Modified Carnoy's Compared to Carnoy's Solution Is Equally Effective in Preventing Recurrence of Odontogenic Keratocysts.

PURPOSE: Carnoy's solution (CS), the gold standard for adjunctive chemical cautery in treatment of odontogenic keratocysts (OKCs), has been banned for 7 years, leading to substitution with the non-chloroform containing modified Carnoy's solution (MC) without data to support its effectiveness. We performed this study to compare the earlier data with CS to the more current outcomes with MC. METHODS: A retrospective cohort study was conducted on patients diagnosed with OKC and treated by a single surgeon (GHB) with enucleation and curettage (EC), peripheral ostectomy, and application of CS or MC. The primary predictor variables were use of CS or MC. The primary outcome variables were recurrence (yes vs. no) and time to recurrence. Secondary variables included demographics, anatomic location, and whether teeth adjacent to the lesion were extracted. Statistical analyses included chi-squared test/Fisher's exact test, Wilcoxon rank sum test, and Kaplan-Meier curves. RESULTS: 77 patients, 36 patients in the CS group and 41 in the MC group, met inclusion criteria, including at least 1 year of follow-up time. Characteristics of the groups were similar: median age 41.5 and 46, 61% and 71% male gender, 81% and 90% posterior, and 64% and 50% mandibular lesions, respectively. Overall recurrence was similar, 14.29%, with 5 (13.9%) recurrences in the CS group and 6 (14.6%) in the MC group (P = 0.92). Median time to recurrence was 24 months for both groups. Preserving adjacent teeth was associated with a significant increase in recurrence (P = 0.0036). CONCLUSION: Based on this comparison of retrospective outcome data, we found no significant difference in recurrence rate or distribution of time to recurrence between OKCs treated with CS or MC. Aggressiveness of surgical technique is likely a predictive factor in recurrence rate. Future studies should focus on prospective studies and continuing follow-up of the MC group.

High Fidelity Virtual Reality Orthognathic Surgery Simulator.

Surgical simulators are powerful tools that assist in providing advanced training for complex craniofacial surgical procedures and objective skills assessment such as the ones needed to perform Bilateral Sagittal Split Osteotomy (BSSO). One of the crucial steps in simulating BSSO is accurately cutting the mandible in a specific area of the jaw, where surgeons rely on high fidelity visual and haptic cues. In this paper, we present methods to simulate drilling and cutting of the bone using the burr and the motorized oscillating saw respectively. Our method allows low computational cost bone drilling or cutting while providing high fidelity haptic feedback that is suitable for real-time virtual surgery simulation.

Topical application of a mucoadhesive freeze-dried black raspberry gel induces clinical and histologic regression and reduces loss of heterozygosity events in premalignant oral intraepithelial lesions: results from a multicentered, placebo-controlled clinical trial.

PURPOSE: Approximately 30% higher grade premalignant oral intraepithelial neoplasia (OIN) lesions will progress to oral cancer. Although surgery is the OIN treatment mainstay, many OIN lesions recur, which is highly problematic for both surgeons and patients. This clinical trial assessed the chemopreventive efficacy of a natural product-based bioadhesive gel on OIN lesions. EXPERIMENTAL DESIGN: This placebo-controlled multicenter study investigated the effects of topical application of bioadhesive gels that contained either 10% w/w freeze-dried black raspberries (BRB) or an identical formulation devoid of BRB placebo to biopsy-confirmed OIN lesions (0.5 g × q.i.d., 12 weeks). Baseline evaluative parameters (size, histologic grade, LOH events) were comparable in the randomly assigned BRB (n = 22) and placebo (n = 18) gel cohorts. Evaluative parameters were: histologic grade, clinical size, and LOH. RESULTS: Topical application of the BRB gel to OIN lesions resulted in statistically significant reductions in lesional sizes, histologic grades, and LOH events. In contrast, placebo gel lesions demonstrated a significant increase in lesional size and no significant effects on histologic grade or LOH events. Collectively, these data strongly support BRB's chemopreventive impact. A cohort of very BRB-responsive patients, as demonstrated by high therapeutic efficacy, was identified. Corresponding protein profiling studies, which demonstrated higher pretreatment levels of BRB metabolic and keratinocyte differentiation enzymes in BRB-responsive lesions, reinforce the importance of local metabolism and differentiation competency. CONCLUSIONS: Results from this trial substantiate the LOH reductions identified in the pilot BRB gel study and extend therapeutic effects to significant improvements in histologic grade and lesional size.

