Students' clinical experience on outreach placements

Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development.

OBJECTIVE

To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings.

SETTING

One dental hospital and eight existing primary care block placements in England.

SUBJECTS AND METHODS

Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared.

MAIN OUTCOME MEASURES

(1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales.

RESULTS

Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting.

CONCLUSION

Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes. Multiple contrasting outreach placements for each student might increase the uniformity of learning experiences.

Keeping current with the evolving makeup of the Pennsylvania population

The changing residential population of the Pennsylvania requires continued monitoring if health practitioners are to maintain an awareness of the individuals in their community. A review of federal agency reports provides a general overview of Pennsylvania and national demographic and health factor characteristics.

Outcomes of root canal treatment in Dental Practice-Based Research Network practices

This study sought to quantify the incidence of root canal treatment (RCT) failure and identify its predictors in root canals that were performed or referred by general dentistry practices in a practice-based research network (PBRN). This retrospective cohort study involved 174 endodontically treated teeth. Mean duration from initial therapy to follow-up was 8.6 years. Permanent restorations were ultimately placed in 89% of teeth, although 18% of teeth were ultimately extracted anyway. Receiving a permanent restoration was a significant predictor of treatment failure (in other words, patients who did not receive a permanent restoration were more likely to experience RCT failure), whether failure was determined clinically or radiographically. This study of PBRN practices suggests a higher failure rate compared with studies that utilized highly controlled environments or populations with high levels of dental insurance.

Factors associated with orthodontic stability: a retrospective study of 209 patients

AIM

To assess the long-term stability of orthodontic treatment and some factors associated to posttreatment changes.

METHODS

Six hundred twenty-seven dental casts of 209 patients were examined with the PAR Index at pretreatment (T1), end of treatment (T2), and at long-term follow-up (T3, mean 8.5 years posttreatment). Friedman test and multiple regression analysis at P < .05 were used to evaluate changes among the time points and factors associated with stability.

RESULTS

After orthodontic treatment, the PAR Index improved by 94.2%. No significant change was observed between T2 and T3 (P>.05). However, when the sample was divided into a well- (PAR Index ≠ 3) and a less well-finished (PAR Index >3) group, it was observed that well-finished patients experienced some deterioration (P<.001), whereas the less well-finished ones showed some improvement (P<.05). Even with the deterioration, the well-finished patients still had a better PAR Index at T3 compared to the less well-finished ones. Regression analysis showed that PAR Index at T1 and T2, age at T1, and length of retainer wear had a slight association with occlusal stability (R(2)=0.27). No significant association was observed between stability and length of treatment, length of follow-up, sex, extraction, or third molar status on the other side.

CONCLUSION

Orthodontic treatment is quite stable. Not so well-finished treatments tend to show some improvement and well-finished ones deteriorate some. Well-finished patients still have better occlusal characteristics. Retention contributes to maintenance of the final orthodontic results.

Keeping current with evolving makeup of New York State population

The changing residential population of New York State requires continued monitoring if health practitioners are to maintain an awareness of the individuals in their community. A review of federal agency reports provides a general overview of state and national demographic and health factor characteristics.

Causes and patterns of loss of permanent teeth among patients attending a dental teaching institution in south India

AIM

The aims of the present study are to determine the causes and pattern of loss of permanent teeth among patients attending a dental teaching institution in southern India.

METHODS AND MATERIALS

Data collected from patients attending the outpatient wing of the Sri Sankara Dental College, Kerala, during a three month period was used for the study. The cause for extraction was classified as follows: (1) caries and its sequelae, (2) periodontal disease, (3) orthodontic purposes, (4) impactions, (5) prosthodontic purposes, and (6) other reasons.

RESULTS

A total of 1791 permanent teeth were extracted of which 708 (39.5%) teeth were extracted due to caries and its sequelae, 508 (28.4%) due to periodontal disease, 347 (19.4%) for orthodontic purposes, 29 (1.6%) due to impactions, 155 (8.7%) for prosthodontic purposes, and 44 (2.5%) for other reasons.

CONCLUSION

The results of the present study suggest caries and periodontal disease are the major causes of tooth mortality in the study population.

