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Thomas B Dodson

Publications and source records attributed to Thomas B Dodson.

At least 19 recordsLinked to original sources
PubMed2007

Preoperative computed tomography imaging in the management of impacted mandibular third molars.

PURPOSE: The purpose of this study was to examine the role of preoperative computed tomography (CT) imaging of the inferior alveolar nerve (IAN) for patients at increased risk for nerve injury during mandibular third molar (M3) extraction. MATERIALS AND METHODS: To address the research purpose, the investigators enrolled a sample composed of subjects who presented for mandibular M3 extraction and had panoramic radiographic signs interpreted as being associated with an increased risk for inferior alveolar nerve injury. All subjects had preoperative CT imaging studies done to ascertain the position of the IAN with respect to M3. The predictor variable was the preoperative assessment of risk for IAN injury based on panoramic imaging. The outcome variable was the preoperative assessment of IAN injury risk after reviewing the CT studies. We documented the number of IAN injuries. Descriptive statistics were computed as indicated. RESULTS: The sample consisted of 23 patients who had bilaterally impacted wisdom teeth. The sample's mean age was 26 +/- 6 years (range: 18-48 years); 69.6% of the patients were female. After reviewing the panoramic radiographic, 80.4% of M3s were classified as having an increased risk for IAN injury. Upon examining the CT imaging, 32.6% were classified as high risk for IAN injury. After reviewing all imaging studies, 71.7% of the teeth in the sample were extracted. Intraoperative IAN visualization occurred in 21.2% of the cases. At 1 week postoperative, 3 patients had dysesthesia (9.1%); none had a permanent nerve injury. CONCLUSION: In this small series of patients, the additional information provided by 3-dimensional imaging changed the majority of patients from increased risk for nerve injury to low risk for nerve injury.

Adolescent↗
PubMed2007

Functional sensory recovery after trigeminal nerve repair.

PURPOSE: The aim of this study was to estimate the proportion of subjects who achieved functional sensory recovery (FSR) 1 year after inferior alveolar or lingual nerve repair and to identify risk factors associated with failure to achieve FSR. METHODS: Using a retrospective cohort study design, we developed a sample composed of subjects who underwent lingual or inferior alveolar nerve repair. Eligible subjects had at least 1 postoperative visit. For subjects having bilateral nerve repair, 1 side was selected randomly for analysis. Predictor variables were categorized as demographic, anatomic, and operative. The outcome variable was the time to FSR, measured in days. Kaplan-Meier survival methods were used to estimate the proportion of subjects with FSR at 1 year. Uni- and multivariate Cox proportional hazard models were used to identify risk factors for the failure to reach FSR at 1 year. RESULTS: The study sample was composed of 60 subjects with a mean age of 28.7 +/- 8.3 years; 68.3% were female. The majority (86.7%) of subjects presented with a preoperative chief complaint of altered sensation and had lingual nerve damage (93.3%) that was repaired by direct suturing (75%). The mean interval between injury and repair was 145.9 +/- 200.0 days. At 1 year postoperatively, 75% of the subjects had achieved FSR (95% confidence interval [CI]: 64% to 86%). CONCLUSIONS: The majority of subjects undergoing trigeminal (V(3)) nerve repair achieved functional sensory recovery within 1 year of surgical repair. Patients with evidence of neuroma formation were less likely to achieve FSR at 1 year in a multivariate model.

Adolescent↗
PubMed2006

Comparison of wound management methods after removal of maxillofacial osseous lesions.

PURPOSE: To evaluate outcomes associated with choice of wound management, ie, primary closure or healing by secondary intention, of osseous defects after excision of maxillofacial bone lesions as a guide to clinical practice. PATIENTS AND METHODS: Using a retrospective cohort study design, we enrolled a sample composed of subjects treated for jaw lesions between 1995 and 2003. The primary predictor variable was the wound management choice of the residual jaw defect, classified as primary closure or healing by secondary intention. The primary outcome variable was postoperative inflammatory complications. Other study variables were grouped as demographic, medical/dental history, lesion information, preoperative complications, operative treatment, and follow-up information. Appropriate uni-, bi-, and multivariate statistics were computed. RESULTS: The sample was composed of 93 subjects with 126 jaw lesions, of which 90 (71.4%) were managed by primary closure. In the bivariate analyses, tobacco use was statistically associated (P < .05) with wound management and near statistically associated (P = .06) with complications. In the multivariate model, after adjusting for the presence of multiple cysts and tobacco use, there was not a statistically significant difference between the 2 wound management choices in terms of postoperative complications. CONCLUSIONS: Our results suggest that the choice of managing the osseous wound, ie, primary closure versus secondary intention, was not associated with increased risk of postoperative inflammatory complications. The implications of these findings are discussed below.

