Radiographic identification of symptomless mandibular third molars without clinical pericoronitis.

OBJECTIVES: The aim was to identify radiographic characteristics of mandibular third molars in young adults without symptoms or clinical signs of pericoronal infection. MATERIALS AND METHODS: An existing cross-sectional material, including records from clinical oral examination and panoramic radiographs (PANs) of university students, was submitted to retrospective analysis. The outcome variable was a symptomless and clinically pericoronitis-free mandibular third molar. Predictor variables for the third molar were clinical eruption level, pathological signs in the follicle, marginal bone level, radiographic depth in bone, inclination, stage of root development, and available space for eruption. Statistics included χ2 and Mann-Whitney U tests. RESULTS: Analysis included 345 mandibular third molars in 189 participants (20% men, 80% women; mean age 20.7 years; SD ± 0.6). Symptomless and clinically pericoronitis-free mandibular third molars were characterized as follows: clinically unerupted in 78% of teeth, associated with reduced marginal bone level in 70%, located deeper in the bone in 87%, mesially inclined in 73%, and stage of root development incomplete in 68% (p ≤ 0.001 for all). CONCLUSIONS: Radiographic characteristics of symptomless mandibular third molars without clinical pericoronitis in young adults can be assessed from a PAN with 68-87% certainty. CLINICAL RELEVANCE: These findings may prove useful when trying to exclude non-pathological mandibular third molars from diseased teeth.

Application of Denaturing Gradient Gel Electrophoresis to the Analysis of Bacterial Communities Associated With Asymptomatic and Symptomatic Pericoronitis.

PURPOSE: Denaturing gradient gel electrophoresis (DGGE) was used to investigate the bacterial communities associated with asymptomatic and symptomatic pericoronitis. The aim of the study was to compare the fingerprinting patterns of these 2 clinical conditions. MATERIALS AND METHODS: The microbiota of mandibular third molar pockets associated with asymptomatic or symptomatic pericoronitis cases were collected and profiled by the polymerase chain reaction DGGE method. Banding patterns were compared by cluster analysis techniques. RESULTS: Thirteen symptomatic pericoronitis and 7 asymptomatic pericoronitis samples were collected. Comparative analysis of the 2 clinical conditions showed bands that were common to the symptomatic and asymptomatic cases, but most DGGE bands appeared to be unique to the clinical condition. No single band occurred in all profiles. The mean number of bands detected in the 16S rDNA community profiles was 23.8 ± 4.2 (range, 19 to 34) for samples from symptomatic cases and 24.1 ± 2.4 (range, 21 to 29) for those from asymptomatic cases. Cluster analysis and multidimensional scaling analysis of the DGGE banding pattern showed a distinction in the similarity of banding patterns according to the presence or absence of symptoms. CONCLUSIONS: These results suggest that the diversity of pericoronal pocket microbiota in asymptomatic pericoronitis cases differs markedly from that of symptomatic cases.

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.

Intracoronal radiolucency in an incompletely erupted permanent molar with a diagnosis of pericoronitis: importance of radiographic examination.

Because of clinical signs and symptoms, a diagnosis of pericoronitis in a partially erupted, partially impacted first molar was made. A more thorough diagnosis was made with the help of a periapical radiograph that showed caries and thus revealed an irreversible pulpitis. Appropriate treatment was the result.

Anatomical considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: computed tomographic analyses.

OBJECTIVES: The aims of the present study were to clarify the anatomy of impacted mandibular third molars in relation to surrounding structures and to investigate the pathway of infection originating from pericoronitis of this tooth. STUDY DESIGN: Computed tomography (CT) images were evaluated in 87 patients with uninfected mandibular third molar impaction and in 12 patients with infection originating from an impacted mandibular third molar. In uninfected patients, bony features around the impacted crown were investigated together with the relationship between the crown and surrounding muscles. In infected patients, involvements of bony and soft tissue structures were evaluated according to the disappearance of cortices and lateral asymmetry of density and shape in the spaces and muscles. RESULTS: In uninfected patients, the disappearance of the lingual cortical plate was observed in 48 (35.3%) impacted molars, while only in 11 (8.1%) teeth for buccal cortices. The cortical thickness was thinner on the lingual side than the buccal side. Sixty-five percent of the masseter muscle horizontally overlapped the crown, while almost all of the medial pterygoid muscle was posteriorly situated apart from the crown. The mylohyoid muscle horizontally overlapped the crown at below or intermediate vertical positions. In infected patients, the involvement of lingual structures was more frequently observed than that of buccal structures. The mylohyoid muscle was involved in 10 (83.3%) of 12 patients. Among them, 8 showed submandibular space involvement. CONCLUSION: CT findings supported the clinical observations of infection spread in patients with pericoronitis of the impacted mandibular third molar. CT appeared to be an effective tool for investigating the pathway of infection originating from the pericoronitis of impacted mandibular third molars.

