title: Severe third molar complications including death-lessons from 100 cases requiring hospitalization.
abstract: OBJECTIVE
  In this study we investigated patients that were hospitalized due to third molar (M3) complications. Specifically we analyzed frequency, age distribution, and outcome with respect to the M3 clinical status.
  
  
  METHODS
  We set up a prospective cohort study and included 100 subjects admitted for management of acute M3-associated complications. The clinical status of the M3 was defined as 1) prophylactic M3 removal, 2) therapeutic (nonelective) M3 removal, or 3) M3 present at the time of admission. Outcome variables were clinical infection markers (C-reactive protein, leukocyte counts) and economic parameters (treatment costs, length of hospital stay, and days of disability). Nonparametric tests were used for comparison of subpopulations (surgical vs nonsurgical, prophylaxis-related vs nonprophylaxis-related).
  
  
  RESULTS
  One third of the 100 patients were age 40 or older. Overall 80 severe infections, 11 mandibular fractures, 3 nerve injuries, 5 tooth/root luxations, and 1 postoperative hemorrhage were noticed. Twenty-seven complications resulted from prophylactic surgery, 44 from nonelective removal, and 29 from pericoronitis. Postoperatively, a 77-year-old male patient hospitalized with nonelective removal sustained fatal myocardial infarction. Treatment costs were 260,086 euro (mean 2,608 euro/case); total days of disability were 1,534. The postsurgical complications showed higher C-reactive protein values compared with pericoronitis-induced complications.
  
  
  CONCLUSIONS
  Within the catchment area of our institution, the majority of complications requiring hospitalization resulted from diseased third molars or their removal. Side effects of observational strategies such as the shifting of complications to higher ages deserve future attention.
authors: Department of Oral and Maxillofacial Surgery, University of Mainz, Mainz, Germany. kunkel@mkg.klinik.uni-mainz.de
authors: Martin
authors: M
authors: Kunkel
authors: Wilfried
authors: W
authors: Kleis
authors: Thomas
authors: T
authors: Morbach
authors: Wilfried
authors: W
authors: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D017281:Cost of Illness; D017809:Fatal Outcome; D005260:Female; D005858:Germany; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery*; D009203:Myocardial Infarction / Q000209:etiology; D010497:Pericoronitis / Q000150:complications* / Q000191:economics; D011446:Prospective Studies; D018434:Sickness Impact Profile; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000191:economics* / Q000209:etiology*; D014081:Tooth Extraction / Q000009:adverse effects* / Q000191:economics / Q000401:mortality
chemical_list: D002097:C-Reactive Protein