Do tooth gaps matter? Evaluation of self-assessments: a pilot study.

This study aimed to test the hypothesis stating no difference in number of teeth or tooth gaps counted by the dentist or the patient. The sample consisted of 49 randomly selected regular patients and their dentists (response rate 10%, 53% males). Mean age of the patients was 53.6 +/- 11.9 years. The mean number of teeth was 26.5, 20/49 reported tooth gaps (excluding second and third molars) and 12/20 had visible gaps. The calculation of patients' detection of gaps showed a sensitivity = 79%, specificity = 96% and a positive predictive value of 95%. The patients reported more teeth in the maxilla and fewer teeth in the mandible compared with their dentists. More teeth were misdiagnosed as the number of teeth increased in the mandible. Patients reported more gaps than dentists in both jaws (NS); an average of 0.04, 0.18 and 0.22 misdiagnosed gaps in the maxilla, mandible and for both jaws respectively. Agreement on tooth present/missing in the maxilla was 91.3% (+/-9.82) and in the mandible 88.2% (+/-10.44). Correlation between self-report and dentist's report of the number of teeth present and the number of gaps in the maxilla was (Pearson's r) 0.94 and 0.83. One person with self-perceived visible gaps and five persons with non-visible gaps were recommended treatment; two persons agreed about a treatment need. Self-assessments of tooth gaps show limited but acceptable sensitivity and excellent specificity. No significant differences in tooth counting were found when comparing self-reports and dentists' reports. The study should be tried on a larger scale.

Survival of single crystal sapphire implants supporting mandibular overdentures.

One hundred and sixteen sapphire (Bioceram, Kyocera) implants were inserted in 30 patients between 1984 and 1991 to support mandibular overdentures. Survival analyses were made on the basis of clinical and radiographic follow-up evaluation for 15 patients with 56 implants. For the 15 patients who were lost to follow-up, 7 of whom were deceased, reviews of records and available radiographs determined outcome and observation time. The resulting Kaplan-Meier cumulative survival rate for the sapphire implants was 68.66%, mean survival time 11.44 years, 95% confidence interval 10.56-12.32 years. Uni- and multivariate analysis using the Cox Regression model, indicated an increased risk of implant failure in patients over 60 years at time of operation, and in patients who smoke. Limited experience in implant surgery were associated with increased implant failure rate. A qualitative analysis of survived implants showed a mean annual bone loss of 0.2 mm, moderate to excellent plaque control, and excellent to good subjective global assessment of the treatment. The long-term results of the sapphire implant system used for mandibular overdenture support are inferior to other implants systems.

Public awareness, information sources and evaluation of oral implant treatment in Norway.

A nation-wide survey from a representative sample of the general Norwegian population was made in co-operation with Statistics of Norway, to assess public awareness, sources of information and evaluation of oral implants. A response rate of 70.8% was obtained. Of the general population 70.1% (95% confidence interval: 68.6-71.6%) had heard of oral implants. No specific demographic variables were associated with unawareness of oral implants. Of the general population 60.4% (95% confidence interval: 57.9-62.8%) evaluated oral implants positively and 56.7% (95% confidence interval: 54.7%-58.7%) would consider oral implants as treatment for themselves if needed, while 18.0% gave negative evaluation and 23.0% would not consider implant treatment. Logistic regression analyses indicated that young males in urban areas with high income and high educational level were most positive to oral implants. News media like newspapers and TV/radio were together with personal communications the most frequently indicated sources of information. News media were associated with negative evaluation of implants. The overall positive evaluation of oral implants suggests however that the Norwegian general public utilises several sources of information, and are able to evaluate them critically.

Acceptance and side effects of nitrous oxide oxygen sedation for oral surgical procedures.

