Objective: This study aimed to determine the prevalence of third molar impaction and related pathologic conditions in a cohort of patients living in North-eastern Peninsular Malaysia.
Methods: In this retrospective study, 490 orthopantomograms (OPGs) of patients who were referred to the Oral and Maxillofacial Surgery department between January 2010 and December 2019 were assessed. Data including age, gender, ethnicity, frequency of third molar impactions, their angulations and levels of eruption, retromolar space, and associated pathologic conditions were collected. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24.0. The significance level was set to P < 0.05.
Results: A total of 490 patients with a mean age of 28.87 years (range: 20-64) demonstrated 1957 impacted third molars (1022 mandibular + 935 maxillary). Impacted third molars were more likely present in females than males (1:2.20) (p < 0.05); and in Malay-ethnic (44.49%) patients followed by Chinese (34.45%) and Indians (21.02%). Mesioangular was the most common angulation of impaction both in the maxilla (24.68%) and mandible (18.34%). The most common pattern of third molar impaction was IIA (61.67%), and the retromolar space was significantly larger in males (13.6 mm; P < 0.05) than females (11.6 mm). The most frequently occurring pathological condition associated with third molars impaction is dental caries in the second or third molar (15.38%).
Conclusions: This study highlights mesioangular impaction with their occlusal plane at the same level as the occlusal plane of the adjacent tooth being the most prevalent pattern of third molar impaction in North-eastern Peninsular Malaysia.
METHODS: Case records of patients who underwent third molar extractions at the Prince Philip Dental Hospital in Hong Kong between 3 July 2012 and 22 June 2017 were evaluated retrospectively. Data extraction was performed for indications, clinical and radiographic findings, antibiotic treatment, postoperative complications, and treatment for postoperative infection. The odds ratio (OR) for postoperative infection was estimated.
RESULTS: In total, 1615 extracted over 5 years from 992 patient records were included in the final analysis. Antibiotics were prescribed postoperatively for 44% of the extractions. The overall infection rate was 2.05%. There was no significant difference in infection rates between the groups which underwent extractions with or without antibiotics (OR = .68; P = .289). We found a significantly higher risk for infections with increasing age (P = .002).
CONCLUSION: Infection rates after third molar extraction is minimal in the current setting, with no significant benefit from postoperative antibiotic prescription.
DESIGN: Dental pulp from extracted human permanent teeth was processed for fluorescence immunohistochemistry. Ten asymptomatic (normal) and 10 symptomatic (symptoms associated with pulpitis) teeth were used in this study. Nerve fibers were identified by immunostaining for a marker, protein gene product 9.5, and the cells were counterstained with 4',6-diamidino-2-phenylindole. An anti-TRPV4 antibody was used to trace TRPV4 expression.
RESULTS: TRPV4 expression was co-localized with the nerve fiber marker. Immunoreactivity for TRPV4 was more intense (p
MATERIALS AND METHODS: A total of 370 orthodontic records including their pre-treatment orthopantomographs (OPG) and study models of orthodontic patients in permanent dentition who attended dental clinic were assessed for impaction, hypodontia, supernumerary, supraocclusion, infraocclusion, and any other anomalies excluding the third molars. The association of anomalies with gender status and racial status was analyzed using Pearson's Chi-square test. A P value of <0.05 is considered as significant. The confidence interval at 95% (CI) was set.
RESULTS: Among the 370 subjects, 105 (28.4%) presented with at least one anomaly. Eighty-five (23%) demonstrated a single anomaly and 20 (5.4%) with more than one anomaly. The most prevalent anomaly was impaction (14.32%), followed by hypodontia (7.03%). The less common anomalies were microdontia (1.08%), dilacerations (0.27%), and generalised enamel hypoplasia (0.27%). Maxillary right lateral incisors and canines were the most common affected teeth and these are located on the maxillary right quadrant. It was evident that dental anomalies were statistically dependant on race (P = 0.025), but independent of gender. The most common treatment planned for these patients was fixed appliance.
CONCLUSIONS: Impaction was predominant among 28.4% subjects observed with anomaly and most patients with anomaly are treated with fixed appliances (49%).
CLINICAL RELEVANCE: These anomalies play a great role in occlusion and alignment in treatment planning and relapse for orthodontic treatment.
AIM: To calculate age of transition of the mandibular third (M3) molar tooth stages from archived dental radiographs from sub-Saharan Africa, Malaysia, Japan and two groups from London UK (Whites and Bangladeshi).
MATERIALS AND METHODS: The number of radiographs was 4555 (2028 males, 2527 females) with an age range 10-25 years. The left M3 was staged into Moorrees stages. A probit model was fitted to calculate mean ages for transitions between stages for males and females and each ethnic group separately. The estimated age distributions given each M3 stage was calculated. To assess differences in timing of M3 between ethnic groups, three models were proposed: a separate model for each ethnic group, a joint model and a third model combining some aspects across groups. The best model fit was tested using Bayesian and Akaikes information criteria (BIC and AIC) and log likelihood ratio test.
RESULTS: Differences in mean ages of M3 root stages were found between ethnic groups, however all groups showed large standard deviation values. The AIC and log likelihood ratio test indicated that a separate model for each ethnic group was best. Small differences were also noted between timing of M3 between males and females, with the exception of the Malaysian group. These findings suggests that features of a reference data set (wide age range and uniform age distribution) and a Bayesian statistical approach are more important than population specific convenience samples to estimate age of an individual using M3.
CONCLUSION: Some group differences were evident in M3 timing, however, this has some impact on the confidence interval of estimated age in females and little impact in males because of the large variation in age.
PATIENTS AND METHODS: This prospective, randomized, double-blind study included 65 patients who required surgical removal of impacted mandibular third molars with Class II or position B impaction (Pell and Gregory classification). Patients were randomly assigned to 1 of 3 groups: dexamethasone, methylprednisolone, or placebo (control). Surgery was performed with patients under local anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on postoperative day 1, 2, 5, and 7 to measure postoperative facial swelling by use of 2 linear measurements: interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Wound healing also was assessed on postoperative day 7. Descriptive and multivariate statistics were computed, and significance was set at P
MATERIALS AND METHODS: A PubMed, Medline, EMBASE and Google search was undertaken of all controlled clinical trials on the effects of corticosteroids on pain, swelling and trismus after lower third molar surgery. The review was limited to studies published over the last 10 years (2006-2015).
RESULTS: Of the 46 initially retrieved articles, 34 were finally included. Eleven studies compared the effect of 2 similar (but different dose) or different group of corticosteroids. Thirty-one studies reported the effects of corticosteroids on all sequale, 2 reported the outcome on swelling and trismus and another 1 on swelling and pain only. In 16 of the studies, corticosteroid use resulted in significant reductions in pain after third molar removal. Twenty-two out of 29 studies reported reduced swelling against negative control while 18 out of 25 studies reported improved mouth opening. Fourteen studies reported the benefit of corticosteroids on all 3 sequelae, with 71.4% resulted from the use of methylprednisolone.
CONCLUSION: Although there are some conflicting effects, the results of this analysis shows in general the benefits derived from short-term use of corticosteroids in relation to pain, swelling and trismus following third molar surgical extraction, with no side effects observed.
FUNDING: This work was supported by the University of Malaya's High Impact Research grant UM.C/625/1/HIR/MOHE/05.