Adult↗
PubMed2006

A protocol to diagnose intimate partner violence in the emergency department.

BACKGROUND: To better identify women at risk for intimate partner violence (IPV), we developed a diagnostic protocol composed of injury location and response to a verbal questionnaire to identify women at high risk for reporting an IPV-related injury etiology. The purpose of this study was to test the external validity of the protocol when applied at two institutions that differ considerably in terms of geography and socioeconomic measures. METHODS: A cross-sectional design was used at two demographically and geographically different hospitals, designated H1 and H2. The sample was composed of adult females age >or=18 years presenting to the emergency department (ED) for evaluation and management of nonverifiable traumatic injuries. The predictor variable was risk for reporting an IPV-related injury. Risk was categorized per the protocol as high or low. High-risk subjects had visible head, neck, or face (HNF) injuries and positive responses to the questionnaires. Low-risk subject had non-HNF injuries or negative responses to the screening questionnaires. The outcome variable was self-reported injury etiology classified as IPV-related or other. Descriptive and bivariate statistics and standard measurements for a diagnostic test were computed. RESULTS: The sample was composed of 400 subjects, with 200 subjects enrolled at each institution. Self-reported IPV was 34% and 9.5% at H1 and H2, respectively. The protocol classified 33% (H1) and 18% (H2) of subjects as high risk. Sensitivities were 90% (H1) and 74% (H2). Specificities were 96% (H1) and 88% (H2). Subjects classified per protocol as high-risk had an 18-fold (p < 0.01, H1) and 13-fold (p < 0.01, H2) increased risk for reporting IPV-related injuries. CONCLUSIONS: Despite significant geographic and socioeconomic differences between the two hospitals, the results suggest that our protocol may be applicable in disparate clinical settings.

Adolescent↗
PubMed2006

A predictive model to identify women with injuries related to intimate partner violence.

PURPOSE: The diagnosis of intimate partner violence (IPV) is challenging. The authors conducted a cross-sectional study to develop a predictive model to identify IPV-related injuries and validate the model with an independent sample. MATERIALS AND METHODS: The authors enrolled women older than 18 years seeking treatment for injuries. They randomized the sample into index and validation datasets. They used the index dataset to develop a predictive model; the validation set served as an independent sample for assessing the predictive model's goodness of fit. Study variables included risk of self-report of an IPV-related injury and demographic and socioeconomic variables. The outcome variable was self-reported injury etiology (IPV or other). The authors used multiple logistic regression techniques to develop a predictive model that they then applied to the validation dataset, and they measured goodness of fit with the Hosmer-Lemeshow test. RESULTS: The sample was randomized into index (n = 201) and validation (n = 104) sets. For the index set, age, race and risk of IPV were associated with IPV-related injuries (P < .01). The accuracy of the model was 92 percent. Application of the model to the validation dataset resulted in excellent agreement between the observed and actual number of women with IPV-related injuries (accuracy: 93 percent). No statistically significant differences existed between the observed and predicted outcomes (P = .64). CONCLUSIONS: A predictive model composed of age, race and risk of experiencing IPV accurately characterizes women likely to report IPV-related injuries. CLINICAL IMPLICATIONS: Once the clinician diagnoses IPV-related injury, he or she can intervene to prevent future IPV-related injuries.

Adult↗
PubMed2006

Predictors of dental implant survival.

PURPOSE: To summarize dental implant survival rates under a variety of clinical conditions and identify prognostic variables associated with implant survival. MATERIALS/METHODS: The articles reviewed in this paper were designed as retrospective cohort studies and composed of three subject cohorts having implants placed between 1992 and 2003. The prognostic variables were categorized as demographic/health status, anatomic, implant-specific, prosthetic, and perioperative/operative. The primary outcome variable was duration of implant survival. Kaplan-Meier methods were used to estimate implant survival rates. Multivariate Cox proportional hazards models were used to identify prognostic variables. RESULTS-During the study interval, 921 subjects had 2996 implants placed. Implant survival rates at one year ranged from 90.3 percent for immediate-load implants to 96.2 percent for implants inserted into grafted sinuses. The five-year survivals ranged from 87.9 percent (sinus graft cases) to 91.2 percent (all implants). Frequently cited prognostic variables included tobacco use and implant staging. Other prognostic variables identified included implant length, well size, implant coating, and timing of implant placement relative to tooth extraction. CONCLUSION: Using implants to replace missing teeth is a predictable procedure with five-year survival rates approximating 90 percent. Some of the prognostic variables identified in these studies are under the control, at least to some degree, of the clinician and may be manipulated to enhance implant survival.

