Search

Purpose Carnoy's solution (CS), the gold standard for adjunctive chemical cautery in treatment of odontogenic keratocysts (OKCs), has been banned for 7 years, leading to substitution with the non-chloroform containing modified Carnoy's solution (MC) without data to support its effectiveness. We performed this study to compare the earlier data with CS to the more current outcomes with MC. Methods A retrospective cohort study was conducted on patients diagnosed with OKC and treated by a single surgeon (GHB) with enucleation and curettage (EC), peripheral ostectomy, and application of CS or MC. The primary predictor variables were use of CS or MC. The primary outcome variables were recurrence (yes vs. no) and time to recurrence. Secondary variables included demographics, anatomic location, and whether teeth adjacent to the lesion were extracted. Statistical analyses included chi-squared test/Fisher's exact test, Wilcoxon rank sum test, and Kaplan-Meier curves. Results 77 patients, 36 patients in the CS group and 41 in the MC group, met inclusion criteria, including at least 1 year of follow-up time. Characteristics of the groups were similar: median age 41.5 and 46, 61% and 71% male gender, 81% and 90% posterior, and 64% and 50% mandibular lesions, respectively. Overall recurrence was similar, 14.29%, with 5 (13.9%) recurrences in the CS group and 6 (14.6%) in the MC group (P = 0.92). Median time to recurrence was 24 months for both groups. Preserving adjacent teeth was associated with a significant increase in recurrence (P = 0.0036). Conclusion Based on this comparison of retrospective outcome data, we found no significant difference in recurrence rate or distribution of time to recurrence between OKCs treated with CS or MC. Aggressiveness of surgical technique is likely a predictive factor in recurrence rate. Future studies should focus on prospective studies and continuing follow-up of the MC group.

Summary Introduction Patients with dentofacial disharmonies (DFDs) seek orthodontic care and orthognathic surgery to address issues with mastication, esthetics, and speech. Speech distortions are seen 18 times more frequently in Class III DFD patients than the general population, with unclear causality. We hypothesize there are significant differences in spectral properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonants and that severity of Class III disharmony correlates with the degree of speech abnormality. Methods To understand how jaw disharmonies influence speech, orthodontic records and audio recordings were collected from Class III surgical candidates and reference subjects (n = 102 Class III, 62 controls). A speech pathologist evaluated subjects and recordings were quantitatively analysed by Spectral Moment Analysis for frequency distortions. Results A majority of Class III subjects exhibit speech distortions. A significant increase in the centroid frequency (M1) and spectral spread (M2) was seen in several consonants of Class III subjects compared to controls. Using regression analysis, correlations between Class III skeletal severity (assessed by cephalometric measures) and spectral distortion were found for /t/ and /k/ phones. Conclusions Class III DFD patients have a higher prevalence of articulation errors and significant spectral distortions in consonants relative to controls. This is the first demonstration that severity of malocclusion is quantitatively correlated with the degree of speech distortion for consonants, suggesting causation. These findings offer insight into the complex relationship between craniofacial structures and speech distortions.

Necrotizing cellulitis, necrotizing fasciitis, and necrotizing myositis are a constellation of severe soft tissue infections characterized by rapid progression, dusky soft tissue changes, and edema and induration expanding beyond the clinical wound edges. The cases of two female patients with type II necrotizing soft tissue infections occurring after routine third molar extraction are reported here. The patients were treated for the infections at the University of North Carolina Hospitals in 2016. Both were previously healthy. Of particular interest, recent inoculation of group A Streptococcus appears to have contributed to the infection in both cases.

Purpose There are few data available on the experience of minority surgeons in the field of oral and maxillofacial surgery (OMS). Therefore, the purpose of this study was to 1) explore factors that contribute to African Americans choosing OMS as a career, 2) examine satisfaction among minority oral and maxillofacial surgeons with the residency application and training process, 3) report on practice patterns among minority oral and maxillofacial surgeons, and 4) identify perceived bias for or against minority oral and maxillofacial surgeons in an attempt to aid the efforts of OMS residency organizations to foster diversity. Materials and Methods A 19-item survey was sent to 80 OMS practitioners by use of information from the mailing list of the National Society of Oral and Maxillofacial Surgeons, an American Association of Oral and Maxillofacial Surgeons–affiliated organization. All surveys were sent by mail and were followed by a reminder mailing after 8 weeks. Responses returned within 16 weeks were accepted for analysis. Results Of the 80 mailed surveys, 41 were returned within the 16-week parameter, representing a return rate of 51%. Most of the minority surgeon respondents were married men with a mean age of 60 years who worked as private practitioners. Most respondents practiced on the eastern and western coasts of the United States. Exposure in dental school was the most important factor in selecting OMS as a specialty. Location and prestige were the most important factors in selecting a residency program. Most respondents reported that race did not affect the success of their application to a residency program and did not currently affect the success of their practice. However, 25 to 46% of participants experienced race-related harassment, and 48 to 55% of participants believed there was a bias against African Americans in OMS. Conclusions Our data suggest that a substantial number of minority oral and maxillofacial surgeons subjectively perceive race-based bias in their career, although it does not appear to affect professional success.

Objectives To assess the effect of virtual surgical planning (VSP) on the accuracy of condylar seating in surgical cases involving Bilateral Sagittal Split Osteotomy (BSSO). An additional aim was to quantify differences between actual surgical outcome and planned virtual outcome. Setting and sample population A private practice in Charlotte North Carolina. Twenty-five consecutively operated subjects prepared with VSP and twenty consecutively subjects operated with conventional surgery planning were enrolled. Material and methods Cone beam computed tomography (CBCT) scans were obtained before surgery (T1) and post-surgery after splint removal (T2). The T1 and T2 CBCTs were superimposed on the anterior cranial base using voxel-based registration. Three dimensional (3D) models were built and oriented to a 3D Frankfurt horizontal. Displacement of corresponding condylar landmarks was measured. Results No significant difference was found between the VSP and conventional group in the magnitude of translation or rotation of the condyles following surgery. VSP surgical outcomes differed significantly from predicted positions at all landmarks. Virtual surgical planning does not prevent changes to condylar position as a result of surgery. Actual surgical results differed significantly from VSP-predicted outcomes. Conclusions Virtual surgical planning did not reduce the changes to condylar position and angulation that resulted from conventionally planned orthognathic surgery.

