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PubMed1998

UK National Third Molar project: the initial report.

The National Third Molar (NTM) project was set up to assess current clinical practice in the UK concerning the management of third molar teeth. Patients were recruited from both hospital and general dental practice. During the one month study period 9248 patients with 26,577 third molars were recruited. In this report we present the findings in the 8298 patients with 25,001 third molars who were referred to hospital for assessment. Over half of all patients referred for assessment had either no extractions or a single third molar extracted. Less than a quarter of all patients referred underwent removal of all four third molars. Twenty per cent of all third molars assessed were not extracted. Of all lower third molars listed for extraction, 9574 (78%) were associated with symptoms or disease. Pericoronitis was the commonest indication for extraction and was cited in 39.5% of all extractions. Almost 70% of third molar extractions were done under general anaesthesia while less than a quarter were performed under local anaesthesia alone.

Adult↗
PubMed1998

An audit of oral and dental health regimens practised in the management of oropharyngeal cancer.

The purpose of the present study was to find out what preventive care was offered to patients after radiotherapy, particularly if they were dentate. As the mean age of the population increases and the number of people who retain at least some of their teeth into old age also rises, it is likely that more and more people with a diagnosis of oral cancer will be dentate. The incidence of oropharyngeal cancer has also started to increase recently and is affecting more young and dentate people. It is of paramount importance to provide comprehensive management for these patients, not only to remove the disease and reconstruct the defect, but also to provide the patient with the opportunity of experiencing a good quality of life by having a comfortable mouth after treatment. A questionnaire was sent to all senior fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and the results analyzed. The results of this survey show that improvements could be made if some simple preventive measures were instigated in the early stages of treatment.

Age Factors↗
PubMed2000

Long-term evaluation of estimates of need for third molar removal.

PURPOSE: The aim of this study was to evaluate the estimates on need for third molar removals made at age 20 after 12 years. PATIENTS AND METHODS: The series consisted of 81 university students followed from age 20 to 32 years. At baseline and at study end, these students were clinically examined, and panoramic radiographs were taken. At baseline in 1982, a qualified oral surgeon had made estimates on need for removal of third molars within 5 years; 75% of students needed removals. Actual treatment performed was evaluated after 12 years. A questionnaire served to determine symptoms related to third molars during the 12-year period. RESULTS: During the follow-up, one or more third molars had been removed from 67% of the former students. A total of 155 third molar removals had been estimated, but by age 32 years the percentage actually removed was only 59%. Of the 79 third molars taken out at the Finnish Student Health Service, 77% were initially estimated to need a surgical procedure, but actually 66% were simply extracted. Most were removed at around age 27 years. According to the questionnaire, 67% of the students were asymptomatic in the third molar region during 12 years. CONCLUSION: Because need for surgical removal decreases during early adulthood, routine prophylactic extraction of asymptomatic third molars in young adults cannot be recommended. Well-defined indications for prophylactic removals are needed.

Adult↗
PubMed2003

Determinants of surgical decisions about mandible fractures.

PURPOSE: The study goal was to explore contextual patient- and surgeon-related characteristics that influence the perception of injury severity and treatment strategy for mandible fractures. METHODS: After reviewing plain radiographs of 22 patients with mandible fractures, 18 oral and maxillofacial surgeons were queried on summary severity ratings and treatment decisions for each injury. Subsequently, they were asked to indicate how various hypothetical fracture and patient-specific factors would alter their perception of injury severity and original treatment recommendations. The effect of the level of clinician trauma expertise on perception of injury severity and treatment choice was also assessed. RESULTS: Each of the fracture-specific characteristics-number of constituent fractures, fracture complexity, degree of displacement, and summary injury severity-influenced the choice of treatment modality. Surgeon-specific characteristics were related to both perception of injury severity and treatment choice. Although clinicians with greater trauma loads tended to provide higher summary severity ratings for the same range of injuries (P <.001), they appeared to recommend maxillomandibular fixation for a much broader spectrum of injury severity (R = -0.42). Surgeons' perception of injury severity appeared to escalate with increasing damage to the soft tissue envelope; the influence of patient-related risk factors was less distinct. More than half of the surgeons suggesting maxillomandibular fixation for a particular case changed their treatment recommendation to rigid internal fixation on learning that the patient was noncompliant. CONCLUSIONS: Clinical decision making for mandible fractures is not a precise and fully reliable activity. Contextual factors (fracture, patient, and surgeon related) appear to influence the clinical decision and may be responsible for the existing variations in practice patterns.

