Toothache among dental patients attending a Nigerian secondary healthcare setting

INTRODUCTION. Pain intensity and oral health practices among patients with toothache, a major dental public health problem is necessary information for the formulation of preventive and interventional oral health policies. OBJECTIVE. To assess the pain intensity and oral health practices among dental patients attending a Nigerian secondary healthcare setting with toothache. MATERIALS AND METHODS. This study was a prospective study of adult patients attending the dental clinic of Rasheed Shekoni Specialist Hospital, Dutse, Jigawa State, Nigeria. Interviewer-administered questionnaire which elicited information include demography, pain intensity using visual analogue, tooth brushing behaviour and previous dental treatment was the tool of data collection. RESULTS. The majority of the respondents were males and young adults. More than half (60.5%) of the respondents reported pain of moderate to severe intensity and 42.6% have engaged in self medication for the toothache. More than one-third (34.2%) had experienced the pain for ≥ four weeks and the major factor that prompted the decision to visit dentist were unbearable nature of the pain and sleep disturbances. Almost half (46.2%) of the respondents had previously visited the dentist and the common received treatment was tooth extraction. A total of 57.9% of the respondents indulge in twice-daily tooth cleaning. CONCLUSION. Data from this study revealed that respondents with toothache had history of dental visit and visited dental clinic when the pain is unbearable and disturbed sleep. There is a need for proper patient education at any encounter with dentist.

Reasons for extraction of permanent teeth in general dental practices in Tehran, Iran

OBJECTIVES

The aim of this survey was to investigate the primary reason for extraction of permanent teeth, its correlations with age, gender and education level, as well as identify the important predictors for dental caries in general dental centers in Tehran, Iran.

SUBJECTS AND METHODS

The study was conducted over a period of 6 months; its population consisted of 1,382 patients, aged 9-95 years, who underwent tooth extraction. There were 673 (47.8%) male and 709 (51.3%) female patients. The frequency distribution was calculated using the χ(2) test, ANOVA and t test for differences in mean number of extracted teeth and the logistic regression model to evaluate the variables associated with reasons for tooth extraction.

RESULTS

A total of 2,620 teeth were extracted from the 1,382 patients. The highest rate (36.9%) of extraction occurred for those 41-60 years old. Males comprised 48.7% of patients but had more teeth (1,470, 55.3%) extracted than females (1,150, 43.9%). Nine hundred and thirty-six (67.7%) patients had incomplete secondary education or less. Tooth loss due to caries was 51%; periodontal disease was 14.4%; supernumerary and tooth impaction 13.9%. There was a significant association between patient characteristics (age, gender and education level) and number of teeth extracted.

CONCLUSION

Dental caries and periodontal disease were the main reasons for tooth extraction in Tehran, Iran.

Spectrum of trigeminal neuralgia

BACKGROUND

Trigeminal neuralgia (TN) is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup.

METHODS

This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College. Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience (non probability) sampling technique. All the patients presenting with the clinical features of TN were included in study.

RESULTS

Out of 117 cases, 49 (41.9%) were males and remaining 68 (58.1%) were females. Age of the patients ranged from 32-72 (53.90 +/- 10.21) years. Right side was involved in 63 patients (53.8%), while the left side was involved in 51 patients (43.60). In only three cases (2%) there was bilateral involvement. The maxillary division was involved in 68 cases (58.1%) and mandibular division was involved in 37 cases (31.6%). The most common site of involvement was infra-orbital, which was involved in 68 cases (58.11%). The next common site was the mental nerve which showed involvement in 35 cases (29.9%) followed by inferior alveolar nerve which was affected in 14 cases (12%). Thirty three (28.2%) patients were having mild pain. 54 (46.2%) patients having moderate, 21 (18%) patients with severe and 9 (7.7%) patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 (88%) patients underwent dental extraction for the same pain.

CONCLUSION

The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions.

