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PubMed1993

[Two cases of mediastinitis as a complication of odontogenic infection and tonsillitis].

We experienced two cases of descending necrotizing mediastinitis with different etiology. Case 1: A 59-year-old woman presented with chief complaints of dyspnea and swallowing disturbance. She had been diagnosed as having tonsillitis one week before. She was very pyrexic, and laboratory examination indicated acute inflammation. Chest X-ray and CT-scan showed enlargement of the mediastinum and pleural effusion. We diagnosed the mediastinitis to be a complication of tonsillitis. Case 2: A 54-year-old man had a tooth extracted 3 weeks prior to admission. His chief complaints were craniomandibular disturbance and neck swelling. Laboratory examination disclosed multiple organ failure and DIC. Chest X-ray and CT-scan showed enlargement of the mediastinum and pleural effusion. We diagnosed the mediastinitis in this case to be a consequence of an odontogenic infection following tooth extraction. Both patients received continuous drainage and irrigation of the abscesses and recovered in about 2 months. Case 1 showed an impaired glucose tolerance after recovery from mediastinitis. Although the main causes of mediastinitis are cardiac surgery and esophageal perforation, our cases demonstrate that mediastinitis may occur as a complication of deep neck infection.

Female↗
PubMed1997

A feasibility study evaluating rhBMP-2/absorbable collagen sponge device for local alveolar ridge preservation or augmentation.

This two-center human clinical trial evaluated recombinant human bone morphogenetic protein-2 delivered in an absorbable collagen sponge (rhBMP-2/ACS) for either alveolar ridge preservation after tooth extraction or augmentation of localized osseous defects. This 24-month study comprised two parts: a 4-month acute safety and bone induction period (Part I) followed by a 20-month, osseointegration, functional restoration, and long-term safety evaluation (Part II). The primary objective of Part I, discussed in this article, was to evaluate the short-term safety and technical feasibility of the rhBMP-2 device implantation. Twelve patients (six preservation and six augmentation) were enrolled in the investigation. Patient safety was monitored by oral examinations, radiographs, and the collection of blood samples to measure serum chemistries, hematology, and potential antibody formation. Technical feasibility was evaluated by collecting information relating to the handling properties of the rhBMP-2/ACS device. The ability of various evaluative tools to measure the bone-inducing activity of the rhBMP-2/ACS device was also assessed. The clinical results suggested that rhBMP-2/ACS was well tolerated locally and systemically, with no serious adverse events. The device was found to be easily handled and adapted to the ridge and extraction socket. Using direct measurements, all sites demonstrated firmness and fullness to palpation at 4 weeks; however, a loss of volume was noted in some treatment areas between 4 and 8 weeks. Augmentation of the alveolar ridge was not observed in the patients as assessed by the evaluation techniques. This trial indicated that the use of rhBMP-2/ACS to preserve alveolar ridge after tooth extraction or augmentation of localized defects is safe and feasible. Bone fill was observed in all alveolar sockets filled with the rhBMP-2 device.

Absorption↗
PubMed2006

[Changes of orthodontic tooth in different healing extraction sites].

OBJECTIVE: To compare the canines root resorption and alveolar bone height when they were moved into different healing extraction sites. METHODS: Twenty patients with overjet were treated by extracting the maxillary first premolars. By random determination, distalization of different lateral upper canines started after 1 week and 12 weeks. Every 4 weeks use a force of approximately 100 g to distalize the canines. The experiment was ended when bilateral canines have contacted with the second maxillary bicuspids completely. Periapical radiography of the canine in the end of the distalization was made. RESULTS: External apical root resorption and alveolar bone height of the canines have no significant difference between the different healing extraction sites. CONCLUSION: Tooth extraction site healing has not much effect on the canine external apical root resorption and alveolar bone height, when it was distalization. In practice, tooth movement into extraction sites can start early.

Adolescent↗
PubMed2003

Tooth retention as an indicator of quality dental care: development of a risk adjustment model.

