Multitaper Spectrum Analysis of Consonants Produced by Patients With Dentofacial Disharmonies.

PURPOSE: This study investigates differences in American English consonants produced by patients who present with various dentofacial disharmonies (DFDs), including severe overbites (Class II), underbites (Class III), and anterior open bites. Previous studies have found that patients with these malocclusion types all produce lingual sibilants and plosives with increased spectral center of gravity and increased spectral variance relative to controls. This result is puzzling since some DFD groups differ from controls in opposite ways, and it is also difficult to interpret because spectral moment measures are affected by a wide range of speech and nonspeech factors. METHOD: To better understand the articulatory basis of these differences, we apply articulatorily interpretable spectral measures derived from multitaper spectra. RESULTS: We find that all groups of DFD patients produce /s ʃ t tʃ/ with midfrequency spectral peaks that are less prominent than those of the control group, but peak frequency measures are largely the same across all groups. CONCLUSION: We conclude that the DFD patients differ more in sibilant noise source properties than in front cavity filter properties.

Impacts of Development, Dentofacial Disharmony, and Its Surgical Correction on Speech: A Narrative Review for Dental Professionals.

Speech is a communication method found only in humans that relies on precisely articulated sounds to encode and express thoughts. Anatomical differences in the maxilla, mandible, tooth position, and vocal tract affect tongue placement and broadly influence the patterns of airflow and resonance during speech production. Alterations in these structures can create perceptual distortions in speech known as speech sound disorders (SSDs). As craniofacial development occurs, the vocal tract, jaws, and teeth change in parallel with stages of speech development, from babbling to adult phonation. Alterations from a normal Class 1 dental and skeletal relationship can impact speech. Dentofacial disharmony (DFD) patients have jaw disproportions, with a high prevalence of SSDs, where the severity of malocclusion correlates with the degree of speech distortion. DFD patients often seek orthodontic and orthognathic surgical treatment, but there is limited familiarity among dental providers on the impacts of malocclusion and its correction on speech. We sought to review the interplay between craniofacial and speech development and the impacts of orthodontic and surgical treatment on speech. Shared knowledge can facilitate collaborations between dental specialists and speech pathologists for the proper diagnosis, referral, and treatment of DFD patients with speech pathologies.

Impacts of anterior-posterior jaw disproportions on speech of dentofacial disharmony patients.

BACKGROUND/OBJECTIVES: Articulation problems impact communication, development, and quality of life, and are diagnosed in 73-87% of patients with Class II Dentofacial Disharmony (DFD). We evaluated whether differences exist in stop (/t/ or/k/), fricative (/s/ or/ʃ/), and affricate (/tʃ/) consonant sounds of Class II DFD subjects, and whether extent of malocclusion correlates with severity of speech distortion. We hypothesized that Class II patients display milder distortions than Class III and anterior open bite (AOB), as Class II patients can posture into a Class I occlusion. MATERIALS/METHODS: Audio and orthodontic records were collected from DFD patients (N = 53-Class II, 102-Class III, 72-Controls) who were pursuing orthodontics and orthognathic surgery. A speech pathologist perceptually scored speech. Acoustic differences in recordings were measured using Spectral Moment Analysis. RESULTS: When Class II subjects were compared to controls, significant differences were found for the centroid frequency (M1) of the /s/ sound and the spectral spread (M2) of /t/, /tʃ/, and /s/ sounds, with pairwise significance for controls relative to Class II AOB and all Class II subjects. Class II AOB subjects had higher M1 and M2 values than patients with Class II closed bites and Class I controls for most sounds. When comparing across anterior-posterior (AP) groups, differences exist between controls, Class II and III DFD subjects for M1 of /t/, /tʃ/, and/ʃ/ and M2 for /t/, /tʃ/, /s/, and /ʃ/ sounds. Using linear regression, correlations between Class II and III severity and spectral measures were found for /t/ and /tʃ/ sounds. CONCLUSIONS/IMPLICATIONS: Class II and III patients have a higher prevalence of qualitative distortions and spectral changes in consonants compared to controls, but Class II spectral shifts are smaller and affect fewer sounds than in Class III and AOB cohorts. Linear correlations between AP discrepancy and spectral change suggest causation and that treatment may improve articulation problems.

