Pericoronitis: a reappraisal of its clinical and microbiologic aspects

Impact of Pericoronary Microbiota Composition on Course of Recovery after Third Molar Alveotomy

Although the role of microbiota has been investigated in relation to different oral diseases, it is unknown if its composition has any effect on the course of recovery after third molar alveotomy. Our aim was to determine the influence of patient clinical characteristics as well as pericoronary microbiota composition on the course of recovery after a semi-impacted third molar alveotomy. Thirty-six patients were included and samples obtained with paper points, swabs, and tissue samples were analyzed using DNA hybridization and culture methods. Among the 295 organisms detected, the most frequent were Streptococcus spp. (22.4%; 66/295) followed by Fusobacterium spp. (11.9%; 35/295), and T. forsythia (9.1%; 27/295). A comparison of microbiota composition in patients with better and worse recovery did not show significant differences. Worse recovery outcomes were more frequent in patients with a grade 2 self-assessment of oral health (p = 0.040) and better recovery courses were observed in patients with a grade 4 self-assessment (p = 0.0200). A worse recovery course was statistically significant more frequently in patients with previous oral surgical procedures (p = 0.019). Although we demonstrate that worse recovery outcomes were more frequent when certain bacteria were detected, there was no statistically significant difference. Further research is needed to identify microbial profiles specific to the development of worse outcomes after a third molar alveotomy.

Erbium, chromium:Yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser versus diode laser in the treatment of pericoronitis

Background

There are limited number of studies about the lasers used for the treatment of pericoronitis infection.

Aim

To compare the Er, Cr:YSGG laser and diode laser applications clinically in the treatment of pericoronitis infection.

Patients and Methods

Sixty patients with pericoronitis infection were divided into three groups using block randomization: Er, Cr:YSGG + antibiotic group, n = 20 (mean age: 24.20 ± 6.13; 14 females, 6 males); diode group + antibiotic, n = 20 (mean age: 23.45 ± 2.96; 14 females, 6 males); and antibiotic, n = 20 (mean age: 22.45 ± 3.02; 11 females, 9 males). In addition, laser application was performed for patients in the Er, Cr:YSGG and diode laser groups on the 1st and 2nd days until the extraction day. Tooth extractions were performed on the 3rd day for all patients. Patients' pain (with visual analog scale [VAS]), lymphadenopathy, and local edema were clinically evaluated in the first 3 days and on the 7th day of treatment.

Results

Pain score on the 2nd day of treatment was determined to be significantly lower in the Er, Cr:YSGG + antibiotic laser group as compared with the other two groups (P = 0.019). Although regression of lymphadenopathy on the 3rd day was highest (P = 0.025) in the Er, Cr:YSGG group, there was no significant difference between the groups regarding local edema.

Conclusion

Er, Cr:YSGG laser improved the healing process in the treatment of pericoronitis and made an important contribution to the treatment.

The Significance of Oral Inflammation in Elite Sports: A Narrative Review

Recently, there has been intense discussion about sports dentistry and potential interactions between oral health and athletes' performance. This narrative review aims to provide a comprehensive overview of the available literature about oral inflammation in sports. For this purpose, it presents the most common types of oral inflammation (gingivitis, periodontitis, pericoronitis, apical periodontitis), and their prevalence in athletes. Both the impact of oral inflammation on performance and causes for oral inflammation in athletes are discussed by presenting current literature. Finally, international recommendations for dental care in sports are presented. Several studies stated a high prevalence of oral inflammation in athletes, especially of gingivitis (58-97%) and periodontitis (41%). Also, many athletes report oral pain (17-30%) and a negative impact of oral health on training (3-9%). Besides this, a systemic impact of oral inflammation is discussed: In periodontitis patients, blood parameters and physical fitness are changed. In athletes, associations between muscle injuries and poor oral health are reported. There are deficits in oral health behavior. Furthermore, systemic changes due to physical stress could influence oral tissues. Overall, complex bidirectional interactions between competitive sports and oral inflammation are possible. Regular dental examinations and prevention strategies should be implemented in sports.