Removal of symptomatic third molars may improve periodontal status of remaining dentition.

PURPOSE: To assess the impact of third molar removal on the periodontal status of adjacent second molars and teeth more anterior in the mouth in patients with mild symptoms of pericoronitis. PATIENTS AND METHODS: Healthy patients with mild symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for a study approved by the institutional review board. The subset analyzed in this study had all 4 third molars removed. Data were collected at enrollment and at least 3 months after surgery. Full-mouth periodontal probing was conducted at 6 sites per tooth. A probing depth of at least 4 mm (PD4+) was considered an indicator for periodontal pathology. The presence of a PD4+ on the distal of second molars (D2Ms) or anterior to the D2Ms, the number of PD4+s, and extent scores (percentage of PD4+s of all possible probing sites) were assessed at the patient and jaw levels. The association between patients' pre- and postsurgical periodontal status was assessed using the McNemar exact test. The level of significance was set at .05. RESULTS: The median age of the 69 patients was 21.8 years (interquartile range, 20.2 to 25.2 yr). Forty-five percent were men, and 57% were Caucasian. Significantly more patients (88%) had at least 1 D2M PD4+ at enrollment compared with after surgery (46%; P < .01). D2M extent scores decreased from 31.5 at enrollment to 11 after surgery. Significantly more patients (61%) had at least 1 PD4+ anterior to the D2M at enrollment compared with after surgery (29%; P < .01). Extent scores anterior to the D2M decreased from 2.0 at enrollment to 0.6 after surgery. CONCLUSIONS: Removal of third molars in patients with mild pericoronitis symptoms improved the periodontal status of the D2Ms and teeth more anterior in the mouth.

Mechanical debridement of subgingival biofilm in participants with asymptomatic third molars does not reduce deeper probing depths in the molar regions of the mouth.

PURPOSE: To assess the impact of mechanical debridement of subgingival biofilm on periodontal outcomes in adolescents and young adults with asymptomatic third molars. METHODS: Healthy participants with 4 asymptomatic third molars were enrolled in an institutional review board-approved longitudinal study. Clinical data were collected at enrollment and at follow-up visits. Full-mouth periodontal probing, 6 sites per tooth, was assessed as a measure of clinical periodontal status. At enrollment, all participants had dental prophylaxis after data collection, which included removal of subgingival biofilm; this was repeated annually. The primary outcome measures were the comparison from baseline to follow-up 2 years after enrollment of participants' periodontal probing depths for third molars and first/second molars. In addition, a comparison of extent scores at baseline to follow-up 2 years after enrollment for periodontal probing sites of at least 4 mm was performed for the same molar regions of the mouth. Changes over time in clinical periodontal status from enrollment to the follow-up at least 2 years later were analyzed with Mantel-Haenszel row mean score statistics. The level of significance was set at P < .05. RESULTS: The median follow-up from entry to the study was 2.2 years (interquartile range, 2.0-2.8 years) for 262 participants who averaged 27.7 years of age (SD, 1.2 years); 53% were female participants, and 81% were white. Most participants (90%) were educated beyond high school. On the basis of periodontal probing depths, participants' clinical periodontal status did not differ from enrollment to follow-up. CONCLUSIONS: Dental prophylaxis at yearly intervals in participants with asymptomatic third molars, which included mechanical removal of subgingival biofilm, had minimal or no impact on reducing deeper probing depths, clinical indicators of periodontal pathology in young adults.

Quality of life outcomes after third molar removal in subjects with minor symptoms of pericoronitis.

