Maxillary Tuberosity Fractures Following Third Molar Extraction, Prevalence, and Risk Factors.

OBJECTIVES: The aim of this study was to evaluate the prevalence of maxillary tuberosity fractures in an adult population and to examine the different risk factors associated with these fractures. MATERIALS AND METHODS: This is a retrospective study; data was collected from medical records of patients who underwent a non-surgical extraction of a maxillary third molar tooth between January 2017 and March 2019. All extractions were performed by 2 maxillofacial specialists. RESULTS: A total of 403 extracted maxillary third molar teeth were included in the study. Out of them 73 cases of tuberosity fractures were recorded (18.1%). No significant difference in the number of recorded fractures was found between the 2 surgeons. The mean age of patients was 32.8 ± 11.5. In the age group of 30 years and under a fractures rate of 12.1% was recorded compared to 25.0% in the age group of over 30 (P = 0.001). Divergent or extremely curved root morphology were associated with a higher risk for fractures (30.7%) compared to convergent root morphology (13.1%) ( P < 0.001). Borderline significance ( P = 0.069) was observed for extractions of teeth with caries lesions (21.9%) compared to teeth with no caries lesions (14.6%). CONCLUSIONS: The risk of developing a tuberosity fracture during an extraction of an upper wisdom tooth increases with age by 3.1% per year. Teeth with a caries lesion or teeth with divergent or extremely curved root morphology are associated with a higher risk for tuberosity fractures. Although, distoangular teeth had reduced risk of developing a tuberosity fractures. Data collected in this study may help to evaluate the risk factors associated with tuberosity fractures, and can assist in minimizing complications during extractions.

Unique challenges in naval military dentistry.

Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver's head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines.

Where periodontitis meets metabolic syndrome-The role of common health-related risk factors.

OBJECTIVES: To analyse and compare associations between metabolic syndrome (MetS) and its components in periodontitis compared to control patients. METHODS: This 7-year cross-sectional study retrospectively analysed medical records of 504 individuals aged 18-90 who attended the student dental clinic between 2008 and 2014. Demographics, smoking habits, blood pressure, waist circumference, as well as presence of: periodontitis, MetS, diabetes, hypertension, hyperlipidaemia, stroke, heart disease, cancer and psychiatric disorders were recorded. RESULTS: The study population composed of 231 (45.8%) males and 273 (54.2%) females, with an average age of 55.79 ± 16.91 years. A patient profile associated with periodontitis was identified and included male sex, older age, smoking, higher smoking pack-years, abdominal obesity, higher systolic and diastolic blood pressures, the presence of MetS or its components, hypertension, hyperlipidaemia, diabetes or diseases associated with its consequences such as ischaemic heart disease and stroke. Following multivariate logistic regression analysis, age and smoking retained a significant association with periodontitis, whereas the systemic disorders did not. CONCLUSIONS: The association between periodontitis and MetS may be explained by shared common profile and risk factors. An appropriate risk factors management approach should be adopted by both dental and general health clinicians and health authorities, to control common high-risk behaviours.

[BURNING MOUTH SYNDROME - A FLAME HARD TO EXTINGUISH].

INTRODUCTION: Burning mouth syndrome (BMS) is a common condition that mostly affects elderly women. This symptom presents as a severe chronic burning sensation affecting the oral cavity and especially the dorsum of the tongue and its lateral aspects. Mouth burning sensation can result from an idiopathic primary condition or evolve from a secondary problem. The difficulty in reaching a correct diagnosis and especially to determining an appropriate treatment leads to considerable dissatisfaction among patients. In this paper we review the causes and the characteristics of the primary and secondary forms of the syndrome, the means of diagnosis and known treatment options.

Survival Rates of Amalgam and Composite Resin Restorations from Big Data Real-Life Databases in the Era of Restricted Dental Mercury Use.

