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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 4  |  Page : 197-200

Does caries in the adjacent tooth justify prophylactic odontectomy of impacted tooth?


1 Department of Conservative Dentistry and Endodontics, Government Dental Surgeon, PHC Sampatchak, Patna, Bihar, India
2 Department of Oral and Maxillofacial Surgery, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India
3 General Dentist, Government Dental College and Hospital, Ahmedabad, Gujarat, India
4 Department of Orthodontics and Dentofacial Orthopaedics, Purvanchal Institute of Dental Sciences, Gorakhpur, Uttar Pradesh, India
5 DMD Student, Rutgers School of Dental Medicine, Newark, New Jersey, USA
6 Department of Conservative Dentistry and Endodontics, Chandra Dental College and Hospital, Barabanki, Uttar Pradesh, India

Date of Submission05-Jun-2020
Date of Decision13-Jun-2020
Date of Acceptance20-Jun-2020
Date of Web Publication30-Nov-2020

Correspondence Address:
Vijay Shekhar
Department of Conservative Dentistry and Endodontics, Government Dental Surgeon, PHC Sampatchak, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_56_20

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  Abstract 


Purpose: To ascertain the influence of impacted lower wisdom tooth on the initiation and progression of distal caries in the lower second molar and whether prophylactic removal of lower wisdom tooth is justified. Materials and Methods: A retrospective study was conducted based on the records of the patients who underwent surgical removal of lower wisdom tooth in 3 dental clinics of the different cities during December 2015 to August 2019. The orthopantomogram and intraoral periapical radiograph images of 470 patients were considered to evaluate the impact of impacted lower wisdom tooth on the initiation and progression of distal caries in the lower second molar and whether prophylactic removal of lower wisdom tooth is justified. In order to achieve this, parameters evaluated on the radiographs are the presence of dental caries in relation to lower second molar, angulation of the lower wisdom tooth, depth of impaction, presence of pericoronitis, and patient characteristics like age and gender. The results were analyzed to ascertain whether prophylactic removal of lower wisdom tooth is justified to preserve the long term health of the lower second molar. Results: The results of this study reveal that 28% of the patients developed dental caries in relation to lower second molar in the presence of a wisdom tooth. The mandibular third molars were impacted unilaterally in 63% of cases and bilaterally in 37% of cases. Caries in lower second molars was noticed when the wisdom tooth was in Class I position in 53.8% of the cases and 69% in position A. This finding is commonly encountered in the presence of a mesioangular impacted third molar. It was observed that when a wisdom tooth was in Class I relationship for any kind of angulation it increased the chances for the initiation and progression of caries in lower second molars. Conclusion: It can be concluded that to preserve the lower second molars, it is advisable to prophylactically remove an impacted third molar that have a mesial angulation and Class I and Level A position.

Keywords: Dental caries, impacted tooth, prophylactic removal


How to cite this article:
Shekhar V, Khanna SS, Gandhi C, Bhushan R, Shaik I, Sharma S. Does caries in the adjacent tooth justify prophylactic odontectomy of impacted tooth?. J Dent Res Rev 2020;7:197-200

How to cite this URL:
Shekhar V, Khanna SS, Gandhi C, Bhushan R, Shaik I, Sharma S. Does caries in the adjacent tooth justify prophylactic odontectomy of impacted tooth?. J Dent Res Rev [serial online] 2020 [cited 2021 Jan 16];7:197-200. Available from: https://www.jdrr.org/text.asp?2020/7/4/197/302053




  Introduction Top


Surgical intervention for the removal of the lower third molars is a frequently performed minor surgical interventions due to its numerous indications.[1] An incidence range of 16.7% to 68.6% is noted with lower wisdom tooth impaction.[2] Literature suggests that an impacted lower third molar that is left unattended can lead to the development of odontogenic cysts, pericoronitis, dental caries to the adjacent second molar and can even result in the mandible becoming susceptible to fracture.[3],[4],[5],[6] This has lead to the concept of prophylactic removal of the impacted lower third molars.

However, there is sufficient evidence in the literature suggesting that surgical intervention for removal of lower wisdom tooth is associated with numerous intraoperative and postoperative complications in the form of pain, edema, bleeding, alveolitis, trismus and paresthesia.[7] Literature suggests that the prevalence of dental caries in lower second molars as a result of the presence of an impacted lower third molar ranges from 7% to 32%.[8],[9] This clinical scenario is predominantly encountered in the presence of a mesioangular third molar.[9],[10] Studies have shown that the gender, period of exposure and the angulation of the impacted third molar determine the initiation and progression of caries in the tooth adjacent to a wisdom tooth.[3] Hence this study is designed to analyze the incidence of caries in a tooth adjacent to an impacted lower wisdom tooth.