PURPOSE: Our purpose was to assess the effect of third molar removal on the quality of life in subjects with symptoms of pericoronitis. PATIENTS AND METHODS: Healthy subjects (American Society of Anesthesiologists Classes I and II), aged 18 to 35 years, with minor symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for an institutional review board-approved study. The exclusion criteria were major symptoms of pericoronitis, generalized periodontal disease, body mass index greater than 29 kg/m(2), and antibiotic or tobacco use. The data from patients undergoing surgery to remove all third molars with a follow-up examination after surgery at least 3 months later were included in these analyses. The clinical, demographic, and quality of life data were collected at enrollment and after surgery. At entry, the debris was removed from symptomatic third molar sites; no attempt was made to mechanically remove nonsheddable biofilm. The patients scheduled surgery electively with a recall examination at least 3 months after surgery. RESULTS: The median age of the 60 subjects was 21.9 years (interquartile range 20.2 to 24.7). The median postoperative follow-up was 7.7 months (interquartile range 6.0 to 12.4). The proportion of patients reporting the worst pain as severe decreased from enrollment to after surgery from 32% to 3%. Those responding "none" for the worst pain increased from 10% to 78%. Fifteen percent of subjects reported the pain intensity as "nothing," "faint," or "very weak" at enrollment. This increased to 96% after surgery. One third of patients reported the unpleasantness of pain as "neutral," "slightly unpleasant," or "slightly annoying" at enrollment, which increased to 97% after surgery. Also, 22% and 18% of the patients reported "quite a bit" or "lots of difficulty" with eating desired foods and chewing foods at enrollment, respectively; only 1 patient reported this degree of difficulty at the follow-up examination. In contrast, 42% and 37% of the patients reported no difficulty with eating and chewing at enrollment, which had increased to 95% and 93% at the follow-up examination, respectively. CONCLUSIONS: Removal of the third molars positively influenced the quality of life outcomes in those with minor symptoms of pericoronitis.

Changes over time in the prevalence of caries experience or periodontal pathology on third molars in young adults.

PURPOSE: To assess the prevalence of caries experience and periodontal pathology on third molar teeth compared with first and second molars and teeth more anterior from subjects who had data collected over time in a longitudinal clinical study. PATIENTS AND METHODS: Healthy subjects with 4 asymptomatic third molars and data for at least 4 years after enrollment were included in these analyses. The presence or absence of caries experience on the occlusal surface of the third molars and any surface of the first or second molars was assessed using a visual-tactile caries examination. Full mouth periodontal probing, 6 sites per tooth, was conducted as a measure of clinical periodontal status. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none, and caries experience versus no caries experience. The prevalence of caries experience and periodontal pathologic findings at follow-up and the relationship of the occurrence between the third molars and teeth more anterior in the mouth were examined using McNemar's statistics. RESULTS: The follow-up was a median of 6.9 years (interquartile range 4.6 to 7.7 years) for 179 subjects, with a mean age of 29 years. More subjects were female (54%) and white (80%). At follow-up, 85% of the subjects had caries experience detected on the first or second molars, and only 50% had a third molar affected. In contrast, at follow-up, the presence of at least 1 periodontal probing depth of at least 4 mm was marginally more prevalent on the third molars than on the first or second molars (56% and 50%, respectively). Fewer subjects had third molars free of caries experience and periodontal pathology at follow-up compared with at enrollment (28% versus 38%, respectively). CONCLUSIONS: The prevalence of both third molar caries experience and third molar periodontal pathology increased from baseline to the follow-up examination. At follow-up, the prevalence of caries experience was greater on the first or second molars than on the third molars, and periodontal pathology were greater on the third molars than on the more anterior teeth.

Prevalence of third molars with caries experience or periodontal pathology in young adults.