CLINICAL SIGNIFICANCE

Data regarding the causes of tooth loss indirectly provides invaluable information on the pattern of oral health in a population which can be utilized for planning public health policies designed to address the burden of oral diseases.

Dental treatment profile of New Zealand Defence Force personnel

OBJECTIVE

To evaluate the dental treatment provided over one year to serving personnel and new entrants in the New Zealand Defence Force (NZDF).

METHOD

Dental treatment data from 4,380 personnel in the 12 months following their last annual dental examination were retrieved and evaluated from electronic data archives. These included all treatment provided for 2000 randomly-selected regular serving personnel and for all 2380 new entrants entering the Service in the years 2005 and 2006.

RESULTS

Treatment data were recorded for 1770 (88.5%) of the 2000 serving personnel in the year following their last dental examination. Excluding examinations and radiographs, treatments averaged 2.3 per person. Amalgam and composite restorations contributed 40%, preventive and oral hygiene services 44%, and tooth extractions 6% of treatments; the "other" category amounted to 10% of treatments. For the 2380 new entrants, treatment data were recorded for 1959 (82.3%) during their first year of service. Treatments averaged 3.6 per person; amalgam and composite restorations contributed 58%, preventive and oral hygiene services 25%, and extractions 10%. The remaining 10% of treatment items recorded comprised a diverse range of procedures.

CONCLUSIONS

The level of treatment provided was low for both serving personnel and new entrants. Ninety percent of teeth were present and functional. Amalgam and composite restorations, preventive care and oral hygiene procedures made up the majority of treatment provided.

Patterns and reasons for tooth extraction at the Winterveldt Clinic: 1998-2002

BACKGROUND

Tooth extraction is the most common form of dental treatment in developing countries despite significant advances in medicine and dentistry. Dental caries, periodontitis, orthodontics, trauma and prosthodontics are the main reasons for extractions.

OBJECTIVE

To determine the patterns of tooth extractions and the reasons for these extractions in a primary care dental clinic attached to a dental training institution.

METHODS

A descriptive, retrospective and quantitative study design was followed. Data was gathered from 3793 patient files to record the following variables: age, gender, type of tooth extracted and reason for the extraction.

RESULTS

Almost 60% of teeth extracted were lower and upper molars. The main reasons for extractions were dental caries (47.9%) and periodontitis (22.6%).

CONCLUSIONS

The findings of the study show an urgent need to reverse the trends in extractions and more emphasis should be placed on primary prevention in order to reduce tooth loss.

Retrospective audit of Taranaki children undergoing dental care under general anaesthetic from 2001 to 2005

A retrospective audit of trends in day-stay treatment for dental caries at a New Zealand hospital dental unit showed that demand for treatment has risen. The annual number of children undergoing a GA increased by over 13%, although the average waiting time after the initial consultation decreased. The cost of treatment also dramatically increased with time, as the numbers and complexity of cases increased. The type of treatment under GA changed over the five years, with more extractions occurring over the course of the audit. Restorations were still the most common treatment item provided, although the use of SSC trebled in 2004 and 2005. Socio-economic status, sex and ethnic differences were observed, with more boys and Măori receiving GA care and having a higher number of extractions. These children were identified as being high users of other hospital services (such as the Emergency Department).

Previous radiographic experience of children referred for dental extractions under general anaesthesia in the U.K

OBJECTIVE

To determine what proportion of children undergo radiographic assessment prior to referral to a dental hospital for extractions under general anaesthesia.

BASIC RESEARCH DESIGN

This prospective survey was conducted over a 6-month period. A data sheet was used to record the following information: patient's age; referrer's name and place of work (general dental practice or community dental service); teeth to be extracted (primary dentition and/or permanent dentition) and reported previous radiographic examination. Patients were excluded from the study if, following a clinical examination, radiographs were not actually deemed necessary for diagnosis and treatment planning purposes. Clinical setting A paediatric dentistry clinic within a dental hospital in the North of England. Participants 161 patients with a mean age of six years (SD = 2.2, range = 3-14 years) who were referred to the dental hospital for extractions under general anaesthesia.

