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PubMed1992

Correlation of magnetic resonance image and histology of human teeth.

Current methods for diagnosis of pulpal pathosis are often inadequate and there is a need for an in vivo method to visualize dental pulp tissue. This report compares micromagnetic resonance imaging (MMRI) with routine H & E histology on a cross sectional view of a molar tooth. The extracted tooth was imaged with a Bruker AM-400 NMR spectrometer modified with a microimaging accessory. The tooth was then decalcified and sectioned at the same level as the MMR image. Image intensity readings were acquired for specific areas of the pulp chamber for comparison with histology. The results demonstrate that there is a close correlation between the MMRI and the low power H & E appearance of pulp tissue.

Dental Pulp↗
PubMed2004

The first picture of a dental forceps in a printed book.

Niccolo Leonico Tomeo authored numerous volumes on a variety of themes, and was principally responsible for reintroducing the works of Aristotle in the original Greek. In one of Tomeo's works, he included a picture of forceps holding an extracted tooth. This was the first time a forceps was pictured in a printed book.

Dental Instruments↗
PubMed2004

Microbiological basis of oral infections and sensitivity to antibiotics.

Because oral infections are common, the physician must understand the underlying etiology, pathogeny, and other variables that determine how these processes evolve in order to choose the most appropriate antibiotic drug. The special characteristics of the oral cavity determine the make-up of the microflora that lives there. Different anaerobic species belonging to the Peptostreptococcus, Prevotella, Fusobacterium, Gemella, and Porphyromonas genera are of particular interest, as are the aerobic species Streptococcus, Staphylococcus, and Corynebacterium. Each of these microorganisms occupies a different microniche within the oral cavity, and the prevailing balance is upset when conditions become modified as a result of illness or due to dental interventions such as tooth extraction or tooth scaling and polishing. Pathogenic or opportunistic bacteria (Actinomyces, Prevotella intermedia species, etc.) can develop in these conditions, as can yeasts (Candida sp., Histoplasma capsulatum), virus (herpes simplex, papilomavirus), and parasites (Entamoeba gingivalis, Trichomonas tenax). When infection occurs, the patients s immune system reacts by means of inborn immunity (non-specific) and acquired immunity (specific). Empirical treatment is administered that should be based on etiological data and on the antimicrobial sensitivity of the pathogen that is causing the infection. However, oral microflora sensitivity to different antibiotics is currently declining and there is a noticeable trend towards resistances. As a consequence of all this, the treatment of oral infections must also aim to restore the ecological balance of the oral cavity and to minimize the emergence of resistance in the microorganisms present in the mouth. Hence, epidemiological oral pathogen sensitivity studies must be conducted, fostering the administration of appropriate antibiotics at proper doses and keeping specialists abreast of the latest trends. In recent decades, oral infections comprise one of the most common pathologies in the general population, due in large part to infectious complications associated with poor oral hygiene. This in turn, translates into an increased need and demand for dental care, while at the same time, it requires that the professional accurately understand the etiological factors involved, as well as the pathogeny and different variables that determine the specificity of these kinds of infections, so as to be able to choose the appropriate antimicrobial drugs for proper treatment.

Anti-Bacterial Agents↗
PubMed1989

[The state of the recall visit at the pediatric dentistry clinic of Nagasaki University Dental Hospital].

The purpose of this study is to discover the actual condition and the state of the recall visit of the patients who appeared at the Pediatric Dentistry Clinic of Nagasaki University Dental Hospital, and to compare the results of 1987 and 1985. Concerning the making of appointments for the recall visit, we sent cards to patients in 1987 though, in 1985 we did not send cards to the patients so the patients themselves had to make a telephone call to arrange an appointment. The results were as follows: 1) The rate of the patients who were making their first time recall visit increased by means of sending cards to patients. 2) Of the total number of 493 patients who appeared at our clinic in 1985, 127 (25.8%) did not finish their dental treatment and stopped visiting our clinic for treatment. 3) The rate of the patients who finished their dental treatment and were making the first time recall visit was 69.9% in 1987. 4) The average ages of the patients were 6 years 5 months in 1987 and 5 years 6 months in 1985. The lower the age of patients, the higher the rate of the recall visits, while the rate of pre-school children was higher than that of school children. 5) The rate of the patients who finished their dental treatment and made recall visits was higher in cases in which the chief complaints of the first visit were caries prevention (86.2%) and caries treatment (71.3%) than the cases of tooth extraction (50%), tooth shape anomalies (50%) and tooth pain (50.5%). 6) There was no significant difference in the number of caries decayed teeth at the first oral examination between the group of patients making their first recall visit and the group of patients rejecting a recall visit. 7) In the case of the patients to whom space retainers and orthodontic appliances were applied, the rate of making recall visits decreased more in 1987 than that of 1985. 8) There was no difference in the rate of those making their first time recall visit between the two categories of diseased children and nondiseased children.

