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Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving radiotherapy for treatment of nasopharyngeal carcinoma.

A group of 43 patients requiring tooth extraction after radiotherapy for nasopharyngeal carcinoma (NPC) was studied retrospectively to determine the incidence of post-extraction complications. It was found that because of the method used in the delivery of radiation, extraction of maxillary posterior teeth resulted in the greatest risk of complications (28.9 per cent), including a 10.5 per cent risk of osteoradionecrosis (ORN). Based on the findings, a protocol was established for the dental care of such patients. It was concluded that when extraction of maxillary posterior teeth was necessary, prophylactic antibiotics were not sufficient to prevent the complication of delayed healing. The risk of ORN was 10.5 per cent within the field of maximal radiation dose. Hyperbaric oxygen may be the better choice of preventive measures. However, in view of the low risk of ORN, wholesale prescription of hyperbaric oxygen therapy may not be indicated. An additional patient who had tooth extraction two weeks prior to radiotherapy was included to show that if adequate time for wound healing was not allowed, ORN could develop.

Adult↗

Degenerative changes of primary neurons following tooth extraction.

In summarizing the present experimental results of tooth extraction, it can be emphasized that the disturbance of the sensory input units from the teeth resulted in a definite degeneration of the primary neurons. On this ground, it is suggested that the lesion of the sensory input units in the masticatory computer system, according to the individual age affected, may become a large factor in impeding the masticatory activity and accelerating the aging of the masticatory function.

Animals↗

[Use of PAR index to evaluate the treatment outcome for Class II division 1 malocclusion with different tooth extraction patterns].

PURPOSE: To assess the outcome of orthodontic treatment for Class II division 1 malocclusion with different tooth extraction patterns using PAR index. METHODS: PAR index was applied on pre- and post-orthodontic treatment cast for 64 Class II division 1 malocclusion patients with two different tooth extraction patterns: extraction of maxillary teeth only (Group 1), and extraction of maxillary and mandibular teeth(Group 2). SPSS 10.0 software package was used for Student's t test. RESULTS: The PAR index of group 1 and group 2 pre-orthodontic treatment was 36.21+/-6.82 and 38.34+/-7.51. There were no significant difference (P>0.05) between the two groups. The PAR index of group 1 and group 2 post-orthodontic treatment was 6.13+/-1.64 and 5.89+/-1.75. There were no significant difference (P>0.05) between the two groups. The decrement and the rate of reduction of group 1 was 30.05+/-7.43 and 85.33%+/-5.68%. The decrement and the rate of reduction of group 2 was 32.38+/-8.12 and 87.47%+/-5.21%. The occlusal relationship improved significantly in the two groups after treatment. CONCLUSIONS: Treatment for Class II division 1 malocclusion with different extraction patterns can both acquire satisfactory results.

Humans↗

Histometric study of socket healing after tooth extraction in rats treated with diclofenac.

The purpose of the present study was to investigate if diclofenac administration interferes with the time course of alveolar wound healing in rats. Forty-two Wistar rats were used, 21 rats received 10 mg/kg/day of diclofenac one day before and 4 days after extraction of the right maxillary incisors and 21 rats received saline. The animals were sacrificed 7, 14 and 21 days after tooth extraction. Progressive new bone formation and a decrease in the volume fraction of blood clot and connective tissue from 1 to 3 weeks after tooth extraction was quantified using the histometric point-counting method. Diclofenac treatment caused a significant delay in new bone formation in association with an impairment of blood clot remission/organization.

Alveolar Process↗

[Tooth extraction in irradiated areas].

Tooth avulsion after head and neck radiotherapy has always been and is still a risk gesture when the avulsion is situated on the irradiation sites. The post-operating effects can become complicated with a delay in healing which can eventually induce an osteoradionecrosis. Dental treatment before the begining of radiotherapy aiming at the elimination of any suspicious tooth, and the generalisation of fluorotherapy aiming at limiting the decayed degeneration, did not make the avulsion indication disappear. At present tooth avulsion is still possible in case of tooth infection or broken tooth.

Collagen Type II↗

Spatial and temporal localization of secretory IgA in healing tooth extraction sockets in a rabbit model.

PURPOSE: The purpose of this study was to look at the spatial and temporal localization of secretory IgA in healing tooth extraction sockets in a rabbit model. MATERIALS AND METHODS: Twenty-four male New Zealand White rabbits were used in the study. Incisor teeth were extracted from both jaws, and the healing extraction socket with the surrounding jaw bone was harvested at 48 hours, 4 days, and 1, 2, 4, 8, 12, and 16 weeks. Tissues were fixed, decalcified, and processed for hematoxylin and eosin and immunohistochemical staining. The sections were stained to detect secretory IgA. The stained sections were then imaged, and an automated computer program was used to detect the brown 3,3'-diaminobenzidine stain that represented the secretory IgA. The data were obtained in the form of percentage area and intensity of stain and analyzed using analysis of variance (Tukey-Kramer and Scheffé's tests). RESULTS: Spatial and temporal differences in localization of secretory IgA were observed across time frames in both jaws. CONCLUSION: The results of this study showed definite trends in the spatial and temporal localization of secretory IgA in healing tooth extraction sockets in a rabbit model.

