Comprehensive management of pericoronitis in lower third molars: extraction, operculectomy, and coronectomy approaches.

Pericoronitis is a common dental condition involving the inflammation of soft tissues around a partially erupted wisdom tooth, typically the lower third molars. It is most frequently diagnosed in young adults aged 20-29, with a higher prevalence in women. The condition often results from the accumulation of bacteria and food debris under the operculum, leading to infection and inflammation. Common symptoms include localized pain, gum swelling, trismus, and sometimes pus discharge. This study aims to discuss the types of clinical management of pericoronitis of the lower third molar as described in the literatureTooth extraction eliminates the source of inflammation, providing long-term relief but carries a higher risk of inferior alveolar nerve damage and greater postoperative discomfort compared to other methods.This minimally invasive procedure removes the gingival cap to prevent food and bacteria accumulation. It is suitable for patients with good oral hygiene and proper tooth angulation. Electrosurgery and laser methods reduce bleeding and swelling but have contraindications. Coronectomy, an alternative to extraction, avoids nerve damage by leaving the roots in place. Suitable for non-carious, pathology-free teeth, it shows lower risk of sensory disturbances and postoperative complications, though root migration may occur. Pericoronitis requires personalized treatment based on patient condition and tooth positioning. Thorough diagnostics and tailored approaches are crucial for effective management and improved outcomes.

Assessment of a combined mouthwash on pain relief in pericoronitis: a randomized clinical study.

BACKGROUND: Pericoronitis, an inflammation near wisdom teeth, often occurs when they are partially emerged, especially in the lower jaw. Commonly, the gingiva partially envelops the tooth. Treatments vary from gingival surgery to extraction. This study assessed the efficacy of a mouthwash with Chlorhexidine, Benzydamine, Nanosilver, Amoxicillin, and Metronidazole for pain reduction and enhancement of maximum mouth opening in acute pericoronitis cases. MATERIALS AND METHODS: In this randomized controlled clinical trial conducted at the Gorgan Dental Faculty, 48 pericoronitis patients were randomized into two groups. The control group used a 0.12% chlorhexidine mouthwash, while the case group used a mouthwash containing Chlorhexidine, Benzydamine, Nanosilver, Amoxicillin, and Metronidazole. The study recorded Visual Analog Scale (VAS) scores for 7 days, and Maximum mouth opening (MMO) was measured at the start and after 7 days. The analysis was performed using SPSS v20. RESULTS: In this study, we compared the effects of a combined mouthwash with those of a chlorhexidine mouthwash on pericoronitis in 48 patients, with an average age of 21.56 years. No significant difference in pain reduction was observed between the groups; however, both groups exhibited decreased pain and improved MMO post-treatment. The gender distribution was balanced across both groups. CONCLUSION: The results indicate that both chlorhexidine mouthwash and combined mouthwash significantly improved maximum mouth opening. Nonetheless, there were no notable differences in efficacy between the two groups. These findings suggest that these mouthwashes may be beneficial for oral hygiene, warranting further in-depth research. TRIAL REGISTRATION: Registered on 12/03/2023, registration number IRCT20230104057046N1.

Risk factors associated with the severity of pericoronitis of mandibular third molar.

PURPOSE: The factors related to pericoronitis severity are unclear, and this study aimed to address this knowledge gap. MATERIALS AND METHODS: In total, 113 patients with pericoronitis were included, and their demographic, clinical, and radiographic characteristics were recorded. The Patient-Clinician Pericoronitis Classification was used to score and categorize the severity of pericoronitis. Statistical analysis was conducted to examine the participants' characteristics, validity of the Patient-Clinician Pericoronitis Classification, and risk factors associated with the severity of pericoronitis. RESULTS: The demographic, clinical, and radiographic characteristics of males and females were similar, except for Winter's classification, pain, and intraoral swelling. The constructive validity of the Patient-Clinician Pericoronitis Classification was confirmed with three latent factors, including infection level, patient discomfort, and social interference. Ordinal logistic multivariate regression analysis revealed that upper respiratory tract infection was the sole risk factor associated with pericoronitis severity in males (odds ratio = 4.838). In females, pericoronitis on the right side (odds ratio = 2.486), distal radiolucency (odds ratio = 5.203), and menstruation (odds ratio = 3.416) were significant risk factors. CONCLUSION: This study demonstrated the constructive validity of the Patient-Clinician Pericoronitis Classification. Among females, pericoronitis in mandibular third molars on the right side with radiolucency in menstruating individuals was more severe. In males, upper respiratory tract infection was the sole risk factor associated with pericoronitis severity. CLINICAL RELEVANCE: Individuals with risk factors should be aware of severe pericoronitis in the coming future.

