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PubMed2001

Anesthetic implications of a partial molar pregnancy and associated complications.

In the United States, molar pregnancy occurs between 1 in 1,200 and 1 in 2,500 pregnancies. The critical nature of complications associated with a molar pregnancy requires advanced perioperative anesthetic management. This case report details the perioperative events of a 34-year-old gravida 5, para 3, with a partial molar pregnancy who underwent general anesthesia for a dilatation and curettage procedure, following therapeutic termination of a coexisting fetus at 18 weeks' gestation. Her initial presentation, anesthetic and operative management, and postoperative course are described clearly. The medical and anesthetic interventions required for treatment of molar pregnancy are reviewed. Of molar pregnancies, 80% are uncomplicated and follow an unremarkable course. However, for the remaining 20%, complications can be severe and may lead to substantial morbidity and mortality in otherwise healthy women.

Abortion, Therapeutic↗
PubMed2003

Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy.

OBJECTIVE: To determine pregnancy outcome, including the rate of repeat molar pregnancy, following histologically confirmed complete or partial hydatidiform mole. DESIGN: Retrospective review of a large supraregional database of registrations for gestational trophoblastic disease. SETTING: Supraregional Trophoblastic Disease Unit, London. SAMPLE: Women with pregnancies affected by complete or partial hydatidiform mole registered between 1992 and 1998. METHODS: All patients with a diagnosis of histologically confirmed complete or partial hydatidiform mole were identified and data on subsequent pregnancies compared between groups using comparison of proportion test. MAIN OUTCOME MEASURES: Pregnancy outcome by partial or complete mole subtype, with particular regard to risk of subsequent molar pregnancy. RESULTS: Of 2578 complete moles, the subsequent pregnancy was affected by hydatidiform mole in 27 (1.9%) cases, including 22 (81%) complete moles and 5 (19%) partial moles. Of 2627 partial moles, the subsequent pregnancy was also molar in 25 (1.7%) cases, including 17 (68%) partial moles and 8 (32%) complete moles. Overall recurrence risk for molar pregnancy was 1.8% (1 in 55), or a 20-fold increase compared with the background risk. Of 27 cases with repeat complete moles, three had further complete moles, suggesting the recurrence risk following two previous complete moles is approximately 10%. There were no other significant differences in pregnancy outcome between cases with previous complete or partial hydatidiform mole and that expected in an unselected obstetric population. CONCLUSIONS: Women having a pregnancy affected by a histologically confirmed complete or partial hydatidiform mole may be counselled that the risk of repeat mole in a subsequent pregnancy is about 1 in 60 and if this were to occur, the majority of cases will be of the same type of mole as the preceding pregnancy. However, >98% of women who become pregnant following a molar conception will not have a further hydatidiform mole and these pregnancies are at no increased risk of other obstetric complications.

Adolescent↗
PubMed1996

[A clinical observation on 218 maxillary first molars canal system]

218 maxillary first molars were observed during clinical endodontic therapy for canal system;the number of canal,working length,and the location at the floor of each orifice.As to the patients;97 are male,121 are female,age from 13 to 76.Results shown that each mesiobuccal root of 28 molars(12.84%) included two canals,there was no significant difference in canal number in the mesiobuccal root of maxillary first molar were decreased with the age.The suggestion was made the notice for the complicated canal system,improving the shape of access,holding the method to find out the second canal in the mesiobuccal root could avoid missing canal on treating maxillary first molars endodontically. The resinifying therapy seems to raise successful rate for treating molar with complicated canal system.

Journal Article↗
PubMed2004

Distribution of molar mass and branching index of natural rubber from Hevea brasiliensis trees of different age by size exclusion chromatography coupled with online viscometry.

Natural rubber from hevea brasiliensis trees (Thailand, RRIM 600 clone) of different age (8, 20, and 35 years) were characterized by size exclusion chromatography coupled with online viscometry according to their distribution of molar mass and branching index at a temperature of 70 degrees C using cyclohexane as solvent. Washing with an aqueous solution of sodium dodecylsulfate and subsequent saponification purified the natural rubber samples. With this procedure physical branching points caused by phospholipids, proteins and hydrophobic terminal units, mainly fatty acids, of the natural rubber (cis-1,4-polyisoprene) molecule, could be removed leading to completely soluble polymer samples. All samples investigated possess a very broad (10 to 50,000 kg/mol) and distinct bimodal molar mass distribution. With increasing age the peak area in the low molar mass region decreases favoring the peak area in the high molar mass region. By plotting the branching index as a function of the both, the molar mass and the age of the trees.

