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PubMed1979

Changes in bone mass in rat mandibles after tooth extraction.

An experimental study concerning changes in bone mass in trabecular bone of mandibles on rats after extractions of upper molars has been carried out. The material consisted of 32 SPF Wistar rats, fed on Nafag-184 only. Experimental and control groups consisted of eight females and eight males, each group having same average weight with respect to sex at the age of 16 weeks. At this age the upper right molars were extracted on all rats in the experimental group. The rats were sacrificed after 16 weeks. Identical increase in weight within each sex group was found. Microradiograms of two buccal-lingual 100-mu-thick ground sections at a distance of 0.5 mm through the first molar in each side of the mandible were used. Quantitation of bone mass (bone area in percent) of a trabecular bone was done by electronic point counting. No significant difference in bone mass was found between left and right sides in the control group (P greater than 0.50), whereas a significant difference was found between left and right sides in the experimental group (P approximately 0.0001) with lowest mean value in right sides. Conclusively the analysis shows that local reduction in bite force causes osteoporotic changes in trabecular bone of the jaw.

Animals↗
PubMed1993

Cost evaluation of two methods of post tooth extraction hemostasis in patients on anticoagulant therapy.

The classical management of patients on oral anticoagulant therapy included hospitalisation, cessation of the anticoagulant agent, and extraction of teeth when the prothrombine levels rise. This method was substituted in the High Risk Dental Clinic at Barzilai Medical Center in Ashkelon by use of a tissue sealant (Tisseel) which does not need hospitalisation nor cessation of the anticoagulant therapy. In comparing the last 23 sessions employing the former method to the first 23 sessions using the new method there were significant differences in the cost effectiveness for the health system, provider, insurer and patient. Despite the fact that from the health system point of view the new method is much more cost effective, there is no financial incentive for the provider (hospital) nor awareness on the part of the insurer (General Sick Fund) to embrace it and 'market' it.

Ambulatory Care↗
PubMed1981

Short - term effects of occlusal hypofunction following antagonist tooth extraction upon periodontal tissues in the rat.

This histological study was designed to observe the early effects of occlusal hypofunction on periodontal tissues. Eighteen Wistar rats were used. Hypofunction was induced by extracting the right maxillary molars. Histological observations were reported on the right lower jaws which were embedded in methyl-metacrylate, sectioned at 4 micrometer without decalcification and stained with toluidine blue. The periodontal ligament disorganization began after 2 days and continued until 16 days. The outstanding observation was a considerable increase in bone formation, which was responsible for ligament narrowing as no change in cementoblastic activity was observed. At the top of the interradicular septa, the osteoblastic proliferation began at 24 hours, and bone mineralization increased until 4 days creating osteophytic bone, and then decreased. On the modelling sides of the sockets, a great amount of osteoid tissue deposited by osteoblasts set around large vessels was present at 4 days, and mineralization extended between 4 and 8 days. On the remodelling sides, bone formation extended at 4 days and osteoclastic resorption fell of except along oblique roots sockets; then the remodelling sides returned to nearly normal aspect at 16 days. The biological significance and clinical implications of these findings are discussed.

Animals↗
PubMed1996

The use of general anaesthesia for tooth extraction in young handicapped adults in France.

The anaesthetic management of handicapped young adults is often difficult. However, few examples were found in the literature that attempted to specifically measure the frequency of general anaesthesia in the dental treatment of this group of patients. This paper focuses on the management of mentally or physically handicapped young patients undergoing extractions at a specialist dental service in Southern France. A survey of 184 young patients treated during a 39-month period, either under general (34 cases) or local (150 cases) anaesthesia was carried out. A minimum one-year follow-up period was used for each patient. The main characteristics of the patients who received general or local anaesthesia were compared and the factors which indicated the choice of general rather than local anaesthesia were assessed. This study attempts to define precise selection criteria, including dental and non-dental factors. Limited past treatment history was found to be a strong indicator of the need for general anaesthesia. The results of this study suggest that non-dental background factors were also important. The need for general anaesthesia was markedly increased in the groups with severe behavioural disturbances or low levels of contact with the general dental practitioner. If provision of regular dental services for disabled young patients can significantly reduce the need for general anaesthesia, care will have to be taken in developing the relationships between the hospital and general dental practitioner.