DENTOFACIAL DISHARMONY PATIENTS' SIBILANTS DIFFER FROM CONTROLS' MORE IN SOURCE THAN FILTER PROPERTIES.

This study uses multitaper spectral analysis to examine the differences in consonants produced by patients who present with different dentofacial disharmonies (DFD) including severe overbites (Class II), underbites (Class III) and anterior open bites. Previous studies have found that patients with these malocclusion types all produce sibilants and plosives with increased spectral center of gravity and increased spectral spread relative to controls. This result is puzzling since some DFD groups differ from controls in opposite ways. To better understand the articulatory basis of these differences, we apply several spectral shape measures and find that all groups of DFD patients produce /s ʃ t tʃ/ with mid-frequency spectral peaks that are less prominent than those of the control group, but peak frequency measures are largely the same across all groups. This indicates that the DFD patients differ more in sibilant noise source than front cavity size.1.

Impacts of Skeletal Anterior Open Bite Malocclusion on Speech.

Introduction: Articulation problems are seen in 80-90% of dentofacial deformity (DFD) subjects compared with 5% of the general population, impacting communication and quality of life, but the causal link is unclear. We hypothesize there are both qualitative (perceptual) and quantitative (spectral) differences in properties of stop (/t/ or /k/), fricative (/s/ or /∫/), and affricate (/t∫/) consonant sounds and that severity of anterior open bite (AOB) jaw disharmonies correlates with degree of speech abnormality. Methods: To test our hypotheses, surgical orthodontic records and audio recordings were collected from DFD patients (n=39 AOB, 62 controls). A speech pathologist evaluated subjects and recordings were analyzed using spectral moment analysis (SMA) to measure sound frequency distortions. Results: Perceptually, there is a higher prevalence of auditory and visual speech distortions in AOB DFD patients when compared to controls. Quantitatively, a significant (p<0.01) increase in the centroid frequency (M1) was seen in the /k/, /t/, /t∫/, and /s/ sounds of AOB subjects compared to the controls. Using linear regression, correlations between AOB skeletal severity and spectral distortion were found for /k/ and /t/ sounds. Conclusions: A higher prevalence of qualitative distortion and significant quantitative spectral distortions in consonant sounds were seen in AOB patients compared to controls. Additionally, severity of skeletal AOB is correlated with degree of distortion for consonant sounds. These findings provide insight into how the surgical and/or orthodontic treatment of AOB may impact speech.

Orthognathic speech pathology: impacts of Class III malocclusion on speech.

INTRODUCTION: Patients with dentofacial disharmonies (DFDs) seek orthodontic care and orthognathic surgery to address issues with mastication, esthetics, and speech. Speech distortions are seen 18 times more frequently in Class III DFD patients than the general population, with unclear causality. We hypothesize there are significant differences in spectral properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonants and that severity of Class III disharmony correlates with the degree of speech abnormality. METHODS: To understand how jaw disharmonies influence speech, orthodontic records and audio recordings were collected from Class III surgical candidates and reference subjects (n = 102 Class III, 62 controls). A speech pathologist evaluated subjects and recordings were quantitatively analysed by Spectral Moment Analysis for frequency distortions. RESULTS: A majority of Class III subjects exhibit speech distortions. A significant increase in the centroid frequency (M1) and spectral spread (M2) was seen in several consonants of Class III subjects compared to controls. Using regression analysis, correlations between Class III skeletal severity (assessed by cephalometric measures) and spectral distortion were found for /t/ and /k/ phones. CONCLUSIONS: Class III DFD patients have a higher prevalence of articulation errors and significant spectral distortions in consonants relative to controls. This is the first demonstration that severity of malocclusion is quantitatively correlated with the degree of speech distortion for consonants, suggesting causation. These findings offer insight into the complex relationship between craniofacial structures and speech distortions.