Appointments and Schedules↗
PubMed1989

Tooth loss in a selected population in Saskatoon.

Tooth mortality in a population can provide information about the prevalence of dental disease, availability of dental care and attitudes about tooth extraction. The tooth mortality of patients presenting for treatment at the University Dental Clinic (Saskatoon, Canada) during the school terms 1981-1986 was determined to provide base-line data during a time when the dentist-to-population ratio has been increasing, and to compare the results with similar studies carried out in Britain and Greece. The data were analyzed according to the same quinquennial age groups as in the other studies. There were no statistically significant differences between the two time periods at all ages and therefore the data were pooled. Totally edentulous persons were excluded from the analysis for comparison purposes. The prevalence of tooth loss increased with age with a rapid period of tooth loss encompassing the mean ages of 34 to 47 years, a slowing of further loss up to the mean age of 62 and thereafter, a further increase. The initial rapid loss was most apparent for molar teeth and least apparent for mandibular incisor teeth. With the exception of first molars, more teeth were lost in the maxilla than in the mandible. The present data are similar to the findings reported in British and Greek studies.

Adolescent↗
PubMed2006

Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installation.

OBJECTIVE: To determine whether the reduction of the alveolar ridge that occurs following tooth extraction and implant placement is influenced by the size of the hard tissue walls of the socket. MATERIAL AND METHODS: Six beagle dogs were used. The third premolar and first molar in both quadrants of the mandible were used. Mucoperiostal flaps were elevated and the distal roots were removed. Implants were installed in the fresh extraction socket in one side of the mandible. The flaps were replaced to allow a semi-submerged healing. The procedure was repeated in the contra later side of the mandible after 2 months. The animals were sacrificed 1 month after the final implant installation. The mandibles were dissected, and each implant site was removed and processed for ground sectioning. RESULTS: Marked hard tissue alterations occurred during healing following tooth extraction and implant installation in the socket. The marginal gap that was present between the implant and the walls of the socket at implantation disappeared as a result of bone fill and resorption of the bone crest. The modeling in the marginal defect region was accompanied by marked attenuation of the dimensions of both the delicate buccal and the wider lingual bone wall. Bone loss at molar sites was more pronounced than at the premolar locations. CONCLUSION: Implant placement failed to preserve the hard tissue dimension of the ridge following tooth extraction. The buccal as well as the lingual bone walls were resorbed. At the buccal aspect, this resulted in some marginal loss of osseointegration.

Alveolar Bone Loss↗
PubMed1990

Bacteremia in children following dental extraction.

The incidence and intensity of bacteremia following tooth extraction in children were measured by blood culture. The effects on bacteremia of the number and type of teeth extracted, oral hygiene, gingival health, presence of abscess, and antibiotic prophylaxis were assessed. Antibiotic prophylaxis reduced the incidence of bacteremia from 63% to 35%. The intensity of bacteremia was 2 cfu/mL of blood or less in 80% of the children. An agar pour-plate method of blood culture was significantly more effective than broth in culturing the small volumes of inoculum. Of 83 bacterial strains characterized, 39 were strict anaerobes or micro-aerophilic, and the remainder mainly streptococci. S. mitior and S. sanguis were most commonly isolated, often in pure culture, and were generally sensitive to antibiotics. No direct association was demonstrated between the plaque and gingival indices and incidence of bacteremia or between the number of teeth extracted and the incidence or intensity of bacteremia. It is concluded that all children at risk from infective endocarditis require antibiotic prophylaxis prior to tooth extraction, since it is impossible for the likelihood or intensity of transient bacteremia to be clinically predicted.

Adolescent↗
PubMed1989

[Osteoradionecrosis. I. Etiology, pathogenesis, clinical aspects and risk factors].