Surgical simulators are powerful tools that assist in providing advanced training for complex craniofacial surgical procedures and objective skills assessment such as the ones needed to perform Bilateral Sagittal Split Osteotomy (BSSO). One of the crucial steps in simulating BSSO is accurately cutting the mandible in a specific area of the jaw, where surgeons rely on high fidelity visual and haptic cues. In this paper, we present methods to simulate drilling and cutting of the bone using the burr and the motorized oscillating saw respectively. Our method allows low computational cost bone drilling or cutting while providing high fidelity haptic feedback that is suitable for real-time virtual surgery simulation.

To assess the impact of a multimodal antiemetic protocol on postoperative nausea and vomiting (PONV) after Le Fort I osteotomy.Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution were recruited as the intervention cohort for an institutional review board-approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol, including total intravenous anesthesia; prophylactic ondansetron, steroids, scopolamine, and droperidol; gastric decompression at surgery end; opioid-sparing analgesia; avoidance of morphine and codeine; prokinetic erythromycin; and fluids at a minimum of 25 mL/kg. The comparison group consisted of consecutive patients from a larger study who underwent similar surgical procedures before protocol implementation. Data, including occurrence of PONV, were extracted from medical records. Data were analyzed in bivariate fashion with the Fisher exact and Wilcoxon rank-sum tests. Logistic regression was used to compare the likelihood of nausea and vomiting in the 2 cohorts after controlling for demographic and surgical characteristics. A P value less than .05 was considered significant.The intervention (n = 93) and comparison (n = 137) groups were similar in gender (58% and 65% female patients; P = .29), race (72% and 71% Caucasian; P = .85), age (median, 19 and 20 years old; P = .75), proportion of patients with known risk factors for PONV (P = .34), percentage undergoing bimaxillary surgery (60% for the 2 groups), and percentage for whom surgery time was longer than 180 minutes (63% and 59%; P = .51). Prevalence of postoperative nausea was significantly lower in the intervention group than in the comparison group (24% vs 70%; P.0001). Prevalence of postoperative vomiting was likewise significantly lower in the intervention group (11% vs 28%; P = .0013). The likelihood that patients in the comparison group would develop nausea was 8.9 and that for vomiting was 3.7 times higher than in the intervention group.This multimodal protocol was associated with substantially decreased prevalence of PONV in patients undergoing Le Fort I osteotomy.

To assess the impact of third molar removal on the periodontal status of adjacent second molars and teeth more anterior in the mouth in patients with mild symptoms of pericoronitis.Healthy patients with mild symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for a study approved by the institutional review board. The subset analyzed in this study had all 4 third molars removed. Data were collected at enrollment and at least 3 months after surgery. Full-mouth periodontal probing was conducted at 6 sites per tooth. A probing depth of at least 4 mm (PD4+) was considered an indicator for periodontal pathology. The presence of a PD4+ on the distal of second molars (D2Ms) or anterior to the D2Ms, the number of PD4+s, and extent scores (percentage of PD4+s of all possible probing sites) were assessed at the patient and jaw levels. The association between patients' pre- and postsurgical periodontal status was assessed using the McNemar exact test. The level of significance was set at .05.The median age of the 69 patients was 21.8 years (interquartile range, 20.2 to 25.2 yr). Forty-five percent were men, and 57% were Caucasian. Significantly more patients (88%) had at least 1 D2M PD4+ at enrollment compared with after surgery (46%; P.01). D2M extent scores decreased from 31.5 at enrollment to 11 after surgery. Significantly more patients (61%) had at least 1 PD4+ anterior to the D2M at enrollment compared with after surgery (29%; P.01). Extent scores anterior to the D2M decreased from 2.0 at enrollment to 0.6 after surgery.Removal of third molars in patients with mild pericoronitis symptoms improved the periodontal status of the D2Ms and teeth more anterior in the mouth.

Purpose Compare the post-surgery red cell mass as indicated by hematocrit value of orthognathic surgery patients given iron supplementation and a single presurgery dose of erythropoietin alpha(EPO) and patients who did not receive either EPO or iron supplementation (NEPO).

Purpose To assess the prevalence of caries experience and periodontal pathology on third molar teeth compared with first and second molars and teeth more anterior from subjects who had data collected over time in a longitudinal clinical study. Patients and Methods Healthy subjects with 4 asymptomatic third molars and data for at least 4 years after enrollment were included in these analyses. The presence or absence of caries experience on the occlusal surface of the third molars and any surface of the first or second molars was assessed using a visual-tactile caries examination. Full mouth periodontal probing, 6 sites per tooth, was conducted as a measure of clinical periodontal status. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none, and caries experience versus no caries experience. The prevalence of caries experience and periodontal pathologic findings at follow-up and the relationship of the occurrence between the third molars and teeth more anterior in the mouth were examined using McNemar's statistics. Results The follow-up was a median of 6.9 years (interquartile range 4.6 to 7.7 years) for 179 subjects, with a mean age of 29 years. More subjects were female (54%) and white (80%). At follow-up, 85% of the subjects had caries experience detected on the first or second molars, and only 50% had a third molar affected. In contrast, at follow-up, the presence of at least 1 periodontal probing depth of at least 4 mm was marginally more prevalent on the third molars than on the first or second molars (56% and 50%, respectively). Fewer subjects had third molars free of caries experience and periodontal pathology at follow-up compared with at enrollment (28% versus 38%, respectively). Conclusions The prevalence of both third molar caries experience and third molar periodontal pathology increased from baseline to the follow-up examination. At follow-up, the prevalence of caries experience was greater on the first or second molars than on the third molars, and periodontal pathology were greater on the third molars than on the more anterior teeth.

Purpose To assess the prevalence of periodontal inflammatory disease on the distal side of second molars after third molar removal and the association between presurgical and surgical variables and postsurgical periodontal outcomes. Patients and Methods Data before and after surgery from 2 studies approved by an institutional review board were used. In 1 study, 26 subjects had 4 asymptomatic third molars and in the other 49 subjects had at least 1 mandibular third molar with symptoms of pericoronitis. Full-mouth periodontal probing data, 6 sites per tooth, were obtained as a measurement of periodontal status before and after surgery. A probing depth (PD) ≥4 mm on either of the 2 possible probing sites on the distal side of any second molar (D2M) served as an indicator of periodontal inflammatory disease; periodontal health was defined as all D2M PD

The American Association of Oral and Maxillofacial Surgeons (AAOMS) has been at the forefront of formal evidence-based dentistry with such projects as the Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgeons, the AAOMS Outcomes Assessment Program, the AAOMS Third Molar Clinical Trial, and the AAOMS "White Paper on Third Molar Data." This article reviews these evidence-based resources to provide a consensus of opinion for the management of the third molar.