Modified Carnoy's Compared to Carnoy's Solution Is Equally Effective in Preventing Recurrence of Odontogenic Keratocysts.

PURPOSE: Carnoy's solution (CS), the gold standard for adjunctive chemical cautery in treatment of odontogenic keratocysts (OKCs), has been banned for 7 years, leading to substitution with the non-chloroform containing modified Carnoy's solution (MC) without data to support its effectiveness. We performed this study to compare the earlier data with CS to the more current outcomes with MC. METHODS: A retrospective cohort study was conducted on patients diagnosed with OKC and treated by a single surgeon (GHB) with enucleation and curettage (EC), peripheral ostectomy, and application of CS or MC. The primary predictor variables were use of CS or MC. The primary outcome variables were recurrence (yes vs. no) and time to recurrence. Secondary variables included demographics, anatomic location, and whether teeth adjacent to the lesion were extracted. Statistical analyses included chi-squared test/Fisher's exact test, Wilcoxon rank sum test, and Kaplan-Meier curves. RESULTS: 77 patients, 36 patients in the CS group and 41 in the MC group, met inclusion criteria, including at least 1 year of follow-up time. Characteristics of the groups were similar: median age 41.5 and 46, 61% and 71% male gender, 81% and 90% posterior, and 64% and 50% mandibular lesions, respectively. Overall recurrence was similar, 14.29%, with 5 (13.9%) recurrences in the CS group and 6 (14.6%) in the MC group (P = 0.92). Median time to recurrence was 24 months for both groups. Preserving adjacent teeth was associated with a significant increase in recurrence (P = 0.0036). CONCLUSION: Based on this comparison of retrospective outcome data, we found no significant difference in recurrence rate or distribution of time to recurrence between OKCs treated with CS or MC. Aggressiveness of surgical technique is likely a predictive factor in recurrence rate. Future studies should focus on prospective studies and continuing follow-up of the MC group.

Comparison of condylar position in orthognathic surgery cases treated with virtual surgical planning vs. conventional model planning.

OBJECTIVES: To assess the effect of virtual surgical planning (VSP) on the accuracy of condylar seating in surgical cases involving Bilateral Sagittal Split Osteotomy (BSSO). An additional aim was to quantify differences between actual surgical outcome and planned virtual outcome. SETTING AND SAMPLE POPULATION: A private practice in Charlotte North Carolina. Twenty-five consecutively operated subjects prepared with VSP and twenty consecutively subjects operated with conventional surgery planning were enrolled. MATERIAL AND METHODS: Cone beam computed tomography (CBCT) scans were obtained before surgery (T1) and post-surgery after splint removal (T2). The T1 and T2 CBCTs were superimposed on the anterior cranial base using voxel-based registration. Three dimensional (3D) models were built and oriented to a 3D Frankfurt horizontal. Displacement of corresponding condylar landmarks was measured. RESULTS: No significant difference was found between the VSP and conventional group in the magnitude of translation or rotation of the condyles following surgery. VSP surgical outcomes differed significantly from predicted positions at all landmarks. Virtual surgical planning does not prevent changes to condylar position as a result of surgery. Actual surgical results differed significantly from VSP-predicted outcomes. CONCLUSIONS: Virtual surgical planning did not reduce the changes to condylar position and angulation that resulted from conventionally planned orthognathic surgery.

High Fidelity Virtual Reality Orthognathic Surgery Simulator.

Surgical simulators are powerful tools that assist in providing advanced training for complex craniofacial surgical procedures and objective skills assessment such as the ones needed to perform Bilateral Sagittal Split Osteotomy (BSSO). One of the crucial steps in simulating BSSO is accurately cutting the mandible in a specific area of the jaw, where surgeons rely on high fidelity visual and haptic cues. In this paper, we present methods to simulate drilling and cutting of the bone using the burr and the motorized oscillating saw respectively. Our method allows low computational cost bone drilling or cutting while providing high fidelity haptic feedback that is suitable for real-time virtual surgery simulation.

African Americans in Oral and Maxillofacial Surgery: Factors Affecting Career Choice, Satisfaction, and Practice Patterns.