Erbium, chromium:Yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser versus diode laser in the treatment of pericoronitis.

Background: There are limited number of studies about the lasers used for the treatment of pericoronitis infection. Aim: To compare the Er, Cr:YSGG laser and diode laser applications clinically in the treatment of pericoronitis infection. Patients and Methods: Sixty patients with pericoronitis infection were divided into three groups using block randomization: Er, Cr:YSGG + antibiotic group, n = 20 (mean age: 24.20 ± 6.13; 14 females, 6 males); diode group + antibiotic, n = 20 (mean age: 23.45 ± 2.96; 14 females, 6 males); and antibiotic, n = 20 (mean age: 22.45 ± 3.02; 11 females, 9 males). In addition, laser application was performed for patients in the Er, Cr:YSGG and diode laser groups on the 1st and 2nd days until the extraction day. Tooth extractions were performed on the 3rd day for all patients. Patients' pain (with visual analog scale [VAS]), lymphadenopathy, and local edema were clinically evaluated in the first 3 days and on the 7th day of treatment. Results: Pain score on the 2nd day of treatment was determined to be significantly lower in the Er, Cr:YSGG + antibiotic laser group as compared with the other two groups (P = 0.019). Although regression of lymphadenopathy on the 3rd day was highest (P = 0.025) in the Er, Cr:YSGG group, there was no significant difference between the groups regarding local edema. Conclusion: Er, Cr:YSGG laser improved the healing process in the treatment of pericoronitis and made an important contribution to the treatment.

Simultaneous presentation of dual pathologies within the oral cavity: an unusual and diagnostically challenging presentation.

Necrotising sialometaplasia (NS) is a rare condition, with a limited scientific evidence base regarding its aetiology and pathophysiology. Diagnosing NS demands extensive investigatory tests. Their accuracy is vital in order to exclude oral malignancy and prevent unwarranted, invasive management.Within Birmingham Dental Hospital, a 22-year-old, South Asian woman presented with generalised pain from the lower right third molar extending to involve the palate, to which the patient's general medical practitioner previously attributed to a viral upper respiratory infection. Clinical examination revealed bilateral erythematous: non-ulcerated, palatal swellings (10 mm x 5 mm) at the greater palatine foramina. Following extensive investigations, the challenging definitive diagnoses of two distinct pathologies were made: non-ulcerative NS and pericoronitis.This case report describes the successful diagnosis and management of non-ulcerating NS, an 'atypical' presentation of a rare condition, that was confounded by a simultaneous episode of pericoronitis - a presentation not previously documented within scientific literature.

Improved Wisdom Tooth Diagnosis Can Reduce Dental Disease and Nonbattle Injuries.

INTRODUCTION: Wisdom teeth are a frequent cause for dental disease and nonbattle injuries (D-DNBIs) during expeditionary deployments. Improved diagnosis and timely treatment before deployment can reduce the need to evacuate a D-DNBI while in a theater. This study proposed key identifiers to diagnose wisdom teeth as Dental Readiness Classification (DRC) 3. MATERIALS AND METHODS: This study was a retrospective chart review conducted to measure concurrence among Army dentists when assigning DRC for wisdom teeth. This study also recorded demographic data and physical findings among the observed patients. Concurrence, or inter-rater reliability, was measured using Cohen's kappa (κ). RESULTS: A Cohen's κ of 0.04 suggested that there was no concurrence among Army dental providers in the diagnosis of wisdom teeth. The study concluded that caries and pericoronitis accounted for 37% and 13% of class 3 nondeployable troops, respectively. Forty-one percent of tobacco users had caries. Fifty-eight percent of the population was diagnosed as DRC 3. CONCLUSIONS: This study proposed DRC 3 criteria for wisdom teeth and measured concurrence among dental providers' diagnoses. Dental Readiness Classification 3 criteria include caries, pericoronitis, infection, and pathology. A Cohen's κ of 0.04 indicated there was a lack of concurrence in examining dentists compared to the DRC 3 criteria. Caries and pericoronitis were the most frequent diagnoses for third molars. Early diagnosis and treatment of these key identifiers can help reduce a significant source of D-DNBIs in the deployed environment.