An unusual case of oral surgical management in a patient with isovaleric acidemia and schizophrenia: A case report

Oral/dental surgical care in patients with chronic medical comorbidities, such as isovaleric acidemia (IVA), can be challenging. In addition to technical complications, different comorbidities also present a complex range of concerning factors/challenges, which can increase the incidence of morbidity and mortality associated with surgery. IVA, a congenital error of metabolism, is a rare organic acidemia with a predisposition towards acute acidosis and life-threatening metabolic decompensation during stressful conditions, such as prolonged fasting and surgery. In addition, schizophrenia, a major neurological disorder, can result in manifestation of severe dental or periodontal conditions, including pericoronitis. The condition is associated with significant risk factors of postoperative complications, such as dangerous behaviors and adverse interactions between antipsychotic drugs and anesthetic agents. A case of comorbid dental disease with two coexisting chronic and life-threatening medical conditions, one of which is rare, is an unusual encounter in oral/dental surgery that is seldomly published. Moreover, implementing a safe and effective surgical intervention in such patients requires several informed considerations. However, only a few reported experiences or guidelines exist, reporting appropriate perioperative management strategies to minimize risks. Hence, in this case report, our experience of managing one of these rare encounters of a 20-year-old man who suffered from bilaterally partially erupted third molars, associated with chronic pericoronitis and dental caries of both the maxilla wisdom teeth with coexisting IVA and schizophrenia comorbidities is described. Additionally, the presentation and anticipated complications of the comorbid disorders of the patient are briefly reviewed. In this case, the pericoronitis and dental caries were treated by surgically removing the impacted third molars and the antagonist maxilla wisdom teeth under regional anesthesia and application of antibiotics for 3 days. The patient recovered without any postoperative complications after 1 year of follow-up.

Maxillary and Mandibular Third Molars Impaction with Associated Pathologies in a North Cyprus Population: A Retrospective Study

This study aimed to find out the incidence of impacted third molars and associated pathologies in people who live in the North Cyprus population. Dr. Burhan Nalbantoglu State Hospital is the only hospital that has an oral and maxillofacial surgery department among the state hospitals in North Cyprus. Patients who were referred to this department during a one-year period due to the complaints regarding their third molar were included in our study. This retrospective study involved 550 patients aged 16 to 65 years (1752 third molars). Chi-square tests were done for bilateral comparison between age, gender, and third molar (p < 0.05). Among the groups included in the study, the highest number of third molars originated from the 20–29 age group (n = 1050). Among all 1752 third molars, 716 (40%) of them erupted, while 1036 (60%) were impacted molar teeth, with significant differences between genders (p > 0.05). The most often impacted position in the mandible was the mesioangular type (42%) and in the maxilla was the vertical type (62%). Partially and completely impacted mandibular third molars showed a significant difference between the left and right sides (p < 0.05). A huge proportion of third molars are impacted in the North Cyprus population. The degree of impaction of wisdom teeth and the problems they cause should be well evaluated, and the surgical approach should be considered according to the baseline of this data.

Interventions for Early-Stage Pericoronitis: Systematic Review of Randomized Clinical Trials

Background: To investigate the efficacy and safety of interventions for early stage pericoronitis. Methods: We searched for randomized controlled trials (RCTs) in databases from inception to July 2020, without language restriction. RCTs assessing adolescents and adults were included. Results: Seven RCT with clinical diversity were included, so, it was not possible to conduct meta-analyses. Individual study data showed an improvement in oral health quality of life in favor of topical benzydamine versus diclofenac capsule (Mean difference (MD) −1.10, 95% Confidence interval (CI) −1.85 to −0.35), and no difference between topical benzydamine and flurbiprofen capsule (MD −0.55 95% CI −1.18 to 0.0). There was no difference between diclofenac and flurbiprofen capsules (MD 0.55, 95% CI −0.29 to 1.39). An imprecise estimate of effects was found for all outcomes, considering (i) oral versus topic pharmacological treatment, (ii) different oral pharmacological treatments, (iii) pharmacological treatment associated with laser versus placebo laser, (iv) pharmacological treatment associated with different mouthwashes, and (v) conventional treatment associated to antimicrobial photodynamic therapy versus conventional treatment, with low to very low certainty of evidence. Conclusions: Until future well-designed studies can be conducted, the clinical decision for early stage pericoronitis should be guided by individual characteristics, settings and financial aspects.

A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists’ therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients’ quality of life, healthcare costs, and antimicrobial resistance development.

