Radiographic Detection Rate of Distal Surface Caries in the Mandibular Second Molar in Populations with Different Third Molar Management Strategies: A Multicenter Study.

Background: Distal surface caries (DSC) has been associated with partially erupted impacted third molars. The purpose of this study was to compare the rates of DSC between populations that had undergone different third molar management strategies. Methods: Radiographs that had been taken during routine examinations of 1012, 251 and 250 patients in Manchester, Bucharest and Amsterdam, respectively, were evaluated. The following parameters were assessed: the state of the distal surface in the second mandibular molar, loss of periodontal support, impaction type of the third molar, contact point localization, and patients' genders, ages and their cumulative history of dental health. Results: The rate of DSC in the second mandibular molar was 63.9%, 19.9% and 26.0% in the Manchester, Bucharest and Amsterdam populations, respectively. A loss of lamina dura of ≥2 mm, increased percentages of decayed, missing or filled teeth and male gender were risk factors in all three populations. All assessed parameters apart from the site of the mandible reached statistical significance in the Manchester sample (p < 0.001). The DSC rate was cumulative with increasing age in the Manchester population, in which third molars were strategically retained. Conclusions: The UK population, treated according to strict guidelines that limit the removal of third molars, had a statistically significant higher DSC prevalence rate (p < 0.001) than the Romanian or Dutch populations. The active surgical management of mandibular third molars seems to have the potential to reduce the DSC rate in the adjacent second molar.

Historical aspects about third molar removal versus retention and distal surface caries in the second mandibular molar adjacent to impacted third molars.

This paper provides an insight into the historical recommendations regarding removal of mandibular third molars, as set out by the Royal College of Surgeons of England and the National Institutes of Health in the USA, as well as regional guidance from the National Institute for Health and Care Excellence and the controversy that surrounds surgical removal of third molars. The influences of third molar management as it developed in the UK, the historical economic evaluations, and the available evidence base on third-molar removal versus retention are described. This article seeks to address the growing concerns regarding the increasing frequency of distal surface caries (DSC) in mandibular second molar teeth when the decay is associated with asymptomatic, partially erupted, mandibular third molars, especially when they are mesially or horizontally impacted. Lastly, we illustrate radiographs of patients affected by DSC and how guidance that has been issued by a guideline institution regarding third molar surgery, even though it is based on insufficient evidence, is perceived as a strictly compulsory clinical strategy, and has been used in clinical practice in the UK for more than 20 years.

Parameters associated with radiographic distal surface caries in the mandibular second molar adjacent to an impacted third molar.

BACKGROUND: To determine the risk factors for the development of radiographic distal surface caries (rDSC) in patients who attend routine dental check-ups during an era of National Institute for Health Care Excellence third molar surgery guidelines. METHODS: Radiographs taken during routine dental examinations involving 1012 patients from Manchester, UK were accessed. Clinical parameters, oral health, patient demographics, and socioeconomic factors were assessed. Risk factors were identified by multivariate logistic regression analysis. RESULTS: The detected rate of rDSC was 63.9% and rDSC was distributed homogenously across all five socioeconomic groups (p = 0.425). Risk factors associated with rDSC (p < 0.001) were identified as partially erupted mesio-angularly impacted mandibular third molars, third molars with compromised molar to molar contact points, loss of lamina dura of ≥ 2 mm, male gender, increasing age, and a higher modified Decayed Missing Filled Tooth score. CONCLUSION: rDSC was significantly associated with the angulation of third molars, the compromised contact position of the adjacent third molar, the periodontal status of the distal aspect of the second molar and the cumulative history of oral health in a population governed by specific third molar guidelines. An active approach to third molar surgical management could reduce rDSC and serve this population, irrespective of patients' socioeconomic or deprivation status.

Distinct microbiome profiles in convergent wisdom tooth impactions.

