Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Saliva: What Dental Practitioners Should Know about the Role of This Biofluid in the Transmission and Diagnostic of SARS-CoV-2.

A novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has become a global ongoing pandemic. This pandemic represents a great work risk for all health professionals, it includes dental professionals who are in constant contact with saliva, which represents one of the main routes of transmission of the disease. This is due to the fact that a wide variety of oral tissues and cells are susceptible to infection by SARS-CoV-2 and that they express the ACE2 receptor, which is the main route of entry of the virus into cells, as well as the proteins TMPRSS and furin that contributes to the binding of the virus to the host cells. According to recent studies, some of the oral cells most susceptible to infection by SARS-CoV-2 are the epithelial cells of the salivary glands. This explains the presence of the virus in the saliva of infected patients and provides scientific evidence that supports the use of saliva as a biofluid that offers the opportunity to develop new detection and diagnostic techniques. This is because saliva is much easier to collect compared to nasopharyngeal swab. However, the presence of the virus in saliva, also represents a great source of transmission, since the main form of infection is through microscopic drops that are generated when infected people cough or sneeze. Likewise, health professionals, such as dentists are exposed to contagion through saliva. The objective of this review article is to provide a perspective on the main cells and tissues that can be affected by the virus, the risk of contagion that the presence of the virus in saliva represents for dentists; and the new techniques developed from saliva samples for the diagnosis and surveillance of SARS-CoV-2 infection. This review is expected to contribute to the knowledge of oral health professionals about the risk of saliva in the spread of SARS-CoV-2, but also its advantages as a diagnostic tool for pandemic control. In conclusion, the authors can mention that information that provides more scientific evidence of the mechanisms of infection of the coronavirus in oral cells and tissues is being published continually. This also explains the presence of the virus in the saliva of infected people and the risk of contagion that this means. It also provides scientific evidence of the use of saliva as a biofluid for the detection, diagnosis, monitoring, and control of the spread of the virus.

Pain and Anxiety Levels Using Conventional versus Computer-Controlled Local Anesthetic Systems in Pediatric Patients: A Meta-Analysis.

The objective of this systematic review and meta-analysis was to compare the pain/anxiety levels associated with the anesthetic process by conventional and computer-controlled delivery systems (CCDS) in children. Four electronic databases (PubMed, EMBASE, Scopus, Google Scholar, and Dentistry & Oral Science Source/EBSCO) were comprehensively explored for eligible studies, in English or Spanish, published from January 1995 to December 2019. A systematic literature review and meta-analysis were conducted according to the PRISMA statement, including only randomized controlled clinical trials. An exhaustive search was performed in different electronic databases under a specific PICO-posed question. Relevant studies were selected based on titles and abstracts, and the full texts were retrieved. From these articles, important information was extracted. Wand demonstrated significantly lower pain than the conventional injection did. In the subgroup by pain scale analysis, the Facial Image Scale and Wong-Baker Faces Pain Scale showed a significant difference in favor of the CCDS. In general, the reviewed evidence shows that less perceived pain and anxiety occur when the local anesthetic technique is performed with a CCDS than with the traditional technique.

Dental pain and associated factors in Mexican adolescents and young adults: a cross-sectional study.

OBJECTIVE: To identify the factors associated with the prevalence of dental pain in Mexican adolescents and young adults. MATERIAL AND METHODS: This is a cross-sectional study in which data from 638 Mexican subjects, 16-25 years of age, who were randomly selected from college applicants, were analysed. Questionnaires were administered to collect sociodemographic, economic and behavioural variables. Clinical examinations were carried out to determine the decayed, missing and filled teeth (DMFT) index. The outcome variable was dichotomised as 0 (no dental pain in the last 12 months) or 1 (dental pain in the last 12 months). Statistical analyses included binary logistic regression. RESULTS: Average age was 18.76 ± 1.76 years, and 49.2% of participants were women. Prevalence of dental pain was 34.0%. In the final model, variables significantly (P < 0.05) associated with the experience of dental pain were the use of preventive dental services (OR = 0.34), being a former smoker (OR = 2.37), self-report of very poor/poor oral health (OR = 1.94) or fair oral health (OR = 1.94), self-reported dental disease (OR = 2.06) or gingival disease (OR = 2.84). CONCLUSIONS: The prevalence of dental pain was associated with self-reported oral health status, preventive dental visits and smoking; these results have implications for dental practice. We found that recent experience of dental pain was common in young adults, being reported by one out of three subjects.