To compare the prevalence and severity of periodontal inflammatory disease in subjects with pericoronitis involving a mandibular third molar and those without pericoronitis.Data obtained from healthy adults consecutively enrolled in an institutional review board-approved trial with pericoronitis affecting at least 1 mandibular third molar (study group) were compared with data obtained during the same time frame from subjects without pericoronitis enrolled in a longitudinal third molar monitoring study (comparison group). The periodontal status of each subject was classified based on periodontal probing depths (PD): all PD4 mm, no disease; 1 to 3 PDor=4 mm, incipient disease; at least 4 PDor=4 mm, early disease. Full mouth periodontal probing data were obtained as clinical measures of periodontal status. Data were aggregated to the subject level for the third molar region, the 6 third molar probing sites and the 2 second molar distal probing sites, the non-third molar region, and all remaining probing sites. The prevalence of disease in the study and comparison groups were compared with the Fisher's exact test. As an indicator of disease severity, the number of PDor=4 mm in the 2 groups were compared by the Kruskal-Wallis test. Level of significance was set at P values less than .05.Median age of the 56 subjects with pericoronitis was 23.3 years (IQR 21.3-26.0 years). Fifty-five percent were Caucasian, 16% African American, and 22% Asian. Males and females were almost equally represented in the study group and in the comparison group. The 194 subjects enrolled without pericoronitis were significantly older (32.8 years; IQR 27.2-40.0 years; P.001). Eighty-four percent were Caucasian, 10% African American, and 4% Asian. The proportion of subjects with periodontal inflammatory disease in the third molar region was significantly different between the study and comparison groups. Thirty-one percent of the subjects with pericoronitis had incipient and 55% early disease in the third molar region compared with 25% with incipient and 38% with early disease among subjects without pericoronitis (P = .003). The pattern was similar, but the proportion of subjects was not significantly different between the groups for the non-third molar region. In the study group, 32% had incipient disease and 32% early disease compared with 27% with incipient disease and 22% with early disease in the comparison group (P = .09). The median number of PDor=4 mm for all teeth differed significantly for subjects with and without pericoronitis (median 5 [IQR 3-9] vs 3 [IQR 0-8], respectively; P = .03).Pericoronitis involving mandibular third molars may reflect more underlying periodontal inflammatory disease in affected young adults than might be found in young adults with retained third molars and no pericoronitis.

This study assessed the utility of a quality-of-life diary for the assessment of postoperative recovery following orthognathic surgery. A 20-item daily recovery diary was designed to assess the patients’ perception of recovery in 4 domains (postoperative sequelae; pain/discomfort; oral function; daily activities) during each of the first 90 days after surgery. Fifteen of 185 patients who had agreed to participate did not return any portion of the diary. Of the remaining patients, 87% returned the full 90 days requested. Younger patients were more likely to complete the entire protocol (P = 0.01). At 30 days, a lower percentage, in general, of patients who completed all 90 days reported recovery in oral function and general activity compared with those who did not complete all diary days. This study confirms that patients will cooperate with the completion of structured medical / health-related quality-of-life diaries during the first few months after orthognathic surgery. Information from such diaries would be valuable to patients deciding on treatment options and to the clinicians counseling them.

Purpose The purpose of this study was to assess the patient-reported time to recovery for quality of life outcomes: postsurgery sequelae, discomfort/pain, oral function, and daily activities after orthognathic surgery. Patients and Methods A total of 170 patients (age = 14-53) were enrolled in a prospective study before orthognathic surgery. Each patient was given a 20-item health-related quality of life instrument (OSPostop) to be completed each postsurgery day (PSD) for 90 days. The instrument was designed to assess patients' perception of recovery for 4 domains: postsurgery sequelae, discomfort/pain, oral function, and daily activities. Discomfort/pain was recorded with a 7-point Likert-type scale; all other items were measured on a 5-point Likert-type scale. Results Postsurgery sequelae, except swelling, resolved within the first week after surgery for over 75% of the subjects. Discomfort/pain and medication usage persisted for 2 to 3 weeks after surgery for most subjects. Return to usual activities, except for recreational activities, which took substantially longer, mirrored the resolution of discomfort/pain. Problems with oral function took the longest to resolve, approximately 6 to 8 weeks for the majority of subjects. Conclusion Comprehensive daily postoperative patient quality of life data provides the orthognathic surgeon with estimated recovery times in distinct domains. This information is vital in the provision of informed consent as well as preoperative education of patients regarding perioperative and postoperative expectations. Ultimately this data can be combined with individual risk factors to provide personalized consent and expectations as well as tailor perioperative and postoperative management regimens.

The purpose of this study was to assess changes in periodontal probing depth (PD) over time for third molar and nonthird molar regions in young adults.The data were obtained from healthy subjects with 4 asymptomatic third molars, enrolled in an IRB-approved longitudinal trial. Demographic and oral health data were collected at baseline. Full-mouth PD, 6 sites per tooth, was conducted to determine periodontal status at baseline and at longest follow-up. The third molar region was defined as the PD for 6 sites around the third molars and the 2 sites on the distal of the second molars. The nonthird molar region was defined as the remainder of the PD sites in the mouth. The primary outcome measures for this study were the occurrence of a PD greater than or equal to 4 mm and the increase in PD of at least 2 mm in the third molar and nonthird molar regions. Changes from enrollment to longest follow-up were compared by the binomial or McNemar's test. Level of significance was .05.Data from 195 subjects were available, and the median follow-up was 5.9 years (interquartile range [IQ], 4.6 to 6.9 years). Median age at enrollment was 26.2 years (IQ, 22.0 to 34.0 years); 52% were female, 84% were Caucasian, and 10% were African American. The proportion of subjects with at least 1 involved site in nonthird molars increased significantly from baseline to follow-up, 36% to 49% (P.01), reflecting mostly changes in mandibular nonthird molars, 33% to 48% (P.01). Of the 122 subjects who presented at baseline with at least 1 PD greater than or equal to 4 mm in the third molar region, the proportion of subjects with at least 1 involved site in nonthird molars increased significantly from baseline to follow-up, 48% to 59% (P = .05), also reflecting mostly changes in mandibular nonthird molars, 44% to 59% (P = .05).In this unique longitudinal clinical study of early periodontal disease in young adults, periodontal pathology worsened over time for nonthird molars. This was more likely if PD greater than or equal to 4 mm was detected 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-1β, and the proportion of subjects with changes in PD ≥2 mm versus those with PD

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 ≥25°) and eruption to the occlusal plane. Full mouth PD including third molars was conducted at follow-up. At follow-up, PD ≥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 ≥35°, 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 ≥4 mm. Similarly, 11% of the 307 maxillary third molars at the occlusal plane had PD ≥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 ≥4 mm.