A retrospective audit to evaluate the effect of the change in midazolam concentration from 10 mg/5 ml to 5 mg/5 ml ampoules on midazolam doses given to sedation patients following the rapid response report (RRR)

The technique of intravenous sedation with a benzodiazepine is a well documented and successful method for reducing fear and anxiety in many patients who regard dental treatment as challenging and potentially painful. One of the most important factors to achieving a well sedated patient is ensuring the dose of the drug given is titrated to the individual patient. Five years ago, a Rapid Response Report issued by the National Patient Safety Agency changed the concentration of midazolam within a 5 ml ampoule from 10 mg/5 ml to 5 mg/5 ml. A retrospective audit of 300 patients undergoing oral surgery treatment under intravenous midazolam sedation at Birmingham Dental Hospital was carried out over a 6-month period to assess whether this difference in midazolam concentration had any influence on the average dose of midazolam given to these patients.

STUDY GROUP

The midazolam doses given by five clinicians were audited both before and after the concentration change.

RESULTS

the mean midazolam dose that was administered by three clinicians decreased following the change in concentration. In addition, the number of patients given greater than 5 mg midazolam following the change decreased with all five clinicians.

CONCLUSIONS

The change in midazolam concentration from 10 mg/5 ml to 5 mg/5 ml ampoules has resulted in the overall average dose of midazolam given by five clinicians at Birmingham Dental Hospital to decrease.

Prognosis of teeth in the line of mandibular fracture: 5-year clinical and radiological follow-up

OBJECTIVE

The purpose of this article is to highlight our experience with the prognosis of teeth retained in the line of mandibular fracture after treatment of the fracture.

PATIENTS AND METHODS

A prospective evaluation of 62 patients with 200 teeth in the line of mandibular fracture seen and treated at the Dental and Maxillofacial Clinic, University of Calabar Teaching Hospital, Calabar south-south Nigeria between 2005 and 2009 was carried out. The focus was on 96 teeth in the line of mandibular fracture retained after reduction and immobilization of the fracture by closed reduction technique. The clinical and radiological follow-up period of patients ranged between six months and 3.5 years.

RESULTS

Majority of the patients 33 (53.2%) were in their third decade of life. The age of patients' ranged, from seven to 48 years with a mean of 24 +/- 2.3 years, There were 48 (77.4%) males and 14 (22.5%) females giving a male-to-female ratio of 3.4:1. One hundred and four teeth (52%) out of the 200 were extracted during treatment of the fracture. Of the remaining 96 teeth, 25 (26.0%) were anterior teeth while 71 (73.9%) were posterior. Twenty-four (25.0%) of the teeth in the line of fracture developed complications. Of those teeth involved with complications 10 (41.7%) were incisors and canine while 14 (58.3%) premolars and molars. Hypersensitivity and discolouration were the predominant complications.

CONCLUSION

Appropriate case selection and thorough clinical and radiological assessment is required to reduce the rate of complications of teeth left in-situ in the mandibular fracture line after treatment. The various complications in this study were managed successfully.

Causes and pattern of tooth loss in children and adolescents in a Nigerian tertiary hospital

BACKGROUND

Tooth loss diminishes the quality of life and is also related to poorer general health. Premature tooth loss in children can have devastating effects such as compromised aesthetics and function, mesial and distal drifts of adjacent teeth leading to crowding and impaction of the permanent successors and other forms of malocclusion.

OBJECTIVE

To assess the causes and pattern of tooth loss in children and adolescents at the Paedodontic Clinic of the Lagos University Teaching Hospital, Lagos.

METHODS

This retrospective study was carried out at the Paedodontic Unit of the Lagos University Teaching Hospital, Lagos using clinical records over a period of time from January 2008 to April 2010. Information obtained included age, gender, missing and extracted teeth, and reasons for extraction/tooth loss. Exfoliated primary teeth and congenitally missing teeth were excluded. Data was analysed using Epi info 2007 statistical software. Chi-square test was used to compare proportions of tooth loss among age groups. The level of significance was set at P < 0.05.

RESULTS

A total of 493 patients aged 1-16 years had lost one or more teeth due to various reasons. There were 244 (49.5%) males and 249 (50.5%) females. Majority of the subjects lost their teeth due to caries and its sequelae (64.3%) compared to trauma (10.8%) and orthodontic reasons (23.5%). Seven (1.4%) lost their teeth due to failure of previous treatment such as pulp therapy.