RESULTS

Overall, 12.4% of children had reportedly undergone a previous radiographic assessment prior to hospital referral. A significantly greater proportion of children referred for permanent tooth extractions had been subject to radiographic examination compared to children referred for primary tooth extractions (46.2% as compared to 6.3%; P = 0.001 chi-squared test). Furthermore, patients referred from the community dental service were significantly more likely to have had previous dental radiographs than children referred from general dental practice (36.9% compared to 9.3%; P = 0.003 chi-squared test).

CONCLUSIONS

Radiographs do not appear to be routinely employed for caries diagnosis and treatment planning in young children within general dental practice in the U.K.

Improving the provision of the Basic Package of Oral Care (BPOC) in Cambodia

Since 1992, 330 medical nurses have been trained to provide basic oral health care (including ART restorations and dental extractions) in remote areas of Cambodia. However, a range of barriers prevent dental nurses from providing these services, especially a lack of dental materials and instruments.

OBJECTIVES

To increase dental nurse (DN) outputs through the regular provision of dental materials and instruments. To improve cross-infection control procedures through the provision of necessary equipment, supplies and training.

METHODS

Six health centres with active DNs participated; three (experimental) health centres received sufficient supplies of dental instruments and materials for one year, and 3-monthly visits by a dentist from the Ministry of Health. The other three health centres (control) did not.

RESULTS

During the project period, the experimental group extractions increased to an average of 119 extractions per quarter (a three-fold increase compared to the baseline), 51 ART restorations, and improved compliance with cross-infection infection control protocols. In the control group the number of extractions remained similar to baseline and no ART restorations were placed.

CONCLUSIONS

The provision of the BPOC increased in the health centres when sufficient supplies of dental materials and instruments were provided. Increased monitoring and communication with MOH dental colleagues was also associated with the increased outputs and resulted in improved compliance with cross-infection control protocols. The MOH should increase supplies to DNs and provide ongoing monitoring and support in order to improve the access to and quality of dental care provided in rural Cambodia.

Lingual eruption of mandibular permanent incisors: a space correlated phenomenon?

AIM

The aim of the present study was to investigate the prevalence and distribution according to various arch length conditions of lingually erupted mandibular permanent incisors and the effect of space condition on this phenomenon with long-term follow-up of these teeth.

METHODS AND MATERIALS

A total of 105 children aged 5-7.5 years with one or more permanent mandibular incisors erupting lingual to the corresponding primary incisors were included in the study. A space analysis was performed. The subjects were divided into six groups according to various space conditions. The subjects were followed for 2 years.

RESULTS

In this study the prevalence of lingual eruption was 18.4%. Eighty-three point seven percent of the subjects had either equivalent space, mild space excess, or a space deficiency (not more than 3 mm). No relationship was found between groups and clinical outcomes (P>.05). Follow up of the main three groups (according to the space analysis results) revealed in the adequate space group 75% of the children lost their primary incisors without any intervention. Similar outcomes occurred in 85.7% and 57.14% of cases in the mild space excess and space deficiency groups, respectively. Considering the three main groups combined, equivalent space, mild space excess, and mild space deficiency, 70.45% of children lost their primary incisors without any intervention and 14.8% needed primary incisor extraction (17.4%, 14.3%, and 10.7% in each group, respectively).

CONCLUSION

There was no predisposition toward a space deficiency or excess found in these subjects so the wait-and-see policy versus early extraction can be considered for lingually erupting permanent mandibular incisors.

CLINICAL SIGNIFICANCE

Lingual eruption of mandibular incisors is a common clinical problem in the early mixed dentition period that is a source of discomfort for parents of patients with this condition. The present study provides a unique insight into the prevalence of the problem as well as the clinical decisions such as favoring retention of primary incisors as long as possible, the extraction of these primary teeth, placement of lower lingual holding arches, or referral for comprehensive orthodontic treatment. These types of data should not be regarded as standards but as illustrative of several key factors that are still not well-understood or which are still ignored.

Racial differences in baseline treatment preference as predictors of receiving a dental extraction versus root canal therapy during 48 months of follow-up

OBJECTIVE

This study aimed to test hypotheses that: a) treatment preference as stated at baseline predicts subsequent receipt of extraction (EXT) versus root canal treatment; and b) racial differences in treatment preference at baseline account for racial differences in receipt of these treatments during follow-up.

