[Hard-to-extract teeth. (2) Management of the wound and extraction of the tooth root and radices relictae].
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Humans↗
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Properties of dissociatively extracted fetal tooth matrix proteins. I. Principal molecular species in developing bovine enamel.
A sequential dissociative extraction scheme is described in which tooth matrix proteins are extracted first in 4 M guanidine HCl, pH 7.4, and then in 4 M guanidine HCl, 0.5 M EDTA, pH 7.4, both with protease inhibitors present. The latter step dissolves the mineralized portion of the tissue and extracts noncollagenous proteins closely associated with hydroxyapatite crystallites in the mineralized matrix. In fetal bovine enamel, the initial dissociative extraction step completely removes proline-rich amelogenins from the tissue without dissolving the enamel apatite. The amelogenin proteins consist of several species on polyacrylamide gel electrophoresis with sodium dodecyl sulfate, but display anomalous migration behavior relative to conventional marker proteins in this technique. Subsequent extraction of fetal bovine enamel with guanidine HCl/EDTA removes matrix enamelins, acidic glycoproteins that are tightly bound to the enamel hydroxyapatite. This latter fetal protein type has not been isolated previously. The enamelins are adsorbed strongly by DEAE-cellulose in 7 M urea and totally adsorb to synthetic apatite, even in 4 M guanidine HCl. The enamelins display normal behavior on polyacrylamide gels and stain positively for sialic acid/phosphate and carbohydrate. With advancing tooth maturation, amelogenins disappear while enamelins are conserved. Gel filtration chromatography in 4 M guanidine HCl showed amelogenin components at apparent molecular weights of approximately 25,000, 15,000, 9,500, 7,500, and 6,000, while the enamelins eluted at Mr positions of approximately 72,000, 56,000, 42,000, 30,000, 21,000, 13,000, and 8,000. The gel filtration data showed a clear shift in molecular size population from higher to lower components for both amelogenins and enamelins with progressive enamel maturation.
Amino Acids↗
[Association between primary dental care and municipal socioeconomic indicators].
OBJECTIVE: To test associations between primary dental care indicators and municipal socioeconomic and dental service provision indicators. METHODS: An ecological study was carried out in the 293 municipalities of the State of Santa Catarina, Brazil, between 2000 and 2003. The primary dental care indicators utilized were: (1) coverage; (2) the ratio between preventive dental procedures and the size of the population aged zero to 14 years; and (3) the ratio between the numbers of extractions of permanent teeth and individual dental procedures within primary dental care. The variables investigated were: number of dentists per 1,000 inhabitants; number of dentists within the public health service per 1,000 inhabitants; fluoridation of the water supply; child development index; human development index; and the size of the population in the municipality. Analyses were performed using the Kruskall-Wallis and Chi-square tests. The Spearman test was used to evaluate correlations between the variables. RESULTS: The coverage was 21.8%, the ratio of preventive dental procedures among the population aged zero to 14 years was 0.37 and the proportion of tooth extractions in relation to the total number of individual dental procedures was 11.9 %. Lower rates of tooth extraction were associated with higher numbers of dentists within the public health service (p<0.01). Higher rates of tooth extraction were associated with lower human development indices for the municipalities (p<0.01). CONCLUSIONS: Greater coverage was associated with higher numbers of dentists within the public health system. Municipalities with worse socioeconomic conditions were associated with greater tooth extraction rates. Oral health policies must target municipalities that present worse socioeconomic indicators.
Adolescent↗
Reasons for dental extractions in children.
PURPOSE: The purpose of this study was to investigate the principal reason for primary tooth extraction and the tooth type most frequently extracted in children aged 3-13 years. METHODS: The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 2,000 records were reviewed, and 567 extracted primary teeth were analyzed from 277 patients who had at least one primary tooth extracted under local anesthesia. The criteria for inclusion in this study included children between the ages of 3 and 13 years. RESULTS: First primary molars were the most common tooth type extracted and comprised 30% of teeth removed. Central incisors were the next common tooth type extracted and accounted for 25% of the extractions. There was no difference, by gender, in the extraction of tooth type but there were striking differences according to age. Almost half of the primary teeth extracted in subjects 3 to 5 years were incisors, and in patients 6 to 9 years the first primary molar was the most common tooth type extracted. Molars were the tooth type most frequently extracted from those patients aged 10 to 13 years. There were significant differences in the reasons for extraction of various tooth types, and, while extractions due to caries predominated overall, this was not the case for all tooth types. CONCLUSIONS: This study has concluded that despite the dramatic improvements in pediatric oral health over the last decades, caries and the resulting pulpal pathology remains the most common reason for extraction of primary teeth.