CONCLUSION

Extraction largely due to caries and its sequelae was responsible for most of the tooth loss among the study population. There is the need for intensified oral health education and awareness programmes in the populace with emphasis on prevention of dental caries and early presentation for dental treatment in order to avert premature tooth loss in children and adolescents.

Dentoalveolar abscess among children attending a dental clinic in Nigeria

OBJECTIVE

To determine the incidence and causes of dentoalveolar abscess among children attending an outpatient dental clinic in Nigeria.

MATERIAL AND METHODS

This is a retrospective study of paediatric dental patients treated in University of Benin Teaching Hospital, Benin City from October 2010 to September 2011.

RESULTS

The incidence of dentoalveolar abscess was 6.4% (53/824). However only 42 cases had their case notes retrieved for final research analysis. It occurred mostly in the lower right quadrant of the mouth. The affected children were majorly males and first or second child of monogamous family. A total 17 (40.5%) of the affected children were in the 6-11 years age group. This was the first dentist consultation among 35 (83.3%) of the children. The presenting complaint was toothache among two-thirds of the children. History of asthma, tonsillitis, peptic ulcer disease and previous surgery were medical history elicited from 6 (14.3) of the patients. The most implicated tooth was deciduous first molar. The causes of abscess include untreated dental caries 35 (83.3%), trauma 5 (11.9%), failed restoration 1 (2.4%) and periodontal diseases 1 (2.4%). Periapical radioluscency was predominant radiological finding among affected children. Tooth extraction was commonest treatment done.

CONCLUSION

The incidence of dentoalveolar abscess among children was significant. The high frequency of untreated dental caries as the cause of dentoalveolar abscess indicates the need for school and community-based preventive strategies like encouraging infant oral health and preventive dentistry programs and early treatment intervention and dental health education.

Dental needs and management of children with special health care needs according to type of disability

PURPOSE

The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability.

METHODS

Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability.

RESULTS

Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group.

CONCLUSIONS

Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.

Causes of tooth extraction at a tertiary care centre in Pakistan

OBJECTIVE

To evaluate the frequency of common causes of permanent tooth extraction and severity of dental condition at the time of tooth extraction.

METHODS

The cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Punjab Dental Hospital, Lahore, Pakistan, from February to June 2010, and involved 1026 patients who were referred for the extraction of permanent teeth. The inclusion criteria comprised caries, periodontitis, restoration failure, trauma, and local pathologies, while 3rd Molar impactions, supernumerary tooth extraction and extractions done as part of orthodontic or prosthodontic treatment were excluded. Oral hygiene was recorded using the Simplified Oral Hygiene Index. SPSS version 17 was used for statistical analysis.

RESULTS

The mean age of the study population was 46.60 +/- 11.321 years, and there were 611 (59.6%) males. A total of 1178 teeth were extracted. Advanced dental caries was the leading cause of tooth extraction (n = 743; 63.1%), followed by periodontitis (n = 309; 26.2%) restoration failure (n = 54; 4.6%), trauma (n = 38; 3.2%) and miscellaneous local pathologies (n = 34; 2.9%). More than half of the patients (n = 540; 52.6%) had poor oral hygiene.

CONCLUSION

Advanced dental caries is the most common cause behind tooth extraction.

What has been the United Kingdom's experience with retention of third molars?

BACKGROUND

In 2000, the first National Institute of Clinical Excellence (NICE) guidelines related to third molar (M3) surgery, a commonly performed operation in the United Kingdom, were published. This followed research publications and professional guidelines in the 1990 s that advised against prophylactic surgery and provided specific therapeutic indications for M3 surgery. The aim of the present report was to summarize the available evidence on the effects of guidelines on M3 surgery within the United Kingdom.

MATERIALS AND METHODS

Data from primary care dental services and hospital admissions in England and Wales during a 20-year period (Hospital Episode Statistics 1989/1990 to 2009/2010), and from private medical insurance companies were analyzed. The volume and, where possible, the nature of the M3 surgery activity over time were assessed together, as were the collateral effects of the guidelines, including patient age at surgery and the indications for surgery.

