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Biomedical subjects

Raymond P White

Publications and source records attributed to Raymond P White.

At least 19 recordsLinked to original sources
PubMed2007

Third molar periodontal pathology and caries in senior adults.

PURPOSE: 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. SUBJECTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Black or African American↗
PubMed2006

Progression of periodontal disease in the second/third molar region in subjects with asymptomatic third molars.

PURPOSE: To assess the change in periodontal status over time by periodontal probing depth (PD) in the third molar region. SUBJECTS AND METHODS: The data for these analyses are part of a study of subjects enrolled with 4 asymptomatic third molars with adjacent second molars in an institutional review board-approved longitudinal trial. Full mouth periodontal probing was conducted to determine periodontal status at baseline and follow-up. Panoramic radiographs were analyzed for angulation and degree of eruption of third molars. Subjects were categorized as those who exhibited at least a 2 mm change in periodontal PD between baseline and follow-up in the third molar region, the distal of a second molar or around a third molar, and those who did not exhibit a 2 mm or greater change. Subjects with and without changes in PD were compared with Cochran-Mantel-Haenzsel statistics. Level of significance was set at 0.05. RESULTS: Data from 254 subjects with at least 2 annual follow-up visits were available for analysis. Mean age at baseline was 27.5 years. Median follow-up from baseline to the second follow-up visit was 2.2 years (interquartile range 2.0, 2.6). At enrollment, 59% of the subjects had at least 1 PD > or =4 mm in the third molar region, one quarter had a PD > or =5 mm. Twenty-four percent of the subjects had at least 1 tooth that had an increased PD > or =2 mm in the third molar region at follow-up. If subjects had at least 1 PD > or =4 mm at baseline, 38% had at least 1 PD deepen by 2 mm or more at follow-up. Only 3% of those who had all teeth with a PD of less than 4 mm at baseline exhibited a change of > or =2 mm (P < .001). CONCLUSION: Increased periodontal PDs > or =2 mm were often found in the third molar region for asymptomatic subjects with at least 1 PD > or =4 mm at enrollment, clinical measures that indicated increased periodontal pathology, and a deteriorating periodontal condition.

Adolescent↗
PubMed2006

Change in third molar angulation and position in young adults and follow-up periodontal pathology.

PURPOSE: This study was designed to assess changes in third molar position and angulation in young adults and the resulting third molar periodontal probing (PD) status. PATIENTS AND METHODS: Data derived from patients with 4 asymptomatic third molars with adjacent second molars enrolled in an institutional review board approved longitudinal trial. Inclusion criteria for the trial dictated that patients be healthy and 14 to 45 years of age. Panoramic radiographs were analyzed for third molar angulation as compared with the long axis of the second molar (mesial/horizontal > or =25 degrees ) and eruption to the occlusal plane. Full mouth PD including third molars was conducted at follow-up. At follow-up, PD > or =4 mm distal of second molars or around third molars was considered important clinically. RESULTS: Data from 237 patients were available. Median age was 25.9 years (interquartile range [IQ], 22.1 years, 32.8 years). With a median follow-up of 2.2 years (IQ, 2.0 years, 3.7 years), 44% of impacted maxillary third and 26% of impacted mandibular third molars changed angulation or position. One third of vertical/distal impacted third molars in both jaws and 11% mesial/horizontal mandibular third molars erupted to the occlusal plane during follow-up from baseline. If mandibular third molar angulation as compared with the long axis of the second molar was mesial/horizontal > or =35 degrees , only 3% erupted to the occlusal plane. At follow-up, 11% of the 125 impacted maxillary third and 29% of the 133 impacted mandibular third molars had PD > or =4 mm. Similarly, 11% of the 307 maxillary third molars at the occlusal plane had PD > or =4 mm, but 51% of the 312 erupted mandibular third molars were affected. CONCLUSION: A change in third molar position or angulation was common. Erupted mandibular third molars were more likely to have PD > or =4 mm.

Adolescent↗
PubMed2006

Reliability of third molar probing measures and the systemic impact of third molar periodontal pathology.

PURPOSE: 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. PATIENTS AND METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.

Adult↗
PubMed2006

Chronic oral inflammation and the progression of periodontal pathology in the third molar region.

