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

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

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

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

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

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

The effect of chronic dental inflammation on development of Stage 0 medication-related osteonecrosis of the jaw.

OBJECTIVE: The pathogenesis of medication-related osteonecrosis of jaw (MRONJ) is poorly understood. The aim of this prospective study was to determine the effect of chronic dental inflammation on the development of Stage 0 MRONJ based on histopathological findings. METHODS: The study involved patients with a history of bisphosphonate use and an indication for tooth extraction. Before surgery, C-terminal telopeptide test (CTX) values were collected from all patients. All tooth extractions were performed according to a determined protocol. To detect whether any medication-related osteonecrotic changes were present in the non-exposed bone, biopsy samples were taken from the alveolar bone. RESULTS: A total of 50 patients were included in the study (39 women and 11 men). The patients were mean age of 57.4 ± 12.1 years. In total, 74 teeth were extracted (29 maxillary and 45 mandibular). Histologic examination of three patients (6%) revealed Stage 0 MRONJ. Postoperatively, the complete mucosal healing success rate was 96%. MRONJ risk was not significantly correlated with low CTX value (p = 0.285). CONCLUSIONS: Chronic inflammation may contribute to Stage 0 MRONJ; however, its role may not be sufficient alone for its development. Application of a predetermined protocol for dentoalveolar processes will help to prevent MRONJ development.

The potential of positron emission tomography/computerized tomography (PET/CT) scanning as a detector of high-risk patients with oral infection during preoperative staging.

OBJECTIVE: It is sometimes difficult to determine during the preoperative period whether patients have oral infections; these patients need treatment to prevent oral infection-related complications from arising during medical therapies, such as cancer therapy and surgery. One of the reasons for this difficulty is that basic medical tests do not identify oral infections, including periodontitis and periapical periodontitis. In this report, we investigated the potential of positron emission tomography/computerized tomography (PET/CT) as a diagnostic tool in these patients. STUDY DESIGN: We evaluated eight patients during the preoperative period. All patients underwent PET/CT scanning and were identified as having the signs of oral infection, as evidenced by (18)F-fludeoxyglucose (FDG) localization in the oral regions. Periodontal examination and orthopantomogram evaluation showed severe infection or bone resorption in the oral regions. RESULTS: (18)F-FDG was localized in oral lesions, such as severe periodontitis, apical periodontitis, and pericoronitis of the third molar. The densities of (18)F-FDG were proportional to the degree of inflammation. CONCLUSIONS: PET/CT is a potential diagnostic tool for oral infections. It may be particularly useful in patients during preoperative staging, as they frequently undergo scanning at this time, and those identified as having oral infections at this time require treatment before cancer therapy or surgery.

Effect of Eruption Status of the Mandibular Third Molar on Distal Caries in the Adjacent Second Molar.

PURPOSE: To analyze the effect of the eruption status of the mandibular third molar (MTM) on distal caries in the mandibular second molar (MSM) by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Five hundred CBCT images of MTMs from 469 patients were evaluated. Presence of distal caries in MSMs, impaction depths and angulations of MTMs, cementoenamel junction (CEJ) distances between distal MSMs and mesial MTMs, presence of pericoronitis in MTMs, and patient characteristics (age and gender) were assessed. Data were analyzed by χ(2) test, univariate and multivariate logistic regression analyses, and Spearman correlation analysis. Descriptive and bivariate statistics were computed and the P value was set at .05. RESULTS: The overall prevalence of distal caries in the MSM was 52.0%. According to the classification of Pell and Gregory, position A was the impaction depth at which most distal caries in MSMs were present (P = .036). For angulation of the MTM, when mesial angulations were 43° to 73°, MSMs developed more distal caries (P < .0001). For the CEJ distance between the distal MSM and the mesial MTM, when distances ranged from 6 to 15 mm, distal caries in MSMs occurred more frequently (6 to 8 mm, P < .0001; 8 to 15 mm, P = .037). Furthermore, there was a linear correlation between angulation of the MTM and the CEJ distance between the distal MSM and the mesial MTM (P < .0001). CONCLUSIONS: Impaction depth and angulation of the MTM are associated with distal caries in the MSM. Angulation of the MTM is more stable and reliable than the CEJ distance between the distal MSM and the mesial MTM for the estimation of risk factors related to the MTM.

Assessment of pain among a group of Nigerian dental patients.