BACKGROUND: Retaining teeth improves oral health and quality of life. Thus, receipt of a root canal (vs. a tooth extraction) is a useful indicator of the quality of dental care. However, use of this quality measure without adjusting for the severity of oral disease could lead to spurious conclusions. OBJECTIVES: This paper describes the development of a dental severity adjustment methodology. RESEARCH DESIGN: Retrospective study. SUBJECTS: 54,423 users of Department of Veterans Affairs (VA) dental care who had either root canal therapy or a tooth extraction at a VA facility in Fiscal year 1998. MEASURES: International Classification of Disease Clinical Modification codes for dental diagnoses and comorbid medical conditions. We modeled the effects of dental disease severity in logistic regression models of the probability of receiving a root canal, using both conceptual and Modified Delphi-Panel derived models, adjusting for age, and medical comorbidities. RESULTS: Conceptual and Modified Delphi models performed similarly. The dental disease severity adjustments increased the fit in models of the probability of receiving a root canal (C-statistic = 0.822 for the conceptual model and 0.804 for the Modified Delphi Panel model) compared with the model including comorbid medical conditions alone (C-statistic = 0.561). CONCLUSIONS: Risk adjustment for dental disease severity improves the fit of models of the probability of receiving a root canal. Studies of the quality of dental care should consider employing risk-adjusted models.

Alcoholism↗
PubMedDate not supplied

Treatment of oroantral fistula:experience with 27 cases.

PURPOSE: To review patients with chronic oroantral and oronasal fistula who underwent surgical correction. MATERIAL AND METHODS: Twenty-seven patients with chronic oroantral and oral fistula who underwent surgical correction in the Hacettepe University Faculty of Medicine Department of Otorhinolaryngology Head and Neck Surgery between 1968 and 2001 were reviewed retrospectively. RESULTS: Local mucosal flaps were used for surgical correction. The underlying factors were tooth extraction in 13 patients (48%), tumor in 5 (18.5%), osteomyelitis in 3 (11%), Caldwell-Luc procedure in 2 (7.5%), trauma in 2 (7.5%), dentiginous cyst in 1(3.7%), and correction of septal perforation in 1 (3.7%). Among the fistulas, 23 were oroantral, 3 were oroantronasal, and 1 was oronasal, respectively. Two patients required revisional repairment. The surgical procedure failed in 1 diabetic patient and 3 patients with prior history of external radiotherapy. CONCLUSION: Tooth extraction was the most common etiologic factor, and malignancy should be excluded in all patients. The outcome may not be satisfactory in patients with systemic disease and in patients with history of radiotherapy. Multiple surgical interventions may be necessary only on rare occasions.

Adolescent↗
PubMed1995

Animal model for evaluating the effect of systemic estrogen deficiency on residual ridge resorption.

The rate of resorption of residual ridges after tooth extraction varies among subjects. Despite many human studies, the etiologic factors of severe forms of resorption of residual ridges are unknown and probably multifactorial. To facilitate investigations of resorption of residual ridges, it is preferable to use an animal model with a dentoalveolar component similar to that of human beings. This study developed a rapid, nonhuman primate model in which one could measure resorption of residual ridges at the most critical period, with the least amount of time, minimal operation, and the least interference with normal nutrition. Three female Macaca fascicularis monkeys, 7 to 9 years old, were selected for simple extraction of four maxillary incisors, four mandibular incisors, and two mandibular canines. Lateral cephalographs were taken at weeks 0, 1, 2 to 3, 5 to 6, 8 to 9, 11 to 12, and 26 to 28 after extraction with a newly constructed cephalostat that allowed easy reproducibility of animal placement in the prone position. Height and area measurements were made of maxillary and mandibular anterior residual ridges in the superimposed cephalographs. Sequential mean bone loss data produced bone loss curves similar to those observed in humans. One animal underwent ovariectomy. The plasma levels of both estrogen and progesterone decreased over 25 days and stayed below the detection limits thereafter. Tooth extraction was done 4 weeks after the ovariectomy and the bone resorption pattern was able to be observed longitudinally with the newly established monkey cephalostat. The results indicated that Macaca fascicularis need not be sacrificed when used in longitudinal studies of resorption of residual ridges in a relatively short period of experimental time. This model can provide an excellent opportunity to investigate a causal relationship between the rate of resorption of residual ridges and predisposing systemic factors such as estrogen deficiency.

Alveolar Bone Loss↗
PubMed1997

Immediate partial denture with a cast metal framework. A 6-year evaluation.