Evaluación radiográfica de la presencia/agenesia de terceros molares en una población infantil Mexicana / Radiographic Evaluation of the Presence/Agenesis of Third Molars in a Mexican Child Population

RESUMEN En el ser humano, el tercer molar es el órgano dentario que más variaciones presenta durante su desarrollo embriológico, y es causa de diversas alteraciones y malestares durante su proceso de erupción. Se ha señalado que la agenesia del tercer molar tiene una prevalencia entre 9 y 37%. El objetivo del presente estudio transversal comparativo fue evaluar radiográficamente la presencia/ausencia de gérmenes de terceros molares (G3M) en pacientes pediátricos de origen mexicano. Se analizaron 513 radiografías panorámicas de pacientes que asistieron al Posgrado en Estomatología Pediátrica de la Universidad Autónoma de San Luis Potosí (México), durante los años 2011 a 2017. Se tomaron como criterios de inclusión, pacientes entre los 7 y 18 años de edad, sexo indistinto; se excluyeron pacientes con antecedentes de extracción de alguno de los terceros molares, tratamiento ortodóntico previo, enfermedades congénitas y/o síndromes asociados. Se compararon las frecuencias y prevalencias de agenesia de terceros molares, en total y por cuadrantes, comparando por sexo y grupo de edad. 245 radiografías panorámicas correspondieron al sexo femenino y 268 al masculino. La prevalencia total de agenesia del G3M fue estimada en casi 56%, y el grupo de edad de 7-8 años mostró el mayor porcentaje; sin embargo, cuando este grupo de edad se excluyó del análisis, dicha prevalencia disminuyó a 27.3%. Los cuadrantes mandibulares mostraron mayor porcentaje de agenesia. No hubo diferencia estadística significativa en la comparación por sexo. La prevalencia total de agenesia del G3M reportada en el presente estudio se encuentra muy por encima de los parámetros internacionales. Es muy posible que la falta de visualización radiográfica de agenesia de los terceros molares haya sido errónea en algunos casos debido a la ausencia frecuente de indicios de calcificación de este diente durante las edades tempranas (7-8 años). El análisis ajustado proporcionó un valor de prevalencia más acorde con los estándares reconocidos por la literatura dental.

ABSTRACT In the human being, third molar is the tooth that exhibits more variants during its embryologic development, usually causing diverse anomalies and discomfort when erupting to the oral cavity. It has been pointed out that the prevalence of third molar agenesis is between 9 to 37%. The aim of the present comparative cross- sectional study was to radiographically assess the presence/absence of third molar germs (G3M) in a sample of pediatric patients of Mexican origin. A total of 513 panoramic radiographs were analyzed from patients attending the Pediatric Dentistry Postgraduate Program ( San Luis Potosí University, México), during the years 2011 to 2017. Inclusion criteria were patients between 7 and 18 years old, any gender; children with antecedents of a third molar extraction, previous orthodontic treatment, or with an associated congenital or systemic condition were excluded. Total prevalence G3M agenesis was calculated. Then, statistical comparisons of agenesia proportions per dental quadrant, gender, and age group were performed. 245 panoramic radiographs corresponded to the female gender, while 268 belonged to the male gender. The total prevalence of G3M agenesia was estimated in nearly 56%, and the 7-8 years old group exhibited the highest proportion; however, when this age group was excluded from the analysis, such prevalence decreased to 27.3%. Both mandibular quadrants showed higher proportions of G3M agenesia. There were no significant differences between genders. The total prevalence reported in the present study was found to be well above regarding the international parameters. It is quite possible that lack of radiographic visualization of G3M had been inaccurate in some cases due to the common absence of calcification traces from those teeth during early ages (7-8 years old). The adjusted analysis provided a prevalence value more in line with the recognized standards in the dental literature.

Agreement analysis of three mandibular third molar retention classifications.

