Maxillofacial space infection experience and risk factors: a retrospective study of 222 cases.

BACKGROUND: Maxillofacial space infection (MSI) experience review is beneficial for its management. AIM: To identify potential risk factors predisposing to the exacerbation of MSI and a prolonged length of stay (LOS). METHODS: We performed a comprehensive retrospective review of medical records of 222 MSI patients admitted in Center of Stomatology during 1993-2019. RESULTS: About 63.5% of 222 patients had an odontogenic infection, and submandibular space was the most involved space. Streptococcus spp. was the most common organism isolated (72.4%). Multiple-space cases had more systemic diseases, respiratory difficulty, and life-threatening complications and exhibited worse clinical characteristics (higher white-blood-cell-count, higher body temperature, and restricted mouth opening) than single-space cases (P < 0.05). No significant difference in LOS was found between multiple-space cases and single-space cases. Diabetes and hypertension both accounted for 35.1% in life-threatening cases. Multiple-space infection (60.4%), respiratory difficulty (11.7%), and systemic conditions (43.2%) were identified as critical risk factors associated with life-threatening complications in MSI patients (P < 0.001). A significantly prolonged LOS was found in cases aged ≥ 60 years or with systemic diseases. Community outpatient treatment shortened 1.9 days of LOS compared with self-medication before admission during 2010-2019 (P < 0.05). CONCLUSION: Comprehensive managements are advisable for MSI patients with multiple-space infection, respiratory difficulty, systemic diseases to avoid disseminated exacerbation, and occurrence of life-threatening complications. Community outpatient treatment was beneficial to a reduced LOS. Timely access to dental outpatient management and simultaneously steady control of diabetes and hypertension was advocated. Improved coverage of insured dental outpatient treatment should be stressed.

Computerized measurement of the location and value of the minimum sagittal linear dimension of the upper airway on reconstructed lateral cephalograms compared with 3-dimensional values.

INTRODUCTION: Identifying the location and value of the smallest airway dimension can be useful in screening and planning treatment for patients with obstructive sleep apnea. Our objectives in this study were to (1) objectively identify the vertical location and value of the minimum sagittal linear dimension (MSLD) on 2-dimensional reconstructed lateral cephalograms (RLCs), (2) compare the location and value of the MSLD on RLCs with the vertical location and sagittal dimension of the minimum cross-sectional area (MCSA), and (3) investigate the association between the MSLD on RLCs and both the MCSA and the airway volume. METHODS: Cone-beam computed tomography (CBCT) scans of 91 patients, in 3 age groups (<20, 20-40, and >40 years), were used to perform 3-dimensional assessments of the upper airway and reconstruct lateral cephalograms. Airway volume, MCSA, vertical level, and sagittal dimension of MCSA on the CBCT scans were obtained using Dolphin 3D software (version 11.7; Dolphin Imaging, Chatsworth, Calif). Customized software was used to objectively obtain the location and value of the MSLD of the airway on RLCs. RESULTS: In all age groups, correlation tests showed significant correlations between the MSLD on RLCs and both the MCSA (rs ≥0.59; P <0.001) and the airway volume (rs ≥0.37; P <0.05). Additionally, there were significant correlations between the vertical location of the MSLD and the vertical location of the MCSA (rs ≥0.41; P <0.05) and between the MSLD and the sagittal dimension of the MCSA (r ≥0.61; P <0.001). Bland-Altman plots for the MSLD and the sagittal dimension of the MCSA showed much narrower 95% limits of agreement compared with the Bland-Altman plots for the vertical locations of the MSLD and the MCSA. CONCLUSIONS: Two-dimensional images may be used as a screening tool and to identify the sagittal dimension of the smallest airway dimension. However, comprehensive assessment of airway characteristics is better achieved with CBCT-based 3-dimensional evaluation.

Change in the vertical dimension of Class II Division 1 patients after use of cervical or high-pull headgear.

INTRODUCTION: The goals of this study were to compare the effects that cervical and high-pull headgear have on the vertical dimensions in Class II Division 1 patients during phase 1 treatment and to compare these effects with untreated predicted growth for the sample population. METHODS: Pretreatment and posttreatment cephalometric radiographs of children who had undergone Class II Division 1 correction with cervical (n = 22) or high-pull headgear (n = 19) were analyzed for the measurements that describe the changes in the vertical component of growth and mandibular position. The groups were matched for age (mean, 9 ± 2.5 years), treatment time (mean, 14 months), malocclusion, and similar skeletal features. The groups were compared with each other and also with an untreated growth model. RESULTS: Treatment with cervical headgear resulted in smaller increases in measurements that describe the vertical dimension than with high-pull headgear. Cervical headgear showed more favorable changes in mandibular growth that were statistically significant when compared with the untreated growth models. CONCLUSIONS: In this study, the cervical headgear showed more control over the vertical dimension and produced more favorable changes in mandibular position by normalizing the occlusal plane. Compared with the untreated growth model, cervical headgear worked synergistically with growth to produce more optimal changes in mandibular position.

Accuracy of digital American Board of Orthodontics Discrepancy Index measurements.

INTRODUCTION: A digital analysis that is shown to be accurate will ease the demonstration of initial case complexity. To date, no literature exists on the accuracy of the digital American Board of Orthodontics Discrepancy Index (DI) calculations when applied to pretreatment digital models. METHODS: Plaster models were obtained from 45 previous patients with varying degrees of malocclusion. Total DI scores and the target disorders were computed manually with a periodontal probe on the original plaster casts (gold standard) and digitally using Ortho Insight 3D (Motion View Software, Hixson, Tenn) and OrthoCAD (Cadent, Carlstadt, NJ). Intrarater and interrater reliabilities were assessed for 15 subjects using the Spearman rho correlation test. Accuracies of the DI scores and target disorders were assessed for all 45 subjects using Wilcoxon signed ranks tests. RESULTS: Intrarater and interrater reliabilities were high for total DI scores and most target disorders (r > 0.8). No significant difference was found between total DI score when measured with OrthoCAD compared with manual calculations. The total DI scores calculated by Ortho Insight 3D were found to be significantly greater than those by manual calculation by 2.71 points. CONCLUSIONS: The findings indicate that a DI calculated by Ortho Insight 3D may lead the clinician to overestimate case complexity. OrthoCAD's DI module was demonstrated to be a clinically acceptable alternative to manual calculation of the total scores.

A comparison of compliance in Medicaid versus non-Medicaid patients.

BACKGROUND: Medicaid patients have been associated with lack of compliance during their orthodontic treatment in comparison with the non-Medicaid patients. In this study, Medicaid and non-Medicaid orthodontic patients' compliance from a state university and private practice orthodontic clinic within close location were analyzed. METHODS: Charts of 30 Medicaid and 30 non-Medicaid orthodontic patients at each orthodontic clinic were reviewed. From each chart, mean percentage of failed and late appointments, number of broken appliances, number of comments on compliance with auxiliary wear and number of comments on oral hygiene maintenance were recorded. RESULTS: Statistically significant differences between Medicaid and non-Medicaid orthodontic patients were not found. CONCLUSIONS: The results of this study indicated that in general there are no differences between Medicaid and non-Medicaid orthodontic patients. PRACTICAL IMPLICATIONS: These results may alleviate the doubts of the dental practitioner in treating Medicaid patients.