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PubMed1995

Transient bacteremia after tooth extraction with intravenous cefuroxime prophylaxis.

Twenty-four blood samples obtained after tooth extraction with intravenous cefuroxime prophylaxis were cultured on Bactec NR16A and NR 17A (Becton Dickinson, Maryland, U. S. A.). MIC of identified microbes and the serum levels of cefuroxime were also measured. The overall incidence of bacteremia was 16.7% (four out of 24). Although nine strains were isolated, no streptococcal bacteremia occurred. The MICs of cefuroxime varied from 0.05 to 12.5 micrograms/ml, and serum levels ranged from 100 to 233 micrograms/ml, which were satisfactory concentrations for the microorganisms isolated. The results suggested that intravenous cefuroxime prophylaxis for tooth extraction reduced the incidence of bacteremia, as well as the isolation rate of streptococci, significantly.

Adult↗
PubMed1977

A survey of causes of permanent tooth extractions in South Australia.

Reasons for permanent tooth extractions were studied in a survey in South Australia conducted over a two week period in which 154 dentists participated, a response rate of 43 per cent. Of 2,387 teeth extracted from 1,104 patients, caries accounted for 52 per cent, periodontal and orthodontic causes 25.6 and 11.1 per cent respectively, impacted teeth 6.5 percent, and prosthetic reasons 2.8 per cent. Caries was the most prevalent cause in the age groups 20-40 and over 70 years. Between 40 and 70 years more than 50 per cent of the teeth were extracted for periodontal reasons.

Adolescent↗
PubMed1980

Neuro-histological reactions following tooth extractions.

The neuro-histological reactions after tooth extraction were investigated in the extraction alveolus, the mandibular nerve and the trigeminal ganglion. In the ganglion, nerve cell bodies showing signs of retrograde reaction (chromatolysis and nuclear displacement) were seen 12 h after extraction. Maximal number of reacting cells were registered in the first postoperative week. Three weeks after extraction the number of reacting cells were at a normal low level. In the mandibular nerve no signs of axon degeneration could be demonstrated. In the alveolus, initial traumatic axon degeneration was followed by regeneration 2 days after extraction. Within the first postoperative week the alveolus was filled with connective tissue, in which many long thin axons were seen. Cancellous bone then filled the alveolus; the axons were thereby gathered - concentrated - into fascicles in the central part, with a direction towards the limbus. However, this was only passed by very few axons. Four months after extraction signs of axon degeneration were seen, and 2 months later the myelin sheaths also displayed degenerative signs. Ten months after extraction a minor area of connective tissue with a content of few axons and vessels was found at the bottom of the former alveolus. The histological appearance was of a small traumatic neuroma.

Alveolar Process↗
PubMed1995

Intravenous administration of vancomycin is ineffective against bacteremia following tooth extraction.

The incidence of transient bacteremia after tooth extraction without antimicrobial prophylaxis has been reported was high as 69.2%; that with intravenous ampicillin as 4.2% (1, 2). Currently, we tested a regime of vancomycin that was recommended by the American Heart Association as prophylaxis for oral surgery patients who were allergic to penicillin and evaluated its effectiveness. Before the surgical procedures, we started an intravenous drip infusion of vancomycin. Ten of 26 patients became blood culture positive (38.5%). Seventeen strains of bacteria were isolated. The Minimum Inhibitory Concentrations (MICs) of vancomycin were lower than 3.13 micrograms/ml, with just one exception.

Anti-Bacterial Agents↗
PubMed2003

Orbital penetration associated with tooth extraction.

Three cats and 2 dogs were evaluated for ophthalmologic complications associated with tooth extraction procedures. Orbital penetration leading to ocular and, in one case, brain trauma was secondary to iatrogenic injury from a dental elevator. Outcomes included enucleation of the affected eye in 3 cases, and death from brain abscessation in 1 case. Early treatment or, preferably, referral to a veterinary ophthalmology specialist may prevent such outcomes. Awareness of the anatomical proximity of caudal maxillary tooth roots and the orbit, appropriate interpretation of diagnostic intraoral dental radiographs, and technical proficiency in tooth extraction techniques will minimize these complications in veterinary dental practice.