Adult↗
PubMed2001

[Forensic evaluation of injuries to nerves and jaw bone after wisdom tooth extraction from the viewpoint of current jurisprudence].

The removal of lower wisdom teeth is one of the most frequent operations in oral surgery. Iatrogenic lesions of the lingual and inferior alveolar nerve and fractures of the lower jaw are rare, but can lead to actions for damage and compensation for personal suffering. The aim of our investigation was to elaborate recommendations for the oral surgeon from the legal point of view. Therefore we investigated in two data banks all court decisions concerning wisdom teeth and analysed them in regard to the obligation to provide information, documentation and the minimum requirements of the surgical treatment. In 57% of all court decisions the obligation to provide information was omitted by the surgeon. Surprisingly, regarding injuries of the lingual nerve we found different opinions from various law courts. In some former decisions only the fact of the damage was equivalent to a lack of care, while recently other courts had the opinion that an injury of the lingual nerve could also be caused in spite of careful treatment. With regard to lower jaw fracture all courts emphasized that the patient must be informed about the risk by the surgeon. Moreover, minimum requirements for the removal of wisdom teeth were given. In conclusion, the recent court decisions restrict the liability for complications but demand the observance of minimum requirements for the surgical treatment. Additionally, all courts stress that informed consent about the risk of nerve damage of jaw fracture must be obtained before the removal of wisdom teeth.

Germany↗
PubMed2002

[Wound healing after surgical wisdom tooth extraction. Evidence-based analysis].

BACKGROUND: The purpose of this article was to conduct a review of current evidence focusing on parameters influencing wound healing after removal of mandibular third molars. SELECTION OF PUBLICATIONS: For selection of publications, methods of evidence-based dentistry were used. Systematic selection of studies included in this review was performed after search of publications by electronic databases (MEDLINE) concentrating on five keywords ("third molar" or "wisdom teeth" and "evidence," "wound healing," and "incision," respectively) published within the last 15 years. Of the 126 articles found, 56 were included regarding contents and after formal evaluation and 29 after narrative search. WOUND HEALING: Parameters for the evaluation of the course of wound healing after mandibular third molar removal were postoperative pain (32% of publications), swelling (28%), trismus (18%), and sensory disturbances (13%). The peak of incidences of alveolar ostitis (0.3-35%) and wound infections (1-16.7%) correlated with the age group between 25 and 35 years. The incidence of sensory disturbances (transient disturbances of the inferior alveolar nerve 0.4-0.6% and lingual nerve 0.06-11.5%, permanent disturbances 0.2-1%) was found to be increased above the age of 25 years. PREDICTORS: Age, duration of operation, primary or secondary wound closure, retention or impaction type, and pathoses associated with the third molar were identified as evident predictors for the postoperative course. Due to the higher incidence of postoperative complications above the age of 25 years, third molars should be removed before this age if indicated. Evidence status of the conclusions drawn varies due to the different quality of studies included, sample sizes, and statistical methods.

Evidence-Based Medicine↗
PubMed1998

Pharmacokinetics and the pharmacodynamic action of midazolam in young and elderly patients undergoing tooth extraction.