In curative therapy of mouth-cavity and oropharyngeal carcinomas the osteoradionecrosis has to be accepted as a calculated risk with an incidence of 4-35%. It is the question of a radio-caused bone death that comes about by progressive and irreversible morphological alterations at bones and at vessels: Loss of osteocytes, active osteoblasts and osteoclasts (hypocellularity), injury of normal bone metabolism, slackening of regeneration process, extreme susceptibility to infections of the devitalized bone, radio-induced obliterating endarteritis with hyalinization, thrombosis and fibrosing of vessels, obliteration of the lumen and gradual reduction of blood-supply at the level of tissue (hypovascularity and hypoxemia: Aseptic osteoradionecrosis, radio-osteonecrosis). If there is a secondary infection of dental, periodontal or traumatic origin additionally, the condition explodes as septic osteoradionecrosis with the symptoms and findings of radio-osteomyelitis. The osteoradionecrosis begins more frequently in the mandibula than in the maxilla. The cumulative incidence is 30% after 6, 60% after 12, and more than 80% after 24 months. The duration of osteoradionecrosis follows an exponential curve with constant probability of necrosis termination at any moment after necrosis event in which the monthly probability of necrosis healing is nearly 0.06. Risk factors for formation of an osteoradionecrosis are tumor neighbourhood to bones and teeth, tumor and mandibula dosis, tumor stage, irradiation technique, status of teeth as well as moment and carrying out of tooth extractions. Tumors in neighbourhood of mandibula have a fivefold higher risk, with 80 Gy irradiated patients a 2.9-fold and toothed patients a 2.6-fold, altogether high-risk patients have a 17.7-fold higher necrosis risk than low-risk patients. Promoting factors are caries, parodontosis, a periapical pathology, a trauma, irritation by artificial teeth, elective tooth extraction before irradiation, tooth extraction after irradiation as well as jaw operations because of remains or recurrence of the tumor.

Humans↗
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↗
PubMed2005

Influence of premolar extractions on tooth size discrepancy. part one: analysis of Bolton index.

The purpose of this study is to determine the influence on four premolar extractions for upper and lower anterior tooth size discrepancy (for total Bolton index (TBI=Overall ratio) and for Bolton value (BV)) and to find out the differences of four first and second premolar extractions tooth size discrepancies (TSD). 148 pretreatment dental casts have been examined. It has been determined that upper teeth of 93 patients suited lower teeth sizes (normal TBI - 91.3%+/-1.91), 27 patients had upper teeth wider than lower ones (low TBI<89.39%) and 28 patients had wider teeth in lower jaw (high TBI>93.21%). In this study the influence of four hypothetical first and second premolar extractions (1. all first premolars, 2. all second premolars, 3. upper first and lower second premolars, 4. upper second and lower first premolars) on TSD frequency appearance and size has been estimated. After performing the analysis it was estimated that in normal Bolton index group TSD is more frequent, when four first premolars are extracted (p<0.05 after comparing with extraction of four second premolars). When TBI is high, in all four hypothetical teeth extraction variations TBI remain increased, which determine 100% TSD. In low TBI group TSD is more usual when four-second premolars are extracted (p<0.01, after comparing with teeth extractions using 1-st or 3-rd method).

Bicuspid↗
PubMed1996

Survey of reasons for extraction of permanent teeth in Italy.

The purpose of the study is to collect information on the reasons given by dentists, randomly selected from the Italian Dental and Maxillo-Facial Association's, for extracting permanent teeth in Italy. From the 164 dentists responding, 1056 teeth in 839 patients were extracted during two weeks of working activity. More than two-thirds of the teeth were extracted for dental caries (34.4%) and periodontal disease (33.1%). The mean number of teeth extracted per patient showed a significant increasing trend with increasing age, being 1.09 in those from 16 to 39 yr, 1.25 in the 40-59-yr-old group, to 1.54 in those over 59 yr of age (F = 21.44; P < 0.0001). The third molar was the most frequently extracted tooth and 41.3% were removed due to impaction reasons, in particular from the mandible. The first and second molars and the premolars were extracted most often because of caries; more than half of the incisors and the canines were extracted for periodontal reasons; the majority of the teeth removed for prosthetic reasons, 57.1%, were incisors and canines, especially in the mandible; of the teeth extracted for orthodontic reasons, 47.4% were first and second premolars. The prevalence of subjects with at least one tooth extracted for dental caries and for orthodontic reasons were respectively significantly higher in the irregular than the regular attenders (chi-square = 46.55; P < 0.0001), and in the regular than the irregular dental attenders (chi-square = 63.12; P < 0.0001). Dental practitioners should promote targeted initiatives for prevention and treatment of diseases in order to reduce in particular the incidence of tooth extraction because of caries and periodontal disease.

Adolescent↗
PubMed2000

Immediate and delayed implant placement into extraction sockets: a 5-year report.

BACKGROUND: As a complement to the earlier reported 3-year results from a prospective multicenter study of immediate and delayed placement of implants into fresh extraction sockets, the 5-year results are reported. PURPOSE: The purpose of this 5-year report was to evaluate the immediate and long-term success of implants placed into fresh extraction sockets, with respect to implant size and type, bone quality and quantity, implant position, initial socket depth, and reason for tooth extraction. MATERIALS AND METHODS: This paper presents the 5-year results of the original 12 centers that participated with 143 consecutively included patients. A total of 264 implants were placed either immediately after tooth extraction or after a short soft-tissue healing time (3-5 weeks). The patients were divided into five subgroups, depending on the type of insertion method used. RESULTS: The outcome demonstrated that the cumulative implant survival rate after 5 years of loading has not changed and remains 92.4% in the maxilla and 94.7% in the mandible. No difference in failure rates can be seen between the groups when relating the failures to insertion method. CONCLUSION: This prospective study demonstrated that placing Brånemark implants into fresh extraction sites can be successful over a period of 5 years of loading. One of the outcomes of the study shows that there is a clinical correlation between implant failure and periodontitis as a reason for tooth extraction, even if it is difficult to give it a casual association. It can be hypothesized that periodontitis affected tissues might have a negative local influence because of the presence of infrabony defects that could possibly increase the gap between bone and implant or jeopardize achievement of primary stability.