Age Factors↗
PubMed2006

Clinical characteristics of persistent gestational trophoblastic neoplasia after partial hydatidiform molar pregnancy.

OBJECTIVE: To identify clinical characteristics associated with developing persistent gestational trophoblastic neoplasia (GTN) after partial hydatidiform molar pregnancy (PHM). STUDY DESIGN: Utilizing the Donald P. Goldstein in patients who developed persistence between 1973 and 1989. CONCLUSION: Older age at diagnosis and history of prior mole were significantly more common in women who developed persistence after partial molar pregnancy in referral of patients the earlier cohort but not in idefined clinical the recent cohort. In recent years no clinical factor was at increase their risk significantly associated with rsistence. database at the New England Trophoblastic Disease Center, 284 women with partial molar pregnancy diagnosed between 1973 and 2003 were characteristics identified. Clinical charac- for pe teristics, such as gravidity, parity, age, uterine size, gestational age at diagnosis, human chorionic gonadotropin levels at presentation and time to development of persistence (GTN) were analyzed. Data were also divided into 2 cohorts, an earlier one (1973-1989) and a later one (1990-2003), in order to look at potential changes over time. RESULTS: GTN developed in 5.6% of partial molar pregnancies. Older maternal age was significantly associated with development of persistent GTN in the earlier cohort but not in the recent cohort. Previous molar pregnancy was also statistically significantly more common the development of +/-after PHM.

Adult↗
PubMed1980

Natural history of recurrent molar pregnancy.

Seven patients with recurrent molar pregnancy were managed at the New England Trophoblastic Disease Center (NETDC) between July 1965 and December 1978. Recurrent molar pregnancy was associated with a worsening histology and an increased incidence of proliferative trophoblastic sequelae in the successive episodes of hydatidiform mole. While none of the initial 7 patients with molar pregnancy required any further treatment after evacuation, 5 of the 7 patients needed chemotherapy to achieve complete sustained remission of the recurrent episodes of hydatidiform mole. None of the patients with recurrent hydatidiform mole had normal viable pregnancies after 2 or more consecutive molar gestations. The literature regarding recurrent molar pregnancy is reviewed in the context of the authors' current observations.

Adult↗
PubMed1998

Eclampsia complicating hydatidiform molar pregnancy with a coexisting, viable fetus. A case report.

BACKGROUND: Eclampsia is a rare and serious complication of pregnancy. The occurrence of preeclampsia prior to the 20th week of gestation has been associated with concurrent hydatidiform molar pregnancy. We present a case of eclampsia complicating a partial molar pregnancy associated with a viable fetus. CASE: A 22-year-old white woman, gravida 1, para 0, at 14 weeks' gestation, presented with an excruciating headache associated with hypertension, proteinuria and a viable intrauterine fetus with gastroschisis. Subsequently the patient had a generalized tonic-clonic seizure which resolved with magnesium sulfate therapy. Markedly elevated quantitative human chorionic gonadotropin and a moderately thickened placenta were the sole clinical features suggestive of a molar gestation. Dilation and evacuation was performed revealing unremarkable products of conception. Pathologic and cytogenetic analyses revealed a triploid fetus (69,XXX) consistent with partial molar pregnancy. CONCLUSION: Development of preeclampsia/eclampsia prior to 20 weeks of gestation should prompt a clinical evaluation to exclude the possibility of an underlying hydatidiform molar pregnancy.

Adult↗
PubMed1994

Effect of removing impacted third molars on plaque and gingival indices.

This study investigated the effect of removal of partially erupted mandibular third molars on the plaque and gingival indices. Sixty patients were studied and assigned to one of three groups: control, asymptomatic partially erupted third molars, and symptomatic partially erupted third molars. Plaque and gingival indices were scored for the second molar to the canine in all four quadrants preoperatively and again at 6 weeks after surgery. Results show that removing impacted teeth may provide some benefit in terms of improved gingival health.

