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Pericoronitis and military dentistry
Pericoronitis and military dentistry
I
nflammatory lesions of the soft tissues covering erupting or ljartially erupted teeth are a common problem in rout,ine dental practice. Dental practitioners, when confronted with this problem, discuss it among themselves and routinely t,reat it in a myriad of ways, most of which are successful. Yet, in spite of its prevalence, little of a factual nature has been recorded concerning pericoronitis. One needs but to review the dental literature to verify this statement. In any given person, pcricoronal inflammation can be seen from the time his teeth erupt until he is made edcntulous or until death intcrvencs. No t.ooth is spared, but the condition is most commonly scrn around the mandibular third molars. It has been postulatchd that this local infknmation is the result of cruptive processes, local loss of tissue resistance and subsequent bacterial invasion, kanms from opposing teeth, gcncralizcd infection, and extension of gingiral dyscrasias. L411of these are ctiologic factors and may be obscrvcd in any practice. Trcat,ment of this condition runs the gamut from very conservative to slightly radical. l~o~al irl*igation, itnCil)iotics, lT~lllit~ill Of an opposing tooth, wtlwtioii of an opposing t~tlsp, lY’lllO\-ill of the involved soft. tissue, removal of tht~ involved tooth, or ~onrbin;ttic~ns of thclsct ha\x: lwx nstd Jvith \-arying dcgrrrs of success.
MILITARY
DENTISTRY
O.S., O.M. & O.P. October, 1966
t~<~~~at(~tl. it is far from true in the managenu>nt, of individual patients or groups of patients. The military dentist must be cognizant at all times of the welfare of t.hc entire military machine: and not just. one patient or a small group of patients. IIP is faced at all times with the responsibilit,y of doing the most that he can for the grclatcst. number of people, and yet he must maintain his individual patient’s ability to wage TGW.In essence, his is a role of prevention and public health. Pcricoronitis associated with mandibular third molars is probably seen as often as any common painful dental condition in the practice of military dentistry. This is readily explained by the age group being treated. In view of this situation, a \Tery simple study was devised and carried out wit.h the hope of dcI-eloping prcvcntive measures of a simplified nature. STUDY
A consecutive series of patients with mandibular third molar pericoronitis were seen and evaluated. Each patient was examined to note any communication between the inrolved tooth and the oral cavity. The relationship of the involved tooth to its adjacent members was noted clinically and by roentgenogram and recorded. The results arc presented in Table I. The position is expressed as the relationship of the long axis of the third molar to the long axis of the second molar. FACTS
From past and continuing experience, and from this simple collection of cases, it is possible to state several facts concerning pericoronitis: 1. The mandibular third molar is the most frequently involved tooth. 2. A communication with the oral cavity must be present for the condition to occur. 3. In the majorit,y of cases, the third molar is at the same occlusal level as the sccontl molar, and both present parallel axial relationships. PREVENTION
There is no doubt t,hat all nonfunctional third molars and all teeth that prcsent no hope of function should be removed from the oral cavity, for reasons that are well documented and well known to astute pract.itioners. Unfortunately, this represents a Utopian goal that offers no hope of achievement. Our ideals must be tempered to fit the practicality of each case in order to meet our responsibility
Table
I. Mundibulw Position
Vertical Mesio-angular Horizontal isolated Total
thid
molar position Number 146 11 4 2 163
Per oent 90 7 2 1
Volume 22 ITumber 4
P~ricoronitis
cold ntilitclry
dentistry
547
to the nation. This ttmpcrament must. 1,~ ~vtbn more manifest in military dentistry if we are to fulfill the mission of conscrvat.ion of fighting strength. Since acute third molar pain due to pericoronitis is a daily problem in the almy, causing a formidable loss of productive time, some means to control its prc~valence or to prcvcnt its incidence must be instit,uted. It is readily obvious that the r*c,lnoval of all nonfunctional third molars from the oral cavities of the militar?- population would require the cspt:ndit,ure of vast funds and call for a profrssional staff of gigantic size. Since those involved in Ihe surgical practirc of dentistry arc faced with a multitude of grossly diseased teet,h, little time is left, for the clcctive trcatmcnt, of asymptomatic nonfunctional members of the dentition. Therefore, clecti\c extractions must be t,empcred with sound judgment and justification. Unfortunately, this condition is not prcvcntablc by medications or immuniza. tions. Prevention of pericoronitis in the true sense of the word is impossible, but control appears to be feasible by the application of strict oral hygiene measures and sound treatment pla,ns. Since the value of adequate oral hygiene measures is well established, no further comment will be made. However, the use of sound treatment plans is not a universal application of prevention. Therefore, control of this condition falls upon those responsible for diagnosis and treatrrlent planning. In a military population, preventive treatment planning must give priority to the elective removal of those teeth which present an immediate potential for trouble and must suppress strictly elective surgical procedures because of a decided lack of time and personnel. Mandibular third molars t,hat are in a vertical position with communication to the oral cavity should receive priorit
In military dentistry pericoronit.is is one of the most frequently seen conditions which are acut,ely painful. Not, only is this condition limited in a large tl~grcc to the mandibular third molar region: but the involved third molars arc usually in a vertical position and on the same occlusal lcv~~l as the st~vmd molar. (‘ontrol and pre-T-cnt.ion ran be accomplish4 onlp with sound treatment plans t.hal. direct al.tent,ion to ihose third mui;rrs which al’11Jloi~~lliiiil s~iiiwvs Of twuhl~~. In other words, the military dentist must liirrit rl(d ivt, s~rvgic;ll ~~~tw.~dut~:s in order to Conserve time and do the most good.