Two hundred and forty-one treatment sessions with nitrous oxide oxygen sedation were performed in 194 patients undergoing ambulatory oral surgery procedures. Removal of mesiodentes and tooth transplants were the most frequent procedures in age groups under 13 years, while removal of impacted teeth was predominant in older age groups. Local anesthesia was used in addition to inhalation sedation in 238 sessions. Median gas volume rate was 10 l/min, median concentration 50% and median duration of procedures 31 min. In 10 sessions (4.1%) sedation was not accepted, while in 25 (10.4%) sessions the procedure could be completed with some difficulty. No potentially dangerous complications were noted. Side effects occurred in 18 sessions in 16 patients. All side effects were minor and easily handled. Logistic regression analysis revealed that failure, defined as poor acceptance and/or presence of side effects, was associated with ASA class 2 and general apprehension, especially based on previous negative experience with medical or dental treatment. Nitrous oxide oxygen sedation is a reliable, efficient and safe adjunct to local anesthesia in both healthy children and adults undergoing ambulatory oral surgery procedures.

Pattern of self-administered paracetamol and codeine analgesic consumption after mandibular third-molar surgery.

Pattern of analgesic consumption after unilateral mandibular third-molar surgery was investigated in an open study in 201 patients. All patients were supplied with six analgesic tablets containing 500 mg paracetamol and 30 mg codeine. Instructions for use were given. A mean consumption of 4.9 tablets over the 1st week and 3.6 tablets the day of operation was found. Eight (4%) patients indicated inadequate or no effect of the medication. The remaining patients were able to control pain, to a level of one-third of maximum pain, by using from one to five tablets. One hundred and thirty-two (68%) patients followed instructions with regard to start of medication. No difference in mean tablet consumption was found between compliant patients and those who delayed the intake of the first analgesic dose by more than 1 h. Predictor analysis showed the most powerful predictors to be preoperative depth of the third molar and moderate or heavy smoking. Thirteen per cent explanatory power of all predictors together was found.

Inability to work after surgical removal of mandibular third molars.

Inability to work after mandibular third-molar surgery was studied in 201 patients operated on in a specialist clinic. Mean indicated inability to work was 1.07 days; 95% confidence interval, 0.91-1.23 days; range, 0-6 days. Eighty-six (43%) patients did not indicate any reduction in working ability. Duration of operation more than 14 min, heavy smoking (> 19 cigarettes/day), and female sex were associated with prolonged inability to work. Self-administered analgesic consumption and pain scores over the first postoperative week showed positive correlations with inability to work: r = 0.44 and 0.41, respectively. Other indicators of the normal postoperative reaction were to a lesser extent associated with reduced ability to work. Total sick-leave cost in Norway associated with surgical third-molar removals, adjusted for age-related income, employment rate, treatment rate, and provider of treatment, was 46.4 million NOK per year.

Incidence of infections requiring hospitalization associated with partially erupted third molars.

A retrospective study of patients hospitalized for infections associated with partially erupted third molars during a 10-year period (1985-94) showed a total of 17 cases: 6 women and 11 men, aged 18 to 57 years. Eight patients were in the third decade. No deviation from the habits of the general population with regard to cigarette smoking and alcohol consumption or overrepresentation of general health problems was found. All infections were of pericoronal origin. Bacteriologic cultures from six patients showed mixed aerobic-anaerobic oral flora, without any penicillin-resistant strains. The incidence rate of serious orofacial infections associated with partially erupted third molars was calculated to be 0.016 cases per year per 1000 patients at risk.

Incidence of large third-molar-associated cystic lesions requiring hospitalization.

A retrospective study of patients hospitalized for treatment of cystic lesions associated with retained third molars during a 10-year period showed a total of 32 cystic lesions in 25 patients. Twelve cysts were or had been infected, and seven were detected by routine radiographic investigation. Male to female ratio was 1.8, and mean age, 44.7 years; range, 16-76 years. Three of four lesions were found in the mandible. A compromised general health situation was found in eight patients. Mean largest diameter of the lesions was 48 mm; range, 26-72 mm. No differences in patient age or size of the lesions were found between infected and non-infected cases. All cysts were treated surgically, with a complication rate of 19%. Infection and age did not influence complication rate. Crude incidence rate was 0.038 per year per 1000 at risk-that is, persons more than 16 years old with at least one retained third molar present.

Complications requiring hospitalization after third-molar surgery.