PURPOSE: There are few data available on the experience of minority surgeons in the field of oral and maxillofacial surgery (OMS). Therefore, the purpose of this study was to 1) explore factors that contribute to African Americans choosing OMS as a career, 2) examine satisfaction among minority oral and maxillofacial surgeons with the residency application and training process, 3) report on practice patterns among minority oral and maxillofacial surgeons, and 4) identify perceived bias for or against minority oral and maxillofacial surgeons in an attempt to aid the efforts of OMS residency organizations to foster diversity. MATERIALS AND METHODS: A 19-item survey was sent to 80 OMS practitioners by use of information from the mailing list of the National Society of Oral and Maxillofacial Surgeons, an American Association of Oral and Maxillofacial Surgeons-affiliated organization. All surveys were sent by mail and were followed by a reminder mailing after 8 weeks. Responses returned within 16 weeks were accepted for analysis. RESULTS: Of the 80 mailed surveys, 41 were returned within the 16-week parameter, representing a return rate of 51%. Most of the minority surgeon respondents were married men with a mean age of 60 years who worked as private practitioners. Most respondents practiced on the eastern and western coasts of the United States. Exposure in dental school was the most important factor in selecting OMS as a specialty. Location and prestige were the most important factors in selecting a residency program. Most respondents reported that race did not affect the success of their application to a residency program and did not currently affect the success of their practice. However, 25 to 46% of participants experienced race-related harassment, and 48 to 55% of participants believed there was a bias against African Americans in OMS. CONCLUSIONS: Our data suggest that a substantial number of minority oral and maxillofacial surgeons subjectively perceive race-based bias in their career, although it does not appear to affect professional success.

Multimodal protocol reduces postoperative nausea and vomiting in patients undergoing Le Fort I osteotomy.

PURPOSE: To assess the impact of a multimodal antiemetic protocol on postoperative nausea and vomiting (PONV) after Le Fort I osteotomy. MATERIALS AND METHODS: Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution were recruited as the intervention cohort for an institutional review board-approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol, including total intravenous anesthesia; prophylactic ondansetron, steroids, scopolamine, and droperidol; gastric decompression at surgery end; opioid-sparing analgesia; avoidance of morphine and codeine; prokinetic erythromycin; and fluids at a minimum of 25 mL/kg. The comparison group consisted of consecutive patients from a larger study who underwent similar surgical procedures before protocol implementation. Data, including occurrence of PONV, were extracted from medical records. Data were analyzed in bivariate fashion with the Fisher exact and Wilcoxon rank-sum tests. Logistic regression was used to compare the likelihood of nausea and vomiting in the 2 cohorts after controlling for demographic and surgical characteristics. A P value less than .05 was considered significant. RESULTS: The intervention (n = 93) and comparison (n = 137) groups were similar in gender (58% and 65% female patients; P = .29), race (72% and 71% Caucasian; P = .85), age (median, 19 and 20 years old; P = .75), proportion of patients with known risk factors for PONV (P = .34), percentage undergoing bimaxillary surgery (60% for the 2 groups), and percentage for whom surgery time was longer than 180 minutes (63% and 59%; P = .51). Prevalence of postoperative nausea was significantly lower in the intervention group than in the comparison group (24% vs 70%; P < .0001). Prevalence of postoperative vomiting was likewise significantly lower in the intervention group (11% vs 28%; P = .0013). The likelihood that patients in the comparison group would develop nausea was 8.9 and that for vomiting was 3.7 times higher than in the intervention group. CONCLUSION: This multimodal protocol was associated with substantially decreased prevalence of PONV in patients undergoing Le Fort I osteotomy.

Topical application of a mucoadhesive freeze-dried black raspberry gel induces clinical and histologic regression and reduces loss of heterozygosity events in premalignant oral intraepithelial lesions: results from a multicentered, placebo-controlled clinical trial.

