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At least 289 records · Page 16Linked to original sources
PubMed2005

The American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study.

PURPOSE: The purpose of this investigation was to assess the frequency of complications of third molar surgery, both intraoperatively and postoperatively, specifically for patients 25 years of age or older. MATERIALS AND METHODS: This prospective study evaluated 3,760 patients, 25 years of age or older, who were to undergo third molar surgery by oral and maxillofacial surgeons practicing in the United States. The predictor variables were categorized as demographic (age, gender), American Society of Anesthesiologists classification, chronic conditions and medical risk factors, and preoperative description of third molars (present or absent, type of impaction, abnormalities or association with pathology). Outcome variables were intraoperative and postoperative complications, as well as quality of life issues (days of work missed or normal activity curtailed). Frequencies for data collected were tabulated. RESULTS: The sample was provided by 63 surgeons, and was composed of 3,760 patients with 9,845 third molars who were 25 years of age or older, of which 8,333 third molars were removed. Alveolar osteitis was the most frequently encountered postoperative problem (0.2% to 12.7%). Postoperative inferior alveolar nerve anesthesia/paresthesia occurred with a frequency of 1.1% to 1.7%, while lingual nerve anesthesia/paresthesia was calculated as 0.3%. All other complications also occurred with a frequency of less than 1%. CONCLUSION: The findings of this study indicate that third molar surgery in patients 25 years of age or older is associated with minimal morbidity, a low incidence of postoperative complications, and minimal impact on the patients quality of life.

Absenteeism↗
PubMed2006

Surgical outcomes for suture-less surgery in 366 impacted third molar patients.

PURPOSE: The purpose of this study is to identify surgical outcomes in third molar surgery when no sutures are used for primary closure. PATIENTS AND METHODS: A total of 1,280 third molars were removed from 366 patients in an outpatient setting using intravenous sedation and local anesthesia. A small V-shaped flap was raised in all cases and no sutures were placed over a 2-year period (2001 to 2003). All people were contacted by a registered nurse within 24 hr. All records were reviewed by a medical investigator and IRB approval was obtained. RESULTS: The mean age was 22.14 years, males 39%, females 61%, white 75%, African American 22%, and Asian 3%. Ninety-three people of 366 experienced at least 1 complaint. Alveolar osteitis was 2.81% for the total teeth extracted and 10.7% for the mandibular Class IV impactions. A total of 652 mandibular third molars were removed (Class III, n= 113; Class IV, n= 522). Forty-eight of 366 patients (13.1%) had postoperative diagnosis of alveolar osteitis. CONCLUSIONS: Small flap third molar surgery without sutures is less invasive and saves time. Delayed healing in oral surgery is not new. The outcome of 1,280 extractions demonstrates good results.

Adult↗
PubMed2005

Prevention of alveolar osteitis with chlorhexidine: a meta-analytic review.

OBJECTIVE: The objective of this study was to assess if chlorhexidine (CHX) rinse decreases the occurrence of alveolar osteitis (AO) following third molar removal. STUDY DESIGN: A literature search identified 7 randomized prospective clinical trials reporting incidence of AO following removal of mandibular third molars. Studies were combined into 2 groups and summary relative risks were calculated for each group. One group of studies evaluated rinsing on the day of surgery only and the second group of studies rinsed at least on the day of surgery and several days after surgery. RESULTS: The relative risk for the single rinse group was 1.36 (95% confidence interval [CI] 0.80, 2.33), P>.05, whereas for the multiple rinse group, the relative risk was 1.90 (95% CI 1.46, 2.47), P<.05. CONCLUSION: Rinsing with CHX on the day of surgery and several days after may reduce the incidence of AO.

Anti-Infective Agents, Local↗
PubMed2006

Effect estimates and methodological quality of randomized controlled trials about prevention of alveolar osteitis following tooth extraction: a systematic review.

