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PubMed2001

Tooth extraction, bleeding and pain control.

Local anaesthesia is used routinely in dental surgery; it is effective in both pain control and--through the vasoconstrictors often contained within it--the reduction of bleeding. The extraction of deciduous teeth under general anaesthesia is often carried out without these local effects. There are no previous studies to investigate the combined effect of local anaesthesia with general anaesthesia on blood loss and pain control. A randomised, controlled clinical trial was carried out with one hundred children aged 3-5 years. Ethical approval and informed consent were obtained. Surface anaesthetic cream (EMLA) was placed on the hand into which the intravenous access was to be placed. One to two ml of blood was taken at the time of induction as a baseline of the patient's level of haematin pigment. Children in the experimental group were given one quarter of a cartridge (0.5 ml) of local anaesthetic containing epinephrine (1:80,000) in each quadrant before tooth extraction; all blood in swabs, suction equipment and disposables was collected and digested with NaOH. The children were observed for 11 minutes post-operatively for any signs of distress. Total blood loss was calculated by comparison of the baseline sample and the shed blood digests. This study showed that using local anaesthesia for dental extractions under general anaesthesia was associated with decreased blood loss (p = 0.001). The second finding--which has not been reported before--was that this use of local anaesthesia was shown to cause distress to this age group of children upon recovery from the general anaesthetic (p <0.0001). The use of local anaesthetic in this situation provided a useful reduction in post-operative bleeding. However, its use was associated with greater post-operative distress.

Analgesics↗
PubMed2001

[A clinical investigation of oro-maxillary sinus-perforation due to tooth extraction].

Oro-maxillary sinus perforation occurs occasionally at the extraction of a maxillary tooth, and it may be a cause of maxillary sinusitis or antro-oral fistula. Our purpose was to investigate the most frequent site of perforation, and to understand the clinical course of patients after perforation. We examined 2,038 maxillary teeth extracted from 1,337 patients (473 males and 864 females) at the First Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University, from January 1991 to December 1993. Perforation occurred in 77 of all 2,038 teeth (3.8%). Of these, 38 teeth were from males (38/733; 5.2%), and 39 were from females (39/1,305; 3.0%). The perforation rate was significantly higher in males. Perforation occurred most often with extraction of an upper first molar, and in the third decade of life. The perforation rate gradually decreased with higher age. We classified 38 cases into 3 categories according to panorama X-P: 1) The tip of the root crossed over the bottom line of the maxillary sinus (29 cases), 2) Not crossed over distinctly (4 cases), 3) Just lie on, or whether the tip of the root crossed over the bottom line of the maxillary sinus was not distinct (5 cases). As to treatment, 30 perforations (39.0%) closed spontaneously in the course of observation, irrigation with physiological saline was used in 43 cases (55.8%), radical sinusotomy accompanied by closure of the perforation was performed in 4 cases, and only flap closure was used in 7 cases. There were no cases of relapse.

Adult↗
PubMed1990

[Study of structural changes in canine maxillary trabecular bone after tooth extraction].

All teeth on the right side of the upper and lower jaws were extracted from canine specimens; and changes in maxillary trabecular-bone structure caused by the resultant reduction in functional pressure were studied by means of image analysis of trabecular-bone density, width, specific length (which indicates bone length to unit area), and trabecular-bone orientations. Results 1. Trabecular-bone density Over the 13-month period, in comparison with the normal side, trabecular-bone density on the experimental side dropped to 69.4% in the incisor region, 82.2% in the premolar region, and from 60.0 to 68.0% in the molar region. The greatest reduction occurred in the molar region. 2. Trabecular-bone width Over the 13-month period, in comparison with the normal side, trabecular-bone width on the experimental side dropped to 86.9% in the incisor region, 86.1% in the premolar region, and from 66.4 to 71.4% in the molar region. The greatest reduction occurred in the molar region. 3. Specific length Over the 13-month period, in comparison with the normal side, specific length on the experimental side dropped to 81.9% in the incisor region, 82.9% in the premolar region, and from 65.6 to 70.5% in the molar region. The greatest reduction occurred in the molar region. 4. Orientation No regular trabecular-bone orientation was observed in the tooth-extraction sockets. In the incisor region, trabecular bone was often distributed at from 100 degrees to 120 degrees in relation to the dental roots. As time passed after extraction, the amount of bone with this orientation gradually decreased. At 13 months, amounts with bone orientation of from 40 degrees to 60 degrees had increased. In the premolar region, a great deal of trabecular bone was oriented at from 140 degrees to 150 degrees in relation to the dental roots. As time passed after extraction, the amount of bone with this orientation gradually decreased. At 13 months, amounts with bone orientation of from 110 degrees to 130 degrees had increased. In the molar buccal region, trabecular bone was often distributed at from 20 degrees to 40 degrees, and 90 degrees in relation to the dental roots. In the molar palatal region, trabecular bone was often distributed at from 120 degrees to 140 degrees in relation to the dental roots. At 13 months, the amount of trabecular bone oriented at about 90 degrees had increased.

