Association between mandibular third molar position and the occurrence of pericoronitis: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to investigate the association between mandibular third molar position and occurrence of pericoronitis. DESIGN: The systematic review was performed based on PRISMA criteria (Prospero: CRD42018102835). The electronic search was performed in Medline, Virtual Health Library and Web of Science (until August 2018), without language restriction. Two researchers independently selected studies, extracted data, and assessed methodologic quality. Twenty-one articles were included in the review, comprising 6895 patients, with 1913 third mandibular molars being affected by pericoronitis. Ten studies were incuded in meta-analysis. RESULTS: The third molar in vertical position of Winter is the one with the greatest chance of presenting pericoronitis, compared to the other positions, while the horizontal position decreases this chance. There was no significant difference in the chance of pericoronitis between positions I and II of Pell & Gregory (OR: 0.29; IC: 0.07-1.23, I2 = 88%). Third molars classified in position A had greater chance of pericoronitis when compared to those in position B (OR: 7.13; IC: 1.31-38.74, I2 = 93%). The vertical position of the lower third molar is more associated with the occurrence of pericoronitis when compared to the other positions. CONCLUSIONS: Vertical position of the lower third molar is more associated with the occurrence of pericoronitis when compared to the other Winter' positions. Considering Pell and Gregory positions, position A had a greater chance of pericoronitis compared to position B. The prophylactic removal of lower third semi-erupted vertical molar or in position A is indicated to prevent pericoronitis.

Assessment of Third Molar Impaction Pattern and Associated Clinical Symptoms in a Central Anatolian Turkish Population.

OBJECTIVES: The purpose of this study was to assess the pattern of third molar impaction and associated symptoms in a Central Anatolian Turkish population. MATERIAL AND METHODS: A total of 2,133 impacted third molar teeth of 705 panoramic radiographs were reviewed. The positions of impacted third molar teeth on the panoramic radiographs were documented according to the classifications of Pell and Gregory and of Winter. The presence of related symptoms including pain, pericoronitis, lymphadenopathy and trismus was noted for every patient. Distributions of obtained values were compared using the Pearson χ2 test. Nonparametric values were analyzed using the Mann-Whitney U test and Kruskal-Wallis test. RESULTS: The mean age of the subjects was 30.58 ± 11.98 years (range: 19-73); in a review of the 2,133 impacted third molar teeth, the most common angulation of impaction in both maxillaries was vertical (1,177; 55%). Level B impaction was the most common in the maxilla (425/1,037; 39%), while level C impaction was the most common in the mandible (635/1,096; 61%). Pain (272/705; 39%) and pericoronitis (188/705; 27%) were found to be the most common complications of impaction. Among 705 patients (335 males, 370 females), pericoronitis was more prevalent in males (101; 30%) and usually related to lower third molars (236; 22%). The retromolar space was significantly smaller in females (p < 0.05). Moreover, there was a significant difference in retromolar space for the area of jaw (maxillary: 11.3 mm; mandibular: 14.2 mm) and impaction level (A: 14.7 mm; B: 11.1 mm; C: 10.3 mm; p < 0.05). CONCLUSION: The pattern of third molar impaction in a Central Anatolian Turkish population was characterized by a high prevalence rate of level C impaction with vertical position. Pain and pericoronitis were the most common symptoms usually associated with level A impaction and vertical position.

Oral pain due to severe pre-eruptive intracoronal resorption in permanent tooth.

BACKGROUND: Pre-eruptive intracoronal resorption is a dental lesion located within the dentin. This defect is usually discovered incidentally on routine dental radiographs. Occasionally this process may be associated with oral pain in advanced lesions. CASE REPORT: This case report describes a 12-year-old boy whose chief complaint was a diffuse oral pain due to a severe pre-eruptive intracoronal resorption in a permanent second molar. The previous radiographs, taken at the age of nine years, showed no evidence of the lesion. After surgical exposure, a pulp-like tissue under the crown was removed and analyzed; subsequently the tooth was extracted due to extensive resorption. A follow-up of the unerupted third molar, still in formation process, allowed to see that it was favourably positioned for replacing the extracted molar.