Influence of inflammation on bleeding and wound healing following surgical extraction of impacted lower third molars.

OBJECTIVE: This study aimed to investigate the effect of inflammatory states following impacted lower third molar (ILTM) surgery regarding postoperative bleeding and wound healing. METHODS: The study included patients who underwent extraction of ILTMs associated with or without inflammatory conditions. Post-extraction bleeding and wound healing were assessed. In addition, mean grey values (MGVs) of alveolar bone and bone height using an orthopantomography radiograph were analyzed. RESULTS: A total of 376 patients were enrolled; 171 pericoronitis, 51 pulpitis, 44 chronic periapical periodontitis, 36 chronic periodontitis, and 74 control. The bleeding score in the control group was significantly lower than in the periapical periodontitis and periodontitis groups. Excellent wound healing for control, pericoronitis, pulpitis, periapical periodontitis, and periodontitis groups was (78.38%, 35.67%, 70.59%, 70.45%, and 33.33%, respectively). Patients with pericoronitis and periodontitis had significantly poorer wound healing (P < 0.01). The MGV in periapical periodontitis and periodontitis was considerably lower than in the control group. CONCLUSIONS: The inflammatory conditions associated with ILTMs increase the risk of bleeding. So suturing with the placement of local hemostatic agents over a pressure pack alone is recommended. The poorest wound healing was in localized gingival inflammation. Furthermore, MGV was affected by age and was lower with periapical periodontitis.

Pericoronitis treatment with antimicrobial photodynamic therapy using a new formula of methylene blue: A case report.

Pericoronitis is a common disease that impacts the quality of life of individuals during the eruption of the third molars. Among the main clinical signs and symptoms reported were the presence of gingival operculum, pain, difficulty swallowing, and trismus with functional impairment. The present study shows a case report of pericoronitis treated with antimicrobial photodynamic therapy (aPDT), using a new oral formulation (INPI BR 1020170253902) of methylene blue. A female patient, 27 years old, presenting initial pericoronitis, had her pain, mouth opening, and swelling evaluated. She was submitted to a protocol of irrigation with sterile saline and photodynamic therapy using the new MB at 0.005% concentration and irradiation with low-intensity laser λ = 660 nm, 9 J per point, and radiant exposure of 318 J/cm2. The variables were evaluated on 4th day after aPDT. There was a 100% improvement in pain and an increase of 1,3 cm in mouth opening. There was no difference in the edema before and after aPDT using the new MB formula. Although the results are based on a single case report, suggest the hypothesis that aPDT using the new MB formula is an efficient therapy in the treatment of pain and trismus caused by the early stage of pericoronitis. Well-conducted randomized clinical trials are needed to compare this new formulation with conventional aPDT for further generalization of results.

Mandibular Third Molar Impaction among Patients Visiting Outpatient Dental Department of a Tertiary Care Centre.

Introduction: Mandibular third molar impaction is the most common impaction as third molars are last to erupt at the age of 17-25 years. Despite its high prevalence and negative impacts, there is limited study about mandibular third molar impaction. The aim of this study is to find out the prevalence of mandibular third molar impaction among patients visiting the outpatient Dental Department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Dental Department of a tertiary care centre from 1 January 2023 to 30 June 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. A total of 414 orthopantomograms were prospectively reviewed for the angulation of impaction, depth and position. The indication for extraction was recorded from patients' cards during the time of extraction. Convenience sampling method was used. The point estimate at a 95% confidence interval was calculated. Results: The prevalence of mandibular third molar impaction was 37.13% (34.29-39.97, 95% Confidence Interval). There was a high prevalence of mesioangular 344 (45.38%) pattern followed by vertical 249 (32.85%) for mandibular third molar impaction, the most commonly involved group was 20-30 years, with female 247 (59.70%) predominance. Bilateral impaction 344 (83.10%) was more prevalent than unilateral. Depth A, 639 (84.3%), ramus relation level I, 602 (79.42%) was the most common level of impaction. Recurrent pericoronitis 160 (38.6%) was the common indication for extraction followed by dental caries 145 (35%). Conclusions: The prevalence of mandibular third molar impaction was lower than other similar studies done in similar settings. Keywords: impacted tooth; pericoronitis; prevalence; third molar.