PURPOSE: To assess the association between risk markers of chronic oral inflammation and changes over time in periodontal probing depth (PD) in the third molar region, the distal of a second molar, or around a third molar. SUBJECTS AND METHODS: The data from these analyses are part of a study of subjects enrolled with 4 asymptomatic third molars with adjacent second molars in an institutional review board-approved longitudinal trial. Full-mouth periodontal probing was conducted at enrollment and follow-up. Enrollment levels of periodontal pathogens and gingival crevicular fluid inflammatory mediators were assayed as indicators of the degree of oral inflammation. Subjects were categorized as those who had at least a 2 mm change in periodontal PD between baseline and follow-up in the third molar region and those who did not. The relationship between aggregated subject baseline PD, levels of periodontal pathogens, and gingival crevicular fluid IL-1 beta, and the proportion of subjects with changes in PD >or=2 mm versus those with PD <2 mm were compared with Cochran-Mantel-Haenzsel statistics. Level of significance was set at 0.05. Risk assessment models for a change in PD >or=2 mm were developed using logistic regression analysis. RESULTS: Twenty-four percent of 254 subjects exhibited a change in PD from baseline to follow-up of >or=2 mm in the third molar region. Of these, 95% had a baseline PD of >or=4 mm. Both high (>or=10(5)) "orange" and "red" complex bacteria and PD of >or=4 mm detected at enrollment were significantly associated with a change in PD >or=2 mm. Odds of a change in PD >or=2 mm were increased if baseline pathogen levels were >or=10(5) or a PD of >or=4 mm was detected at enrollment. CONCLUSION: Our findings are consistent with chronic oral inflammation leading to a progression of periodontal disease in the third molar region.

Adolescent↗
PubMed2006

Impact of topical minocycline with third molar surgery on clinical recovery and health-related quality of life outcomes.

PURPOSE: Compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients treated with or without topical minocycline at surgery. PATIENTS AND METHODS: Sixty-three patients at least 18 years of age with all 4 third molars below the occlusal plane were treated with topical minocycline during third molar surgery. Topical minocycline (1.0 mg in bioresorbable polyglycolide-co-dl-lactide [PGLA] sustained-release microspheres) was placed sequentially in bony defects after removal of lower third molars. Clinical and health-related quality of life (HRQOL) outcomes of these patients postsurgery were compared with those of a nonconcurrent control group (n = 60 patients) who did not receive antibiotics. The control group was selected using the same criteria and treated under the same surgical protocol as the antibiotic group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics. RESULTS: The 63 patients in the minocycline group were treated at 4 clinical centers. The incidence of delayed clinical recovery, defined as a postsurgery visit with treatment, was significantly lower in the minocycline group compared with the control group. In the minocycline group, 10% had 1 postsurgery visit with treatment; no patient had 2 visits. In the control group without antibiotics, 28% had at least 1 postsurgery visit with treatment (P = .01) and 13% had at least 2 postsurgery visits with treatment. Recovery time to "no" or "little trouble" with chewing and mouth opening was significantly improved in the minocycline group (P < .05). CONCLUSIONS: Administration of topical minocycline with third molar surgery may improve clinical and HRQOL recovery in healthy adult patients with all 4 third molars below the occlusal plane, a presenting characteristic that has been suggested as a risk factor for delayed recovery.

Administration, Topical↗
PubMed2006

Assessment of oral health-related quality of life before and after third molar surgery.

PURPOSE: This study was designed to further our understanding of recovery after third molar surgery by using 2 instruments to measure quality of life outcomes, the more global Oral Health Impact Profile (OHIP-14), and the condition-specific Health-Related Quality of Life (HRQOL) instrument. PATIENTS AND METHODS: Clinical and quality of life data pre- and postsurgery from 63 patients with all 4 third molars below the occlusal plane, treated with topical minocycline during third molar surgery to reduce the incidence of delayed clinical healing, were available for analyses. Each patient was given 2 questionnaires to complete; the more global OHIP-14 and the HRQOL instrument designed to assess recovery after third molar surgery. Prevalence, Extent, and Severity of the OHIP-14 scores were calculated presurgery and for postsurgery days (PSD) 1, 7, 14. The percentage of patients reporting clinically relevant responses detrimental to quality of life from the condition-specific HRQOL instrument were reported for the same time frame. RESULTS: Study patients were most likely female, less than 25 years old, and Caucasian. Most (72%) had bone removed from both lower third molars. Median surgery time was 27 minutes (interquartile range [IQ], 20, 40 minutes.). Median surgeons' estimate of overall difficulty was 14 of a possible 28 (IQ 10, 18), and the median degree of difficulty for lower third molars was 8 of 14 (IQ 6, 10). Few patients (only 10%) had delayed clinical healing. Prevalence for all OHIP-14 items, percent of patients reporting items "fairly often" or "very often," were increased from presurgery on PSD 1 and then decreased on PSD 7 and PSD 14. OHIP-14 Severity scores, the sum of OHIP-14 responses, followed the same pattern as the Prevalence scores. OHIP-14 Severity scores on PSD 1 were 27 (IQ 16, 34), decreasing to 8 (IQ 3, 13) by PSD 7, and 1 (IQ 0, 5) by PSD 14. Recovery for outcomes addressed by both instruments followed a similar pattern and time course. However, each instrument also assessed distinctly different outcomes, adding information that could not be obtained by 1 instrument alone. CONCLUSION: Complementary instruments to measure quality of life outcomes provide a broader understanding of recovery after third molar surgery.