PURPOSE: We assessed the prevalence of caries experience and periodontal pathology on asymptomatic third molars in young adults. SUBJECTS AND METHODS: Healthy subjects with 4 asymptomatic third molars were enrolled in an institutional review board-approved study during a 5-year period. Full mouth periodontal probing, 6 sites per tooth, was the measure of clinical periodontal status. The presence or absence of occlusal caries experience (carious lesions or restorations, including sealants) on third molars and on any surface of the first and second molars were assessed using a visual-tactile examination and panoramic radiographs. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none and caries experience versus no caries experience. RESULTS: The data were analyzed from 409 subjects, who averaged 25 years old. More subjects were female (53%) and white (76%). More subjects had at least 1 periodontal probing depth of 4 mm or deeper on a third molar (55%) than on the distal of a second molar (46%). These findings were more likely to be detected around a third molar in subjects with all third molars at the occlusal plane (72%) than in subjects with at least one third molar below (33%). Overall, fewer subjects were affected by third molar caries experience than first or second molars (24% vs 73%, respectively). Of the subset of subjects with all four third molars at the occlusal plane, 26% were affected by both third molar periodontal pathology and caries experience and 16% were caries and periodontal pathology free. CONCLUSIONS: In these cross-sectional analyses, periodontal pathology was detected more frequently on third molars than on first and second molars and caries experience was detected more frequently on first and second molars than on third molars.

Second molar periodontal inflammatory disease after third molar removal in young adults.

PURPOSE: To assess the prevalence of periodontal inflammatory disease on the distal side of second molars after third molar removal and the association between presurgical and surgical variables and postsurgical periodontal outcomes. PATIENTS AND METHODS: Data before and after surgery from 2 studies approved by an institutional review board were used. In 1 study, 26 subjects had 4 asymptomatic third molars and in the other 49 subjects had at least 1 mandibular third molar with symptoms of pericoronitis. Full-mouth periodontal probing data, 6 sites per tooth, were obtained as a measurement of periodontal status before and after surgery. A probing depth (PD) ≥4 mm on either of the 2 possible probing sites on the distal side of any second molar (D2M) served as an indicator of periodontal inflammatory disease; periodontal health was defined as all D2M PD <4 mm. Cochran-Mantel-Haenszel row mean score tests compared the subjects' postsurgical periodontal status (all D2M PD <4 mm and at least 1 D2M PD ≥4 mm) with respect to age and time intervals, and the Fisher exact test was used to compare ethnicity, gender, and clinical data at surgery. The McNemar test was used to assess the discordance between subjects' pre- and postsurgical periodontal status. The level of significance was set at .05. RESULTS: Of the 75 subjects, 52% were women and 65% were white. The median age at surgery was 23.6 years (interquartile range, 20.9 to 26.6 years). At enrollment, 53 of 75 subjects (71%) had at least 1 D2M PD ≥4 mm. Subjects were significantly more likely to have an improved D2M periodontal status after surgery than a deteriorated status (P < .01). Fewer subjects, 17 of 75 (24%), had at least 1 D2M PD ≥4 mm after surgery. D2M PD ≥4 mm was more likely after surgery if presurgical D2M was PD ≥4 mm (P < .01). Gender, ethnicity, age, presurgical symptoms, and data estimating the extensiveness of surgery were not significantly associated with postsurgical D2M periodontal outcomes. CONCLUSIONS: After third molar removal, periodontal inflammatory disease on the distal of D2Ms was detected significantly less often. None of the variables examined except for presurgical presence of D2M PD ≥4 mm were significantly associated with postsurgical D2M periodontal inflammatory disease.

Third molars and periodontal pathology in American adolescents and young adults: a prevalence study.