Alveolar Process↗

Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient.

A case is reported of unexpected atrial fibrillation in response to tooth extraction under intravenous sedation in a 70-yr-old patient with thoracic aneurysm of the aorta. Atrial fibrillation developed after the additional injection of a 2% solution of lidocaine containing 1:200,000 epinephrine. After 20 min, the arrhythmia disappeared spontaneously. The arrhythmia was associated with insufficient analgesia for tooth extraction, epinephrine in the local anesthetic, decreased blood pressure, and the presence of cardiovascular disease. Even when a low concentration of epinephrine is employed, caution should be paid to development of unexpected cardiovascular reactions in elderly patients with severe cardiovascular disease. We conclude that an electrocardiogram, blood pressure device, and pulse oximeter should be used in high-risk patients in order to prevent and detect potentially dangerous cardiovascular emergencies, even if dental treatment is scheduled under local anesthesia.

Aged↗

Intra-operative pain perception in tooth extraction--possible causes.

OBJECTIVES: To elicit the perception of pain in patients undergoing dental extraction under local anaesthesia and also to identify factors that might contribute to this experience despite the administration of local anaesthesia. SETTING: Ile-Ife, Southwestern Nigeria. PARTICIPANTS: 122 randomly selected single-tooth extraction patients. METHODS: Informed consent was obtained from patients who subsequently completed a questionnaire on the Corah Dental Anxiety Scale prior to treatment. Details documented for each patient included the demographics, history of previous tooth extraction and the status of the operator. The extraction was timed from the application of instrument until tooth delivery. Immediately after extractions, patients were asked to indicate on a Visual Analogue Scale (VAS) scores graded 0-10, the level of pain perceived during extraction. The data were subjected to simple descriptive and statistical analysis using SPSS for Windows 11.0. RESULTS: Positive correlations were found between the VAS and the anxiety scores, the attending surgeons' status, patients' anxiety score and the duration of surgery. A significant difference was found between the anxiety and the VAS scores in the different occupational groups. CONCLUSIONS: These results suggest that the status of the attending surgeon may affect the level of anxiety in patients undergoing tooth extractions prior to surgery. While patient's occupational group and duration of surgery could contribute to patient's intraoperative pain perception despite the administration of local anaesthesia.

Adolescent↗

Periodontal reasons for tooth extraction in an adult population in Jordan.

This survey studies the reasons for periodontal extraction of permanent teeth in an adult Jordanian population. A random sample of 30 general dental practitioners (GDPs) from a list of 300 GDPs (1:10) was contacted. Of these, the 26 dentists who participated in this study were asked to record teeth extracted and give reasons for extraction. Personal and demographic information and clinical details were obtained from 898 patients aged from 20 to 60 years. A total of 1,098 teeth were extracted during the 3-month study period. The results of this study revealed that dental caries (56.4% overall) was the main reason for tooth extraction, especially in 20-39 year olds. Periodontal disease (23.4% overall) was the next most frequent indication for extraction and became the commonest cause of tooth extraction in patients aged 40 years or more. Other reasons for tooth loss accounted for only 20.2% of the series. Advanced periodontal disease represented by pocketing were the dominant pathology when tooth loss occurred as the result of periodontal disease. As far as the type of tooth was concerned, the most frequently extracted teeth were molars followed by premolars, regardless of whether their loss was the result of the caries or the periodontal disease. This study suggests that caries and its consequences are responsible for more tooth loss in patients less than 40 years of age while extraction because of periodontal problems increases with age, and more commonly related to pocketing.

Adult↗

Soft tissue healing around implants placed immediately after tooth extraction without incision: a clinical report.

PURPOSE: The purposes of the present study were to evaluate implants placed immediately after tooth extraction without incision or primary flap closure and to observe the peri-implant soft tissue healing. MATERIALS AND METHODS: Fifteen patients (9 men and 6 women) aged 31 to 54 years were included in this study. Each patient had a tooth that required extraction, and each had at least 4 mm of bone beyond the root apex. Teeth with multiple roots were excluded from this study. After tooth extraction, the implants were immediately placed without incision or flap elevation. Implant sites showing bone fenestrations, bone dehiscences, or peri-implant bone defects exceeding 2 mm were excluded from this study. In these cases, a standard guided bone regeneration procedure with a surgical flap elevation was used. The second-stage surgical procedure was performed 6 months after the first procedure. The following clinical parameters were evaluated at the time of implant placement and at second-stage surgery: levels of mesial and distal papillae, width of keratinized mucosa, position of mucogingival junction relating to the surrounding tissues, and peri-implant radiolucency and marginal bone loss, which were evaluated radiographically. RESULTS: The postsurgical healing period was uneventful for all patients. Soft tissue closure over the implant sites was achieved in 1 to 3 weeks after surgery at all sites. At second-stage surgery, no peri-implant bone defects were observed or detected by probing around all the experimental implants. The soft tissue anatomy was considered clinically acceptable in all patients. DISCUSSION AND CONCLUSION: Successful osseointegration and complete bone healing were observed for all patients. The soft tissue healing and morphology were satisfactory; additional mucogingival surgery was not required before definitive prosthetic rehabilitation.

