The impact of the COVID-19 pandemic on 397 631 elective dental admissions among the under-25s in England: a retrospective study.

BACKGROUND: COVID-19 caused widespread disruptions to health services worldwide, including reductions in elective surgery. Tooth extractions are among the most common reasons for elective surgery among children and young people (CYP). It is unclear how COVID-19 affected elective dental surgeries in hospitals over multiple pandemic waves at a national level. METHODS: Elective dental tooth extraction admissions were selected using Hospital Episode Statistics. Admission trends for the first 14 pandemic months were compared with the previous five years and results were stratified by age (under-11s, 11-16s, 17-24s). RESULTS: The most socioeconomically deprived CYP comprised the largest proportion of elective dental tooth extraction admissions. In April 2020, admissions dropped by >95%. In absolute terms, the biggest reduction was in April (11-16s: -1339 admissions, 95% CI -1411 to -1267; 17-24s: -1600, -1678 to -1521) and May 2020 (under-11s: -2857, -2962 to -2752). Admissions differed by socioeconomic deprivation for the under-11s (P < 0.0001), driven by fewer admissions than expected by the most deprived and more by the most affluent during the pandemic. CONCLUSION: Elective tooth extractions dropped most in April 2020, remaining below pre-pandemic levels throughout the study. Despite being the most likely to be admitted, the most deprived under-11s had the largest reductions in admissions relative to other groups.

Is the third molar the most frequently extracted tooth? A population-based study utilizing dental panoramic radiographs in adults.

OBJECTIVES: The study aimed to examine the authenticity of the often-mentioned statement that the third molar is the most frequently extracted tooth. This finding has not been shown previously in a large population-based sample. MATERIALS AND METHODS: Data comprised a nationally representative sample of 6082 panoramic radiographs taken from adults in the cross-sectional Health 2000 Survey. From the radiographs, all missing teeth were recorded. Information on congenital agenesis of individual teeth was retrieved from two published meta-analyses. Primary outcome was the frequency of missing teeth by tooth type. Explanatory variables were age, sex, and the jaw (maxilla/mandible). Statistical analyses included χ2 test and binomial logistic regression. RESULTS: Mean age of participants (46% men, 54% women) was 53 years (SD 14.6; range 30‒97 years). Missing teeth occurred more often in women than in men (P < 0.001). The third molar was most frequently missing and the canine least frequently. In the maxilla and mandible, the third molar was missing more often than each of the other tooth types up to the age of 80 years (P < 0.01). CONCLUSIONS: When considering the rates of congenital agenesis of individual teeth, it is concluded that the third molar remained the most common tooth extracted up till the age of 80 years. CLINICAL RELEVANCE: The third molar is the most common target for extraction, but also the most common tooth associated with malpractice claims, and therefore, calls for skills, adequate equipment, and other resources for a successful extraction.

What is the impact of the UK soft drinks industry levy on childhood tooth decay?

DESIGN: Interrupted time series analysis. DATA ANALYSIS: An interrupted time series (ITS) analysis was conducted to determine if there was an association between the announcement and implementation of the soft drinks industry levy (SDIL) and rates of hospital admission for tooth extractions due to dental caries in children. Hospital Episode Statistics (HES) were used on hospital admissions for tooth extraction of one or more primary or permanent tooth due to a primary diagnosis of dental caries in children aged 0-18 years attending a National Health Service (NHS) hospital in England from January 2012 (pre-SDIL) to February 2020 (post-SDIL implementation). HES data were grouped and summarised by Index of Multiple Deprivation (IMD) and age group. RESULTS: There was an absolute reduction of 3.7% (95% CI 5.3% to 2.2%) per 100,000 population/month and a relative reduction of 12.1% (95% CI 17.0% to 7.2%) in hospital admissions for carious tooth extractions in all children (0-18 years) compared if there had been no announcement of the SDIL (counterfactual scenario). Reductions were observed in children living in most areas regardless of the level of deprivation and most notably in the youngest children (<10 years). CONCLUSIONS: An ITS analysis of administrative data on hospital admissions found the announcement of the UK SDIL was associated with improvements (reduction) in the incidence of hospital admissions for tooth extractions due to dental caries. This study provides evidence of benefits of the UK SDIL to children's oral health.