INTRODUCTION: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. OBJECTIVE: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. METHOD: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. RESULTS: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. CONCLUSION: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

INTRODUCCIÓN: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. OBJETIVO: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. MÉTODO: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. RESULTADOS: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. CONCLUSIÓN: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

Análisis de concordancia de tres clasificaciones de terceros molares mandibulares retenidos / Agreement analysis of three mandibular third molar retention classifications

Resumen Introducción: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. Objetivo: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. Método: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. Resultados: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. Conclusión: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

Abstract Introduction: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. Objective: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. Method: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. Results: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. Conclusion: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

Dentinogenesis Imperfecta Type II in Children: A Scoping Review.

Dentinogenesis Imperfecta type II (DI2), also known as hereditary opalescent dentin, is one of the most common genetic disorders affecting the structure of dentin, not related with osteogenesis imperfecta, which involves both primary and permanent dentitions. The purpose of this article is to perform a scoping review of the published peer-reviewed literature (1986-2017) on DI2 management in children and to outline the most relevant clinical findings extracted from this review. Forty four articles were included in the present scoping review. According to the extracted data, the following are the most important tasks to be performed in clinical pediatric dentistry: to re-establish the oral mastication, esthetics, and speech, and the development of vertical growth of alveolar bone and facial muscles; to reduce the tendency to develop caries, periapical lesions and pain; to preserve vitality, form, and size of the dentition; to avoid interfering with the eruption process of permanent teeth; to decrease the risk of tooth fractures and occlusion disturbances; to return the facial profile to a more normal appearance; and to prevent or treat possible temporomandibular joint problems. Therefore, Pediatric Dentists should bear in mind that early diagnosis and treatment, together a long-term follow-up of DI2 in children, continue to be the best approaches for achieving enhanced patient psychological well-being and, in consequence, their quality of life.

El expediente clínico electrónico: una opción con posibilidades ilimitadas / The electronic clinical file: an option with unlimited possibilities

El expediente clínico se define como el conjunto de datos médicos y clínicos ordenados y detallados en forma cronológica, que permiten al profesional de la salud plantear un diagnóstico sindrómico y nosológico, con su posterior pronóstico, para finalmente llevar un registro del desarrollo de un tratamiento. Refleja la capacidad resolutiva de la clínica o consultorio, así como la capacidad profesional de su personal, de ahí la importancia de tener un expediente clínico bien integrado, ordenado, completo, legible y en apego a la normatividad vigente (AU)

The clinical file is defined as a set of medical and clinical data, which are ordered and chronologically detailed, allows the health professional to identify a syndromic and nosological diagnosis, with a later prognosis, to finally make a treatment plan. It reflects the resolutive capacity and the professional capacity of the clinician and his staff. Therefore, it becomes a legal document of the greatest importance, having to have the characteristics of being well integrated, orderly, complete, legible and in compliance with current regulations (AU)

Prevalencia de Bruxismo y Trastornos Temporomandibulares Asociados en una Población de Escolares de San Luis Potosí, México / Prevalence of Bruxism and Associated Temporomandibular Disorders in a Population of School Children of San Luis Potosí, México

RESUMEN: El término "Transtornos Temporomandibulares" (TTM) incluye numerosos problemas clínicos asociados con las articulaciones temporomandibulares, músculos de la masticación y otras estructuras asociadas. El bruxismo, un hábito oral parafuncional, consiste en rechinar o apretar de manera rítmica e involuntaria los dientes, lo que puede conducir a trauma oclusal y problemas articulares. El objetivo del estudio fue determinar la frecuencia y prevalencia de signos y síntomas de TTM y bruxismo en niños escolares de 6 a 12 años, en una población de San Luis Potosí, México. Se empleó un diseño transversal descriptivo en una muestra de 314 participantes, estudiantes de una escuela primaria de la ciudad de San Luis Potosí, México. Los participantes fueron seleccionados aleatoriamente en forma estratificada y polietápica. La muestra total consistió en 153 femeninos y 161 masculinos. Los signos y síntomas de TTM más frecuentes fueron la alteración de la función de la ATM (35 %), seguido por los ruidos y chasquido articulares (29,2 %). En los sujetos con diagnóstico de bruxismo, la alteración más frecuente fueron molestias asociadas en la ATM (19,4 %), dolor de cabeza (17,8 %) y atrición dental (16,5 %).