Adult↗
PubMed2006

Qualitative effects of dioxin on molars vary among inbred mouse strains.

OBJECTIVE: We evaluated the effects of different levels of the potent environmental toxicant and teratogen, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), on molar development in mice in six inbred strains, all with TCDD responsive Ahr alleles. DESIGN: Pregnant females were exposed on gestation day 13 to 4 different levels of TCDD (control, 0.01, 0.1 and 1.0 microg/kg) and their offspring were examined for the frequency of missing third molars (M3s) and for differences in first mandibular molar (M1) cuspal morphology. RESULTS: Missing M3s were prevalent only in mice in two strains, C3H/HeJ and CBA/J, and their frequency significantly increased with increasing TCDD exposure. The frequency of the M1 variant was high in mice in only one strain, C57BL/10J, and was significantly higher in the treated compared with the control group. CONCLUSIONS: Inbred mice strains exhibited differential responses to TCDD suggesting that there is a genetic component, beyond Ahr differences, mediating the effects of TCDD on molar development.

Alleles↗
PubMed1991

Periodontal healing after impacted lower third molar surgery in adolescents and adults. A prospective study.

The effects of impacted lower 3rd molar surgery on periodontal tissues in the adjacent 2nd molar area have been investigated in a prospective study comprising 176 cases from 2 age groups: less than or equal to 20 years (n = 93) and greater than or equal to 30 years (n = 83), respectively. The preoperative and 1-year postoperative examinations included both clinical and radiographic variables. All patients were subjected to a standardized surgical procedure and optimal plaque control pre-, intra- and postoperatively. Early removal of impacted lower 3rd molars with large angulation and close positional relationship to the adjacent 2nd molar proved to have a beneficial effect on periodontal health.

Adolescent↗
PubMed1997

Radiologic variables of clinical significance in the extraction of impacted mandibular third molars.

OBJECTIVE: To determine which radiologic variables have a clinical significance in the extraction of impacted mandibular third molars. STUDY DESIGN: A prospective study was carried out on 100 consecutive extractions of unilateral impacted mandibular third molars (60 women and 40 men, mean age: 26.27 +/- 10.63 years). Fourteen radiologic variables were ordinally evaluated, establishing their relation to the surgical intervention time. The Kruskal-Wallis test, a multivariant analysis of the principal components, the Pearson correlation coefficient, and logistical regression tests were carried out. RESULTS: Seven variables (occlusal plane, relation to the second molar, depth, follicle, periodontal ligament width, ramus of the mandible, and angulation) demonstrated a statistically significant relation to the surgical intervention time (Kruskal-Wallis tests, p < 0.007). Two associated variables, depth and periodontal ligament width, showed the most powerful and simple relation to the surgical intervention time (r2 multiple = 0.307, p < 0.001). CONCLUSION: The model we propose is a tool that may help the general practitioner to establish competence in an extraction of the impacted mandibular third molar by measuring the association of two radiologic variables: depth and periodontal ligament width.

Adolescent↗
PubMed1997

Remaining mandibular third molars in an adult population.

Although tooth loss with age has been extensively investigated, there appears to be no literature on the relationship of age to remaining mandibular third molars. The study showed that as age increases so does the frequency of absent vertically erupted mandibular third molars. However, no correlation was found between age and loss of mandibular impacted third molars in men of 71 years of age or older. The evidence presented here suggests that impacted mandibular third molars, which have not been infected, may be more likely to remain compared with other teeth at potential risk.

Adult↗
PubMed2001

A radiologic analysis of dentigerous cysts and odontogenic keratocysts associated with a mandibular third molar.

