Tonsillectomy as a risk factor of periodontitis: A population-based cohort study.

BACKGROUND: To determine whether patients who had undergone tonsillectomy would have higher risks of postoperative periodontitis. METHODS: Data were collected from the Taiwan Longitudinal Health Insurance Dataset from 1999 to 2013, a population-based cohort study consisting of cases of newly-onset sleep apnoea, chronic diseases of tonsils and adenoids, peritonsillar abscess, and periodontal diseases. A total of 1482 tonsillectomy cases and 14,796 non-tonsillectomy controls were selected. Propensity score matching37 between the tonsillectomy group and the non-tonsillectomy group was conducted to exclude the confounding effect resulting from indications of tonsillectomy. Cox proportional hazard model and subgroup analyses were conducted to identify subpopulations at risk of tonsillectomy-associated periodontitis, and a sub-outcome analysis was applied to identify the subtype of tonsillectomy-associated periodontitis. RESULTS: A total of 648 patients who had undergone tonsillectomy and 648 out of 6509 propensity score-matched controls were retrieved, among which 230 cases in the tonsillectomy group were associated with post-surgical periodontitis (adjusted HR = 1.31, 95% CI = 1.08 to 1.59). The association persisted in a subpopulation of patients with periodontitis who received mechanical and surgical treatments for periodontitis (adjusted HR = 1.33, 95% CI = 1.09 to 1.63). The incidence of periodontitis was significantly high in the individuals who underwent tonsillectomy and was particularly high in those that were below 12 years of age (HR = 1.58, 95% CI = 1.10 to 2.27). The risk of periodontitis increased 4 years after tonsillectomy (HR = 1.82; 95% CI = 1.29 to 2.59). The majority of post-tonsillectomy periodontitis was aggressive and acute periodontitis (HR = 1.37; 95% CI = 1.10 to 1.71). CONCLUSIONS: Tonsillectomy performed in pediatric patients of < 12 years old, increased the risk of developing periodontitis. Aggressive and acute periodontitis as a long-term, postoperative adverse event took place at 4 years or longer after tonsillectomy.

MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting.

OBJECTIVE: This prospective clinical study evaluated the success of vital pulpotomy treatment for permanent teeth with closed apices using mineral trioxide aggregates (MTA) in a dental public health setting. METHODS: Twenty-seven mature permanent first molars and 2 premolars (in 25 patients) with carious exposure were treated using MTA pulpotomy. Age of patients ranged from 10- to 15-years (mean=13.2±1.74-years). Four trained and calibrated practitioners performed the same clinical procedure for all patients. Following isolation and caries removal, the inflamed pulp tissue was completely removed from the pulp chamber. This was followed by irrigation with 2% sodium hypochlorite. Haemostasis was achieved using a cotton pellet damped in normal saline. A white MTA paste was placed against the pulp orifices. MTA was covered with a damped cotton pellet and a base of IRM. Patients were recalled after 1 day where a glass ionomer liner and a final restoration were placed. Teeth were evaluated clinically and radiographically for up to 47 months. RESULTS: Mean follow-up period for all teeth was 25±14 months. Twenty-six of the 29 teeth were clinically asymptomatic with no evidence of periradicular or root pathology during the follow-up period. The estimated success rate was 90%. Three teeth presented with clinical symptoms of pain and radiographic evidence of periradicular pathology that indicated root canal treatment (RCT) or extraction. CONCLUSION: When managing carious pulp exposures of permanent teeth with closed root apices in children, MTA pulpotomy showed a high success rate. CLINICAL SIGNIFICANCE: MTA pulpotomy for permanent molars in children is a viable alternative to RCT.