ABSTRACT: The term "Temporomandibular disorders" (TTM) includes numerous clinical problems associated with joint temporomandibular, muscles of mastication and other associated structures. Bruxism, oral parafunctional habit, consists of grinding or clenching of involuntary, rhythmic manner, which can lead to trauma, occlusal and problems joint. The objective of the study was to determine the frequency and prevalence of signs and symptoms of DTM and bruxism in school children aged 6 to 12, in a population of San Luis Potosí, México. A crosssectional descriptive design was used in a sample of 314 participants, students of a primary school in the city of San Luis Potosi, Mexico. The participants were randomly selected in tiered form and conglomerated. The total sample consisted of 153 female and male 161. The signs and symptoms of TMD frequent were alteration of the function of the ATM (35 %), followed by noise and snap joint (29.2 %). In subjects with a diagnosis of bruxism, the most frequent alteration was associated with TMJ discomfort (19.4 %), headache (17.8 %) and dental attrition (16.5 %).

Clinical and Radiographic Characteristics as Predictive Factors of Swelling and Trismus after Mandibular Third Molar Surgery: A Longitudinal Approach.

Introduction: Factors that contribute to swelling and trismus are complex, and they are originated by surgical trauma. The aim of the present study was to determine whether clinical and radiographic factors could predict the level of swelling and trismus after lower third molar surgery, through longitudinal approach. Methodology: A prospective longitudinal trial was carried out. Forty-five patients of both genders with clinical and radiographic diagnosis of asymptomatic mandibular impacted third molar and with no intake of analgesic or anti-inflammatory drugs 12 h prior to surgery were recruited and evaluated in a 72 h follow-up period. A mixed repeated measures model and backward and restricted maximal likelihood methods were used to analyze the data. Results: Male gender, body mass index (BMI), the relation to the lingual and buccal walls, and age were determinants for predicting postoperative swelling and for exerting a significant influence (P < 0.05). Conclusions: This study suggests the association of male gender, the relation to lingual and buccal walls, BMI, and age with measurement of swelling.

Evaluación del efecto sedativo del Midazolam con y sin Ketamina, por vía subcutánea, en pacientes dentales pediátricos / Evaluation of the Sedative Effect of Midazolam with and Without Ketamine, by Subcutaneous Via in Pediatric Dental Patients

Resumen El miedo y la ansiedad de los niños por el tratamiento dental pueden conducir a dificultades en el manejo de la conducta por parte del profesional, lo cual puede ser una barrera para el éxito del tratamiento dental. Los niños no cooperadores pueden necesitar recibir tratamiento dental bajo sedación, la que se indica cuando la guía de comportamiento no farmacológico no tiene éxito. Existen ensayos controlados aleatorios que comparan diferentes protocolos sedantes para procedimientos dentales; sin embargo, la evidencia de superioridad de una forma sobre otra es débil. El objetivo del presente estudio es evaluar el efecto sedativo de Midazolam por vía subcutánea, con y sin ketamina, en procedimientos odontológicos realizados en pacientes pediátricos no cooperadores. Se llevó a cabo un ensayo clínico aleatorizado, cruzado, con cegamiento simple, en 13 niños (10 del género masculino y 3 del femenino) de 19 a 48 meses de edad, ASA I y comportamiento Frankl I. Los dos métodos se aplicaron en el mismo paciente, y el orden de los mismos fue asignado aleatoriamente, para las dos citas de tratamiento. En cada sesión se evaluaron: el comportamiento general del paciente, los movimientos corporales y el llanto, por medio de la escala de Houpt modificada. Además, se monitorearon la frecuencia cardíaca y la saturación de oxígeno por medio de un oxímetro de pulso.

Abstract Children's fear and anxiety about dental treatment can lead to difficulties in the behavior management by the practitioner, which can be a barrier to successful dental treatment. Non cooperative children may need dental treatment under sedation, which is indicated when the non-pharmacological behavioral guidance is unsuccessful. There are randomized controlled trials comparing different sedative protocols for dental procedures; however, evidence of superiority from one form over another is weak. The aim of the present study was to evaluate the sedative effect of midazolam subcutaneously, with and without ketamine, on dental procedures performed in non-cooperative pediatric patients. A randomized, crossover clinical trial with single blinding was performed in 13 children (10 males and 3 females) from 19 to 48 months of age, ASA I and Frankl I behavior. The two methods were applied in the same patient, and the order of the same was assigned randomly, for the two treatment appointments. In each session were evaluated the patient's general behavior, body movements and crying through the modified Houpt scale. In addition, heart rate and oxygen saturation were monitored by means of a pulse oximeter.