Age Factors↗
PubMed2005

Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction.

OBJECTIVES: The aim of this study was to estimate the sensitivity and specificity of panoramic radiographic findings in relation to inferior alveolar nerve (IAN) exposure after mandibular third molar (M3) extraction. METHODS: The study used a retrospective cohort model. The primary predictor variable was the presence or absence of > or = 1 panoramic radiographic sign associated with an increased risk for IAN injury. The secondary predictor variable was the surgeons assessment of IAN exposure risk. The outcome variable was IAN exposure, defined as direct visualization of the IAN at the time of M3 extraction. Appropriate univariate and bivariate statistics were computed and the level of statistical significance was set at P < or = .05. RESULTS: The sample was composed of 230 patients having 423 mandibular M3s evaluated and removed. Following M3 extraction, the IAN was visualized in 24 (5.7%) extraction sites. Four of the radiographic signs were statistically associated with IAN exposure ( P < or = .05). The sensitivities and specificities of the 4 radiographic findings ranged from 0.42 to 0.75 and 0.66 to 0.91. The clinicians preoperative estimate of the likelihood of IAN exposure was statistically associated with IAN exposure after M3 extraction ( P < .001; sensitivity = 0.79; specificity = 0.86). CONCLUSION: Four radiographic findings (darkening of the tooth root, narrowing of the tooth root, interruption of the white lines, and diversion of the canal) were statistically associated with IAN exposure following M3 extraction. The surgeons overall estimate of risk based on the panoramic radiograph was also statistically associated with an increased risk of IAN exposure.

Adult↗
PubMed2005

How well do clinicians estimate third molar extraction difficulty?

PURPOSE: The goals of this study were to measure surgeons abilities to estimate third molar (M3) extraction difficulty and to identify variables associated with errors in estimates of difficulty. MATERIALS AND METHODS: To address our research purpose, we implemented a prospective cohort study and enrolled a sample of surgeons who remove M3s. Predictor variables were categorized as either surgeon or subject specific. The primary outcome variable was the error in estimating operative difficulty. Preoperative and postoperative estimates of difficulty were obtained using a 100-mm visual analogue scale. Error was defined as the difference between preoperative and postoperative estimates of extraction difficulty. Appropriate univariate, bivariate, and multivariate statistics were computed. RESULTS: The sample was composed of 15 surgeons who operated on 82 subjects having 250 M3s (53.2% mandibular) extracted. The mean level of surgical experience was 8.8 +/- 11.1 years. The mean age of the subjects was 26.2 +/- 10.7 years; 57.3% were female; and 72.0% were white. The mean preoperative and postoperative estimates of difficulty were 44.3 +/- 23.4 and 39.6 +/- 24.7 mm, respectively. The mean absolute and actual differences between preoperative and postoperative estimates were 15.7 +/- 13.6 and 4.8 +/- 20.2 mm, respectively. We identified several demographic and anatomic variables statistically associated ( P < or = .05) with error in estimating difficulty. CONCLUSIONS: Our models indicate that errors in the estimates of difficulty were related to demographic (age, gender, ethnicity, snoring) and anatomic (cheek flexibility, mouth opening) variables, with little or no dependence on radiographic variables or surgical experience.

Adolescent↗
PubMed2005

Estimating third molar extraction difficulty: a comparison of subjective and objective factors.

PURPOSE: The purpose of this study was to compare and contrast subjective and objective assessments of variables associated with third molar (M3) extraction difficulty. MATERIALS AND METHODS: To address the research purpose we implemented a prospective cohort study and enrolled a sample of surgeons removing M3s in an ambulatory care setting. Predictor variables were categorized as demographic, anatomic, or operative. The outcome variables were subjective and objective rankings of the importance of the variables in terms of estimating M3 extraction difficulty. Subjective rankings were made by surveying the surgeons and asking them to rank each variable's importance on a scale ranging from 0 (not important) to 100 (extremely important). Objective rankings of each variable's importance were made using the absolute values of coefficients derived from a multivariate linear regression model with extraction time as the outcome. Appropriate uni-, bi-, and multivariate statistics were computed. RESULTS: The sample consisted of 14 surgeons who removed 450 M3s from 150 subjects from June 2002 to August 2003. Based on the multivariate linear regression model, variables associated with M3 extraction time were gender, arch location, Winter's classification, tooth morphology, number of teeth extracted, procedure type, and surgical experience. For these variables, there was a strong, statistically significant correlation (r = 0.86; P <.01) between the standardized coefficient absolute values and the surgeons' estimates of importance. CONCLUSION: There was a large, positive correlation between variables that surgeons consider most important in determining M3 extraction difficulty and those exhibiting the most influence over extraction times in a multivariate model.