Animals↗
PubMed2001

The relationship between radiologic interpretation and root tip fracture during tooth extraction performed by junior clinicians.

OBJECTIVES: The purpose of this study was to analyze the relationship between root tip fracture and radiologic interpretation of root morphology on periapical radiographs during third molar extraction performed by junior clinicians. METHODS: Before tooth extraction, periapical radiographs of 107 patients with 116 third molars were evaluated by junior clinicians, all with less than 5 years of clinical experience. Radiologic interpretations of root morphology-including number, curvature, fusion, and accessory root-were recorded before each extraction. The clinicians were also asked to estimate the possibility of root fracture on a Visual Analogue Scale before the procedure. The exact morphology of the extracted teeth was recorded after the extraction for the purpose of comparison. RESULTS: Twenty-nine of 116 teeth extracted were not correctly interpreted in at least 1 of the morphologic categories surveyed. The average expected fracture rate of nonfractured teeth was 23.1%, whereas the average expected fracture rate of fractured teeth was a significantly higher 50.3%. Misinterpretation of root morphology on radiographs decreased with increased clinical experience. Senior residents had the lowest misinterpretation and fracture rate. Logistic regression analysis showed that fracture is most closely related to the estimated fracture rate (4.95) and is also significantly related to underestimation of root curvature (0.95; 24.56 with 2 df of chi-square, P = .0001). CONCLUSIONS: Misinterpretation of root morphology on radiographs occurred in 25% of the teeth. Root curvature was the most misinterpreted item studied. Fracture was most closely related to the estimated fracture rate. Junior clinicians in this study expected that only 50% of the fractured teeth would fracture, reflecting a general underestimation of root tip fracture. Further study should be performed to evaluate how to increase the accuracy of root curvature interpretation.

Clinical Competence↗
PubMed1991

A longitudinal study of the condition of first permanent molars in a group of adolescents with special reference to elective orthodontic tooth extraction.

The aim of this study was to investigate changes in the condition of first permanent molars over the teenage years, with special reference to adolescents who lost premolar teeth for orthodontic purposes. A total of 453 South Wales schoolchildren (219 males and 234 females) were examined at the ages of 11-12 and 19-20 years. At 11-12 years, 89.6 per cent of the cohort had all four first permanent molars, while 3.3 per cent had already lost these teeth. Of those first permanent molars present, 61.7 per cent had some caries experience. At age 19-20, 80.6 per cent of subjects retained four first permanent molars while 4.4 per cent had none. Of the first permanent molars present, 80.6 per cent had been affected by caries. In 60 per cent of the 186 subjects (75 males and 111 females) who had lost premolar teeth in the course of orthodontic treatment, a sound premolar was extracted in preference to a first permanent molar which already had evidence of dental disease. At age 19-20 years, the majority of the first permanent molars were restored and otherwise sound, though a small number which had been restored at age 11-12 years had been lost due to caries.

Adolescent↗
PubMed1994

Effect of chlorhexidine (0.12%) rinses on periodontal tissue healing after tooth extraction. (II). Radiographic parameters.

The aim of the present study was to assess the influence of a 1-month period of chlorhexidine digluconate (CHX) rinses on the remodelling activity of periodontal tissues adjacent to an extraction wound. From 12 patients assigned to the test group rinsing 2 x daily with 15 ml of 0.12% CHX solution (Peridex) starting 2 days after tooth extraction and from 11 patients assigned to the control group rinsing with a placebo solution, standardized radiographs were available taken immediately after tooth extraction and 1, 2, 3 and 6 months thereafter. Computer assisted densitometric image analysis (CADIA) was applied in order to quantify changes in density during the healing phase after tooth extraction. Regions of interest (ROI) were chosen for CADIA covering supracrestal periodontal soft tissue adjacent to the extraction wound. ROIs were also defined on crestal alveolar bone adjacent to the extraction wound. In the active group, 15/20 sites demonstrated an increase in alveolar bone density between months 1 and 6 (mean CADIA value 6.7 +/- 10.0), whereas in the control group 11/21 sites demonstrated a loss in density (mean CADIA values -1.4 +/- 10.5). Similar observations were made when the ROIs covering supracrestal periodontal tissues were analyzed (mean CADIA values 7.8 +/- 8.4 for the experimental group and -0.3 +/- 10.5 for the control group). These differences were statistically significant (p < 0.04). The digitized series of standardized radiographs were also evaluated for changes in bone height. The distance from the alveolar bone crest to reference points were measured in mm within the baseline: the 1, 2, 3 and 6 month radiographs.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗
PubMed2003

Racial variations in dental procedures: the case of root canal therapy versus tooth extraction.