RESULTS

The volume of M3 removal decreased in all sectors during the 1990 s before the introduction of the NICE guidelines. During the 20-year period, the proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore, an increase occurred in the mean age for surgical admissions from 25.5 to 31.8 years. The change in age correlated with a change in the indications for M3 surgery during that period, with a reduction in "impaction," but an increase in "caries" and "pericoronitis" as etiologic factors, in accordance with the NICE guidelines.

CONCLUSION

The significant decrease in M3 surgery activity occurred before the NICE guidelines. Thus, M3 surgery has been performed at a later age, with indications for surgery increasingly in accordance with the NICE guidelines. The importance of clinical monitoring of the retained M3s is discussed.

[Local haemostasis with an adhesive cyanoacrylate-coated membrane following tooth extraction in patients under anticoagulant or anti-platelet therapy]

OBJECTIVE

Assessment of a local hemostasis with a compressive, extemporaneous gutter glued to the alveolar crest after tooth avulsion in patients under anticoagulant and/or platelet aggregation inhibitors, and economical impact of this technique.

MATERIAL AND METHOD

Ninety-seven tooth extractions were performed in patients under AVK and/or anti-platelet drugs. The interventions were consecutive and concerned 251 teeth (138 different alveolar sites). The extraction alveolus was protected by an absorbable oxycellulose membrane coated with sterilized cyanoacrylate adhesive for medical use. This procedure was used with all patients, whatever the hemorrhagic risk (the only inclusion criterion was INR less than 4 for patients under AVK). All procedures were performed under local anesthesia.

RESULTS

There was one hemorrhagic complication (0.72%) due to mechanical gutter destruction by an antagonist tooth. The adhesive did not run, there was no tissue necrosis, and no wound infection requiring gutter removal.

DISCUSSION

This local hemostasis procedure is reliable. It may be an alternative to substitution of heparin, without or with hospitalization. This procedure, requiring modification of treatment, greatly decreases healthcare costs. Contra-indications include the presence of an antagonist tooth harmful for the gutter, and patients with impaired consciousness or tongue dyspraxia.

Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars

The objective of this study was to verify, using periapical radiographs, whether a partially erupted mandibular third molar is a factor in the presence of dental caries on the distal surface of the adjacent second molar. Two-forty six high quality periapical radiographs were selected, each showing a partially erupted mandibular third molar. The variables analyzed were: tooth number; gender; age; radiographic presence of caries on the distal surface of the adjacent molar; Pell and Gregory classification; Winter classification; angulation and distance between the second and mandibular third molar. The examiners were previously calibrated to collect data (kappa statistics from 0.87 to 1.0). The prevalence rate of caries on the distal surface of the second molar was 13.4%. In the logistical multivariate regression analysis, the angulation (OR=8.5; IC95%: 1.7-43.8; p=0.011) and the gender (OR=3.3; IC95%: 1.4-7.7; p=0.005) remained statistically significant after an age adjustment was made. The results indicate that the presence of a partially erupted mandibular third molar with an angulation of 31 degrees or more, is a risk factor for caries on the distal surface of the mandibular second molars.

The caries experience of 11 to 12 year-old children in Scotland and Wales and 12 year-olds in England in 2008-2009: reports of co-ordinated surveys using BASCD methodology

OBJECTIVE

This paper brings together summarised findings on surveys of 106,828 mainstream school pupils aged 11-12 years old undertaken in Scotland, Wales and England in 2008/09. These surveys are the latest in a series using common criteria for measurement and a range of consent arrangements which, for this age group, allow comparison between the three "countries" and over time.

METHOD

Representative samples were drawn within the geographies of primary care organisations in the three countries and within English Local Authorities according to BASCD criteria for sampling. Consent was sought from pupils in Wales and England and passive consent was used in Scotland. Children aged twelve were examined in England and children in school year 7 (rising 12) were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners using BASCD standard criteria and caries was diagnosed at the dentinal threshold using visual criteria.