The use of dentures immediately after tooth removal is a common practice in dentistry especially when tooth extraction causes aesthetic problems. In the field of complete dentures, the procedure for the construction of immediate dentures permits the preparation of prostheses with the characteristics of standard dentures that can be used for a long period of time, promoting the recovery of function and aesthetic appearance without impairing patient comfort. For removable partial dentures, immediate prostheses are usually provisional for use over a short period of time while the extraction site heals. These dentures are usually made with acrylic resin and wrought wires, and in addition to compressing delicate parts of the support system, often do not provide the comfort and security needed by the patient. Immediate removable partial dentures with a metal framework are seldom used for this procedure, probably because of the difficulty in fitting the framework prior to surgery. The authors present a clinical example in which a modification of framework positioning permitted previous fitting of the framework, eliminating the possibility of lack of fit after tooth extraction, which resulted in clinical success 6 years later.

Dental Casting Technique↗
PubMedDate not supplied

Bacterial isolates from blood cultures of dogs undergoing dentistry.

Bacteria in blood cultures in 30 dogs undergoing high-speed dental scaling and tooth extraction were examined. One or more positive blood cultures were identified in 9 of 30 (30%) dogs. Pasteurella spp. were most frequently (5 dogs) isolated and were sensitive to ampicillin, penicillin, cephalothin, chloramphenicol, tetracycline, amoxicillin with clavulanic acid, and sulfamethoxazole with trimethoprim. Two groups of 15 dogs each, anesthetized or sedated but not undergoing dental procedures, served as non-dentistry controls. There were no significant (p < .05) differences between the number of positive cultures in dentistry and non-dentistry groups. In healthy dogs undergoing high-speed dental scaling and tooth extraction, the occurrence of bacteria in blood cultures was much lower than previously reported. The clinical significance of positive blood cultures was uncertain.

Animals↗
PubMed2006

Comparative investigations on the efficacy of articaine 4% (epinephrine 1:200,000) and articaine 2% (epinephrine 1:200,000) in local infiltration anaesthesia in dentistry--a randomised double-blind study.

A randomised double-blind study investigated 155 patients with tooth extractions in the mandibular and maxillary jaws for a loss of anaesthetic potency when reducing the concentration of the active in articaine solutions. Tests were performed on the preparations of articaine 4% with a 1:200,000 addition of epinephrine (Ultracain D-S) and articaine 2% with a 1:200,000 addition of epinephrine (Ultracain 2%-Suprarenin). Local infiltration anaesthesia was the chosen method of anaesthesia. The most noticeable difference observed between the two injection solutions concerned the duration of anaesthesia, which was significantly shortened under the low-dose solution. The 4% articaine solution did not prove superior in local anaesthetic effect. Articaine 2% with epinephrine 1:200,000, therefore, can be considered a suitable local anaesthetic for tooth extractions.

Adult↗
PubMed1993

Recrudescence of herpes simplex virus type 1 in latently infected rats after trauma to oral tissues.

Tooth extraction in rats was used to trigger a latent HSV-1 infection. HSV-1 was inoculated unilaterally in the rat palates. Eight weeks later two molars were removed bilaterally. The trigeminal ganglia were co-cultivated and HSV-1 was isolated from 63% of the ganglia on the infected sides but from only 11% on control sides. The immune response pattern was analysed by immunoblotting of rat serum, and strong reactivity to HSV-1 specific cell polypeptides and glycoproteins (ICP6, gC, pgC, gD) was seen after reactivation. The extraction sockets were histopathologically evaluated and showed healing on the infected side in 26% compared to 63% in contralateral control sockets. The effect of acyclovir (ACV) treatment was elucidated and was found to influence the subsequent development of antibodies and to promote healing of the sockets. Vesiculation in intra- and subepithelial tissue was present on the infected side in 58% but in only 12% of ACV-treated animals. The present study in rats has shown that a latent HSV-1 infection can be established and reactivated by tooth extraction. Reactivation resulted in delayed healing of sockets on the latently infected side but not on the contralateral control side. HSV-1 reactivation was demonstrated serologically by immunoblotting. Healing was significantly promoted by administration of ACV, which also supports the contention that HSV-1 interferes with the healing process.

Acyclovir↗
PubMed2002

Comparative study of buccal dehiscence defects in immediate, delayed, and late maxillary implant placement with collagen membranes: clinical healing between placement and second-stage surgery.

