Comparison of the Effects of Dexamethasone Administration on Postoperative Sequelae Before and After "Third Molar" Extraction Surgeries.

INTRODUCTION: Impacted third molars (ITMs) surgery, is one of the most common methods in the field of oral and maxillofacial surgical operations. Administration of corticosteroid such as dexamethasone diminishes the postoperative sequelae. The study aimed to compare the impact of dexamethasone administration on pre-operative and post-operative complications in third molar surgery. METHODS: We collected all randomized controlled trial data on the influences of pre-operative and postoperative dexamethasone administration between 2006-2019 on third molar surgery sequelae by searching the keywords: dexamethasone, third molar surgery, wisdom teeth, corticosteroids, oral surgery, maxillofacial surgery, preoperative, postoperative, pain, swelling, and trismus in international databases such as: Web of Science (ISI), PubMed, Scopus, Embase and Cochrane Library. RESULTS: Twenty-three articles were included in this narrative review. Among them, 22 studies used dexamethasone in particular and 1 study used dexamethasone with amoxicillin. Twenty studies evaluated the prescription of dexamethasone in pre-operative and post-operative routes on pain, trismus and edema following third molars operation. Five studies administered dexamethasone postoperatively and 15 studies administered the drug preoperatively. Two studies evaluated the preoperative and postoperative administration method. Fourteen studies used a 4 mg dexamethasone dose and drug administration was variable. The treatment period in postoperative studies varied between 1 to 7 days. CONCLUSION: Dexamethasone appears to be a promising agent in in reduction of post-operative complications following third molar surgery. As a potent anti-inflammatory agent, it has an effective role in pain, trismus and edema reduction distinguished from the routes of administration, dosage and timing, pre or postoperative prescription.

Contemporary exodontia.

Exodontia is a cardinal skill of all dentists. Patients expect extractions to be skillfully and painlessly accomplished every time. It's not necessarily so simple and can be challenging. In this paper we explore contemporary issues of the full process of exodontia including diagnosis, technique, complication minimization as well as management of medically compromised patients with appropriate post-operative care, including pharmacotherapy.

Evaluation of Kharma scale as a predictor of lower third molar extraction difficulty

Background: The Evaluation of the degree of lower third molar (L3M) extraction difficulty is extremely important for both clinicians and patients. This study aimed to evaluate the validity of a new index (Kharma scale) as a preoperative predictor index of the difficulty of surgical removal of impacted L3M. Material and Methods: Extraction difficulty of a series of 49-impacted L3M was predicted preoperatively by Kharma scale, and postoperative difficulty was assessed with a modified Parant scale. Results: The sensitivity of Kharma scale, as a predictor of difficulty, was 18.2% and the specificity was 68.4%. Likelihood ratios for the Kharma categories also indicated that the scale is of little value for predicting a difficult extraction. There was no significant association between the Kharma score and duration of operation, but highmodified Parant scores were significantly associated with longer operations. Conclusions: The proposed Kharma scale was unreliable as preoperative predictor of the L3M extraction difficulty, and both radiological and clinical information must be taken into account (AU)

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Risk factors for and the role of dental extractions in osteoradionecrosis of the jaws: A national-based cohort study.

BACKGROUND: The purpose of this study was to investigate the risk factors, especially the use of certain drugs and the dental procedures, for osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer undergoing irradiation as their primary treatment. METHODS: The cohort was composed of 23,527 patients with head and neck cancer. Cox proportional hazard models were used for risk factors analysis. RESULTS: The overall incidence of ORNJ is 3.93 per 100 person-years. Buccal cancer carried the highest ORNJ risk. The use of steroids had a protective effect. Preradiotherapy extraction posed no excess risk, whereas postradiotherapy extraction was associated with gradually increased risk of ORNJ over time that peaked at 4 to 5 years. CONCLUSION: ORNJ warrants life-long attention for head and neck cancer survivors. The present study strongly confirms the role of preirradiation dental extractions. Meanwhile, efforts should be made to prevent posttreatment extractions, especially in the first posttreatment 4 years. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1313-1321, 2017.