Microbial Profile During Pericoronitis and Microbiota Shift After Treatment

The microflora of the distal pocket is considered as the major cause of pericoronitis. How the oral microflora changes during pericoronitis and whether different types of impacted third molar harbor the same microflora are still unknown. Saliva, subgingival plaque, and gingival plaque of mandibular third molars (M3Ms) were collected from twelve patients with acute pericoronitis. They were given local irrigation or local irrigation + antibiotics according to symptoms. Samples were harvested at the first visit with pericoronitis, 1 week after treatment, and 6 weeks after treatment. 16S rRNA gene polymerase chain reaction products were generated and sequenced after DNA isolation. Comparison of three sampling sites showed that, the subgingival plaque of M3Ms had most remarkable changes in symptomatic period, including a significant increase in microbial richness, and a convergent trend in microbial composition. After treatment, the subgingival microbiome was altered and largely returned to the state in asymptomatic period. In summary, the distal subgingival microbiota of M3M was most likely to be associated with the pathogenesis of pericoronitis. The post-treatment microbiota shift of M3M proved the effectiveness of treatment. The inclination type of impacted M3Ms and treatment method would also make a difference to the pericoronal microbiota.

Oral spirochetes: Pathogenic mechanisms in periodontal disease

Periodontitis is an infectious inflammatory disease resulting from infection of biofilm forming bacteria. Several bacterial factors regulate inflammatory response and cause to tissue damage and loss of connection between gingival and tooth. Since bacterial virulence factors and also host immune responses have role, understanding of periodontal disease is complex, in overall we can say that in this disease epithelium is deleted by bacteria. Oral spirochetes are related to periodontitis, among them, Treponema denticola, have been associated with periodontal diseases such as early-onset periodontitis, necrotizing ulcerative gingivitis, and acute pericoronitis. This review will analyse mechanisms of pathogenesis of spirochetes in periodontitis. Microorganisms cause destruction of gingival tissue by two mechanisms. In one, damage results from the direct action of bacterial enzymes and cytotoxic products of bacterial metabolism. In the other, only bacterial components have role, and tissue destruction is the inevitable side effect of a subverted and exaggerated host inflammatory response to plaque antigens.

Microbial profile of symptomatic pericoronitis lesions: a cross-sectional study

OBJECTIVE

The microbial composition of pericoronitis (Pc) is still controversial; it is not yet clear if the microbial profile of these lesions is similar to the profile observed in periodontitis (Pd). Therefore, the aim of the present study was to describe the microbial profile of Pc lesions and compare it directly with that of subjects with Pd.

METHODOLOGY

Subjects with Pc and Pd were selected, and subgingival biofilm samples were collected from (i) third molars with symptomatic Pc (Pc-T), (ii) contralateral third molars without Pc (Pc-C) and (iii) teeth with a probing depth >3 mm from subjects with Pd. Counts and proportions of 40 bacterial species were evaluated using a checkerboard DNA-DNA hybridization technique.

RESULTS

Twenty-six patients with Pc and 18 with Pd were included in the study. In general, higher levels of microorganisms were observed in Pd. Only Actinomyces oris and Eubacterium nodatum were present in higher mean counts in the Pc-T group in comparison with the Pc-C and Pd-C groups (p<0.05). The microbiota associated with Pc-T was similar to that found in Pc-C. Sites with Pc lesions had lower proportions of red complex in comparison with the Pd sites.

CONCLUSION

The microbiota of Pc is very diverse, but these lesions harbour lower levels of periodontal pathogens than Pd.

Pericoronitis: A clinical and epidemiological study in greek military recruits

Background

This paper presents a statistical analysis of epidemiological, clinical and radiographical characteristics of third molar-related pericoronitis.

Material and Methods

650 conscripts of the First Training Division of Conscript Soldiers of 2005 in Greece were recruited for the study. Each conscript was given a questionnaire and underwent a clinical test and a radiographic examination. The tested variables included the conscripts’ personal information, oral hygiene parameters along with the radiographic angulation of the third molar, the level of impaction and their classification in relation to the edge of the mandible.

Results

The prevalence of pericoronitis was found to be 4.92%. The group of patients between 20 and 25 years old dominated in a percentage of 72.41%.

Conclusions

The use of mouthwash along with the adequate frequency of teeth-brushing appeared to be related to a statistically significant decrease of the disease. Vertical impacted molars are more likely to present pericoronitis at a rate of 61.11%; plane A and the impacted teeth that are positioned to the front edge of the mandible according to class II, have a higher rate of prevalence. Finally, a brief literature review in comparison to our study is also presented.

Key words:Third-molar-related pericoronitis, impacted wisdom teeth, prevalence, epidemiological study, Greece.