PURPOSE: To assess the association between visible third molars and the prevalence of periodontal inflammatory disease of non-third molars. PATIENTS AND METHODS: Subjects aged 14 to 45 years with 4 asymptomatic third molars were enrolled in an institutional review board-approved study. Subjects were classified based on whether at least 1 third molar was visible or all third molars were not visible. Full-mouth periodontal probing depth (PD) data, with 6 sites per tooth, were obtained as a measure of a subject's periodontal status. At least 1 non-third molar PD of 4 mm or greater was indicative of periodontal inflammatory disease. Outcomes for the respective groups were compared by use of Cochran-Mantel-Haenszel row mean score statistics. The level of significance for differences was set at .05. RESULTS: The 342 subjects in the visible group were significantly older, with a median age of 26 years (interquartile range, 22.4-32.2 years), as compared with the 69 subjects in the not visible group, with a median age of 21 years (interquartile range, 18.8-24.9 years) (P < .01). The proportion of males and females was not statistically different between groups (P > .05). Most subjects were white. Significantly more subjects with at least a college education were in the visible group than in the not visible group (P < .01). The rate of tobacco use was low and did not differ between groups. Subjects in the visible group were significantly more likely to have at least 1 PD of 4 mm or greater on non-third molars than those in the not visible group: 59% versus 35%. In both groups, first/second molars were more affected than nonmolars when we controlled for differences in age between groups. CONCLUSIONS: The visible presence of third molars in adolescents and young adults was significantly associated with periodontal inflammatory disease of non-third molars.

Changes over time in the periodontal status of young adults with no third molar periodontal pathology at enrollment.

PURPOSE: To assess changes in periodontal status over time in subjects with all third molar region periodontal probing depths (PDs) of less than 4 mm at enrollment. PATIENTS AND METHODS: Subjects were a subsample of young adults enrolled with 4 asymptomatic third molars in an institutional review board-approved longitudinal study. Full-mouth periodontal PD data, 6 sites per tooth, were measures of periodontal status. Data were aggregated to subject and jaw levels. A PD of 4 mm or greater was considered an indicator variable for periodontal pathology. Subjects were classified according to PD at follow-up: all PDs of less than 4 mm or at least 1 PD of 4 mm or greater. The demographic differences and the third molar anatomic position at baseline were compared to assess whether enrollment factors were related to the changes in periodontal pathology. The level of significance was set at .05. RESULTS: One hundred six subjects had all third molar region PDs of less than 4 mm at enrollment and were aged 25 years on average. Of these, 38% had a change in third molar region periodontal status, with at least 1 third molar region PD of 4 mm or greater detected at a median follow-up of 4.1 years (interquartile range, 2.4-5.9 years). A PD of at least 4 mm was detected significantly more often in the mandibular third molar region than in the maxillary third molar region (P < .01). No significant differences in age, gender, education, or length of follow-up were detected between the 40 subjects with a change in periodontal status in the third molar region and the 66 subjects who remained periodontally healthy (P > .05). At follow-up, 50% of subjects with at least 1 PD of 4 mm or greater in the third molar region had at least 1 PD of 4 mm or greater in non-third molar regions as compared with 15% of subjects with all third molar region PDs of less than 4 mm (P < .01). CONCLUSIONS: Periodontal pathology developing over time in healthy young adults was significantly more likely in the mandibular third molar region and mandibular non-third molars.

Multimodality surgical and hyperbaric management of mandibular osteoradionecrosis.

PURPOSE: To elucidate long-term outcomes in 65 consecutive patients meeting a uniform definition of mandibular osteoradionecrosis (ORN) treated with multimodality therapy including hyperbaric oxygen (HBO). METHODS AND MATERIALS: Pretreatment, post-treatment and long-term follow-up of mandibular lesions with exposed bone were ranked by a systematic review of medical records and patient telephone calls. The ranking system was based on lesion diameter and number plus disease progression. Changes from pretreatment to post-treatment and follow-up were analyzed by Wilcoxon signed-rank tests. Improved wound survival, measured by time to relapse, defined as any less favorable rank after HBO treatment, was assessed by Kaplan-Meier analysis. RESULTS: In all, 57 cases (88%) resolved or improved by lesion grade or progression and evolution criteria after HBO (p < 0.001). Four patients healed before surgery after HBO alone. Of 57 patients who experienced improvement, 41 had failed previous nonmultimodality therapy for 3 months and 26 for 6 months or more. A total of 43 patients were eligible for time-to-relapse survival analysis. Healing or improvement lasted a mean duration of 86.1 months (95% confidence interval [95% CI], 64.0-108.2) in nonsmokers (n = 20) vs. 15.8 months (95% CI, 8.4-23.2) in smokers (n = 14) versus 24.2 months (95% CI, 15.2-33.2) in patients with recurrent cancer (n = 9) (p = 0.002 by the log-rank method). CONCLUSIONS: Multimodality therapy using HBO is effective for ORN when less intensive therapies have failed. Although the healing rate in similarly affected patients not treated with HBO is unknown, the improvements seen with peri-operative HBO were durable provided that the patients remained cancer free and abstained from smoking.