Radiographic quantification of chronic dental infection and its relationship to the atherosclerotic process in the carotid arteries.

BACKGROUND: Atherosclerosis may be initiated/accelerated by chronic dental infection (CDI). Noninvasively visualizing the carotid arteries is an accepted surrogate marker for determining coronary artery atherosclerosis (CAA). We hypothesized that 36 individuals with radiographic carotid atheromas would have more radiographic CDI than risk-matched individuals without atheromas. METHODS: We determined the arithmetic sum of individuals' periapical and furcal lesions, pericoronitis sites, carious roots, teeth with pulpal caries, and vertical bony defects (>4 mm). RESULTS: Individuals with atheromas had a significantly (P < .01) greater mean score of 15.5 +/- 10.4 compared with control subjects (7.9 +/- 8.1). Similarly significant (P < .05) was the difference in the mean numbers of mesial and distal vertical bony defects in the atheroma group (4.1 +/- 3.9 and 4.8 +/- 3.8, respectively) compared with control subjects (1.6 +/- 2.4 and 1.8 +/- 2.7, respectively). CONCLUSIONS: Individuals with atheromas on their radiographs (and high probability of CAA) had significantly greater amounts of CDI than individuals without atheromas.

Pericoronitis: a reappraisal of its clinical and microbiologic aspects.

Pericoronitis is an infectious disease of the operculum overlying an erupting or semi-impacted tooth. It manifests itself mainly in late adolescence and young adulthood and nearly always occurs around the lower third molar. The distinctive location, age, clinical picture, and link with predisposing factors warranted a reappraisal of pericoronitis and its etiology. Spirochetes and fusobacteria proved prevalent at all stages of the disease. The presence of these microbacteria may provide a clue as to the late appearance, particular location, and singular clinical picture of pericoronitis. The fact that spirochetes and fusobacteria are also found in acute necrotizing ulcerative gingivitis, and have been associated with alveolar osteitis, indicates a possible relationship between these disorders and pericoronitis.

[Inflammatory paradental cyst. Report of 6 cases]. / Entzündliche paradentale Zyste. Bericht von 6 Fällen.

BACKGROUND: The inflammatory paradental cyst has been described as an entity in the WHO classification of odontogenic tumors and cysts (1992). It is mainly located at mandibular molars, in particular third molars of the lower jaw. Radiologically, involved molars show a circumscribed, mostly half-moon shaped translucency distal or distobuccal to the involved tooth. Patients frequently report episodes of infection (pericoronitis). The histological findings are identical to those of inflammatory radicular cysts. The inflammatory paradental cyst has been described infrequently in the international literature. There are no reports available in German. AIM OF THE STUDY AND CASES: The aim of the present study was to present six of our own cases of inflammatory paradental cysts. Five men and one woman with an average age of 29.5 years were affected. In two cases paradental cysts occurred bilaterally. Three patients reported recurrent previous infections (pericoronitis). Radiologically, the typical translucency with clear demarcation distal to the third molars was observed. All of the third molars were vertically retained. Histologically, the inflammatory paradental cysts showed features identical to those of radicular cysts. The inflammatory paradental cyst is a clear indication for osteotomy of lower wisdom teeth. Postoperative complications or recurrences of the inflammatory paradental cysts have not been described. DISCUSSION: A correct clinical, radiological, and histopathological diagnosis of paradental cysts is mandatory, and more reports are needed in order to compile more information about relative frequency and pathogenesis of this cyst variant.

Radiographic findings on 3rd molars removed in 20-year-old men.

In this study we assess radiographic findings characteristic of mandibular 3rd molars that had required either routine or surgical extraction. X-ray findings relating to acute pericoronitis were also examined. The material was collected by investigating patient records and rotational panoramic radiographs of 20-year-old Finnish male conscripts (n = 738) treated during military service because of 3rd-molar-related problems. The follicle around the crown of mandibular 3rd molars with acute pericoronitis was enlarged in 19% of cases and in 13% of chronic symptom-free pericoronitis cases (not statistically significant difference). Mandibular 3rd molars extracted surgically were more often mesially inclined than those extracted routinely (61% vs. 23%; P < 0.001), partially or totally intrabony impacted (92% vs. 66%; P < 0.001) and deep situated (on average 4.2 mm vs. 2.5 mm under the occlusal plane). Surgical extraction was also associated with the roots completely developed [92% vs. 84% of the teeth routinely extracted, odds ratio (OR) 2.6, 95% confidence interval (CI) 1.2-5.5] and with the absence of radiographic pericoronitis [around 27% vs. 39% of the teeth routinely extracted (OR 0.5, 95% CI 0.3-0.8)]. In 86% of cases the space between 2nd molar and ramus of the mandible was narrower than the 3rd molar extracted surgically, whereas this was 62% in routine extraction cases (P < 0.001). We conclude that there are some typical 3rd-molar findings in rotational panoramic radiographs that show a need for surgical extraction.