BACKGROUND: Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients' level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients. METHODS: A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales. RESULTS: Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and pericoronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85. CONCLUSION: It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with patients with multiple diagnoses experiencing more severe pain, and there is a correlation between the VAS and FCT for pain assessment among dental patients.

Osteomyelitis of the condyle secondary to pericoronitis of a third molar: a case and literature review.

In this study, we report a very unusual case of a patient with osteomyelitis of the condyle secondary to pericoronitis of an impacted third molar. The patient was treated by removal of the impacted third molar, opening of the drainage, combined with systemic application of antibiotics for two weeks. This treatment option did not lead to any functional defects or facial asymmetry. The patient fully recovered and the disease did not recur.

Differential diagnosis of orofacial pain and temporomandibular disorder.

When a patient complains of orofacial pain, health care providers must make a correct diagnosis. Doing this can be difficult, since various signs and symptoms may not be specific for 1 particular problem or disorder. One initially should formulate a broad differential diagnosis that can be narrowed after analysis of the history and examination. In this article, orofacial pain is categorized as being caused by: intracranial pain, headaches, neuropathic pain, intraoral pain, temporomandibular disorder, cervical pain, pain related to anatomically associated structures, referred pain, or mental illness.

Comparison of buccal infiltration of 4% articaine with 1 : 100,000 and 1 : 200,000 epinephrine for extraction of maxillary third molars with pericoronitis: a pilot study.

We compared the buccal infiltration of 4% articaine with 1 : 100,000 or 1 : 200,000 epinephrine without a palatal injection for the extraction of impacted maxillary third molars with chronic pericoronitis. This prospective, double-blind, controlled clinical trial involved 30 patients between the ages of 15 and 46 years who desired extraction of a partially impacted upper third molar with pericoronitis. Group 1 (15 patients) received 4% articaine with 1 : 100,000 epinephrine and group 2 (15 patients) received 4% articaine with 1 : 200,000 epinephrine by buccal infiltration. None of the patients in group 1 reported pain, but 3 patients in group 2 reported pain, which indicated a need for a supplementary palatal injection. The palatal injections were all successful in eliminating the pain. Two additional patients in group 2 experienced pain when the suture needle penetrated their palatal mucosa. Based on these results, 4% articaine with 1 : 100,000 epinephrine was found to be more effective for the removal of upper third molars in the presence of pericoronitis than 4% articaine hydrochloride with 1 : 200,000 epinephrine when only a buccal infiltration was used.

Assessment of factors associated with surgical difficulty during removal of impacted maxillary third molars.

PURPOSE: Estimating the difficulty of removing third molars is a common dilemma. However, the estimation of the difficulty associated with maxillary third molar surgery has not yet been defined. The aim of the present study was to determine the degree of difficulty and identify predictor variables associated with the occurrence of difficulty in the removal of impacted maxillary third molars. MATERIALS AND METHODS: A prospective cohort study was carried out involving patients who underwent at least 1 surgical removal of an impacted maxillary third molar at the Oral and Maxillofacial Surgery Unit, University of Pernambuco (Pernambuco, Brazil). Predictor variables indicative of surgical difficulty were classified by their demographic, clinical, and radiographic aspects. Degree of surgical difficulty was categorized as low, moderate, or high based on the surgical technique used. Descriptive and bivariate statistics were computed. RESULTS: In total, 106 patients fulfilled the eligibility criteria and 204 surgeries were performed. Patients' mean age was 22.8 ± 2.2 years and the proportion of women to men was 3:1. Approximately 20% of patients were overweight. Surgical difficulty was generally low and 5 variables were significantly associated with the occurrence of a high degree of surgical difficulty. CONCLUSION: Surgical difficulty during the removal of impacted maxillary third molars is generally low. However, for cases with a high degree of difficulty, identification of predictor variables may be useful for students and inexperienced clinicians to consider the decision not to execute the procedure, thus avoiding complications that often require complex management.

