3 main parts of assessment for third molars
- History
- Clinical Examination
- Radiographic Assessment
Which underlying systemic diseases may affect normal healing processes?
Diabetes
Chronic renal disease
Liver disease
Bleeding disorders
Immunosuppression
Radiation / Chemotherapy
Name 3 drugs you should consider within MH
contraception
steroid therapy
bisphosphonates
What questions might you ask regarding previous extractions?
Have they had any previous extractions - how did they find this?
Any post-op infections?
Any post-op bleeding episodes?
Why might you assess TMJ during 3M3 clinical assessment?
3M pain may affect TMJ
TMD can show same presentation as pericoronitis - want to avoid mis-diagnosis
patient may return after M3M c/o clicking jaw - want to have note that this was happening pre-surgery
what 3 factors is the degree of surgical access guided by?
- mouth opening
- size of oral cavity
- tongue
Why is limited mouth opening important to consider in regards to surgery for M3M
increases surgical difficulty?
What considerations must you take into account when assessing lymph nodes during extra-oral examintation
is there lymphadenopathy present?
Are lymph nodes enlarged/tender?
Is this unilateral / bilatera;?
What would you clinically assess regarding the M3M during I/O exam?
The M3M condition
Its eruption potential
(fully / partially / unerupted)
Is there an operculum present?
What eruption class would you give a M3M which has no clinical signs of eruption but communication present on probing?
Partially erupted
What would you assess regarding the operculum during an I/O exam?
Is there an operculum present?
It is inflamed?
Is there any pus?
Is there evidence of food trapping?
is there any caries presetn?
List 9 components of an I/O exam for M3M assessment
- soft tissue exam
- dentition
- M2M
- M3M (eruption status)
- condition of remaining dentition
- occlusion
- OH
- caries status
- periodontal status
What is the lower 7 and ascending ramus known as during M3M assessment
working space
What are the two components of the working space
lower 7
ascending ramus
What factors do you need to take into account when assessing the occlusion during an I/O
are the upper 7/8 occluding on the operculum
are all of the 8s present (are they impacted / causing problems / are they functioning?
What 2 factors would not not justify radiographic assessment of M3Ms
Patient states they do not want surgical removal of M3M
No symptoms, no signs of third molars
What is the radiograph of choice when considering M3M surgery
OPT
9 components of a radiographic report of M3Ms
- presence or absence of disease
- anatomy of 3M
- depth of impaction
- orientation of impaction
- working distance
- follicle width
- periodontal status
- relationship or proximity of upper 3M to maxillary antrum / lower 3M to ID canal
- any other associated pathology
Radiographically, what would you report on regarding the anatomy of the third molar in a radiographic report.
- caries
- size and shape of crown
- number of roots
- root morphology
(crown to root ratio)
What are the three categories when reporting on depth of impaction of within a radiographic report?
- superficially impacted
- moderatley impacted
- deeply impacted
What is the dental follicle?
Tissue surrounding the crown of the developing tooth
What measurements would be considered outside the normal limits of dental follicle size which would cause suspicion
> 2.5 - 3mm
Pathology concern
What 8 radiographic signs may suggest close relationship between M3M + ID canal?
- Interruption to tram lines of ID canal
- Darkening of root where crossed by canal
- Diversion / deflection of ID canal
- Root deflection
- Narrowing of ID canal
- Narrowing of root
- Dark + bifid root
- Juxta-apical area
What 3 radiographic signs are associated with a significantly increased risk of nerve injury during M3M surgery?
- Diversion of canal
- Darkening of root
- Interruption of white lines of canal (lamina dura)
