSardar T, Sadiq N, Ishfaq M, Sheikh G. Incidence of dry socket after removal of impacted mandibular third molar and its relation to surgical. 2019;39(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkinbami BO, Godspower T. Dry socket: Incidence, clinical features, and predisposing factors. Int J Dent. 2014;2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNusair YM, Abu Younis MH. Prevalence, clinical picture, and risk factors of dry socket in a Jordanian Dental Teaching Center. J Contemp Dent Pract. 2007;8(3):53\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMURAD N, BANGASH ZQ, QAYYUM FA, KHAN MY. Serious Post Extraction Complaint. Pakistan Oral Dent J [Internet]. 2014;34(3):433\u0026ndash;6. Available from: https://search.ebscohost.com/login.aspx?direct=true\u0026amp;db=ddh\u0026amp;AN=99149472\u0026amp;%0Alang=es\u0026amp;site=ehost-live.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHakobyan G, Yesayan L, Mathevosyan D, Tunyan G, Gyulamiryan L. Clinical and microbiological assessment of the results of combined treatment of patients with alveolar osteitis. Clin Res Trials. 2020;6(6):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkpata O, Omoregie OF, Owotade F. Alveolar Osteitis: Patients \u0026rsquo; compliance to post-extraction instructions following extraction of molar teeth. 2013;54(5):335\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhawaja N, Parveen K, Almotreb A, Tashkandi R. The Survey of the Knowledge of Dry Socket and Management Among Dental Practitioners. Still Controversy? 2019;28(04):192\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHon JCK, Fathonah A, Basirah NA, Nadia, Adnan NIM. Patient Compliance Towards Postoperative Care Following. 2021;(October):6\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli S, Sharif S. Frequency of Dry Socket in Patients coming to dental out- patients \u0026rsquo; Frequency of Dry Socket in Patients coming to dental out- patients \u0026rsquo; Department, Saidusharif hospital, SWAT. 2021;(February).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSahafi YAM, Al, Juhani AM, Al, Foudah BM, Alrehaily LA, Jabri SA, Al, Tola RW et al. Can Knowledge about Post Extraction Instruction Affect Post Extraction Behavior: A Cross Sectional Study among the Patients Visited Taibah University College of Dentistry Clinic, Madinah, KSA. J Adv Med Med Res. 2020;(June):36\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamalingam S, Alotaibi O, Alqudairy Z, Alnutaifi A, Alotaibi A. Effectiveness of Phone Call Follow-Ups in Improving Patient Compliance to Post-extraction Instructions: A Cross-Sectional Study. Cureus. 2022;14(11).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOsunde O, Bassey G, Anyanechi C. Warm saline mouth rinse instructions after dental extractions: How well do patients comply? J Med Trop. 2016;18(1):33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAloy-Pr\u0026oacute;sper A, Pellicer-Chover H, Balaguer-Mart\u0026iacute;nez J, Llamas-Monteagudo O, Pe\u0026ntilde;arrocha-Diago M. Patient compliance to postoperative instructions after third molar surgery comparing traditional verbally and written form versus the effect of a postoperative phone call follow-up a: A randomized clinical study. J Clin Exp Dent. 2020;12(10):e909\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamalingam S, Alsaleh MS, Almhidy NM, Aljeadi AA, Almosa OM, Alshehri AM, et al. Patient\u0026rsquo;s Knowledge and Attitude towards Post-extraction Instructions Following Permanent Teeth Extraction. J Pharm Res Int. 2021;33:533\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlvira-Gonz\u0026aacute;lez J, Gay-Escoda C. Compliance of postoperative instructions following the surgical extraction of impacted lower third molars: A randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2015;20(2):e224\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOmorodion GI, Osadolor AJ. Dental Patients\u0026rsquo;Compliance With Post-Extraction Instructions At a Secondary Health Care Facility in Nigeria. Education. 2021;2022(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdebayo E, Dairo M. Patients` compliance with instructions after oral surgery in Nigeria. J Community Med Prim Heal Care. 2005;17(1):38\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFaheem S. Patients compliance and follow-up rate after tooth extraction. IOSR J Dent Med Sci. 2017;16(5):115\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdebayo ET, Dairo M. Patients ` compliance with instructions after oral surgery in Nigeria. 2005;17(June):38\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMesfin K, Abaynew Y. Patient understanding and compliance with post-operative instructions and follow-up at Yekatit 12 Hospital, Addis Ababa, Ethiopia. BMC Oral Health. 2025;25(1):4\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003edemographics and health status\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.2%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge Mean and SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eAge Categories\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18- 37years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38- 57years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNonformal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUp to Matric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUp to intermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOccupation status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed and self-employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed and retired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther (Housewife and student)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSmoking status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eCigarettes per day\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eremove\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eless than 20 cigarettes per day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 cigarettes per day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 20 cigarettes per day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eMedical History\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther (thyroid problem and Asthma)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eMedication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno medicines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiabetic drugs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAntihypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther (thyroid and Asthma drugs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOral procedure description\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTooth Extraction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eanterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eposterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eReason of Extraction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriodontal diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImpacted tooth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProsthetic Reason\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther (Orthodontic Treatment, Periapical infection, RCT treated, Pericoronitis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eExtraction Technique\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-surgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e270\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eOperator Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFinal year student\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResident (HO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostgraduate (TMO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConsultant (MO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLocal anaesthetic cartridges are used\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eless than two cartridges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003etwo or more cartridges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eTechnique of local anesthesia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfiltration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMandibular Block\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eImpacted tooth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLevel of Compliance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompliance\u003c/p\u003e\u003cp\u003e(8\u0026ndash;10 score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePartial compliance\u003c/p\u003e\u003cp\u003e(5\u0026ndash;7 score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePost-operative instruction compliance assessment\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCompliance questions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%age\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1: Did you keep pressing folded gauze for 30 minutes after extraction?