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.

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.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.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.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.

Purpose: Our goal was to report the detection and levels of pathogenic bacteria in subgingival plaque samples taken from the distal of all second molars in 295 patients with asymptomatic third molars. Patients and Methods: Data assessing oral health were collected from each of these healthy patients (ASA Classes I and II). Probing depth (PD), at 6 sites per tooth, including third molars, was obtained to determine periodontal status. Subgingival plaque samples were taken from the distal of all second molars before periodontal probing. The presence and levels of 11 bacterial species were determined using whole chromosomal DNA probes and checkerboard DNA-DNA hybridization. Detected bacterial species were grouped into clusters of periodontal pathogens designated as “red” or “orange” complex microorganisms as described by Socransky et al (J Clin Periodontal 25:134, 1998) who found an association of these specific microorganisms with periodontitis. Results: As a group these relatively young patients were periodontally healthy. “Orange and red” complex microorganisms were detected at levels equal to or greater than 105 more often if patients had a PD equal to or greater than 5 mm with periodontal attachment loss at the distal of second molars or around third molars at their entry examination. In patients with no PD equal to or greater than 5 mm in the third molar region, “orange and red” complex microorganisms were detected at levels equal to or greater than 105 more frequently than would be anticipated in patients with little clinical evidence of periodontal disease. Conclusions: The clinical findings of increased periodontal PDs and periodontal attachment loss coupled with colonization of periodontal pathogens support the concept that clinical and microbial changes associated with the initiation of periodontitis may present first in the third molar region in young adults. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1234-1240, 2002

Purpose: We report the prevalence of periodontal probing depth (PD) as a clinical measure of the extent of periodontitis associated with asymptomatic third molars at the initial examination in a cohort of patients enrolled in an institutional review board–approved longitudinal clinical trial. Patients and Methods: Three hundred twenty-nine healthy patients were enrolled during a 30-month period. Full mouth periodontal probing that included third molars was conducted to determine periodontal status. Panoramic radiographs were taken to assess the degree of eruption of the third molars and the angulation of third molars compared with the adjacent second molar. Vertical bitewing radiographs were analyzed to detect alveolar bone levels relative to the cementoenamel junction on the distal of second molars. Results: Twenty-five percent (82 of 329) of all enrolled patients, and 34% (14 of 41) of black patients, had at least one PD equal to or greater than 5 mm on the distal of a second molar or around a third molar. PD equal to or greater than 5 mm was associated with periodontal attachment loss of at least 1 mm in every patient; PD equal to or greater than 5 mm was associated with attachment loss equal to or greater than 2 mm in 80 of 82 patients. A higher proportion of patients 25 years old or older had a PD equal to or greater than 5 mm on the distal of second molars or around third molars compared with patients younger than 25 years (33% vs 17%, P =.002). The distals of second molars and third molars in the mandible were affected more often than in the maxilla (25% vs 5%, P =.0001). Conclusions: Our data indicating that 25% of patients with retained asymptomatic third molars have considerable periodontal pathology in the third molar region were unexpected. National epidemiologic surveys indicate a much lower rate of periodontitis in the population younger than 35 years. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1227-1233, 2002

Purpose: Vastly different surgical techniques have been advocated for osseous reconstruction of the severely atrophic mandible. Endoseous implants placed in autologous bone grafts have been proposed to minimize graft resorption and restore function; however, sufficient bone must exist to support the implants and prevent pathologic fracture. The purpose of this retrospective analysis was to assess the efficacy of autologous bone grafting and the subsequent placement of endosteal implants as a staged procedure in patients with severely atrophic mandibles. Materials and Methods: The records of all patients presenting to The University of North Carolina for treatment from 1997 to 1999 with atrophic mandibles (vertical mandibular height

Long-face individuals make up approximately one fourth of the dentofacial deformity group who seek surgical treatment, almost 20% more than would have been expected from the presumed population incidence. Just fewer than 25% of patients who undergo surgical treatment are in the long-face group, and this group is slightly more likely to accept and receive surgical treatment than their proportion of the surgical population. When the severity of vertical deformity is so great that reasonable correction cannot be obtained by growth modification or camouflage, the combination of orthodontics and orthognathic surgery may provide the only viable treatment option. Because many long-face patients will also present with an anteroposterior problem involving prominent incisors and a receding chin, it is often easy to dwell on the Class II aspect of the problem and ignore the vertical contribution. Should a camouflage treatment plan be implemented by extracting maxillary first premolars and retracting the maxillary incisors, quite unacceptable esthetics may result because the nasolabial angle will increase. The option of vertical maxillary impaction now allows the orthodontist to avoid the negative facial esthetics that were once considered an inevitable consequence in improving the dental occlusion. Careful planning involving both the orthodontist and the oral maxillofacial surgeon now provides patients with an option that results in both desirable esthetics and good occlusion.

Purpose: This study evaluated patients' perceptions of recovery after third molar surgery. Methods: Two hundred forty-nine patients (age 13 to 37 years) at 2 clinical centers were enrolled in a prospective study before the surgical removal of third molars. Each patient was given a 21-item Health-Related Quality of Life instrument (HRQOL) to be completed each postoperative day (POD) for 14 days. The instrument was designed to assess patients' perception of recovery: pain, oral function, general activity measures, and other symptoms. Pain dimensions were recorded with a 7-point Likert-type scale; all other conditions were measured on 5-point Likert-type scales. The impact of each predictor variable such as age, gender, and length of surgery on recovery was assessed with Cochran-Mantel-Haenszel statistics, controlling for clinical center. Results: After the 14-day postoperative period, 201 of the original 249 patients returned the completed HRQOL instrument; the 48 patients who did not return their diary had third molar conditions and surgery similar to the 201 patients who responded. On POD 1, 63.5% of patients reported their worst pain as severe (score, 5 to 7/7) at some time during the day. By POD 7, only 15% of patients reported their worst pain as severe. Average pain levels were much less; 29% reported their average pain as severe (score, 5 to 7/7) on POD 1, decreasing to 5.5% by POD 7. Patients experienced substantial interference in oral function; chewing, 85%; mouth opening 78.5%, and speaking 37.5% on POD 1. By POD 6, oral function had improved; chewing, 19%, mouth opening, 15%; and speaking, 1.5%. General measures also were affected on POD 1; social activity, 61.5%; recreation, 70.5%; and daily routine, 60%. Patients assumed a more normal lifestyle by POD 5. Swelling seemed to be at its maximum on PODs 1 and 2 (day 1, 53%; day 2, 61%) and decreased markedly by POD 5 (10%). Food collection in the surgical sites posed the biggest problem for patients on POD 9 (20%). Age was not a predictor of prolonged recovery. However, surgery time 30 minutes or longer, or having all third molars below the occlusal plane, did prolong recovery. Females also reported a longer recovery period. Conclusions: This information is valuable to patients deciding on third molar surgery and to clinicians providing informed consent.

