Odontogenic Infections: A 1-year Retrospective Study.

OBJECTIVES: The purpose of this study was to analyze the prevalence, demographic patterns and management of odontogenic infections in patients undergoing treatment in an outpatient dental emergency service of a university hospital. MATERIALS AND METHODS: In a retrospective study of the year 2012, all patients suffering from odontogenic infections were included. Demographic data, diagnosis and the conducted treatment were analyzed. Odontogenic infections were defined as pulpitis, apical and marginal periodontitis, abscesses and pericoronitis. RESULTS: A total of 2,058 out of 4,209 emergency patients suffered from odontogenic infections. The majority (45.0%) had an apical periodontitis, 20.8% abscesses, 17.3% a marginal periodontitis, 16.3% a pulpitis and 5.8% a pericoronitis. Mean age was 37.5 ± 17.0 years standard deviation (SD) (1.2-96.4). Most patients were 20 to 29 years (24.6%), followed by the age group of 30 to 39 year old patients (21.0%). Males were affected more frequently (55.5%) than females (45.5%). Most of the patients (64.5%) of the patients received a dental or surgical treatment. Antibiotics were prescribed in 31.7% of cases. Amoxicillin was the most common prescribed antibiotic (54.5%). CONCLUSION: Odontogenic infections represent one of the main reasons for consulting the emergency service. Due to the high number of cases and the severe complications, dentists have to be familiar with the surgical management of odontogenic infections as well as the appropriate use of antibiotics. CLINICAL SIGNIFICANCE: Nearly half of all patients who sought, treatment in the emergency service had an odontogenic infectious disease. This should be considered for the organization and planning of the service.

Number of teeth, C-reactive protein, fibrinogen and cardiovascular mortality: a 15-year follow-up study in a Finnish cohort.

AIM: To test whether the number of teeth, an inverse proxy for composite oral infection scores is associated with better survival. MATERIALS AND METHODS: The Kuopio Oral Health and Heart study initiated a case-control study in 1995-1996 consisting of 256 consecutive coronary artery disease patients and 250 age and gender-matched controls. We appended the mortality data and formulated a longitudinal study. By May 31st, 2011, 124 mortalities had occurred and 80 of which were of cardiovascular origin. Using Cox proportional hazards models, we assessed the association of the teeth group (Teethgrp) - consisting of 10 teeth - with cardiovascular and all-cause mortality after 15.8 years of median follow-up. RESULTS: In multivariate models, with the edentulous state as reference, one level increase in Teethgrp was associated with significantly increased survival from cardiovascular disease (CVD) mortality with a Hazard Ratio (HR) 0.73, p-value = 0.02 but not with all-cause mortality (HR = 0.87, p = 0.13). The findings were not mediated by C-reactive protein (CRP) levels ≥3 mg/L or by median fibrinogen levels, but were mediated by CRP levels >5 mg/L. CONCLUSION: Each increment of 10 teeth from the edentulous state was associated with a 27% improved CVD survival, independent of low-grade systemic inflammation.

Non-third molar related pericoronitis in a sub-urban Nigeria population of children.

BACKGROUND: The study will report on the prevalence, clinical presentation, diagnosis, and management of non-third molar related pericoronitis seen in children below the age of 15 years who report at the Pediatric Dental Clinic, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 4½ year period. MATERIALS AND METHODS: This is a prospective study of cases of pericoronitis affecting any tooth exclusive of the third molar diagnosed in the pediatric dentistry out-patient clinic in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and June 2012. Pericoronitis was diagnosed using the criteria described by Howe. Information on age, sex, history malaria fever, upper respiratory diseases, tonsillitis, and evidence of immunosuppression were taken. Radiographs were taken in all cases to rule out tooth impaction and information on treatment regimen was also collected. RESULTS: The prevalence of non-third molar related pericoronitis was 0.63%. More females (63.6%) were affected. Chronic pericoronitis was the most common presentation (73.3%). No case was reported in the primary dentition and the premolar. No case was associated with tooth impaction and the tooth most affected was the lower right second permanent molar (35.7%). Bilateral presentation was seen in 36.4% patients. Herpetic gingivostomatitis was reported in association with one case. Chronic pericoronitis resolved within 3 days of management with warm saline mouth bath (WSMB) and analgesics, while acute/subacute resolved within 10 days of management with antibiotics, analgesics, and WSMB. CONCLUSIONS: The prevalence of non-third molar related pericoronitis is the low. The most prevalence type is chronic pericoronitis affecting the lower right second permanent molar.

Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study.

BACKGROUND: Oral health is important both for well-being and successful elite sporting performance. Reports from Olympic Games have found significant treatment needs; however, few studies have examined oral health directly. The aim of this study was to evaluate oral health, the determinants of oral health and the effect of oral health on well-being, training and performance of athletes participating in the London 2012 Games. METHODS: Cross-sectional study at the dental clinic within the Polyclinic in the athletes' village. Following informed consent, a standardised history, clinical examination and brief questionnaire were conducted. RESULTS: 302 athletes from 25 sports were recruited with data available for 278. The majority of athletes were from Africa, the Americas and Europe. Overall, the results demonstrated high levels of poor oral health including dental caries (55% athletes), dental erosion (45% athletes) and periodontal disease (gingivitis 76% athletes, periodontitis 15% athletes). More than 40% of athletes were 'bothered' by their oral health with 28% reporting an impact on quality of life and 18% on training and performance. Nearly half of the participants had not undergone a dental examination or hygiene care in the previous year. CONCLUSIONS: The oral health of athletes attending the dental clinic of the London 2012 Games was poor with a resulting substantial negative impact on well-being, training and performance. As oral health is an important element of overall health and well-being, health promotion and disease prevention interventions are urgently required to optimise athletic performance.

Cysts and tumors associated with impacted third molars: is prophylactic removal justified?

PURPOSE: The aim of this retrospective analysis was to determine the frequency and type of cysts and tumors related to impacted third molars (ITMs) in Greek patients. Indications, complications, risks, and benefits of ITM removal are also discussed. PATIENTS AND METHODS: Over a 12-year period, 7,782 third molars were removed in 6,182 patients. RESULTS: Of the 417 specimens submitted for histopathologic examination, 167 cysts (40.04%) and 48 tumors (11.5%) were found. CONCLUSION: Surgical removal of ITMs should only be performed in the presence of specific indications. Our study confirmed that the incidence of pathologic conditions related to ITMs is relatively low (2.77%).

The prophylactic extraction of third molars: a public health hazard.

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion. In addition, more than 11 million patient days of "standard discomfort or disability"--pain, swelling, bruising, and malaise--result postoperatively, and more than 11000 people suffer permanent paresthesia--numbness of the lip, tongue, and cheek--as a consequence of nerve injury during the surgery. At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of iatrogenic injury that afflicts tens of thousands of people with lifelong discomfort and disability. Avoidance of prophylactic extraction of third molars can prevent this public health hazard.

A retrospective study of some socio-demograhic factors associated with pericoronitis in Nigerians.

BACKGROUND: Pericoronitis is an infectious disease of the operculum overlying an erupting or semi-impacted tooth particularly the lower third molars. It is a painful, sometimes debilitating and common periodontal emergency commonly found in young adults. OBJECTIVE: The purpose of this study was to determine the socio-demographic factors related to pericoronitis among Nigerians and compare these factors to other similar studies. METHODS: The patients included in this retrospective study were those who with a diagnosis of pericoronitis from January 2000 to December 2006. Socio-demographic and clinical data such as sex, age, tooth/teeth affected by pericoronitis and date of presentation were retrieved from the records of the Oral Diagnosis Clinic. RESULTS: During the study period, 373 patients presented with pericoronitis, 222 (59.5%) were female and 151 (40.5%) were male. The peak age of occurrence of pericoronitis was 19-23 years, accounting for 170 (45%) of the patients. The occurrence of pericoronitis was highest in the month of February, 67 (18%), followed by January (14.5%). The lower left third molar 169 (453%) was more affected than the lower right third molar 138 (37.1%) or combination of either lower third molars 66 (17.7%). More females 136 (68.1%) than males 64 (32.3%) were affected particularly in the younger age groups 14-23 years. CONCLUSION: Pericoronitis occurs more often in adult female Nigerians while the lower left third molar is the commonest tooth associated with this condition. Further studies are required to elicit the predisposing factors in this group of Nigerians.

