Non-third Molars Research Articles

HUMAN TEETH APATITE MICROANALYSIS: DETERMINATION OF INDIVIDUALS' AGE AND SEX FOR FORENSIC APPLICATIONS

Teeth, as well as other hardened body structures, are extremely useful in forensic analysis and identification of human remains. Due to their compositional characteristics, they are preserved over time and are resistant to high temperatures, making them a fundamental in contexts where individuals cannot be identified visually or by other means. Current studies of the crystal structure properties of human dental apatite (hydroxyapatite) have been conducted and highlight its decrease in function of age, but fail in establishing a mathematical relationship between these parameters. This study performed X-ray diffractometry (XRD) and electronic microprobe analyses (EPMA) in 29 teeth aiming at determining an age and sex criteria of identification based on the crystalline reticulum’s parameters results, crystallite size and chemical composition of dental apatite. Through these methods it was possible to recognize that decreasing contents of calcium correlate to the formation of mineral phases that alter the original dental composition, causing a decrease in crystallinity with advancing age, and most importantly, it was possible to verify, as a result of a theoretical model, here proposed, that crystallinities values are not absolute, but a spectrum for a certain age: where permanent non-third molar vary between 20 and 45 µm, with a range of for the same age; deciduous teeth between 50 and 57 µm, with a range of for the same age and third-molar teeth, above 60 µm.

Comprehensive characterization of epidemiological and 3D radiographic features of non-third molar impacted teeth in a Chinese dental population.

This retrospective study aimed to comprehensively delineate the epidemiological and 3-dimensional radiographic characteristics of non-third molar (non-M3) impacted teeth in a Chinese dental population. Patients with impacted teeth except for the third molar (ITEM3) were retrospectively screened via cone-beam CT images from 75,021 patients treated at our institution from June 2012 to December 2018. Demographic and clinical data of patients with ITEM3 were retrieved from medical records. CBCT coupled with 3-dimensional reconstruction was employed to characterize the radiographic features of ITEM3. Associations between these epidemiological, clinical, and radiographic features were further statistically analyzed. Among 1975 eligible patients, 2467 ITEM3s were identified with a prevalence of 2.63% (1975/75,021). Females slightly outnumbered males with a ratio of 1.12:1. The majority of ITEM3 was single (1577, 79.85%) in the maxilla. The maxillary canine teeth were the most frequently impacted (52.45%), followed by maxillary incisors. The mesioangular position was the most common orientation (43.8%), followed by vertical and buccal-lingual orientations. The most frequently associated lesion was external root resorption of the adjacent tooth, which was significantly correlated with the morphology and position of the impacted tooth. Most ITEM3 was single, mesioangular, found at maxillary canines, sometimes associated with diverse complications. Our data advance the current understanding of ITEM3 and offer insights into the management of this dental abnormality. These findings are useful for clinicians to comprehensively understand the prevalence, radiographic features, and complications of non-M3 impacted teeth.

An Evaluation of A Practice-Based Minor Oral Surgery Service

AIM To report the findings of a service evaluation of an NHS practice-based minor oral surgery service. METHOD A service evaluation including a retrospective analysis of activity and outcome data and assessment of patient and practitioner satisfaction. RESULTS 623 appointments were arranged, with a mean waiting time of 43 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (29.7%, 44.1%, 3.0% and 23.4% of cases respectively). Antibiotics were prescribed at 16.1% of treatment appointments and 1.9% required appointments for post-operative complications. All participants reported overall satisfaction with their care and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding and acceptance; 77.5% were seen on time and none were seen more than 15 minutes late; 87.5% felt the standard of the service was better than expected than at a hospital and none felt it was worse. Over 80 of practitioners agreed that waiting times were better than expected at a hospital, urgent problems were seen quickly and the referral process was easy and understandable. All practitioners strongly agreed/agreed they that they were happy with the service provided. CONCLUSIONS A range of minor oral surgery procedures can be provided with low complication rates, acceptable waiting times and accessibility, and high patient and referring practitioner satisfaction from a practice-based specialist oral surgery service.

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

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. 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. 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. 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.