RESULTS

The trend for reducing caries prevalence and severity continues in this age group in all three countries. Unlike data for 5 year old children, the impact of seeking positive consent from pupils does not appear to have introduced bias into the results. Variation in caries levels between and within geographical areas continues.

CONCLUSION

Caries prevalence surveys of children aged 11-12 years have been conducted across Great Britain. Those carried out with positive consent appear to produce unbiased results, comparable with previous surveys. Health inequalities in this age group persist, as does the burden of disease for those with end-stage caries.

Predictive variables for postoperative pain after 520 consecutive dental extraction surgeries

The aim of this study was to evaluate postoperative pain in patients who had a single tooth or multiple erupted teeth extracted. This research evaluated 520 consecutive dental extraction surgeries in which 680 teeth were removed. Data collection was obtained through a questionnaire of patients and of the undergraduate students who performed all procedures. Pain was evaluated through qualitative self-reported scores at seven days postsurgery. An increased pain level was statistically associated with ostectomy, postoperative complications, and tobacco consumption. Pain that persisted for more than two days was statistically associated with the amount of anesthetic solution used, with a notable increase in surgical time and development of postoperative complications. Periods of pain lasting more than two days could be expected for traumatic surgeries lasting more than 30 minutes. Both severe and prolonged pain were signs of development of postoperative complications, such as alveolar osteitis and alveolar infection.

Relationship of smoking and smokeless tobacco use to tooth loss in a central Indian population

PURPOSE

The present study was conducted to determine the patterns of tooth loss among subjects with different tobacco- related habits and compare it with non-users of tobacco.

MATERIALS AND METHODS

A total of 1075 patients over the age of 14 years attending the Department of Periodontics, People's College of Dental Sciences and Research Centre, Bhopal, India from May to September 2009 were included in the study. Besides name, age and gender, information regarding tobacco habits was recorded through interviews. Based on the tobacco habits, the patients were grouped into 4 categories: group 1 (non-users of tobacco), group 2 (smokers only), group 3 (smokeless tobacco users only) and group 4 (users of both smoking and smokeless tobacco). Tooth loss was determined by clinical examination of all permanent teeth excluding the third molars. Tooth loss included missing or extracted teeth as well as teeth indicated for extraction due to periodontal disease, dental caries or wasting diseases. Prevalence and mean tooth loss for whole dentition, maxillary and mandibular arches were compared between the 4 groups. The chi-square test and one-way ANOVA were used for comparing the prevalence and mean tooth loss, respectively, between different groups.

RESULTS

The overall prevalence and mean tooth loss, respectively, for different groups were as follows: group 1: 28.3% and 0.85; group 2: 56.1% and 1.97; group 3: 58.7% and 2.38; group 4: 56.7% and 2.48 (P < 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the maxillary arch for the different groups were: group 1: 15.3% and 0.32; group 2: 43% and 1.24; group 3: 34.3% and 0.91; group 4: 45.4% and 1.26 (P < 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the mandibular arch for the different groups were: group 1: 22.3% and 0.52; group 2: 33.6% and 0.73; group 3: 50.9% and 1.48; group 4: 48.5% and 1.23 (P < 0.001 for both prevalence and mean tooth loss).

CONCLUSION

When compared to non-users of tobacco, tooth loss was greater among subjects who consumed tobacco. In India, where consumption of tobacco in different forms is very common, public health programmes need to be implemented to increase public awareness regarding the adverse effects of tobacco on oral health.

The relationship between dental care and perceived oral health impacts

BACKGROUND

Knowledge of the effect of dental care and dental visiting behavior on oral health impacts is important for effective resource allocation.

OBJECTIVE

To determine the association between dental care, including the reason for dental attendance and time since last dental visit, with perceived oral health impacts among Australian adults.

METHODS

Data were obtained from the Australian National Survey of Adult Oral Health 2004/06. Analysis was limited to 4,170 dentate adults who answered the Oral Health Impact Profile (OHIP-14) questions. Prevalence of frequent impacts was defined as the percentage of people reporting 'fairly often' or 'very often' to one or more of the OHIP-14 questions.