OBJECTIVE: To determine whether age-dependent pharmacokinetic and pharmacodynamic alterations account for a more pronounced response to benzodiazepines among elderly patients. METHODS: Twelve young patients and 10 elderly patients received an intravenous dose of 0.05 or 0.03 mg/kg midazolan, respectively, before third molar extraction. Postoperative pain was treated with 30 mg dihydrocodeine. Serum concentrations of midazolam and sedative effects were monitored with visual analog scales and choice reaction time measurements for 6 hours. Test values above baseline were integrated, and pharmacokinetic-pharmacodynamic analysis was performed. Heart rate, blood pressure, arterial oxygen saturation, and amnesia also were assessed. RESULTS: There were no significant age-dependent differences in disposition of midazolam between young and elderly patients (apparent volume of distribution, 1.3 +/- 0.2 versus 1.1 +/- 0.4 L/kg; halflife, 3.3 +/- 1.5 hours versus 3.7 +/- 2.2 hours; total body clearance, 451 +/- 186 ml/min versus 343 +/- 137 ml/min). However, higher values of area under the effect curve (AUEC) and AUEC divided by area under the serum concentration-time curve (AUC) (sensitivity index) were observed among the elderly as follows: AUEC for reaction time (AUECRT) (573 versus 261; p = 0.042), AUEC for visual analog scale (AUECVAS) (37.7 versus 14.4; p = 0.011), AUECRT/AUC (6.3 versus 1.8; p = 0.007), and AUECVAS/AUC (0.40 versus 0.11; p = 0.009) compared with the young group. Likewise, mean concentration at half-maximal effect for sedation was lower (p = 0.025) among older patients (20.5 +/- 2.2 ng/ml) than among younger (29.7 +/- 6.6 ng/ml) patients. Amnesia was observed among 86% of patients and oxygen saturation was always 95% or more of basal value. There were no age-related differences in concentration of dihydrocodeine and its active metabolite dihydromorphine, but dihydromorphone levels were much lower in there intermediate metabolizers (455 to 879 fmol/l) and especially in five poor metabolizers (65 to 498 fmol/L) than among extensive metabolizer of cytochrome p450 2D6 (1604 to 6490 fmol/L). CONCLUSION: Elderly patients are more sensitive to the sedative action of midazolam than young patients, and the sensitivity is caused by age-dependent pharmacodynamic alterations. The age-adjusted doses used are both effective (for sedative amnesia) and safe (in terms of arterial oxygen saturation, heart rate, and blood pressure.

Adolescent↗
PubMedDate not supplied

[Subcutaneous emphysema as a complication of tooth extraction].

Subcutaneous emphysema is a rare complication in dentistry, which may lead to diagnostic errors and inadequate therapy. A 17 year old female patient, in whom the separation of tooth roots was performed by the use of air-powered drill during the extraction of the first right lower molar, is presented in this paper. During the intervention, swelling of the right half of the face and the lower eyelid suddenly occurred, accompanied with simultaneous feeling of choking, and pressure in the neck and chest. Because of the suspicion of the allergic reaction, the patient was administered antihistaminic agent, together with parenteral corticosteroid, and was sent to an institution where she was treated as an in-patient. During hospitalization, subcutaneous emphysema of the face and neck was diagnosed by physical and x-ray examination. The emphysema completely disappeared after the use of oxygen and antibiotics.

Adolescent↗
PubMed1985

Alveolar wound healing and ridge remodeling after tooth extraction in the rat: a histologic, radiographic, and histometric study.

Healing of extraction wounds in rats was analyzed by histologic, radiographic and histometric methods at 0, 7, 14, 30, 60 days after tooth removal. Total alveolar volume, volume density of bone, percentage of bone formation, bone resorption areas, and height of both vestibular and lingual crests were analyzed. Total alveolar bone volume and bone density in the apical third increased from 0 to 60 days. Maximum bone formation was observed at 14 days, whereas the greatest bone resorption was observed seven days after extraction. The height of the lingual crest was lowest 14 days postextraction and then increased progressively to day 60.

Alveolar Process↗
PubMed1992

Missing primary teeth due to tooth bud extraction in a remote village in Tanzania.

The practice by traditional healers of extracting tooth buds as a cure for diarrhoea and fevers in children has existed in Tanzania for many years, but its extent is not known. This paper reports on the prevalence of missing primary teeth due to this practice among children living in Manghweta, a remote village in Tanzania. All children (n = 262) aged 5 years and below were examined for missing primary teeth. Only cases in which mothers confirmed that tooth bud extraction had been performed were recorded. Tooth buds had been extracted from 37.4% of the children. The majority of extractions (60.5%) were from the lower jaw, and almost all (99.4%) were canines. Tooth bud extraction was always bilateral. It is concluded that the practice of extracting tooth buds as a cure for diarrhoea and fevers in children still exists in Tanzania.

Child, Preschool↗
PubMed1997

Surgical management of a labially placed permanent maxillary central incisor after supernumerary tooth extraction: report of a case.