Analysis of Variance↗
PubMed1998

Orthodontists' views of justification for cost of orthognathic surgery.

PURPOSE: This study evaluated whether orthodontists' treatment of patients was influenced by their perception of the justification for the cost of orthognathic surgery. MATERIALS AND METHODS: A survey of 334 Canadian orthodontists was used to determine what factors influenced views of cost justification. RESULTS: Approximately 80%, 49%, and 9% of orthodontists perceived cost of surgery to be justified for severely, moderately, and mildly compromised patients, respectively. Whether the compromise was functional or aesthetic did not particularly affect their views. Least experienced orthodontists were more likely than more experienced orthodontists to perceive cost of surgery as justified for patients with moderate functional compromise (P < .01). Most experienced orthodontists were more likely than less experienced orthodontists to perceive cost of surgery as unjustified for patients with moderate aesthetic compromise (P < .01). Orthodontists who did not believe cost of surgery to be justified for patients with mild or moderate compromise tended to recommend orthognathic surgery less frequently than camouflage orthodontics for borderline surgery patients (P < .05). CONCLUSIONS: The findings suggest that costs may be contained by orthodontists rationing surgery on the basis of severity of facial skeletal malrelationship and perception of justification of cost. Less experienced orthodontists are less likely to contain costs for patients with moderate functional and aesthetic compromise. Most experienced orthodontists are less likely to contain costs for patients with severe functional compromise. Patient satisfaction may be affected by rationing, which affects the treatment approach and thus the outcome.

Adult↗
PubMed1998

Dental extractions in patients on an oral anticoagulant: a survey of practices in North America.

PURPOSE: The World Health Organization (WHO) recommends the use of the International Normalized Ratio (INR) for reporting prothrombin time (PT) values. However, there are no scientifically based guidelines for performing dental extractions when using the INR. Oral and maxillofacial surgeons were surveyed to determine whether the INR is the method they use to monitor the level of anticoagulation and to determine what protocols are followed when anticoagulated patients require dental extractions. MATERIALS AND METHODS: A mail survey of academic oral and maxillofacial surgeons in North America was conducted to determine their choice of laboratory tests for assessing patients on oral anticoagulants and their protocol before proceeding to dental extractions. RESULTS: Fifty-three of 73 respondents (73%) routinely use the INR, but only 21% rely on this method alone. Twelve percent and 11% of respondents, respectively, also use the PT value and PT ratio. The level of anticoagulation at which surgeons would proceed with dental extractions was variable. For those using the INR, it was from 1.3 to 4.0, for those using PT ratios the perceived safe range was from 1.0 to 2.0, and for those using the PT value, the range was from 13 to 21 sec. CONCLUSIONS: Despite the support in the medical literature for use of the INR, many oral and maxillofacial surgeons still use the PT for monitoring oral anticoagulant therapy. There is no consensus on the INR interval at which dental extractions can be safely performed. Prospective studies are needed in this area.

Administration, Oral↗
PubMed2000

General dental practitioners diagnostic and treatment decisions related to fissure sealed surfaces.

OBJECTIVES: The purpose of this in-vitro study was to assess the validity and reproducibility of the diagnosis and treatment planned for occlusal surfaces prior to and following the placement of a clear sealant by a sample of general dental practitioners (GDPs). METHODS: 160 permanent posterior teeth were examined by 25 GDPs. The GDPs were not given any criteria and were therefore free to diagnose and plan care, as they felt appropriate. Each GDP conducted four examinations, two prior to and two after sealing. The teeth were serially sectioned to provide the validating criterion. RESULTS: After sealant placement, there was a statistically significant increase in specificity and decrease in sensitivity of both diagnostic and treatment decisions. The reproducibility expressed by the kappa-statistic was of the order of 0.5 prior to and after sealing with regard to diagnostic decisions. There was a general tendency to diagnose less disease after placement of a sealant (P<0. 001). There was also significantly less care (preventive or restorative) planned after sealant placement (P<0.001). CONCLUSIONS: The placement of a sealant resulted in the diagnosis of less disease and less restorative treatment. This may be appropriate as evidence exists to support the use of sealants as caries therapeutic agents.

