Elda L. Fisher

Prevalence of Visible Third Molars With Caries Experience or Periodontal Pathology in Middle-Aged and Older Americans

PURPOSE To assess the prevalence of periodontal pathology and caries experience in visible third molars, as well as the relationship of these findings to periodontal pathology and caries experience in teeth more anterior in the mouth. PATIENTS AND METHODS Data were from 6,793 Dental Atherosclerosis Risk in Communities participants who underwent a clinical examination for periodontal disease and coronal caries experience and who retained at least 1 visible third molar. Outcome variables were the detection of periodontal pathology or coronal caries experience on visible third molars and on teeth more anterior in the mouth (non-third molars). Periodontal probing depths at least 4 mm (PD4+) and clinical attachment levels at least 3 mm (CAL3+) were indicator variables for periodontal pathology. At least 1 carious/decayed coronal surface or filled coronal surface was an indicator variable for caries experience. Outcomes for third molar and non-third molar teeth were compared by descriptive statistics and χ(2) tests with statistical significance set at P < .05. RESULTS A third of the 6,793 Dental Atherosclerosis Risk in Communities subjects, who averaged 62 years of age, had at least 1 visible third molar. Subjects were more likely to have at least 1 third molar CAL3+ as compared with at least 1 third molar PD4+: 78% versus 61%. PD4+ and CAL3+ were significantly more prevalent among non-third molars as compared with third molars (P < .01). Most subjects, 73%, had restorations on visible third molars and non-third molars, and over two-thirds of subjects had a visible third molar with caries experience and periodontal pathology. Fewer than 2% of subjects had third molars free of caries experience or periodontal pathology. CONCLUSIONS Most subjects had clinical evidence of caries experience or periodontal pathology on visible third molars; few subjects had visible third molars that were disease free. Subjects with periodontal pathology or caries experience on third molars were significantly more likely to have these findings detected on teeth more anterior in the mouth.

Third molars and periodontal pathologic findings in middle-age and older Americans.

PURPOSE To assess the association between the visible presence of third molars and the severity of periodontal pathologic findings on teeth more anterior in the mouth. PATIENTS AND METHODS The present analysis included dentate participants, 52 to 74 years old, from the Dental Atherosclerosis Risk in Communities study who had undergone an oral examination that included periodontal probing depths (PDs) on all visible teeth, including any third molars. A PD of 4 mm or more and a clinical attachment level of 3 mm or greater were indicator variables for periodontal pathologic features. Explanatory variables were the presence or absence of visible third molars. The covariates included gender, ethnicity, age, income level, education, and smoking status. The outcome variables for periodontal pathologic features were the mean PD, extent (percentage of probing sites) of PDs of 4 mm or more, and the extent (percentage of probing sites) of a clinical attachment level of 3 mm or more. The outcomes between those with and without visible third molars were compared using descriptive statistics and chi-square tests, with significance set at P = .05. Multivariate modeling was performed using Statistical Analysis Systems SAS Proc GLM (SAS Institute, Cary, NC) to calculate the least squared means, adjusting for the study outcome variables and covariates. RESULTS The Dental Atherosclerosis Risk in Communities study sample included 6,793 subjects; 80% were white and 19% were black. Most (53%) were 62 to 74 years old and female (54%). Of the 6,793 participants, 2,035 (30%) had at least 1 visible third molar. The presence of a visible third molar was significantly associated with male gender, black race, age younger than the mean of 62.4 years, greater income, and never smoking (all P < .01). A greater mean PD for the first and second molars, the extent of PD of 4 mm or more at the first and second molars, and the extent of a clinical attachment level of 3 mm or more at the first and second molars were all significantly associated with the presence of a visible third molar in the unadjusted and adjusted models. CONCLUSIONS In these middle-age and older Americans, the presence of a visible third molar was significantly associated with more severe periodontal disease on teeth more anterior in the mouth compared with those subjects with no visible third molars.

Visible Third Molars as Risk Indicator for Increased Periodontal Probing Depth

PURPOSE To assess the relationship between visible third molars and the periodontal status of teeth more anterior in the mouth from reports that included periodontal probing data for all teeth. MATERIALS AND METHODS Each of 4 reports that included periodontal probing data, 6 probing sites for all teeth, including third molars collected by trained, clinician examiners, were briefly summarized. The design, strengths, and weaknesses of each of the 4 studies were compared and summarized. A Forest plot was used to combine the findings from the 4 studies comparing the mean second molar probing depth differences in mm by the presence of at least 1 visible third molar or no visible third molar. RESULTS A review of the data from 4 reports, 1 from middle-age adults and 3 from young adults, suggested an association between the visible presence of a third molar and increased periodontal probing depths on teeth more anterior in the mouth, predominately the first and second molars. Coupled with the probing depth around the third molars, the result was an expanded surface area at the biofilm-gingival interface. CONCLUSIONS Although all those with retained third molars are not at increased risk, the summary data we have reported suggest that those with a visible third molar are more likely to have greater periodontal probing depths overall, particularly on second molars, and a greater surface area of the biofilm-gingival interface compared with those with no visible third molar.

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.