Dental management of a patient with incidentally detected hemophilia: Report of a clinical case

Individuals with hemophilia are at risk for bleeding episodes, which range from mild mucosal/soft-tissue bleeding to life-threatening hemorrhages. This report describes the dental/medical management provided to a 23-year-old patient suffering from uncontrolled bleeding after an electrosurgical procedure (operculectomy) in relation to the mandibular right third molar, in which hemophilia was a true accidental finding. Various safety measures that need to be considered during the dental surgical management of hemophilic patients are discussed.

The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study

Aim:

The aim of this study was to describe the characteristics of the mandibular third molar at highest risk for acute pericoronitis using clinical and radiographic analysis.

Materials and Methods:

A total of 120 patients ranging in age from 18 to 55 years suffering from pericoronitis were examined. Subjective and objective observations were recorded that included the age, gender, angulation of partially impacted mandibular third molar, the frequency of pericoronitis in a year, the presence of impinging maxillary third molar, the extent of soft tissue coverage over the impacted mandibular third molar, the clinical signs evaluated in the patient, the class and position of the impacted mandibular third molar, and the presence of distal radiolucency with respect to the impacted mandibular third molar.

Results:

The results obtained in the study indicate that pericoronitis is associated more in the age group of 26–35 years and is more commonly reported in the female gender. Distoangular partially impacted mandibular third molars impacted at Class II and position B seem to be at the highest risk of developing pericoronitis.

Conclusion:

The results obtained in the study indicate that pericoronitis is associated more in the age group of 26-35 years and is more commonly reported in the female gender. Distoangular partially impacted mandibular third molars impacted at class II and position B seem to be at the highest risk of developing pericoronitis.

Herpesviral-bacterial co-infection in mandibular third molar pericoronitis

OBJECTIVE

The aim of this study was to assess the presence of herpesviruses and periodontopathic bacteria and to establish their potential association with pericoronitis.

MATERIALS AND METHODS

Fifty samples obtained with paper points (30 from pericoronitis and 20 controls) were subjected to polymerase chain reaction (PCR) analysis. A single-stage and nested PCR assays were used to detect herpesviruses: human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) and six periodontopathic anaerobic bacteria: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, Treponema denticola, and Tannarella forsythia.

RESULTS

Pericoronitis samples harbored HCMV and EBV at significantly higher rates than the control group (70 vs. 40 % and 46.7 vs. 15 %, P = 0.035, P = 0.021, respectively). P. micra and T. forsythia (66.7 vs. 0 %, and 40 vs. 10 %, P = 0.001, P = 0.021, respectively) were significantly more common in pericoronitis compared to the control group. Multivariate logistic regression analysis showed that the presence of T. forsythia was associated with pericoronitis development (OR 7.3, 95 % CI, 1.2-43.2, P = 0.028).

CONCLUSION

The occurrence of HCVM and EBV extends our previous knowledge on microbiota in pericoronitis. These PCR-based findings demonstrated that bacterial and viral DNA occurred concomitantly in pericoronitis samples. T. forsythia appeared to be significantly associated with pericoronitis development in the examined sample.

CLINICAL RELEVANCE

Herpesviral-bacterial co-infections might exacerbate the progression of pericoronitis.

Is malaria a predisposing factor for third molar pericoronitis in the tropics?

BACKGROUND

Malaria is an important disease in the tropics, and its role as a predisposing factor or co morbidity has been investigated in many diseases including HIV infection and tuberculosis. There are very few studies, which have investigated its role in oral and dental diseases. Our study aimed to demonstrate the possible role of malaria in predisposing to pericoronitis, an infection affecting impacted third molars predominantly.

PATIENTS AND METHODS

Thirty-eight patients presenting with pericoronitis were tested for malaria parasites and results compared with that obtained from controls that were equally susceptible to pericoronitis but did not have the infection.

RESULTS

19.7% of the study group compared to 6.6% of control group had malaria parasite in their blood. This difference was statistically significant, P=0.018 (Fisher's exact). The odds ratio was 4.3 (95% CI=1.2-17.0).

CONCLUSIONS

Malaria appears to be a predisposing factor to pericoronitis in this study. There is a need for further studies on the possible role of malaria in oral and dental diseases.

Microbiology of mandibular third molar pericoronitis: incidence of beta-lactamase-producing bacteria

OBJECTIVES

The purpose of this study was to evaluate the predominant flora associated with pericoronitis in third molars and to investigate the presence of beta-lactamase-producing strains.

STUDY DESIGN

The third molars in 26 adults were evaluated by cultures with nonselective media and with selective media containing amoxicillin, pristinamycin, spiramycin, metronidazole, and spiramycin plus metronidazole.