Tooth decay, also known as caries, is a significant medical problem that harms teeth. Treatment is based on the removal of the carious material and then filling the cavity left in the tooth, most commonly with amalgam or composite resin. The consequences of filling failure include repeating the filling or performing another treatment such as a root canal or extraction. Dental amalgam contains mercury, and there is a global effort to reduce its use. However, no consensus has been reached regarding whether amalgam or composite resin materials are more durable, and which is the best restorative material, when using randomized clinical trials. To determine which material is superior, we performed a retrospective cohort study using a large database where the members of 58 dental clinics with 440 dental units were treated. The number of failures of the amalgam compared to composite resin restorations between 2014 and 2021 were compared. Our data included information from over 650,000 patients. Between 2014-2021, 260,905 patients were treated. In total, 19,692 out of the first 113,281 amalgam restorations failed (17.49%), whereas significantly fewer composite restorations failed (11.98%) with 65,943 out of 555,671. This study indicates that composite is superior to amalgam and therefore it is reasonable to cease using mercury-containing amalgam.

The effect of cessation of drinking water fluoridation on dental restorations and crowns in children aged 3-5 years in Israel - a retrospective study.

BACKGROUND: Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3-5, treated in "Assuta Tel Aviv" dental clinics, under general anesthesia or deep sedation. METHODS: The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014-2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation. RESULTS: A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages. CONCLUSION: The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel.

Correlates of Early Dental Implant Failure: A Retrospective Study.

PURPOSE: To examine whether patient-level disease diagnoses, drug treatments, and dental clinical factors are correlates of early implant failure. MATERIALS AND METHODS: This historical, nested case-control study used electronic medical records to retrieve patient-level data on individuals with implant failure occurring up to 6 months after implantation, including demographics, clinical information (number, location, and complicated status of implants), underlying diseases (osteoporosis, diabetes, hypertension, inflammatory bowel disease [IBD], myocardial infarction [MI]), and drug purchases (chemotherapy, bisphosphonates, selective serotonin inhibitors, antihypertensive medications, proton pump inhibitors [PPIs], disease-modifying antirheumatic drugs, corticosteroids, and nonsteroidal anti-inflammatory drugs) among adult members of a large, state-mandated health provider in Israel between 2015 and 2020. Individuals with implant extraction occurring up to 6 months after implantation were matched 1:1 to controls. Univariate and adjusted multivariate conditional logistic regression models were used to examine the odds ratios (ORs) of all dental implant risk factors among the patients. RESULTS: A total of 585 individuals with implant failure (mean age, 53 years [42,62], 51.3% females and 49.7% males) were identified among 29,378 eligible patients. Compared to controls, patients who experienced implant failure (ie, cases) were more likely to have smoked in their lifetime (18% vs 11.5%, P = .009), experienced IBD (1.5% vs 0.02%, P = .059), and consumed PPIs within 6 months of the implant surgery (40.0% vs 32.5%, P = .028). Clinical factors, including the number of implants per person (individuals with two implants, OR = 1.53; individuals with at least four implants, OR = 3.33; P < .01), location of implant (maxilla; OR = 1.59; 95% CI: 1.2-2.04), and smoking (OR = 1.57; 95% CI: 1.09-2.26) were significant correlates of early implant failure among the included cases. Crohn's disease, MI, and osteoporosis were found to be borderline significant correlates of early dental implant failure. CONCLUSIONS: Among the factors examined, the number of implants, the location of implants, and smoking history were significant correlates of early implant failure, while Crohn's disease, MI, and osteoporosis were found to not be significant. Larger patient-level studies are needed to examine the individual and combined effects of diseases, medications, and clinical factors on early implant failure.

Caries experience, periodontal status, and metabolic morbidity in patients with psychiatric disorders.

