Dental public health Taking dental self-care to the extreme: 24-month incidence of dental self-extractions in the Florida Dental Care Study

Gilbert GH, Duncan RP et al. J Public Health Dent 1998; 58: 131–134

Thirteen of 739 adults in this study performed a subsequently verified extraction of one or more of their own teeth over a 2 year period.

The Florida Dental Care Study commenced with 873 subjects who were interviewed and examined. The aim was to develop a model for risk assessment of dental outcomes, using a sample of subjects at greater risk of oral deterioration (namely, black persons, rural residents and persons below the US poverty level). At 6, 12 and 18 months, subjects were interviewed by telephone. At 24 months, 739 were clinically examined after a further interview.

Over the 2 year period, 176 persons had lost one or more teeth, and 13 of them had extracted one or more of their own teeth (total 28). Two of these persons had also had 19 teeth extracted by a dentist. The self-extracted teeth showed advanced periodontitis (60%) or severe caries (32%) in most cases at the baseline examination, and were removed with fingers (5 persons), string (4) or by eating tough foods (4). All of these subjects reported that the teeth in question were very loose, and two persons had experienced a severe infection of the tooth. One unexpected finding was that more than half the self-extractors lived in urban areas where dentists were more easily available.

Endodontics Root canal morphology of maxillary premolars

Kartal N, Özçelik B et al J Endodon 1998; 24: 417–419

In first premolars, 2 canals were the norm, but half of second premolars also had 2 canals.

These investigators examined 300 first and 300 second maxillary premolars. Teeth were prepared with access cavities and immersed in Indian ink, and then decalcified and treated for dissecting microscope examination. One additional type was added to Vertucci's classification (Oral Surg 1984; 53: 589-599): Type IX, where 2 canals leave the chamber in separate roots, and one of these divides in two in the apical third, thus yielding 3 foramina.

In first premolars, 89% had 2 apical canal foramina and 10% had one foramen, leaving just 4 teeth with 3 foramina. The respective figures for second premolars were 55%, 44% and 2 teeth. Teeth with 2 apical foramina showed wide variation in other aspects of canal morphology. The authors give useful advice on the relationship of pulp chamber exit position and the usual course of canals.

Periodontology; oral surgery Periodontal disease associated with interdental osteotomies after orthognathic surgery

Schultes G, Gaggl A et al J Oral Maxillofac Surg 1998; 56: 414–417

Radiographically-assessed periodontal pathology was reported in 51 of 74 interdental osteotomy sites.

In 30 patients presenting with Class II malocclusion, 15 anterior maxillary osteotomies, 10 sagittal maxillary splits, 9 Le Fort I osteotomies (4 in 2 segments, and 5 in 3 segments) and 8 anterior mandibular segmental osteotomies were performed. Ten patients received orthodontic treatment also. Panoramic and periapical radiographs were compared with pre-operative views 4 to 10 years later.

In 16 osteotomy sites, 32 teeth were lost, and half the sites were affected by periodontitis (36 teeth). In addition, lateral tooth resorption was found in 15% of sites. In only 5 sites were there no pathological findings. An accompanying discussion by another surgeon draws attention to the possibility of pre-existent periodontal disease in one-fifth of the patients and recommends precautions to limit adverse surgical effects.

Oral surgery The relationship between chronic cocaine or alcohol use and blood pressure in black men during uncomplicated tooth extraction

Johnson CD, Lewis VA et al. J Oral Maxillofac Surg 1998; 56: 323–329

Cocaine users' blood pressure followed a different pattern even after several days' abstention.

Fifteen casual alcohol users, 9 'crack' users and 22 cocaine users were compared during the procedure of extraction with 10 control subjects who used neither drugs nor alcohol. A single mandibular molar was extracted by the same operator in all subjects before noon. All subjects were black and 30–40 years old.

Patients receiving treatment for hypertension, and those with an acute drug problem, were excluded. Twelve other patients declined treatment after being informed of the possible dangers of dental treatment after recent cocaine exposure. The cocaine group reported an average 17 days since last drug use.

Mean blood pressure at the start was 156/97 in cocaine users, 146/91 in crack users, 134/87 in alcohol users and 128/83 in controls. During injection and extraction, pressures rose and subsequently decreased in all except the cocaine users, in whom they decreased. The authors consider that this group of subjects initially hyper-reacted emotionally, but then failed to generate additional pressure in response to the stress of the procedure. There was also an increased body temperature in this group. The authors discuss the increased risks of cardiac effects during dental treatment in drug users.