Prevalence of Visible Third Molars With Caries Experience or Periodontal Pathology in Middle-Aged and Older Americans

To assess the prevalence of periodontal pathology and caries experience in visible third molars, as well as the relationship of these findings to periodontal pathology and caries experience in teeth more anterior in the mouth. Data were from 6,793 Dental Atherosclerosis Risk in Communities participants who underwent a clinical examination for periodontal disease and coronal caries experience and who retained at least 1 visible third molar. Outcome variables were the detection of periodontal pathology or coronal caries experience on visible third molars and on teeth more anterior in the mouth (non-third molars). Periodontal probing depths at least 4 mm (PD4+) and clinical attachment levels at least 3 mm (CAL3+) were indicator variables for periodontal pathology. At least 1 carious/decayed coronal surface or filled coronal surface was an indicator variable for caries experience. Outcomes for third molar and non-third molar teeth were compared by descriptive statistics and χ(2) tests with statistical significance set at P < .05. A third of the 6,793 Dental Atherosclerosis Risk in Communities subjects, who averaged 62 years of age, had at least 1 visible third molar. Subjects were more likely to have at least 1 third molar CAL3+ as compared with at least 1 third molar PD4+: 78% versus 61%. PD4+ and CAL3+ were significantly more prevalent among non-third molars as compared with third molars (P < .01). Most subjects, 73%, had restorations on visible third molars and non-third molars, and over two-thirds of subjects had a visible third molar with caries experience and periodontal pathology. Fewer than 2% of subjects had third molars free of caries experience or periodontal pathology. Most subjects had clinical evidence of caries experience or periodontal pathology on visible third molars; few subjects had visible third molars that were disease free. Subjects with periodontal pathology or caries experience on third molars were significantly more likely to have these findings detected on teeth more anterior in the mouth.

Third Molars and Periodontal Pathology in American Adolescents and Young Adults: A Prevalence Study

To assess the association between visible third molars and the prevalence of periodontal inflammatory disease of non-third molars. Subjects aged 14 to 45 years with 4 asymptomatic third molars were enrolled in an institutional review board-approved study. Subjects were classified based on whether at least 1 third molar was visible or all third molars were not visible. Full-mouth periodontal probing depth (PD) data, with 6 sites per tooth, were obtained as a measure of a subject's periodontal status. At least 1 non-third molar PD of 4 mm or greater was indicative of periodontal inflammatory disease. Outcomes for the respective groups were compared by use of Cochran-Mantel-Haenszel row mean score statistics. The level of significance for differences was set at .05. The 342 subjects in the visible group were significantly older, with a median age of 26 years (interquartile range, 22.4-32.2 years), as compared with the 69 subjects in the not visible group, with a median age of 21 years (interquartile range, 18.8-24.9 years) (P < .01). The proportion of males and females was not statistically different between groups (P > .05). Most subjects were white. Significantly more subjects with at least a college education were in the visible group than in the not visible group (P < .01). The rate of tobacco use was low and did not differ between groups. Subjects in the visible group were significantly more likely to have at least 1 PD of 4 mm or greater on non-third molars than those in the not visible group: 59% versus 35%. In both groups, first/second molars were more affected than nonmolars when we controlled for differences in age between groups. The visible presence of third molars in adolescents and young adults was significantly associated with periodontal inflammatory disease of non-third molars.

Evaluation of an NHS practice-based minor oral surgery service

To evaluate a pilot specialist practice-based minor oral surgery service. Service monitoring data were analysed to evaluate activity, waiting times and outcomes. Patient satisfaction was assessed by a modified version of the Dental Visit Satisfaction Scale. Of 705 treatment appointments, 12.7% were not attended and treatment was not provided in another 11.6%. Mean waiting time from referral receipt to treatment was 6.8 weeks. Treatment provided included surgical removal of third molars, surgical removal of non-third molars and surgical endodontics (26.7%, 60.4% and 4.9% of cases, respectively). Antibiotics were prescribed in 15.0% of treatment cases and 2.3% of treatment cases required appointments for postoperative complications. The response rate for the satisfaction survey was 81%. All participants reported overall satisfaction and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding/acceptance. 77.8% were seen on time and 22.2% within 15 minutes of their appointment. Overall 74.1% felt the standard of service was better than they would expect from a hospital and none felt it was worse. The findings of the evaluation suggest that specialist minor oral surgery can be successfully provided in dental practice and is acceptable to patients.