Adult↗
PubMed2006

Proximity of a lower third molar to the inferior alveolar canal as a predictor of delayed recovery.

PURPOSE: This study was designed to test the hypothesis that removal of lower third molars below the occlusal plane and in close proximity to the inferior alveolar canal (IAC) delays recovery after surgery as compared with lower third molars below the occlusal plane yet not close to the IAC. PATIENTS AND METHODS: Recovery data were available for 579 patients enrolled in an institutional review board-approved clinical trial. After surgery a questionnaire designed to assess health-related quality of life (HRQOL) recovery was given to the patient to be completed each day for 14 days. At each postsurgery visit, clinical data were collected detailing healing and treatment. Based on radiographic findings, patients with at least 1 mandibular third molar below the occlusal plane were identified. Outcomes for patients with at least 1 radiographic sign indicating proximity of a lower third molar to the IAC were compared with those with none. Clinical and HRQOL outcomes were compared with Cochran-Mantel-Haensel statistics (P < .05). RESULTS: No significant differences were found between groups for delayed clinical recovery. If radiographic signs for a patient at presurgery evaluation indicated close proximity of a lower third molar to the IAC, odds were significantly increased for delayed HRQOL recovery for worst pain, lifestyle, and oral function. CONCLUSION: Our findings support the hypothesis that a presurgery finding of a lower third molar below the occlusal plane and in close proximity to the IAC is associated with patients' prolonged HRQOL recovery, but not a significant delay in clinical recovery.

Adolescent↗
PubMed2005

The impact of intravenous corticosteroids with third molar surgery in patients at high risk for delayed health-related quality of life and clinical recovery.

PURPOSE: To compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients predicted to be at risk for delayed recovery, treated with or without intravenous (IV) corticosteroids at surgery. PATIENTS AND METHODS: Patients at least 18 years of age and with all 4 third molars below the occlusal plane were given IV corticosteroids just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group who did not receive corticosteroids. No antibiotics were administered. The control group was selected using the same criteria and treated under the same surgical protocol as the corticosteroid group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics. RESULTS: Sixty patients were in each cohort. The incidence of delayed clinical recovery, a postsurgery visit with treatment, was higher in the control group compared with the corticosteroid group. In the corticosteroid group, 6 patients (10%) had 1 postsurgery visit with treatment. In the control group without corticosteroids, 17 patients (28%) had at least 1 postsurgery visit with treatment (P = .01). Compared with the control group, nausea tended to bother patients less on postsurgery day 1 (P = .07); sleep was improved on postsurgery days 1 through 4 (P < .05). Though not statistically significant, corticosteroids reduced the patients reported recovery by at least 1 day for pain, lifestyle, and oral function. CONCLUSION: Administration of IV corticosteroids before third molar surgery without antibiotics does not hamper clinical recovery even when healthy adult patients are predicted to have delayed recovery. Overall, IV corticosteroid administration had a limited, but beneficial effect on HRQOL outcomes.

Adrenal Cortex Hormones↗
PubMed2005

Third molars associated with periodontal pathology in older Americans.