Dental attendance, restoration and extractions in adults with intellectual disabilities compared with the general population: a record linkage study.

BACKGROUND: Oral health may be poorer in adults with intellectual disabilities (IDs) who rely on carer support and medications with increased dental risks. METHODS: Record linkage study of dental outcomes, and associations with anticholinergic (e.g. antipsychotics) and sugar-containing liquid medication, in adults with IDs compared with age-sex-neighbourhood deprivation-matched general population controls. RESULTS: A total of 2933/4305 (68.1%) with IDs and 7761/12 915 (60.1%) without IDs attended dental care: odds ratio (OR) = 1.42 [1.32, 1.53]; 1359 (31.6%) with IDs versus 5233 (40.5%) without IDs had restorations: OR = 0.68 [0.63, 0.73]; and 567 (13.2%) with IDs versus 2048 (15.9%) without IDs had dental extractions: OR = 0.80 [0.73, 0.89]. Group differences for attendance were greatest in younger ages, and restoration/extractions differences were greatest in older ages. Adults with IDs were more likely prescribed with anticholinergics (2493 (57.9%) vs. 6235 (48.3%): OR = 1.49 [1.39, 1.59]) and sugar-containing liquids (1641 (38.1%) vs. 2315 (17.9%): OR = 2.89 [2.67, 3.12]). CONCLUSION: Carers support dental appointments, but dentists may be less likely to restore teeth, possibly extracting multiple teeth at individual appointments instead.

Evaluation of the effects of the surgical removal of impacted third molars on the emotional state of individuals with Beck depression inventory.

AIMS: In this study, using Beck depression inventory (BDI), we aimed to determine alterations in the emotional state of patients who had impacted third molars (M3) extracted owing to postoperative pain, edema, and trismus.In this prospective clinical trial, which was conducted at Tokat Gaziosmanpasa University, Faculty of Dentistry, Department of Maxillofacial Surgery Clinic, we studied 60 patients (30 males and 30 females), who were 18-47 years old (the mean of 25.6 years of age). The patients with M3 with moderate preoperative pain intensities, edema, and maximal mouth opening (MMO) data were recorded, and BDI was applied to determine their emotional states. The patients were re-evaluated using BDI to detect alterations in their emotional state owing to pain intensity, edema, and trismus on postoperative second and seventh day. SUBJECTS AND METHODS: Descriptive statistical analysis, Chi-square, and independent t-test were utilized to interpret the obtained data. RESULTS: According to our findings, a statistically significant relationship was observed between BDI scores and gender on the second postoperative day (P = 0.004), and between MMO and BDI scores on the second and seventh postoperative day (P = 0.012, P = 0.045). Pain intensity scores on the postoperative sixth hour and seventh day were significantly correlated with BDI scores on the postoperative second and seventh day (P = 0.000/ P = 0.000/P = 0.002/P = 0.004/P = 0.010/P = 0.017/P = 0.001/P = 0.000). CONCLUSIONS: Our results suggest that the pain and trismus owing to the M3 surgery were significantly correlated with an increase in the postoperative BDI scores.

Oral health is a mediator for disease severity in patients with Behçet's disease: A multiple mediation analysis study.

OBJECTIVES: The aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behçet's disease (BD). METHODS: In the study, oral health of 194 BD patients was examined at baseline and follow-up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow-up period. The Behçet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow-up period in the study. RESULTS: Dental and periodontal indices were found to be higher at follow-up visit compared to those of baseline (P < 0.05). Disease severity score was found to be higher in males (5.3 ± 2.4) compared to females (4.4 ±2.5) in the whole group (P = 0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 ± 2.4; 5.5 ± 2.5) compared to others (4.2 ± 2.3; 4.4 ± 2.4; P < 0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B = -0.8822, P = 0.0145) and indirectly mediated through the presence of dental caries (B = 0.9509 P = 0.0110) and need of tooth extraction (B = 0.8758, P = 0.0128). CONCLUSION: Both presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes.