OBJECTIVES: To investigate the association of psychiatric disorders with (1) caries experience, (2) periodontal status, and (3) metabolic syndrome (MetS) components. METHOD AND MATERIALS: This 7-year cross-sectional study retrospectively analyzed the medical records of 504 individuals aged 18 to 90 years who attended the student dental clinic. Collected data included: demographics, smoking habits, systolic and diastolic blood pressures, pulse, waist circumference, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), maximal pocket probing depth (PPD), average and maximal radiographic bone loss (RBL), the sum of the number of decayed (D), missing (M), and filled (F) teeth (DMFT score), and presence of MetS components, consequences and related conditions including diabetes, hypertension, hyperlipidemia, ischemic heart disease, heart failure, s/p stroke, and cancer. RESULTS: 68 (13.5%) had psychiatric disorders with an average age of 53.42 ± 15.71 years. Psychiatric disorders were positively associated with smoking (P = .008), smoking pack-years (P = .004), DMFT score (P = .005), and negatively associated with hypertension (P = .046). Psychiatric disorders had no statistically significant associations with all periodontal indices studied and with other components of MetS. Following multivariate analysis, psychiatric disorders retained a statistically significant positive association with smoking (odds ratio [OR] and 95% confidence interval [CI] = 2.24 [1.28 to 3.92]) and with DMFT (OR and 95% CI = 1.08 [1.02 to 1.14]), and a statistically significant negative association with hypertension (OR and 95% CI = 0.46 [0.25 to 0.84]). CONCLUSIONS: Psychiatric disorders were positively associated with smoking and caries experience but not with periodontal status and metabolic morbidity. Communication between dental and medical professionals is needed to address the higher smoking consumption and caries morbidity in psychiatric patients. (Quintessence Int 2021;52:516-526; doi: 10.3290/j.qi.b1044091).

Preventing Ventilator-Associated Pneumonia in Intensive Care Unit by improved Oral Care: a Review of Randomized Control Trials.

To assess the effects of various oral care methods on the incidence of VAP in patients receiving mechanical ventilation in intensive care units, an exhaustive literature search was undertaken using MEDLINE as well as a manual review of the relevant literature and citations. Eight publications were selected for this review. The primary endpoint was the incidence of VAP. Different oral care methods for preventing VAP were the subject of this review. Two studies that were reviewed in this article showed significant statistical difference between the intervention group and the control group regarding different oral care for lowering the incidence of VAP. The rest of the studies showed no significant statistical difference between the intervention group and the control group, but showed the importance of meticulous oral hygiene in those patients. Mechanically ventilated patients who suffer from poor oral hygiene are exposed to the harmful accumulation of oral plaque and the initiation of VAP. Proper oral care by qualified care givers can reduce the incidence of VAP. Proper oral care needs to be considered part of the medical treatment plan when a patient is admitted to the ICU to lower the incidence rates of VAP. Oral care treatment of ventilated patients in the intensive care units, for prevention of ventilator-associated pneumonia, is with high clinical relevance, decreasing morbidity and mortality in the ICU. We recommend that ICU medical teams will plan a protocol of oral care treatment, based on our article results, and implement it as part of the daily routine.

A critically severe gingival bleeding following non-surgical periodontal treatment in patients medicated with anti-platelet.

BACKGROUND: Only a few dental procedures have been reported to cause life-threatening bleeding. All of these cases followed surgical intervention. MATERIAL AND METHODS: In this paper, we report a case of severe bleeding following non-surgical periodontal procedures in a patient treated with a dual anti-platelet regimen post-coronary stent insertion. RESULTS: Her medical history included ischaemic heart disease, hypertension and diabetes mellitus. Haemostasis was achieved at the conclusion of the non-surgical periodontal treatment. However, several hours later, the patient arrived at the emergency room and was diagnosed with hypovolemic shock. CONCLUSION: This case should raise the clinician's awareness of bleeding complications in non-surgical procedures as well as the risk for bleeding when a dual anti-platelet regimen is administered. The importance of patient monitoring and the use of local haemostatic agents is demonstrated in these cases.

Dental treatment in the era of new anti-thrombotic agents.

BACKGROUND: In recent years, there have been dramatic changes in anti-thrombotic treatment as a result of new anti-thrombotic agents, as well as changes in the indications for their use. As a consequence, dentists are encountering larger numbers of patients who are undergoing anti-thrombotic treatment and who have increased risk for bleeding. The current paper aims to review the literature regarding up-to-date anti-thrombotic treatment and provide information regarding their implications on dentistry. METHODS: An online search was performed of the literature published between 2000 and 2016. Articles dealing with evidence-based clinical guidelines for anti-thrombotic treatments, as well as literature reporting the use of anti-thrombotic medications were included. The manuscripts were screened according to their relevance to dentistry as well as their treatment protocol guidelines. RESULTS: In total, 5,539 publications were identified: 56 of 554 evidence-based clinical guidelines were found that dealt with treatment protocols with anti-thrombotic agents; and 132 of 5,539 articles describe direct anti-thrombotic medications. CLINICAL IMPLICATIONS: Dental treatment includes a risk for bleeding. As a result of the increasing number of patients taking new-generation anti-thrombotic drugs, dentists must be up to date regarding the implications of such drugs on dental treatment as well as the practical means to achieve haemostasis.