Purpose: Approximately 30% higher grade premalignant oral intraepithelial neoplasia (OIN) lesions will progress to oral cancer. Although surgery is the OIN treatment mainstay, many OIN lesions recur, which is highly problematic for both surgeons and patients. This clinical trial assessed the chemopreventive efficacy of a natural product-based bioadhesive gel on OIN lesions. Experimental Design: This placebo-controlled multicenter study investigated the effects of topical application of bioadhesive gels that contained either 10% w/w freeze-dried black raspberries (BRB) or an identical formulation devoid of BRB placebo to biopsy-confirmed OIN lesions (0.5 g × q.i.d., 12 weeks). Baseline evaluative parameters (size, histologic grade, LOH events) were comparable in the randomly assigned BRB (n = 22) and placebo (n = 18) gel cohorts. Evaluative parameters were: histologic grade, clinical size, and LOH. Results: Topical application of the BRB gel to OIN lesions resulted in statistically significant reductions in lesional sizes, histologic grades, and LOH events. In contrast, placebo gel lesions demonstrated a significant increase in lesional size and no significant effects on histologic grade or LOH events. Collectively, these data strongly support BRB's chemopreventive impact. A cohort of very BRB-responsive patients, as demonstrated by high therapeutic efficacy, was identified. Corresponding protein profiling studies, which demonstrated higher pretreatment levels of BRB metabolic and keratinocyte differentiation enzymes in BRB-responsive lesions, reinforce the importance of local metabolism and differentiation competency. Conclusions: Results from this trial substantiate the LOH reductions identified in the pilot BRB gel study and extend therapeutic effects to significant improvements in histologic grade and lesional size. Clin Cancer Res; 20(7); 1910–24. ©2014 AACR.

The purpose of this study was to evaluate whether skeletal and dental outcomes following Le Fort I surgery differed when stabilization was performed with polylactate bioresorbable devices or titanium devices. Fifty-seven patients with preoperative records and at least 1 year postoperative records were identified and grouped according to the stabilization method. All cephalometric X-rays were traced and digitized by a single operator. Analysis of covariance was used to compare the postsurgical change between the two stabilization methods. Twenty-seven patients received bioresorbable devices (group R), while 30 received titanium devices (group M). There were no statistically significant differences between the two groups with respect to gender, race/ethnicity, age, or dental and skeletal movements during surgery. Subtle postsurgical differences were noted, but were not statistically significant. Stabilization of Le Fort I advancement with polylactate bioresorbable and titanium devices produced similar clinical outcomes at 1 year following surgery.

Purpose : This prospective clinical study was designed to determine the clinical and biologic outcomes of treatment for minor signs and symptoms of pericoronitis. Patients and Methods : Patients (n = 20) with all third molars, presenting consecutively to an academic clinical center for treatment of minor signs and symptoms of pericoronitis, were enrolled in the study. At the initial visit, gingival crevicular fluid (GCF) samples to assess levels of the cytokines interleukin-1b (IL-1b) IL-1b and prostaglandin E2 (PGE2) as a measure of the host inflammatory response, and plaque samples to identify microorganisms, were collected from the distal of all second molars and the mesial of first molars. Standardized vertical bite wing radiographs were taken to assess alveolar bone height on the distal of the second molars and the inclination and the degree of eruption of the third molar. Full-mouth periodontal probing was conducted to determine probing depths and relative clinical attachment levels (CAL). Pain levels were assessed with Gracely verbal descriptor scales for sensory intensity and unpleasantness and 10-cm visual analog scales. Symptomatic third molar sites were treated with local debridement and irrigation after baseline data collection. One week after entry, data were collected again. Subsequently, the patients were scheduled for removal of all third molars. Data collection was repeated 3 months postsurgery. As controls, data were collected from 12 subjects who had asymptomatic third molars removed previously. Results : At entry, symptomatic mandibular third molars (n = 21) were mostly vertical (n = 18) and at or above the occlusal plane (n = 19). No maxillary teeth had symptoms. Microbial counts were elevated for specific anaerobic microorganisms. GCF IL-1 b levels were elevated at the distal of second molars adjacent to symptomatic third molars, as compared with asymptomatic third molars and second molars in control patients. Alveolar bone levels and CAL-on the distal of second molars were normal. At 1 week, patients' pain symptoms and IL-1b levels were reduced, but microbial counts remained high. Three months after surgery, patients had no pain symptoms, and alveolar bone levels and CAL were similar to entry levels. IL-1b levels were elevated at both the distal of second molars and the mesial of first molars for all patients; microbial counts decreased, although not to levels of control patients. No increase in microbial counts for Porphyromonas gingivalis or Bacteroides forsythus, or GCF PGE2 levels, risk factors for progressive periodontal disease, was detected in samples taken from the study patients. Conclusion : Pericoronitis expressed by minor signs/symptoms in these patients was associated with considerable discomfort. Symptomatic mandibular third molars were vertical and at or near the occlusal plane. Additionally, this condition was characterized by microbial flora and GCF inflammatory mediator levels that are more consistent with gingivitis than periodontitis. Removal of third molars eliminated symptoms, but the microbial burden and an affected patient's inflammatory response, as measured by IL-1b levels, remained elevated as compared with controls. Further study is needed to determine which of these factors can be used to identify patients at risk for pericoronitis before symptoms arise.