Adult↗
PubMed2005

Is there a role for reconstructive techniques to prevent periodontal defects after third molar surgery?

PURPOSE: Among patients at high risk for second molar (M2) periodontal defects after third molar (M3) removal, does active treatment at the time of extraction, when compared with no treatment, alter the risk of postextraction M2 periodontal defects? MATERIALS AND METHODS: We used a prospective cohort study design and a sample composed of subjects at high risk for developing M2 periodontal defects after M3 extraction, that is, age > or = 26 years, pre-existing periodontal defects (attachment level [AL] > or = 3 mm), and mesioangular or horizontal M3 impaction. The predictor variable was treatment status of the M3 extraction site. The M3 extraction sites were reconstructed with demineralized bone powder (DBP), bioresorbable guided tissue regeneration (GTR) therapy, or no treatment. The outcome variable was ALs measured at the M2 distobuccal line angle preoperatively and 26 weeks after extraction. Appropriate univariate, bivariate, and multivariate statistics were computed, and statistical significance was set at a value P < .05. RESULTS: The cohort was composed of 12 subjects contributing 18 high-risk M3s. Twenty-six weeks after M3 removal, the ALs for GTR-treated (3.0 +/- 1.2 mm), DBP-treated (1.4 +/- 0.5 mm), and control (3.8 +/- 0.9) M3 sites were statistically significantly different ( P = .002). Tukey post-hoc comparisons revealed a statistically significant difference between control and DBP ALs ( P = .001) and GTR-treated and DBP-treated ALs ( P = .037). There was no statistically significant difference in ALs between control and GTR-treated M3s ( P = .35). CONCLUSIONS: The results of this study suggest that subjects at high risk for developing M2 periodontal defects after M3 removal may benefit from the use of DBP placed at the time of M3 extraction to enhance periodontal healing.

Adult↗
PubMed2005

A comparison of patient satisfaction and objective assessment of neurosensory function after trigeminal nerve repair.

PURPOSE: The purpose of this study was to compare objective and subjective assessments of neurosensory function after trigeminal nerve repair. METHODS: This was a retrospective cohort study using a sample of patients who underwent surgical repair of trigeminal nerve injuries. The primary study variables were categorized as objective or subjective. The objective variable was the change in neurosensory examination between preoperative and 1-year postoperative visits. Neurosensory status was measured using an ordinal scale ranging from anesthetic (0) to normal (4). Subjective variables included patient satisfaction with the nerve repair and patient assessment of injury-related oral dysfunction. Demographic, anatomic, and operative variables were also collected. Appropriate univariate and bivariate statistics were computed. RESULTS: The sample was composed of 19 patients (14 female, 17 Caucasian) who had trigeminal nerve repair (17 lingual, 2 inferior alveolar). The mean duration between injury and repair was 4.5 +/- 2.3 months; between repair and postoperative assessment was 11.9 +/- 0.9 months. The mean change in neurosensory status was 1.3 +/- 1.0 levels. The majority of patients (63.1%) rated their satisfaction with the outcome of treatment as "good" to "excellent." There was a statistically significant correlation between change in neurosensory status and patient satisfaction (rho = 0.86; P < .01). CONCLUSION: There is evidence of a strong correlation between improvement in the neurosensory examination following trigeminal nerve repair and patient satisfaction with the surgical outcome 1-year postoperatively. Patients who experience greater neurosensory improvement also report lower frequencies of related oral dysfunction.

Adolescent↗
PubMed2005

Injury location and screening questionnaires as markers for intimate partner violence.