Non-third molar related pericoronitis in a sub-urban Nigeria population of children.

BACKGROUND: The study will report on the prevalence, clinical presentation, diagnosis, and management of non-third molar related pericoronitis seen in children below the age of 15 years who report at the Pediatric Dental Clinic, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 4½ year period. MATERIALS AND METHODS: This is a prospective study of cases of pericoronitis affecting any tooth exclusive of the third molar diagnosed in the pediatric dentistry out-patient clinic in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and June 2012. Pericoronitis was diagnosed using the criteria described by Howe. Information on age, sex, history malaria fever, upper respiratory diseases, tonsillitis, and evidence of immunosuppression were taken. Radiographs were taken in all cases to rule out tooth impaction and information on treatment regimen was also collected. RESULTS: The prevalence of non-third molar related pericoronitis was 0.63%. More females (63.6%) were affected. Chronic pericoronitis was the most common presentation (73.3%). No case was reported in the primary dentition and the premolar. No case was associated with tooth impaction and the tooth most affected was the lower right second permanent molar (35.7%). Bilateral presentation was seen in 36.4% patients. Herpetic gingivostomatitis was reported in association with one case. Chronic pericoronitis resolved within 3 days of management with warm saline mouth bath (WSMB) and analgesics, while acute/subacute resolved within 10 days of management with antibiotics, analgesics, and WSMB. CONCLUSIONS: The prevalence of non-third molar related pericoronitis is the low. The most prevalence type is chronic pericoronitis affecting the lower right second permanent molar.

Influence of a pedicle flap design on acute postoperative sequelae after lower third molar removal.

Pain, swelling, trismus, and alveolar osteitis often occur after removal of impacted third molar teeth. To minimize these complications a number of mucoperiosteal flap designs have been advocated, but, to date, a pedicle flap design has not been evaluated. In a randomized prospective split mouth study, 52 participants had bilateral symmetrically impacted mandibular third molars removed over two sessions. A buccal envelope or pedicle flap was randomly assigned to the left or right third molar site. Pre-and postoperative pain and swelling were recorded using a standardized visual analogue scale, trismus was measured as the maximum inter-incisal opening distance in millimetres and dry socket was assessed clinically. Greater continuous pain, pain on maximum opening, and oro-facial swelling were recorded with the pedicle flap design. Continuous pain resolved significantly faster with this flap design (p<0.05). Trismus was similar for both flap designs (p>0.05). Five cases of alveolar osteitis occurred with the envelope flap whilst no cases developed with the pedicle flap, but the incidence was too small for statistical analysis. The pedicle flap improved some aspects of postoperative pain experience and reduced the incidence of alveolar osteitis, but further investigation with a larger sample size is required to evaluate its significance.

Soft tissue pathosis associated with asymptomatic impacted lower third molars

Objective: The aim of this study was to identify the prevalence of pathological changes in the pericoronal tissue of asymptomatic impacted lower third molars and to assess the correlation between pathological changes and patient demographic, radiographic and morphological characteristics.Study Design: Follicles associated with fully impacted lower third molars were submitted for histological examination after surgical extraction from 50 patients. The correlation between pathological changes in the dental follicleand age, gender, depth of impaction, angular position, and coverage and tooth development was analyzed.Results: Cystic changes were observed in 10% of specimens and inflammatory changes in 62%. Incidence of pathological changes was significantly higher in Class B impacted teeth when compared to Class C impacted teeth. Asignificant correlation was found between epithelial cell activity and the completion of tooth development.Conclusion: We recommend monitoring all third molars whether or not they are symptomatic and conducting histopathological analyses on all surgically extracted follicle tissue (AU)

Cellulitis on face in a patient with congenital afibrinogenemia.

Congenital afibrinogenemia is a rare coagulation disorder, with an estimated prevalence of 1 : 1,000,000, characterized by a complete absence to reduced level of circulating fibrinogen. This article presents a case of congenital afibrinogenemia, which presented as cellulitis on the face.