RESULTS

In the majority of cases (19/26), the flora found in an anaerobic atmosphere predominated. Obligate anaerobes were present in 21 of the 26 samples. The bacteria most commonly detected were alpha-hemolytic streptococci (26/26) and the genera Prevotella (15/26), Veillonella (15/26), Bacteroides (9/26), and Capnocytophaga (9/26). Amoxicillin and pristinamycin were the most active in reducing the anaerobic cultivable counts. beta-Lactamase-producing strains were detected in 9 samples and were mostly bacteria of the genera Prevotella, Staphylococcus, and Bacteroides.

CONCLUSIONS

These results highlight (1) the diversity of the microflora associated with pericoronitis and the importance of the anaerobic flora and (2) the existence of selection pressure related to the use of beta-lactams that may culminate in failure of prescribed penicillins.

Dentists' judgment strategies on prophylactic removal of mandibular third molars

The number of molars selected for prophylactic removal varies widely among general dental practitioners and oral surgeons. To understand the basis for such variations, we investigated two hypotheses: (1) Individual judgment strategies will differ concerning the use of cues (items of information), and (2) few dentists will integrate the cues according to evidence in the literature. To analyze 30 general dental practitioners' (GDPs) and 10 oral surgeons' use of cues in the judgment preceding the treatment decision, we used the Brunwik's lens as a conceptual model. The cues were the patient's age, and the angular position and the degree of impaction of the molar. The clinical situation was simulated by written case descriptions. The proportion of variation explained by the cues and their combinations (total model) varied between 61% and 100% and between 4% and 76% as main effects. Two GDPs and one oral surgeon integrated the cues additively, i.e., any of the cues is independent of the other cues in the judgment. In general, the dentists integrated the cues interactively, i.e., the impact of one cue depends on the levels of some other cues. Even though most variations in judgments were accounted for by the cues, the dentists did not integrate the cues according to evidence in the literature and lacked insight into their decision-making thought processes.

Symptoms of unerupted mandibular third molars

OBJECTIVE

The purpose of this study was to analyze the occurrence of symptoms in patients with unerupted mandibular third molars and to investigate the associated pathoses.

STUDY DESIGN

Through a review of clinical records and periapical radiographs of completely unerupted and partially erupted mandibular third molars, a retrospective study was carried out. For each axial inclination, symptoms and pathoses associated with these teeth were analyzed. Statistical differences were tested by chi square analysis.

RESULTS

Most of the patients were between 16 and 30 years of age. In 83% of cases, the mandibular third molars were partially erupted; in the other 17% of cases, the mandibular third molars were completely unerupted. Pain was the most frequent symptom in both groups. Pericoronitis was found mostly in third molar teeth with vertical and distal inclinations (P< .05), whereas caries was found mainly in mesially tipped third molars (P < .05).

CONCLUSIONS

Most of the patients were in the third decade of life. Partially erupted mandibular third molars had more symptoms than completely unerupted teeth. Pain and pericoronitis were the most common problems in patients with unerupted third molars.

Incidence of infections requiring hospitalization associated with partially erupted third molars

A retrospective study of patients hospitalized for infections associated with partially erupted third molars during a 10-year period (1985-94) showed a total of 17 cases: 6 women and 11 men, aged 18 to 57 years. Eight patients were in the third decade. No deviation from the habits of the general population with regard to cigarette smoking and alcohol consumption or overrepresentation of general health problems was found. All infections were of pericoronal origin. Bacteriologic cultures from six patients showed mixed aerobic-anaerobic oral flora, without any penicillin-resistant strains. The incidence rate of serious orofacial infections associated with partially erupted third molars was calculated to be 0.016 cases per year per 1000 patients at risk.

Pathoses associated with mandibular third molars subjected to removal

OBJECTIVES

To measure the prevalence of disease of mandibular third molars referred for removal and to estimate the risk for development of pathoses for two cues.

STUDY DESIGN

A prospective cohort study on molars subjected to removal was performed. The prevalence of different diseases and the patient's age, angular position, and degree of impaction of the molars were registered. Odds ratio for molars with different positions and impaction states were estimated.

RESULTS

Pericoronitis was found in 64% of cases, caries in the third molar in 31%, periodontitis in association with 8%, caries in the second molar in 5%, and root resorption of the second molar with 1% of the molars with pathoses. Odds ratio was highest for distoangular molars (5.8) and for molars partially covered by soft tissue (6.7).

