Outpatient treatment of hemophiliacs for dental extractions.

The outpatient treatment program for dental extraction in persons with the various forms of hemophilia has been reported. This program was initiated at the Hemophilia Rehabilitation Center at Orthopaedic Hospital in Los Angeles in 1966. During the nine years of this program, 260 patients have had 642 teeth extracted. eighty percent of these patients were outpatients and 64% of the extractions were performed on an outpatient basis. This outpatient treatment has been accompanied by an absence of a significant number of complications as evidenced by the postextraction hospitalization of only five patients during the nine-year period. The surgical technique uses a local anesthetic containing a vasoconstrictor or an ultralight intravenous general anesthetic in addition to the local anesthetic for the apprehensive or acutely infected patient. EACA is used as an antifibrinolytic agent postsurgically. Patient education and cooperation, diet control, and daily contact are important factors for the success of an outpatient oral surgery program for hemophilic patients.     

Tooth-size ratio for patients requiring 4 first premolar extractions.

INTRODUCTION: The relationship between total mesiodistal widths of the maxillary and mandibular teeth is an important factor in orthodontic treatment planning. The purposes of this article are to report a mathematical tooth-size ratio specifically designed for patients needing the extraction of 4 first premolars and to compare the anterior "6" and overall "12" ratio values reported by Bolton with the calculated anterior "6" and overall "10" ratio values obtained from data in this study. METHODS: This study was conducted in 3 phases. In the first 2 phases, we used the peer assessment rating and ideal cephalometric norms to select 53 ideal posttreatment models of patients who had had 4 premolars extracted. In the third phase, the mean overall "10" ratio and the mean anterior "6" ratio were calculated for the selected models. Bolton's mean overall "12" (91.3%) and anterior "6" ratios (77.2%) were compared statistically with calculations derived from this study by using 1-sample t test. RESULTS: The mean overall "10" ratio and the mean anterior "6" ratio were found to be 89.28 +/- 1.07% and 77.68 +/- 1.12%, respectively. Although the difference in anterior ratio was not significantly different from Bolton's anterior "6" ratio, there was a statistically significant difference between Bolton's study and our study in overall ratio. CONCLUSIONS: The mathematical tooth size overall ratio of 89.28% was determined for patients requiring the extraction of 4 first premolars and is recommended for use in diagnosis and treatment planning.     

The indications for third-molar extractions

Background.Defining the indications for third- molar extraction continues to be a topic of controversy.Methods.The dentist's management of third molars commonly hinges on identifying the presence of symptoms or disease that clearly is attributable to the third molar. Use of a guide that serves as a systematic and unambiguous way to classify third molars has been advocated.Results.Patients’ symptoms are designated as present and attributable to the third molar (Sx+) or as absent (Sx−). In addition, clinical or radiographic evidence of disease is evaluated and designated as present (D+) or absent (D−).Conclusions.Evidence-based clinical data developed from prospective investigations have shown that an asymptomatic third molar does not necessarily reflect the absence of disease.Practical Implications.Current data are not sufficient to refute or support prophylactic extraction versus active surveillance for the routine management of third molars that are asymptomatic and free of disease (group D). Although decisions regarding third-molar management usually are straightforward, the evidence supporting extraction versus retention of asymptomatic disease-free (group D) third molars is lacking. Active surveillance, a prescribed program of follow-up and reassessment at regular intervals are recommended for retained third molars rather than waiting for the onset of symptoms.     

Reasons for dental extractions in children

PURPOSE: The purpose of this study was to investigate the principal reason for primary tooth extraction and the tooth type most frequently extracted in children aged 3-13 years. METHODS: The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 2,000 records were reviewed, and 567 extracted primary teeth were analyzed from 277 patients who had at least one primary tooth extracted under local anesthesia. The criteria for inclusion in this study included children between the ages of 3 and 13 years. RESULTS: First primary molars were the most common tooth type extracted and comprised 30% of teeth removed. Central incisors were the next common tooth type extracted and accounted for 25% of the extractions. There was no difference, by gender, in the extraction of tooth type but there were striking differences according to age. Almost half of the primary teeth extracted in subjects 3 to 5 years were incisors, and in patients 6 to 9 years the first primary molar was the most common tooth type extracted. Molars were the tooth type most frequently extracted from those patients aged 10 to 13 years. There were significant differences in the reasons for extraction of various tooth types, and, while extractions due to caries predominated overall, this was not the case for all tooth types. CONCLUSIONS: This study has concluded that despite the dramatic improvements in pediatric oral health over the last decades, caries and the resulting pulpal pathology remains the most common reason for extraction of primary teeth.