Alveolar Bone Loss↗
PubMed1979

Frequency of tooth extraction in orthodontic treatment.

Orthodontic extraction frequency describes the percentage of an orthodontic patient population experiencing extractions of one or more permanent teeth, excluding third molars. It is a useful statistical measure of the many variables associated with the extraction-nonextraction decision. For a study sample of 537 North American white orthodontic patients, the frequency of tooth extraction was determined as 42.1 percent. This is compared with a range of 6.5 percent to 83.5 percent reported in the world dental literature. Factors responsible for the enormous differences in orthodontic extraction frequency are explored. The study of extraction frequency offers a simple, valuable aid for the clinician to understand better the nature of his patient population, his treatment methods, and his rationalizations.

Adolescent↗
PubMed1999

Disuse and functional overload induced by tooth extraction alters neuromuscular morphology in C57BL/6J mice.

The effects of functional disuse and overload on the morphology of neuromuscular junctions (NMJ) in masseter muscles of 8 month old C57BL/6J mice were studied. In order to stimulate disuse caused by tooth loss, teeth were extracted from one upper quadrant of 10 mice. The side where teeth were removed was functionally disused (D), since occlusion could not be achieved. Similarly, the intact contralateral (CL) side experienced overload. Morphological measurements were taken of zinc iodide osmium (ZIO)-stained NMJs from control animals, and treated animals at 7 days (7D) and 4 months (4M) post-extraction. Data was analyzed with repeated measures multivariate analysis of covariance (MANCOVA). Test animals did not lose weight, which indicated that sufficient food was consumed after tooth extraction. Fiber diameters from the 7D group were smaller than the controls, while those from the 4M animals were larger. In both the 7D and 4M animals, the CL fibers were larger than the D fibers. There was a trend towards larger NMJs in the 4M animals than in control animals of the same age. NMJs from the CL side of the 4M animals had 14% larger nerve terminal areas (p<0. 1), while on the 4M D side they were 6% larger (p<0.10). NMJs from the 4M D group had 5% longer nerve terminals (p<0.07), while the 4M CL NMJs were 6% longer (p<0.05). NMJs from the D side of the 7D animals were 5% smaller in area while on the CL side they were 11% smaller (p<0.1). Nerve terminals in 7D animals were 6% longer (p<0.05) than in controls. Changes in NMJ morphology following tooth extraction were probably due to differences in degeneration -regeneration of nerve terminals. Acute disuse and overload probably produced greater nerve terminal retraction, whereas chronic changes consisted of a recovery characterized by NMJ plasticity similar to that observed in exercise, disuse and aging studies.

Animals↗
PubMed1989

The effect of tooth extraction on periodontal ligament mechanoreceptors represented in the mesencephalic nucleus of the cat.

When a force is applied to a tooth, mechanoreceptors in the periodontal ligament are stimulated. When teeth are extracted the remnants of the periodontal ligament break down and disappear, but it is not known what happens to the mechanoreceptor neurones that innervated it. The present study seeks to determine the effect of tooth extraction on the population of periodontal ligament mechanoreceptor neurones represented in the mesencephalic nucleus of the fifth cranial nerve. The incisor and canine teeth were extracted from adult cats; terminal experiments were performed between 7.5 months and 2 yr later. Recordings were made in the mesencephalic nucleus with microelectrodes, and neurones were identified in the inferior alveolar nerve that previously innervated the periodontal ligament of one of the extracted mandibular teeth. The majority of these neurones responded only to electrical stimuli applied to the edentulous ridge of the mandible in the area where the incisor or canine teeth had previously been. It was not possible to stimulate them mechanically, despite the use of large forces. A small number had reinnervated new soft-tissue sites. They could be mechanically stimulated and were found adjacent to the area in which the mandibular incisor and canine teeth had been. Thus the population of periodontal ligament mechanoreceptor neurones represented in the mesencephalic nucleus do not all degenerate after tooth extraction. As the majority of those still present do not appear to reinnervate new tissues in which they can be mechanically stimulated, it is unlikely that they have any functional role after tooth loss.

Animals↗