A retrospective study of patients hospitalized for complications after third-molar surgery during a 10-year period showed that of the total 19 cases, 15 presented as infections. Five admissions were attributable to surgery performed by oral surgeons, including two cases of postoperative bleeding, two infections, and one displaced root fragment. Fourteen patients admitted after surgery by general dental practitioners included 12 acute and 2 chronic infections. Apart from daily smoking, no medical problems or other risk factors were associated with the complications. According to assessments of regional volume of third-molar surgery by general dental practitioners and oral surgeons, the rates of serious postoperative infections were 2.8.10(-4) and 6.5.10(-5) cases per operation, respectively. This difference in infection rates may be explained by less surgical training and experience in general dental practice.

Predictor evaluation of postoperative morbidity after surgical removal of mandibular third molars.

The effect of several pre- and per-operative variables on indicators of postoperative morbidity was assessed in 204 patients after unilateral mandibular third-molar surgery. The variables included gender, age, use of tobacco and alcohol, state of eruption, depth and angulation of the tooth, duration of the operation, pericoronitis, and time of day of surgery. Visual analogue scales were used for patient assessment of pain and swelling and for clinical assessment of swelling. Maximum pain was indicated 6 h postoperatively and maximum swelling the first postoperative evening. The results showed a mean reduction of mouth opening capacity (trismus) of 31% the 1st postoperative day. Mean analgesic consumption was 3.7 tablets, mean number of days of inability to work 1.1, and the rate of postoperative alveolitis 1.9%. The variation of the morbidity indicators was considerable. Multiple classification analyses showed that the predictors explained from 17% (clinically assessed swelling) to 8% (pain 6 h postoperatively) of the variance of these indicators. It is concluded that these commonly used predictors only to a minor extent can explain the wide variation in postoperative morbidity after mandibular third-molar surgery.

Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon.

Per- and post-operative indicators in 25 patients who had lower third-molar surgery performed by 4 general practitioners (GP) in their own practices were compared with those of a control group of 25 patients operated on by an oral surgeon. The preoperative variables age; sex; general health; use of medications, alcohol, and tobacco; and depth, position, and presence of infection of the third molar were considered in individual matching of the patients. The operations performed by the GPs lasted 17.9 min (p = 0.0001) longer than those of the oral surgeon. Increased rates of postoperative alveolitis (p = 0.03) and secondary healing (p = 0.0005) were found in the GP patient group, as was a tendency for increased postoperative pain and consumption of strong analgesics. The number of days unable to work was 1.9 in the GP group, compared with 0.6 in the surgeon group (p = 0.0012). No differences in swelling and trismus were found.

General practitioners' and dental students' decisions on third-molar diagnoses, treatment, and referrals.

A questionnaire on third-molar problems was mailed to a systematic random sample of 200 Norwegian general dental practitioners in November 1991. The return rate was 88%. Similar questions were given to 59 5th-year dental students, with a return rate of 83%. Ten third-molar cases were presented by means of copies of radiographs and written information. The following conclusions were drawn: Apart from a terminology problem consisting of lack of discrimination between the terms retention and impaction, overall good diagnostic abilities were shown by both practitioners and students. Receiver operating characteristic analysis of treatment decisions indicated that students were more radical than practitioners. The students had an increased referral rate for third-molar surgery, whereas the practitioners indicated a more selective practice of referring advanced cases.

Symptoms and lesions associated with retained or partially erupted third molars. Some variables of third-molar surgery in Norwegian general practice.

A questionnaire on third-molar problems was mailed to a systematic random sample of 200 Norwegian general dental practitioners in November 1991. A 88% return rate was obtained. The following conclusions were drawn: on an average, 3.8 patients with lesions or complaints from retained or partially erupted third molars were seen in general practice in 1 month, and most of these consultations were associated with partially erupted third molars. A mean of 1.3 surgical removals of third molars was performed in general practice in 1 month. The mean one-way travel time for patients to specialists in oral surgery was 1.3 h, and variations were not related to surgical activity in practice. Fourteen per cent of the general practitioners refer surgical cases to non-specialists.

Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated.

Third molars in Norwegian general dental practice.