Large peripheral ossifying fibroma: clinical, histological, and immunohistochemistry aspects. A case report / Gran fibroma osificante periférico: aspectos clínicos, histológicos e inmunohistoquímicos. Presentación de un caso

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Análisis de las causas de exodoncia en la población infantil atendida en una clínica universitaria / Causes of tooth extraction

Introducción: conocer las causas de exodoncia en la población infantil, tanto en la dentición temporal como en la permanente, es necesario para poder valorar el impacto de las medidas preventivas, así como para definir las actuaciones en materia de salud bucodental. Material y métodos: estudio de campo epidemiológico, observacional, descriptivo, transversal en la práctica clínica habitual, siendo la población de estudio los menores de 18 años que acuden a la clínica universitaria y a los que se les exodoncia uno o varios dientes. Resultados: se realizaron 97 exodoncias a 55 pacientes (4% de la población atendida), un 58,8% eran niñas. La media de edad fue de 8,69 años (desviación estándar [DE] 2,15). El tramo etario en el que se realizaron más exodoncias fue el de seis a diez años (52,6%). La alteración de la erupción dentaria (39,2%) fue la causa más frecuente de exodoncia, seguido por la caries (34%). En la población inmigrante la causa más frecuente fue la caries (69,56%). Conclusiones: es necesario implementar, desde las consultas de Pediatría y gabinetes de Odontología, medidas preventivas en la población de seis a diez años potenciando hábitos dietéticos y nutritivos que faciliten una correcta reabsorción de la dentición temporal, para disminuir el número de exodoncias y conseguir una correcta salud oral (AU)

Introduction: to know the causes of tooth extraction in child population, both deciduous and definitive dentition, is necessary to be able to appreciate the impact of the preventive measures, as well as determine the intervention in matters of oral health to get a healthy population. Materials and methodologies: epidemiologic, observational, descriptive and transversal study is designed in the usual practice of odontology. Its population consisted of people under the age of 18 who went to University clinic, and those who got one or more teeth extracted. Results: 97 removals were made to 55 patients (4% of treated population), 58.8% were female patients. The average age was 8.69 (EV 2.15). The most frequent age range to have teeth extracted was from 6 to 10 years old (52.6%). Dental growing disorder was the most frequent cause of tooth extraction (39.2%), followed by caries (34%). In inmigrant population the most frequent cause was the caries (69.76%). Conclusions: it is necessary to introduce, from pediatric consulting rooms in odontology, preventive measures in the population from 6 to 10 years old, reinforcing dietary and nutritional habits which facilitate a proper reabsorption of deciduous dentition, to decrease the number of extractions and to get a good oral health (AU)

A 15-Year Time-series Study of Tooth Extraction in Brazil.

Tooth loss is considered to be a public health problem. Time-series studies that assess the influence of social conditions and access to health services on tooth loss are scarce.This study aimed to examine the time-series of permanent tooth extraction in Brazil between 1998 and 2012 and to compare these series in municipalities with different Human Development Index (HDI) scores and with different access to distinct primary and secondary care.The time-series study was performed between 1998 and 2012, using data from the Brazilian National Health Information System. Time-series study was performed between 1998 and 2012. Two annual rates of tooth extraction were calculated and evaluated separately according to 3 parameters: the HDI, the presence of a Dental Specialty Center, and coverage by Oral Health Teams. The time-series was analyzed using a linear regression model.An overall decrease in the tooth-loss tendencies during this period was observed, particularly in the tooth-extraction rate during primary care procedures. In the municipalities with an HDI that was lower than the median, the average tooth-loss rates were higher than in the municipalities with a higher HDI. The municipalities with lower rates of Oral Health Team coverage also showed lower extraction rates than the municipalities with higher coverage rates.In general, Brazil has shown a decrease in the trend to extract permanent teeth during these 15 years. Increased human development and access to dental services have influenced tooth-extraction rates.

Trends in dental service provision in Australia: 1983-1984 to 2009-2010.