RESULTS

Over half the dentate Australians (63.0%) visited a dentist in the past year. Unadjusted analysis showed a statistically significant association between the prevalence of frequent impacts and receipt of: extractions (prevalence ratio = 1.7, 95% CI = 1.2-2.2), scale/clean (0.7, 0.5-0.8), and denture care (1.6, 1.1-2.4). After adjustment for the usual reason for dental attendance there was no effect of any of the three treatments or the time since last visit on the prevalence of frequent impacts.

CONCLUSION

The usual reason for dental attendance, and not the time since last visit or the type of dental care supplied, accounted for differences in perceived oral health impacts.

Maxillary incisor root resorption induced by ectopic canines

OBJECTIVE

To evaluate the long-term clinical and radiographic effects of maxillary incisor root resorption in cases of ectopic canines treated during the late 1970s and 1980s in Jönköping, Sweden.

SUBJECTS AND METHODS

The material comprised 55 incisors in 38 subjects. The posttreatment follow-up time was 13 to 28 years. All subjects underwent intraoral radiography, 33 were referred for computed tomography or cone beam computed tomography, and 24 also underwent clinical examination. The severity of incisor root resorption was correlated with clinical characteristics. Radiographs of the resorptive lesions were documented in detail and compared with intraoral radiographs taken immediately posttreatment.

RESULTS

Four incisors in three subjects had been lost, in part because of root resorption. Of the 36 incisors with root resorption, the lesions were unchanged in 26 teeth, improved in three teeth, and exacerbated in seven. In one case the resorption had progressed to pulpal exposure, necessitating endodontic treatment. For most of the incisors, the periodontal ligament was more clearly defined and the lamina dura showed improved trabeculation. The clinical characteristics of the incisors with resorption were not significantly different from those of sound incisors.

CONCLUSIONS

In this long-term follow-up, most cases of incisor root resorption induced by ectopic maxillary canines did not progress and teeth with root resorption showed no clinically relevant symptoms. The prognosis for long-term survival of teeth with resorbed roots is good, but in cases where extraction is indicated, lateral incisors with severe root resorption should be extracted in favor of healthy premolars.

Reasons for extraction in a group of Libyan patients

AIMS AND OBJECTIVES

To investigate the pattern and causes of tooth loss in patients among eastern part of Libya.

MATERIALS AND METHODS

This study carried out at Faculty of Dentistry, Garyounis University, Benghazi, Libya. The out patients undergoing extractions at the Oral Surgery Department were randomly selected for this study between Jan 2007 and March 2008 where a total of 9,570 extractions were performed on 8,514 patients. The incidence and reasons for tooth extraction, their distribution according to age and sex were studied.

RESULTS

Males had more teeth extracted than females. Forty patients had one or more systemic illnesses, 34 were on regular medication. The study revealed two major causes of tooth loss: dental caries (55.90%) and periodontal diseases (34.42%). Other important causes were trauma (3.76%), impaction (1.83%), prosthodontic reasons (2.19%), and orthodontic reasons (1.30%) and others which included extraction where the tooth was associated with a tumour, cyst or supernumerary tooth (1.61%). Dental caries was the main causes of tooth loss during the 2nd, 3rd and 4th decades. While periodontal diseases were the prevalent aetiological factor during the 4th, 5th, 6th and 7th decades of life. The posterior teeth most frequently extracted due to dental caries were lower first molars (43.92%). Whereas anterior teeth were more frequently extracted due to periodontal diseases (28%) with the remaining posterior teeth also being extracted (7%).

Nationwide survey for bisphosphonate-related osteonecrosis of the jaws in Japan

PURPOSE

A nationwide retrospective cohort study was conducted by the Japanese Society of Oral and Maxillofacial Surgeons to assess the occurrence of bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ) during 2006 to 2008 and to elucidate the outcome and factors associated with remission of BRONJ.

MATERIALS AND METHODS

A written questionnaire, including the clinical characteristics, management, and outcome of patients with BRONJ, was sent to 248 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons in 2008.