Should systemic antibiotics be prescribed in periodontal abscesses and pericoronitis? A systematic review of the literature.

This study assessed whether systemic antibiotics are beneficial or harmful in patients who present with an acute periodontal abscess or pericoronitis, with or without systemic involvement, and, if antibiotics are beneficial, which type, dosage, and duration are the most effective. Medline, Embase, and the Cochrane Library were screened from 1948 up to 1 April 2022 for systematic reviews, randomised clinical trials (RCTs), and other studies. Dedicated websites were consulted for systematic reviews, clinical practice guidelines, and health technology assessments on the topic. Outcomes of interest comprised tooth survival, swelling, pain, tooth mobility, periodontal probing depth, suppuration, adverse effects, quality of life measurements, and medication required for pain relief. Overall, five guidelines, seven systematic reviews, 15 RCTs, and 34 other studies were identified and selected for full-text assessment, but none of them fulfilled the inclusion criteria. At present there is no single randomised or non-randomised controlled trial assessing the harms and clinical effectiveness of systemic antibiotics in adults with a periodontal abscess or pericoronitis.

Are there differences between dental diseases leading to severe odontogenic infections requiring hospitalization? A retrospective study.

OBJECTIVES: Common dental diseases may develop into severe odontogenic infections (OIs). This study aimed to characterize the occurrence and nature of dental diseases in OIs requiring hospitalization. METHOD AND MATERIALS: Data of a total of 168 adult patients requiring hospital care for severe OI were retrospectively investigated. Study participants were grouped according to OI etiology: apical periodontitis, marginal periodontitis, combined infection (apical and marginal periodontitis) or vertical root fracture, pericoronitis, and root remnant. The categorization of the dental diseases was achieved by radiologic evaluation and supplemented with clinical findings from patient records. Differences in background variables and infection severity were statistically analyzed. RESULTS: Apical periodontitis was the most common dental infection disease leading to OI (n = 113; 67%). In 83 cases, no root canal treatment (RCT) was administered prior to hospital admission; in 30 cases, RCT had been commenced or completed. Between study groups, significant differences were observed in age (P < .001), immunocompromised status (P = .024), and pulse (P = .012). Patients with marginal periodontitis were older and more often immunocompromised; patients with pericoronitis were younger. Pulse was higher in patients with a severe OI originating from apical periodontitis than in patients with OI originating from other dental diseases. CONCLUSION: Apical periodontitis, specifically with no prior endodontic treatment, was observed in the majority of severe OIs. Additionally, when compared with other types of dental diseases, apical periodontitis was associated with features of more severe infections. This highlights the importance of periapical health.

An evaluation of an array of viruses and fungi in adult Lebanese patients presenting with various dental infections: A cross-sectional study.

INTRODUCTION: The role of bacteria in the pathogenesis of periodontitis, pericoronitis, and periapical infections has been well-established. However, the variation in the severity and prognosis of these lesions could suggest a potential role of other microorganisms, such as viruses and fungi. This study aims to evaluate the presence of adenovirus, human papillomavirus-16, Epstein-Barr virus, Candida, and non-Candida fungi in these infections. METHODOLOGY: A cross-sectional study including 120 healthy adult patients presenting with dental infections requiring dental extractions were conducted to assess the prevalence and the relative quantity of viruses and fungi in saliva, infected, and healthy tissues using quantitative polymerase chain reaction tests. Samples were collected, and a categorical scale was used for the prevalence and a continuous scale for the relative quantification. Statistical analyses were performed using Chi-square for the prevalence and Wilcoxon rank test for the relative quantification. RESULTS: Except for the Epstein-Barr virus and Candida, the presence of viruses and fungi was significantly associated with dental infections. Adenovirus showed an association with pericoronitis, while human papilloma virus-16 exhibited an association with periapical infections. Non-Candida fungi, on the other hand, showed a positive association with all infected tissues and saliva as compared to healthy control lesions except for periapical infections. CONCLUSIONS: According to this study, viruses and fungi were found to be prevalent in dental infections. However, their associations with those infections vary depending on the types of viruses or fungi involved and the category of dental infections.

