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.

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 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.

Proximity of a lower third molar to the inferior alveolar canal as a predictor of delayed recovery.

PURPOSE: This study was designed to test the hypothesis that removal of lower third molars below the occlusal plane and in close proximity to the inferior alveolar canal (IAC) delays recovery after surgery as compared with lower third molars below the occlusal plane yet not close to the IAC. PATIENTS AND METHODS: Recovery data were available for 579 patients enrolled in an institutional review board-approved clinical trial. After surgery a questionnaire designed to assess health-related quality of life (HRQOL) recovery was given to the patient to be completed each day for 14 days. At each postsurgery visit, clinical data were collected detailing healing and treatment. Based on radiographic findings, patients with at least 1 mandibular third molar below the occlusal plane were identified. Outcomes for patients with at least 1 radiographic sign indicating proximity of a lower third molar to the IAC were compared with those with none. Clinical and HRQOL outcomes were compared with Cochran-Mantel-Haensel statistics (P < .05). RESULTS: No significant differences were found between groups for delayed clinical recovery. If radiographic signs for a patient at presurgery evaluation indicated close proximity of a lower third molar to the IAC, odds were significantly increased for delayed HRQOL recovery for worst pain, lifestyle, and oral function. CONCLUSION: Our findings support the hypothesis that a presurgery finding of a lower third molar below the occlusal plane and in close proximity to the IAC is associated with patients' prolonged HRQOL recovery, but not a significant delay in clinical recovery.