Factors predictive of difficulty of mandibular third molar surgery.
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AIM: Historically the difficulty of third molar surgery has been judged using radiologically assessed dental factors specifically tooth morphology and position. This study investigated additional factors that have a bearing on the difficulty of extraction. STUDY DESIGN: A prospective study undertaken by three clinical assistant grade surgeons who removed 354 single mandibular third molar teeth under day case anaesthesia over the 4-year period (1994-1998). METHOD: Data relating to patient, dental and surgical variables were collected contemporaneously as the patients were treated. The difficulty of extraction was estimated by the surgeons pre-operatively using dental radiographic features and compared by the same surgeon within the actual surgical difficulty encountered at surgery. Operation time strongly related to both pre and post treatment assessments of difficulty and proved to be the best measure of surgical difficulty. RESULTS: Univariate analysis identified increased patient age, ethnic background, male gender, increased weight, bone impaction, horizontal angulation, depth of application, unfavourable root formation, proximity to inferior alveolar canal and surgeon as factors increasing operative time. Multivariate analysis showed that increasing age (P = 0.014), patient weight (P = 0.024), ethnicity (P = 0.019), application depth (P = 0.001), bone impaction (p=0.008) and unfavourable root formation (P = 0.009) were independent predictors for difficulty of extraction. CONCLUSIONS: Half of the six independent factors that predicted surgical difficulty of third molar extraction were patient variables. (+info)
The reasons for extraction of permanent teeth in Scotland: a 15-year follow-up study.
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AIMS: Although Scotland has the highest proportion of edentulous adults in the UK, the frequency of edentulousness has fallen by 21% during the last 20 years. This study, carried out in 1999, was designed to establish whether the reasons for tooth loss have also changed since 1984 when they were last determined. METHODS: The Scottish Dental Practice Board provided the names of every fourth dentist on its list among which 425 general dental practitioners were identified. They were asked to record permanent tooth extractions for 1 week, specifying the age, sex and dental attendance of patients who underwent extractions and the reasons for these extractions. 352 dentists took part: a response rate of 82.8%. RESULTS: The study confirmed that there has been a reduction in the number of extractions between 1984 and 1999: there were 25% fewer teeth extracted per patient and 30% fewer per dentist per week. From 0-20 years of age, orthodontics has replaced caries as the commonest reason for extraction and in all age groups over 20 years, caries has become the commonest reason in contrast to 1984 when periodontal disease was the principal reason in patients over 40 years old. CONCLUSIONS: Caries and its sequelae remain the most important cause of tooth loss throughout adult life in Scotland and, therefore, caries prevention and maintenance of restorations are of great importance at all ages. (+info)
Hyperbaric oxygen therapy and mandibular osteoradionecrosis: a retrospective study and analysis of treatment outcomes.
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BACKGROUND: Hyperbaric oxygen (HBO) therapy is recognized as an adjunctive treatment for osteoradionecrosis (ORN). It may also be used prophylactically in patients who require dental extractions and are at high risk for developing ORN. This article reviews the treatment outcomes of patients treated with HBO therapy at the Toronto General Hospital from 1985 to 1997. MATERIALS AND METHODS: A total of 297 charts of patients treated with HBO were reviewed. Criteria assessed included age of patient, gender, original diagnosis, radiation dose, time between radiation treatment and onset of ORN, presence or absence of fracture, orocutaneous fistula, pain, history of a precipitating event triggering ORN, medical status, HBO therapy (total oxygen time, number of dives), method of treatment of ORN and follow-up period. Minimum patient follow-up time for inclusion in the study was 6 months. RESULTS: Adequate information to meet the inclusion criteria was obtained for 75 patients. Group A (51 patients) had been treated for overt ORN with HBO alone, HBO with sequestrectomy, or HBO with sequestrectomy and reconstruction. Group B (24 patients at risk for developing ORN) had been treated with HBO prophylactically for dental extractions. In group A, only 3 patients (5.9%) failed to show improvement. In group B, only one patient (4.2%) had complications during healing. CONCLUSIONS: Encouraging results were achieved when HBO was used in the 2 groups described above. This paper supports existing literature on the potential benefit of HBO as a prophylactic agent and adjunctive treatment of ORN. (+info)
The influence of orthodontic extraction treatment on dental structures: a two-factor evaluation.
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The purpose of this investigation was to evaluate the effects of different growth patterns and treatment types on dentoalveolar structures in patients treated with fixed Edgewise mechanics and the extraction of four first premolars. A total of 41 patients with a mean chronological age of 14 years 7 months and skeletal age of 14 years 6 months were included in the study. The type of growth pattern was assessed as mesio- or hyper-divergent, and the treatment type as the use or non-use of headgear. The results were analysed by two-way analysis of variance (ANOVA). The decrease in overbite in the mesiodivergent group was statistically significant when compared with the increase in the hyper-divergent group (P < 0.01). Extrusion of the lower molar was observed in all groups, and a statistically significant difference was found between the mesio- and hyper-divergent groups (P < 0.05). Interaction between growth pattern and treatment type was not found to be significant for any variable. It can be concluded that premolar extractions and the use of headgear with fixed appliances does not significantly change the overjet, occlusal plane angle, upper and lower anterior dentoalveolar heights, upper posterior dentoalveolar height, or the inclination of the upper and lower incisors. The only significant changes were observed in overbite as a result of treatment mechanics and in lower posterior dentoalveolar height due to the growth pattern. (+info)
The formation of apical delta of the permanent teeth in dogs.
