April 09, 2004

By: Rachel Zelmer
Website: http://www.teeth-whitening-smiles.com

Impacted Teeth – A Hidden Danger

Not only do impacted teeth pose a greater risk of serious oral disease than previously recognized, reimbursement policies that discourage pathology exams of soft tissue surrounding the teeth increase the likelihood that destructive cysts and tumors will go undiagnosed.

In studies reported over the past decade, experts had concluded that the development of cysts and tumors from impacted teeth is rare. These growths often didn’t show up on x-rays. But a new study in the June issue of the Journal of Oral and Maxillofacial Surgery bucks that conventional wisdom, showing that about one in three individuals with an impacted tooth can expect to have a tumor or cyst in soft tissues called follicles that surround the teeth deep in the jaw.

This was higher than we had expected, said Alice Curran, DMD, associate professor at the University of Mississippi School of Dentistry and lead author of the study.

In their study, Curran and dental researchers from the University of Kentucky (UK) Department of Oral Health Sciences examined 2,646 tissue specimens taken from the archives of the UK Oral Pathology Biopsy Service. The vast majority of specimens, 91%, were taken from impacted third molars, more commonly known as wisdom teeth. Analyses of the tissue samples showed that 33% contained a cyst or tumor.

The most common lesion, found in 78% of tissue samples that contained a cyst or tumor, was a dentigerous cyst. Even though they are benign, dentigerous cysts can grow very large and eat away at the jawbone. The jaw becomes weak and may fracture easily. These cysts can get to be so huge that if you were in a car accident, or got an elbow in the jaw during a sports game, you could break your jaw, Curran said. Once they are removed, bone in the jaw regenerates.

Other types of growths found in the tissue samples included a more aggressive variety of dentigerous cyst, and highly aggressive odontogenic keratocysts that destroy jaw bone and often recur after they are removed. Benign and malignant tumors were discovered in a small percentage of the tissue samples. Oral cancer was present in 0.7% of the specimens.

Curran and her colleagues also found that the most serious oral disease was found in older populations. Their analysis showed that the mean age of individuals with oral disease was seven years older than those who were disease-free. After age 50, approximately 50% of follicular tissue contained a cyst or tumor,said Curran.

We can’t say with certainty which impacted teeth will develop a cyst or tumor, she noted. But if someone chooses not to have impacted teeth out at a young age, they should be strongly advised to monitor the teeth for the rest of their life.

The Journal’s editor-in-chief, Leon Assael, DMD, notes in an accompanying editorial that the structure of educational institutions, insurance coverage, and government programs has created an artificial separation of medicine and dentistry that causes oral disease to viewed as less serious than diseases in other parts of the body.

There is little in the health economy, public policy, or health education to even recognize [the oral health disease burden] as disease, he wrote.

One of the consequences, he noted, is lack of insurance coverage for pathology exams of follicular tissue. Insurance carriers routinely discourage oral and maxillofacial surgeons from sending follicles for examination, and surgeons who do may be harassed by the carriers, Assael said in his editorial. Most follicles are removed without the benefit of histopathologic examination, a procedure that would never be tolerated for pathologic tissue removed in a hospital setting, he wrote.

Assael said that pathology exams of follicles are performed too infrequently to be considered a standard of care. But he said he believes that the incidence of oral disease from impacted teeth makes it prudent to send all follicular tissue for pathology examinations.

Author Notes:

Rachel Zelmer contributes and publishes news editorial to http://www.teeth-whitening-smiles.com.  Everything you need to know to get a whiter, brighter smile!