Prophylactic Extraction of Third Molars: Evidence-Based Dentistry

his new perspective article was performed to investigate the evidence from published dental literature about the prophylactic extraction of asymptomatic (or disease-free) impacted third molars (ITM) in adolescents and young adults. This clinical procedure is common until today and has been the origin of controversy among the dental community worldwide. However, evidence-based data from wellconducted clinical studies and systematic reviews are not sufficient to justify the routine prophylactic extraction of ITM. Active surveillance at regular intervals has been proposed as a better management strategy. As a conclusion, surgical removal of ITM is only justified in the presence of specific pathosis, independently of the patient's age.

l presente artículo se realizó para investigar la evidencia en literatura dental publicada sobre la extracción profiláctica de terceros molares impactados asintomáticos (o libres de enfermedad) (TMI) en adolescentes y adultos jóvenes. Este procedimiento clínico es común y ha sido el origen de la controversia entre la comunidad dental en todo el mundo. Sin embargo, los datos basados en evidencia de estudios clínicos y revisiones sistemáticas no son suficientes para justificar la extracción profiláctica rutinaria de TMI. La vigilancia activa a intervalos regulares se ha propuesto como una mejor estrategia de manejo. Como conclusión, la remoción quirúrgica de TMI sólo se justifica en presencia de patología específica, independientemente de la edad del paciente.

Dental Management of a Child with Incidentally Detected Hemophilia: Report of a Clinical Case.

Children with hemophilia (A or B) are at risk for bleeding episodes, which rank from mild mucosal/soft tissues bleeding to life-threatening hemorrhages. This report describes the dental/medical management provided to an 8.10-year-old patient suffering from uncontrolled bleeding after a surgical procedure to expose both permanent upper central incisors, in which hemophilia was a pure incidental finding. Additionally, diverse precautions to be considered during the dental clinical treatment of hemophilic children are discussed.

Comparison of the analgesic efficacy of preoperative/postoperative oral dexketoprofen trometamol in third molar surgery: A randomized clinical trial.

The aim of this study was to compare the efficacy of preoperative and postoperative dexketoprofen trometamol for pain control after third molar surgery. Sixty subjects indicated for impacted mandibular third molar surgery were randomly assigned to two groups: preoperative (group 1, n = 30) and postoperative (group 2, n = 30) administration. Group 1 received 25 mg of dexketoprofen trometamol 30 min before surgery and 1 placebo capsule (same color and size with active drug) immediately after surgery. Group 2 received the placebo capsule 30 min before surgery and 25 mg of dexketoprofen trometamol immediately after surgery. Pain intensity was assessed using a numeric rating scale (NRS) during the first 8 h. The time of the need for a second dose of dexketoprofen trometamol, after the first administration, was recorded. The data were analyzed using mixed-model repeated-measures (MMRM), Wilcoxon rank-sum, and Kaplan-Meier analysis. After the 8 h period, no statistically significant difference was observed in the intensity of pain (MMRM, p = 0.41); and no significant difference in the time for a second dose (p = 0.956). In conclusion, preoperative administration of dexketoprofen trometamol is a reasonable clinical approach that is as effective as conventional postoperative pharmacological treatment, with the advantage of allowing early analgesia before pain develops. (ClinicalTrials.gov: NCT02380001).

Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery.

OBJECTIVE: The aim of this study was to compare preemptive analgesia of oral ketorolac plus submucous local placebo with oral ketorolac plus submucous local tramadol after impacted mandibular third molar surgery. STUDY DESIGN: A double-blind, randomized, placebo-controlled clinical trial was conducted. Patients were randomized into two treatment groups (n = 15 per group): group A, oral ketorolac 10 mg, 30 minutes before surgery plus submucous local placebo (1 mL saline solution); group B, oral ketorolac 10 mg, 30 minutes before surgery plus submucous local tramadol (50 mg diluted in 1 mL saline solution). We evaluated the intensity of pain, time for the first analgesic rescue medication, and total analgesic consumption. RESULTS: Pain intensity, number of patients requiring analgesic rescue medication, number of patients in each group not requiring analgesic rescue medication, and total analgesic consumption showed statistical significance. CONCLUSIONS: Preemptive use of oral ketorolac plus submucous local tramadol is an alternative treatment for acute pain after surgical removal of an impacted mandibular third molar.