A case of a 12-year old-boy having a chief complaint of labially placed maxillary central incisor is presented. Radiographic evaluation revealed the presence of a supernumerary tooth impeding the eruption of the left permanent central incisor. The mesiodens was surgically removed and the permanent central incisor was positioned and splinted into proper alignment.

Child↗
PubMed1997

Tooth bud extraction and rubbing of herbs by traditional healers in Tanzania: prevalence, and sociological and environmental factors influencing the practices.

The practice by traditional healers in Tanzania of extracting tooth buds or of rubbing herbs on to the gingivae of young children to cure fevers and diarrhoea has been known for many years. The aim of this study was to determine the prevalence of these practices in different regions of Tanzania and to identify sociological and environmental factors influencing belief in their efficacy. A total of 1052 children were examined for missing primary teeth, or scars or wounds on the gingivae, resulting from tooth bud extraction. In addition, 268 parents of children who had received treatment from a traditional healer were interviewed to identify factors that led them to go to a traditional healer. The prevalence of tooth bud extraction in villages in which tooth bud extraction was first reported in the early 1980s was 0.5%, and in villages in which the practice was only recently reported it was 60%; the prevalence of rubbing herbs was 32% and 0.4%, respectively. Persistent fevers and diarrhoea were the major symptoms which led parents to go to a traditional healer. However, 60% of the parents had taken their child to a hospital before going to a healer; 72% of these had attended at least three times but only 5.5% reported that the treatment given in the hospital cured the condition. It is recommended that intensive health education on the causes, treatment and prevention of fevers and diarrhoea should be instituted, in conjunction with effective management of these conditions in hospital facilities.

Age Factors↗
PubMed2005

[Combined use of local anesthetic with clonidine in cases of tooth extraction].

The technique of local anesthesia by lidocain in combination with clonidine (clofelinum) as vasoconstrictor in the dose of 1 microg/kg was compared with local anesthesia by novocain in combination with adrenaline (1:200 000) or by lidocain without vasoconstrictor or by articain in combination with adrenaline (0.012 mg/ml). Lidocain use led to expressed tachycardia and considerable increase of cardiac oufput in moderate hypertension reactions. Adrenaline addition in anesthetic solution increases general peripheral resistance and all parameters of arterial pressure with simultaneous rise of heart contractions. Adrenaline substitution as local vasoconstrictor for clofelinum decreases sympathetic tension during operation, prevents hypertensive reactions as the result of general peripheral resistance decrease, stabilizes heart rhythm and basic indices of central hemodynamics, that testifies to its (technique) adequacy.

Adrenergic alpha-Agonists↗
PubMed1993

Differences two years after tooth extraction in mandibular bone reduction in patients treated with immediate overdentures or with immediate complete dentures.

In a randomized controlled clinical trial, 74 patients who required immediate dentures were randomly treated with immediate overdentures on two lower canines or with immediate complete dentures. Mandibular bone reduction was measured by use of oblique lateral cephalometric radiographs made at baseline and the results compared with those of one year and two years after denture treatment. Analysis of the data showed that the average bone reduction in the lower canine regions in the first year was 0.9 mm in the immediate-overdenture group and 1.8 mm in the immediate complete-denture group. In the posterior parts of the mandible, the bone reductions were, respectively, 0.7 mm and 1.9 mm. The differences were statistically significant in all measured regions. During the second year, no significant differences in bone reduction were found. The sums of differences in the first two years were significant in all regions except the molar region, preserving the initial difference. Retention of roots of canines beneath a mandibular denture in immediate denture patients, even when they were in poor condition, reduced the collapse of the alveolar processes in all regions of the mandible.

Alveolar Bone Loss↗
PubMed1975

[Orthodontic therapy by tooth extraction--indication and prognosis].

From 1000 current orthodontic treatments, a percentage of 23.3 (233 patients) was selected for extraction therapy. The indication and the prognosis were analysed from various viewpoints to deduce suggestions for the application in practice. The advantages described and the possibilities of use meet the demands on efficient orthodontic therapy.

Adult↗