Commentary on: Evaluation of an NHS practice-based minor oral surgery service

Objectives To evaluate a pilot specialist practice-based minor oral surgery service. Methods Service monitoring data were analysed to evaluate activity, waiting times and outcomes. Patient satisfaction was assessed by a modified version of the Dental Visit Satisfaction Scale. Results Of 705 treatment appointments, 12.7% were not attended and treatment was not provided in another 11.6%. Mean waiting time from referral receipt to treatment was 6.8 weeks. Treatment provided included surgical removal of third molars, surgical removal of non-third molars and surgical endodontics (26.7%, 60.4% and 4.9% of cases, respectively). Antibiotics were prescribed in 15.0% of treatment cases and 2.3% of treatment cases required appointments for postoperative complications. The response rate for the satisfaction survey was 81%. All participants reported overall satisfaction and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding/acceptance. 77.8% were seen on time and 22.2% within 15 minutes of their appointment. Overall 74.1% felt the standard of service was better than they would expect from a hospital and none felt it was worse. Conclusion The findings of the evaluation suggest that specialist minor oral surgery can be successfully provided in dental practice and is acceptable to patients.

Changes Over Time in the Periodontal Status of Young Adults With No Third Molar Periodontal Pathology at Enrollment

To assess changes in periodontal status over time in subjects with all third molar region periodontal probing depths (PDs) of less than 4 mm at enrollment. Subjects were a subsample of young adults enrolled with 4 asymptomatic third molars in an institutional review board-approved longitudinal study. Full-mouth periodontal PD data, 6 sites per tooth, were measures of periodontal status. Data were aggregated to subject and jaw levels. A PD of 4 mm or greater was considered an indicator variable for periodontal pathology. Subjects were classified according to PD at follow-up: all PDs of less than 4 mm or at least 1 PD of 4 mm or greater. The demographic differences and the third molar anatomic position at baseline were compared to assess whether enrollment factors were related to the changes in periodontal pathology. The level of significance was set at .05. One hundred six subjects had all third molar region PDs of less than 4 mm at enrollment and were aged 25 years on average. Of these, 38% had a change in third molar region periodontal status, with at least 1 third molar region PD of 4 mm or greater detected at a median follow-up of 4.1 years (interquartile range, 2.4-5.9 years). A PD of at least 4 mm was detected significantly more often in the mandibular third molar region than in the maxillary third molar region (P < .01). No significant differences in age, gender, education, or length of follow-up were detected between the 40 subjects with a change in periodontal status in the third molar region and the 66 subjects who remained periodontally healthy (P > .05). At follow-up, 50% of subjects with at least 1 PD of 4 mm or greater in the third molar region had at least 1 PD of 4 mm or greater in non-third molar regions as compared with 15% of subjects with all third molar region PDs of less than 4 mm (P < .01). Periodontal pathology developing over time in healthy young adults was significantly more likely in the mandibular third molar region and mandibular non-third molars.

Changes Over Time in the Periodontal Status of Young Adults With No Third Molar Periodontal Pathology at Enrollment

Statement of the Problem: Patients with periodontally healthy third molars want to know the likelihood of their teeth remaining free of periodontal pathology if the third molars are retained. The purpose of this study is to assess the changes in periodontal status over time in subjects with all third molar region periodontal probing depths (PD) <4mm at enrollment and the association of new periodontal pathology at the third molar site with new pathology in the non-third molar dentition.