OBJECTIVE: To systematically review the scientific evidence derived from randomized controlled trials (RCT) about prevention of alveolar osteitis (AO). STUDY DESIGN: Literature searches were conducted to locate RCTs about prevention of AO. The RCTs were scrutinized for methodological details and categorized according to the preventive intervention studied. Data were analyzed in relation to the frequency of AO. Absolute risk reductions (ARR), and numbers needed to treat were calculated with 95% confidence limits. RESULTS: There was a wide variation in the design and quality of the RCTs (N = 32). The greatest risk reduction for AO was seen for local treatment with tetracycline (ARR, 12%-31%). For a majority of the preventive interventions, the evidence was absent or inconclusive. CONCLUSIONS: Local treatment with tetracycline, and also 0.12% chlorhexidine rinsing preoperatively and 7 days postoperatively, seem to have significant and clinically relevant preventive effect on AO following surgical removal of lower third molars.

Anti-Bacterial Agents↗
PubMed1975

Analgesic effect of apernyl and phenol-camphor solutions on alveolitis.

Phenol-camphor or Apernyl were applied in 82 patients in whom alveolitis had been diagnosed. The effect of the drugs was recorded during the following days according to the patients' subjective judgment. The analgesic effect of Apernyl was significantly better than that of phenol-camphor. The treatment with phenol-camphor took an average of 1.8 days longer than that with Apernyl.

Anesthesia, Dental↗
PubMed1979

Influence of oral hygiene measures on the development of alveolitis sicca dolorosa after surgical removal of mandibular third molars.

This study was carried out in order to investigate the prophylactic effect of plaque control on the development of alveolitis sicca dolorosa (ASD). Sixty patients took part in the investigation. The patients in the test group had their teeth polished 5 days preoperatively and then used a 0.2% aqueous solution of chlorhexidine digluconate as a mouth rinse twice a day before the operation and during the postoperative week. No special oral hygiene measures were taken in the control group. Compared with the control group, the patients in the test group had significantly less plaque on their teeth on the day of operation (P less than or equal to 0.001). One patient in the test group developed ASD, while there were five cases of ASD in the control group. The results indicated that plaque control may be a possible way to decrease the incidence of ASD.

Adult↗
PubMed1980

Effect of azidocillin, erythromycin, clindamycin and doxycycline on postoperative complications after surgical removal of impacted mandibular third molars.

Treatment of osteitis after surgical removal of the third molar of the mandible is still a clinical problem. A total of 140 patients undergoing operations for removal of an impacted third molar of the mandible, were included in a double-blind study. Placebo or antibiotics - azidocillin, erythromycin, clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days. The concentrations in serum, alveolar serum and mandibular bone were measured and the postoperative courses - pain, trismus, swelling and wound-healing - were recorded. No correlation was obtained between the antibiotic concentration and the postoperative complaints, except in the azidocillin group on day 2, in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations. The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups. Only 15 operations lasted more than 15 min and the three of them which subsequently resulted in alveolitis were in the placebo groups. Antibiotics significantly reduced pain on day 7 postoperatively. In general, no statistically significant differences in trismus and swelling could be demonstrated between the patient groups. However, there was a significant difference between the placebo and doxycycline groups with respect to swelling (day 2 postoperative, P < 0.01; day 5 postoperative, P < 0.05). Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third mandibular molars, but could decrease the rate of infections after traumatic operations.

Adolescent↗
PubMed1981

Alveolitis after operative removal of third molars in the mandible.

The aim of the investigation was to assess the importance of various factors in the aetiology of alveolitis sicca dolorosa. Two hundren partially erupted or totally impacted mandibular third molars were surgically removed. The patients were divided into four groups. The patients in group 1 were premedicated with a single dose of penicillin-V (phenoxymethylpenicillin), those in group 2 with an antisialogogue (methylscopolamine nitrate), and those in group 3 with an antifibrinolytic agent (tranexamic acid). Group 4 were non-premedicated controls. The frequency of alveolitis in the groups 1 and 2 was significantly less than in the groups 3 and 4. This indicates the importance of salivary contamination of the surgical field and of infection as aetiologic factors in alveolitis.