Dental extraction for patients presenting at oral surgery student clinic.

The aim of this study was to examine the reasons for dental extraction and to determine the pattern of tooth loss in patients seeking care at the oral surgery teaching clinics in the Faculty of Dentistry of the University of Jordan, Amman, Jordan, over a 3-year period. Data pertaining to the dental extractions of 2435 patients were analyzed. The results showed that 63.8% of the teeth included in this study were extracted because of dental caries, 22.9% because of periodontal disease, and 11.0% for prosthetic reasons. Pericoronitis, orthodontic treatment, trauma, and eruption problems accounted for 2.4% of the reported extractions. The upper premolars were the teeth most commonly extracted, and the lower first and second molars were the teeth most commonly extracted because of dental caries. The logistic regression test revealed that extraction because of dental caries occurred mostly in the group aged 21 to 30 years (P < .001). Periodontal disease was not likely the cause of extraction in patients younger than 40 years. Mandibular incisors were the teeth least likely extracted because of dental caries (P < .001), but they were the teeth most commonly extracted because of periodontal disease (P < .001). Extraction for orthodontic reasons mostly involved the premolars (P < .05) and occurred in patients 20 years of age or younger (P < .001). Men were less likely to lose teeth because of caries and periodontal disease (P < .05 and P < .001, respectively) and were more likely to lose teeth for prosthetic reasons and trauma. The information gained from this study is useful to shift oral health planning toward emphasizing the importance of maintaining natural dentition and preventing dental disease.

Infection frequency of Epstein-Barr virus in subgingival samples from patients with different periodontal status and its correlation with clinical parameters.

OBJECTIVE: To detect the infection frequencies of different genotypes of Epstein-Barr virus (EBV) in subgingival samples from chronic periodontitis (CP) patients, and to discuss the correlation between infection with EBV and clinical parameters. METHODS: Nested-PCR assay was used to detect EBV-1 and EBV-2 in subgingival samples from 65 CP patients, 65 gingivitis patients and 24 periodontally healthy individuals. The amplicons were further identified by restriction fragment length polymorphism analysis (RFLP) with endonucleases Afa I and Stu I. Clinical parameters mainly included bleeding on probing (BOP), probing depth (PD), attachment loss (AL) in six sites of the dentition. RESULTS: In CP patients, gingivitis and periodontally healthy individuals, the infection frequencies were 47.7%, 24.6% and 16.7% for EBV-1, and 15.4%, 7.7% and 0% for EBV-2, respectively. In 2 out of the 65 CP patients co-infection of EBV-1 and EBV-2 was found. The positive rate of EBV-1 in chronic periodontitis patients was higher than that in gingivitis patients (P=0.01) and periodontally healthy individuals (P=0.01). But no significant difference was shown in EBV-1 frequency between gingivitis patients and healthy individuals (P>0.05) or in EBV-2 frequency among the three groups (P>0.05). In CP patients, higher mean BOP value was found in EBV-1 or EBV-2 positive patients than that in EBV negative ones (P<0.01), but with no statistical difference in the mean PD or AL value between EBV positive and negative patients (P>0.05). After initial periodontal treatment, 12 out of the 21 EBV-1 positive CP patients did not show detectable EBV-1 in subgingival samples. CONCLUSION: nPCR plus RFLP analysis is a sensitive, specific and stable method to detect EBV-1 and EBV-2 in subgingival samples. Subgingival infection with EBV-1 is closely associated with chronic periodontitis. Infection of EBV in subgingival samples was correlated with BOP.

The reasons for the extraction of various tooth types in Scotland: a 15-year follow up.