Coronectomia em terceiro molar superior: relato de caso / Maxillary third upper molar coronectomy: case report

Introdução: A extração de terceiros molares é um dos procedimentos mais realizados em cirurgias orais. As indicações para esse procedimento estão ligadas à doença cárie, doença periodontal, pericoronite, entre outras. Objetivo: O objetivo deste artigo é apresentar um relato de caso e discussão com a técnica aplicada a um terceiro molar superior com risco de comunicação oroantral, demonstrando os benefícios deste procedimento. Relato de Caso: Paciente sexo masculino, 49 anos, ausência de comorbidades, encaminhado para remoção de terceiro molar superior por dificuldade de higienização e acúmulo de placa bacteriana, ao exame tomográfico, apresentou proximidades das raízes com o seio maxilar, onde foi optado pela contra indicação de extração devido a grande chance de comunicação oroantral e sugerido coronectomia para resolução do caso. Conclusão: A coronectomia é uma técnica bastante difundida nos casos em que o terceiro molar está intimamente relacionado ao nervo alveolar inferior, com chances de parestesia. Não há relatos na literatura dessa técnica aplicada ao terceiro molar superior... (AU)

Introduction: Extraction of third molars is one of the most commonly performed procedures in oral surgeries. The indications for this procedure are linked to caries disease, periodontal disease, pericoronitis, among others. Case Report: Male patient, 49 years old, absent from comorbidities, referred for removal of the upper third molar due to difficulty in cleaning and bacterial plaque accumulation, on tomographic examination, proximity of the roots to the maxillary sinus, where it was opted for the contraindication of extraction due to great chance of oroantral communication and suggested coronectomy to resolve the case. Objective: The purpose of this article is to present a case report and discussion with the technique applied to a maxillary third molar at risk of oroantral communication, demonstrating the benefits of this procedure. Conclusion: Coronectomy is a widespread technique in cases where the third molar is closely related to the lower alveolar nerve, with chances of paresthesia. There are no reports in the literature of this technique applied to the upper third molar... (AU)

A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry.

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists' therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients' quality of life, healthcare costs, and antimicrobial resistance development.

Pathologies associated with the mandibular third molar impaction.

To evaluate the associations of impaction patterns of mandibular third molars (M3Ms) with pathologies caused by them. In this study, 262 patients with 432 impacted M3Ms who referred in Shanghai Xuhui District Center were reviewed. The pathologies include pericoronitis, mandibular second molar (M2M) caries, and M2M distal periodontal pathology. The impaction patterns of M3Ms and the pathologies were examined, while the M2M outcomes after surgeries were evaluated. A χ2 test was used to analyze the data, with a p value of <0.05 being considered statistically significant. Pericoronitis was the major symptom in all patients, whereas the propensities of M2M distal caries and periodontal pathologies increased in older patients. Soft tissue impacted and vertically angulated teeth were more associated with pericoronitis (p < 0.05); mesio-angular impacted teeth in less deep positions had greater risks of M2Ms distal caries (p < 0.05); mesio-angular and horizontal impacted teeth in relative deep positions were more likely to cause M2Ms distal periodontal pathologies (p < 0.05). Extractions of soft tissue impacted teeth in vertical angulations should be considered, while removals of mesially and horizontally angulated or bony impacted teeth could be delayed.

Risk indicators of operculitis.