Adolescent↗
PubMed1983

Alveolitis sicca dolorosa after removal of impacted mandibular third molars.

The aim of the investigation was to study the occurrence of alveolitis and other side effects in women taking oral contraceptives after surgical removal of impacted mandibular third molars. Reactions to surgical removal of 156 bilateral third molars were examined in 78 patients. The material was divided into 2 groups. In 1 group, the patients took oral contraceptives of the combined type and in the other group the patients took no contraceptives. Each group was further divided into 2 subgroups: (1) removal of a molar during menstruation; and (2) removal of the contralateral molar in the same patient at the middle of the menstrual cycle. The results showed significantly more alveolitis in the group taking oral contraceptives and in women who were operated on during menstruation. These findings would suggest that oral surgery involving fertile women should be undertaken during periods free from oral contraceptives and menstruation.

Adolescent↗
PubMed1984

Dental extractions in Paget's disease of bone.

The results of a postal questionnaire completed by 360 patients with Paget's disease of bone, on behalf of themselves and their unaffected spouses, suggest that dental practitioners have some awareness of the potential problems associated with extractions for patients with Paget's disease, but that nevertheless patients still suffer from greater difficulty at extraction and more post-extraction complications than normal.

Adult↗
PubMed1993

A comparison of morbidity following the removal of lower third molars by the lingual split and surgical bur methods.

Fifty-two consecutive healthy patients with bilateral, similarly impacted mandibular third molars were studied. For each patient, both third molars were removed at the same operation by the same experienced operator. On one side, the lingual split method by chisel was used; on the other, the buccal approach with surgical bur. Standard preoperative and postoperative drug regimens were used. Pain, facial swelling (visual analogue scales), and lingual and labial sensory disturbance were recorded for each side by the patients at home 6, 24, and 48 h and 7 days after surgery. Wound healing was assessed at 4 weeks. There were no statistically significant differences between methods in relation to pain, facial swelling, sensory loss, infection, or periodontal pocket depth distal to the second molar, although 2% of third molars removed by chisel had lingual sensory disturbance at 7 days, as compared with 8% where burs had been used. There were no statistically significant differences between duration of procedures; mean operating time with burs was 8.28 min (range 4-15 min) and with chisels 7.57 min (range 4-15 min). This study provided no evidence of difference in either efficiency or outcome between two standard methods of removing lower third molars.

Adolescent↗
PubMed1992

Does metronidazole prevent alveolitis sicca dolorosa? A double-blind, placebo-controlled clinical study.

The effect of a single preoperative dose of metronidazole in the prevention of alveolitis sicca dolorosa (ASD) after surgical removal of one impacted, non-infected mandibular third molar was investigated. A patient sample of 270 were given either 1000 mg of metronidazole or placebo at least 30 min before surgery. The preoperative recordings included gender, age, tooth to be removed, experience of surgeon, time of test medication, and duration of surgery. No difference was found between the metronidazole and placebo groups in the occurrence of ASD. The duration of surgery and the experience of the operating surgeons had no effect on the occurrence of ASD. The present study failed to demonstrate any preventive effect of a single dose of metronidazole on the development of ASD.

Adult↗
PubMed1995

Effects of gender-related factors on the incidence of localized alveolar osteitis.

Numerous literature references have suggested increased risk for localized alveolar osteitis associated with female gender, use of oral contraceptives, and point in menstrual/contraceptive cycle. However, the available information has not been systematically considered with the intent to accurately estimate the magnitude of these effects. The present review suggests that under certain conditions, some of which may be avoidable, females may have at least a two to threefold increase in osteitis risk compared with males. It appears that this greater risk may be reduced by considering hormonal cycles when scheduling elective exodontia.

Contraceptives, Oral, Hormonal↗
PubMed1997

Predictors of postextraction complications in HIV-positive patients.