OBJECTIVES: The aim of this survey was to investigate the reasons for extraction of the various tooth types in Scotland. This study replicated one which was undertaken 15 years earlier. A further aim, therefore, was to identify any changes in the frequency of extraction of each tooth type in the 15 years between the two studies. METHODS: The names of every fourth dentist on the list of the Scottish Dental Practice Board were obtained. Four hundred and twenty-five general dental practitioners were asked to record permanent tooth extractions for 1 week. Data requested for each extraction were: the patient's age, gender and dental attendance pattern, the type of tooth removed and the reason for the extraction. RESULTS: Three hundred and fifty-two dentists participated (a response rate of 82.8%). There were 25% fewer teeth extracted per patient and 30% fewer per dentist than in the 1984 study. In 1999, more teeth of most types were extracted from regular attenders whereas, in 1984, more teeth of all types were extracted from irregular attenders. Premolars and first and second molars were the tooth types most frequently extracted in both surveys. In 1999 premolars were the teeth most commonly removed below 21 years of age, accounting for 57.5% of extractions in this age range. Molars accounted for 33.8% of extractions in this age range compared with 52% in 1984. Overall, caries was found to be the principal reason for loss of all tooth types apart from lower incisors which were extracted mainly for periodontal reasons. However, below 21 years, 84.5% of premolar extractions were performed for orthodontic purposes. CONCLUSIONS: Over the last 15 years, the overall number of extractions has reduced and the proportion of extractions from regular attenders has increased. Proportionately more premolars and fewer molars were extracted from under-21-year-olds. This observation can be explained by an increase in orthodontic extractions or a decline in extractions for caries in this age group. However, when extractions from the population as a whole are considered, caries and its sequelae remains the principal reason for loss of all tooth types other than lower incisors which are extracted mainly for periodontal reasons.

Pathoses associated with mandibular third molars subjected to removal.

OBJECTIVES: To measure the prevalence of disease of mandibular third molars referred for removal and to estimate the risk for development of pathoses for two cues. STUDY DESIGN: A prospective cohort study on molars subjected to removal was performed. The prevalence of different diseases and the patient's age, angular position, and degree of impaction of the molars were registered. Odds ratio for molars with different positions and impaction states were estimated. RESULTS: Pericoronitis was found in 64% of cases, caries in the third molar in 31%, periodontitis in association with 8%, caries in the second molar in 5%, and root resorption of the second molar with 1% of the molars with pathoses. Odds ratio was highest for distoangular molars (5.8) and for molars partially covered by soft tissue (6.7). CONCLUSIONS: The odds ratio is about 22 and 34 times higher for molars partially covered by soft tissue than for molars completely covered by soft or bone tissue. For distoangular molars the odds ratio is 5 to 12 times higher than for molars in other positions.

The relative importance of reasons for tooth extraction in terms of potential tooth years of life lost (PYLL).

The aim of the present study was to introduce the potential tooth years of life lost (PYLL) approach to the analysis of data showing the incidence of tooth extraction according to the reason for extraction and to illustrate its use. Six sets of data from prospective nationwide questionnaire surveys of patients treated by systematic random samples of dentists in five European countries were translated into PYLL. Response rates ranged from 25 to 81 per cent and the number of extracted teeth from 959 to 29,397, according to the study. PYLL in Norway 1988 was calculated using the ages of 85 and 80 as cut-off points, or the average sex-specific remaining life expectancy at the age of extraction; otherwise the age of 85 was used. Mean PYLL for all reasons varied from 40.6 to 46.3 years for Norway in 1988 depending on the cut-off point used. For patients aged 21 and older PYLL85 ranged from 35.7 years for France in 1984 to 42.3 years for Sweden in 1959-61. Employing PYLL changed the rank order of the reasons for extraction based on the number of extracted teeth in some instances. It combined the two dimensions 'incidence of 'potential years of tooth function lost' into a continuous quantitative variable which was easy to understand and simple to handle analytically.

An emergency dental service for students: 4-year findings.