Flexible, removable partial denture for a patient with systemic sclerosis (scleroderma) and microstomia: a clinical report and a three-year follow-up.

This article describes an optional mode of treatment for a partially edentulous patient with severe microstomia, severe changes to the intraoral soft tissues, and compromised hand function. The principles discussed in this article describe a patient with systemic sclerosis but are applicable to any patient who suffers from scarring in the oral and facial areas due to disease, trauma, or burning injuries. Since dental implants were contraindicated, it was determined that long-term comfort and function could be achieved only through the use of a removable partial denture (RPD). A Valplast flexible RPD was used because of its unique characteristics and a specially designed folded custom impression tray was used to obtain an accurate impression of hard and soft tissues. This article describes the complete process and management of the patient's needs, focusing on the decision-making process for the chosen treatment plan, the special impression technique, and the completion of the RPD.

Lymphangiomatosis with dental involvement.

BACKGROUND: Lymphangiomatosis characterized by lymphangiomatous proliferation is a rare disease of unknown etiology, which seems to be more aggressive than Gorham-Stout Syndrome, also known as "the vanished bone disease." METHODS AND RESULTS: A woman presented with a lytic lesion in the tibia and multiple lytic lesions in teeth dentin. Upon autopsy, a single lytic bone lesion and fulminant lymphangiomatous proliferation were found in the pleura, pericardium, and peritoneum. The histological findings from a tooth lytic lesion included fibroblastic proliferation interspersed with vascular spaces embedded with fragments of lamellar bone and dentin containing osteoclast like multinucleated giant-cell lined resorption bays. CONCLUSIONS: The histological findings support the notion that hard tissue resorption is conducted by lymphangiomatosis and osteoclastic activity.

Levels of sirolimus in saliva and blood following oral topical sustained-release varnish delivery system application.

PURPOSE: Sirolimus (rapamycin) is a mammalian target of rapamycin pathway blocker. The efficacy of sirolimus is currently studied for its antiproliferative properties in various malignancies and particularly in squamous cell carcinoma and other oral disorders. Topical application at the oral cavity can augment sirolimus availability at the site of action by increasing sirolimus levels in saliva and hence efficacy, along with improved safety (low levels in the blood to avoid side effects) and compliance. Our purpose was to evaluate the release profile and safety of a topical sirolimus sustained-release varnish drug delivery system. SUBJECTS AND METHODS: Sirolimus sustained-release varnish drug delivery system containing a total of 0.5 mg of the drug was applied to nine healthy male volunteers. Saliva and blood levels were determined utilizing mass spectrometry and chemiluminescent microparticle immunoassay, respectively. The prolonged release profile and safety were evaluated for the oral topical delivery system. RESULTS: After the application of the drug delivery system, a sustained-release profile was observed in the oral cavity. We have measured moderate sirolimus levels for up to 12 h. The safety was confirmed, and systemic sirolimus blood levels were negligible. CONCLUSIONS: After an application of sirolimus sustained-release varnish drug delivery system, prolonged drug levels can be achieved in the saliva. The oral topical sirolimus concentrations were potentially therapeutic along with minimal systemic exposure. These results broaden the potential clinical use of sustained-release oral topical rapalogs.

Dental treatment for high-risk patients with refractory heart failure: a retrospective observational comparison study.