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2: Did you avoid rinsing with any liquid for the first 24 hour?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e3: Did you take a soft or semi-liquid diet at low or warm temperature?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4: Did you apply ice wrapped in a cloth on the outside of the face where the extraction has been performed?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5: Did you maintain proper oral hygiene?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6: Did you avoid smoking during the postoperative period (7 days after surgery)?\u003c/p\u003e\u003cp\u003eAmong smokers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e7: Did you avoid to take carbonated drinks?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8: Did you take antibiotics according to the recommendations of the surgeon?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e9: Did you take analgesics and anti-inflammatories according to the recommendations of the surgeon?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e10: Did you perform rinses with Chlorhexidine 0.12% from 24 hours (3 times each day / 10 days) starting the day after surgery?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between the level of compliance and its predictors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eOutcome: Level of compliance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnivariate\u003c/p\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMultivariate\u003c/p\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0 (0.6\u0026ndash;1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3(0.6\u0026ndash;2.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge Category\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38\u0026ndash;57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6(0.4\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.6\u0026ndash;2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e58 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5(0.2\u0026ndash;1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.4\u0026ndash;3.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation Category\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp to matric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.4(0.7\u0026ndash;2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5(0.8\u0026ndash;3.05)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp to intermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.1(0.9\u0026ndash;4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.1(0.8\u0026ndash;5.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6(1.5\u0026ndash;4.7)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1(1.5\u0026ndash;6.7)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation category\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed and retired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed and self employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5(0.2\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.2(0.08\u0026ndash;0.7)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers(housewife and student)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6(0.2\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3(0.1\u0026ndash;1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.4 (0.08\u0026ndash;2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4(0.05\u0026ndash;2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOperator status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResident (HO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.4(0.8\u0026ndash;2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7(0.9\u0026ndash;3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostgraduate (TMO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.1(0.6\u0026ndash;2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.6\u0026ndash;2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsultant (MO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.0 (0.01\u0026ndash;24.4)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1(0.5\u0026ndash;18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eImpacted tooth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.2(1.6\u0026ndash;32.0)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.2\u0026ndash;7.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExtraction technique\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-surgical extraction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical extraction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.6(2.6\u0026ndash;22.1)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.9(1.8\u0026ndash;26.7)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedical History\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.9(0.3\u0026ndash;2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.4\u0026ndash;3.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5(0.2\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5(0.2\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (thyroid and asthma)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.8(0.05\u0026ndash;13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3(0.01\u0026ndash;8.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTooth location\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6(1.3\u0026ndash;5.1)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3(0.04-5.0)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between the dry socket and its predictors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eOutcome: Dry Socket\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnivariate\u003c/p\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultivariate\u003c/p\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.4\u0026ndash;3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7(0.1\u0026ndash;3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge Categories\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e18\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e38\u0026ndash;57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6(0.2\u0026ndash;1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2(0.3\u0026ndash;5.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e58 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.2\u0026ndash;6.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5(0.5\u0026ndash;39.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation categories\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNon formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eUp to matric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6(0.1-3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0(0.1\u0026ndash;6.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eUp to intermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6(0.07\u0026ndash;5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5(0.05\u0026ndash;6.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.02(0.7\u0026ndash;6.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.9(0.5\u0026ndash;15.