OBJECTIVE: To describe the arrangements for the provision of emergency dental services for students at the University of Manchester and to report data collected during the first four and a half years of the student emergency dental services (SEDS) unit based at the University Dental Hospital of Manchester. METHOD: Data pertaining to every student attending SEDS since its inception were collected by means of questionnaire including provision to record diagnoses, treatment needs and the emergency care provided. RESULTS: The incidence of dental emergencies within the student population served by SEDS has been found to be 39 emergencies per 1000 students per annum, with the service being most heavily used by overseas students. Caries, pulpal pathology and failed restorations account for 46 per cent of the presenting emergencies, with pericoronitis (19 per cent) and other emergencies of periodontal origin (14 per cent) being common place. CONCLUSION: It is concluded that a student emergency dental service may be found to be an important element of student medical and related welfare services.

UK National Third Molar project: the initial report.

The National Third Molar (NTM) project was set up to assess current clinical practice in the UK concerning the management of third molar teeth. Patients were recruited from both hospital and general dental practice. During the one month study period 9248 patients with 26,577 third molars were recruited. In this report we present the findings in the 8298 patients with 25,001 third molars who were referred to hospital for assessment. Over half of all patients referred for assessment had either no extractions or a single third molar extracted. Less than a quarter of all patients referred underwent removal of all four third molars. Twenty per cent of all third molars assessed were not extracted. Of all lower third molars listed for extraction, 9574 (78%) were associated with symptoms or disease. Pericoronitis was the commonest indication for extraction and was cited in 39.5% of all extractions. Almost 70% of third molar extractions were done under general anaesthesia while less than a quarter were performed under local anaesthesia alone.

The predisposing factors of pericoronitis of mandibular third molars in a Jordanian population.

OBJECTIVES: The purpose of this study was to identify the most frequently encountered predisposing factors in relation to the etiology of pericoronitis in young adults and to compare these findings with similar studies. METHOD AND MATERIALS: The patients included in this prospective study were those presenting for treatment of signs and symptoms of pericoronitis in the mandibular third molar area during an 8-year period from 1994 to 2001. A standard check sheet of subjective and objective observations was completed, and female patients were asked about menstruation or pregnancy. Each patient with a diagnosis of pericoronitis was interviewed and observations were recorded. Patients were asked about the symptoms relating to the pericoronitis. Patients were divided into five 5-year age groups ranging from 16 to 40 years. RESULTS: During the 8-year period, 2,151 patients presented diagnosed cases of pericoronitis; 932 (43.3%) patients were male and 1,219 (56.7%) were female. The peak age of occurrence of pericoronitis varied from 21 to 25 years (55.2% of the patients). The incidence of pericoronitis was highest in September (207 [9.6%]), followed by April (181 [8.4%]); for subacute pericoronitis, the highest was in February (128 [5.95%]) and April (112 [5.2%]), followed by October (97 [4.5%]). The most frequently seen predisposing factor was upper respiratory tract infection in 815 (37.9%) patients, followed by stress in 473 (22%) patients. CONCLUSION: It was concluded that the upper respiratory tract infection was the most frequently predisposing factor, which could precipitate pericoronitis.

[4-year clinico-statistical observation of outpatients].

Clinico-statistical observations were made on the outpatients visiting the Department of Initial Diagnosis and Emergency, Faculty of Dentistry Hospital, Tokyo Medical and Dental University in 1986, 1987, 1989 and 1990. The following findings were obtained according to sex, age group, and chief complaints of new outpatients. Approximately 60% of the outpatients were female during the year examined. The number of outpatients tended to increase in March and to decrease during the winter. The largest number of new outpatients visiting the hospital was in the 20-24-year-old group in both males and females. In the female patients, the 50-54-year-old group had a relatively higher peak. The greatest chief complaint was tooth pain. Further, the chief complaint involving oral soft tissues was due to inflammation. The main disease diagnosed due to chief complaints was caries in the 20-29-year-old group, marginal periodontitis in the 50-59, pericoronitis of wisdom tooth in the 20-29, temporomandibular joint problem in the < or = 19 and masticatory disturbance in the 60 < or = -year-old groups.

Restorative needs and pathological findings in northern Manhattan dentate community.

When determining the dental health of the population, radiographic findings cannot be omitted. Nor should large groups of people be left out as this affects the results significantly.

Actuarial life-table analysis of lower impacted wisdom teeth in general dental practice.