Use of therapeutic laser after surgical removal of impacted lower third molars.

PURPOSE: To evaluate the effectiveness of a therapeutic laser in the control of postoperative pain, swelling, and trismus associated with the surgical removal of impacted third molars. PATIENTS AND METHODS: A double-blind, randomized, controlled clinical trial was conducted in 2 groups of 15 patients each undergoing surgical removal of impacted lower third molars under local anesthesia. The experimental group received 4 J/cm(2) of energy density intraorally and extraorally, with a laser with a diode wavelength of 810 nm and output power of 100 mW in a continuous wave. The control group received only standard management. The degree of postoperative pain, swelling, and trismus was registered for both groups. RESULTS: The experimental group exhibited a lower intensity of postoperative pain, swelling, and trismus than the control group, without significant statistical differences. Patients of both groups required rescue medication; however, the time lapse between the end of the surgery and the administration of the medication was shorter for the control group. CONCLUSION: The use of therapeutic laser in the postoperative management of patients having surgical removal of impacted third molars, using the protocol of this study, decreases postoperative pain, swelling, and trismus, without statistically significant differences.

Pre-emptive analgesic effect of tramadol after mandibular third molar extraction: a pilot study.

PURPOSE: We compared the efficacy of tramadol given before or immediately after surgical extraction of an impacted mandibular third molar under local anesthesia. MATERIALS AND METHODS: In this prospective, randomized, controlled, double-blind pilot study, 3 groups of 20 patients each were included: tramadol preoperative, 100 mg intramuscularly (IM) 1 hour before surgery (group A); tramadol postoperative, 100 mg IM immediately after surgery (group B); and saline (group C). We evaluated intensity of pain and analgesic consumption as was requested. RESULTS: The analgesic efficacy measured as complete relief of pain at 24 hours was 86% in the preemptive tramadol compared with 70% and 36% for postoperative tramadol administration and control group. A significant reduction in the consumption of analgesics was seen in preoperative group as compared with the postoperative and control groups. Adverse events were minimal and similar in all groups. CONCLUSIONS: This study suggests the preemptive use of tramadol as an alternative for the acute pain treatment after the removal of an impacted mandibular third molar carried out under local anesthesia.

Analgesic efficacy of tramadol by route of administration in a clinical model of pain.

The objective of this study was to evaluate the analgesic efficacy produced by tramadol given by two different routes of administration in patients experiencing pain after removal of an impacted mandibular third molar under local anesthesia. A double-blind, randomized, placebo-controlled clinical trial was conducted. Patients were assigned into four groups of treatment, twelve subjects per group: Group A, tramadol 50 mg IM one hr before surgery; group B, tramadol 50 mg into the surgical site; group C, tramadol by both routes of administration, 50 mg IM one hr before surgery plus 50 mg into the surgical site; and group D, control. We evaluated intensity of pain and analgesic consumption as was requested. Demographic characteristics and variables describing the difficulty of the surgical procedure were similar between groups. The duration of the anesthetic effect was significantly longer in the groups where tramadol was injected into the surgical site (215 and 252 min). Administration of systemic and local tramadol (50 mg) suppressed the pain intensity values in comparison to the control group (p < 0.05). Also, tramadol in both routes of administration suppressed the pain intensity values in comparison to all groups (p < 0.05). A significant reduction in the consumption of ketorolac was seen in all treatments as compared to the control group. However, only in the route combination group was a significant reduction in the requirement of acetaminophen observed. Nine patients requiring additional medication were treated with ketorolac 30 mg injected intramuscularly; 2 in the systemic group, 2 in the local group, 4 in the control group and only 1 in the combination group. Adverse events were minimal and similar in all groups.

Trastornos en el sentido del gusto. Revisión de la literatura / Taste sense disorders. Review of the literature

Las alteraciones en el sentido del gusto son problemas que por lo general han recibido poca atención de la comunidad médica, por una parte el diagnóstico es complicado, y por otra no existe un tratamiento estandarizado. Se hace una revisión de la literatura y se enfatiza la necesidad del estomatólogo de profundizar sobre estos trastornos, para formar parte del equipo multidisciplinario que se requiere en este tipo de pacientes