Impact of Removal of Asymptomatic Third Molars on Periodontal Pathology

This study assessed the impact of third molar removal on periodontal pathology in subjects with third molars asymptomatic at enrollment. Subjects in whom at least 2 third molars were removed were a subsample of healthy young subjects enrolled with 4 asymptomatic third molars in an institutional review board-approved longitudinal study. Full-mouth periodontal probing (PD) data, 6 sites per tooth, were obtained as a measure of periodontal status at each of 3 visits: enrollment, before removal of third molars, and after removal of third molars. Data were aggregated to subject and jaw levels. The oral cavity was divided by jaw into segments: the third molar region including the third molar (12 probing sites), distal to the second molar (4 probing sites), and non-third molars (80 probing sites). A PD >or=4 mm was considered an indicator variable for periodontal pathology. The number and percent of sites with a PD >or=4 mm were calculated from the total number of probing sites across all subjects. The frequency of subjects with at least one PD >or=4 mm and all third molars removed were compared with the frequency of subjects retaining at least 1 mandibular third molar using Fisher's exact test, with significance set at 0.05. Sixty-nine subjects had third molars removed: 57% were female, and 77% were Caucasian. The median age at surgery was 26.3 years (interquartile range, 23.3-31.5 yr). The median interval from enrollment to surgery was 2.4 years (interquartile range, 1.5-4.2 yr). The median follow-up after surgery was 9 months (interquartile range, 6.7-15.4 mo). All third molars were removed in 56 subjects; 13 retained at least 1 mandibular third molar. More subjects had at least 1 PD >or=4 mm around their mandibular third molars before surgery compared with enrollment (52% vs 45%, respectively). Of the total possible mandibular third molar probing sites, 18% had PD >or=4 mm presurgery compared with 12% at enrollment. Significantly fewer subjects who had all third molars removed had a PD >or=4 mm on the distal of their mandibular second molars after surgery, compared with those retaining at least 1 mandibular third molar (20% vs 69%, respectively, P= .001). The number of PDs >or=4 mm in the mandible was less after surgery if all third molars had been removed (1.4% vs 6.6%, respectively). Removal of the mandibular third molars significantly improved the periodontal status on the distal of second molars, positively affecting overall periodontal health.

Impact of the Visible Presence of Third Molars on Periodontal Health in Middle-Aged Americans

Problem: Document the presence of third molars in a population of middle-aged Americans and evaluate the impact of the presence of third molars on periodontal health on non-third molars in these same subjects.

Changes in Third Molar and Nonthird Molar Periodontal Pathology Over Time

The purpose of this study was to assess changes in periodontal probing depth (PD) over time for third molar and nonthird molar regions in young adults. The data were obtained from healthy subjects with 4 asymptomatic third molars, enrolled in an IRB-approved longitudinal trial. Demographic and oral health data were collected at baseline. Full-mouth PD, 6 sites per tooth, was conducted to determine periodontal status at baseline and at longest follow-up. The third molar region was defined as the PD for 6 sites around the third molars and the 2 sites on the distal of the second molars. The nonthird molar region was defined as the remainder of the PD sites in the mouth. The primary outcome measures for this study were the occurrence of a PD greater than or equal to 4 mm and the increase in PD of at least 2 mm in the third molar and nonthird molar regions. Changes from enrollment to longest follow-up were compared by the binomial or McNemar's test. Level of significance was .05. Data from 195 subjects were available, and the median follow-up was 5.9 years (interquartile range [IQ], 4.6 to 6.9 years). Median age at enrollment was 26.2 years (IQ, 22.0 to 34.0 years); 52% were female, 84% were Caucasian, and 10% were African American. The proportion of subjects with at least 1 involved site in nonthird molars increased significantly from baseline to follow-up, 36% to 49% (P < .01), reflecting mostly changes in mandibular nonthird molars, 33% to 48% (P < .01). Of the 122 subjects who presented at baseline with at least 1 PD greater than or equal to 4 mm in the third molar region, the proportion of subjects with at least 1 involved site in nonthird molars increased significantly from baseline to follow-up, 48% to 59% (P = .05), also reflecting mostly changes in mandibular nonthird molars, 44% to 59% (P = .05). In this unique longitudinal clinical study of early periodontal disease in young adults, periodontal pathology worsened over time for nonthird molars. This was more likely if PD greater than or equal to 4 mm was detected in the third molar region.