BACKGROUND: Implants can be placed at the time of tooth extraction (immediate), after several weeks (delayed), or after complete healing (late). The purpose of this study was to evaluate clinical bone healing of buccal dehiscence-type defects around maxillary implants placed together with bioabsorbable collagen barrier membranes and bone graft at the 3 time points. METHODS: Three implant placement protocols were compared: immediate procedures primarily closed by a rotated split palatal flap (19 patients, 23 implants; group 1); delayed sites closed by a rotated (full-thickness) palatal flap at the time of tooth extraction (25 patients, 39 implants; group 2); and late implantation (22 patients, 40 implants; group 3). One to 3 proximal implants were simultaneously placed. Defect height and width were measured at the time of implant placement and at second-stage surgery. Surface area was calculated as half ellipses. RESULTS: The best results were obtained with delayed implantation. The mean percentage of the reduced defect height for groups 1, 2, and 3 was 77.4%+/-16.92%, 88.8%+/-15.29%, and 75.2%+/-17.99%, respectively, and the mean percentage area of the reduced defect was 90.2%+/-9.15%, 95.6%+/-8.73%, and 87.6%+/-11.48%, respectively. Differences between groups were statistically significant. The mean percentage of the reduced defect height and area was significantly smaller when there was spontaneous implant cover screw exposure. Single rather than multiple implant placement led to significantly better results. CONCLUSIONS: Timing of placement, number of simultaneously placed implants, and spontaneous implant exposure significantly influence clinical bone healing around maxillary implants placed together with augmentation procedures.

Absorbable Implants↗
PubMed2005

Evaluation of different treatments for oroantral/oronasal communications: experience of 112 cases.

This retrospective study analyzed the etiologic factors, location and treatments for patients with oroantral or oronasal communications (OAC or ONC). Data analysis extended to gender, age, etiology, location, type of treatment and short-term complications from January 1988 to May 2004. A total of 112 patients with 101 (90%) OAC and 11 (10%) ONC were included. The main etiology for OAC was tooth extraction (95%) with similar prevalence between right (49%) and left (51%) side. For ONC, pathological conditions (27%) and exodontia (27%) were the most prevalent. For the treatment of OAC, suture was the technique most frequently used (60%), followed by buccal fat pad (28%), buccal flap (9%), palatal flap (2%) and one dental transplant (1%). For ONC, the following treatments were used: suture (46%), buccal flap (36%) and palatal flap (18%). Failure to eliminate the communication occurred in six (6%) patients of the OAC group and three (27%) of the ONC group. The results confirm that tooth extraction was the most common etiologic factor for ONC and OAC. Suture, when the communication was small (3-5 mm), and the use of a buccal fat pad (100% successful), when a larger communication existed (>5 mm), seemed to be the two best choices for treatment.

Adipose Tissue↗
PubMedDate not supplied

[Intravenous administration of deamino-D-arginine-vasopressin (DDAVP) to patients with hemophilia A and von Willebrand's disease].

Following an intravenous infusion of DDAVP in a single dose of 0.3 microgram/kg b.w. and subsequent infusion of 4 g of epsilon-aminocaproic acid, 28 tooth extractions have been performed in 18 patients with mild haemophilia A and 5 patients with type I von Willebrand's disease. During the subsequent 7-10 days, the patients received epsilon-aminocaproic acid orally. In 89% of cases the healing was uneventful and no bleeding complications occurred. A single infusion of DDAVP and epsilon-aminocaproic acid was also effective for the management of muscle hematoma ++ and haemarthroses in 4 of the 7 mildly affected haemophiliacs. In the remaining 3, the symptoms of bleeding subsided following repeated infusion of DDAVP. The results indicate that a single intravenous infusions of DDAVP when combined with the administration of antifibrinolytic agents can insure sufficient haemostasis after tooth extraction and is useful for the management of muscle hematoma and hemarthroses in patients with mild haemophilia A mild von Willebrand's disease.

Adult↗
PubMed2003

Malignant haemangio endothelioma (angiosarcoma) concomitant presentation in the mandible and occiput--a case report.

A case of angiosarcoma presenting simultaneously in the mandible and occiput is presented. The mandibular swelling was preceded by toothache for which the patient had tooth extraction, after which the rate of growth increased tremendously. It was not possible to determine without doubt which lesion presented first. The need to evaluate and investigate all cases of jaw swelling that require tooth extraction is emphasised. Angiosarcoma being a haemorrhagic lesion could be complicated life threatening haemorrhage, if a tooth related to it is extracted, as was experienced on incisional biopsy of this lesion. The procedure was accompanied by torrential bleeding which was only controlled after external carotid artery ligation. This, to our knowledge, is the first reported case of angiosarcoma occurring simultaneously in the mandible and occipital bones.