BACKGROUND: The appropriateness of extraction of asymptomatic impacted third molars has been much debated and as a result the number of extractions has fallen in the UK in the past few years. As a direct consequence of this decrease more impacted third molars are left in situ and yet, little is known about the natural history of these teeth. OBJECTIVE: The aim of this study was to create an actuarial life-table and related survival analysis that would shed light on the natural history of an impacted lower third molar. METHODS: Panoramic radiographs taken in 14 different general dental practices in Scotland were analysed and matched with their respective case notes in order to generate a sample of patients with asymptomatic impacted lower third molars. Subjects were assessed to confirm the presence of impaction and absence of symptoms and then re-assessed 1 year later for the development of symptoms during the study period to relate the incidence of symptoms within 1 year in the sample studied to age. Logistic regression was used to construct a life table based on the survival of symptom-free teeth (independently of extraction) during the study period. RESULTS: The number of patients included in the study was 583 and 421 for the baseline and follow-up assessments respectively. The total number of teeth analysed in both appointments was 676; from those 37 (5.47%) were extracted during the study period. About 562 teeth (83.13%) survived the study period symptom-free. There was a statistically significant inverse association between the development of symptoms studied and age. There was no statistically significant association between extraction and age. CONCLUSIONS: The study indicates that older patients are less likely to develop the symptoms studied. In addition the authors believe that there is evidence to suggest that general dental practitioners might not be following current guidelines when deciding whether or not to extract an impacted lower third molar in the centres studied.

Third molar-related morbidity in deployed Service personnel.

INTRODUCTION: The minimisation of disease and non-battle injury (DNBI) is essential for maintaining efficiency in a fighting force. Third molar-related morbidity is a common cause of DNBI. With extended lines of communication in current military deployments, travelling for dental care is often subject to significant danger. MATERIAL AND METHODS: Military dental officers in Afghanistan and Iraq recorded data on patients presenting with third molar pathology. Related previous history was obtained from the individual and from the military dental records. RESULTS: Three hundred and three individuals presented during the 23 month study period; 27.7% were unable to access care immediately, most commonly citing work pressure or lack of safe transport. Of those needing to travel, 70% were moved by helicopter. Pericoronitis was diagnosed in 84.4% of cases, 20.6% of these teeth being extracted; 53.5% of patients reported no prior symptoms, 22.7% with two or more episodes. There was documented evidence in military dental records of previous problems in 29.2% of cases. 11.3% had previously been listed for extraction of the presenting tooth. DISCUSSION: Dental treatment for troops in combat situations is fraught with difficulty. Special consideration must be given to the management of third molars in military personnel.

Unerupted mandibular third molars: symptoms, associated pathologies, and indications for removal in a Turkish population.

OBJECTIVES: To analyze the occurrence of symptoms of unerupted mandibular third molars, to investigate associated pathologies, and to determine indications for removal of unerupted mandibular third molars in a Turkish population. METHOD AND MATERIALS: A retrospective study was performed by reviewing 832 patients referred to Gulhane Military Medical Academy Dentistry Center for evaluation of their mandibular third molars. The patients were clinically examined, and unerupted and partially erupted mandibular third molars were determined from radiographs. The symptoms and pathologies associated with these teeth were analyzed. The indications for removal were classified into 10 groups. RESULTS: Two-thirds of the patients were between 20 and 29 years of age. Of the 832 unerupted mandibular third molars found, 557 (66.9%) teeth were partially erupted and 275 (33.1%) were completely unerupted. A total of 521 (62.6%) of all unerupted third molars had no symptoms, while 311 (37.4%) were associated with symptoms. The most frequent complaints of the patients were pain and swelling. Pericoronitis was observed as the most frequent pathology, in 142 patients. Of 832 unerupted mandibular third molars, 582 (69.9%) had complete root formation, 177 (21.2%) had two-thirds root formation, and 73 (8.9%) had one-third root formation. CONCLUSION: Patients between 20 and 29 years of age had the highest prevalence of unerupted mandibular third molars (69.3%). However, this figure decreased with increasing age. Partially erupted teeth (n = 228) caused the occurrence of symptoms more than completely erupted teeth (n = 83) in a Turkish population.