Evidenced-based decision making: the third molar.

The American Association of Oral and Maxillofacial Surgeons (AAOMS) has been at the forefront of formal evidence-based dentistry with such projects as the Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgeons, the AAOMS Outcomes Assessment Program, the AAOMS Third Molar Clinical Trial, and the AAOMS "White Paper on Third Molar Data." This article reviews these evidence-based resources to provide a consensus of opinion for the management of the third molar.

Impact of removal of asymptomatic third molars on periodontal pathology.

PURPOSE: This study assessed the impact of third molar removal on periodontal pathology in subjects with third molars asymptomatic at enrollment. PATIENTS AND METHODS: Subjects in whom at least 2 third molars were removed were a subsample of healthy young subjects enrolled with 4 asymptomatic third molars in an institutional review board-approved longitudinal study. Full-mouth periodontal probing (PD) data, 6 sites per tooth, were obtained as a measure of periodontal status at each of 3 visits: enrollment, before removal of third molars, and after removal of third molars. Data were aggregated to subject and jaw levels. The oral cavity was divided by jaw into segments: the third molar region including the third molar (12 probing sites), distal to the second molar (4 probing sites), and non-third molars (80 probing sites). A PD >or=4 mm was considered an indicator variable for periodontal pathology. The number and percent of sites with a PD >or=4 mm were calculated from the total number of probing sites across all subjects. The frequency of subjects with at least one PD >or=4 mm and all third molars removed were compared with the frequency of subjects retaining at least 1 mandibular third molar using Fisher's exact test, with significance set at 0.05. RESULTS: Sixty-nine subjects had third molars removed: 57% were female, and 77% were Caucasian. The median age at surgery was 26.3 years (interquartile range, 23.3-31.5 yr). The median interval from enrollment to surgery was 2.4 years (interquartile range, 1.5-4.2 yr). The median follow-up after surgery was 9 months (interquartile range, 6.7-15.4 mo). All third molars were removed in 56 subjects; 13 retained at least 1 mandibular third molar. More subjects had at least 1 PD >or=4 mm around their mandibular third molars before surgery compared with enrollment (52% vs 45%, respectively). Of the total possible mandibular third molar probing sites, 18% had PD >or=4 mm presurgery compared with 12% at enrollment. Significantly fewer subjects who had all third molars removed had a PD >or=4 mm on the distal of their mandibular second molars after surgery, compared with those retaining at least 1 mandibular third molar (20% vs 69%, respectively, P= .001). The number of PDs >or=4 mm in the mandible was less after surgery if all third molars had been removed (1.4% vs 6.6%, respectively). CONCLUSION: Removal of the mandibular third molars significantly improved the periodontal status on the distal of second molars, positively affecting overall periodontal health.

Comparison of periodontal inflammatory disease in young adults with and without pericoronitis involving mandibular third molars.