METHODS

Data were taken from the Florida Dental Care Study This stratified random sample included at baseline 873 subjects, all of whom were 45-years-old or older, reported race as non-Hispanic African American or non-Hispanic white, and had at least one tooth. At baseline, participants were asked about past dental care characteristics, history of or current presence of various dental diseases and conditions, and sociodemographic circumstance. An EXT/root canal treatment "CHOICE" scenario was also queried at baseline. Predisposing, enabling, and need factors were tested as predictors of EXT/root canal treatment received during follow-up. Bivariate multivariable logistic regression analyses quantified associations between the outcomes (EXT/root canal) and the predictors.

RESULTS

Receipt of EXT or root canal treatment during follow-up was strongly related to race even after people with mobile teeth at baseline were excluded from the analysis. Certain baseline factors (tooth mobility, periodontal attachment level, and ability to pay an unexpected dental bill) strongly predicted EXT/root canal treatment receipt during follow-up, although significant race effects remained; however, including "CHOICE" removed the race effect.

CONCLUSIONS

Baseline treatment preference strongly predicts subsequent receipt of EXT versus root canal treatment. Racial differences in treatment received during follow-up were explained by baseline racial differences in treatment preference, tooth mobility, and periodontal status.

[Our experience in sanation organization in pregnants and the ways of its perfection]

Results of oral cavity sanation performed upon 2366 pregnants during years 2003-2006 in the city of Derbent were studied. It was established that the need in caries and its complications treatment was equal to 78.91+/-0.84% of all pregnants. Due to the study of sanation refusal reasons and individually oriented educational work it was possible to reduce the number of unfavourable decisions (to refuse from sanation) from 15.02+/-1.77% in 2003 to 8.91+/-1.21% in 2006. Due to the reduction of this number and the ART-technique of caries treatment implementation in women with heavy pregnancy running the following sanation indeces improved: the portion of sanated pregnants from all needed in such procedure increased from 77.59+/-2.07% in 2003 to 87.45+/-1.41% in 2006, the number of filled carious lesions increased from 74.13+/-1.16% to 88.18+/-1.86% in 2006, the portion of extracted teeth from those intended for extraction 0- from 75.90+/-2.71% in 2003 to 89.17+/-1.75% in 2006.

[Frequency of tooth removal because of orthodontic reasons]

In certain orthodontic treatments therapy includes the removal of permanent tooth or teeth. The number of objective studies on assessing extraction frequency is low and values in the international publications range between wide limits. This shows that often the extraction decision in the treatment planning does is not made upon the criteria of evidence-based dentistry. In our practice, a retrospective analysis of treatment plans prepared between the 1st of January 2004 and the 31st of December 2006 (416 cases) has been performed. The overall prevalence of treatments with extraction was 41.59% for all patients, the rate was 51.63% in patients with permanent dentition at the time of the planning. The highest proportion of extraction (49.71%) was found in Class II subdivision 2 cases, and the lowest percentage (30.17%) in Class I cases. The decision for extraction does not seem to be influenced by cephalometric analysis directly. The higher percentage of extraction found in permanent dentition period shows that when we cannot use interceptive treatment alternatives, we are forced to extract tooth more frequently. On the other hand, the lower value in early mixed dentition period can be explained by the relatively higher number of treatments with the aim to avoid extraction.

The prevalence and aetiology of molar-incisor hypomineralisation in a group of children in Istanbul

AIM

To our knowledge, the prevalence and aetiology of molar-incisor hypomineralisation has not been discussed nor investigated in Turkish children in Istanbul. Therefore the aim of the present study is to investigate the prevalence and aetiology of MIH in a group of children in Istanbul.

DESIGN

Between April and July 2007, a retrospective clinical study was initiated at the Dept. of Paediatric Dentistry, School of Dentistry, Yeditepe University, Istanbul, Turkey. A total of 147 children aged 7-9 years visiting our clinic were examined by two calibrated paediatric dentists (kappa: 0.89). The examiners used the criteria for the diagnosis of demarcated opacities, post-eruption breakdown, atypical restorations, and extracted PFMs due to MIH developed by Weerheijm et al.