Evolución clínica de la pericoronaritis en terceros molares inferiores semirretenidos / Clinical evolution of pericoronitis in the third inferior semi-retained molars

Se realizó un estudio longitudinal, prospectivo, analítico y descriptivo, con el objetivo de determinar la evolución clínica de la pericoronaritis en terceros molares inferiores semirretenidos, patología que aqueja a un porciento elevado de la población, siendo importante su diagnóstico y tratamiento oportuno. Esta investigación se desarrolló en el Hospital General Docente Abel Santamaría Cuadrado, durante el período comprendido de enero a octubre de 2009. La muestra estuvo compuesta por 52 pacientes que asistieron a la consulta de cirugía maxilofacial, por presentar síntomas y signos clínicos propios de la pericoronaritis. Para el análisis estadístico se utilizaron como principales medidas los números absolutos y relativos, y las pruebas no paramétricas de ji cuadrado; se tomó como nivel de significación á-0,005. En los pacientes con pericoronaritis de terceros molares inferiores semirretenidos, la forma serosa fue la más frecuente con un 48 por ciento, siendo el dolor moderado el síntoma clínico de mayor incidencia en esta pericoronaritis, no así en la forma supurada, que en el 42,3 por ciento existía un dolor severo. Como otros síntomas clínicos presentes, surgieron la inflamación y enrojecimiento del tejido pericoronario en el 100 por ciento de los casos, seguido del trismo en un 86,53 por ciento y la presencia de pus en un 22 por ciento, que se hicieron más notables en la forma supurada de la pericoronaritis...(AU)

A longitudinal, prospective, analytic and descriptive study was conducted aimed at determining the clinical evolution of pericoronitis in the third inferior semi-retained molars, a pathology that affects a high percent of the population, where the diagnosis and appropriate treatment is very important. This research was carried out from January to October 2009 at Abel Santamaria Cuadrado University Hospital. The sample was comprised of 52 patients attending to the oral offices presenting clinical signs and symptoms of pericoronitis. Absolute and relative numbers, parametric chi-square test and the level of significance á- 0,005 were used to perform the statistical analysis. In patients presenting pericoronitis in the third inferior semi-retained molars were found: the serous form that was the most frequent with 48 per cent, being the moderate pain the clinical symptoms that showed the highest incidence in this pericoronitis, that differed from the suppurated which presented 42,3 per cent of severe pain. Other clinical symptoms suggested inflammation and flare of the pericoronary tissue in 100 per cent of the cases, followed by trismus in 86, 53 per cent and the presence of pus (22 per cent), which were more notable in the suppurated form of pericoronitis...(AU)

Evolución clínica de las pericoronaritis tratadas con OLEOZON® en urgencias estomatológicas / Clinical evolution of pericoronaritis treated with OLEOZÓN® in stomatologic urgencias

La pericoronaritis es una patología bucal que aparece con frecuencia en consultas de urgencias estomatológicas. Se considera un proceso infeccioso agudo caracterizado por inflamación del tejido blando que rodea el diente retenido, lo cual provoca efectos indeseables en el paciente. El tratamiento indicado es la aplicación de sustancias caústicas que pueden ocasionar daños en los tejidos dentarios, por lo cual se decidió utilizar la ozonoterapia para realizar un ensayo clínico fase III, aleatorizado, controlado y abierto, lo cual permitió estudiar la eficacia del OLEOZON® en el tratamiento de la Pericoronaritis, en la Clínica Estomatológica Docente César Escalante, del municipio Matanzas, de enero 2003 a enero de 2008. El universo de estudio fueron los pacientes que en ese período asistieron con Pericoronaritis a la consulta de urgencia, y la muestra abarcó 90 pacientes, conformándose dos grupos: uno experimental, donde se aplicó el OLEOZON®, y otro control, donde se empleó el tratamiento convencional. Se caracterizaron los grupos desde el punto de vista sociodemográfico y clínico, determinándose la eficacia del OLEOZON®, la cual resultó ser alta en los pacientes tratados...(AU)