Bicuspid↗
PubMedDate not supplied

The prescription and relative outcomes of different materials used in general dental practice in the north west region of England to restore the primary dentition.

OBJECTIVE: To identify the type of restorative materials used in general dental practice and their effects on the outcomes of restorative treatment of primary teeth. METHOD: The study involved a retrospective investigation of case notes of 677 child patients of 50 general dental practitioners (GDPs) in the northwest of England. The history of dental care received by each child during the primary dentition period was recorded. The type of restorative material used and the number of times that each tooth was restored were recorded. The proportion of primary teeth that were extracted due to pain or sepsis was calculated according to whether they were filled by amalgam or glass ionomer, or were left unfilled. RESULTS: Of the treated teeth, 61% of first and 55% of second primary molars were restored with glass ionomer. Some 27.4% of first molars restored with amalgam required repeat restorations, compared with 42.5% of those filled with glass ionomer. The difference was highly significant (p<0.001). For all primary molar teeth, there was no difference in the proportion of extractions, according to the type of restorative material used or if carious teeth were left unrestored. CONCLUSIONS: In the hands of GDPs, glass ionomer restorations are used most commonly and are significantly more likely to require replacement than amalgam restorations. The type of restorative material used had no influence on outcomes.

Anti-Bacterial Agents↗
PubMed2000

Reasons for tooth extraction in Scotland.

OBJECTIVES: A 1984 study investigated the reasons underlying the extraction of teeth in Scotland. The survey described in this paper, used a similar methodology and aimed to determine the reasons for the extraction of permanent teeth by general dental practitioners and investigate changes in the influences on tooth extraction over a 10 year period. METHODS: During a 1 week period in November 1994, 139 general dental practitioners working throughout Scotland, recorded the reasons for all permanent tooth extractions. RESULTS: A total of 917 permanent teeth were extracted from 613 patients, the reason for extraction being stated as dental caries (51%), periodontal disease (21%), orthodontics (11%) and failed endodontics (4%). Trauma, pericoronitis and other reasons accounted for 5.5% of extractions whilst, in 7.5% of cases, patients requested extraction in preference to other treatments. The proportion of extractions attributed to periodontal disease increased from age 31-60 years, but declined thereafter. CONCLUSIONS: Comparing the results with those obtained in the 1984 study, whilst the mean number of teeth extracted by each practitioner had reduced, the overall relative contribution of different reasons for extraction was similar.

Adolescent↗
PubMed1997

Treatment and posttreatment changes in patients with Class II, Division 1 malocclusion after extraction and nonextraction treatment.

The purpose of this study was to evaluate the treatment and posttreatment changes in the facial and dental parameters in two groups of patients with Class II, Division 1 malocclusions. In one group (n = 46), the patients were treated with a nonextraction approach, whereas in the second group (n = 45), the treatment included the extraction of four first premolars. The treatment groups were compared with matched untreated normals (n = 35) from the Iowa Growth Study. Lateral cephalograms and dental casts were evaluated at three stages: pretreatment, posttreatment, and approximately 2 years after treatment. Student's t tests were used to compare the extraction and nonextraction groups. Significance was predetermined at p < or = 0.05. The cephalometric findings indicate that before treatment, the subjects treated with four first premolar extractions had more protrusive upper and lower lips and a larger tooth size-arch length discrepancy. After treatment the upper and lower lips were more retrusive in the extraction groups, and more protrusive in the nonextraction groups. The extraction groups tended to have straighter faces and slightly more upright maxillary and mandibular incisors, whereas the nonextraction groups had the opposite tendencies. The average soft tissue and skeletal measurements for both groups were close to, but on opposite sides of, the corresponding averages derived from the Iowa normative standards. The findings from the dental arch measurements indicate that after treatment both the extraction and nonextraction groups experienced an increase in tooth size-arch length discrepancy and a reduction in arch length. In general, extractions did not significantly alter the direction of the overall posttreatment trends. Furthermore, the trends in the posttreatment changes were similar in male and female patients, as well as in the maxillary and mandibular arches. The current findings suggest that the extraction/nonextraction decision, if based on sound diagnostic criteria, does not have a systematic detrimental effect on the facial profile. But clinicians should be aware of the trends introduced by the two treatment modalities to avoid accentuating undesirable profile characteristics.

Adolescent↗