  Materials and Methods Top


This study was conducted based on the records of the patients who underwent surgical removal of lower wisdom tooth in 3 dental clinics of the different cities during December 2015 to August 2019. Institutional ethical clearance was obtained. Preoperative orthopantomogram (OPG) + intraoral periapical radiograph (IOPA) images of 470 patients were considered to evaluate the impact of impacted lower wisdom tooth on the initiation and progression of distal caries in the lower second molar and whether prophylactic removal of lower wisdom tooth is justified.

This study included those patients who were aged ≥25 years with fully erupted second molar adjacent to an impacted lower wisdom tooth. Those patients aged <25 years and in whom there was a missing second molar adjacent to a wisdom tooth and those patients who did not have both radiographs (OPG + IOPA) are excluded from the study.

Classification system proposed by Pell and Gregory was employed to ascertain the relationship of wisdom tooth in relation to occlusal plane and the available space between the anterior border of ascending ramus and the lower second molar distal surface. The angulation and depth of the wisdom tooth was determined and compared to determine the relationship for the initiation and progression of caries on the lower second molar in the presence of a wisdom tooth.

Digital OPG were taken by using ORTHOPHOS XG machine with a tube voltage of 73 kV, tube current of 15 mA and exposure time of 9.4 s and measurements were done using SIDEXIS software. Sirona Dental Systems GmbH, Fabrikstrasse 31, 64625 Bensheim Germany. The angulation and position of impacted wisdom tooth is evaluated. Tooth which is buccolingually and distohorizontally angulated or with mesioinversion, distoinversion were excluded. Pell and Gregory classification was employed to determine the depth of impaction. All interpretations were carried out by a single examiner.


  Results Top


This study comprised of 470 patients (male = 263, female = 207). The mean age of the patients was 28.3 years as shown in [Figure 1]. Majority of the patients (212, 45.10%) were in the age group of 25–30 years. The mandibular third molars were impacted unilaterally in 63% of cases and bilaterally in 37% of cases as shown in [Figure 2]. Mesioangular impaction (41%) was found to be the most commonly encountered type of third molar impaction as shown in [Figure 3]. It was observed that in 50.5% of the cases the position of impacted tooth was in Class I and in 38.5% of the cases it was in Class II, and 11% of the cases it was in Class III relationship. Caries in lower second molars was noticed when the wisdom tooth was in Class I position in 53.8% of the cases, Class II position in 38% of the cases, and Class III position in 8.2% of the cases respectively as shown in [Figure 4].
Figure 1: Graph showing the gender of the subjects involved in the study

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Figure 2: Graph showing the location of the impacted tooth

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Figure 3: Graph showing the angulation of the impacted lower third molars

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Figure 4: Graph showing the class of the impacted lower third molars and its association with caries

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Most of the mesioangularly positioned wisdom teeth causing caries in lower second molars were in depth A (65%). Even when the wisdom tooth is horizontally angulated, caries in lower second molars were most noted when the wisdom tooth is at depth A. The same results were noticed when the wisdom tooth is vertically angulated. However, when the wisdom tooth is distoangularly angulated, caries in lower second molars were most noted at equal proportions for depth A and B. Wisdom teeth in classification of Position A were 63%, Position B were 31%, and Position C were 6%, respectively. Whenever carious second molars were encountered, the impacted mandibular third molars were 69% in Position A and 31% in Position B as shown in [Figure 5]. It was observed that when a wisdom tooth was in Class I relationship for any kind of angulation it increased the chances for the initiation and progression of caries in lower second molars.
Figure 5: Graph showing the position of the impacted lower third molars and its association with caries

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The results of this study show that caries in the lower second molar was found in 28% of the cases in the lower jaw. The incidence of caries increased to 58% when only mesially angulated wisdom teeth were considered. The study also showed a higher incidence of caries with Level A occlusal relationship (53.8%).


  Discussion Top


This study reveals that Mesioangular impactions (41%) was found to be the most commonly encountered. This is in accordance with previous studies.[11],[12] However, few studies in past have encountered vertical impaction more frequently.[13] Literature shows that there is a difference in the type of impactions encountered in the Libyan and Asian-Indian populations and attributed this to the various classification systems employed.[14]

The results of this study reveal a higher incidence of the unilateral impactions than bilateral impactions. This is in accordance with previous studies.[15] Few previous studies have shown that a mesioangular tooth that is angulated between 40° and 80° is more likely to cause distal cervical caries in the adjacent second molars while few studies have advocated an angulation between 30° and 70°.[15],[16]

Literature has shown that a critical factor that predisposes a second molar to caries is where it makes contact with the wisdom tooth. Previous studies have shown that partially erupted and mesioangular impacted lower third molars that lie in close proximity with the cementoenamel junction of the second molar generally have a greater risk of developing caries.[15],[16] The results of this study are ion accordance with the results of previous studies.