Pericoronaritis is an oral pathology frequently found in stomatologic urgency consultations. It is considered an acute infectious process characterized by inflammation of the soft tissues surrounding the retained tooth, causing unwanted effects in the patient. The indicated treatment is applying caustic substances that may damage dental tissues, so we decided using ozonotherapy to develop a clinical assay Phase III, randomized, controlled and open, allowing us to study the efficacy of OLEOZÓN® in treating Pericoronaritis at the Teaching Stomatologic Clinic Cesar Escalante, municipality of Matanzas, from january 2003 to january 2008. The universe of study were the patients assisting to the urgency consultation with Pericoronaritis in that period of time, and the sample were 90 patients, divided in two groups, an Experimental one where OLEOZÓN® was applied, and a Control one where the conventional treatment was used. Both groups were characterized from the sociodemographic and clinic points of view, stating the efficacy of OLEOZÓN®, high in treated patients...(AU)

Evolución clínica de las pericoronaritis tratadas con OLEOZON® en urgencias estomatológicas / Clinical evolution of pericoronaritis treated with OLEOZÓN® in stomatologic urgencias

La pericoronaritis es una patología bucal que aparece con frecuencia en consultas de urgencias estomatológicas. Se considera un proceso infeccioso agudo caracterizado por inflamación del tejido blando que rodea el diente retenido, lo cual provoca efectos indeseables en el paciente. El tratamiento indicado es la aplicación de sustancias caústicas que pueden ocasionar daños en los tejidos dentarios, por lo cual se decidió utilizar la ozonoterapia para realizar un ensayo clínico fase III, aleatorizado, controlado y abierto, lo cual permitió estudiar la eficacia del OLEOZON® en el tratamiento de la Pericoronaritis, en la Clínica Estomatológica Docente César Escalante, del municipio Matanzas, de enero 2003 a enero de 2008. El universo de estudio fueron los pacientes que en ese período asistieron con Pericoronaritis a la consulta de urgencia, y la muestra abarcó 90 pacientes, conformándose dos grupos: uno experimental, donde se aplicó el OLEOZON®, y otro control, donde se empleó el tratamiento convencional. Se caracterizaron los grupos desde el punto de vista sociodemográfico y clínico, determinándose la eficacia del OLEOZON®, la cual resultó ser alta en los pacientes tratados.

Pericoronaritis is an oral pathology frequently found in stomatologic urgency consultations. It is considered an acute infectious process characterized by inflammation of the soft tissues surrounding the retained tooth, causing unwanted effects in the patient. The indicated treatment is applying caustic substances that may damage dental tissues, so we decided using ozonotherapy to develop a clinical assay Phase III, randomized, controlled and open, allowing us to study the efficacy of OLEOZÓN® in treating Pericoronaritis at the Teaching Stomatologic Clinic Cesar Escalante, municipality of Matanzas, from january 2003 to january 2008. The universe of study were the patients assisting to the urgency consultation with Pericoronaritis in that period of time, and the sample were 90 patients, divided in two groups, an Experimental one where OLEOZÓN® was applied, and a Control one where the conventional treatment was used. Both groups were characterized from the sociodemographic and clinic points of view, stating the efficacy of OLEOZÓN®, high in treated patients.

Pericoronitis: treatment and a clinical dilemma.

Pericoronitis is an infection associated with impacted lower third molars that can necessitate the removal of these teeth. The clinical features of this condition are described and its treatment outlined, emphasising local measures. A case of pericoronitis in a 52-year-old patient is discussed, which illustrates the risks and benefits of removal of wisdom teeth; removal can lead to nerve damage, retention can precipitate serious, even life-threatening infection.

Angulation of mandibular third molars as a predictive factor for pericoronitis.