OBJECTIVE: To investigate time trends in dental service provision. METHODS: A random sample of Australian dentists was surveyed by mailed questionnaires in 1983-1984, 1993-1994, 2003-2004, and 2009-2010 (response rates 67-76%). The service rate per visit was collected from a log of services. RESULTS: The rate of service provision per visit [rate ratio (RR)] increased from 1983-1984 to 2009-2010 for the service areas of diagnostic (RR=1.8; 1.6-1.9), preventive (RR=1.9; 1.6-2.1), endodontic (RR=2.1; 1.7-2.6), and crown and bridge (RR=2.9; 2.3-3.8), whereas prosthodontic services decreased (RR=0.7; 0.6-0.9). CONCLUSIONS: The profile of services provided by dentists changed over the study period to include less emphasis on replacement of teeth and more on diagnosis, prevention, and retention of natural dentitions.

Single-dose intra-alveolar chlorhexidine gel application, easier surgeries, and younger ages are associated with reduced dry socket risk.

PURPOSE: Although dry socket (DS) is commonly investigated, many of its risk factors remain highly controversial. In addition, few studies are available to show the preventive effect of chlorhexidine gel on DS. Moreover, multivariable analyses of DS risk factors are scarce, and their interactions have not been assessed previously. Therefore, the simultaneous effect of chlorhexidine gel and 4 DS risk factors and their interactions were analyzed within a multivariable framework. MATERIALS AND METHODS: Using a split-mouth randomized clinical trial design, the investigators enrolled a cohort of patients requiring extraction of 2 mandibular third molars. The primary predictor variable was extraction socket treatment status, classified as experimental or standard. Experimental treatment was the insertion of chlorhexidine gel (0.2%) into the extraction socket. Each patient had 1 third molar randomly selected as the treatment site. The contralateral third molar served as the control socket and was treated in the usual manner. The primary outcome variable was DS status, present or absent, assessed on postoperative day 3. Other study variables were categorized as demographic, smoking, and surgical difficulty according to the Pederson scale. Appropriate bivariate and multiple logistic regression statistics were used to measure the association between risk for DS and chlorhexidine gel use, age, gender, smoking, and surgical difficulty and their interactions (α = 0.05). RESULTS: The sample consisted of 90 bilateral extraction sockets in 45 patients (24 men; 21 smokers; mean age, 21.1 ± 2.7 yr). Regression analysis showed that when other factors and their interactions were controlled for, chlorhexidine gel application lowered the risk of DS (odds ratio [OR] = 0.05; P = .004). Increasing age (OR = 2.9; P = .030) was associated with an increased risk for DS. A similar association existed between increased difficulty level of extraction and DS risk (OR = 3.8; P = .051). The effect of gender was marginally significant (P = .091), whereas smoking did not have a significant influence (P = .4). CONCLUSIONS: Intra-alveolar application of chlorhexidine gel and practicing less traumatic surgeries are advocated, particularly in older patients. Smoking seems unlikely to affect DS frequency. The role of gender is inconclusive.

Changes in demographics of patients undergoing third molar surgery in a hospital setting between 1994 and 2012 and the influence of the National Institute for Health and Care Excellence guidelines.

PURPOSE: To evaluate changes in demographics of patients undergoing third molar surgery (TMS). MATERIALS AND METHODS: This retrospective study used the World Health Organization's International Classification of Diseases, Tenth Revision codes F091 and F093 to generate data on patients (N = 10,447) undergoing TMS from 1994 through 2012 at the authors' institution. The data is described in terms of mean, median, mode and were analyzed using analysis of variance and the Student t test. RESULTS: Fewer female patients were treated after implementation of the National Institute for Health and Care Excellence (NICE) guidelines. The mean patient age increased from 29 years (1994) to 36 years (2012), with the median increasing from 27 to 31 years (P < .001). There was a significant difference in the age of patients treated before and after the introduction of the NICE guidelines (P < .001). CONCLUSIONS: The increase in age appears to be influenced by the NICE guidelines. Given the increased risk of complications in older patients, consideration should be given to the removal of a similarly impacted, asymptomatic, contralateral third molar without obvious radiographic relation to the inferior dental canal, if a young patient is undergoing general anesthesia.

