Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial.

INTRODUCTION: Enhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes. METHODOLOGY: A randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes. RESULTS: Baseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001). CONCLUSION: Our study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.

Caries experience scores revisited for caries risk assessment using cariogram model - A cross-sectional study.

Context: The widely accepted caries risk assessment tools such as the Cariogram model needs modifications in the scoring of different factors for reliable results. Aims: The study was aimed to report the caries experience in 3-60 years of the Rajasthan population and to apply the newly derived average decayed exfoliated filled teeth/Decayed Missing Filled Teeth (deft/DMFT) scores in the Cariogram model to assess the caries risk. Settings and Design: The cross-sectional study was planned in the Department of Dentistry and a total of 500 participants were equally divided into five groups (3-6, 7-12, 13-30, 31-44, and 45-60 years) were included. Methods and Material: All participants were examined for caries detection using deft/DMFT, ICDAS, and CAST indices according to the predefined protocol. A single examiner evaluated the participants in a dental operatory and data was recorded. Statistical Analysis Used: One-Way ANOVA and Tukey's Post-Hoc tests were used to evaluate the significant difference between the groups of each caries index. Results: A statistically significant difference was observed between the mean deft/DMFT and CAST scores of 3-6, 7-12, and 13-30 age groups with the 45-60 years age group. Caries prevalence was highest (83%) in 31-44 and 45-60 year age groups and lowest (51%) in the 3-6 year age group. Conclusions: Caries experience scores increase as the age increases and the highest scores were observed in 31-44 and 45-60 year age groups and the lowest were observed in the 3-6 year age group. The average ICDAS and CAST scores were higher when compared to the deft/DMFT index.

Comparative assessment of conventional and light-curable fluoride varnish in the prevention of enamel demineralization during fixed appliance therapy: a split-mouth randomized controlled trial.

Objective: To evaluate the effects of single application of a conventional versus light-curable fluoride varnish (LCFV) on prevention of enamel demineralization during fixed orthodontic treatment over a 4 month period. Design: The research was designed as a split-mouth, randomized control trial (RCT). Methods: Twenty-two patients requiring fixed orthodontic treatment with premolar extractions were included in the RCT. In each patient, two diagonal quadrants (i.e. upper right and lower left, or vice versa) were randomly assigned to receive conventional fluoride varnish or LCFV. After allocation of one intervention, the other diagonal quadrants received the second intervention. At specific time intervals, premolars were extracted and sectioned, and the demineralized lesion was assessed in each group. Main outcome measures: The primary outcome was demineralized enamel lesion depth (DELD) at the end of 45, 90, and 120 days. Randomization: A simple complete randomization list using random allocation rule (restricted randomization) was computer generated to ensure homogeneity of application of conventional or LCFV to each contralateral quadrant in a split-mouth design. Allocation concealment was not employed. Blinding: Blinding was done only for outcome assessor because of clinical limitations. Results: Twenty-two patients with 88 teeth were enrolled in the trial. After excluding the drop-outs, primary analysis was performed on 66 teeth distributed among two interventional groups. Mean difference between DELD among two groups was 36.6 µm [95 per cent confidence interval (CI) 34.61-38.55] and 58.5 µm [95 per cent confidence interval (CI) 55.65-61.43] at 90 and 120 days, respectively. Cluster level analysis performed by Paired t-test showed that DELD was significantly higher (P < 0.001) in the conventional fluoride varnish group at the end of 90 and 120 days as compared to LCFV group. No adverse effect was observed in any patient. Limitations: Being a histologic study, the role of fluoride varnish could be assessed only for 4 months. Conclusion: The result of this study indicate that single application of LCFV (Clinpro™ XT) can prevent enamel demineralization for longer duration (for up to 4 months) of time as compared to conventional fluoride varnish (Duraphat™, 45 days) during fixed appliance therapy. Registration: The trial was registered retrospectively in the Clinical Trial Registry-India, number CTRI/2016/09/007232.