Third molar complications requiring hospitalization.

OBJECTIVE: The aim of this study was to describe demographic and clinical patterns of subjects hospitalized with complications associated with third molars (M3). STUDY DESIGN: The investigation was designed as a prospective cohort study composed of subjects admitted to hospital for management of M3-associated complications. The predictor variable was "clinical status of the M3" defined as (A) prophylactic M3 removal, (B) nonelective M3 removal, or (C) M3 present at the time of admission. Outcome variables were infection parameters, treatment costs, length of hospital stay, and days of disability. Postoperative complications (A and B) were compared to complications based on pericoronitis (C). Complications due to prophylactic removal (A) were compared to those arising from pericoronitis or from the removal of symptomatic teeth (B and C). RESULTS: From January 2003 to December 2004, 45 deep space infections, 6 mandibular fractures, 2 lingual nerve injuries, 1 parapharyngeal tooth luxation, and 1 osteomyelitis were noticed. Fifteen complications resulted from prophylactic surgery (A), 25 from nonelective removal (B), and 15 from pericoronitis (C). Direct treatment costs were 147,000 euro (A: 42,000 euro; B: 74,000 euro; C: 31,000 euro). In 10 of the 15 patients of group C, deep space involvement resulted immediately from the first episode of pericoronitis. Neither clinical markers of infection nor economic parameters showed significant differences between the groups. CONCLUSION: Within the catchment area of our institution, the majority of third molar-related hospitalizations resulted from diseased third molars or their removal.

Socio-economic burden of permanent incisor replantation on children and parents.

This study describes the socio-economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6-17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first-year post-trauma management was 1465 dollars CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post-trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty-one patient-parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over 2000 dollars CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio-economic burden and responsibilities of patient/parent and dentist and their role in informed consent.

Tooth avulsions resulting from basketball net entanglement.

The authors conducted a survey of dentists reporting tooth avulsions from basketball net accidents. Although the number of people injured was small, the dental injuries were serious. In many cases, multiple teeth were avulsed as a result of the maxillary anterior teeth becoming entangled in the basketball net while the patients were attempting to slamdunk a basketball either on a lowered backboard or from a raised take-off area. The authors present recommendations for preventing tooth avulsions resulting from basketball net entanglement.

Treatment of traumatic dental injuries. Shift in strategy.

A more conservative approach to the treatment of traumatic dental injuries has been made possible by knowledge concerning the pathogenesis of external root resorption, increased knowledge about wound healing processes in the pulp and periodontium, as well as by advances in restorative dentistry (reattachment of crown fragments with a dentin bonding system, the use of adhesive bridges, and advances in autotransplantation and implantation). However, a rethinking by the public, clinicians, and third-party payers is necessary for these procedures to gain wider acceptance. The present article describes the state of the art of treating dental trauma in the hope that these advances can become an accepted part of the dental trauma armamentarium and not merely scientific curiosities.