RESULTS

A total of 568 patients with BRONJ, including suspicious cases, were registered. Of these 568 patients, 263, including the maxilla in 81, the mandible in 160, and both in 22, met the working definition of BRONJ proposed by the American Association of Oral and Maxillofacial Surgeons. The patients included 219 women (83.3%) and 44 men (16.7%). Of these patients, 152 (57.8%) had received intravenous BPs, 104 (39.5%) had received oral BPs, and 7 (2.7%) had received both. The mean duration of administration until onset of BRONJ was 23.6 months for intravenous BPs and 33.2 months for oral BPs. BRONJ was stage 1 in 42 patients (16.0%), stage 2 in 187 (71.1%), stage 3 in 32 (12.2%), and unknown in 2. Of these patients, 34.2% had remission of BRONJ, 46.0% had persistent or progressive disease, and 19.7% died of malignancy or were lost to follow-up. Statistical analysis revealed that surgical treatment, including tooth extraction, sequestrectomy, and segmental mandibulectomy, contributed to the remission of BRONJ. In contrast, conservative treatment, concurrent anticancer drugs, poor oral hygiene, and the use of intravenous BPs did not.

CONCLUSIONS

The relative ratio of BRONJ related to the use of oral BPs was greater in Japan than in the United States and European Union. Surgical treatment contributed to remission of BRONJ, and conservative treatment, concurrent anticancer drugs, poor oral hygiene, and intravenous BPs did not.

Frequency, causes and pattern of adult tooth extraction in a Nigerian rural health facility

OBJECTIVE

To determine the frequency, causes and pattern of tooth extraction in a Nigerian rural health facility.

MATERIALS AND METHOD

This descriptive cross sectional study was conducted in Eden dental clinic of Mount Gilead hospital; Uselu from January 2006 to December 2008. The information collected with questionnaire included demography of patients, indications for extraction, type of tooth extracted and other treatments performed. Results were presented as simple frequency tables and graph. Data analysis was done with SPSS statistical software version 13.0.

RESULTS

Tooth extractions represented one third (33.4%) of the total treatment procedure. Periodontal disease (45%) and caries (32.6%) were the main reasons for extraction. Other reasons in descending order are failed root canal treatment (1.5%), orthodontic reason (1.2%), tooth in fracture line (1.0%), trauma (0.6%), supernumeraries (0.4%) and prosthetic reasons (0.2%). There was higher extraction among females than males p > 0.05. Tooth extraction in 27-36 years age group was the highest and the main reason for extraction in this age group was impaction (47.8%). Higher number of extracted teeth was from lower right quadrant, lower arch and right side of mouth in this survey. Molars made up 95.3% of all extracted teeth with first molar predominating (40.1%). The proportion of extractions attributed to periodontal disease increased from 17-56 years, but declined thereafter.

CONCLUSION

Tooth extraction was a highly frequent treatment procedure in this survey. Molars were mostly extracted as a result of caries although periodontal disease was the dominant reason for extractions. This result is different from results from previous studies.

RECOMMENDATION

Findings in this study showed that tooth extraction constitute about one third of the total procedures done in this rural health facility during the study period. This is mainly due to late presentation and brings to the fore, the degree of ignorance on oral health issues among the Nigerian rural dwellers. It is the opinion of the authors that the attention of the dental professionals be drawn to the need to reach out, educate and encourage best oral healthcare practices.

A sixteen year sample of surgically treated supernumerary teeth

AIM

Supernumerary teeth represent a numerical dental anomaly in which more teeth than the norm are present in the dentition. A sixteen year sample of supernumerary teeth has been reviewed in order to analyse epidemiological data, morphological and topographic features of these teeth, especially of those located in the praemaxillary region.

MATERIALS AND METHODS

All cases in which supernumerary teeth were surgically treated from 1991 to 2006 at the Oral Surgery Unit of the Sapienza University of Rome have been reviewed.