The prevalence and causes of wrong tooth extraction.

BACKGROUND: Dental extraction is a common procedure that is subject to complications and errors including extraction of the wrong tooth. This study aimed to determine the prevalence and identify the causes of wrong tooth extractions and explore the attitude of dentists after extraction of a wrong tooth. METHODS: A questionnaire was adapted to fit the needs of this project and was distributed among all the dentists in four teaching dental clinics. The questionnaire was available in both the English and Arabic languages. RESULTS: Of the 486 questionnaires, 186 questionnaires were returned (response rate of 37%) and used for the analysis. The prevalence of wrong tooth extraction was 21.1%. The three most common reasons for extracting a wrong tooth were miscommunication (31.6%), inadequate referral (28.9%), and exhaustion of an overworked dentist (28.9%). Surprisingly, only 50% informed the patient and documented the incident in the patient's chart. Few dentists apologized to their patients or offered any kind of solution or compensation. CONCLUSION: Wrong tooth extraction is a prevalent yet preventable problem. Most of the common causes of this problem appear to be more system rather than individual related. There is a pressing need to implement the universal protocol for the prevention of wrong site, wrong procedure, and wrong person surgery.

Human papillomavirus prevalence in a Mid-European oral squamous cell cancer population: A cohort study.

OBJECTIVES: Human papillomavirus infection has been investigated intensively regarding oropharyngeal carcinoma. However, there is still lack of knowledge about the impact of oral HPV infections concerning oral squamous cell carcinoma. This study investigates the prevalence of oral HPV infection in such patients, identifying possible differences between HPV+ and HPV- patients. SUBJECTS AND METHODS: One hundred and six consequent patients were investigated. After completion of a study questionnaire regarding risk factors, a brush smear sample was taken in each subject to identify the individual oral HPV status (overall/low risk/high risk). RESULTS: About 35.8% of the patients were tested positive for HPV in the oral cavity (14% low risk, 28.3% high risk). Patients with oral HPV infection and high-risk HPV infection were significantly younger (p < 0.001) and had a higher alcohol consumption (p = 0.0075 resp. p = 0.0022). A high number of different sexual partners were significantly correlated with any type of HPV infection. At last, patients with high-risk oral HPV infection had experienced more tooth extractions during their lifetime. CONCLUSION: Oral HPV infections may influence the course of disease of oral squamous cell carcinoma as HPV+ patients are about 10 years younger. It seems that high alcohol consumption facilitates high-risk HPV infection. It may be presumed that both alcohol consumption and high-risk oral HPV infection act synergistically, explaining earlier cancer onset.

A 20-year historical prospective cohort study of root canal treatments. A Multilevel analysis.

AIM: To evaluate the number of healthy and functional root filled teeth of patients included in a recall programme for at least 20 years. METHODOLOGY: Teeth were root filled by a single specialist following manual canal instrumentation, lateral/vertical compaction of gutta-percha and restored with glass-ionomer cements and bonding system/composite resin. In a large percentage of teeth, a metal-ceramic crown was placed during follow-up. Patients included in the recall programme (n = 130) were blindly assessed both clinically and radiographically (every 2 years) to evaluate clinical symptoms and periapical status (PAI). The following variables were analysed: age, tooth location, tooth type, initial diagnosis, PAI, root filling length and coronal restoration type. Chi-square test and multilevel analysis were performed to detect variables associated with treatment functionality and disease/lesions (P < 0.05). A cumulative teeth survival curve was constructed by means of Kaplan-Meier using extractions as the end-point. RESULTS: At the 20-year recall, 72 patients (31 M, 41 F; mean age 57.7 ± 8.29 years; 196 teeth) completed the follow-up. Thirty-six patients were excluded for medical complications or died before the end of the study. Drop-outs consisted of 22 patients (17%) who did not complete the follow-up. Single metal-ceramic crowns were positioned after 4-6 months in 40% of teeth. Composite restorations were replaced with single metal-ceramic crowns during the follow-up in 53% of teeth after 8-19 years. Of 196 teeth, 155 were classified as Survived (79%), 128 of which (65%) were Healthy (PAI ≤ 2). Thirty-nine teeth (20%) were extracted for nonendodontic reasons. Twenty-nine teeth (15%) were classified as: re-exacerbation (11 teeth; 5.6%) or persistent asymptomatic lesions (18 teeth; 9%). Only two re-exacerbated teeth were extracted. Multilevel analysis confirmed the clinical relevance of tooth type (P = 0.001) on Survived and healthy teeth (P = 0.007). Tooth location (P = 0.0045) and initial diagnosis (P = 0.019) significantly affected only Healthy teeth. CONCLUSIONS: Root filled teeth were more frequently extracted for non-endodontic reasons rather than for endodontic disease. The majority of teeth with adequate root fillings, adequate restorations and included in a recall programme remained functional and healthy for more than 20 years.