Adolescent↗
Patient experience of, and satisfaction with, delayed-immediate vs. delayed single-tooth implant placement.
OBJECTIVES: Recent investigations have focused on patients' subjective assessment of implant treatment. The aim of this study was to compare the patients' experience of surgical and prosthetic procedures, as well as satisfaction with function and aesthetics following single-tooth replacements mounted to early vs. delayed placed dental implants. MATERIAL AND METHODS: Forty-six patients were treated with a single-tooth implant in the anterior or premolar region. Twenty-three implants were placed on average 10 days after tooth extraction (Im), while 23 implants were placed approximately 3 months after tooth extraction (De). Forty-one patients completed a questionnaire regarding the treatment using visual analog scales (VAS) and check boxes 16-18 months after delivery of the restoration. RESULTS: In all, 90% of the respondents rated 88 or higher on the VAS regarding satisfaction with the crown. Satisfaction with the restoration in general and the appearance was significantly greater in the Im group than in the De group (96 vs. 93; P<0.02). Assessment of the implant surgery was not significantly different between the delayed-immediate and the delayed group. Approximately 25% of the patients experienced unpleasantness in relation to the prosthetic procedures, and in 8 of 11 cases, impression taking was the cause. When evaluating satisfaction with the overall implant treatment, the VAS scores for the delayed-immediate group were significantly higher than for the delayed group (96 vs. 90; P<0.02). CONCLUSION: The patients in the present study were highly satisfied with the outcome of the treatment and experienced it to be without significant unpleasantness irrespective of the treatment concept.
Adult↗
A survey of reasons for extraction of permanent teeth in Singapore.
A survey was carried out to determine the reasons for tooth extractions of permanent teeth in Singapore. Data were obtained from 52 dentists practising general dentistry over a period of 12 months. At the end of the 12-month period, data were collected from 1276 patients, from whom a total 272 teeth were extracted. In this population group, the results showed that the percentage of teeth extracted due to periodontal reasons and caries were about the same, that is 35.8% and 35.4%, respectively. There was an increase in teeth extracted due to periodontal reasons with age. In patients above 40 yr, an average of 76% of teeth were lost due to periodontal reasons. An average of 26.7% of teeth were lost due to periodontal reasons in patients under 40 yr old. However, the trend for loss of teeth due to caries is reversed. Posterior teeth were more frequently extract compared to anterior teeth. Third molars accounted for 24.7% of all extractions carried out, whilst central incisors were 8.0% of all extractions. Molars were often lost due to caries and lower anterior teeth were most frequently lost due to periodontal reasons. The results of this study did not demonstrate one predominant reason for extraction. Both caries and periodontal reasons were equally common causes of tooth extraction.
Adolescent↗
Natal teeth: a review.
The incidence of natal teeth is approximately 1:2,000 to 1:3,000 live births. The most commonly affected teeth are the lower primary central incisors. Natal teeth usually occur in pairs. The eruption of more than two natal teeth is rare. The majority of natal teeth represent the early eruption of normal primary deciduous dentition. Less than 10% of natal teeth are supernumerary. Natal teeth might resemble normal primary dentition in size and shape; however, the teeth are often smaller, conical and yellowish, and have hypoplastic enamel and dentin with poor or absent root formation. Complications include discomfort during suckling, sublingual ulceration, laceration of the mother's breasts and aspiration of the teeth. A dental roentgenogram is indicated to differentiate the premature eruption of a primary tooth from a supernumerary tooth. Tooth extraction is indicated if the tooth is supernumerary or excessively mobile. If the tooth does not interfere with breastfeeding and is otherwise asymptomatic, no treatment is necessary.
Humans↗
Maxillary molar extraction decreases stiffness of the mandible in ovariectomized rats.