Purpose Our purpose was to assess the effect of third molar removal on the quality of life in subjects with symptoms of pericoronitis. Patients and Methods Healthy subjects (American Society of Anesthesiologists Classes I and II), aged 18 to 35 years, with minor symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for an institutional review board-approved study. The exclusion criteria were major symptoms of pericoronitis, generalized periodontal disease, body mass index greater than 29 kg/m2, and antibiotic or tobacco use. The data from patients undergoing surgery to remove all third molars with a follow-up examination after surgery at least 3 months later were included in these analyses. The clinical, demographic, and quality of life data were collected at enrollment and after surgery. At entry, the debris was removed from symptomatic third molar sites; no attempt was made to mechanically remove nonsheddable biofilm. The patients scheduled surgery electively with a recall examination at least 3 months after surgery. Results The median age of the 60 subjects was 21.9 years (interquartile range 20.2 to 24.7). The median postoperative follow-up was 7.7 months (interquartile range 6.0 to 12.4). The proportion of patients reporting the worst pain as severe decreased from enrollment to after surgery from 32% to 3%. Those responding “none” for the worst pain increased from 10% to 78%. Fifteen percent of subjects reported the pain intensity as “nothing,” “faint,” or “very weak” at enrollment. This increased to 96% after surgery. One third of patients reported the unpleasantness of pain as “neutral,” “slightly unpleasant,” or “slightly annoying” at enrollment, which increased to 97% after surgery. Also, 22% and 18% of the patients reported “quite a bit” or “lots of difficulty” with eating desired foods and chewing foods at enrollment, respectively; only 1 patient reported this degree of difficulty at the follow-up examination. In contrast, 42% and 37% of the patients reported no difficulty with eating and chewing at enrollment, which had increased to 95% and 93% at the follow-up examination, respectively. Conclusions Removal of the third molars positively influenced the quality of life outcomes in those with minor symptoms of pericoronitis.

Purpose We assessed the prevalence of caries experience and periodontal pathology on asymptomatic third molars in young adults. Subjects and Methods Healthy subjects with 4 asymptomatic third molars were enrolled in an institutional review board-approved study during a 5-year period. Full mouth periodontal probing, 6 sites per tooth, was the measure of clinical periodontal status. The presence or absence of occlusal caries experience (carious lesions or restorations, including sealants) on third molars and on any surface of the first and second molars were assessed using a visual-tactile examination and panoramic radiographs. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none and caries experience versus no caries experience. Results The data were analyzed from 409 subjects, who averaged 25 years old. More subjects were female (53%) and white (76%). More subjects had at least 1 periodontal probing depth of 4 mm or deeper on a third molar (55%) than on the distal of a second molar (46%). These findings were more likely to be detected around a third molar in subjects with all third molars at the occlusal plane (72%) than in subjects with at least one third molar below (33%). Overall, fewer subjects were affected by third molar caries experience than first or second molars (24% vs 73%, respectively). Of the subset of subjects with all four third molars at the occlusal plane, 26% were affected by both third molar periodontal pathology and caries experience and 16% were caries and periodontal pathology free. Conclusions In these cross-sectional analyses, periodontal pathology was detected more frequently on third molars than on first and second molars and caries experience was detected more frequently on first and second molars than on third molars.

Sensory retraining teaches the patient to ignore or blot out postinjury unpleasant orofacial sensations to optimally tune into and decipher the weakened and damaged signals from the tissues. Sensory retraining is a simple, inexpensive, noninvasive exercise program, which initiated shortly after injury, can lessen the objectionable impression of orofacial altered sensations. Sensory retraining exercises are most effective on decreasing the perceived burden associated with hypoesthetic orofacial altered sensations.

To assess the association between visible third molars and the prevalence of periodontal inflammatory disease of non-third molars.Subjects aged 14 to 45 years with 4 asymptomatic third molars were enrolled in an institutional review board-approved study. Subjects were classified based on whether at least 1 third molar was visible or all third molars were not visible. Full-mouth periodontal probing depth (PD) data, with 6 sites per tooth, were obtained as a measure of a subject's periodontal status. At least 1 non-third molar PD of 4 mm or greater was indicative of periodontal inflammatory disease. Outcomes for the respective groups were compared by use of Cochran-Mantel-Haenszel row mean score statistics. The level of significance for differences was set at .05.The 342 subjects in the visible group were significantly older, with a median age of 26 years (interquartile range, 22.4-32.2 years), as compared with the 69 subjects in the not visible group, with a median age of 21 years (interquartile range, 18.8-24.9 years) (P.01). The proportion of males and females was not statistically different between groups (P.05). Most subjects were white. Significantly more subjects with at least a college education were in the visible group than in the not visible group (P.01). The rate of tobacco use was low and did not differ between groups. Subjects in the visible group were significantly more likely to have at least 1 PD of 4 mm or greater on non-third molars than those in the not visible group: 59% versus 35%. In both groups, first/second molars were more affected than nonmolars when we controlled for differences in age between groups.The visible presence of third molars in adolescents and young adults was significantly associated with periodontal inflammatory disease of non-third molars.

To assess changes in periodontal status over time in subjects with all third molar region periodontal probing depths (PDs) of less than 4 mm at enrollment.Subjects were a subsample of young adults enrolled with 4 asymptomatic third molars in an institutional review board-approved longitudinal study. Full-mouth periodontal PD data, 6 sites per tooth, were measures of periodontal status. Data were aggregated to subject and jaw levels. A PD of 4 mm or greater was considered an indicator variable for periodontal pathology. Subjects were classified according to PD at follow-up: all PDs of less than 4 mm or at least 1 PD of 4 mm or greater. The demographic differences and the third molar anatomic position at baseline were compared to assess whether enrollment factors were related to the changes in periodontal pathology. The level of significance was set at .05.One hundred six subjects had all third molar region PDs of less than 4 mm at enrollment and were aged 25 years on average. Of these, 38% had a change in third molar region periodontal status, with at least 1 third molar region PD of 4 mm or greater detected at a median follow-up of 4.1 years (interquartile range, 2.4-5.9 years). A PD of at least 4 mm was detected significantly more often in the mandibular third molar region than in the maxillary third molar region (P.01). No significant differences in age, gender, education, or length of follow-up were detected between the 40 subjects with a change in periodontal status in the third molar region and the 66 subjects who remained periodontally healthy (P.05). At follow-up, 50% of subjects with at least 1 PD of 4 mm or greater in the third molar region had at least 1 PD of 4 mm or greater in non-third molar regions as compared with 15% of subjects with all third molar region PDs of less than 4 mm (P.01).Periodontal pathology developing over time in healthy young adults was significantly more likely in the mandibular third molar region and mandibular non-third molars.

