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Impacted teeth—a frequent phenomenon among Hong Kong Chinese

Hong Kong Med J 2003;9:158-63

Tooth impaction was found to be frequent among Hong Kong Chinese, according to a radiographic study of more than 7000 patients by the Faculty of Dentistry, University of Hong Kong. Percentage of symptomatic patients was also considerably higher than reported in previous literature.

In order to determine whether the chief complaints were related to impacted teeth and associated pathologies, researchers studied the records of 7486 patients. These patients attended the Reception and Primary Care Clinic at the Prince Philip Dental Hospital within a 12-month period. The major complaints were pain and swelling. Examination using panoramic radiographs revealed that 2115 (28%) patients had at least one impacted tooth.

Among the 3853 impacted teeth, 83% were mandibular third. More than 50% of maxillary third molars had erupted, creating potential trauma of the pericoronal tissues of the partially erupted mandibular third molars. Periodontal diseases and caries of the lower second molars adjacent to impacted third molars were found in approximately 8% of cases. Approximately 30% of patients with impacted teeth were symptomatic, whereas the figure was only 8% according to another study.

Although removal of impacted third molars is common, many investigators have questioned the necessity of removal for patients who are free of symptoms or associated pathologies. Such comments are based on the view that long-term retention of impacted teeth has little risk of pathological change in the tooth itself, or of adverse effects on adjacent structures.

The concept of withholding and withdrawing life-sustaining is ethically acceptable and legal in situations where further medical treatment is deemed futile for the restoration of normal physiological function. Yet the issue remains ethically debatable. A survey has been performed to evaluate the attitudes of Hong Kong teachers towards life-sustaining therapy for dying patients.

A total of 436 questionnaires were sent to teaching staff at the Hong Kong Institute of Education. More than half (66%) of the respondents were aged between 30 and 49 years, and the distribution of sex was even. Teachers in this survey tended to support the practice of withdrawing and withholding life-sustaining treatment for dying patients when treatment was considered futile. Unlike previous studies, age, sex, educational level, personal experience, and religious beliefs, were not shown to significantly affect respondents’ attitudes to end-of-life decisions.

If the patient is competent, half of the respondents agreed that the patient alone should make the decision, while 27% believed that it should be a joint decision made by the patient, the family, and the doctor. Conversely, if the patient is unconscious or incompetent, 11% of respondents thought that the decision should be made by family alone, while 53% agreed that it should be a joint decision made by the family and the doctor. It was noticeable that 22% of respondents did not think that anyone should make such a decision.

Teachers in this survey showed strong support for advanced directives. 69% of respondents thought that, every patient should make an advance decision and a legal record on whether to continue life-support treatment when approaching death.