Although osteoporosis is a major public health concern, the effect of this condition on oral bone has not been determined. Using the ovariectomized rat as a model, we examined whether acute estrogen depletion affects the mandible of the ovariectomized rat with and without maxillary molar extraction. Twenty-two ovariectomized and 20 sham-ovariectomized 90-day-old Sprague-Dawley rats were divided into the following groups: (1) sham-ovariectomized, baseline control; (2) ovariectomized, baseline control; (3) ovariectomized; (4) ovariectomized, tooth extraction; (5) sham-ovariectomized; and (6) sham-ovariectomized, tooth extraction. On day eight, sham-ovariectomized and ovariectomized rats had all their maxillary molars extracted, and the baseline control sham-ovariectomized and ovariectomized rats were killed. On day 35, the remaining animals were killed. After teeth were harvested, the right mandible was tested to failure in three-point bending. The bone mineral density of the left mandible was measured with dual-energy x-ray absorptiometry. The area fraction and area moment of inertia of a section of mandible were determined. Neither ovariectomy nor tooth extraction significantly affected the bone mineral density or structural properties of the rat mandible. However, there was an interaction between ovariectomy and maxillary molar extraction on the stiffness of the rat mandible (p < 0.008). Maxillary molar extraction decreased the stiffness of the mandible by 25% (p < 0.05) in the ovariectomized rat, whereas it did not do so in the sham-ovariectomized rat.
Alveolar Bone Loss↗
Chronic inflammation and pain inside the mandibular jaw and a 10-year forgotten amalgam filling in an alveolar cavity of an extracted molar tooth.
A 55-year-old woman, suffered from severe pain in her mandibular jaw for several years. A metallic artifact of about 2(3) mm was detected by a panorama radiography in an edentulous region with a surrounding inflammation in close contact to the canal of the mandibular nerve. Inflammated tissue with the central metallic inclusion was removed from the bone under local anesthesia and operation. Postoperatively, pain and missensitivity disappeared within 1 week. Although the patient had no macroscopically visible so-called amalgam tattoo, the metallic cube was identified as amalgam by the detection of mercury, silver, tin, copper, and zinc using energy dispersive X-ray analysis (EDX) in a scanning electron microscope (SEM). Nevertheless, brown to black pigments in the connective tissue matrix and inside histiocytes, fibroblasts, and multinucleated foreign giant cells of the surrounding inflammatory tissue were observed by light and electron microscopy. However, the elemental analysis by EDX in SEM or by electron energy loss spectroscopy in transmission electron microscope detected only silver, tin, and sulfur but no mercury in these precipitates and in the residual bodies of phagocytes. The presented case demonstrates a seldom complication of amalgam deposition in the tissue. The authors assume that the chronic pain results from a forgotten amalgam filling inside an alveole after extraction of a molar tooth, causing a chronic inflammation by resolving mercury and other toxic elements out of the metallic artifact.
Dental Amalgam↗
[Unusual complications in wisdom tooth eruption; extraction during inflammation].
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Humans↗
Smoking may affect the alveolar process dimensions and radiographic bone density in maxillary extraction sites: a prospective study in humans.
PURPOSE: Loss of ridge width and height typically occur after tooth extraction. This study aimed to investigate whether smoking would effect alveolar ridge remodeling after tooth extraction. MATERIALS AND METHODS: Twenty-one individuals (11 nonsmokers, 10 smokers) requiring a nonmolar extraction in the upper jaw were selected. Radiographs were taken 7 and 180 days after surgery, and the following parameters obtained: alveolar process height (AH), alveolar process width (AW), radiographic bone density in the postextraction socket (BDS), and in the pre-existing bone apically (BDPB). RESULTS: Six months after surgery, intragroup analysis showed that both groups presented a significant reduction in AH, while only smokers had a significant reduction in AW, BDS, and BDPB (P < .05). Furthermore, intergroup analysis showed that smokers presented lower BDS (91.45 pixels +/- 26.62 and 59.53 pixels +/- 19.99, for nonsmokers and smokers, respectively; P = .006) and continued to present lower BDPB (129.34 pixels +/- 42.10 and 89.29 pixels +/- 29.96, for nonsmokers and smokers, respectively; P = .023). Additionally, smokers presented a tendency for lower AH and AW than nonsmokers, but this was not statistically significant. CONCLUSION: Within the limits of the present study, smoking may lead to a more significant dimensional reduction of the residual alveolar ridge and postpone postextraction socket healing.
Absorptiometry, Photon↗
A 3-year prospective multicenter follow-up report on the immediate and delayed-immediate placement of implants.