BACKGROUND: The aim of this study was to illustrate the features of tooth number 38 and 48 having acute operculitis employing clinical parameters and radiological distinctiveness. METHODS: Fifty subjects of both genders in the age range of 19-36 years with a diagnosis of acute operculitis comprised the group for study. After thorough clinical examination, uniform orthopantomograms (Rotograph 230 eur, Villa Sistemi Medicali, Buccinasco, Milan, Italy) for each of the individual subject participating in the study was made. Four parameters were evaluated as plausible prognostic factors for the progression of acute operculitis. The χ2 test was used to foretell the role of individual factors studied in the progression of acute operculitis. Significance was set at P less than 0.05. For all statistical analysis, the SPSS (version 16; SPSS Inc., Chicago, IL, USA) software was used. RESULTS: Based on the assessment of the parameters investigated in this study, most likely to be among the essential determinants of acute pericoronitis are vertical angulations, part (50%) encapsulation, eruption point underneath the occlusal plane and existence of an encroaching opposing 28 and 18. CONCLUSIONS: Prophylactic extractions may thus be recommended in such cases, as a delay may result in grave complications. All patients with impacted wisdom teeth should be evaluated and the treatment planned must be based on their individual presentation.

Association of Oral Hygiene and Periodontal Health with Third Molar Pericoronitis: A Cross-Sectional Study.

BACKGROUND: Pericoronitis is a painful inflammatory condition commonly associated with third molar teeth. The purpose of this study was to investigate the relationship between oral hygiene and periodontal health status and the presence of pericoronitis in semi-impacted third molar teeth. METHODS: A cross-sectional study was conducted, and 54 patients having at least one mandibular vertically semi-impacted third molar tooth with or without pericoronitis were consecutively enrolled. Subjects with pericoronitis and subjects with healthy third molars were selected according to symptoms in the gingiva overlying semi-impacted third molar teeth. Periodontal health status and oral hygiene were evaluated with the measures of plaque index (PI), gingival index (GI), and total number of sites with a probing depth (PD) ≥ 4 mm. The clinical data collected in this study was analyzed with Mann-Whitney U test using SPSS 20.0 package program. RESULTS: The PI scores were found to be significantly higher in patients with pericoronitis (p < 0.05). Although the GI scores and PD scores were higher in patients with pericoronitis, the difference did not reach statistical significance when compared with those in healthy subjects (p > 0.05). CONCLUSION: The findings obtained in this study suggest that the amount of dental plaque was positively associated with third molar pericoronitis. Gingival and periodontal health conditions were similar between patients with and without pericoronitis. Improving oral hygiene and controlling dental plaque may help prevent third molar pericoronitis.

Ten reasons to not ignore the third molar

ABSTRACT Introduction: The third molars are forgotten because they are the last in the dental arch, they do not directly influence the smile and they appear only in adolescence, when they do. Objectives: 1) to provide the clinician with a "checklist" to assess and diagnose changes to be screened in the third molar region in new patients; 2) to reveal the importance of not discharging the patient submitted to any dental treatment without first analyzing the third molars region clinically and on imaging examinations, since many diseases are associated to them. Result: A list of 10 situations that cover all diagnostic possibilities involving the third molars is presented. Conclusion: Adopting this protocol is a matter of habit, since the need is fundamental. The next professional assisting your patient may ask: "Did he not request examinations for the third molars?".

RESUMO Introdução: Os terceiros molares são esquecidos por serem os últimos dentes na arcada dentária, por não influenciarem diretamente no sorriso e por aparecerem apenas na adolescência - quando aparecem. Objetivos: 1) Fornecer ao clínico um checklist de conferência e diagnóstico de alterações a serem checadas na região dos terceiros molares em novos pacientes; e 2) Destacar a importância de não dar alta ao paciente submetido a qualquer tratamento odontológico sem antes analisar, clínica e imagiologicamente, a região dos terceiros molares, pois muitas doenças estão a eles associadas. Resultado: Criou-se uma lista de 10 situações que englobam todas as possibilidades diagnósticas envolvendo os terceiros molares. Conclusão: Adotar esse protocolo é uma questão de hábito, pois a necessidade é imperiosa. O próximo profissional a atender o seu paciente vai perguntar: "Ele não solicitou exames para os terceiros molares?".

[A surprising cause of a neck fistula]. / Een verrassende oorzaak van een halsfistel.

A 24-year-old woman presented with trismus, which had left her unable to open her mouth beyond 1 centimetre. It proved to be a pericoronitis with lingual swelling in the region of tooth 38. The trismus disappeared after removal of the 38. After a week, however, a submandibular swelling occurred. From this, an orocutaneous neck fistula developed from which a hay stalk was removed. In retrospect, the hay stalk ended up under the operculum of tooth 38 after eating meat cooked in hay, the stalk next made its way to the neck.