Surgical removal for khat inducible verruca vulgaris lesion of the oral mucosa.

The harmful effects of khat chewing on the oral mucosa membrane are still uncertain. Verruca vulgaris (common warts) is a benign lesion of skin and mucous membranes and can be caused by human papillomavirus. The lesions are typically self-limited but may vary in size and number. The occurrence on the floor of mouth is extremely rare. To the best of our knowledge, there are few number of oral lesions reported in connection with khat users. This case report shows that the chronic khat chewing has contributed to the development of verruca vulgaris warts that were confined to the chewing side of the mouth. A rare case of verruca vulgaris of the floor of mouth occurring in a 27-year-old Yamani male is presented with a discussion on etiopathogenesis and the treatment methods. Verruca vulgaris must be remembered in the differential diagnosis of the floor of mouth lesions, and surgical treatment may provide satisfactory outcomes.

Role of intraseptal anesthesia for pain-free dental treatment.

Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

Distress related to dental extraction for children under general anaesthesia and their parents.

AIM: The aims of this study were to observe levels of distress in children and their parents before and after extractions under general anaesthesia (GA) and to assess the effect of age, gender and the number of extractions on distress. DESIGN: a randomized comparative trial. Setting University Dental Hospital of Manchester. SUBJECTS AND METHODS: Two hundred and one children, together with their parents took part in this study. Immediately before GA, the Modified Child Smiley Faces Scales (MCSFS) and Modified Adult Smiley Faces Scales (MASFS) were completed by a trained observer for children and accompanying parents respectively, and again on recovery from anaesthesia and 15 minutes postoperatively. RESULTS: There were generalised increases in mean distress scores for children when comparing the pre-operative with the postoperative scores. However, mean distress scores for parents reduced at recovery and 15 minutes postoperatively and were less than the mean distress scores for children. There was no correlation between the child and parent distress scores preoperatively, postoperatively and 15 minutes postoperatively. There were significant increase in median distress scores for younger children compared to the older children at recovery and 15 minutes postoperatively (P0.05). Children who had 8 - 14 teeth extracted demonstrated higher levels of distress than those who had 1 - 7 teeth extracted (P0.05). CONCLUSION: Extraction of teeth under general anaesthesia does produce distress in children and their parents. Child and parental distress were not related. Both age and number of teeth extracted appear to influence the level of distress in children.

Intraoperative local anaesthesia for paediatric postoperative oral surgery pain--a randomized controlled trial.

The aim of this study was to improve the pain experience for children following oral surgery under general anaesthesia. To this end, the efficacy and safety of intraoperative local anaesthetic (2% lidocaine with 1:200,000 epinephrine) for postoperative pain control was investigated. In a randomized controlled trial, 142 patients aged 12 years or less, who were scheduled for dental extractions under general anaesthesia, received local anaesthesia or saline intraoral injection after induction of anaesthesia. There was statistically no significant difference between groups for pain scores recorded preoperatively, on waking, at 30 min, at 24h, or for distress scores recorded preoperatively, on waking and at 30 min. 'Severe' pain scores were recorded for 13% of treatment and 12% of control patients and 'very severe' for 13% of treatment and 10% of control patients on waking. These rates were similar at 30 min but reduced at 24h. Lip/cheek biting injuries occurred in one control and three treatment patients. Intraoperative local anaesthesia has been found to be effective for pain control following a range of other surgical procedures, but we did not find it to be effective in reducing postoperative pain or distress in children after oral surgery. Reasons may include unfamiliarity with altered orofacial sensation.

A double-blind randomized controlled trial investigating the effectiveness of topical bupivacaine in reducing distress in children following extractions under general anaesthesia.

OBJECTIVE: This study was designed to investigate the effectiveness of topical bupivacaine (0.25%) in reducing postoperative distress following extraction of teeth under general anaesthesia in children. DESIGN: The study was a double-blind randomized controlled trial. SETTING: The study was conducted in a dental hospital. SAMPLE: The sample comprised 135 children aged between 2 and 12 years of age who were undergoing outpatient general anaesthesia for simple dental extractions. METHODS: The children were randomly allocated to one of two groups: the bupivacaine group (the study group) comprised 68 children whilst the sterile water group (the control group) comprised 67. Following the extraction of their teeth, children had swabs soaked in the appropriate solution placed over the exposed teeth sockets. A five-point face scale was employed by an independent observer to evaluate the distress for each child. Evaluation of distress was made preoperatively, on recovery from the general anaesthetic, and again, 15 min following recovery from the anaesthetic. RESULTS: There were no statistically significant differences between the mean distress scores for the bupivacaine and sterile water groups preoperatively, postoperatively or 15 min postoperatively. For both groups, however, there were significant increases in distress scores between the preoperative and 15 min postoperative assessment scores. CONCLUSION: Extraction of teeth under general anaesthesia does cause distress in children. There is no evidence that topical bupivacaine reduces this distress when compared to sterile water.