PURPOSE: Approximately 30% higher grade premalignant oral intraepithelial neoplasia (OIN) lesions will progress to oral cancer. Although surgery is the OIN treatment mainstay, many OIN lesions recur, which is highly problematic for both surgeons and patients. This clinical trial assessed the chemopreventive efficacy of a natural product-based bioadhesive gel on OIN lesions. EXPERIMENTAL DESIGN: This placebo-controlled multicenter study investigated the effects of topical application of bioadhesive gels that contained either 10% w/w freeze-dried black raspberries (BRB) or an identical formulation devoid of BRB placebo to biopsy-confirmed OIN lesions (0.5 g × q.i.d., 12 weeks). Baseline evaluative parameters (size, histologic grade, LOH events) were comparable in the randomly assigned BRB (n = 22) and placebo (n = 18) gel cohorts. Evaluative parameters were: histologic grade, clinical size, and LOH. RESULTS: Topical application of the BRB gel to OIN lesions resulted in statistically significant reductions in lesional sizes, histologic grades, and LOH events. In contrast, placebo gel lesions demonstrated a significant increase in lesional size and no significant effects on histologic grade or LOH events. Collectively, these data strongly support BRB's chemopreventive impact. A cohort of very BRB-responsive patients, as demonstrated by high therapeutic efficacy, was identified. Corresponding protein profiling studies, which demonstrated higher pretreatment levels of BRB metabolic and keratinocyte differentiation enzymes in BRB-responsive lesions, reinforce the importance of local metabolism and differentiation competency. CONCLUSIONS: Results from this trial substantiate the LOH reductions identified in the pilot BRB gel study and extend therapeutic effects to significant improvements in histologic grade and lesional size.

Removal of symptomatic third molars may improve periodontal status of remaining dentition.

PURPOSE: To assess the impact of third molar removal on the periodontal status of adjacent second molars and teeth more anterior in the mouth in patients with mild symptoms of pericoronitis. PATIENTS AND METHODS: Healthy patients with mild symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for a study approved by the institutional review board. The subset analyzed in this study had all 4 third molars removed. Data were collected at enrollment and at least 3 months after surgery. Full-mouth periodontal probing was conducted at 6 sites per tooth. A probing depth of at least 4 mm (PD4+) was considered an indicator for periodontal pathology. The presence of a PD4+ on the distal of second molars (D2Ms) or anterior to the D2Ms, the number of PD4+s, and extent scores (percentage of PD4+s of all possible probing sites) were assessed at the patient and jaw levels. The association between patients' pre- and postsurgical periodontal status was assessed using the McNemar exact test. The level of significance was set at .05. RESULTS: The median age of the 69 patients was 21.8 years (interquartile range, 20.2 to 25.2 yr). Forty-five percent were men, and 57% were Caucasian. Significantly more patients (88%) had at least 1 D2M PD4+ at enrollment compared with after surgery (46%; P < .01). D2M extent scores decreased from 31.5 at enrollment to 11 after surgery. Significantly more patients (61%) had at least 1 PD4+ anterior to the D2M at enrollment compared with after surgery (29%; P < .01). Extent scores anterior to the D2M decreased from 2.0 at enrollment to 0.6 after surgery. CONCLUSIONS: Removal of third molars in patients with mild pericoronitis symptoms improved the periodontal status of the D2Ms and teeth more anterior in the mouth.

Mechanical debridement of subgingival biofilm in participants with asymptomatic third molars does not reduce deeper probing depths in the molar regions of the mouth.