CONCLUSIONS

The odds ratio is about 22 and 34 times higher for molars partially covered by soft tissue than for molars completely covered by soft or bone tissue. For distoangular molars the odds ratio is 5 to 12 times higher than for molars in other positions.

Pericoronitis and tonsillitis: clinical and darkfield microscopy findings

OBJECTIVE

Upper respiratory tract infections and tonsillitis and pharyngitis in particular increase the risk of lower third molar pericoronitis. The study was made to investigate clinical and microbiologic associations between pericoronitis and tonsillitis.

STUDY DESIGN

The subjects were 20-year-old Finnish male conscripts. Thirty-eight patients had tonsillitis without and 33 patients had tonsillitis with a symptom-free erupting lower third molar; 27 patients had pericoronitis but healthy tonsils. All subjects were examined clinically. Bacterial samples were taken from healthy and diseased tonsils and from healthy and diseased third molar pericoronal pockets. The microbes were classified morphologically with the use of a darkfield microscope.

RESULTS

Eighty-two percent of infected tonsils had deep crypts and 52% of them exudated pus compared with 36% (p < 0.001) and 0% (p < 0.001) in healthy tonsils, respectively. Infected lower third molars were less than half erupted and had on average 8.8 mm deep pericoronal pockets compared with pockets 5.5 mm deep recorded in symptom-free cases (p < 0.001). Spirochetes were more common in infected pockets than in symptom-free cases comprising 8.2% versus 3.0% of the total bacterial count (p = 0.044). Rods were more common in infected tonsils than healthy ones (8.9% versus 4.8%, p = 0.041).

CONCLUSION

There were similarities in morphologic microbiota of pericoronitis and tonsillitis. However, clinical findings of tonsils did not appear to link with the findings of third molars.

Population genetic analysis of oral treponemes by multilocus enzyme electrophoresis

Seventeen treponemes recently isolated from necrotic pulps, periodontal and periapical infections and 17 previously well characterized oral treponemal strains were analyzed by multilocus enzyme electrophoresis. Ten genetic loci were characterized on the basis of the electrophoretic mobilities of their enzymatic products. All loci were polymorphic. The average number of alleles per locus was 7.8. The genetic diversity among the electrophoretic types at each locus ranged from 0.624 to 0.836 with a mean genetic diversity per locus of 0.751. The 34 strains represented 34 electrophoretic types, constituting 6 main divisions (I-VI) separated at genetic distances greater than 0.75. Several of the previously characterized treponemes revealed multiple bands of enzyme activity at several loci, indicating that they were not pure. The characterized strains usually clustered within established species, whereas fresh clinical isolates overlapped species borders. There was a large genetic difference between some reference and clinical strains, indicating that the latter may contain undescribed species. Treponema socranskii and Treponema denticola strains clustered in distinct divisions (IV and V, respectively), with the exception of T. denticola strain FDC 51B2 and T. socranskii subsp. paredis strain VPI D46CPE1, both previously well described. This indicated that the taxonomic assignment of these 2 strains should be reconsidered.

Respiratory tract infections and concomitant pericoronitis of the wisdom teeth

OBJECTIVE

To discover if there is an association between respiratory tract infections and pericoronitis of erupting third molars in young adults.

DESIGN

Data from male military conscripts' medical records were collected over five years and the incidence of respiratory tract infection before and after acute pericoronitis (191 cases) and before and after standard (722 cases) and operative (741) extractions compared with that in controls (n = 703) who had no infections in the third molar regions.

SUBJECTS

14,500 male military conscripts aged 20.

SETTING

Garrisons in Valkeala and Kouvola, Finland.

RESULTS

The incidence of respiratory tract infection was significantly higher during the two weeks before acute pericoronitis was diagnosed compared with that in controls. The highest incidence was observed in the three days before pericoronitis (odds ratio 6.8; 95% confidence interval 3.0 to 15.0). The incidence was also increased in the first week after pericoronitis (odds ratio 3.7; 1.6 to 8.4) and three days before (odds ratio 2.6; 0.9 to 7.5) and during the first week after extraction of third molars (odds ratio 2.6; 1.3 to 5.3).

CONCLUSIONS

Respiratory tract infection may precipitate and occur concomitantly with acute pericoronitis. Third molar surgery for pericoronitis, on the other hand, may trigger respiratory tract infection.