Demographic factors in Swedish adults undergoing root filling and subsequent extraction of a maxillary first molar: a comparative study.

AIM: To study the demographics of Swedish adults who had received a root filling, followed by extraction during the following 5-6 years in comparison with subjects who had undergone a corresponding root filling with an uneventful outcome. METHODOLOGY: The root filled maxillary first molar was chosen as the comparison model. The Swedish Social Insurance Agency provided data on all teeth reported as root filled in Sweden during 2009. A comparison group, equally large as the study group, was constructed by randomly selecting subjects with root filled maxillary first molars, which had not subsequently been extracted, that is, an uneventful outcome. Demographic data on the subjects were obtained from Statistics Sweden: country of birth, disposable income, educational level, age, civil status and gender. Chi-square, t-tests and logistic regression were used for statistical analyses. RESULTS: In the year 2009, 36 139 maxillary first molar teeth were reported to have been root filled, 4362 (12.1%) of which were then recorded as extracted during the following 5-6 year period. Only minor intergroup differences were noted: 86.5% of the study group were Swedish-born, compared with 84.4% of the comparison group (P = 0.007). Women comprised 53.2% of the study group and 50.5% (P = 0.01) of the comparison group. There was an association between extractions and gender as well as age; men had a lower odds ratio (OR) for extraction OR, 0.87; confidence interval (CI), 0.80-0.95. For every additional year, the chance for extraction was higher OR, 1.01; CI, 1.01-1.01. No other significant differences were detected. CONCLUSIONS: There was only little or no demographic differences between the study group, comprising Swedish adults who had undergone root filling of one of their maxillary first molars in 2009 and subsequent extraction during the following 5-6 years, and the comparison group, with uneventful outcomes after a corresponding root filling.

Retention of molars after root-resective therapy: a retrospective evaluation of up to 30 years.

OBJECTIVES: Long-term retention of teeth and especially molars in function is the ultimate goal of periodontal therapy. Root-resective therapy is a treatment option for molars with advanced furcation involvement, which has been questioned because of the heterogenous success rates published in literature. This study aimed to evaluate long-term results of root-resective treatment over a period of up to 30 years. METHODS: In this retrospective cohort, 90 root-resected molars in 69 patients were examined for 4-30 years (14.7 ± 6.8 years). The complete treatment sequence was performed by one of the authors in a general dental practice. RESULTS: Overall cumulative survival rate was 90.6% after 10 years, but then decreased considerably. Molars after root resection had a median survival time of 20 years. The incidence of endodontic complications leading to tooth extraction was only 26.7%, 50% were lost due to periodontal problems, and 16.7% because of caries. Mandibular molars had a significantly lower relative risk of loss than molars in the maxilla (HR 0.31, 95% CI 0.1-0.91, p = 0.033). Mandibular molars showed a survival probability of almost 80% even 20 years after root resection. CONCLUSION: Root-resective therapy is a predictable treatment option, when care is administered at each phase of therapy. CLINICAL RELEVANCE: This study provides important information about what is possible in daily practice under the outlines of public health care, when care is administered at each phase of resective therapy.

