A technique for long term decompression of large mandibular cysts.

Decompression is a conservative treatment that has frequently been used in the treatment of large odontogenic cysts. Techniques described in the recent literature have involved only fixation of a stent to soft tissue. In the present investigators' experiences, this technique has a high failure rate because of the dislodgement of the stent, due to tearing of the sutures over the course of a long-span treatment period. This report describes the use of a molded plastic stent that is fixated to bone and soft tissue, allowing access for daily irrigation during the long-span treatment period.

Acute Pain Management.

Control of acute pain in oral and maxillofacial surgery is important for patient care and comfort. Oral surgical procedures are associated with tissue injury and inflammation. Acute pain can arise directly from a surgical procedure or from problems such as dental caries, infection, perforation of maxillary sinus, pericoronitis, and jaw fractures. The major factor in acute pain management is deciding on an appropriate intervention and/or analgesics that will provide the best pain relief. Multimodal pain control has taken a leading role in effectively managing acute pain. This article covers the different options available to dental clinicians.

Excision of Sublingual Gland.

There are 2 types of ranulas: oral ranulas and plunging (cervical) ranulas. The management of the cervical ranula involves surgical excision of the oral portion of the ranula along with the associated sublingual salivary gland. The sublingual gland is easily removed from an intraoral approach. Significant anatomic structures associated with the removal of the sublingual gland are the submandibular duct, lingual nerve, and sublingual artery. Knowledge of the anatomy makes the surgery easier and without complications.

Vertical and Horizontal Augmentation of Deficient Maxilla and Mandible for Implant Placement.

Ridge augmentation for implant procedures has been shown to be highly successful. There are several techniques available to the dentist, but they require some degree of surgical expertise and experience. No particular technique has been shown to be superior. This article presents the indications, techniques, and complications of the various procedures for alveolar ridge augmentation. This information will educate the general dental practitioner of the techniques available and provide information on the surgical procedures that could be used to discuss with patients when they are being referred to a specialist.

New Approaches to Pain Management.

Opioid addiction has reached epidemic proportions in the United States and it is thought that the problem started with the prescription for legal pain medications by health care professionals, particularly for treating patients who had undergone surgery. To reduce the reliance on opioids in dental pain management, increase use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other adjunctive techniques have emerged. The use of NSAIDs, transdermal and transmucosal patches are presented. Understanding the rational for these different approaches requires a basic knowledge of the molecular biology of dental pain.

Salivary Gland Diseases.

A variety of diseases ranging from obstructions, infections, to benign and malignant tumors occur in salivary glands. The most common problem is painful blockage of ducts by stones that prevents drainage of saliva. Sialadenitis can be due to either infectious or noninfectious factors. Bacterial or viral infections are the most common causes of acute sialadenitis. Staphylococcus is the usual bacterial cause, whereas paramyxovirus (mumps) is the common viral cause. Eighty percent of salivary tumors are benign, whereas about 20% are malignant. Most tumors occur in the parotid gland and on the hard palate. Classifications, imaging, and suggested treatment are described.

Odontogenic Tumors.

Odontogenic tumors are a group of neoplastic growths that originate from the tissues responsible for tooth formation and the periodontal apparatus of the jaw. Odontogenic tumors usually present as radiolucent defect, which makes diagnosis somewhat confusing while differentiating them from cysts. Although cystic lesions are surrounded by sclerotic borders, few odontogenic tumors share similar features. This article reviews clinical concepts of several odontogenic tumors that occur in the proximity or in association with teeth and not merely focusing on relatively common conditions.

Credentialing.

Credentialing is the administrative process for validating the qualifications of licensed professionals and appraising their background. It is used by hospitals and other health care facilities, educational institutions, and insurance companies to ensure the qualification of their clinicians and to grant privileges to provide specific services and perform different medical or dental procedures. This article familiarizes the reader with the credentialing process and the documentation that is needed to be credentialed by certain organizations.