RESULTS

In the present study, prevalence of MIH was 14.9%. Of the 22 children affected with MIH, 17 (77.2%) had only demarcated opacities, but no breakdown or atypical restorations. Regarding diseases in the first 3 years of life, 55% of MIH and 19.4% of non-MIH children had a disease history. 27% of MIH children had suffered from upper and lower respiratory tract infections including bronchitis. This was significantly different from non-MIH children (p<0.001).

CONCLUSION

MIH was common among a group of 7-9 years old children, Istanbul.

Severe dental caries, impacts and determinants among children 2-6 years of age in Inuvik Region, Northwest Territories, Canada

In 2004-2005, 349 of 541 eligible, mostly preschool, children in the Inuvik Region in the Northwest Territories of Canada were examined clinically, and the parents or caregivers of 315 of these children were interviewed to measure their oral health status, and its impacts and determinants. Dental caries is a highly prevalent health problem among these preschool children in Inuvik Region: we found that 66% (230/349 children) had the disease and had, on average, 4.8 affected teeth, of which 2.4 had untreated decay. Twelve percent (42/349) of the children needed urgent dental care. Among the 315 children whose parents or caregivers were interviewed, 46% (144/315) had severe early childhood tooth decay. Significantly more of the parents of children with severe decay reported that their children had pain and a decreased ability to chew than the parents of children with no or moderate disease. Using logistic regression, we found that protective factors for severe early childhood tooth decay were higher family income (OR = 0.68; 90% CI = 0.54-0.85), community water fluoridation (OR = 0.49; 90% CI = 0.26-0.91), and drinking milk (OR = 0.44; 90% CI = 0.24-0.81) and fruit juices (OR = 0.46; 90% CI = 0.24-0.90) after the child began to walk, whereas significant risks were consuming drinks made from flavour crystals before (OR = 2.4; 90% CI = 1.3-4.6) and after (OR = 2.0; 90% CI = 1.2-3.2) that age. This information should enable the Health and Social Services Authority to plan health promotion and service delivery programs for the children in Inuvik Region.

Case series: a clinical study of 27 cases of dentoalveolar root fractures in children and adolescents

AIM

This was to assess fracture type, treatment delay, splinting periods and various treatment methods on periradicular healing of root fractures in a group of patients attending a Paediatric Dentistry clinic.

METHODS

Records and radiographs of children with root-fractured teeth, referred during 1999-2003, were assessed.

STATISTICS

Correlation analysis was performed using Spearman rank test.

RESULTS

There were 27 root-fractured teeth in 20 patients aged between 8-18 years. One root-fracture occurred in 13 patients (65%) and 7 (35%) had two root-fractured teeth; all maxillary teeth and the most affected teeth were central, followed by lateral, incisors. Only 4 patients were seen on the day of the trauma. The commonest cause of injury was a fall (12 patients), followed by collisions, bicycle and motorcycle accidents. Treatments consisted of: splinting, splinting+pulp therapy, extraction of coronal fragment accompanied with orthodontic interventions and restorative procedures, and surgical operations. Healing was related to treatment delay, location and type of fracture, and splinting time. Statistical analysis showed significant correlations only between healing type and splinting time.

CONCLUSIONS

Preventive educational programs concerning traumatic dental injuries are needed in Turkey and mandatory use of mouthguards and preventive use of helmets with bicycles and motorcycles.

A survey on orthodontic-restorative dental services in a NHS hospital

The provision of a joint orthodontic-restorative hospital service is important in providing a quality service for some dental malocclusions. A prospective survey was carried out of the joint orthodontic-restorative clinic at Mayday University Hospital, during the months of January to August 2005. Data was collected using a data collection form. In total 61 patient's attended 4 joint clinics. Fifty per cent of referrals were by general dental practitioners. The commonest referral reasons were spacing and dental trauma. Over one third of patients were seen within 12 weeks of their referral, whilst two thirds start their treatment within 12 weeks of consultation. The commonest restorative treatment was periodontal therapy, crown and bridgework. Over one third of patients required joint orthodontic and restorative treatment. More than 12% of patients require oral surgery in the form of removal of impacted teeth, exposure of unerupted teeth, placement of bone anchors or orthognathic surgery. Consultation and treatment waiting times could be reduced by the introduction of more clinics and employment of more staff A representative in oral surgery maybe useful with the increase use of bone anchors and mini implants to aid joint orthodontic-restorative treatment. Access to an orthodontic and restorative consultant clinic is useful in providing patients with a high quality of multidisciplinary treatment planning in an efficient manner.