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To determine the process of formation of apical delta, a histological study on the permanent teeth was carried out in dogs. A litter of 7 clinically healthy beagle dogs and 33 adult dogs (4- to 15- year-old) of 12 breeds with periodontal disease were used for the experiments. Teeth extracted from 6-,7-,8- and 9-month-old beagles were sectioned and stained with HE solution. Tooth roots obtained from adult dogs with periodontal disease were ground. Each tooth was classified into the following root types under a light microscope: Type I (no apical delta = no apical closure), II (few apical delta), IIIA (low apical delta) and IIIB (high apical delta). In the 6-month-old beagles, more than half the tooth roots were classified as type I. In the 7-month-old beagles, type IIIB apical delta was the most predominant and types I, II and IIIA apical delta were occassionally seen. Apical closure and delta were observed in all beagles at 8 months of age histologically. In the 8- and 9-month-old beagles, all root apexes observed were type IIIB. Most of the 314 tooth roots extracted from 33 adult dogs were type IIIB, but a few were type IIIA. (+info)
Dental transfigurements in Borneo.
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Dental transfigurement, formerly termed dental mutilation, has been practised by many societies worldwide. This article gives many of the forms that have been attributed to the indigenes of the island of Borneo. The method has been performed by review of anthropological books, sparse dental references, Borneo research literature, and popular writing. (+info)
Pain control with paracetamol from a sustained release formulation and a standard release formulation after third molar surgery: a randomised controlled trial.
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OBJECTIVE: To compare the analgesic efficacy and safety of a sustained release (SR) paracetamol formulation (Panadol Extend) with a standard immediate release (IR) formulation (Panadol) after third molar surgery. DESIGN: A multi-centre, double-blind, randomised clinical trial. METHODS: Patients received either a single oral dose of SR paracetamol or IR paracetamol for pain after the removal of at least one impacted third molar requiring bone removal under general anaesthesia. Post-operative pain and pain relief assessments were undertaken at time intervals up to 8 hours. Global assessments of effectiveness were made at 4 and 8 hours. Any adverse events were also recorded. RESULTS: Of 627 randomised patients, 314 were treated with SR paracetamol and 313 with IR paracetamol. In the per protocol population at 4 hours, 35.1% of the 252 patients on SR paracetamol rated the study medication as very good or excellent compared with 27.7% of the 258 patients on IR paracetamol. There were few statistically significant differences among the secondary parameters but where they did occur they favoured SR paracetamol. Trends in favour of SR paracetamol were observed among the secondary parameters and these tended to emerge at the later time points. For example, while there was no statistically significant difference in time to re-medication between the treatment groups, the estimated time to re-medication was longer for patients treated with SR paracetamol (4 hr 5 min) compared with IR paracetamol (3 hr 10 min). The high rate of re-medication observed is consistent with that reported for IR paracetamol using the post-operative dental pain model(4,6). No difference was observed between the SR paracetamol and IR paracetamol treatment groups in distribution, incidence or severity of adverse events. CONCLUSIONS: SR paracetamol and IR paracetamol are clinically and statistically equivalent. While SR paracetamol and IR paracetamol were similar in terms of both onset of analgesia and peak analgesic effect, SR paracetamol had a longer duration of activity than IR paracetamol. The safety profiles of SR paracetamol and IR paracetamol were found to be very similar. (+info)
Tramadol drops in children: analgesic efficacy, lack of respiratory effects, and normal recovery times.
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Tramadol hydrochloride is a racemic mixture of two enantiomers. It has analgesic activity suitable for mild to moderate pain, part of its analgesic activity being modulated via mu receptors. Adult studies have raised the question of increased electroencephalographic activity. The study examined the analgesic efficacy, respiratory effects, and behavior plus recovery-influencing properties of tramadol in the pediatric patient. Day-case dental extraction children, aged 4-7 years having 6 or more extractions, were studied. Tramadol drops, 3 mg/kg, plus oral midazolam, 0.5 mg/kg, were administered 30 minutes prior to a sevoflurane in N2O and O2 anesthetic. Forty children received this premedication treatment (T) and 10 entered a placebo control group (P), where no tramadol was administered. Entry was random, double blind, and parallel. Analgesic efficacy was measured using the Oucher face pain scale (OFPS), with responders scoring three or less. Respiration was measured by rate and oxygen saturation. Behavior and ease of mask induction were assessed on a 4-point scale. Recovery was measured with the Aldrete scale. Parameters were measured from 30 minute preanesthetic to 120 minute postanesthetic. Analgesic efficacy was shown, with an OFPS score of 11.42 (SD 18.66) (T) and 29.80 (SD 25.14) (P) (P < .05). Responders on tramadol were 77.5% versus 0% on placebo (P < .05). No respiratory depression was seen; rates and oxygen saturations were the same preanesthetic and postanesthetic. Similarly, the two groups had no cardiovascular differences. Preanesthetic behavior patterns were the same (P > .05), with 85% of the tramadol group being drowsy but awake versus 90% in the placebo group. Similarly satisfactory induction behavior was seen in 95% of the tramadol group and 90% of the placebo group. Recovery times were 48.6 minutes (SD 32.3) (T) and 43.1 minutes (SD 32.5) (P) (P > .05). It is concluded that tramadol at 3 mg/kg has no clinical respiratory depressant effect and that behavior and recovery times are unaffected. Analgesic efficacy is demonstrated. (+info)