Odontogenic Infections.

The pathogenesis of odontogenic infection is polymicrobial, consisting of various facultative and strict anaerobes. The dominant isolates are strictly anaerobic gram-negative rods and gram-positive cocci. The periapical infection is the most common form of odontogenic infection. Although odontogenic infections are usually confined to the alveolar ridge vicinity, they can spread into deep fascial spaces. Cavernous sinus thrombosis, brain abscess, airway obstruction, and mediastinitis are possible complications of dental infections. The most important element in treating odontogenic infections is elimination of the primary source of the infection with antibiotics as adjunctive therapy.

Epidemiology of Oral and Maxillofacial Infections.

Dental caries and periodontal disease are the most common dental infections and are constantly increasing worldwide. Distribution, occurrence of dental caries, gingivitis, periodontitis, odontogenic infections, antibiotic resistance, oral mucosal infections, and microbe-related oral cancer are important to understand the public impact and methods of controlling such disease. Distribution of human papilloma virus and human immunodeficiency virus -related oral cancers in the US population is presented.

Postoperative care of oral and maxillofacial surgery patients.

The postoperative care of a surgical patient will depend on the site of the surgery, the nature of the surgery, the type of anesthesia used, and co-morbidities from diseases of major organ systems. Despite these variables, certain general principles are applicable and are discussed in this article. Important aspects of the immediate postoperative phase and pain management are emphasized along with the concepts of general postoperative care.

Gastrointestinal diseases and considerations in the perioperative management of oral surgical patients.

This article presents commonly encountered and clinically significant entities affecting the gastrointestinal (GI) system with emphasis on assisting the clinician in developing management strategies to reduce the associated risks. Xerostomia, osteoradionecrosis, gastroesophageal reflux disease, and ulcerative diseases occurring in the proximal portion of the GI system and antibiotic-associated diarrhea, pseudomembranous colitis, adynamic ileus, and malabsorption problems occurring in the distal portion are presented. Lastly, suggestions for managing patients who have splenomegaly and splenectomy are addressed.

Perioperative considerations of the patient on cancer chemotherapy.

Chemotherapeutic treatment of cancer has made great progress over the past 25 years and is frequently used as an important component of combined-modality therapy with surgery and radiation. Individuals undergoing cancer treatment with chemotherapeutic drugs frequently experience oral complications that may require oral surgical intervention. This article reviews the categories of drugs that are used and their side effects, and possible management strategies for patients undergoing cancer treatment with chemotherapy drugs in oral surgery practice.

Medication Management of Jaw Lesions for Dental Patients.

Most pathologic lesions of the jaws or of oral mucosa are treated successfully by surgical interventions. For treatment of the central giant cell lesion, aneurysmal bone cysts, histiocytosis of the mandible, hemangioma, odontogenic keratocyst, Paget disease, oral submucous fibrosis, and oral lichen planus, medical management consisting of intralesional injections, sclerosing agents, and systemic bisphosphonates is as successful as surgical procedures with fewer complications. Pharmacology of agents used and protocols are presented.

Implant surface material, design, and osseointegration.

The structural and functional union of the implant with living bone is greatly influenced by the surface properties of the implant. The success of a dental implant depends on the chemical, physical, mechanical, and topographic characteristics of its surface. The influence of surface topography on osseointegration has translated to shorter healing times from implant placement to restoration. This article presents a discussion of surface characteristics and design of implants, which should allow the clinician to better understand osseointegration and information coming from implant manufacturers, allowing for better implant selection.

Local anesthesia: agents, techniques, and complications.

This article outlines the different classes of local anesthetics available for dental procedures. It also gives an overview of the mechanism of action and metabolism of each different class of local anesthetic. Furthermore, it discusses indications and contraindications of each local anesthetic and the proper dosage of each. The techniques for the administration of local anesthetics with the relevant anatomy are explained. An overview is given of the possible complications that can occur because of local anesthetic use and their possible treatment options.