AIM: The aims of this study were to investigate the association between pericoronitis and the angular position, state of eruption, and the depth of impaction of mandibular third molars as well as to compare these findings with similar studies. METHODS AND MATERIALS: A total of 242 patients ranging in age from 18 to 41 years of age suffering from pericoronitis were examined. Subjective and objective observations were recorded on a checklist that included the name, age, gender, type of pericoronitis and state of eruption, position of the affected tooth for each patient as well as any radiographic changes in the mandibular third molars. RESULTS: The peak age for the occurrence of pericoronitis was in the 21-25 year-old age group. The soft tissues adjacent to vertically inclined, partially erupted mandibular third molars at the level of or above the occlusal plane were the most commonly affected. There was a statistically significant association between radiographic changes and the mesioangular position of the tooth (p<0.002) and the age group of the subject (p=0.004), but the association was not statistically significant between the gender of the subject, type of pericoronitis, state of eruption, and depth of impaction. CONCLUSION: The soft tissues adjacent to vertically inclined, partially erupted mandibular third molars were more frequently affected by pericoronitis than teeth that are soft tissue impacted or erupted. Mesioangular erupted third molars were the teeth most frequently associated with bone loss. CLINICAL SIGNIFICANCE: The soft tissues at highest risk of developing pericoronitis are those adjacent to mandibular third molars that are partially erupted, in a vertical position, and erupted to the level of or above the occlusal plane.

Case report of self-injurious behaviour (SIB) presenting as gingivitis artefacta major.

The case report described here discusses gingivitis artefacta major, an oral presentation of self-injurious behaviour, in an adolescent. On presentation, the patient knew well the ramifications of her gum scratching behaviour, however, was unable to stop. At further presentations new lesions had appeared with further bone loss. The cause of her behaviour seemed to be of psychological origin and therefore no interventive dental treatment was possible until this issue was resolved. A more preventive approach was adopted in the meantime. Referral to appropriate services from the dental profession also proved to be challenging. In conclusion, gingivitis artefacta, although rarely seen to this extent, is extremely challenging to diagnose and treat fully in a dental setting.

The relationship between pericoronitis, wisdom teeth, putative periodontal pathogens and the host response.

PURPOSE: To review the literature concerning pericoronitis, in particular the nature of the lesion and its aetiology, what factors may be used to predict if some patients would benefit from early removal of third molars, and if a scoring system can be developed for this purpose. METHOD AND MATERIALS: A literature search using PubMed and the facilities of the Dublin Dental Hospital (DDH) library were used to gather the relevent information. PubMed lists all of the journals available in the DDH library and was used to identify relevent papers, which were then retrieved from the shelves and stacks with the help of library staff. The key word used was 'pericoronitis'. RESULTS: The studies reviewed assert that the bacteriology of pericoronitis is predominantly anaerobic in character, yet no causative species has been identified. Marker organisms for periodontitis were not generally isolated. Host factors examined in various studies were the inflammatory markers interleukin 1b and prostaglandin E2, and the immunological responses of neutrophils, macrophages, natural killer cells, T cells, helper T cells and suppressor/cytotoxic T cells. While all of these factors, with the exception of prostaglandin E2, tend to be elevated in cases of pericoronitis, both symptomatic and asymptomatic, no clearcut measurable entity has emerged that can be used as a predictive marker. CONCLUSION: A hypothesised scoring system to predict which patients would benefit from early removal of asymptomatic impacted lower third molars would be clinically advantageous in justifying prophylactic third molar surgery, but is not yet feasible or proven.

Malaria and oral health.

Half of the world population resides in malaria-prone areas, and the disease is responsible for more than a million deaths annually. This is apart from the economic impact of the disease through resources expended towards treatment and prevention and the loss of manpower. In addition to the overt clinical signs and symptoms, the association of malaria with other diseases such as tuberculosis and HIV infection has been described. However few studies have attempted to investigate its relationship to oral diseases. This review provides an overview of the relevance of malaria to the mouth and adjacent structures. The need for further research is also emphasized.

The predictivity of mandibular third molar position as a risk indicator for pericoronitis.