Minimum intervention dentistry--a new horizon in public oral health care.

Public dental patients suffer from poorer oral health than the general population. Management of dental caries tends to focus on surgical interventions, such as restorations and extractions, rather than prevention and early intervention of the disease process. The current public dental system struggles to address the lifestyle and broader health issues affecting oral health and although an immediate dental problem can usually be alleviated, it can often be through the unnecessary removal of tooth structure, which invariably leads to other health and quality of life problems. There is widespread recognition by oral health clinicians that the restorative approach to the management of dental caries in the public sector is failing to improve oral health outcomes for many public patients. Oral health experts have recently adopted a national consensus statement on minimum intervention dentistry indicating their intention to work together to develop ways to implement this approach across the public dental sector. It is clear that, despite some significant challenges and required changes, the momentum for minimum intervention dentistry continues to grow across Australia. There is an urgent need to undertake research to assess the cost-effectiveness of this approach in the public sector.

How often do asymptomatic, disease-free third molars need to be removed?

The preventive removal of third molars (M3s) should be based on evidence. To optimize the timing of removal of M3s, it is essential to predict the eruption of the tooth and, even more importantly, to recognize beforehand which teeth will become involved in pathologic conditions later in life. The first aim of this review was to determine how well physicians currently can predict the eruption of an M3. The second aim was to review how frequently impacted M3s are removed. The third aim was to summarize the indications for preventive removals as presented in the evidence-based Current Care Guideline for the management of M3s in Finland. The prediction of eruption can be made at accuracies from 80% to 97%. In addition, the decrease in the number of M3s is very rapid, with only 31% remaining at 38 years of age. According to the Current Care Guideline, preventive removals at a young age are justified for 3 groups of teeth in the mandible: partially impacted teeth in the horizontal position, partially erupted teeth in the vertical position, and incomplete roots growing close to the mandibular canal. In conclusion, one fourth of retained and disease-free M3s need to be removed preventively at a young age, whereas the rest should be treated according to signs and symptoms.

Influência do tratamento ortodôntico com extração no apinhamento da região retromolar / Influence of the orthodontic treatment with extraction on crowding in the mandibular second molar area

Uma das grandes discussões que acompanham a Ortodontia desde os seus primórdios refere-se à dicotomia extrair ou não extrair. Diante de um apinhamento severo, a indicação da extração não causa dúvidas para o ortodontista. Entretanto, diante da protrusão dentária, a decisão pela extração de dentes pode gerar dúvidas. O mesmo acontece em casos limítrofes em pacientes com apinhamento moderado. O presente artigo evoca a avaliação do espaço retromolar nos casos onde existe a dúvida sobre a extração de dentes em um tratamento ortodôntico. Analisada na telerradiografia em norma lateral ou na radiografia panorâmica, a distância entre a distal do primeiro molar e o ramo mandibular pode ser decisiva na opção por extrair. Valorizando a presença dos segundos molares e sua completa diferenciação na cavidade bucal, o ortodontista deve avaliar se o espaço retromolar é suficiente para a irrupção completa dos segundos molares. Em casos onde há falta de espaço na região posterior, o tratamento com extração de dentes e mesialização dos primeiros molares pode favorecer a irrupção dos segundos molares.

One of the controversies regarding orthodontic treatment is related to extraction versus non-extraction treatment. Orthodontists have no doubts that teeth extraction is required to correct severe crowdings. However, the correction of protruded incisors generally raises questions as to whether treatment should be performed with or without extractions. Borderline cases with moderate crowding may also lead to doubts. This article focuses on the evaluation of the mandibular second molar area in cases where the orthodontic treatment includes teeth extraction. The distance between the distal aspect of the mandibular second molar and the mandibular ramus, when analyzed on either lateral or panoramic radiographs, can be decisive as to whether to extract or not. Considering the presence of the second molar and its complete eruption, orthodontists should always evaluate if the mandibular posterior space is sufficient for the eruption of the molars. Therefore, in cases where there is lack of space in the molar area, treatment with teeth extraction and mesial movement of the first molars may facilitate the eruption of the second molars.