OBJECTIVE: The purpose of this study was to discriminate radiographically between dentigerous cysts (DCs) and odontogenic keratocysts (OKCs) associated with a mandibular third molar. STUDY DESIGN: The material consisted of panoramic radiographs of dentigerous cysts (44 patients, 45 cysts) and odontogenic keratocysts (15 patients, 16 cysts), all of which were related to a mandibular third molar. The radiographic images were analyzed with reference to the patients' ages and symptoms. RESULTS: The mean age of patients in the OKC group was less than that of patients in the DC group. The mean area of the cysts in the OKC group was larger than that of those in the DC group. The mean distance from the second to the third molar in the DC group was greater than that in the OKC group. Although there was a significant correlation between the area and distance in the DC and OKC groups, the patients' ages did not significantly correlate to the area and distance of either cyst. CONCLUSIONS: The OKCs had a tendency toward rapid growth in the patient's youth but short movement of a third molar compared with the DCs. The DCs and OKCs do not appear to develop gradually from the period when follicles or dental lamina were formed but arise at various periods randomly.

Adolescent↗
PubMed1999

Arrested eruption of the permanent lower second molar.

The incidence of retention/impaction of the permanent lower second molar (M2inf) lies between 0.6/1000 and 3/1000. Therefore, the purpose of the present study was to investigate the craniofacial morphology, the frequency of dental anomalies and the inclination of the affected M2inf and the adjacent first molar in patients with arrested eruption of M2inf. The overall goal was to elucidate the aetiology of arrested tooth eruption and to present the characteristics of these patients in order to improve diagnosis and treatment planning. Radiographic material (profile radiographs and orthopantomograms) from 19 patients (nine females and 10 males; 13-19 years of age at the time of referral) were analysed. The ages of the patients when profile radiographs were taken for cephalometric analysis varied from 8 to 16 years. The study shows that this group of patients, compared with a reference group, had an increased sagittal jaw relationship (Class II). Specifically, the mandibular prognathism was less, the mandibular gonial angle smaller, the mandibular alveolar prognathism enlarged and the maxillary incisor inclination less than in the reference group. Furthermore, this group of patients had a more frequent occurrence of morphological tooth anomalies, such as root deflections, invaginations, and taurodontism. However, none of the patients with arrested eruption of M2inf had agenesis of the lower third molar. The study did not reveal an association between the degree of inclination of the M2inf and that of the first molar in the same region. The results of this investigation show that conditions such as the craniofacial morphology and deviations in the dentition are associated with arrested eruption of M2inf. Therefore, it is important to evaluate these conditions in future diagnosis and treatment planning of patients with arrested eruption of M2inf.

Adolescent↗
PubMed1990

Incidence and features of three-rooted permanent mandibular molars.

Seven hundred and eighty-six patients of Singaporean Chinese origin requiring extractions of permanent mandibular molars were screened. Personal details, identification of the tooth and the presence or absence of an extra root were recorded. Thirty-two cases (4.1 per cent) exhibited an extra disto-lingual root. None was found in the second molar. The first molar was affected (7.9 per cent) slightly more than twice as often as the third molar (3.7 per cent). The extra root was present almost equally in both sexes with a higher presentation on the left side. Six cases had a fracture of the extra root. A comparison was made with a study done by Tratman' on the same population and with other studies involving those of Chinese and Mongoloid origin in other countries.

China↗
PubMed1997

Incidence of inflammation in completely impacted lower third molars.

The influence of ageing and the contact of the adjacent tooth on purulent inflammation associated with the completely impacted lower third molar was assessed in 26 patients with clinical symptoms of infection out of 800 patients who had roentgenographically-confirmed completely impacted lower third molars. These 26 patients were 23 years of age or older. The 9 with pain alone ranged from 25 to 44 years of age, whereas the 17 patients with inflammation ranged from 29 to 67 years of age, and non-contact to adjacent tooth was associated with purulent inflammation in older patients, indicating completely impacted lower third molars may cause pain only until 45 years of age; but purulent inflammation occurs even in the group of non-contact to adjacent tooth after 45 years of age. The authors recommend that a completely impacted lower third molar should be removed if the risk factors of advanced age and contact with the adjacent tooth are present.

Adult↗
PubMedDate not supplied

Supernumerary molars. A review of 53 cases.

Supernumerary molars are not uncommon and may be found nearly anywhere in the dental alveolar arches. A series of 36 patients that presented with 53 supernumerary molars are reviewed. They occurred more frequently in the maxilla (86.8%), had little or no clinical significance, tended to be impacted, and were not associated with the impactation of the third molar. Four cases of maxillary fifth molars are described.

Adolescent↗