Blood pressure monitoring following individual carpules of anesthetic utilizing computer-controlled anesthetic delivery.

To date, no study has evaluated blood pressure following administration of each carpule given for dental procedures using a computerized dental anesthesia system. Blood pressures taken prior to performing invasive periodontal procedures were compared with those readings measured following delivery of each of up to three consecutive carpules of Marcaine or Xylocaine in varying order. Pressure differences were also adjusted for age, sex, race, and whether a prescribed anxiolytic was taken beforehand. Neither systolic nor diastolic blood pressures changed significantly as compared to initial blood pressure readings. However, compared with Whites, Hispanics, and Middle Easterners, Blacks had significantly higher systolic pressure at the third carpule delivery, the cause being unknown. Blood pressure in patients being anesthetized for root planing and various periodontal surgical procedures will not increase significantly when administering up to three carpules, whether Marcaine or Xylocaine, in varying order, using controlled flow dental anesthesia, and this method may be preferable to syringes in managing dental procedural stress.

The Hospice Patient's Right to Oral Care: Making Time for the Mouth.

The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care. Varying viewpoints are discussed regarding the need for oral health monitoring and maintenance in both the capable patient with capacity and in the patient who lacks capacity and is totally dependent, yet who exhibits no particular signs of oral distress nor desire for hygiene measures. Consideration is given to family dynamics in such care. Oral care of the elderly patients and terminally ill is sorely lacking, and dental educators are challenged to cultivate in students a sense of professional duty toward caring for the vulnerable elderly patients. Dental professionals should create initiatives in developing, promoting, and implementing an appropriate standard of oral care for the hospice patient.

Assessment of gingival symmetry with digital measuring tools and its reproducibility.

OBJECTIVE: The aim of this study was to investigate the accuracy of digital measuring tools to measure the position of gingival zeniths and to assess its reproducibility between different examiners. MATERIALS AND METHODS: A total of 108 subjects were photographed at the Louisiana State University School of Dentistry. The settings, positioning of the digital camera, and subjects' Frankfurt levels were standardized. A photograph was taken of the six anterior maxillary teeth of each subject, and their corresponding free gingival margins. Digital caliper measurements were taken intraorally from the zenith to the incisal edge of the right maxillary central incisor. A reference line was drawn across the screen on each image at the level of the zenith of tooth 8. Three calibrated examiners then measured the distance from the reference line to the zeniths of the other five anterior maxillary teeth. RESULTS/CONCLUSIONS: There was no statistically significant difference between the examiners regarding any of the measurements. Central incisors were at the same level in 84.24% of the subjects, and lateral incisors were within 0.5 mm of central incisors in only 58% of the subjects. Canine zeniths were within 0.5 mm of each other in 43% of the subjects. Only 28% of the subjects presented with zeniths of tooth 6 to tooth 11 within 0.5 mm of each other. Lateral incisors were at or beneath the line drawn from central incisors to cuspids in 90.8% of the subjects. Standardized digital photography taken with the aid of a stadiometer and used to evaluate esthetic parameters allowed for reproducible measurements.

A histologic evaluation of various stages of palatal healing following subepithelial connective tissue grafting procedures: a comparison of eight cases.

BACKGROUND: It is often necessary to procure tissue from the same area of the palate in cases where connective autogenous grafting procedures are warranted due to limitations caused by anatomical features. The purpose of this study was to determine whether the length of time between a first procurement and a second would have any bearing on the quality of tissue available for recipient sites. METHODS: Eight patients requiring more than one grafting procedure underwent surgery at baseline and again at various intervals ranging from 6 weeks to 11 months. Specimens were taken from the palate and evaluated microscopically, and photographs were taken for purposes of visual comparison. RESULTS: The 6.9- to 7.7-week specimens exhibited complete reepithelialization. The lamina propriae were composed of a cellular proliferation of fibroblasts with loosely arranged collagen deposition and an occasional thin vascular channel. However, remodeling of the wound appeared complete in the specimens removed at the 9-week interval and beyond. The lamina propria was, in general, composed of thick, dense, interlacing bundles of collagen. Small-caliber blood vessels were interspersed throughout the fibrous element. CONCLUSION: Reharvesting of tissue performed earlier than at 9 weeks may result in poorer autogenous graft quality due to indications that remodeling of the connective tissue is still progressing and not as mature as specimens noted at weeks 9 to 47.

Oral post-surgical complications following the administration of bisphosphonates given for osteopenia related to malignancy.

BACKGROUND: This case report seeks to illustrate the clinical consequences of the administration of bisphosphonate therapy to prevent osteopenia secondary to malignancy in one patient. METHODS: A 69-year-old white female with a history of breast cancer with metastasis presented with pain in the upper left quadrant and periodontal pocketing of at least 6 mm in each of the four quadrants of the oral cavity. One week following surgery on the lower right region, lingual bone exposure was noted, and several attempts at achieving healing over the course of 15 months proved unsuccessful. RESULTS: Upon referral to a surgeon at the Louisiana State University Medical Center, New Orleans, Louisiana, a potential causative factor was finally identified. The drug zoledronic acid, a bisphosphonate given for prevention of osteoclastic activity of bone metastasis, secondary to breast cancer, was identified as the possible cause of inhibition of healing, most likely from regional vascular insufficiency. The drug was immediately discontinued. The patient is healing very slowly with the aid of hyperbaric therapy; she has been unable to achieve smoking cessation, which is deterring thorough healing of the exposed bony area on the lower right lingual side. CONCLUSIONS: Physicians and dentists alike must become increasingly aware of impaired oral healing following the use of bisphosphonates given for malignancy-related osteopenia. A dental exam should be performed before bisphosphonate therapy, as recommended for radiation therapy related to malignancy.

Treatment of a mucogingival defect associated with intraoral piercing.

BACKGROUND: In the previous decade, a notable increase in body adornment through tattooing and piercing has been a cause for concern among both dental and medical professionals. The author reports on the clinical consequences of wearing oral jewelry, specifically periodontal injury that requires surgical intervention. She also presents a general literature review of dental and medical consequences of wearing oral jewelry. CASE DESCRIPTION: A 20-year-old woman with a tongue piercing had severe periodontal recession in lingual aspect of the mandibular incisal area proximal to the location of the oral jewelry. The author used a connective tissue graft to correct the defect via root coverage and an addition to the gingival width. CLINICAL IMPLICATIONS: Wearing intraoral jewelry can lead to the development of severe mucogingival defects and necessitates careful and comprehensive periodontal evaluations on a regular basis to monitor attachment loss and damage to dental structures. Patients must be educated about these risks through counseling, patient information brochures and individual case documentation.

Evaluation of frozen subepithelial connective tissue grafts to increase the zone of attached gingiva. Report of 5 cases.

BACKGROUND: In the past decade, gingival tissue has been regenerated using subepithelial connective tissue grafts (SECT). This report presents the use of frozen subepithelial connective tissue (FSECT) for increasing the zone of attached keratinized gingiva (KG). METHODS: Five cases, 4 females and 1 male, aged 55 to 73 years, presented with inadequate attached KG. The SECT grafts were harvested from the palatal flap during conventional flap surgery. All grafts were frozen immediately. Five weeks to 10 months later, the grafts were placed in areas in which patients had inadequate KG. RESULTS: In all cases, healing was uneventful. All cases were followed up 3 months to 1.5 years. An increase of 1 to 3 mm of KG was achieved. CONCLUSIONS: These cases show that the FSECT graft is useful in treating mucogingival problems. Further randomized controlled trials over long periods of time are necessary to establish whether this procedure offers long-term benefits to patients.