OBJECTIVE: The purpose of this study was to identify factors associated with an increased risk for post-tooth-extraction complications in a sample of HIV-positive patients. STUDY DESIGN: A cohort of HIV-positive patients who required the extraction of one or more teeth was enrolled. The predictor variables were grouped into the following sets: demographics; medical and social history; preoperative clinical findings; preoperative laboratory measures (hematologic, immunologic, and nutritional); and treatment. The outcome variable was defined as the presence or absence of a complication following tooth extraction. Logistic regression techniques were used to identify variables associated with an increased risk for complications following tooth extraction. RESULTS: During the enrollment period, 76 HIV-positive patients were enrolled into the study cohort. Seventeen patients (22.4%) had postoperative complications. Based on the bivariate statistical analyses, variables associated with the presence of postoperative complications were red blood cell count, CD8 count, total number of positive sites tested using cell-mediated immunity skin tests, and extraction technique (p < or = 0.05). Using a stepwise logistic regression technique, the variable identified as being predictive of postoperative complications was the CD8 count (p = 0.02). The post-tooth-extraction complication rate of the HIV-positive patients in this study sample was greater than the rate reported in most other studies (22% vs. 3%-5%). The complications, however, were minor and easily treated. The variable consistently identified with an increased risk for complications was the CD8 count: the lower the CD8 count, the higher the risk for complications. The CD8 count, however, had poor predictive value. CONCLUSION: In acute clinical situations--for example, in cases of patients with significant dental pain--the results suggest that delaying treatment to obtain laboratory studies may be of little clinical value. It may be appropriate to proceed with suitable, definitive procedure(s) to alleviate symptoms.

Adult↗
PubMed1998

Perioperative use of 0.12% chlorhexidine gluconate for the prevention of alveolar osteitis: efficacy and risk factor analysis.

OBJECTIVES: The purposes of this study were to evaluate the use of 0.12% chlorhexidine gluconate as a prophylactic therapy for the prevention of alveolar osteitis and to further examine subject-based risk factors associated with alveolar osteitis. STUDY DESIGN: The trial was a randomized, double-blind, placebo-controlled, parallel-group study conducted among 279 subjects, each of whom required oral surgery for the removal of a minimum of one impacted mandibular third molar. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine or placebo mouthrinse for 30 seconds for 1 week before and 1 week after the surgical extractions. This regimen included a supervised presurgical rinse. Alveolar osteitis diagnosis was based on the subjective finding of increasing postoperative pain at the surgical site that was not relieved with mild analgesics, supported by clinical evidence of one or more of the following: loss of blood clot, necrosis of blood clot, and exposed alveolar bone. RESULTS: In comparison with use of the placebo mouthrinse, prophylactic use of the chlorhexidine mouthrinse resulted in statistically significant (p < 0.05) reductions in the incidence of alveolar osteitis. With chlorhexidine therapy, the subject- and extraction-based incidences of alveolar osteitis in the evaluable subset (271 subjects) were reduced, relative to placebo, by 38% and 44%, respectively. The corresponding odds ratios that describe the increased odds of experiencing alveolar osteitis in the placebo group were 1.87 and 2.05 for subject- and extraction-based analyses, respectively. In comparison with nonuse of oral contraceptives, the use of oral contraceptives in female subjects was related to a statistically significant increase in the incidence of alveolar osteitis (odds ratio = 1.92, p = 0.035). Relative to male subjects, the observed incidence of alveolar osteitis for female subjects not using oral contraceptives was not statistically significant (odds ratio = 1.18, p = 0.64). Smoking did not increase the incidence of alveolar osteitis relative to not smoking (odds ratio = 1.20, p = 0.33). CONCLUSIONS: These data confirm that the prophylactic use of 0.12% chlorhexidine gluconate mouthrinse results in a significant reduction in the incidence of alveolar osteitis after the extraction of impacted mandibular third molars. In addition, oral contraceptive use in females was confirmed to be a risk factor for the development of alveolar osteitis.

Adolescent↗