Variables preoperatorias e intraoperatorias asociadas al aumento del tiempo quirúrgico en la exodoncia de terceros molares inferiores / Pre-surgical and surgical factors related to increase of surgical time in lower third molar remove

Introducción: La exodoncia de tercer molar es un procedimiento frecuente en odontología, lo que exige conocer los factores que pueden anticipar el tiempo quirúrgico y sus características. El objetivo de esta investigación es conocer los factores asociados al aumento del tiempo quirúrgico (ATQ) en la exodoncia de terceros molares inferiores (3M). Material y método: 145 sujetos de entre 15 y 40 años fueron seleccionados desde tres centros quirúrgicos de Temuco (Chile), en los que fueron realizados 158 cirugías; todos los pacientes consultaron por exodoncia de tercer molar siendo operados en tales centros. Las variables del paciente, del diente y de la cirugía fueron estudiadas; la información fue analizada con el paquete estadístico Stata 9.1, empleando en test de Fisher y chi cuadrado con p<0,05 para establecer significado estadístico. Resultados: el tiempo quirúrgico para cada cirugía fue menor de 20 minutos en el 50% de los casos y menor a 30 minutos en el 75% de los casos. La edad del paciente, la posición del tercer molar, la presencia de pericoronaritis y la anatomía desfavorable de las raíces de 3M fueron significativamente asociadas con ATQ (p<0,05); la realización de colgajo mucoperióstico, osteotomías y secciones corono radiculares también fueron asociadas al ATQ (p<0,05) Conclusión: factores como la edad del paciente, experiencia del cirujano, posición del molar, pericoronaritis y fusión radicular contribuyeron al ATQ (AU)

Introduction: Everyday, the third molar's surgery is more frequent. That fact makes necessary to know the factors that allow to anticipate the surgical time and its characteristics. The aim of this research was to know the pre-surgical and surgical factors associated with the increase of the surgical time (IST) of the mandibular third molar (3M)'s surgery. Methodology: 145 subjects between the 15-40 years-old were selected from three surgical centers of Temuco (Chile). In this enclousures 158 surgeries were realized. All of the patients consulted by a 3M' s surgery, being put under surgical extraction in this centers. Variables from the patients, tooth and surgery itself were studied. The information were analyzed in the Stata 9.1 statistical package, utilizing the Fisher Test and Chi-Square Test, with p<0,05 for statistical significance. Results: The surgical time used in the surgery was minor of 20 minutes in the 50% of the cases and minor of de 30 minutes in the 75 % of the cases. The patient's age, the molar's position, the presence of pericoronaritis and the 3M' s root anatomy were significantly associated with a IST (p<0,05), of equal way the flap elevation, osteotomy and coronal orroot section had statistical significance with IST (p<0,05). Conclusion: Factors like the patient's age, molar's position, surgeon's experience, pericoronaritis and the root fusion contribute significantly to and IST (AU)

Assessment of factors associated with surgical difficulty during removal of impacted lower third molars.

PURPOSE: The aim of the present study was to adjust a multivariate model to explain each of the response variables for the occurrence of surgical difficulty during the removal of impacted lower third molars. PATIENTS AND METHODS: A prospective cohort study was carried out involving patients submitted to at least one surgical removal of an impacted lower third molar. A total of 285 patients fulfilled the eligibility criteria and 473 surgeries were performed. Preoperative variables indicative of surgical difficulty were recorded. All surgical procedures were performed under the same conditions by two surgeons who were unaware of the data collected in the pre-selection phase. Either Pearson's chi-square test or Fisher's exact test was used for the data analysis (P<5.0%). RESULTS: Root number (P((1)) < 0.004*) and morphology (P((1)) < 0.031*), tooth position (P((1)) = 0.001*), periodontal space (P((2)) < 0.004*) and second molar relation (P((1)) = 0.001*) were significant predictors of surgical difficulty, whereas patient age (P((1)) = 0.097), gender (P((1)) = 0.470), body mass index (P((1)) = 0.719), associated pathologies (P((1)) = 0.237), relation with mandibular canal (P((1)) = 0.384) and width of 3rd molar crown (P((1)) = 0.154) were not significant predictors. CONCLUSION: Many factors contribute to surgical difficulty, but considering these factors individually, some are only determinants of either difficulty or complications. Thus, not all significant predictors of surgical difficulty should be considered indicators of complications.

Visible third molars as risk indicator for increased periodontal probing depth.