AIMS: Long-term retention of impacted third molars (wisdom teeth) is associated with plaque stagnation and the development of caries on the adjacent surface of the neighboring second molar. While caries and tooth loss are common outcomes of impaction, there is currently insufficient evidence to support the pre-emptive removal of asymptomatic wisdom teeth. Emerging evidence suggests that convergently growing impactions are associated with caries. We have therefore investigated the composition of dental plaque on the distal surface of the mandibular second molar at various impaction angles. METHODS AND RESULTS: We have compared the microbiome of these surfaces at four impaction angulations using short-read sequencing of the bacterial 16S rRNA gene: two convergent (horizontal and mesial) and two divergent (distal and vertical) angulations, and in cases where the wisdom tooth is missing. Horizontal angulations exhibited lower microbial diversity than mesial impactions. Amplicon Sequence Variants (ASVs) associated with Veillonella were significantly more abundant at impactions with angulations toward the midline. Using machine learning, a random forest classifier trained to distinguish microbiome profiles was used to predict the native angulations for a subset of samples, with samples from the two convergent impactions estimated with the greatest accuracy. CONCLUSIONS: Differences in microbial diversity were apparent between caries-associated convergent (horizontal and mesial) impacted wisdom teeth, as well as greater abundances of Veillonella ASVs at horizontal impactions.

Clinical and histopathological differential diagnosis of Laugier-Hunziker syndrome: An extremely rare case with unusual extensive oral hyperpigmentation.

Laugier-Hunziker syndrome is a rare and benign disorder characterized by hyperpigmentation of the lips and buccal mucosae with associated longitudinal melanonychia of nails. Clinical correlation is needed to rule out other pigmentary disorders.

Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth.

BACKGROUND: Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is the surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is performed in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an review originally published in 2005 and previously updated in 2012 and 2016. OBJECTIVES: To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 May 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2019, Issue 4), MEDLINE Ovid (1946 to 10 May 2019), and Embase Ovid (1980 to 10 May 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov)and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. . SELECTION CRITERIA: We included randomised controlled trials (RCTs), with no restriction on length of follow-up, comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We also considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS: Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently and in duplicate conducted the risk of bias assessments. When information was unclear, we contacted the study authors for additional information. MAIN RESULTS: This review update includes the same two studies that were identified in our previous version of the review: one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom, and one prospective cohort study, which was conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low- to very low-certainty evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effects of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal aspect of the adjacent second molar during a follow-up period of three to over 25 years. Very low-certainty evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure any of our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). AUTHORS' CONCLUSIONS: Insufficient evidence is available to determine whether asymptomatic disease-free impacted wisdom teeth should be removed or retained. Although retention of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is very low certainty. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the current lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision-making with people who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain these teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.

A systematic review of second molar distal surface caries incidence in the context of third molar absence and emergence.

Objective The aim of this systematic review was to gain a greater insight into the incidence rates of distal surface caries (DSC) on second permanent molars.Data sources A literature search using the Cochrane Library, Lilacs, Embase and Medline via Ovid retrieved English and non-English language articles from inception to June 2016. The electronic searches were supplemented with reference searching and citation tracking. Reviewers independently and in duplicate performed data extraction and completed structured quality assessments using a validated risk of bias tool for observational studies and categorised the summary scores.Data selection The search yielded 81 records and, after application of inclusion and exclusion criteria, two incidence studies were included in this systematic review.Data extraction The DSC incidence was reported in one study as relative risk (RR = 2.53; 95% CI, 1.55 to 4.14) adjacent to erupted, (RR = 0.83; 95% CI, 0.11 to 6.04) soft tissue impacted and (RR = 1.44; 95% CI, 0.55 to 3.72) bony impacted third molars in comparison to when the third molar was absent with a 25-year follow-up. The second study reported a DSC incidence of 100 surface-years (1% of all sites) with an 18-month follow-up period.Conclusions Both cohort studies indicated that DSC incidence was higher when third molars were erupted in the intermediate term, but greater over the long term for an ageing male population. However, further high-quality research is required to improve the accuracy of these findings.

Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth.

BACKGROUND: Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. OBJECTIVES: To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 24 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE Ovid (1946 to 24 May 2016) and Embase Ovid (1980 to 24 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing and unpublished studies to 24 May 2016. We imposed no restrictions on language or date of publication in our search of electronic databases. SELECTION CRITERIA: Studies comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We included randomised controlled trials (RCTs) with no restriction on length of follow-up, if available. We considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS: Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently conducted risk of bias assessments in duplicate. When information was unclear, we contacted study authors for additional information. MAIN RESULTS: This review includes two studies. The previous review included one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom; our new search for this update identified one prospective cohort study conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low to very low quality evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures.One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effect of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal of the adjacent second molar during a follow-up period of three to over 25 years. Very low quality evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth.One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch.The included studies did not measure our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). AUTHORS' CONCLUSIONS: Insufficient evidence is available to determine whether or not asymptomatic disease-free impacted wisdom teeth should be removed. Although asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is of very low quality. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision making with patients who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.