With regards to the prevalence of caries on the distal aspects of lower second molars, mesioangular impactions are found to have a significantly impact than other angulations of impactions. Based on the results obtained from this study it can be suggested that the second molar distal caries justifies prophylactic removal of impacted lower third molars particularly those in close contact with the cementoenamel junction. Surgical removal of a mesially angulated lower wisdom tooth before the initiation of caries in the adjacent tooth could result in preserving the dental health of the adjacent tooth.


  Conclusion Top


It can be concluded that to preserve the lower second molars, it is advisable to prophylactically remove an impacted third molar that have a mesial angulation and Class I and Level A position.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Uppada UK. A modification of Ward's incision for third molar surgery. J Dent Res Rev 2019;6:77-8.  Back to cited text no. 1
    
2.
Kumar VR, Yadav P, Kahsu E, Girkar F, Chakraborty R. Prevalence and pattern of mandibular third molar impaction in Eritrean population: A retrospective study. J Contemp Dent Pract 2017;18:100-6.  Back to cited text no. 2
    
3.
Magraw CB, Golden B, Phillips C, Tang DT, Munson J, Nelson BP, et al. Pain with pericoronitis affects quality of life. J Oral Maxillofac Surg 2015;73:7-12.  Back to cited text no. 3
    
4.
Falci SG, de Castro CR, Santos RC, de Souza Lima LD, Ramos-Jorge ML, Botelho AM, et al. Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars. Int J Oral Maxillofac Surg 2012;41:1270-4.  Back to cited text no. 4
    
5.
Revanth Kumar S, Sinha R, Uppada UK, Ramakrishna Reddy BV, Paul D. Mandibular third molar position influencing the condylar and angular fracture patterns. J Maxillofac Oral Surg 2015;14:956-61.  Back to cited text no. 5
    
6.
Uppada UK, Sinha R. Iatrogenic mandibular ramus fracture following surgical removal of third molar. J Maxillofac Oral Surg 2020. [In Press].  Back to cited text no. 6
    
7.
Alcântara CE, Falci SG, Oliveira-Ferreira F, Santos CR, Pinheiro ML. Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: A split-mouth randomized triple-blind clinical trial. Int J Oral Maxillofac Surg 2014;43:93-8.  Back to cited text no. 7
    
8.
Ozeç I, Hergüner Siso S, Taşdemir U, Ezirganli S, Göktolga G. Prevalence and factors affecting the formation of second molar distal caries in a Turkish population. Int J Oral Maxillofac Surg 2009;38:1279-82.  Back to cited text no. 8
    
9.
Glória JCR, Martins CC, Armond ACV, Galvão EL, Dos Santos CRR, Falci SGM. Third molar and their relationship with caries on the distal surface of second molar: A Meta-analysis. J Maxillofac Oral Surg 2018;17:129-41.  Back to cited text no. 9
    
10.
Allen RT, Witherow H, Collyer J, Roper-Hall R, Nazir MA, Mathew G. The mesioangular third molar-to extract or not to extract? Analysis of 776 consecutive third molars. Br Dent J 2009;206:E23.  Back to cited text no. 10
    
11.
Kruger E, Thomson WM, Konthasinghe P. Third molar outcomes from age 18 to 26: Findings from a population-based New Zealand longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:150-5.  Back to cited text no. 11
    
12.
Byahatti S, Ingafou MS. Prevalence of eruption status of third molars in Libyan students. Dent Res J (Isfahan) 2012;9:152-7.  Back to cited text no. 12
    
13.
Haidar Z, Shalhoub SY. The incidence of impacted wisdom teeth in a Saudi community. Int J Oral Maxillofac Surg 1986;15:569-71.  Back to cited text no. 13
    
14.
Sandhu S, Kaur T. Radiographic evaluation of the status of third molars in the Asian-Indian students. J Oral Maxillofac Surg 2005;63:640-5.  Back to cited text no. 14
    
15.
Srivastava N, Shetty A, Goswami RD, Apparaju V, Bagga V, Kale S. Incidence of distal caries in mandibular second molars due to impacted third molars: Nonintervention strategy of asymptomatic third molars causes harm? A retrospective study. Int J Appl Basic Med Res 2017;7:15-9.  Back to cited text no. 15
    
16.
McArdle LW, Renton TF. Distal cervical caries in the mandibular second molar: An indication for the prophylactic removal of the third molar? Br J Oral Maxillofac Surg 2006;44:42-5.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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