BACKGROUND: Racial disparities have been widely documented in medical care, but variations in dental care have not been well examined. OBJECTIVES: To determine if there is racial variation in use of root canal therapy versus tooth extraction across different levels of dental insurance coverage and adjusting for other factors known to influence treatment decisions. METHODS: Within 3 different categories of insurance coverage, we examined whether there were racial differences in the provision of the tooth-sparing treatment of root canal therapy (vs. tooth extraction) among 54,423 users of outpatient Veterans Affairs dental care in 1998. Regression analyses adjusted for the severity of tooth- and gum-related disease, age, sex, medical and psychiatric comorbidities, prior use of preventive dental services, tooth extraction and root canal therapy, and clustering by geographic region. RESULTS: In the adjusted regression models, black patients and those with unknown race were less likely overall to receive root canal therapy than whites, whereas Asians were more likely. Among patients with eligibility for continuing and comprehensive dental care, blacks were less likely and Asians more likely to receive root canals than whites. For patients covered only for emergency dental care, Hispanics had a higher likelihood of receiving root canal therapy. Among all other types of coverage, there were no significant racial differences in the care received. CONCLUSION: We observed substantial racial variations in the provision of root canal therapy among patients treated in Department of Veterans Affairs dental clinics. Future research should identify the causes of such variations.

Black or African American↗
PubMed2003

Laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema.

BACKGROUND: Recurrent angioedema is the hallmark of various inherited or acquired angioedema diseases. Hereditary angioedema, or HAE, due to C1 inhibitor, or C1NH, deficiency has considerable implications for dental health care providers because dental surgery may trigger distressing and even life-threatening episodes. CASE DESCRIPTION: The authors reviewed the literature, focusing on the pathogenesis, clinical signs and treatment of HAE. They also provided case reports of four patients who died from laryngeal edema induced by tooth extraction. In patients with HAE, dental surgery--including tooth extraction--may be followed by self-limiting edema episodes, including lip swelling, facial swelling, tongue edema and laryngeal edema with upper airway obstruction. Preoperative prophylaxis has been performed with attenuated androgens, fresh frozen plasma, C1NH concentrate and antifibrinolytics. The four patients described underwent tooth extraction, which, after a symptom-free latency of four to 30 hours, provoked laryngeal edema. Three of the patients died of asphyxiation the night after surgery, and the fourth died on the second night. In three of the patients, laryngeal edema had not occurred previously. CLINICAL IMPLICATIONS: Before undergoing dental surgery, patients with a history of recurrent angioedema should be evaluated for C1NH deficiency. If it is present, they are at risk of developing life-threatening laryngeal edema.

Adult↗
PubMed2003

Use of third molar transplantation for closure of the oroantral communication after tooth extraction: a report of 2 cases.

OBJECTIVE: This clinical report introduces a promising and unique method for the immediate closure of the oroantral communication (OAC) after tooth extraction: the use of the transplanted third molar with closed apices. STUDY DESIGN: In 2 adult patients, OAC caused by the extraction of an upper molar was immediately closed by using a transplanted third molar with complete root formation. After tooth extraction at the recipient site, OAC with perforated mucosa of the sinus floor was confirmed and the donor third molar was transferred to the prepared recipient socket. Endodontic therapy of the transplanted third molar began at 3 weeks after surgery, and prosthetic treatment was completed at 5 months after the operation. These 2 patients were carefully observed both clinically and radiographically. RESULTS: Closure of the OAC was successfully performed, and the transplanted teeth became fixed with the passage of time in these 2 patients. Root resorption did not occur, and good functional results were obtained without any complications. CONCLUSIONS: Tooth transplantation of a mature third molar for closure of the OAC is a simple and excellent method because the transplanted tooth not only closes the communication to the maxillary sinus, but it also satisfactorily functions at the recipient site during mastication, even in adult patients.

Adult↗