Adult↗

Spatial and temporal localization of FGF-2 and VEGF in healing tooth extraction sockets in a rabbit model.

PURPOSE: The purpose of this study was to test the hypothesis that spatial and temporal localization of growth factors FGF-2 and VEGF in a rabbit tooth extraction socket model correlate with the histologic events of healing. MATERIALS AND METHODS: Twenty-four male New Zealand white rabbits divided into 8 groups of 3 were used in the study. Incisor teeth were extracted from both jaws and the healing extraction socket with surrounding jaw bone was harvested at 48 hours, 4 days, 1, 2, 4, 8, 12, and 16 weeks. Tissues were fixed, decalcified, and processed for hematoxylin-eosin and immunohistochemical staining. The sections were stained to detect FGF-2 and VEGF. The stained sections were then imaged and an automated computer program was used to detect the brown diaminobenzidine stain that represented the growth factors of interest. Data was obtained in the form of percentage area and intensity of stain and analyzed using the analysis of variance (ANOVA - Tukey Kramer and Scheffe's post-test). RESULTS: Spatial and temporal differences in localization of FGF-2 and VEGF were observed across all time frames in both jaws. Statistically significant differences in percentage area and intensity of brown diaminobenzidine stain were seen temporally between FGF-2 and VEGF (P < .05). CONCLUSION: The results of this study showed positive correlation of histologic events to spatial and temporal localization of FGF-2 and VEGF in a rabbit tooth extraction model.

Analysis of Variance↗

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↗

[Necrotizing osteitis of the mandibular angle with facial asymmetry due to tooth extraction--apropos of a case].

Five years after a tooth extraction, a bone necrosis of the mandibular angle happened, without consideration to the antibiotics. Such complication is rare. Living in poor socio-cultural and economic conditions, the patient tried to find help near tradipractionners, prayers groups, without any result. The treatment consisted to an extra oral incision, helping to eliminate bone sequestra, and the liquid around after a dynamic bimaxillary linkage by resin links was settled. About aetiology, only the questioning allowed to say that extraction was traumatic, putting in front of the surgical responsibility and post surgical survey.

Adult↗

Changes of sympathetic activity during tooth extraction.

Urinary VMA excretion was studied in 3 groups of young and healthy subjects, before and 2 h after a standard tooth extraction. Local anaesthesia was either a solution of lignocaine 2% (1st group, n = 17) or a mixture of lignocaine 2% with noradrenaline bitartrate, 1250 micrograms/100 ml, (2nd group, n = 13) or lignocaine 2% with adrenaline hydrochloride 1250 micrograms/100 ml (3rd group, n = 10). Mean VMA excretion rose from 3.6 +/- 2.8 to 6.7 +/- 4.6 mg/g creatinine, in the first group. In the 2nd group, the mean VMA excretion was 2.3 +/- 1.2 and rose to 6.2 +/- 2.8, whereas in the 3rd it rose from 2.3 +/- 0.92 to 8.3 +/- 7.6 mg/g creatinine. The increase of VMA excretion after the tooth extraction was of the same order in the 3 groups studied and was not affected by the addition of noradrenaline and adrenaline in the anaesthetic solution.

Adolescent↗

[Use of the intra-alveolar GR (gelatin-resorcinol) dressing after tooth extraction in patients with hemorrhagic diathesis].

The suitability of an intra-alveolar gelatin-resorcinol dressing for controlling bleeding was tested in 118 tooth extractions on a total of 87 patients. Plain advantages of the dressing are: prompt haemostasis (which in most cases avoids hospitalization and substitution therapy), low cost, and easy application. The dressing is not always reliable in controlling bleeding after milk tooth extraction.

Adult↗

Bacteremia after plate removal and tooth extraction.

Our aim was to investigate the occurrence of bacteremia associated with removal of a semirigid osteosynthesis plate and an adjacent third molar. Ten patients with fixed mandibular angle fracture were bacteriologically sampled from the second molar's distal gingival pocket, from the third molar's extraction socket and from the osteosynthesis plate. Blood samples from the ante-cubital vein were taken 10 times until 30 min postoperatively. Established culture, isolation and identification methods for the bacterial species were used. Bacteremia was detected in 60% of the subjects, most frequently 1.5 min after removal of the plate (20%) and 1.5 and 5 min after extraction of the tooth (20%), but also 10 min (10%) and 30 min (10%) postoperatively. 13 different bacterial species or groups were isolated, mean 2.5 +/- 1.9 per bacteremia-positive subject. The majority (85%) were anaerobes with Actinomyces, Campylobacter and Lactobacillus species predominating. In all the blood culture-positive cases the corresponding species was also recovered from one or more of the oral samples. These results show that oral surgical procedures are associated with a high frequency of longstanding anaerobic bacteremia, which could be harmful in patients at risk.

Adult↗