Sören Eliasson

Pathological changes related to long-term impaction of third molars. A radiographic study.

Pathological changes related to impacted 3rd molars (ITM) were studied in a radiographic investigation of 2128 randomly selected patients. In radiographs from 644 patients, 1211 ITM were noted. Pathological changes were observed in 25 of 477 (5.2%) maxillary ITM and in 59 of 734 (8%) mandibular ITM. A pathologically widened pericoronal space (indicating a dentigerous cyst) was observed in 5 of 477 maxillary and 43 of 734 mandibular ITM (p less than 0.001). Other pathologic changes observed were resorption of the 2nd molars (1% in the maxilla, 1.5% in the mandible) or loss of marginal bone on the distal aspect of the second molars (4% in the maxilla, 1% in the mandible). The risk of pathological sequelae because of ITM, apparently, is low. Prophylactic surgical removal should, therefore, be regarded with some reserve, particularly in view of the high frequency of deep impactions, with greater risk for surgical complications.

Inflammatory mediators and radiographic changes in temporomandibular joints of patients with rheumatoid arthritis

The aim of this study was to investigate the relation between the inflammatory mediators tumor necrosis factor alpha (TNF ! ) and serotonin (5-HT), the inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as rheumatoid factor (RF) and thrombocyte particle concentration (TPC) in blood versus temporomandibular joint (TMJ) radiographic changes in patients with clinical TMJ involvement by rheumatoid arthritis (RA). Twenty patients were included. Venous blood was collected for quantification of the mediators, markers, and TPC. The radiographic signs of erosion, flattening, sclerosis, subchondral pseudocyst, and osteophyte as well as radiographic grade were investigated with computed tomography. The median (IQR) plasma levels of TNF ! and 5-HT were 0 (13) r pg/mL and 13 (22) r nmol/L, respectively, while serum level of 5-HT was 1360 (874) nmol/L. ESR, CRP, and TPC were abnormally high in 53%, 25%, and 15% of the patients, respectively. The most frequent radiographic signs were sclerosis (75%), erosion (50%), and flattening (30%). Erosion was found to be associated with high TPC and flattening with high plasma level of TNF ! . In conclusion, patients with clinical TMJ involvement by RA show an association between high level of TPC and TNF ! in plasma versus radiographic signs of joint bone destruction.

Progression of radiographic changes in the temporomandibular joints of patients with rheumatoid arthritis in relation to inflammatory markers and mediators in the blood

The aim of this study was to investigate longitudinal radiographic changes in the temporomandibular joint (TMJ) with clinical involvement of rheumatoid arthritis (RA) and its relation to the blood level of inflammatory mediators and markers. Sixteen patients were investigated by computed tomography on two occasions 25–46 months apart. The radiographs were assessed independently for changes in presence of erosions, sclerosis, flattening, osteophytes, and subchondral pseudocysts. The serum (S) or plasma (P) concentrations of C‐reactive protein (CRP), thrombocyte particle concentration, serotonin (S‐5‐HT and P‐5‐HT), tumor necrosis factor alpha, interleukin‐1 receptor antagonist, tumor necrosis factor soluble receptor type II, interleukin‐1 soluble receptor type II (P‐IL‐1sRII) and interleukin 6 as well as the erythrocyte sedimentation rate (ESR) were measured. The radiographic status showed no consistent or significant change during the observation period, but the individual variation was considerable. The radiographic signs of erosion and sclerosis varied most. Regression of erosions was associated with high S‐5‐HT and P‐IL‐1sRII, while progression of erosions was associated with high P‐5‐HT. Regression of sclerosis was associated with an increase in P‐5‐HT and high ESR. Progression of flattening was associated with high CRP. In conclusion, this study indicates that the progression of radiographic changes that occurs in the TMJ of patients with well‐controlled RA during a period of 25–46 months seems to be related to the blood levels of CRP, 5‐HT, and IL‐1sRII. However, only minor progression can be expected to occur, and with considerable individual variation.

Alveolar bone height in professional musicians

This study aimed at determining alveolar bone height in musicians playing wind instruments and non-wind instruments. Two hundred and forty-two subjects, 208 men and 34 women, from 3 national orchestras in Stockholm were examined in an intraoral full-mouth survey. The height of alveolar bone, registered by a computerized method, was expressed as a percentage of the root length. Mean alveolar bone height varied from 87.4% in subjects aged 21-30 years to 73.6% in subjects aged 51-60 years. There were no significant differences between the two categories of instrumentalists in any age group. With regard to individual teeth, the greatest values of bone height were observed for canines and second premolars, whereas mandibular incisors and maxillary molars displayed the lowest values. The alveolar bone height was not significantly different for the two categories of instrumentalists in either anterior teeth or posterior teeth. It is concluded that playing wind instruments does not influence the alveolar bone height to such an extent as to be detectable on a large-scale epidemiologic basis.