Factors associated with restoration and extraction receipt among New Zealand children

OBJECTIVES

To assess the relative contribution of demographic socioeconomic, physical/lifestyles, dietary, food security and dental factors to self-reported restoration or extraction receipt among New Zealand children.

BASIC RESEARCH DESIGN

Cross-sectional study of nationally representation data using a two-stage random clustered sampling procedure and complex sampling analysis.

PARTICIPANTS

Mäori, Pacific and New Zealand European or Other (NZEO) children aged 5-14 years.

RESULTS

Of the 3,275 participants 37.4% were Mäori, 32.3% Pacific and 30.3% NZEO. Mäori children had higher odds of having received a restoration than NZEO children after adjusting for age, gender and length of time lived in New Zealand (OR: 1.87) and with addition of household SES (OR: 1.58), lifestyle (OR: 1.92), dietary (OR: 1.64), food security (OR: 1.79) or dental factors (OR: 1.89). By contrast, Pacific children had higher odds of having received an extraction than NZEO children when age, gender and length of time lived in New Zealand were taken into account (OR: 1.69), and with addition of household SES (OR: 1.48), lifestyle (OR: 1.71), dietary (OR: 1.52), food security (OR: 1.21) or other dental factors (OR: 1.93).

CONCLUSIONS

Mäori children were more likely to have received a restoration, and Pacific children more likely to experience an extraction, than NZEO children after adjusting for behavioural and material factors. Household SES contributed to most of the variance in Mäori child restoration receipt, while food security items explained most of the variance in Pacific child experience of extraction.

Taking dentistry to the geriatric patient: a home visit model

Frail, medically complex elders comprise an increasing dentally underserved population. The "demographic imperative" clearly shows that the number of elders is growing-from a current estimate of 40 million to a projection of 87 million in 2050. Oral health is a critical component of overall health and is increasingly recognized as critical to quality of life. This article describes a program to deliver oral health care services to homebound elders in the Greater Boston area through the collaboration of the geriatric dentistry and geriatric medicine fellowship programs at Boston University. The article reports on data collected between 2005 and 2007 on the demographics, needs, and services provided to a sample of 195 patients visited in their homes. Also identified are the types of third-party coverage reported for the patients and the implications for source of payment for dental services for the elderly in the future.

The relationship between jaw injury, third molar removal, and orthodontic treatment and TMD symptoms in university students in Japan

AIMS

To determine the association between temporomandibular disorders (TMD) and experiences of jaw injury, third molar removal, and orthodontic treatment, controlling for confounding factors such as age, sex, emotional stress, and oral parafunction.

METHODS

First-year university students (n = 2,374) were instructed to answer a questionnaire regarding symptoms of TMD, jaw injury, third molar removal, orthodontic treatment, stress, and parafunctional habits. All subjects were classified according to the level of TMD symptoms. Logistic regression was applied to assess the associations of experiences of jaw injury, third molar removal, and orthodontic treatment with presence of TMD symptoms after controlling for age, sex, stress, and parafunctional habits.

RESULTS

Of the 2,374 students, 715 students were TMD symptom-positive. They were classified into 7 groups consisting of those with only clicking (group 1), only pain in the temporomandibular joint (group 2), only difficulty in mouth opening (group 3), clicking and pain (group 4), clicking and difficulty in mouth opening (group 5), difficulty in mouth opening and pain (group 6), and all 3 symptoms (group 7). TMD symptoms were significantly associated with jaw injury. Odds ratios were 2.25, 2.47, 3.38, and 2.01 for groups 2, 3, 6, and 7, respectively. Experience of third molar removal was significantly associated with TMD (odds ratio = 1.81 for group 1). No association was found between orthodontic experience and TMD.

CONCLUSION

Experiences of jaw injury and third molar removal might be cumulative and precipitating events in TMD.