Purpose This study assessed the impact of third molar removal on periodontal pathology in subjects with third molars asymptomatic at enrollment. Patients and Methods Subjects in whom at least 2 third molars were removed were a subsample of healthy young subjects enrolled with 4 asymptomatic third molars in an institutional review board-approved longitudinal study. Full-mouth periodontal probing (PD) data, 6 sites per tooth, were obtained as a measure of periodontal status at each of 3 visits: enrollment, before removal of third molars, and after removal of third molars. Data were aggregated to subject and jaw levels. The oral cavity was divided by jaw into segments: the third molar region including the third molar (12 probing sites), distal to the second molar (4 probing sites), and non-third molars (80 probing sites). A PD ≥4 mm was considered an indicator variable for periodontal pathology. The number and percent of sites with a PD ≥4 mm were calculated from the total number of probing sites across all subjects. The frequency of subjects with at least one PD ≥4 mm and all third molars removed were compared with the frequency of subjects retaining at least 1 mandibular third molar using Fisher's exact test, with significance set at 0.05. Results Sixty-nine subjects had third molars removed: 57% were female, and 77% were Caucasian. The median age at surgery was 26.3 years (interquartile range, 23.3-31.5 yr). The median interval from enrollment to surgery was 2.4 years (interquartile range, 1.5-4.2 yr). The median follow-up after surgery was 9 months (interquartile range, 6.7-15.4 mo). All third molars were removed in 56 subjects; 13 retained at least 1 mandibular third molar. More subjects had at least 1 PD ≥4 mm around their mandibular third molars before surgery compared with enrollment (52% vs 45%, respectively). Of the total possible mandibular third molar probing sites, 18% had PD ≥4 mm presurgery compared with 12% at enrollment. Significantly fewer subjects who had all third molars removed had a PD ≥4 mm on the distal of their mandibular second molars after surgery, compared with those retaining at least 1 mandibular third molar (20% vs 69%, respectively, P = .001). The number of PDs ≥4 mm in the mandible was less after surgery if all third molars had been removed (1.4% vs 6.6%, respectively). Conclusion Removal of the mandibular third molars significantly improved the periodontal status on the distal of second molars, positively affecting overall periodontal health.

Purpose This study was conducted to document the prevalence of occlusal caries experience and periodontal pathology for erupting third molars in young adults. Patients and Methods The data are from 49 subjects enrolled in an institutional review board–approved trial with at least one third molar below the occlusal plane at baseline that erupted by longest follow-up. Teeth were considered erupted if they reached the occlusal plane. Caries experience on the occlusal surface of third molars was assessed by a visual-tactile examination. At least 1 periodontal probing depth (PD) ≥4 mm in the third molar region was considered indicative of periodontal pathology. The third molar region was defined as the 6 probing sites around third molars and 2 sites on the distal of second molars. The prevalence of third molar caries experience and periodontal pathology at longest follow-up was assessed. Results Most of the 49 subjects were female (51%), Caucasian (76%), and educated at least through high school (82%). Median age was 20.5 years (interquartile range [IQR] 18.4 to 24.1 years). Median follow-up was 5.1 years (IQR = 3.4 to 6.9 years). At baseline, none of the subjects had occlusal caries experience in a third molar; 51% of subjects had at least 1 PD ≥4 mm in a third molar region. At follow-up, 27% of the subjects had occlusal caries experience in at least 1 third molar that erupted to the occlusal plane; 61% had at least 1 PD ≥4 mm in a third molar region. Twenty-nine percent had occlusal caries in at least 1 third molar at the occlusal plane and at least 1 PD ≥4 mm in a third molar region. Thirty-seven percent had no third molar occlusal caries experience and all third molar region PD Conclusions For third molars that erupted “late,” periodontal pathology was more prevalent than occlusal caries.

This study was conducted to analyze the clinical impact of risk markers for third molar and non-third molar periodontal pathology over time.Data were obtained from healthy adults with 4 asymptomatic third molars in an institutional review board-approved trial. Full-mouth periodontal probing depth (PD) data were collected as clinical measures of possible periodontal pathology. The third molar region included the 6 third molar probing sites and the 2 second molar distal probing sites (maximum of 16 sites per jaw). The non-third molar region included all remaining probing sites (maximum of 80 sites per jaw). Periodontal PDs were considered indicator variables for clinically detected periodontal pathology or its absence at baseline and follow-up. Subjects were grouped based on all PD less than 4 mm (no disease), 1 to 3 PDor=4 mm (incipient disease), or at least 4 PDor=4 mm (early disease). Levels of periodontal pathogens and gingival crevicular fluid inflammatory mediators at baseline also were assayed as risk markers for periodontal pathology. Baseline risk markers and possible confounding variables were included in risk assessment models to derive odds ratios and 95% confidence intervals for periodontal pathology in the third molar and non-third molar regions at follow-up.A total of 195 subjects had a median follow-up of 5.9 years (interquartile range [IQR] = 4.6 to 6.9 years). Median age at enrollment was 26.2 years (IQR = 22 to 34 years); 52% were female, 84% were Caucasian, and 10% were African-American. A significant association was found between baseline and follow-up third molar region and non-third molar region periodontal pathology indicators (P.01). Subjects who had incipient or early disease in the third molar region at baseline were significantly more likely to have an indication of periodontal pathology at follow-up in the third molar region and in the non-third molar region compared with those in whom no disease was detected at baseline.In young adults, the presence of periodontal pathology as indicated by periodontal PDs in the third molar region at baseline was predictive of detection of periodontal pathology in the third molar and non-third molar regions at follow-up.

This study was designed to assess changes over time in third molar position relative to the occlusal plane and in the periodontal probing status of third molars in asymptomatic subjects who had at least 1 third molar below the occlusal plane at baseline and retained all third molars to follow-up.Between 1998 and 2002, healthy subjects with 4 asymptomatic third molars and adjacent second molars were enrolled in an institutional review board (IRB)-approved longitudinal study. Clinical and radiographic data of 146 subjects who had at least 1 third molar not fully erupted at baseline with at least 2-year follow-up were analyzed. At baseline and longest follow-up, full mouth periodontal probing, 6 sites per tooth, including third molars was conducted. An indicator variable was used to record periodontal status (probed, not probed) for each third molar. A periodontal probing depth (PD) greater than or equal to 4 mm in the third molar region was considered indicative of periodontal pathology. Panoramic radiographs were analyzed to assess whether unerupted third molars erupted to the occlusal plane. To assess descriptively the influence of age and length of follow-up on the change in third molar position and periodontal status, subjects were stratified by age at enrollment as younger (25 years) or older (or=25 years) and by length of follow-up as shorter follow-up (2 to4 years), or longer follow-up (4 or more years). Because of the small sample sizes in each stratum, analyses are limited to descriptive statistics only.Sixty-six percent of the 146 subjects were less than 25 years old at enrollment. The majority were female and Caucasian. Sixty-eight percent of the 97 younger subjects and 43% of the 49 older subjects presented at baseline with all 4 third molars not fully erupted. Of 584 third molars evaluated, 79% were not fully erupted at baseline; of 462 molars, 80% could not be probed at baseline. Eruption to the level of the occlusal plane occurred in all 4 strata although only a third of the unerupted molars reached the occlusal plane even in the younger subjects with the longer follow-up. Of 369 molars that could not be probed at baseline, approximately 35% could be probed at follow-up with the highest percentage of change in the older subjects with the longer follow-up (46%).The anatomic position of third molars was not static over time even if subjects were greater than 25 years old. Thus, unerupted third molars should be monitored for changes in position and periodontal pathology as long as the teeth are retained.