PURPOSE: To assess the impact of mechanical debridement of subgingival biofilm on periodontal outcomes in adolescents and young adults with asymptomatic third molars. METHODS: Healthy participants with 4 asymptomatic third molars were enrolled in an institutional review board-approved longitudinal study. Clinical data were collected at enrollment and at follow-up visits. Full-mouth periodontal probing, 6 sites per tooth, was assessed as a measure of clinical periodontal status. At enrollment, all participants had dental prophylaxis after data collection, which included removal of subgingival biofilm; this was repeated annually. The primary outcome measures were the comparison from baseline to follow-up 2 years after enrollment of participants' periodontal probing depths for third molars and first/second molars. In addition, a comparison of extent scores at baseline to follow-up 2 years after enrollment for periodontal probing sites of at least 4 mm was performed for the same molar regions of the mouth. Changes over time in clinical periodontal status from enrollment to the follow-up at least 2 years later were analyzed with Mantel-Haenszel row mean score statistics. The level of significance was set at P < .05. RESULTS: The median follow-up from entry to the study was 2.2 years (interquartile range, 2.0-2.8 years) for 262 participants who averaged 27.7 years of age (SD, 1.2 years); 53% were female participants, and 81% were white. Most participants (90%) were educated beyond high school. On the basis of periodontal probing depths, participants' clinical periodontal status did not differ from enrollment to follow-up. CONCLUSIONS: Dental prophylaxis at yearly intervals in participants with asymptomatic third molars, which included mechanical removal of subgingival biofilm, had minimal or no impact on reducing deeper probing depths, clinical indicators of periodontal pathology in young adults.

The effect of preoperative recombinant erythropoietin on postoperative hematocrit level after orthognathic surgery.

PURPOSE: To compare the postoperative red cell mass as indicated by the hematocrit value of orthognathic surgery patients given iron supplementation and a single preoperative dose of erythropoietin alpha (EPO) and patients who did not receive either EPO or iron supplementation. PATIENTS AND METHODS: Subjects who had a Le Fort I osteotomy (LFI) or a combination of LFI and bilateral sagittal split osteotomy between 2005 and 2008 and were aged at least 13 years were included. Subjects were excluded if they had a history of maxillofacial trauma, a craniofacial syndrome, or a major systemic medical condition. Subjects either had EPO administered with iron supplements before surgery (surgeon A protocol) or received neither (surgeon B protocol). Venous blood samples were taken, in accordance with clinic protocol, before surgery (before administration of EPO) and on postoperative day 1. Multiple linear regression with backward selection was used to analyze the change in hematocrit value. Explanatory variables included group, preoperative hematocrit level, age, gender, length of surgery, blood loss, and crystalloid (fluid replacement) volume. RESULTS: The study included 178 eligible patients: 86 (48%) had a combination of LFI and bilateral sagittal split osteotomy and 92 (52%) had an isolated LFI. Of the patients, 114 (64%) had EPO/iron supplements administered before surgery whereas 64 did not. The mean change in hematocrit level as an indicator of the change in red cell mass was statistically significantly different (P = .01) for the subjects who received preoperative administration of EPO with iron supplementation compared with those who did not receive EPO plus iron. The administration of EPO plus iron was protective: the decrease in hematocrit level after surgery was smaller for subjects in the EPO group even after we controlled for age, gender, preoperative hematocrit level, length of surgery, blood loss, and crystalloid (fluid replacement) volume. CONCLUSIONS: A single preoperative dose of erythropoietin with iron supplementation resulted in a smaller decrease, on average, in postoperative red cell mass as indicated by hematocrit value in patients with complicated orthognathic surgery procedures.

Quality of life outcomes after third molar removal in subjects with minor symptoms of pericoronitis.

PURPOSE: Our purpose was to assess the effect of third molar removal on the quality of life in subjects with symptoms of pericoronitis. PATIENTS AND METHODS: Healthy subjects (American Society of Anesthesiologists Classes I and II), aged 18 to 35 years, with minor symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for an institutional review board-approved study. The exclusion criteria were major symptoms of pericoronitis, generalized periodontal disease, body mass index greater than 29 kg/m(2), and antibiotic or tobacco use. The data from patients undergoing surgery to remove all third molars with a follow-up examination after surgery at least 3 months later were included in these analyses. The clinical, demographic, and quality of life data were collected at enrollment and after surgery. At entry, the debris was removed from symptomatic third molar sites; no attempt was made to mechanically remove nonsheddable biofilm. The patients scheduled surgery electively with a recall examination at least 3 months after surgery. RESULTS: The median age of the 60 subjects was 21.9 years (interquartile range 20.2 to 24.7). The median postoperative follow-up was 7.7 months (interquartile range 6.0 to 12.4). The proportion of patients reporting the worst pain as severe decreased from enrollment to after surgery from 32% to 3%. Those responding "none" for the worst pain increased from 10% to 78%. Fifteen percent of subjects reported the pain intensity as "nothing," "faint," or "very weak" at enrollment. This increased to 96% after surgery. One third of patients reported the unpleasantness of pain as "neutral," "slightly unpleasant," or "slightly annoying" at enrollment, which increased to 97% after surgery. Also, 22% and 18% of the patients reported "quite a bit" or "lots of difficulty" with eating desired foods and chewing foods at enrollment, respectively; only 1 patient reported this degree of difficulty at the follow-up examination. In contrast, 42% and 37% of the patients reported no difficulty with eating and chewing at enrollment, which had increased to 95% and 93% at the follow-up examination, respectively. CONCLUSIONS: Removal of the third molars positively influenced the quality of life outcomes in those with minor symptoms of pericoronitis.