Bone Density↗
PubMed2000

Suppression of cardiac sympathetic nervous system during dental surgery in hypertensive patients.

We determined the changes in blood pressure, pulse rate, and heart rate variability during dental surgery in hypertensive patients. The study included 18 essential hypertensives and 18 age and sex matched normotensive controls who underwent tooth extraction at our hospital. Holter electrocardiographic monitoring was used to determine the power spectrum of R-R variability before and during dental surgery. The low frequency (LF: 0.041 to 0.140 Hz), high frequency (HF: 0.140 to 0.500 Hz), and total spectral powers (TF: 0.000 to 4.000 Hz) were calculated, and the ratio of LF to HF and the percentage of HF relative to TF (%HF: HF/TF x 100) were used as indexes of sympathetic and parasympathetic activities, respectively. The baseline blood pressure for hypertensive patients (149 +/- 4/85 +/- 2 mmHg) was significantly higher than that for normotensive patients (119 +/- 3/71 +/- 2 mmHg). The baseline pulse rates were similar between the two groups. Blood pressure increased during tooth extraction in both groups; however, changes in blood pressure did not differ between them. Administration of local anesthetic significantly decreased the %HF in normotensive patients (before vs. after anesthesia; 22.3 +/- 2.4 vs. 13.8 +/- 2.7%, p < 0.05). In contrast, the LF/HF significantly decreased during the local anesthesia and tooth extraction in hypertensive patients. These results suggest that pressor response induced by tooth extraction did not differ between normotensive and hypertensive patients, and that suppression of the cardiac sympathetic nervous system during dental surgery might attenuate the pressor response in patients with hypertension.

Adult↗
PubMed2006

Predictable periimplant gingival esthetics: use of the natural tooth as a provisional following implant placement.

UNLABELLED: Maintaining the interdental papilla and bone height following implant placement has been a challenge for the restorative dentist. Bone resorption following anterior tooth extraction is common and often compromises the esthetics of the final restoration. The tissue must be maintained during the surgical and healing phases to achieve an esthetic outcome. Using the patient's natural tooth as a provisional can help maintain the volume and support the papilla. This article describes a technique to achieve maximum esthetics and preservation of tissue following tooth extraction and implant placement. CLINICAL SIGNIFICANCE: By using the patient's extracted natural tooth, the tissue should maintain itself with minimal recession. This will allow for a more esthetic outcome.

Dental Abutments↗
PubMed2005

Extraction environment enhancement: critical evaluation of early socket healing in long-term barrier-protected extraction sockets.

Resorption and remodeling of the alveolar bone occurs after periodontal disease, trauma, or tooth extraction. Loss of the functional apparatus can have a deleterious effect on the ability to place endosseous root-form implants into prosthetically ideal locations. As a result, there has been a trend toward socket preservation at the time of extraction. However, there has been limited investigation with histologic verification of results on types of materials used to preserve or augment extraction sockets. Minimizing bone loss after extractions enables an implant to be placed in an ideal orientation surrounded by bone, thereby increasing the longevity of the implant and associated prosthesis. The case reports presented detail clinical and histological results during the 3 to 6 months after a bone maintenance procedure that used a nonexpanded polytetrafluoroethylene barrier placed over an extraction socket with no graft material at the time of tooth extraction.

Alveolar Bone Loss↗
PubMedDate not supplied

The burned hemophiliac.

Reports of the care of burned hemophiliac patients requiring cutaneous autografting are rare. A 28-year-old white male with classic hemophilia A sustained a 30.5% total body surface area burn. The patient received standard topical antimicrobial therapy and the majority of his burn wound healed. While undergoing therapy, multiple tooth extractions were recommended. On postburn day 25 the patient underwent multiple tooth extractions plus excision and grafting of his unhealed burn after preoperative infusion of cryoprecipitate. Despite a maximum factor VIII concentration of only 23%, no remarkable bleeding occurred from the excision sites, the skin graft donor site, or the tooth extraction wounds. Preoperative infusion of cryoprecipitate does not appear to be required for split-thickness skin graft harvest or excision of burns within the dermis.

Adult↗