I
nflammatory lesions of the soft tissues covering erupting or ljartially erupted teeth are a common problem in rout,ine dental practice. Dental practitioners, when confronted with this problem, discuss it among themselves and routinely t,reat it in a myriad of ways, most of which are successful. Yet, in spite of its prevalence, little of a factual nature has been recorded concerning pericoronitis. One needs but to review the dental literature to verify this statement. In any given person, pcricoronal inflammation can be seen from the time his teeth erupt until he is made edcntulous or until death intcrvencs. No t.ooth is spared, but the condition is most commonly scrn around the mandibular third molars. It has been postulatchd that this local infknmation is the result of cruptive processes, local loss of tissue resistance and subsequent bacterial invasion, kanms from opposing teeth, gcncralizcd infection, and extension of gingiral dyscrasias. L411of these are ctiologic factors and may be obscrvcd in any practice. Trcat,ment of this condition runs the gamut from very conservative to slightly radical. l~o~al irl*igation, itnCil)iotics, lT~lllit~ill Of an opposing tooth, wtlwtioii of an opposing t~tlsp, lY’lllO\-ill of the involved soft. tissue, removal of tht~ involved tooth, or ~onrbin;ttic~ns of thclsct ha\x: lwx nstd Jvith \-arying dcgrrrs of success.
MILITARY
DENTISTRY
O.S., O.M. & O.P. October, 1966
t~<~~~at(~tl. it is far from true in the managenu>nt, of individual patients or groups of patients. The military dentist must be cognizant at all times of the welfare of t.hc entire military machine: and not just. one patient or a small group of patients. IIP is faced at all times with the responsibilit,y of doing the most that he can for the grclatcst. number of people, and yet he must maintain his individual patient’s ability to wage TGW.In essence, his is a role of prevention and public health. Pcricoronitis associated with mandibular third molars is probably seen as often as any common painful dental condition in the practice of military dentistry. This is readily explained by the age group being treated. In view of this situation, a \Tery simple study was devised and carried out wit.h the hope of dcI-eloping prcvcntive measures of a simplified nature. STUDY
A consecutive series of patients with mandibular third molar pericoronitis were seen and evaluated. Each patient was examined to note any communication between the inrolved tooth and the oral cavity. The relationship of the involved tooth to its adjacent members was noted clinically and by roentgenogram and recorded. The results arc presented in Table I. The position is expressed as the relationship of the long axis of the third molar to the long axis of the second molar. FACTS
From past and continuing experience, and from this simple collection of cases, it is possible to state several facts concerning pericoronitis: 1. The mandibular third molar is the most frequently involved tooth. 2. A communication with the oral cavity must be present for the condition to occur. 3. In the majorit,y of cases, the third molar is at the same occlusal level as the sccontl molar, and both present parallel axial relationships. PREVENTION
There is no doubt t,hat all nonfunctional third molars and all teeth that prcsent no hope of function should be removed from the oral cavity, for reasons that are well documented and well known to astute pract.itioners. Unfortunately, this represents a Utopian goal that offers no hope of achievement. Our ideals must be tempered to fit the practicality of each case in order to meet our responsibility
Table
I. Mundibulw Position
Vertical Mesio-angular Horizontal isolated Total
thid
molar position Number 146 11 4 2 163
Per oent 90 7 2 1
Volume 22 ITumber 4
P~ricoronitis
cold ntilitclry
dentistry
547
to the nation. This ttmpcrament must. 1,~ ~vtbn more manifest in military dentistry if we are to fulfill the mission of conscrvat.ion of fighting strength. Since acute third molar pain due to pericoronitis is a daily problem in the almy, causing a formidable loss of productive time, some means to control its prc~valence or to prcvcnt its incidence must be instit,uted. It is readily obvious that the r*c,lnoval of all nonfunctional third molars from the oral cavities of the militar?- population would require the cspt:ndit,ure of vast funds and call for a profrssional staff of gigantic size. Since those involved in Ihe surgical practirc of dentistry arc faced with a multitude of grossly diseased teet,h, little time is left, for the clcctive trcatmcnt, of asymptomatic nonfunctional members of the dentition. Therefore, clecti\c extractions must be t,empcred with sound judgment and justification. Unfortunately, this condition is not prcvcntablc by medications or immuniza. tions. Prevention of pericoronitis in the true sense of the word is impossible, but control appears to be feasible by the application of strict oral hygiene measures and sound treatment pla,ns. Since the value of adequate oral hygiene measures is well established, no further comment will be made. However, the use of sound treatment plans is not a universal application of prevention. Therefore, control of this condition falls upon those responsible for diagnosis and treatrrlent planning. In a military population, preventive treatment planning must give priority to the elective removal of those teeth which present an immediate potential for trouble and must suppress strictly elective surgical procedures because of a decided lack of time and personnel. Mandibular third molars t,hat are in a vertical position with communication to the oral cavity should receive priorit
In military dentistry pericoronit.is is one of the most frequently seen conditions which are acut,ely painful. Not, only is this condition limited in a large tl~grcc to the mandibular third molar region: but the involved third molars arc usually in a vertical position and on the same occlusal lcv~~l as the st~vmd molar. (‘ontrol and pre-T-cnt.ion ran be accomplish4 onlp with sound treatment plans t.hal. direct al.tent,ion to ihose third mui;rrs which al’11Jloi~~lliiiil s~iiiwvs Of twuhl~~. In other words, the military dentist must liirrit rl(d ivt, s~rvgic;ll ~~~tw.~dut~:s in order to Conserve time and do the most good.