Third Molar Periodontal Pathology inthe Third Decade and PeriodontalPathogensPaige E. Nance, DDS, OMFS, UNC School of Dentistry,Chapel Hill, NC 27599-7450 (White Jr. RP;Offenbacher S; Phillips C; Blakey GH; Haug RH)

Statement of the Problem: Increased periodontal prob-ing depth in the 3rd molar region is common for youngpatients. High levels of pathogens detected on the distalof second molars at baseline might predict periodontalpathology. This study assessed the association betweenfollow-up periodontal probing depths in the 3rd molarregion and the baseline levels of periodontal pathogensfor patients in a longitudinal trial.

Patients and Methods: Data derived from healthy pa-tients with four asymptomatic 3rd molars. Panoramicradiographs were analyzed for 3rd molar angulation ascompared to the long axis of the 2nd molar (mesial/horizontal �25 degrees) and eruption to the occlusalplane. Full mouth periodontal probing (PD) was con-ducted at follow-up. The baseline levels of bacteria weredetermined using whole chromosomal DNA probes andDNA checkerboard hybridization. Detected bacteriawere grouped into “orange” and “red” complexes ac-cording to Socransky. A level of “orange” and “red”complex microorganisms at �105 was considered clin-ically important.

Method of Data Analysis: The follow-up PD in the 3rdmolar region, the distal of 2nd or around 3rd molars,were compared to baseline levels of “orange” and “red”complex microorganisms. Level of significance for Chi2

statistics was set at P � 0.05.Results: Data from 240 patients were available. Median

follow-up was 2.2 y (IQ 2.0, 3.7 y). Baseline median agewas 25.9 y (IQ 22, 32.8 y). More were female, 53%, andCaucasian, 82%. At follow-up 12% maxillary mesial/hor-izontal impacted 3rd and 28% mandibular 3rd molars hada PD �4 mm. Similarly affected were 11% of the maxil-lary vertical/distal impacted 3rd and 32% of the mandib-ular 3rd molars. Only 11% maxillary erupted 3rd molarshad a PD �4 mm, but 51% of the mandibular erupted 3rdmolars were affected. If a patient had a PD �4 mm atfollow-up and baseline periodontal pathogens �105, thepathogens �105 were likely to be detected in the samequadrant, 45 of 51 (88%). With a PD �4 mm in themaxilla at follow-up, 43% of patients had baseline patho-gen levels detected in the same quadrant �105, as com-pared to 30% with follow-up PD �4 mm. For the man-dible a PD �4 mm in the 3rd molar region at follow-upwas associated more often with baseline quadrant levelsof pathogens �105, compared to 3rd molar PD �4 mm,29% vs. 26%. Differences were not statistically signifi-cant. Perhaps the short time interval from baseline tofollow-up did not allow for high levels of pathogens at

baseline to influence follow-up PD. Of the 3rd molarregions in the maxilla with �105 pathogens at baseline,22% had PD �4 mm at follow-up. In the mandible with�105 pathogens at baseline, 63% had PD �4 mm atfollow-up.

Conclusion: If pathogens �105 are detected with in-creased PD, both are likely in the same quadrant. Pa-tients continue to be followed to determine how oftenbaseline levels of pathogens predict increased PD.

References

Socransky SS, Haffajee AD, Cugini MA, et al: Microbial complexes.Haffajee AD, Cugini MA, Tanner A, et al: Subgingival microbiota in

healthy.Blakey GH, Marciani RD, Haug RH, Phillips C, Offenbacher S, Pabla

T, White RP Jr.

Funding Source: OMFS Foundation, AAOMS, Dental Foundation of NC

Arterial Stents to Assist in Sialoendoscopy:An Animal StudyMaria Papadaki, DDS, MD, One Emerson Place, Apt10E, Boston, MA 02144 (Kaban L; Kwolek C; Keith D;Troulis M)

Statement of the Problem: Sialolithiasis of the pa-rotid and submandibular glands is a frequently en-countered clinical problem. Due to a high recurrencerate, ablative surgery is often required and carriessome risk for facial nerve paresis (Marchal et al 2003).Sialoendoscopy is a novel minimally invasive tech-nique to visualize the lumen of the ducts and to allowstone removal with a high degree of success (Nahlieliet al 1997). Dilatation of the duct through the naturalorifice is accomplished and the endoscope is navi-gated through the ductal system. Complications in-clude inability to retrieve or break up the stone anddamage to the duct from manipulation of the endo-scope and instruments. The purpose of this study is toassess the feasibility of using expandable cardiovascu-lar stents to protect the parotid and submandibularducts during sialoendoscopy.

Materials and Methods: The sialoendoscopy procedurewas performed on pig cadaver heads (n � 10): theparotid (n � 20) and submandibular ducts (n � 20) wereidentified and dilated using salivary gland dilators. In 10parotid and 10 submandibular ducts the Cypher™ cor-onary stent was inserted and expanded to 3mm. Thescope was inserted and navigated to the hilum of thegland. Navigation of the duct system was repeated 5times. In 10 additional parotid and submandibular ducts(controls), the endoscope was inserted and navigated tothe hilum immediately after dilatation (and repeated 5times), without the placement of a coronary stent.