Modified Backward Avulsion Used in the Treatment of Third-Branch Primary Trigeminal Neuralgia.

OBJECTIVE: A clinical retrospective study was performed to observe the clinical effect of a modified surgical treatment for third-branch primary trigeminal neuralgia. METHOD: Thirty patients who had suffered from neuralgia for several years underwent modified backward avulsion of the inferior alveolar nerve and were followed for 3 to 5 years. In this technique, the inferior alveolar nerve was cut off through the mandibular wisdom tooth extraction socket or the corresponding alveolar ridge window and was avulsed from the mental foramen. Simultaneously, the neural foramen was packed with autogenous bone fragments to prevent recurrence. RESULTS: After a 3- to 5-years follow-up, 19 patients were cured, 8 patients reported a partial effect of treatment, and 3 patients exhibited recurrence. The efficacy rate was 90%. Postoperatively, the patients had different degrees of numbness in the area innervated by the third branch of the trigeminal nerve but did not have any other complications. CONCLUSIONS: This study proved that modified backward avulsion is a simple, effective, and safe method that can be applied in the clinical setting to treat third-branch primary trigeminal neuralgia.

Pufa Index and Related Factors Among 36- to 71-month-old Children in Turkey: A Cross-Sectional Study.

PURPOSE: To determine the clinical consequences of untreated dental caries among preschool children by using the pufa index (visible pulp, ulceration of the oral mucosa due to root fragments, a fistula or an abscess) and the incorporation of some risk factors. MATERIALS AND METHODS: Data were collected via structured, pre-tested questionnaires from 729 parents in Turkey's capital, Ankara. Examinations were performed under field conditions by one examiner. The decayed teeth were scored according to the International Caries Detection and Assessment System (ICDAS) II criteria. The filled and missing teeth and surfaces were also recorded as dmft and dmfs, and the pufa index was used for the consequences of untreated caries. The associations were evaluated by univariate analysis and logistic regression. RESULTS: The means age of the study population was 58.8 ± 8.6 months. 45% of the children were female and 55% were male. Mean dmft and dmfs were 4.8 ± 4.7 and 8.3 ± 10.2, respectively. 73.8% of the children had early childhood caries (ECC), while 51.0% had severe cases. Only 58 children (8.0%) had totally healthy primary teeth according to ICDAS II. Of the children with caries (n = 538), 17.5% had at least one pufa tooth. According to the logistic regression analysis, sex, having at least one sibling, extraction experience, and father's educational level were found to be the factors associated with the existence of pufa. CONCLUSION: Healthcare providers' attention must be drawn to both untreated carious lesions and the high ECC proportion among preschool children.

Factors that cause endodontic failures in general practices in Japan.

BACKGROUND: Bacterial biofilms that develop on root surfaces outside apical foramens have been found to be associated with refractory periapical periodontitis. However, several other factors cause endodontic failures apart from extraradicular biofilms. The aim of this study was to identify the factors causing endodontic failures in general practices in Japan. METHODS: Patients diagnosed as having refractory periapical periodontitis by general practitioners and who requested endodontic treatment at Osaka University Dental Hospital were selected by checking medical records from April 2009 to March 2013. Factors causing endodontic failures were identified. RESULTS: A total of 103 teeth were selected, and 76 teeth completed root-canal treatment. Tooth extractions were required for 18 teeth after or without endodontic treatment. Six teeth required apicoectomy after endodontic treatment. One tooth needed hemisection. One tooth needed intentional replantation. One tooth needed adhesion and replantation. The main causes of treatment failure were open apices (24 teeth), perforation (18 teeth), and root fracture (13 teeth). In six teeth with open apices that required apicoectomy or extraction, extraradicular biofilms may have been related to endodontic failure. CONCLUSIONS: Most endodontic cases diagnosed with refractory periapical periodontitis by general practitioners were compromised by any other factors rather than extraradicular biofilms.

Oral health experiences of individuals with Rett syndrome: a retrospective study.