PURPOSE: The study goal was to assess the association between the presence of visible third molars and periodontal pathology in a community-dwelling sample of middle-aged and older adults. MATERIALS AND METHODS: Data were obtained between 1996 and 1999 on 6,793 persons aged 52 to 74 from the Dental ARIC Study, a substudy of the Atherosclerosis Risk in Communities Study. The main independent variable was presence or absence of third molars assessed visually, and the dependent variable was assessment of periodontal disease as measured by pocket depth of 5 mm or greater (PD5+). Periodontal measures included pocket depth, gingival recession, and attachment level on 6 sites per tooth on all remaining teeth. Second molars were compared for periodontal pathology based on the presence or absence of a visible third molar in the same quadrant. Associations were determined using odds ratios and 95% confidence intervals. Weighted multivariable models were fit using logistic regression, and variances were adjusted to account for the clustering of quadrants within persons with the use of SUDAAN (Research Triangle Institute, Research Triangle Park, NC). RESULTS: A visible third molar was associated with 1.5 times the odds of PD5+ on the adjacent second molar, while controlling for other factors associated with the presence of third molars and periodontal disease. Other factors positively associated with PD5+ in the model were male gender, older age, smoking, and irregular and episodic dental visits. CONCLUSIONS: The finding of more severe periodontal conditions associated with visible third molars in these middle-aged and older adults indicates that third molars may continue to have a negative impact on periodontal health well into later life. The relationship between third molars and periodontal disease pathogenesis deserves further study using longitudinal data.

Black or African American↗
PubMed2005

Incidence of occlusal dental caries in asymptomatic third molars.

PURPOSE: We sought to determine the incidence of caries experience on the occlusal surface of asymptomatic third molars erupted to the occlusal plane and to examine the association between the prevalence of caries experience in third molars and other molars. PATIENTS AND METHODS: Clinical data were collected from healthy patients (ASA Class I, II) with asymptomatic third molars enrolled at 2 clinical centers in an institutional review board-approved clinical trial. All patients with at least one third molar at the occlusal plane and with data at baseline and from the most recent of at least 2 follow-up visits were compared in the analysis. At each visit, the presence or absence of caries experience on the occlusal surface of third molars and on any surface of the first and second molars was recorded during clinical and radiographic examinations. RESULTS: Median time between baseline and the most recent follow-up examination was 2.9 years (interquartile range, 1.6 to 4.0 years). Patients (N = 211) were more often female (55%) and white (79%). Median age at baseline was 26.6 years (interquartile range, 22.7 to 32.6 years). At baseline, 29% of patients were affected by third molar occlusal caries, increasing to 33% at follow-up. Older patients at baseline had more caries in a third molar than those younger than 25 years (43% versus 9%). However, patients who were younger at baseline were more likely to develop caries in third molars at follow-up (9% versus 19%). Mandibular third molars were affected more often than maxillary third molars: 25% versus 19% at baseline and 29% versus 22% at follow-up. At baseline and at follow-up, nearly all patients with third molar caries, 98% and 99%, also had caries in first/second molars. CONCLUSIONS: The 3-year caries incidence in third molars erupted to the occlusal plane was highest among younger patients and mandibular teeth. The presence of caries in first/second molars at baseline was highly predictive of the development of third molar caries during the ensuing 3 years.

Adolescent↗
PubMed2005

The impact of delayed clinical healing after third molar surgery on health-related quality-of-life outcomes.

PURPOSE: This study was designed to examine the impact of delayed clinical healing after third molar surgery on health-related quality-of-life recovery (HRQOL). PATIENTS AND METHODS: Recovery data after removal of 4 third molars for patients in an institutional review board-approved, prospective, multi-site, clinical trial were analyzed. Data obtained from patients with a HRQOL instrument, which included domains for lifestyle, oral function, and pain items, assessed recovery for each of 14 days postsurgery. Delayed clinical healing was defined as having at least 1 postsurgery visit with treatment. Prevalence ratios (PR) with 95% confidence intervals were calculated to compare the prevalence of delayed HRQOL recovery between those participants with delayed clinical healing and those without. Sensory intensity and unpleasantness scores from Gracely scale data for each postsurgery day were compared for those patients with and those without delayed clinical healing using the Cochran-Mantel-Haenszel row mean score statistics. The level of significance was set at .05. RESULTS: Recovery data were analyzed for 547 patients. A subset of the patients also completed Gracely scales each day. If a patient had delayed clinical healing, the prevalence of delayed recovery for lifestyle nearly doubled (prevalence ratio (PR), 1.7; 95% CI, 1.3 to 2.3). Similarly, a higher proportion of those with delayed clinical healing also reported delayed oral function recovery (PR, 1.8; 95% CI, 1.4 to 2.3); late symptoms recovery (PR, 2.0; 95% CI, 1.2 to 3.6) and delayed resolution of pain (PR, 1.6; 95% CI, 1.3 to 2.0). Statistically significant average differences existed between those with delayed clinical healing and those without for the sensory intensity of pain and the unpleasantness of pain from postsurgery day 3 through day 14 (P < or = .01). CONCLUSION: Delayed clinical healing after third molar surgery significantly increased the prevalence of delayed recovery for lifestyle, oral function, late symptoms, and pain.