A 32-year-old black woman came to the Oral and Maxillofacial surgery clinic with a 3-week history of an increasingly tender mass underneath her chin. She reported a history of chin trauma at age 4. The patient denied fever, chills, weight loss, and constitutional symptoms. The patient’s medical history was significant for hypertension, hypothyroidism, and asthma. She had been hospitalized for childbirth and pneumonia. Her medications included beclomethasone dipropionate (Beconase, Allen & Hanburys, Research Triangle Park, NC) and cromolyn sodium (Nasalcrom, Fisons Pharmaceuticals, Rochester, NY) by inhaler as needed. She was allergic to sulfa drugs and cephalosporins. She quit smoking tobacco 3 years ago and denied alcohol abuse. Her family history was noncontributory. Physical examination showed a well-developed, wellnourished, black woman appearing her stated age. Vital signs showed a blood pressure of 130/82 mmHg, a regular pulse of 62 beats/min, a regular respiratory rate of 18 breaths/min, and a temperature of 37.2”C. Facial examination showed a 2-cm, mildly tender, firm, linear nodule in the submental region. A well-healed scar was present over the mass. Oral examination was within normal limits. The neck was without lymphadenopathy, and the thyroid was mildly enlarged. The remainder of her physical examination was unremarkable. The lesion was excised under local anesthesia. Microscopic examination showed florid granulomatous inflammation with focal necrosis and very focal, polarizable foreign material. Special stains for acid-fast bacilli and fungi were performed and were negative (Fig IA, B). The patient returned to the Oral and Maxillofacial clinic 6 days later. The sutures were removed, and a well-healing incision was noted. The patient returned 1 week later for another postoperative visit and after that was instructed to return if necessary. Four months later, the patient presented to the clinic with increasing swelling and tenderness in the previous surgical

Following orthognathic surgery, patients use qualitatively different words to describe altered sensation on their face. These words indicate normal, hypoesthetic, paresthetic, or dysesthetic sensations and so reflect the intrusiveness of the altered sensation. The objective of this study was to examine the relationship between the intrusiveness of the altered sensation and the extent to which it and the associated impairment in facial function were perceived to be a problem in the lives of the patients.One hundred forty-six patients who had a mandibular osteotomy with or without a maxillary procedure were included. Word choice data were obtained during patients' assessment of spontaneous and evoked facial sensations before surgery and at 1 week, 1, 3, and 6 months after surgery and the difficulty or problem levels associated with the altered sensation itself (PAS) and facial functions or oral behaviors in every day life (PAF) were obtained from validated questionnaires. Stratified-by-subject repeated measures Mantel Haenszel correlation statistics were calculated to assess the associations between the intrusiveness of the altered sensation and the problem levels associated with the altered sensation and with the facial functions.On average, the perception of the difficulty with each of the PAS and PAF items decreased from 1 week to 6 months after surgery (all P values.0001). Patients reported more difficulty in every day life related to the effect of the altered sensations than they did related to the effect on facial functions. The correlations of the intrusiveness of the altered sensation and problems with altered sensations (PAS) were stronger overall and at each visit than the correlations with problems of altered facial function (PAF). Although the correlation coefficients tended to increase in value from 1 week to 6 months postsurgery for the PAF items, the increase was proportionately greater for the PAS items.The difficulties in everyday life perceived by patients following orthognathic surgery caused by altered sensations and, to a lesser extent, altered facial function are positively related to the type of altered sensation experienced. The extent of the difficulty follows the intrusiveness level: patients whose sensations are uncomfortable or painful report the most difficulty followed by those who experience nonpainful sensations that are not normally present (ie, positive symptoms), then those who experience only a simple loss in sensation (ie, negative symptoms). Subjective difficulty with altered sensation reflects, in part, its qualitative nature; whereas subjective difficulty with function may reflect the extent of loss in sensory innervation.

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 ≥4 mm in the third molar region, one quarter had a PD ≥5 mm. Twenty-four percent of the subjects had at least 1 tooth that had an increased PD ≥2 mm in the third molar region at follow-up. If subjects had at least 1 PD ≥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 ≥2 mm ( P Conclusion Increased periodontal PDs ≥2 mm were often found in the third molar region for asymptomatic subjects with at least 1 PD ≥4 mm at enrollment, clinical measures that indicated increased periodontal pathology, and a deteriorating periodontal condition.

Purpose: Our goal was to report the detection and levels of gingival crevicular fluid (GCF) inflammatory mediators, sampled at the mesial of 4 first molars and distal of 4 second molars, in 316 patients with asymptomatic third molars. Patients and Methods: Levels of GCF inflammatory mediators, interleukin (IL)-1β and prostaglandin (PG)E2, were determined and log transformed for each patient. Z scores were calculated using the mean and standard deviation of the log values for the entire sample of 316 patients. The log mediator levels and Z scores of patients who had probing depths (PDs) less than 5 mm (n = 238) were compared with patients with at least 1 PD equal to or greater than 5 mm (n = 78) on the distal of second molars or around third molars. A periodontal Composite GCF Inflammation Score was calculated for each patient by summing the Z scores obtained for IL-1β and PGE2 for that patient. Results: The levels of GCF IL-1β and PGE2 were higher if a patient had a PD equal to or greater than 5 mm in the third molar region. The Composite GCF Inflammation Score indicated “elevated inflammation” if a PD equal to or greater than 5 mm was found in the third molar region as well. Conclusions: These data suggest that asymptomatic patients with PD equal to or greater than 5 mm in the third molar region with associated periodontal attachment loss have increased levels of biochemical mediators of inflammation compared with patients with PD less than 5 mm. These findings are consistent with the concept that early periodontitis in young adults that initiates in the third molar region is associated with increases in key inflammatory mediators. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1241-1245, 2002