PURPOSE: To compare the prevalence and severity of periodontal inflammatory disease in subjects with pericoronitis involving a mandibular third molar and those without pericoronitis. PATIENTS AND METHODS: Data obtained from healthy adults consecutively enrolled in an institutional review board-approved trial with pericoronitis affecting at least 1 mandibular third molar (study group) were compared with data obtained during the same time frame from subjects without pericoronitis enrolled in a longitudinal third molar monitoring study (comparison group). The periodontal status of each subject was classified based on periodontal probing depths (PD): all PD <4 mm, no disease; 1 to 3 PD >or=4 mm, incipient disease; at least 4 PD >or=4 mm, early disease. Full mouth periodontal probing data were obtained as clinical measures of periodontal status. Data were aggregated to the subject level for the third molar region, the 6 third molar probing sites and the 2 second molar distal probing sites, the non-third molar region, and all remaining probing sites. The prevalence of disease in the study and comparison groups were compared with the Fisher's exact test. As an indicator of disease severity, the number of PD >or=4 mm in the 2 groups were compared by the Kruskal-Wallis test. Level of significance was set at P values less than .05. RESULTS: Median age of the 56 subjects with pericoronitis was 23.3 years (IQR 21.3-26.0 years). Fifty-five percent were Caucasian, 16% African American, and 22% Asian. Males and females were almost equally represented in the study group and in the comparison group. The 194 subjects enrolled without pericoronitis were significantly older (32.8 years; IQR 27.2-40.0 years; P < .001). Eighty-four percent were Caucasian, 10% African American, and 4% Asian. The proportion of subjects with periodontal inflammatory disease in the third molar region was significantly different between the study and comparison groups. Thirty-one percent of the subjects with pericoronitis had incipient and 55% early disease in the third molar region compared with 25% with incipient and 38% with early disease among subjects without pericoronitis (P = .003). The pattern was similar, but the proportion of subjects was not significantly different between the groups for the non-third molar region. In the study group, 32% had incipient disease and 32% early disease compared with 27% with incipient disease and 22% with early disease in the comparison group (P = .09). The median number of PD >or=4 mm for all teeth differed significantly for subjects with and without pericoronitis (median 5 [IQR 3-9] vs 3 [IQR 0-8], respectively; P = .03). CONCLUSION: Pericoronitis involving mandibular third molars may reflect more underlying periodontal inflammatory disease in affected young adults than might be found in young adults with retained third molars and no pericoronitis.

Risk markers for periodontal pathology over time in the third molar and non-third molar regions in young adults.

PURPOSE: This study was conducted to analyze the clinical impact of risk markers for third molar and non-third molar periodontal pathology over time. PATIENTS AND METHODS: Data were obtained from healthy adults with 4 asymptomatic third molars in an institutional review board-approved trial. Full-mouth periodontal probing depth (PD) data were collected as clinical measures of possible periodontal pathology. The third molar region included the 6 third molar probing sites and the 2 second molar distal probing sites (maximum of 16 sites per jaw). The non-third molar region included all remaining probing sites (maximum of 80 sites per jaw). Periodontal PDs were considered indicator variables for clinically detected periodontal pathology or its absence at baseline and follow-up. Subjects were grouped based on all PD less than 4 mm (no disease), 1 to 3 PD >or=4 mm (incipient disease), or at least 4 PD >or=4 mm (early disease). Levels of periodontal pathogens and gingival crevicular fluid inflammatory mediators at baseline also were assayed as risk markers for periodontal pathology. Baseline risk markers and possible confounding variables were included in risk assessment models to derive odds ratios and 95% confidence intervals for periodontal pathology in the third molar and non-third molar regions at follow-up. RESULTS: A total of 195 subjects had a median follow-up of 5.9 years (interquartile range [IQR] = 4.6 to 6.9 years). Median age at enrollment was 26.2 years (IQR = 22 to 34 years); 52% were female, 84% were Caucasian, and 10% were African-American. A significant association was found between baseline and follow-up third molar region and non-third molar region periodontal pathology indicators (P < .01). Subjects who had incipient or early disease in the third molar region at baseline were significantly more likely to have an indication of periodontal pathology at follow-up in the third molar region and in the non-third molar region compared with those in whom no disease was detected at baseline. CONCLUSIONS: In young adults, the presence of periodontal pathology as indicated by periodontal PDs in the third molar region at baseline was predictive of detection of periodontal pathology in the third molar and non-third molar regions at follow-up.

Changes over time in position and periodontal probing status of retained third molars.