A total of 264 implants was placed in 143 patients using different immediate or delayed-immediate implant placement techniques in 12 different centers participating in a prospective multicenter study. The reason for tooth extraction was evaluated; bone quality and quantity were classified; socket depths were registered; and data on implant type, size, and position were collected. One hundred thirty-nine suprastructures were placed on 228 implants in 126 patients. A follow-up evaluation was done on 125 patients after 1 year of loading and on 107 patients after 3 years of loading. Clinical parameters (bleeding or not bleeding, pocket depth, and implant mobility) were evaluated after 1 and 3 years, and the marginal bone level after 1 year of loading was measured on radiographs. Clinical comparisons were performed to evaluate implant loss in relation to implant type, size, position, bone quality and quantity, socket depth, reason for tooth extraction, and placement method. In addition, life table analysis was done for cumulative implant survival rates. There was no clinical difference with respect to socket depth or when comparing the different placement methods. A higher failure rate was found for short implants in the posterior region of the maxilla and when periodontitis was cited as a reason for tooth extraction. Mean marginal bone resorption from the time of loading to the 1-year follow-up was 0.8 mm in the maxilla and 0.5 mm in the mandible. Over a period of 3 years, the implant survival rate was 92.4% in the maxilla and 94.7% in the mandible.
Bone Density↗
Ovariectomy reduces the gelatinolytic activity and expression of matrix metalloproteinases and collagen in rat molar extraction wounds.
Osteoporosis is commonly associated with estrogen deficiency. However, the mechanisms by which the lack of this hormone causes bone loss are poorly understood. The bone structure of the oral cavity seems to be affected by estrogen deficiency, since a delayed healing process after tooth extraction has been observed after ovariectomy in rats. The aim of this study was to describe the effect of the absence of estrogen on the expression and activity of matrix metalloproteinases (MMC)-2 and -9 and expression of types I and III collagens in the alveolar granulation tissue of young female rats after tooth extraction. Sixty-six, four-week-old female rats underwent bilateral ovariectomies (OVX) or sham operations. Three weeks later, both first and second mandibular molars were extracted and the animals were killed by cervical dislocation 3, 5, or 7 days after tooth extraction. The granulation tissues were collected from the extracted alveolar sockets and used for zymographic, Western blot, or reverse transcription polymerase chain reaction (RT-PCR) analysis. There was a gradual increase on the expression of all studied proteins as well as MMP-2 and -9 activities in the periods after surgery. In contrast, OVX animals showed a significant decrease in the gelatinolytic activities and expression of MMP-2 and -9 and types I and III collagens. The results presented here in suggest that the absence of estrogen may possibly contribute to the delayed alveolar wound healing by interfering with the extracellular matrix turnover.
Animals↗
[Reasons for extraction of permanent teeth in a health community dental centre].
The authors assessed the diagnostic reasons for extraction of 1170 teeth in 565 patients treated in a health community dental centre. They recorded data on the patient's sex and age, on the extracted tooth and reason for extraction. They found that under the age of 30 years permanent teeth were extracter mostly on account of extensive damage by caries and its sequelae. On account of destruction of the periodontium permanent teeth were extracted in patients older than 31 years. At the age of 31-40 years on account of extensive caries and its complications significantly more teeth were extracted in women than in men, at the age above 71 years significantly more teeth were extracted on account of this diagnosis in men, as compared with women. On account of caries and its sequelae 75.7% upper premolars, 69.7% upper molars and 69.9% lower molars were extracted. On account of advanced destruction of the periodontium in the investigated group 80.5% lower incisors were extracted. In other groups of teeth this diagnosis was less frequent.
Adult↗
An in vitro comparison of different bleaching agents in the discolored tooth.
Extracted teeth with intact crowns were stained to compare and evaluate the effectiveness of four bleaching agent combinations. Forty-two permanent and 12 deciduous teeth were used. The bleaching agents were placed into coronal pulp chambers and then evaluated and rated at 1-, 3-, 7-, and 14-day and 6-month intervals. New sodium perborate combined with fresh Superoxol was the most effective bleaching agent with 93% success (the final shade was as light as the prestained shade). New sodium perborate and 1-yr-old Superoxol was 73% successful. New sodium perborate with distilled water and old sodium perborate with distilled water were both 53% successful. Deciduous teeth demonstrated a response to bleaching agents similar to that of permanent teeth. Color regression after 6 months was found in 4% of the cases. When it occurred, the degree of color regression was minimal.