Third Molar Caries Experience in Middle-Aged and Older Americans: A Prevalence Study

PURPOSE To assess the prevalence of third molar caries experience in a middle-aged and older population and the relationship of these findings to caries experience in teeth more anterior in the mouth. PATIENTS AND METHODS Data from 6,550 Dental Atherosclerosis Risk in Communities study participants aged 52 to 74 years who underwent a clinical examination for coronal caries experience were available for these analyses. Subjects with visible third molars (N = 2,003) were divided based on third molar coronal caries experience on at least 1 third molar: no carious/decayed coronal surface (DS) or at least 1 coronal DS and no filled coronal surface (FS) or at least 1 coronal FS. Coronal DS and FS were also calculated for more anterior teeth. Covariates included ethnicity, gender, age, body mass index, education, income, smoking status, and diabetes diagnosis. Subject level outcomes for third molar and more anterior teeth were compared by descriptive statistics and chi(2) or t tests with statistical significance set at P less than .05. Multivariate modeling was performed to adjust outcome variables for covariates. RESULTS Third molar caries experience was detected in 77% of subjects and was significantly associated with caries experience in more anterior teeth and white race (P < .01). Caries experience was detected in only third molars in 1% of subjects, and 1% of subjects were caries free. Subjects with less education (20%) and lower income (19%) were significantly more likely to have DS detected compared with subjects with more education (6%) and higher income (5%) (P < .01). Conversely, subjects with more education (75%) and higher income (77%) were significantly more likely to have FS detected compared with subjects with less education (55%) and lower income (60%) (P < .01). CONCLUSIONS Third molar coronal caries experience was significantly associated with caries experience in teeth more anterior in the mouth in this middle-aged and older population.

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 McNemars 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 Visible Third Molars in the United States Population: How Many Individuals Have Third Molars?

PURPOSE To determine the prevalence of third molars in the US population and to report the differences in prevalence of visible third molars in the most recent National Health and Nutrition Examination Survey (NHANES) population of 2011 through 2012 by participant, jaw, and demographics. MATERIALS AND METHODS The number of visible third molars in the NHANES data was assessed in nonclinical settings by trained, calibrated dental hygienists by decade of age beginning in the 20- to 29-year-old cohort through the 70- to 79-year-old cohort. Cross-sectional analyses of third molar data were conducted by the authors from the NHANES databases of 2001 through 2002, 2009 through 2010, and 2011 through 2012 to compare data for similarity of outcomes on third molar prevalence in the US population. Outcomes on third molar prevalence also were assessed from the NHANES of 2011 through 2012 by participant, jaw, and demographics: gender, race or ethnicity (Caucasian, African American, other), and education (less than high school, high school graduate, some college, college graduate). RESULTS Data on the mean number of third molars from NHANES of 2001 through 2002, 2009 through 2010, and 2011 through 2012 were similar. The number of visible third molars in the NHANES of 2011 through 2012 decreased progressively from a mean of 1.48 in the 20- to 29-year-old cohort to 0.81 in the 60- to 69-year-old cohort, No visible third molars were observed in 47% of the 20- to 29-year-old cohort compared with 53% in the 50- to 59-year-old cohort. Participants who were male, non-Caucasian, and had less than a high school education were more likely to have a visible third molar in all age cohorts. No data were collected by NHANES examiners to determine why third molars were absent. CONCLUSION Third molar prevalence did not appear to differ in the US population during the first decade of the 21st century. Numbers of visible third molars, prevalent in young adults, decreased progressively through each successive age cohort. Demographic differences exist for prevalence of third molars in the US population.

Special contribution: Third molar clinical trials annotated bibliography

PURPOSE To provide clinicians with an annotated bibliography of published articles from research funded externally by the Oral and Maxillofacial Surgery Foundation, spanning 1996 to 2015, addressing the topic of third molar management. MATERIALS AND METHODS A brief summary for each article was generated by the respective authors. RESULTS The complete annotated bibliography generated by the authors is included in the Appendix. CONCLUSION The annotated bibliography provides clinicians and other interested individuals with a summary of current literature emanating from clinical studies on third molar topics.

Zygomatic Intraosseous Hemangioma: Case Report and Literature Review

Intraosseous hemangiomas are uncommon intrabony lesions, representing approximately 0.5 to 1% of all intraosseous tumors. Their description varies from “benign vasoformative neoplasms” to true hamartomatous proliferations of endothelial cells forming a vascular network with intermixed fibrous connective tissue stroma. These commonly present as a firm, painless swelling. Intraosseous hemangiomas present more commonly in females than in males and most likely occur in the fourth decade of life. The most common etiology of intraosseous hemangioma is believed to be prior trauma to the area. They have a tendency to bleed briskly upon removal or biopsy, making preoperative detection of the vascular nature of the lesion of significant importance. There are four variants: (1) capillary type, (2) cavernous type, (3) mixed variant, and (4) scirrhous type. Generally most common in the vertebral skeleton, they can also present in the calvarium and facial bones. In the head, the most common site is the parietal bone, followed by the mandible, and then malar and zygomatic regions. Intraosseous hemangiomas of the zygoma are rare entities with the first case reported in 1950 by Schoenfield. In this article, we review 49 case reports of intraosseous hemangioma of the zygoma, and also present a new case treated with excision followed by polyether-ether ketone implant placement for primary reconstruction.