BACKGROUND: There is relatively little literature on the oral health experiences of individuals with Rett syndrome. This study described the incidence of dental extractions and restorations in a population-based cohort, according to a range of demographic and clinical factors. The association between bruxism and age was also investigated. METHODS: Existing questionnaire data in the population-based Australian Rett Syndrome Database for the years 2004, 2006, 2009 or 2011 on genetically confirmed female cases (n = 242) were analysed. RESULTS: The incidence rate of restorations and extractions were 6.8 per 100 person years (py) and 9.3 per 100 py respectively. The incidence of extractions decreased with increasing levels of income. Compared to those with a C-terminal mutation, the incidence rate of extraction was higher for those with large deletions (Incidence Rate Ratio (IRR) 4.93; 95% CI 1.46-16.7, p = 0.01). There was a 5% decrease in the risk of frequent bruxism for every one-year increase in age (Risk Ratio 0.95; 95% CI 0.94-0.97). CONCLUSIONS: Social advantage may provide some protection for dental health in individuals with Rett syndrome. Those with more severe genotypes seemed to have poorer oral health outcomes.

Prevalence and Reasons for Extraction of Endodontically Treated Teeth in Adult Nigerians.

AIM: Teeth extraction is an important problem in elder patients. Although some of these teeth have been endodontically treated, many of them may be subjected to extraction. The reasons for extraction are important for prevention planning in further patients. The aim of this study was to assess the prevalence and important reasons for extraction of endodontically treated teeth in adult Nigerians. MATERIALS AND METHODS: This study involved a retrospective examination of 2,000 case files in the archives of the University of Nigeria Teaching Hospital. Out of the 2,000 case files, 650 concerned endodontically treated teeth. RESULTS: The prevalence of extractions in the population was 21.5%. This was more often in the mandible (67.9%) than in the maxilla (32.1%). In both jaws, more molars were extracted (57.1%), followed by premolars (27.1%) and anterior teeth (15.7%). Extractions occurred 57.1% of times in females. However, the rate of extraction decreased with age but peaked in the 51-60 year age band. CONCLUSION: The association between age and extraction was proven. Caries, vertical root fracture and endodontic reasons accounted for the commonest cause of extraction in the mandible; while in the maxilla, endodontic reasons and cusp fracture caused extractions most often. CLINICAL SIGNIFICANCE: The reasons for extraction of endodontically treated teeth are different between maxilla and mandible.

Cost comparison of prediction-based decision-making for periodontally affected molars.

AIM: Tooth loss prediction could improve decision-making for periodontally affected molars. We analysed the costs of removing all, none or only those molars predicted to be at-risk for extraction during supportive periodontal therapy (SPT). METHODS: This is a model-based study using a German private payer perspective. Building mainly on cost and effectiveness data from 2039 molars (301 patients) which received long-term SPT, five (exemplary) prediction/decision strategies were compared: Retaining all molars, removing molars with furcation involvement (FI) ≥ I/ ≥ II/ III, or removing all molars. Each strategy came with different proportions of molars correctly or erroneously (false positively) removed. Retaining as well as removing molars had long-term cost implications (via SPT or tooth replacement). Using Monte-Carlo microsimulations, we estimated the lifetime costs of an average population in our cohort and evaluated what accuracy a prediction method needed to have to save costs in different risk groups. RESULTS: Removing only molars with FI III (1188 Euro) and removing no molars (1195 Euro) were significantly less costly than removing all molars (1454 Euro). Prediction methods needed to be highly specific in most populations to avoid unnecessary tooth loss and the associated high costs. CONCLUSIONS: Removing molars prior to SPT should be decided cautiously.

Duration of orthognathic-surgical treatment.