PURPOSE: We sought to evaluate the performance of 2 different screening questionnaires for intimate partner violence (IPV), in conjunction with injury location, as markers for IPV-related injuries. METHODS: We implemented a cross-sectional study and enrolled a sample of women presenting to the emergency department for evaluation and management of nonverifiable injuries. Study subjects were randomly assigned to receive 1 of 2 IPV screening questionnaires: the Partner Violence Screen (PVS) or the short-Woman Abuse Screening Tool (short-WAST). We evaluated a combination of 2 markers of IPV-related injury: (1) injury location, classified as head/neck/facial (HNF) or other and (2) responses to the IPV questionnaires: positive or negative. Our predictor variable was the probability of self-report of IPV-related injury defined as (1) high probability (HNF injuries were present and there was a positive response to the IPV questionnaire) or (2) low probability (all other combinations of injury location and responses to the questionnaires). The outcome variable was self-reported injury etiology, IPV or other. Demographic variables were also recorded for our study sample. Univariate and bivariate statistical analyses were computed for the sample. Sensitivity, specificity, and positive and negative predictive values and odds ratios were calculated (P < .05). RESULTS: The sample was composed of 200 women. The sensitivities/specificities for the PVS-injury location and short-WAST-injury location combinations were 0.75/0.70 and 0.77/0.61, respectively. The odds ratios for IPV-related injury etiology were 10.2 (3 < OR < 41, P = .01) for the PVS-injury location combination and 3.7 (0.90 < OR < 15, P = .07) for the short-WAST-injury location combination. CONCLUSIONS: A set of markers composed of injury location and the PVS was statistically associated with the likelihood of reporting IPV-related injuries. The short-WAST did not perform as well as the PVS in the study's clinical setting.

Adult↗
PubMed2005

Risk of periodontal defects after third molar surgery: An exercise in evidence-based clinical decision-making.

OBJECTIVE: The object of this study was to apply evidence-based principles to answer the question, What is the risk of having periodontal defects on the distal aspect of the mandibular second molar (M2) following third molar (M3) removal? STUDY DESIGN: To identify relevant articles for review, we completed a computerized literature search of Medline. The inclusion criteria for articles included prospective cohort studies or randomized clinical trials with follow-up periods of 6 months or more, and preoperative and postoperative measurements of periodontal probing depths (PDs) or attachment levels (ALs). RESULTS: Eight articles met the inclusion criteria. Overall, the reported mean changes in ALs or PDs on the distal of M2 6 months after M3 removal were clinically insignificant, ie, less than 2 mm. Six months after M3 removal, 52% to 100% of subjects had no change or improvement in ALs or PDs. Given periodontal disease present preoperatively, the number needed to treat (NNT) ranged from 3 to 10. Given healthy periodontal status preoperatively, 48% had worsening of their periodontal measures after M3 removal and the number needed to harm (NNH) was 2. CONCLUSION: Commonly, the second molar periodontal probing depth or attachment levels either remain unchanged or improve after third molar removal. For subjects with healthy second molar periodontium preoperatively, the indication for third molar removal needs to be evaluated carefully as these subjects have an increased risk for worsening of probing depths or attachment levels after third molar removal.

Alveolar Bone Loss↗
PubMed2005

Role of computerized tomography in management of impacted mandibular third molars.

Nerve injury following mandibular third molar (M3) removal is a rare but serious complication. The purpose of this article is to review the role of currently available imaging technologies to facilitate clinical decision-making in the setting of M3 surgery. Given findings suggestive of high risk for inferior alveolar nerve (IAN) injury, the clinician should consider additional imaging to assess better the anatomic relationship of the IAN and M3.

Adult↗
PubMed2004

Massachusetts General Hospital/Harvard Medical School MD oral and maxillofacial surgery program: a 30-year review.

PURPOSE: The first resident enrolled in the Massachusetts General Hospital/Harvard MD Oral and Maxillofacial Surgery (MD/OMFS) program graduated from Harvard Medical School (HMS) in 1972. The purpose of this report is to provide a summary of the first 30 years of the program and to outline plans for its future. MATERIALS AND METHODS: This was a retrospective cohort study and the sample was composed of the residents enrolled in the MD/OMFS program between 1971 and 2000. Study variables included the dental school from which the resident graduated, successful completion of the MD/OMFS program, performance on parts I and II of the United States Medical Licensing Examination/National Board of Medical Examinations (USMLE/NBME), HMS grades, and career trajectories (full- or part-time academic or private practice). Appropriate descriptive and bivariate statistics were computed for all study variables. RESULTS: During the study interval, 56 residents entered the MD/OMFS program and graduated from HMS. All members of the cohort, regardless of the dental school from which they graduated, performed well as evidenced by USMLE/NBME scores and medical school grades. Ninety-four percent of eligible graduates have completed the American Board of Oral and Maxillofacial Surgery examination. The pass rate was 100%. Thirty-four graduates are involved in full- or part-time academic practice. Four trainees completed medical school but did not complete the OMFS program. CONCLUSION: The overwhelming majority of trainees completed the program, became board certified, and currently practice OMFS or a related specialty. A disproportionate number entered academic careers.

Boston↗