Adult↗
PubMed2005

Pain medication as an indicator of interference with lifestyle and oral function during recovery after third molar surgery.

Purpose This study was designed to assess the impact of taking pain medications, as a more comprehensive indicator of perceived pain, on the extent of interference with lifestyle and oral function during recovery after third molar surgery. Patients and Methods Recovery data after the removal of 4 third molars were available for patients enrolled in an institutional review board-approved, prospective, multicenter clinical trial. A self-administered health-related quality of life instrument, designed to assess a patients perception of recovery for pain, lifestyle, and oral function, was completed each postsurgery day (PSD) for 14 days. Taking pain medications was a proxy for a patients perceived level of pain, adding a more sensitive behavioral component to the report of pain. Each PSD day, the patients who thought that their pain was sufficient to require taking medications (an opioid, a nonsteroidal anti-inflammatory, or the combination) were compared with patients not taking pain medications. The extent of interference in lifestyle (daily activity, social life, recreation, sleep) and in oral function (eating, chewing, mouth opening) as self-reported on a scale of 1 (no trouble) to 5 (lots of trouble) were compared for those taking and not taking medications using Cochran-Mantel-Haenszel row mean statistics ( P < .05). Results The 445 study patients were mostly female (63%) and white (86%). Median age was 20 years (IQ, 18, 24 years). Median surgery time was 30 minutes (IQ, 20, 40 minutes). Both mandibular third molars were below the occlusal plane in 60%. Almost all patients took pain medication on PSD 1. By PSD 7, 48% of patients were taking pain medication, decreasing to 20% by PSD 11. Patients with pain sufficient to take an analgesic reported a greater extent of interference for all lifestyle and oral function measures. Recovery was significantly delayed for PSD 2 through 14 for patients who took medications ( P < 0.01). Recovery for females taking pain medications was significantly delayed compared with that for males. Conclusions Patients with pain sufficient to prompt taking pain medications were likely to report interference with recovery for lifestyle and oral function. A patients choice to take pain medication appears to be a better indicator of a patients perceived pain and the impact of that pain on recovery than numerical pain scales. This method provides more sensitive behavioral information during the period of recovery after third molar removal.

Activities of Daily Living↗
PubMed2004

The impact of intravenous antibiotics on health-related quality of life outcomes and clinical recovery after third molar surgery.

PURPOSE: We sought to compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients treated with or without intravenous antibiotics at surgery. PATIENTS AND METHODS: Fifty-six patients at least 18 years of age and with all 4 third molars below the occlusal plane, treated at 3 clinical centers, were given intravenous antibiotics just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group (n = 60 patients) who did not receive antibiotics. The control group was selected using the same criteria and treated under the same surgical protocol as the antibiotic group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics. RESULTS: The incidence of delayed clinical recovery defined as a postsurgery visit with treatment was higher in the control group compared with the antibiotic group. In the antibiotic group, 4% had 1 postsurgery visit with treatment; no patient had 2 visits. In the control group without antibiotics, 28% had at least 1 postsurgery visit with treatment (P <.0001) and 13% had at least 2 postsurgery visits with treatment. No statistically significant differences in HRQOL outcomes were found between the 2 groups. CONCLUSIONS: Administration of intravenous antibiotics before third molar surgery may improve clinical recovery in healthy adult patients with all 4 third molars below the occlusal plane, a presenting characteristic that has been suggested as a risk factor for delayed recovery. The findings from this exploratory trial indicate that evaluation of the effectiveness of systemic antibiotic administration with third molar surgery in a randomized, multi-intervention, explanatory clinical trial is warranted.

Adult↗
PubMed2004

Occlusal caries experience in patients with asymptomatic third molars.