Borates↗
Effects of Tissucol and epsilon aminocaproic acid in the healing process following dental extraction in dehydrated rats.
A histological study was conducted of the alveolar bone healing process following tooth extraction of dehydrated rats after the implantation of fibrin adhesive (TISSUCOL) associated to previous irrigation of the wound with a 5% epsilon aminocaproic acid solution (EACA). Seventy two rats were used, divided into three groups receiving different treatments after the surgical procedure. In group I, the gingival mucosa was sutured after extraction of the right upper incisor. In groups II and III, chronic dehydration was produced by water deprivation for 9 days (3 days in the preoperative period and 6 days in the postoperative period). In the animals of Group II, after tooth extraction, the gingival mucosa was sutured in the same way as performed in group I. In group III, after extraction, the dental socket was irrigated with 5% EACA, followed by implantation of the fibrin adhesive (TISSUCOL). The mucosa was sutured in the same way as performed in the other groups. At 3, 7, 15 and 21 postoperative days, the animals were sacrificed in number of 6 for each group. Specimens containing the dental socket were removed and fixed in 10% formalin and decalcified in an equal part formic acid and sodium citrate solution. After routine processing, the specimens were embedded in paraffin for microtomy. We obtained 6 microm semi-serial slices that were stained with hematoxylin and eosin for histological evaluation. The results showed that the water deprivation in the pre- and postoperative periods caused a delay in the alveolar bone healing process. The use of the fibrin adhesive (TISSUCOL) produced an improvement in the fibrinolytic picture caused by dehydration.
Aminocaproic Acid↗
Sympathetic neuronotrophic activity in the pulp of the cat canine tooth.
Extracts of these dental pulps from adult cats contained a non-dialysable agent or agents which could support neurone survival and neurite development for at least three days in neurone-enriched cultures of sympathetic ganglion cells from 11-day chick embryos. The neurone survival-promoting activity differed from nerve growth factor (NGF) in that: (1) anti-mouse NGF serum did not inhibit it; (2) nearly all ganglionic neurones survived in optimum concentrations of pulp extract, whereas only about 35 per cent were supported by NGF; and (3) cell bodies of NGF-supported neurones were markedly larger than in neurones supported by pulp extracts. The neuronotrophic activity in individual dental pulps was highly variable among different cats, but similar between mandibular canines from the same animal. Smaller pulps had higher concentrations of trophic activity than larger ones. Gingival tissue and the anterior belly of the disgastric muscle contained little neuronotrophic activity.
Animals↗
An analysis of bacteremias during dental extractions. A double-blind, placebo-controlled study of chlorhexidine.
BACKGROUND: The literature is unclear concerning the nature and incidence of bacteremias from oral surgical procedures, the relationship of these bacteremias to dental disease, and the preventive benefit of antibacterial mouth rinses. OBJECTIVE: To determine the incidence and nature of bacteremias during single-tooth extractions in adults. METHODS: A double-blind, randomized placebo-controlled study of 70 patients in which the status of dental disease was compared with the incidence and nature of aerobic and anaerobic bacteremias following a single-tooth extraction and the antibacterial effect of rinses with chlorhexidine hydrochloride. Multiple indicators of dental disease were evaluated and recorded before the surgical procedure. Timing of the mouth rinses, the steps in the surgical procedure, and the two blood drawings were controlled for. RESULTS: Thirty-one (94%) of 34 control patients and 62 (89%) of 70 patients overall had blood cultures positive for organisms at either the 1-minute and or 3-minute mark following the initiation of surgery. The majority of cultures yielded gram-positive cocci. Cultures yielded polymicrobial organisms in 17 patients (24%). Although there was a wide range of severity of odontogenic disease, this did not correlate with results of blood cultures. However, there was a statistically significant difference in the incidence of blood cultures positive for organisms at both shorter (<3 minutes, P=.04) and longer (>6 minutes, P=.04) surgery times. There was not statistically significant difference in either the incidence of blood cultures positive for organisms or in the nature of organisms identified between the chlorhexidine and placebo groups. CONCLUSIONS: Single-tooth extraction should be expected to cause a bacteremia regardless of the status of the dentition or periodontium. Mouth rinses with chlorhexidine not significantly alter the number of positive blood cultures or the nature of the organisms at either of the two blood drawings.
Adult↗