Infections in elderly patients associated with impacted third molars

The objective of this study was to determine the clinical characteristics of infections caused by impacted third molars in elderly persons. Infectious disorders (26 pericoronitis, 8 secondarily infected dentigerous cysts, 4 perimandibular abscesses with limited osteomyelitis, 2 chronic mandibular osteomyelitis, and 1 odontogenic skin fistula) associated with the impacted third molars impacted third molars were clinically investigated in 41 patients over 60 years of age. Twenty-nine causative teeth were located in the mandibular angle and nine in the ramus; the three remaining lesions (two cysts one pericoronitis) were associated with the maxillary third molar. Bone resorption was noted in most patients, and this caused the originally embedded tooth to become exposed intraorally. It was concluded that oral infection in elder persons are occasionally caused by retained impacted third molars with overlapping of other factors.

An infected mandibular fracture. Case report

A case of an infected mandibular fracture is presented. A submandibular abscess appeared to arise from chronic pericoronal infection associated with a third molar tooth in the line of fracture. Treatment of the case is described followed by a short discussion on the aetiology and management of infected mandibular fractures. The importance of adequate first aid and prompt referral is stressed.

Microbiology of the pericoronal pouch in mandibular third molar pericoronitis

The microorganisms associated with mandibular third molar pericoronitis were investigated using direct microscopy and anaerobic culture method. The pericoronal pouch was sampled with paper points in A) 8 patients without mandibular third molar pericoronitis and B) 6 patients with mandibular third molar pericoronitis. Under the microscope, the microflora was found to be a complex mixture comprising gram-positive and gram-negative cocci, rods and filaments (including fusiform and curved rods), motile rods and spirochetes. Significantly higher proportions of motile, gram-negative rods were found in group B than in group A. The predominant cultivable microflora of 9 samples: A (4) and B (5) comprised several species of facultative and obligate anaerobic bacteria, namely Peptostreptococcus, Streptococcus, Actinomyces, Eubacterium, Propionibacterium, Veillonella, Porphyromonas, Prevotella, Bacteriodes, Fusobacterium, Campylobacter, Staphylococcus, Stomatococcus, Lactobacillus, Neisseria, Capnocytophaga, Haemophilus, Selenomonas and Centipeda species. The microflora in pericoronitis appeared similar to that of diseased periodontal pockets.

Spirochaetes in oral infections

Oral spirochaetes, which are small-, medium- or large-sized, include species of the genus Treponema, many of which have not yet been cultured. They are found in root canal infections, pericoronitis, gingivitis and periodontitis, constituting up to 10% of the flora in endodontic abscesses, 30% in acute necrotizing ulcerative gingivitis, and 56% in advanced marginal periodontitis. The strong proteolytic activity of these organisms probably make them causes of infection rather than consequences. Being able to penetrate tissue, they bring their enzymes, metabolic products, and endotoxins, in direct contact with target cells. This may perturb essential functions of host cells and immunoglobulins. Enzyme activities may also help fulfil the complex growth requirements of spirochaetes in vivo. Reaction between infected periodontal tissue and monoclonal antibodies to Treponema pallidum has suggested that uncharacterized pathogen-related oral spirochaetes have surface structures and functions analogue to this well recognized pathogen. This warrants a more intensified search for the role of spirochaetes in oral infections.

Periodontopathic bacteria and salivary microbes before and after extraction of partly erupted third molars

This study examines the effect of extraction of third molars on suspected periodontopathogenic microbes, salivary acidogenic bacteria, and yeasts. The subjects were 39 healthy conscripts aged 20.2 yr, with symptom-free, partly erupted mandibular third molars. Microbial samples were taken from the mandibular third molar pericoronal space and from the adjacent gingival pocket of the second molar. The samples were stained by Gram's and Giemsa's methods and studied under a light microscope. Stimulated saliva was collected for assessing mutans streptococci, lactobacilli, and yeast counts by chair-side kits. All partly erupted third molars were extracted from 20 test subjects; 19 control subjects were left untreated. Microbial samplings were repeated 2 and 5 months postoperatively. Results showed that at base line the total number of Gram-negative bacteria, Gram-negative rods, and spirochetes was significantly higher at the third molar than at the second molar sites. The extraction of the third molars caused a significant decrease in the percentage of these bacteria at the second molar sites. High counts of salivary mutans streptococci (CFU > or = 10(6)) and lactobacilli (CFU > or = 10(5)) were also significantly less frequent after the operations. Yeast counts were not affected by the extractions. Thus, partly erupted third molars may harbor a periodontally pathogenic microflora and increase the number of salivary acidogenic microbes.