PURPOSE: To assess the relationship between visible third molars and the periodontal status of teeth more anterior in the mouth from reports that included periodontal probing data for all teeth. MATERIALS AND METHODS: Each of 4 reports that included periodontal probing data, 6 probing sites for all teeth, including third molars collected by trained, clinician examiners, were briefly summarized. The design, strengths, and weaknesses of each of the 4 studies were compared and summarized. A Forest plot was used to combine the findings from the 4 studies comparing the mean second molar probing depth differences in mm by the presence of at least 1 visible third molar or no visible third molar. RESULTS: A review of the data from 4 reports, 1 from middle-age adults and 3 from young adults, suggested an association between the visible presence of a third molar and increased periodontal probing depths on teeth more anterior in the mouth, predominately the first and second molars. Coupled with the probing depth around the third molars, the result was an expanded surface area at the biofilm-gingival interface. CONCLUSIONS: Although all those with retained third molars are not at increased risk, the summary data we have reported suggest that those with a visible third molar are more likely to have greater periodontal probing depths overall, particularly on second molars, and a greater surface area of the biofilm-gingival interface compared with those with no visible third molar.

Second molar periodontal inflammatory disease after third molar removal in young adults.

PURPOSE: To assess the prevalence of periodontal inflammatory disease on the distal side of second molars after third molar removal and the association between presurgical and surgical variables and postsurgical periodontal outcomes. PATIENTS AND METHODS: Data before and after surgery from 2 studies approved by an institutional review board were used. In 1 study, 26 subjects had 4 asymptomatic third molars and in the other 49 subjects had at least 1 mandibular third molar with symptoms of pericoronitis. Full-mouth periodontal probing data, 6 sites per tooth, were obtained as a measurement of periodontal status before and after surgery. A probing depth (PD) ≥4 mm on either of the 2 possible probing sites on the distal side of any second molar (D2M) served as an indicator of periodontal inflammatory disease; periodontal health was defined as all D2M PD <4 mm. Cochran-Mantel-Haenszel row mean score tests compared the subjects' postsurgical periodontal status (all D2M PD <4 mm and at least 1 D2M PD ≥4 mm) with respect to age and time intervals, and the Fisher exact test was used to compare ethnicity, gender, and clinical data at surgery. The McNemar test was used to assess the discordance between subjects' pre- and postsurgical periodontal status. The level of significance was set at .05. RESULTS: Of the 75 subjects, 52% were women and 65% were white. The median age at surgery was 23.6 years (interquartile range, 20.9 to 26.6 years). At enrollment, 53 of 75 subjects (71%) had at least 1 D2M PD ≥4 mm. Subjects were significantly more likely to have an improved D2M periodontal status after surgery than a deteriorated status (P < .01). Fewer subjects, 17 of 75 (24%), had at least 1 D2M PD ≥4 mm after surgery. D2M PD ≥4 mm was more likely after surgery if presurgical D2M was PD ≥4 mm (P < .01). Gender, ethnicity, age, presurgical symptoms, and data estimating the extensiveness of surgery were not significantly associated with postsurgical D2M periodontal outcomes. CONCLUSIONS: After third molar removal, periodontal inflammatory disease on the distal of D2Ms was detected significantly less often. None of the variables examined except for presurgical presence of D2M PD ≥4 mm were significantly associated with postsurgical D2M periodontal inflammatory disease.

Validation of a dental pain screening questionnaire in a semi-urban hospital setting in South India.

AIMS: To assess the validity of modified DePaQ items in correctly classifying dental pain patients into three groups of common dental conditions when compared against clinically-determined classification; generate a model of classification equations from a sub-population of the sample; and assess the validity of the model in predicting group membership of new dental pain cases. METHODS: Consecutive adult hospital dental patients aged 18 years and older attending with a dental pain complaint were diagnosed by a dentist. Before treatment commenced a self-complete questionnaire was completed. The examining dentist was blinded to the questionnaire responses. The sample was randomly split into two groups (RS1 and RS2). Discriminant analysis was carried out on RS1 to develop a model for classifying new dental pain cases into three groups. This model was used to classify dental pain cases in RS2. RESULTS: Of the 311 questionnaires distributed, 306 (98.4%) were returned. Of the 205 Group 1 cases diagnosed clinically 186 (90.7%) were correctly predicted as belonging to that group by M-DePaQ. For 54 clinically diagnosed Group 2 cases 44 (81.5%) were correctly predicted, and for 32 Group 3 cases, 26 (81.3%) were correctly predicted. The model of classification equations derived from RS1 were capable of correctly classifying 85%, 82% and 79% of clinically-derived classification for Group 1, 2 and 3 respectively. CONCLUSIONS: This study has demonstrated that the M-DePaQ is valid in classifying dental pain patients into three groups of common dental conditions. Classification equations generated from a sub-group of the sample provided a valid statistical model for classifying dental pain cases from the same setting.