OBJECTIVE: The objective of this study was to determine the duration of orthognathic-surgical treatment conducted with conventional pre- and post-surgical orthodontic treatment phases. MATERIAL AND METHODS: The study material was comprised of the files of 185 consecutive patients treated in Oral and Maxillofacial Unit, Tampere University Hospital, Finland, in 2007-2014. The files were reviewed and the following data was obtained: gender and age of patients, ICD-10 diagnosis, type of malocclusion, duration of pre- and post-surgical orthodontic treatment and type of operation. RESULTS: Total treatment duration (median) from placement of separating rings for banding until fixed orthodontic appliances were removed and retention period started was 31.1 months, of which pre-surgical orthodontics took 24.4 months and postsurgical 6.4 months. Treatment duration (median) was in BSSO was 32.1, LeFort 1 30.1 and bimaxillary osteotomy 29.7 months. Orthodontic extractions were performed in 35 patients (19%). If the orthodontic treatment included tooth extraction, the duration of pre-surgical treatment was on average 10 months longer, which is a statistically highly significant difference (p < .001, linear regression). CONCLUSIONS: Tooth extractions (excluding 3rd molars) included in pre-surgical orthodontic treatment prolong treatment time by an average of 8-9 months.

Extraction frequencies at a university orthodontic clinic in the 21st century: Demographic and diagnostic factors affecting the likelihood of extraction.

INTRODUCTION: The aims of this study were to report contemporary orthodontic extraction frequencies at a university center and to investigate what patient-related factors might influence the likelihood of extraction. METHODS: The records of 2184 consecutive patients treated at the University of North Carolina from 2000 to 2011 were analyzed. Year-by-year rates for overall orthodontic extractions and for extraction of 4 first premolars were calculated. Logistic regression, adjusting for all recorded patient risk factors for extraction, was used to examine both the changes in extraction frequencies over time and the influence of individual patient factors on the odds of extraction. RESULTS: Small linear decreases in orthodontic extraction frequency overall (OR, 0.91; 95% CI, 0.88-0.95) and in extraction of 4 first premolars (OR, 0.95; 95% CI, 0.90-0.99) were seen. The overall extraction rate was 37.4% in 2000, and it fell just below 25% from 2006 onward. Four first premolar extraction rates ranged from 8.9% to 16.5%. Extractions were significantly more likely as crowding and overjet increased (OR, 1.2; 95% CI, 1.14-1.25; OR, 1.1; 95% CI. 1.07-1.19), as overbite decreased (OR, 0.8; 95% CI, 0.77-0.89), with Class II dental or skeletal relationships (OR, 1.5; 95% CI, 1.12- 2.05; OR, 1.4; 95% CI, 1.04-1.85), and for nonwhite patients (OR, 3.0; 95% CI, 2.2-4.06 for other races; OR, 4.1; 95% CI, 3.03-5.66 for African Americans). CONCLUSIONS: Extractions were just as likely to be associated with Class II dental and skeletal problems and with open-bite problems as with crowding alone.

Comparison of arch width changes following orthodontic treatment with and without extraction using three-dimensional models.

OBJECTIVE: To compare the arch width changes in patients treated fixed orthodontic mechanics without extraction (Group 1), with upper and lower first premolar extractions (Group 2), and with upper first premolar extraction only (Group 3). MATERIALS AND METHODS: The study was conducted with pre- and post-treatment digital models from 240 patients. Anterior, middle, and posterior distances were measured on pre- and post-treatment models. At T1 measurements, the distance among the canine cusp tips, the second premolar buccal cusp tips, and the first molar mesiobuccal cusp tips were measured. In addition, the distance (D) between the intercanine and intermolar lines and the distance (D') between the interpremolar and intermolar lines were defined on the anatomic y-axis, and this distance was maintained in calculating posttreatment measurements (T2). Mandibular and maxillary arch width changes were evaluated within and between groups. RESULTS: Anterior, middle, and posterior arch widths increased significantly in Groups 1 and 3. Maxillary anterior and middle arch widths also increased in Group 2, but the increases were not statistically significant. Changes in maxillary anterior and middle arch widths were higher in Groups 1 and 3 when compared to Group 2. However, there was no statistically significant difference in mandibular arch changes between the groups. CONCLUSION: Extraction treatment mechanics did not cause narrow dental arches, but nonextraction treatment increased arch width in all 3 measurements. Treatments with only upper arch extraction showed similar results with nonextraction treatment.