Effect of extraction of partly erupted third molars on subgingival microorganisms

This study was made to investigate the effect of extraction of third molars on subgingival microbes in 39 generally and gingivally healthy men with an average age of 20.2 years (SD 0.9). Microbial samples were taken from the pericoronal space of symptom-free partly erupted lower third molars and from the adjacent gingival pockets of the second molars. The samples were cultivated anaerobically. All partly erupted third molars were extracted from 20 subjects. A control group of 19 subjects was left untreated. Microbe sampling was repeated 2 and 5 months postoperatively with highly significant results. It was shown that at baseline the number of black-pigmented gram-negative bacteria and Fusobacterium species was more frequent in third molar than in second molar sites. The total bacterial count decreased significantly at the second molar sites after extraction of the third molars when compared with the control group. Before the extractions, black-pigmented gram-negative bacteria were detected in 45% of the test subjects and Actinobacillus actinomycetemcomitans in 20%. The respective postoperative figures were 30% for black-pigmented gram-negative bacteria and 10% for Actinobacillus actinomycetemcomitans. Capnocytophaga species were not affected by the extractions. The findings suggest that erupting third molars may harbor harmful bacteria that can be reduced by eradicating the foci.

Third molars in Norwegian general dental practice

A questionnaire containing 37 questions on oral surgery was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. A selected part of the questionnaire was also presented to all 5th-year dental students in Bergen and Oslo. The total return rate was 43%. From the 17 questions dealt with in this paper the following conclusions were drawn: Norwegian general practitioners' attitudes towards indications for third-molar removal are in general agreement with the current conservative approach. Norwegian 5th-year dental students had more radical attitudes. Norwegian general practitioners indicated the use of adequate technical measures when surgically removing third molars in practice. Every month 4.3 patients presented to general practice with symptoms or findings indicating removal of an impacted or partially erupted third molar. This suggests that in 1 year a situation indicating third-molar removal will occur in 20% of the patients who have third molars.

Predominant cultivable flora in pericoronitis

The predominant cultivable flora in pericoronitis was investigated by culturing pus from affected sites in 20 patients. Twenty colonies were picked at random from non-selective plates and identified using conventional biochemical and physiological tests, analysis of metabolic end-products by gas chromatography and protein profile analysis. The most frequently isolated organisms were Prevotella (Bacteroides) intermedia, Peptostreptococcus micros, Veillonella species, Fusobacterium nucleatum and Streptococcus mitis. Porphyromonas (Bacteroides) gingivalis was not isolated and asaccharolytic Eubacterium species were virtually absent. The predominant cultivable microflora in pericoronitis was found to be highly anaerobic in nature and superficially similar to that found in chronic periodontitis, although proposed marker organisms of severe periodontitis were absent.

Suspected periodontopathogens in erupting third molar sites of periodontally healthy individuals

29 periodontally healthy subjects (11 female and 18 male) with a mean age of 24 years (range 19 to 38 years) and with partially erupted lower third molars participated in this study. 18 subjects demonstrated no signs or symptoms of acute inflammation and were without pain (group A). 5 subjects showed redness of the pericoronal tissues and experienced pain upon palpation (group B). 6 subjects suffered from acute pain and exhibited formation of pus (group C). Microbiological samples were taken from the lateral aspect of the pericoronal space using the paperpoint-method. Continuous anaerobic techniques were utilized for microbiological processing. The samples were cultivated on ETSA and on selective media and were studied by darkfield microscopy. Gram-negative anaerobic rods accounted for 27% (group A), 34% (group B) and 39% (group C) of all organisms growing on ETSA. Bacteroides intermedius was detected in 61% (group A), 80% (group B) and 83% (group C) of the samples. B. gingivalis was found in 1 sample of group A only. Fusobacterium sp. was detected in 56% (group A), 80% (group B) and 33% (group C) of the samples. Capnocytophaga were seen in 67% (group A), 20% (group B) and 50% of the samples. Actinobacillus actinomycetemcomitans was found in 44% (group A), 40% (group B) and 17% (group C). 72% of the group A and 100% of the group B and C samples contained spirochetes. In all of those positive samples, small spirochetes were present, but only 78% contained medium and only 48% large spirochetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Burning mouth sensation associated with fusospirochetal infection in edentulous patients

Six middle-aged and elderly edentulous, systemically ill patients complaining of burning mouth sensation had a fusospirochetal infection of the oral mucosa. Metronidazole was successful in the treatment of three of these patients.