PURPOSE: Our goals were to determine the prevalence of caries experience, carious lesions, or restorations on the occlusal surface, in asymptomatic third molars erupted to the occlusal plane, and to examine the association between caries experience in other molars and third molars within the same mouth and quadrant. PATIENTS AND METHODS: Clinical data assessing oral health were collected from healthy patients (ASA I, II). The presence or absence of caries experience on the occlusal surface of third molars and on any surface of the first and second molars was recorded during clinical and radiographic examinations. The occurrence of caries experience for younger and older subjects was compared using the general association Cochran-Mantel-Haenszel statistic and the association of occurrence in the maxilla and mandible by the McNemar test. The association between caries experience in a third molar and caries experience in first and second molars also was assessed. RESULTS: Overall, 28% of the 303 patients with at least 1 third molar at the occlusal plane were affected by third molar caries. Patients 25 years or older had more caries experience in a third molar than those younger than 25 years, 39% versus 11% (P <.0001). Mandibular third molars were affected more often than maxillary third molars, 24% versus 18% (P <.0001). Nearly all patients, 76 of 80 (95%), with third molar caries experience also had caries experience in first/second molars, but only 80 of 223 (36%) of patients with first/second molar caries experience had a history of third molar caries. CONCLUSIONS: The prevalence of caries in third molars erupted to the occlusal plane in these young patients was high, but not unique to third molars, particularly in those 25 years of age and older. Although these results provide a baseline description of the association between caries experience in first/second molars and associated third molars, data are needed from longitudinal studies to determine the value of first/second molar caries experience in predicting the risk of caries in third molars.

Adolescent↗
PubMed2004

The impact of third molar symptoms, pain, and swelling on oral health-related quality of life.

PURPOSE: This study was designed to assess the impact of "pain and swelling" associated with third molars on patients' quality of life before surgery. PATIENTS AND METHODS: The data for these analyses were obtained from a larger ongoing study designed to examine the surgical and medical management of problems associated with third molars. Data from 480 patients with 4 third molars scheduled for removal were used in the analysis. Questionnaires administered presurgery assessed patients' medical and dental history, their reasons for seeking third molar removal, and sociodemographic characteristics. Adverse impacts on oral health-related quality of life were measured using the 14-item Oral Health Impact Profile (OHIP) questionnaire. The primary outcome variable was the percentage of people reporting 1 or more of the 12 non-pain-specific OHIP items "fairly often" or "very often" during the 3 months before enrollment. RESULTS: One third (178 of 480) of patients said they were seeking third molar surgery because of current or previous symptoms of pain/swelling, and 17% reported 1 or more of the 12 non-pain-specific OHIP items. In the multivariate logistic regression model, the odds of one or more impacts was greater for people who presented because of symptoms (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.7 to 4.8), who were aged 25 years or more (OR, 1.9; 95% CI, 1.1-3.3), and who had a self-reported history of tooth loss due to pathology or trauma (OR, 2.9; 95% CI, 1.9 to 5.5). CONCLUSIONS: Adverse impacts on quality of life occurred for 1 in 8 patients seeking third molar surgery, and the odds increased 3-fold for patients who had experienced pain/swelling compared with those who were asymptomatic.

Adolescent↗
PubMed2004

Third molars associated with periodontal pathology in the Third National Health and Nutrition Examination Survey.

PURPOSE: Assess the association between visible third molars (VTM) and periodontal pathology in Third National Health and Nutrition Examination Survey (NHANES III). MATERIALS AND METHODS: Data were obtained on 5,831 persons aged 18 to 34 from the NHANES III. Relevant to the present study was the presence of VTM and the assessment of periodontal disease in 2 randomly selected (1 maxillary and 1 mandibular) quadrants. Periodontal measures included gingival index, pocket depth, and attachment level on mesiobuccal and buccal sites on up to 7 teeth (excluding third molars) per quadrant. Second molars were compared for periodontal pathology based on the presence or absence of a VTM in the same quadrant. Associations were determined using odds ratios and 95% confidence intervals. Weighted multivariable models were fit using logistic regression, and variances were adjusted to account for the complex sampling design using SUDAAN (Research Triangle Institute, Research Triangle Park, NC). RESULTS: A VTM was associated with twice the odds of a probing depth 5+ mm (PD5+) on the adjacent second molar, while controlling for other factors associated with VTM and periodontal disease. Other factors positively associated with PD5+ in the model were age 25 to 34 years, smoking, and African American race. CONCLUSIONS: The finding of more severe periodontal conditions associated with VTM in these young adults indicates that third molars may have a negative impact on periodontal health. The relationship between third molars and periodontal disease pathogenesis deserves further study using longitudinal data.

Adolescent↗