The aim of this study was to describe the characteristics of the mandibular third molar at highest risk for acute pericoronitis using clinical and radiographic analysis. A total of 102 volunteers, including 40 (39%) male and 62 (60%) female patients presenting with acute pericoronitis, participated in the study. The mean age of the participants was 23.4 years (range 17-30 years). The variables tested included the percentage of soft tissue coverage, availability of impinging maxillary dentition, and the angulation and eruption level of the mandibular third molar. While vertical impaction was the most frequent angulation (51%), horizontal impaction was quite rare (3%). Mesioangular impaction (25%) was slightly higher than distoangular impaction (21%). Difference between type of angulation was statistically significant for all groups (p < 0.05). The frequency of partial soft tissue coverage, particularly 75% coverage, was far more observed than the full soft tissue coverage (47%). The difference for the amount of soft tissue coverage was statistically significant (p < 0.05). In 57% of the cases, pericoronitis was associated with the third molars that erupted at the same level of the adjacent tooth occlusal plane. The difference among the three levels of eruption was significant (p < 0.000). Impinging maxillary dentition did not have a significant impact on development of pericoronitis (41%). Evidence of impinging maxillary dentition did not have a statistically significant impact on presence of pericoronitis (p = 0.075). Mandibular third molars at or near to the same level of the occlusal plane of the arch and exhibiting vertical inclination were considered at highest risk for developing pericoronitis. Such third molars can be given high priority for prophylactic care due to the possibility of severe consequences of acute pericoronitis.

Unerupted mandibular third molars: symptoms, associated pathologies, and indications for removal in a Turkish population.

OBJECTIVES: To analyze the occurrence of symptoms of unerupted mandibular third molars, to investigate associated pathologies, and to determine indications for removal of unerupted mandibular third molars in a Turkish population. METHOD AND MATERIALS: A retrospective study was performed by reviewing 832 patients referred to Gulhane Military Medical Academy Dentistry Center for evaluation of their mandibular third molars. The patients were clinically examined, and unerupted and partially erupted mandibular third molars were determined from radiographs. The symptoms and pathologies associated with these teeth were analyzed. The indications for removal were classified into 10 groups. RESULTS: Two-thirds of the patients were between 20 and 29 years of age. Of the 832 unerupted mandibular third molars found, 557 (66.9%) teeth were partially erupted and 275 (33.1%) were completely unerupted. A total of 521 (62.6%) of all unerupted third molars had no symptoms, while 311 (37.4%) were associated with symptoms. The most frequent complaints of the patients were pain and swelling. Pericoronitis was observed as the most frequent pathology, in 142 patients. Of 832 unerupted mandibular third molars, 582 (69.9%) had complete root formation, 177 (21.2%) had two-thirds root formation, and 73 (8.9%) had one-third root formation. CONCLUSION: Patients between 20 and 29 years of age had the highest prevalence of unerupted mandibular third molars (69.3%). However, this figure decreased with increasing age. Partially erupted teeth (n = 228) caused the occurrence of symptoms more than completely erupted teeth (n = 83) in a Turkish population.

Progress report on third molar clinical trials.

Third Molar Clinical Trials is a targeted research project with a goal of providing current clinical and biological data to support effective third molar treatment. This special contribution, modified from the report on the progress of Third Molar Clinical Trials to the American Association of Oral and Maxillofacial Surgeons House of Delegates in 2006, summarizes progress on this complex project spanning almost a decade. An annotated bibliography of peer-reviewed publications to date is included.

Do pathologies associated with impacted lower third molars justify prophylactic removal? A critical review of the literature.

Surgical removal of impacted lower third molars is widely carried out in general dental practice and in many institutional clinics. Despite the fact that there are well established indications for the removal of impacted lower third molars, prophylactic removal of these teeth is still being universally practiced. Some reports have estimated that the proportion of impacted third molars that are removed when no clinically sound justification for surgery is present is between 18% and 50.7%. Justifications for prophylactic surgery include the need to minimize the risk of disease (cysts and tumors) development, reduction of the risk of mandibular angle fracture, increased difficulty of surgery with age, and that third molars have no definite role in the mouth. This article critically examines the literature regarding the relationship between impacted lower wisdom teeth, cysts and tumor development, and mandibular fractures.