RESULTS

118 Caucasian subjects with supernumerary teeth have been reviewed in the range of age comprised between 5 and 42 years: 191 SNTs were collected, 136 from the upper jaw and 55 from the mandible. In the maxilla the incisor region was more frequently involved (67.65%), while in the mandible the one most frequently involved was the premolar region (69.1%). Conoid was the most frequent type of supernumerary teeth. Uneruption of the contiguous permanent teeth was the most commonly associated pathological condition, found in 81 out of the 191 cases of supernumerary teeth (40 patients, 42.4%). Tuberculated, infundibuliform and incisiform-shaped teeth caused uneruption of permanent teeth more frequently than the other morphological types of supernumerary teeth.

CONCLUSION

In the upper incisor area, the extraction of SNT is mandatory as early as they are diagnosed, especially if they are tuberculated, infundibuliform and incisiform-shaped, if they are located palatally or just in the middle of the ridge and when more than one SNT is present.

The geographic and socioeconomic distribution of in-hospital treatment of impacted teeth in Western Australia: a 6-year retrospective analysis

OBJECTIVE

The aim of the study was to test the hypothesis that all Australians based on clinical need have equal access to health services for the removal of impacted teeth as hospital in-patients.

METHODS

Data for the current analysis were obtained from the Western Australian Hospital Morbidity Data System (HMDS) for the six financial years 1999/00 to 2004/05. All cases of in-hospital treatment for impacted teeth were analysed and then correlated with socioeconomic status, geographic location of the patients, place of primary residence, and age.

RESULTS

In-patient extraction rates are significantly higher in the 10- to 19-year-old and the 20- to 29-year-old age groups when compared to the other age groups. A young adult from a higher socioeconomic group is 4 times more likely to have an impacted tooth removed in a hospital than his or her counterpart from a lower socioeconomic group, which is significant. Similarly, people living in highly accessible metropolitan areas have a 3 times greater chance of being hospitalised for this procedure than those from the remote and rural areas.

CONCLUSION

There are significant differences among different groups based on socioeconomic status and access to health services for in-hospital removal of impacted teeth, thus rejecting the hypothesis. This raises doubts over the nature of the procedure, considering that most patients are young, non-Indigenous, and live in metropolitan areas. This implies that some of the procedures seem to be elective and there is a need for introduction of guidelines in Australia for removal of impacted teeth, which could reduce expenditures significantly. However, further research is required in this area.

Risk-adapted dental care prior to intensity-modulated radiotherapy (IMRT)

BACKGROUND

At the Clinic for Radiation Oncology at the Zurich University Hospital (UniversitätsSpital Zürich [USZ]), head-and-neck tumor (HNT) patients have been treated with intensity-modulated radiotherapy (IMRT) since 01/2002 (n 〉 800). This method causes less damage to normal tissues adjacent to the tumor, and thus it was possible in the head/neck region to markedly reduce the rate of osteoradionecrosis (ORN), in addition to reducing the rate of severe xerostomia. Based on these results, risk-adapted dental care (RaDC) was adopted by our clinic as the standard mode of pre-IMRT dental treatment. The guidelines as formulated by Grötz et al. were respected. ORN prophylaxis is one of the most important goals of pre-radiotherapy dental care, and the ORN rate is a measurable parameter for the efficacy of dental care, given a certain radiation technique. The aim of the present study was therefore to evaluate the efficacy of RaDC as reflected by the ORN rate of our IMRT patients.

MATERIALS AND METHODS

IN August 2006, RaDC was clinically implemented and has been used for all HNT patients prior to IMRT since then. Before that (01/2002-07/2006), dental restorations were performed according to the usual procedure.

RESULTS

The rate of grade-2 ORN was similar in the conventionally treated and RaDC groups (2% and 1%, resp.); grade-3 ORN had not occurred by the time the analysis was conducted. As expected, fewer extractions were performed in the RaDC cohort (no extractions in 47% of the RaDC/IMRT cohort vs. 27% in the IMRT cohort receiving conventional dental care).

CONCLUSION

After considerably less invasive dental treatment, no higher-grade ORN occurred and no ORN-related jaw resections were required. Based on the present data, risk-adapted minimally invasive dental care is recommended before IMRT.