Association Between the Presence of Impacted Third Molars and Existence of Caries in the Distal Surface of Second Molars: A Radiographic Analysis
Abstract
Objective: To determine the frequency and association of existence of the distal surface caries (DSC) in second molars adjacent to retained impacted third molars
Methodology: This retrospective cohort radiographic study was performed at Fatima Jinnah Dental College & Hospital Trust. Patients of > 25 years of age, having Ortho-pantomogram (OPG) x-ray, satisfying the inclusion criteria were included in this study, Convenient sampling technique was used and informed consent was obtained after ethical committee approval. Radiographs (OPG) were assessed to diagnose DSC in second molars adjacent to ITMs. Kappa test was used with SD +/- 1. Data were analysed to calculate frequency and percentages of age, gender, and angulations of ITMs and DSC in second molars were calculated. Cross tabulation with t-test was performed to find out the relationship of frequency of ITMs and their angulations associated with DSC in second molars.
Results: Total of 92 of 621 patients fulfilling the inclusion criteria, 41 (26.83%) were males, 51 (15.69%) females with mean age of 46 +/- 5 years SD. Our findings showed that out of 140 ITMs, 23 (16.42 %) second molars had DSC adjacent to mandibular ITMs. Fourteen (60.86%) teeth were associated with right impacted mandibular third molars, 9(39.13%) with left mandibular ITMs.
Conclusion: The most common teeth associated with DSC of second molars were mesio-angular right mandibular ITMs. Active surveillance and monitoring of ITMs is highly recommended for early diagnosis and management of second molars associated disease. Most of the studies which were performed to find out the frequency of ITMs associated pathologies were retrospective studies. Therefore, prospective studies should be performed to determine the fate of retained third molars in an adult population.
References
Falci SG, de Castro RC., Santos LD, de Souza Lima ML, Ramos Jorge A, Botelho C, 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(10):1270-74
Al-Khateeb TH, Bataineh AB. Pathology associated with impacted mandibular third molars in a group of Jordanians. J Oral Maxfac Surg. 2006; 64(11):1598- 602
Adeyemo WL. Do pathologies associated with impacted lower third molars justify prophylactic removal? A critical review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102(4):448–52
Sheikh MA, Riaz M, Shafiq S. Incidence of distal caries in mandibular second molars due to impacted third molars – a clinical & radiographic study. Pak Oral Dent J. 2012; 32(3):364-70
Marques J, Montserrat Bosch M, Figueiredo R, Vilchez- Pérez MA, Valmaseda-Castellón E, Gay-Escoda C. Impacted lower third molars and distal caries in the mandibular second molar. Is prophylactic removal of lower third molars justified? J Clin Exp Dent. 2017; 9(6):794-98
Nunn ME, Fish MD, Garcia RI, Kaye EK, Figueroa R, Gohel A, et al. Retained asymptomatic third molars and risk for second molar pathology. J Dent Res. 2013; 92(12):1095-9
Greg JH, Joana CC, Marilyn R., Charles S., Mark D, Loren A, et al. A Prospective Study of Clinical Outcomes Related to Third Molar Removal or Retention. Am J Public Health. 2014; 104(4): 728-34
Venta I, Vehkalahti M, Huumonen S, Suomine AL. Signs of disease occur in the majority of third molars in an adult population. Int J Oral Maxillofac Surg. 2017; 46(12): 1635-40 doi: 10.1016/j.ijom.2017.06.023
Fisher EL, Garaas R, Blakey GH, Offenbacher S, Shugars DA, Phillips C, et al. Changes over time in the prevalence of caries experience or periodontal pathology on third molars in young adults. J Oral Maxillofac Surg. 2012; 70(5):1016-22
Offenbacher S, Beck JD, Moss KL, Barros S, Mendoza L, White RP. What are the local and systemic implications of third molar retention? J Oral Maxillofac Surg. 2012; 70(9):58-65 doi: 10.1016/j.joms.2012.04.036
Hub J R, Ellis Tucker MR. Contemporary Oral & Maxillofacial Surgery. Elsevier Mosby Sant. Louis Missouri. 2014; 6:144
Stanley HR, Alattar M, Collett WK, String-fellow HR, Spiegel EH. Pathological se-quelae of neglected impacted third molars. J Oral Pathol. 1988; 17(3):113–7
Eliasson S, Heimdahl A, Nordenram A. Pathological changes related to long-term impaction of third molars. A radiographic study. Int J Oral Maxillofac Surg. 1989; 18(4):210–12
Van der LW, Cleaton-Jones P, Lownie M. Diseases and lesions associated with third molars. Review of 1001 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 79(2): 142-5
Mc-Ardle 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(1): 42-5
Ozec I, Herguner SS, Tasdemir U, Ezirganli S, Goktolga G. Prevalence and factors affecting the formation of second molar distal caries in a Turkish population. Int J Oral Maxillofac Surg. 2009; 38(12): 1279- 82 doi: 10.1016/j.ijom.2009.07.007
Silvestri AR, Singh I. The unresolved problem of the third molar: would people be better off without it?. J Am Dent Assoc. 2003; 134(4): 450-5
Chang SW, Shin SY, Kum KY, Hong J. Correlation study between distal caries in the mandibular second molar and the eruption status of the mandibular third molar in the Korean population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(6): 838-43 doi: 10.1016/j.tripleo.2009.07.025
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(10):1270-4 doi: 10.1016/j.ijom.2012.03.003. Epub 2012 Mar 30.
Venta I. How often do asymptomatic, disease-free third molars need to be removed? J Oral Maxillofac Surg. 2012; 70(9 sup 1):41-7 doi: 10.1016/j.joms.2012.04.037
Campbell JH. Pathology associated with the third molar. Oral Maxillofac Surg Clin North Am. 2013; 25(1):1- 10
Mc-Ardle 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(1): 42-5
McArdle LW, Renton T. The effects of NICE guidelines on the management of third molar teeth. Br Dent J. 2012; 213(5): 8