Third Molar Periodontal Pathology and Caries in Senior Adults

This study was designed to assess the prevalence at enrollment and incidence over 36 months of periodontal pathology and caries affecting third molars in a community-based study of people over the age of 65 years in North Carolina. A sub-sample of 818 subjects with dental examinations taken from the Piedmont 65+ Study was available for analysis. All visible teeth were examined. Periodontal probing (PD) measures were taken at 2 sites, mesiobuccal and buccal/facial. Clinical data on caries experience were collected by visual-tactile examination. At enrollment, 342 subjects had at least 1 visible third molar that could be examined. PD measures were available for 276 of these same subjects. The significance of comparisons between third molars and nonthird molars were determined by chi(2) tests and the statistical significance was set at .05. Most of the 342 subjects with at least 1 visible third molar were female (57%) or African American (63%). Mean age was 73 years (SD 5.5 years). Of the 197 subjects with caries experience, third molars were affected in 49% of subjects, less than the 87% in nonthird molars. Third molar caries experience was associated with caries experience on nonthird molar teeth (P < .01). Clinical attachment level (CAL) greater than 3 mm was detected at enrollment in third molars in 68% of subjects, and in nonthird molars in 96%. With one exception, CAL greater than 3 mm in third molars was associated with CAL greater than 3 mm elsewhere in the mouth. Few subjects (17%) had clinical evidence of both caries and periodontal pathology affecting third molars. In this older population of individuals with third molars, 21% were free of periodontal pathology or caries experience. Data on the prevalence of third molar periodontal pathology and third molar caries experience in an elderly population should be useful to both clinicians and their younger patients when considering the merits of retaining or removing third molars with no evidence of pathology.

Reliability of Third Molar Probing Measures and the Systemic Impact of Third Molar Periodontal Pathology

This study examined the reliability of assessing clinical periodontal measures on third molars, and the association between oral inflammation with periodontal pathology including third molars, and systemic inflammation including negative obstetric outcomes. Reliability of third molar probing depth (PD) was assessed for 41 patients by trained examiners. The data for the association between oral inflammation with periodontal pathology and systemic outcomes were derived from an IRB-approved study, "Oral Conditions and Pregnancy." Full mouth periodontal exams including third molars were conducted at less than 24 weeks of pregnancy. Periodontal status, moderate/severe periodontal disease (15 or more sites PD > or =4 mm) was considered as a possible predictor of systemic inflammation and pre-term birth. The upper quartile of the extent of PD for third molars alone (PD > or =4 mm) also was considered as a possible exposure variable for the same outcomes. Chi-square and t tests were used to determine statistical significance (0.05). Significant predictor variables were included in multivariate models. Unconditional logistic multivariate models were used to derive odds ratios (OR) and 95% confidence intervals (CI). Reliability of PD within 1 mm was excellent, and similar for third molars and non-third molars. Data from 1,020 obstetric patients were available for analysis. Eighteen percent of the patients delivered preterm, at less than 37 weeks. Having moderate/severe periodontal disease excluding third molars, was significantly associated with preterm birth (P = .008). Results were more significant if third molars were included (P = .0005). With multivariate models moderate/severe periodontal disease at enrollment including third molar PD, was associated with preterm birth (OR, 1.7; 95% CI, 1.1, 2.6). If only the extent of third molar PD was considered, odds also were increased for preterm birth (OR, 2.4; 95% CI, 1.1, 5.2). If only the extent of third molar PD was considered at enrollment, odds were increased for serum markers of systemic inflammation, elevated serum CRP, and oxidative stress, 8-isoPGF(2alpha). Dental examiners could reliably assess clinical periodontal measures on third molars. Third molars should be included in studies of systemic outcomes associated with oral inflammation. Women of child-bearing age should be made aware of the systemic risks of oral inflammation with third molar periodontal pathology.

Surgical management of non-third molars

This presentation will discuss the treatment on non-third molar impacted teeth. Treatment of impacted permanent teeth must be based on clinical and radiographic evaluation as well as determination of future risks. Clearly teeth that are symptomatic, have caused infection in the surrounding tissues, or have evidence of development of radiographic changes (cyst formation, resorption of adjacent teeth, or root resorption of the impacted teeth) require surgical treatment. Treatment of the asymptomatic tooth must take into account many factors, including age, specific prevalence of pathologic conditions, severity of potential pathology associated with impacted teeth, progression of untreated conditions, frequency and severity of potential complications of treatment, potential patient discomfort and inconvenience associated with either treatment or nontreatment, and economic consequences of treatment. Methods of treatment of impacted permanent teeth include orthodontic assistance through surgical exposure with or without attachment of the tooth, surgical uprighting, transplantation, and surgical removal.