Adult↗
PubMedDate not supplied

Oral health status and treatment needs of Canadian adults aged 85 years and over.

In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue through out the lifespan.

Aged↗
PubMed1982

Neonatal hamster molar tooth development: extraction and characterization of amelogenins, enamelins, and soluble dentin proteins.

Amelogenins, enamelins, and soluble dentin proteins were sequentially separated under dissociative conditions from morphologically characterized molar tooth germs of 4-, 6-, and 7-day-old hamsters. Polyacrylamide gel electrophoretic, gel filtration chromatographic, and amino acid compositional data of neonatal hamster amelogenin extracts were in general agreement with those obtained from fetal bovine enamel under similar extraction conditions. As development progressed (e.g., 4 vs. 7 days of life), changes in amelogenin proteins were manifested by altered values of all biochemical parameters measured. A high molecular weight (approximately 160,000-200,000 daltons) Stains-All-positive protein band was observed for all hamster enamelin extracts on SDS gels. Amino acid compositional data from this "enamel crystal protein," partially purified by dissociative gel-filtration chromatography, are presented. The hamster dentin phosphoprotein was partially purified by ion-exchange chromatography in 7M urea. The molecular weight (75,000-80,000 daltons) and amino acid composition of this protein were similar to those of rat incisor dentin phosphoprotein, but different from those of the fetal bovine phosphoprotein.

Amelogenin↗
PubMed2005

A comparison of dental services received by Medicaid and privately insured adult populations.

BACKGROUND: Few studies have compared differences in dental care utilization rates between a publicly and a privately insured adult population in the same geographic area. The authors conducted this study to compare the demographic characteristics and use of dental services for enrollees in the Iowa Medicaid program and in the Delta Dental Plan of Iowa. The focus was on the overall use of dental services, with an emphasis on the use of tertiary care services such as endodontic therapy and tooth extraction services. METHODS: The authors used insurance claims data for adults aged 21 to 64 years who were enrolled in Delta Dental of Iowa and the Iowa Medicaid program for fiscal year 1998. They calculated utilization of dental services rates by type of dental procedure. RESULTS: In fiscal year 1998, 69.3 percent of Delta Dental enrollees and 27.2 percent of Medicaid enrollees had a dental visit. More than 90 percent of those in both populations with a dental visit had used preventive dental services during the year. Medicaid users were nearly twice as likely as Delta Dental enrollees to receive endodontic therapy (9.9 percent versus 5.0 percent, respectively) and nearly four times as likely to have had a tooth extracted (27.4 percent versus 7.1 percent, respectively). CONCLUSIONS: Privately insured enrollees were more likely to use dental services that were Medicaid enrollees. The greater use of tertiary care services by the Medicaid population than by the privately insured population is indicative of a lower oral health status for this group at the time they sought care, even though it was a much younger group of adults. PRACTICE IMPLICATIONS: The oral health status of low-income adults enrolled in Medicaid could benefit greatly from higher use of routine preventive dental services and earlier treatment of oral diseases to prevent the substantial need for preventable tertiary care services.

Adult↗
PubMed1988

Time estimates for dental treatment in four age cohorts of an adult population.

Needs for tooth extractions, conservative dental treatment--including periodontal and caries treatment--and occlusal rehabilitation--including stomatognathic and prosthetic treatment or a combination of these--in a Finnish adult population were summarized and time estimates for the treatment calculated. The study population consisted of 1,275 adults in four age cohorts--25, 35, 50, and 65 years. A decrease was observed from five hours of total dental treatment time needed at ages 25 and 35 years to four hours at age 50 years and three hours at 65 years. At the age of 25 years, 86 percent of the treatment time (255 min) was needed for conservative therapy, the corresponding figures at 65 years being 35 percent (66 min). On the other hand, a fivefold increase (from 13% to 62%) in the proportion of time needed for occlusal rehabilitation was observed between age 25 and 65. A combination of stomatognathic and prosthetic treatment was most frequently needed. The percent of time needed for tooth extractions varied from 1 to 3 percent among the four age cohorts.

Adult↗