A questionnaire containing 37 questions on oral surgery was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. A selected part of the questionnaire was also presented to all 5th-year dental students in Bergen and Oslo. The total return rate was 43%. From the 17 questions dealt with in this paper the following conclusions were drawn: Norwegian general practitioners' attitudes towards indications for third-molar removal are in general agreement with the current conservative approach. Norwegian 5th-year dental students had more radical attitudes. Norwegian general practitioners indicated the use of adequate technical measures when surgically removing third molars in practice. Every month 4.3 patients presented to general practice with symptoms or findings indicating removal of an impacted or partially erupted third molar. This suggests that in 1 year a situation indicating third-molar removal will occur in 20% of the patients who have third molars.

The use of a visual analogue scale in observer assessment of postoperative swelling subsequent to third-molar surgery.

Postoperative swelling after mandibular third-molar surgery was evaluated in 40 patients. Three-dimensional metric measurement of swelling was compared with observer assessment of swelling from clinical examination, from pairs of en-face photographs, and from patient self-assessment, all using a 50-mm visual analogue scale (VAS) for registration. The photographs were evaluated by two groups of observers: general practitioners (n = 5) and oral surgeons (n = 5). The following conclusions were drawn: observer assessment of swelling from clinical examination and from judgement of photographs underestimates large swelling and slightly overestimates small or no swelling compared with objectively measured swelling. General practitioners and oral surgeons assess swelling from photographs almost identically, with a slight tendency for more underestimation of large swelling by the younger oral surgeons. A 50-mm VAS seems sufficiently reliable for assessment of swelling.

Visual analogue scale assessment of postoperative swelling. A study of clinical inflammatory variables subsequent to third-molar surgery.

Subsequent to removal of impacted lower third molars the interrelationship of four postoperative variables (swelling, pain, trismus, and dysphagia) was assessed. Patient assessment of postoperative swelling using a visual analogue scale (VAS) was easily accepted by a group (n = 40) of patients aged 17 to 46 years. A significantly positive correlation (r = 0.66, p less than 0.01) existed between metric extraoral swelling and VAS-assessed swelling; however, the latter may represent a more sensitive method when swelling is discrete. Both extraorally and VAS-assessed swelling showed no correlation with dysphagia and VAS-assessed pain. Trismus correlated moderately positively with pain and extraoral swelling (r = 0.38, p less than 0.05) and dysphagia (p less than 0.01). In the present study dysphagia showed no correlation with pain. This study shows that registration of postoperative swelling by means of a VAS may be a sensitive and accurate method with obvious practical advantages.

Red bone marrow doses, integral absorbed doses, and somatically effective dose equivalent from four maxillary occlusal projections.

Phantom measurements of red bone marrow (RBM) doses, integral absorbed doses, and somatically effective dose equivalent (SEDE) from four different maxillary occlusal projections are presented. For each projection, different combinations of focus-skin distances and tube potentials were compared with regard to the patient's radiation load. The axial incisal view produced the highest patient exposures, with a maximum red bone marrow dose of 122.5 microGy/exposure, integral absorbed dose of 8.6 mJ/exposure, and SEDE values of 39.6 microSv/exposure. The corresponding values from the frontal, lateral occlusal, and tuber views ranged between 4% and 44% of the axial incisal view values for the integral absorbed dose and SEDE values, and between 0.3% and 3% for the red bone marrow doses. Increasing the focus-skin distance from 17.5 cm to 27 cm is accompanied by a 24% to 30% reduction in integral absorbed dose. Increasing the tube potential from 50 kV to 65 kV likewise results in a 23% reduction in absorbed energy.

Changes of lateral soft tissue profile after surgical correction of mandibular prognathism.

The lateral soft tissue profile was recorded in 10 patients with slight to moderate degrees of mandibular prognathism, preoperatively, and 6 weeks after subcondylar sliding osteotomy had been performed. The recording method was mechanical. Only small and insignificant profile changes were found in the submandibular and occlusal plane regions as well as in the ramus region. The only significant change of profile was found in the mandibular body region, probably as a result of firm connection between soft tissue and underlying distally moved bone. The lack of significant profile change in the osteotomy region was in accordance with subjective observations and was probably due to local remodelling and adaptation processes. The facial width was thus found to be unaltered 6 weeks postoperatively.