Raymond P. White

Arterial blood gas levels after midazolam or diazepam administered with or without fentanyl as an intravenous sedative for outpatient surgical procedures

The purpose of this study was to compare arterial blood gas measurements made during the baseline, initial sedation, maintenance, and recovery periods in patients sedated with midazolam and saline (MS), midazolam and fentanyl (MF), diazepam and saline (DS), and diazepam and fentanyl (DF). During induction both the MF and the DF groups had significantly lower average PO2, pH, and O2 saturations and significantly higher PCO2 values than either the MS or the DS group. While the differences were not as great, the same was also true during the maintenance phase of the procedure. During recovery, patients receiving MF had lower average PO2, pH, and O2 saturation and higher PCO2 values than the MS or the DF group. Patients receiving MF had significantly lower average PO2, pH, and O2 saturation levels and significantly higher average PCO2 levels during all three postsurgical periods than at baseline. Patients receiving DF had significantly lower average PO2, pH, and O2 saturation levels and significantly higher Pco2 levels during both induction and maintenance than at baseline.

Autogenous dermal grafts for repair of temporamandibular joint disc perforations

In five Macaca fascicularis monkeys bilateral 5-mm perforations of the intra-articular disc were followed by unilateral repair with autogenous dermal grafts. The monkeys were killed at three, six, 12, 24, and 36 weeks after surgery. The temporomandibular joints (TMJs) were removed en bloc, decalcified, and sectioned in the sagittal plane for histologic examination. All of the control untreated disc perforations, with the exception of one, failed to heal. With all of the grafted disc perforations, viable dermis and fibrous connective tissue proliferation were seen in the area of the repaired perforation. Therefore, autogenous dermal grafting appears to be an acceptable technique for repair of the damaged disc in degenerative joint disease of the TMJ.

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.

Assessment of patients for orthognathicsurgery

Rapid advances in orthognathic surgery now allow the clinician to treat severe dentofacial deformities that were once only manageable by orthodontic camouflage. These cases were often compromised with unacceptable facial esthetics and unstable occlusal results. Over the past 25 years, there have been numerous improvements in technology and the surgical management of dentofacial deformities. These progressions now allow more predictable surgical outcomes, which ensure patient satisfaction. Not all patients are candidates for surgical treatment; therefore, patient assessment and selection remains paramount in the process of diagnosing and treatment planning for this type of irreversible treatment. The inclusion of patients in the decision-making process increases their awareness and acceptance of the final result. The past three decades indicate an increased usage of orthodontic treatment by both children and adults. Patient demographic profiles for severe occlusal and facial characteristics are presented in an effort to understand the epidemiological factors of malocclusion and predict the populations need for this service.

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 Fishers 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.

Treatment of severe malocclusions by correlated orthodontic-surgical procedures.

Abstract No Abstract Available. Presented before the North Atlantic Component of the Angle Society, Ft. Lauderdale, Florida, April 8, 1969.

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.

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 subjects 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.