Oral Abstract Session 5

68 AAOMS • 2005

Method of Data Analysis: A video capture system wasused to document successful exploration and instrumen-tation of the ductal system. The ducts were then har-vested, dissected, and any traumatic injuries photo-graphed.

Results: All submandibular (n � 20) and parotid ducts(n � 20) were dilated without complications. The cor-onary stent was inserted using a guide wire and theballoon inflated to expand the stent. When the balloonwas deflated and withdrawn, the stent remained inplace, serving as scaffolding for the widened duct. Inser-tion and handling of a 1mm endoscope, through thestented salivary duct was facile, fast, and effortless in all20 parotid and 20 submandibular ducts. Insertion of theendoscope was successful in all 10 control parotid andsubmandibular ducts but with greater difficulty. Resultsof the clinical and video capture assessment of damageto the ducts will be presented.

Conclusion: Intraductal stent placement is feasible andprovides easier access for the surgeon with little traumato the salivary gland duct. Live animal experiments areongoing.

References

Marchal F, Dulguerov P: Sialolithiasis management: The state of theart. Arch Otolaryngol Head Neck Surg 129:951, 2003

Nahlieli O, Neder A, Baruchin AM.

The Systemic Impact of Third MolarPeriodontal PathologyAndrew T. Ruvo, DMD, MD, UNC Dept. of Oral andMaxillofacial Surgery, Chapel Hill, NC 27599 (Moss KL;Mauriello SM; Offenbacher S; White RP Jr.; Beck JD)

Statement of the Problem: Recent data link oral inflam-mation with systemic inflammation and negative healthoutcomes. This study examined the association betweenclinical periodontal measures for oral inflammation in-cluding 3rd molars, and markers for systemic inflamma-tion or preterm birth.

Materials and Methods: The data for the associationbetween oral inflammation and systemic outcomeswere derived from patients in an IRB approved, pro-spective study, “Oral Conditions and Pregnancy”(OCAP). Full mouth periodontal exams, six probingsites for each tooth visible in the mouth including 3rdmolars, were conducted less than 24 weeks of preg-nancy. Periodontal status at enrollment was dichoto-mized as healthy/mild periodontal disease (less than15 sites PD � 4 mm), or moderate/severe (15 or moresites PD � 4 mm). Moderate/severe periodontal dis-ease at enrollment was considered a possible predic-tor for negative obstetric outcomes and for systemic

inflammation. The upper quartile of the extent of PDfor 3rd molars alone (PD � 4 mm) also was consideredas a possible predictor for the same outcomes. Theprimary outcome variable for a negative obstetric out-come was preterm birth, gestational age � 37 weeks.The primary outcome variables for systemic inflamma-tion were elevated serum C-reactive protein (CRP) asa marker of an acute phase response from the liver and8-isoPGF2� (d8iso) as a marker of free radical inducedlipid peroxidation.

Method of Data Analysis: Chi-square and t-tests wereused to determine statistical significance, 0.05. Signifi-cant predictor variables were included in multivariatemodels. Unconditional logistic multivariate models wereused to derive odds ratios (OR) and 95% confidenceintervals (CI).

Results: Data from 1020 obstetric patients wereavailable for analysis. Eighteen percent of the patientsdelivered less than 37 weeks. With bivariate analysis,having moderate/severe periodontal disease as deter-mined by PD excluding 3rd molars, was significantlyassociated with preterm birth, P � 0.008. Resultswere more significant if 3rd molars were included, P� 0.0005. With multivariate models moderate/severeperiodontal disease at enrollment including 3rd molarPD was associated with preterm birth, OR 1.7 (95% CI1.1, 2.6). If 3rd molar PD alone was considered, oddswere increased for preterm birth, OR 2.4 (95% CI 1.4,4.4). If 3rd molar PD was ignored in multivariatemodels, having moderate/severe periodontal diseasewas not significantly related to preterm birth, OR 1.4(95% CI 0.9, 2.3). Moderate/severe periodontal diseaseoverall including 3rd molars, OR 1.9 (95% CI 1.3, 3.0)and 3rd molar PD alone, OR 2.3 (95% CI 1.3, 4.3),were associated with elevated serum CRP levels atenrollment. Moderate/severe periodontal diseaseoverall, OR 2.7 (95% CI 1.8, 4.2), and 3rd molar PDalone, OR 3.4 (95% CI 1.9, 6.4), were associated withelevated serum d8iso levels at enrollment.

Conclusion: Third molars with periodontal pathologycontributed significantly to the burden of oral inflamma-tion and its impact on systemic inflammation and pre-term birth.

References

Lieff S, Boggess KA, Murtha AP, et al: The oral conditions andpregnancy study: periodontal status of a cohort of pregnant women. JPeriodontal 75:116, 2004

Offenbacher S: Maternal periodontal infections, prematurity, andgrowth restriction. Clin Obstet Gynec 47:808, 2004

Blakey GH, Marciani RD, Haug RH, et al: Periodontal pathologyassociated with asymptomatic third molars. J Oral Maxillofac Surg60:1227, 2002

Funding Source: Study supported by NIH DE-012453, NIH RR-00046,AAOMS, OMFS Foundation.

Oral Abstract Session 5

AAOMS • 2005 69