PURPOSE: This study was designed to assess changes over time in third molar position relative to the occlusal plane and in the periodontal probing status of third molars in asymptomatic subjects who had at least 1 third molar below the occlusal plane at baseline and retained all third molars to follow-up. PATIENTS AND METHODS: Between 1998 and 2002, healthy subjects with 4 asymptomatic third molars and adjacent second molars were enrolled in an institutional review board (IRB)-approved longitudinal study. Clinical and radiographic data of 146 subjects who had at least 1 third molar not fully erupted at baseline with at least 2-year follow-up were analyzed. At baseline and longest follow-up, full mouth periodontal probing, 6 sites per tooth, including third molars was conducted. An indicator variable was used to record periodontal status (probed, not probed) for each third molar. A periodontal probing depth (PD) greater than or equal to 4 mm in the third molar region was considered indicative of periodontal pathology. Panoramic radiographs were analyzed to assess whether unerupted third molars erupted to the occlusal plane. To assess descriptively the influence of age and length of follow-up on the change in third molar position and periodontal status, subjects were stratified by age at enrollment as younger (<25 years) or older (>or=25 years) and by length of follow-up as shorter follow-up (2 to <4 years), or longer follow-up (4 or more years). Because of the small sample sizes in each stratum, analyses are limited to descriptive statistics only. RESULTS: Sixty-six percent of the 146 subjects were less than 25 years old at enrollment. The majority were female and Caucasian. Sixty-eight percent of the 97 younger subjects and 43% of the 49 older subjects presented at baseline with all 4 third molars not fully erupted. Of 584 third molars evaluated, 79% were not fully erupted at baseline; of 462 molars, 80% could not be probed at baseline. Eruption to the level of the occlusal plane occurred in all 4 strata although only a third of the unerupted molars reached the occlusal plane even in the younger subjects with the longer follow-up. Of 369 molars that could not be probed at baseline, approximately 35% could be probed at follow-up with the highest percentage of change in the older subjects with the longer follow-up (46%). CONCLUSIONS: The anatomic position of third molars was not static over time even if subjects were greater than 25 years old. Thus, unerupted third molars should be monitored for changes in position and periodontal pathology as long as the teeth are retained.

Changes in third molar and nonthird molar periodontal pathology over time.

PURPOSE: The purpose of this study was to assess changes in periodontal probing depth (PD) over time for third molar and nonthird molar regions in young adults. PATIENTS AND METHODS: The data were obtained from healthy subjects with 4 asymptomatic third molars, enrolled in an IRB-approved longitudinal trial. Demographic and oral health data were collected at baseline. Full-mouth PD, 6 sites per tooth, was conducted to determine periodontal status at baseline and at longest follow-up. The third molar region was defined as the PD for 6 sites around the third molars and the 2 sites on the distal of the second molars. The nonthird molar region was defined as the remainder of the PD sites in the mouth. The primary outcome measures for this study were the occurrence of a PD greater than or equal to 4 mm and the increase in PD of at least 2 mm in the third molar and nonthird molar regions. Changes from enrollment to longest follow-up were compared by the binomial or McNemar's test. Level of significance was .05. RESULTS: Data from 195 subjects were available, and the median follow-up was 5.9 years (interquartile range [IQ], 4.6 to 6.9 years). Median age at enrollment was 26.2 years (IQ, 22.0 to 34.0 years); 52% were female, 84% were Caucasian, and 10% were African American. The proportion of subjects with at least 1 involved site in nonthird molars increased significantly from baseline to follow-up, 36% to 49% (P < .01), reflecting mostly changes in mandibular nonthird molars, 33% to 48% (P < .01). Of the 122 subjects who presented at baseline with at least 1 PD greater than or equal to 4 mm in the third molar region, the proportion of subjects with at least 1 involved site in nonthird molars increased significantly from baseline to follow-up, 48% to 59% (P = .05), also reflecting mostly changes in mandibular nonthird molars, 44% to 59% (P = .05). CONCLUSION: In this unique longitudinal clinical study of early periodontal disease in young adults, periodontal pathology worsened over time for nonthird molars. This was more likely if PD greater than or equal to 4 mm was detected in the third molar region.