Periodontal Condition of Epileptic Adults Treated Long-Term with Phenytoin or Carbamazepine

The periodontal condition of 40 adult epileptic subjects (mean age 51 years) receiving long‐term therapy (mean 18 years) with phenytoin (PHT) or carbamazepine (CBZ) was studied. The subjects completed a questionnaire and underwent clinical and radiologic examination. Patients receiving PHT exhibited the same level of alveolar bone loss as those receiving CBZ. Patients receiving PHT exhibited more units with gingival overgrowth, reflected by the significantly higher number of gingival units with increased probing depth (p < 0.05). The results indicate that long‐term PHT does not result in increased risk for alveolar bone loss as compared with CBZ.

Dental care habits, oral hygiene, and gingival health in Swedish professional musicians

The investigation covered 250 professional musicians employed in 3 leading national orchestras in Stockholm, Sweden. The aims were to describe dental care habits, such as frequency of dental visits and frequency and methods of oral hygiene, and to relate these habits to oral cleanliness and gingival health in wind and non-wind instrument musicians. The results showed that 81.2% visited their dentist at least once a year and that 82.8% had had such a regular habit for the past 5 years or more. All subjects claimed to brush their teeth daily, and 66.0% used supplementary oral hygiene aids. The clinical examination showed that oral cleanliness and gingival health were of good standard. Mean plaque index was 0.9 and mean gingival index 1.2. Both measures increased with age and were closely correlated (r = 0.80). The relationships between the dental care habits studied and the clinical conditions with regard to oral cleanliness or gingival health were rather weak, although trends towards better gingival condition and oral cleanliness were observed with increasing frequency of toothbrushing. The results indicate a high degree of dental conscientiousness in professional musicians. No differences were observed between wind and non-wind instrument musicians.

Periapical condensing osteitis and endodontic treatment

Forty-nine roots of thirty-six teeth with the diagnosis of condensing osteitis were followed up by means of radiographs and patient files after endodontic treatment. The mean observation period was 4.3 years. Prior to endodontic treatment the periodontal membrane was widened on thirty-eight roots but on follow-up only on twelve. The periapical condensing osteitis showed total regression on thirty-six of the forty-nine roots. No condensing osteitis showed progress. The results show rebuilding of bone structures to normal appearance after endodontic treatment of periapical condensing osteitis.

Lateral periodontal cysts: Clinical, radiographical and histopathological findings

21 lesions, clinically and radiographically diagnosed as lateral periodontal cysts (LPC), were retrospectively studied. The majority of the lesions were symptomless and were located in the premolar-canine-incisor region and predominantly in the mandible. 15 cases had the typical lining consistent with the diagnosis LPC. Three lesions were odontogenic keratocysts and 3 were inflammatory cysts. It was concluded that cysts in a lateral periodontal position are usually LPC but the diagnoses of keratocyst and inflammatory cyst must be considered.

Pain, tenderness, mandibular mobility, and anterior open bite in relation to radiographic erosions in temporomandibular joint disease

The relationship between radiographic changes and clinical signs and symptoms of the temporomandibular joint (TMJ) was investigated in 39 patients with joint diseases. Radiographic erosions were found in 33% of the TMJ joints, and overall frequency of radiographic changes including remodeling was 47%. Fifty-four percent of the patients had an anterior open bite (AOB). The AOB showed statistically significant correlation to the extension of erosion of the TMJ. Pain expressed by means of a visual analog scale, tenderness to palpation of the TMJ, and pressure pain threshold showed no significant correlation to erosion, but mandibular mobility showed significant negative correlation to erosive changes. In conclusion, AOB is correlated with erosive radiographic changes in this patient group. However, the degree of local pain and tenderness showed no correlation to radiographic changes.

Effect of fixed anterior biteplane therapy-a radiographic study

Orthodontic treatment of eight overbite cases with a maxillary fixed lingual arch appliance with anterior biteplane involved a reduction in overbite of 4 to 7 mm between the upper and the lower front teeth and a first molar separation of 2 to 4 mm. After a treatment period of 3.5 to 5 months, occlusal contact between the upper and the lower molars was established. The appliance was then removed, and permanent overbite reduction was secured with an edgewise appliance. With the subtraction technique, 15 temporomandibular joints were radiographically investigated in the retruded position for change of condylar position on the glenoid fossa before and directly after insertion of the appliance, as well as after achieved molar contact. All condyles changed position directly after the bite opening, indicating that pure rotation did not occur. The direction of movement varied not only between subjects but also between the two condyles of each subject. With one exception, none or very small further positional changes occurred during treatment. No imaged signs of hard structure remodeling were observed. It may be concluded that other factors than change of condylar position must be responsible for the therapeutic effect of the bite-opening appliance that has been demonstrated in an earlier study.