OBJECTIVE: Heart failure affects large population groups. The understanding of the etiology, pathophysiology, and treatment of heart failure has changed considerably within the last few years. The changes have significant implications for the medical management of the disease, as well as on the ability to provide proper dental treatment for these patients. METHOD AND MATERIALS: A retrospective observational study of the outcome following dental treatment of 54 patients was performed: 32 with refractory heart failure stage D (study group) and 22 patients at risk for heart failure stages A to C (control group). Dental management of these patients concentrated on the prevention of iatrogenic, dental setting- induced, and precipitating factors of heart failure. To prevent deterioration of patients' medical condition, a comprehensive, tailored treatment including adequate anxiolysis, close monitoring, profound dental anesthesia, and close follow-up was used. A previously described three-step gradual level protocol (at home, waiting room, and dental chair) was adopted. RESULTS: All the planned dental procedures were successfully completed. Six patients experienced respiratory distress during treatment, and five patients demonstrated arrhythmias during dental treatment. Only minute differences were found between the groups regarding blood pressure and heart rate. CONCLUSION: Use of the suggested protocol facilitated the completion of planned dental treatments for all patients. Thus, providing essential dental treatment for severe heart failure patients with special attention to their medical problems and the use of medications and supporting means to prevent health-compromising situations is recommended.

Dental treatment of a patient with an implanted left ventricular assist device: expanding the frontiers.

BACKGROUND: The left ventricular assist device (LVAD) is used as a bridge to heart transplantation. Currently, these devices are being used for longer periods of time than in previous years for the purpose of bridge to life, thus the need for dental assistance will emerge. CASE DESCRIPTION: A female with severe acute congestive heart failure, owing to dilated cardiomyopathy, needed implantation of an LVAD as a bridge to heart transplantation. Six months after insertion of the device she suffered from spontaneous gingival bleeding and sought dental treatment. She presented with several dento-medical problems that required resolution before commencement of dental treatment. CONCLUSIONS: Management of a patient with LVAD opens new frontiers for the dental team regarding treatment of the medically severely compromised patient who may present with multiple intervening medical aspects: profound antithrombotic therapy, high risk of device infection, possible magnetic interference with dental instruments, and even assessment of vital signs.

Survey of acceptance of the 2007 American Heart Association guidelines for the prevention of infective endocarditis: a pilot study.

OBJECTIVE: To evaluate the acceptance rate of the 2007 American Heart Association (AHA) prophylactic protocol by the patients for whom the need for prophylaxis for infective endocarditis was downgraded. METHOD AND MATERIALS: A survey among patients was conducted. Patients were included if they had to receive antibiotic prophylaxis prior to dental treatment according to the 1997 AHA protocol and did not require antibiotic prophylaxis prior to dental treatment according to the 2007 AHA guidelines. The perception of the patients and their physicians to the change was analyzed. Possible contributing parameters were assessed. RESULTS: The slight decrease in the rate of acceptance with an increase in time since the AHA publication demonstrated by the logistic regression (odds ratio, 0.93; 95% CI, 0.79 to 1.10) was not statistically significant (P=.41). Parameters related to lower patient acceptance rates were invasiveness of dental treatment and the type of dental setting (P=.046 and .001, respectively). Parameters that were found not to affect the patient acceptance rate were the severity of cardiac condition and a durable history of dental treatments in the same institute (P=.06 and .26, respectively). CONCLUSIONS: Sixteen months after publication of the 2007 AHA guidelines, the acceptance rate of the protocol is moderate to high. Reasons for this partial acceptance are discussed.

A new management approach for dental treatment after a cerebrovascular event: a comparative retrospective study.

OBJECTIVE: Current literature recommends postponing dental treatment until 6-12 months after a stroke, based on the presumed risk of recurrent stroke. The purpose of this study was to suggest that the importance of dental care during this period exceeds the risk of medical complications in this patient population. STUDY DESIGN: Two groups were compared: 1) a cerebrovascular (CrbV) study group: patients (n = 16) who had suffered from a CrbV event within the 12 months preceding their dental procedure; and 2) a cardiovascular (CV) control group: patients (n = 25) suffering from ischemic CV disease. Patients were monitored during and after the dental treatment. Treatment parameters and outcome were compared. RESULTS: Patients received various essential dental treatments with intense monitoring during their dental management. Dental procedures were invasive in 68.8% and 0% of CrbV and CV groups, respectively. Dental treatments were completed uneventfully. No clinical CrbV or CV complications were noted in either group after the dental treatment. CONCLUSION: Within the limits of this small retrospective study, it appears that dental treatment may be safely administered in patients a few weeks after the CrbV event as long as these patients are kept under optimal medical surveillance.