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation categories\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eUnemployed and retired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEmployed and self employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7(0.2-2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3(0.06\u0026ndash;1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOthers(housewife and student)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOperator status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eResident (HO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9(0.2\u0026ndash;3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1(0.2\u0026ndash;5.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePostgraduate (TMO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2(0.3\u0026ndash;4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3(0.3\u0026ndash;5.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eConsultant (MO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.2(0.7\u0026ndash;26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.5(0.4\u0026ndash;68.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eImpacted tooth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.2(1.1\u0026ndash;16.2)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.06(0.1\u0026ndash;8.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExtraction technique\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNon-surgical extraction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSurgical extraction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.2(1.8\u0026ndash;15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.0(1.7\u0026ndash;59.4)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedical history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNo disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4(0.2\u0026ndash;12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.5(0.2\u0026ndash;30.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(0.9\u0026ndash;9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.3(0.4\u0026ndash;11.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOther (thyroid and asthma)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTooth extraction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAnterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePosterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of compliance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePartial compliance (5\u0026ndash;7 score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREF value\u0026thinsp;=\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ecompliance (10\u0026thinsp;\u0026minus;\u0026thinsp;8 score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4(0.2\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1(0.04\u0026ndash;0.7)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"compliance, non-compliance, post-extraction instructions, dry socket, Alveolar osteitis","lastPublishedDoi":"10.21203/rs.3.rs-7692941/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7692941/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAlveolar osteitis, also known as dry socket, is a common post-extraction complication that can delay healing and cause significant discomfort for patients. While preventive strategies are well documented, patient compliance with post-extraction instructions plays a critical role in reducing their incidence. In Pakistan, especially in Khyber Pakhtunkhwa, limited data exists on patient compliance to post-extraction instructions, making it difficult to assess their impact on postoperative outcomes. The study aims to assess Patient Compliance with post-extraction instructions in the prevention of Alveolar Osteitis and to determine the factors associated with it.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe included 303 patients who underwent extractions, either surgical or nonsurgical, at the maxillofacial department of Khyber College of Dentistry, using a non-probability consecutive sampling technique. The post-extraction instructions were provided verbally in accordance with guidelines in the local language. One week later, patients were contacted to gather information about their adherence to post-operative instructions through a questionnaire to assess the level of compliance. Using SPSS v 22, descriptive statistics were reported for all variables. Regression analysis was applied to find the strength of association between the independent variables and the level of compliance and dry socket.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e51.2% were male and 48.8% were female. A total of 161 (53.1%) patients showed compliance (score 8 and above) with the instructions while 142 (46.9%) showed partial compliance (score 5\u0026ndash;7). The regression analysis revealed that higher compliance with post-extraction instructions was associated with a lower odds ratio of developing a dry socket. The higher compliance variables are higher education and above, surgical extraction, impacted tooth and posterior tooth extraction, while the non-compliance variables are employed and self-employed. Regarding compliance with post-extraction instructions in the prevention of dry socket, results are statistically significant with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study found a strong correlation between compliance and factors such as education level, employed, operator status, posterior tooth extraction, impacted tooth and extraction technique. Higher compliance significantly reduced the risk of alveolar osteitis. Enhancing patient education and emphasizing adherence to post extraction instructions can effectively minimize post extraction complication.\u003c/p\u003e","manuscriptTitle":"Patient Compliance to Post-extraction Instructions in Prevention of Alveolar Osteitis (Dry Socket): A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-03 07:14:23","doi":"10.21203/rs.3.rs-7692941/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-02T09:29:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-28T06:02:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-28T05:02:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-25T05:06:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50094750291498778213298674629096614937","date":"2026-01-24T14:40:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72179812897573030497959592666415204502","date":"2026-01-23T07:13:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198040655039825934084142952444818184492","date":"2026-01-19T08:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199938437448112436073511036945656032448","date":"2026-01-19T08:36:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-24T19:51:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T06:35:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70460628246067155306743939826382469260","date":"2025-12-05T14:41:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166790394326939393636054178475134149055","date":"2025-12-04T15:10:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8182306553309680939126637868358611165","date":"2025-12-04T02:44:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225447587419534900709583740292284431282","date":"2025-12-03T16:38:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T03:07:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238380931080708503555265607647781129193","date":"2025-10-23T06:56:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-23T06:51:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-13T11:19:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-06T04:23:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-06T04:23:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-09-23T10:00:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"95ed6946-7b25-4665-862a-f715db73d365","owner":[],"postedDate":"November 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-26T15:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-03 07:14:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7692941","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7692941","identity":"rs-7692941","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}