Changes over time in the prevalence of caries experience or periodontal pathology on third molars in young adults.

PURPOSE: To assess the prevalence of caries experience and periodontal pathology on third molar teeth compared with first and second molars and teeth more anterior from subjects who had data collected over time in a longitudinal clinical study. PATIENTS AND METHODS: Healthy subjects with 4 asymptomatic third molars and data for at least 4 years after enrollment were included in these analyses. The presence or absence of caries experience on the occlusal surface of the third molars and any surface of the first or second molars was assessed using a visual-tactile caries examination. Full mouth periodontal probing, 6 sites per tooth, was conducted as a measure of clinical periodontal status. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none, and caries experience versus no caries experience. The prevalence of caries experience and periodontal pathologic findings at follow-up and the relationship of the occurrence between the third molars and teeth more anterior in the mouth were examined using McNemar's statistics. RESULTS: The follow-up was a median of 6.9 years (interquartile range 4.6 to 7.7 years) for 179 subjects, with a mean age of 29 years. More subjects were female (54%) and white (80%). At follow-up, 85% of the subjects had caries experience detected on the first or second molars, and only 50% had a third molar affected. In contrast, at follow-up, the presence of at least 1 periodontal probing depth of at least 4 mm was marginally more prevalent on the third molars than on the first or second molars (56% and 50%, respectively). Fewer subjects had third molars free of caries experience and periodontal pathology at follow-up compared with at enrollment (28% versus 38%, respectively). CONCLUSIONS: The prevalence of both third molar caries experience and third molar periodontal pathology increased from baseline to the follow-up examination. At follow-up, the prevalence of caries experience was greater on the first or second molars than on the third molars, and periodontal pathology were greater on the third molars than on the more anterior teeth.

Prevalence of third molars with caries experience or periodontal pathology in young adults.

PURPOSE: We assessed the prevalence of caries experience and periodontal pathology on asymptomatic third molars in young adults. SUBJECTS AND METHODS: Healthy subjects with 4 asymptomatic third molars were enrolled in an institutional review board-approved study during a 5-year period. Full mouth periodontal probing, 6 sites per tooth, was the measure of clinical periodontal status. The presence or absence of occlusal caries experience (carious lesions or restorations, including sealants) on third molars and on any surface of the first and second molars were assessed using a visual-tactile examination and panoramic radiographs. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none and caries experience versus no caries experience. RESULTS: The data were analyzed from 409 subjects, who averaged 25 years old. More subjects were female (53%) and white (76%). More subjects had at least 1 periodontal probing depth of 4 mm or deeper on a third molar (55%) than on the distal of a second molar (46%). These findings were more likely to be detected around a third molar in subjects with all third molars at the occlusal plane (72%) than in subjects with at least one third molar below (33%). Overall, fewer subjects were affected by third molar caries experience than first or second molars (24% vs 73%, respectively). Of the subset of subjects with all four third molars at the occlusal plane, 26% were affected by both third molar periodontal pathology and caries experience and 16% were caries and periodontal pathology free. CONCLUSIONS: In these cross-sectional analyses, periodontal pathology was detected more frequently on third molars than on first and second molars and caries experience was detected more frequently on first and second molars than on third molars.