Dental consultation requests to oral and maxillofacial surgery in a hospital in Brazil

Introduction: This study analyzed dental consultation requests to the division of oral and maxillofacial surgery in a Brazilian tertiary hospital. Methods: A cross-sectional study with data collected retrospectively from inpatients' electronic medical records containing dental consultation requests made between January 2013 and December 2017. Results: 327 consultation requests were analyzed. Mean (SD) patient age was 38.71 (24.4) years; 164 (50.2%) were male and 267 (81.7%) were Caucasian. Regarding systemic conditions, 34 (10.4%) were classified as ASA I, 86 (26.3%) as ASA II, 182 (55.7%) as ASA III, and 25 (7.6%) as ASA IV. Dental consultations were mostly requested by the internal medicine team (n = 42, 12.8%). The most common reason for consultation was septic teeth (n = 131, 40.1%). Complementary tests were required in 188 (57.5%) cases. Surgical intervention was required in 82 (25.0%), with tooth extraction as the most prevalent procedure (20.2%). The most demanding service was inpatient care, with 276 (84.4%) requests. Cases were resolved in 249 (76.1%). Conclusions: The division of oral and maxillofacial surgery in our hospital deals with a great amount of consultations, contributing with surgical procedures to the adequacy of patients' oral health with a high effectiveness rate. Our data illustrate the contribution of dentists in a hospital setting, assisting the medical team in providing comprehensive care for inpatients. (AU)

Infant oral mutilation (IOM) related to traditional practices among inner city pre-school children in Sudan.

BACKGROUND: The term Infant Oral Mutilation (IOM) refers to the aggressive cultural rituals where primary canine tooth germs of infants are enucleated for therapeutic reasons. OBJECTIVES: To determine the prevalence and risk factors for IOM among inner city pre-school children in Khartoum. METHODS: In this cross-sectional study, 212 randomly selected children from twelve government pre-schools in Khartoum were examined for the presence of IOM. Socio-demographic, feeding and teething-related data were collected by self-administered questionnaires. RESULTS: The mean age of the sample was 4.7 years. The prevalence of clinical IOM was 10.8%. Multivariable regression analysis revealed that children who suffered from diarrhea during teething were 7.15 times more likely to have clinical IOM over their counterparts (p<0.0001). Mothers who were educated below elementary school level were 2.69 times more likely to have children showing clinical IOM (p= 0.0369). CONCLUSION: The present study showed that the practice of IOM is common among inner city children. Certain teething-related symptoms especially diarrhea and maternal education could be strong determinants of the malpractice of IOM.

The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature.

Radiation therapy for the treatment of head and neck cancer can injure normal tissues and have devastating side effects. Hyperbaric oxygen (HBO) is known to reduce the severity of radiation-induced injury by promoting wound healing. While most of the research in literature has focused on its efficacy in osteonecrosis, HBO has other proven benefits as well. The aim of this review was to identify the various benefits of hyperbaric oxygen therapy in patients who have undergone radiation for head and neck cancer. An electronic database search was carried out to identify relevant articles and selected articles were reviewed in detail. The quality of evidence for each benefit, including preserving salivary gland function, preventing osteonecrosis, dental implant success, and overall quality of life, was evaluated. Evidence showed that HBO was effective in improving subjective symptoms of xerostomia, swallowing, speech and overall quality of life. There was no conclusive evidence to show that HBO improved implant survival, prevented osteonecrosis, or improved salivary gland function. The high costs and accessibility of HBO therapy must be weighed against the potential benefits to each patient.

Local vs general anaesthesia in the development of neurosensory disturbances after mandibular third molars extraction: A retrospective study of 534 cases

BACKGROUND: The choice of the anaesthetic modality is one of the primary steps during planning of third molar surgery. The aim of the present study was to compare the risk of developing neurological injures of the inferior alveolar nerve (IAN) and lingual nerve (LN) in patients treated for wisdom teeth removal under general anaesthesia (GA) with a group treated under local anaesthesia (LA). MATERIAL AND METHODS: This is an observational retrospective, unicentric study; between September 2013 and September 2014, 534 patients underwent third molar surgery, 194 (36,3%) under GA and 340 (63,7%) under LA by the same oral surgeon. Difference in the incidence of IAN and LN injures between groups have been statistically analyzed with Fisher exact test and estimated odd ratio for development of such complications has been calculated. RESULTS: In GA patients the incidence of IAN and LN injures was 4.6% and 2.1%, respectively while in the LA group it was and 0.3% and 0%, respectively. A significant difference in IAN and LN involvement between groups was observed (IAN lesion: Fisher exact test, p < 0.001; LN lesions: Fisher exact test, p < 0.05). The estimated odd ratio for development of IAN injures after GA was 16.49 (95% CI: 2.07-131.19) and was not calculable for LN injures because no cases were observed in the LA group. CONCLUSIONS: Since GA is a perioperative variable that seems to significantly increase the risk of developing IAN and LN lesions, when treating patients that request GA, they must be adequately informed that an higher incidence of post-surgical sensory disturbances is expected

Prospective study on dental extractions carried out for paediatric patients under general anaesthetic in a district general hospital.

BACKGROUND: The first line approach to managing healthy anxious children requiring dental extractions should include behavioural management and treatment under local anaesthetic. This can be coupled with conscious sedation. AIM: To evaluate alternative methods attempted prior to treatment under general anaesthesia (GA), to establish the incidence of repeat GA procedures. METHOD: Paediatric cases requiring dental extractions under GA were audited from October 2014 - December 2014 in the Oral and Maxillofacial Department, Great Western Hospital, Swindon. RESULTS: 78 paediatric cases requiring dental extractions were carried out during the study period. 91% of referrals came from local general dental practitioners (GDPs). The indication for the GA was included in 59% of the referral letters. The number of teeth extracted per case ranged from 1 - 14. In 18% of cases treatment under local anaesthetic had been attempted previously. Conscious sedation had not been attempted in any of the cases. There were 5 cases (6.4%) of repeat general anaesthetic procedures. CONCLUSION: Local guidance regarding appropriate paediatric referrals should be distributed to primary care referrers. Treatment under conscious sedation should be considered for paediatric cases and an improved referral pathway to the community dental service should be developed. Preventative advice should be reinforced to the referrer and to the patient.

[Relations between extraction of wisdom teeth and temporomandibular disorders: a case/control study]. / Relations entre les extractions de dents de sagesse et les dysfonctionnements de l'appareil manducateur : étude cas / témoins.

The aim of this study was to assess the impact of extraction of third molars on the occurrence of temporo-mandibular disorders (TMD). A review of the literature and a case-control study have been conducted. The case-control study compares the frequency of extraction of third molars between the sample with TMD (case) and the sample without TMD (control). The proportion of patients who had undergone extractions of wisdom teeth was higher in the case group than in the control group. The difference was statistically significant when patients had undergone extraction of all four wisdom teeth or when the extraction of four wisdom teeth underwent in one sitting or under general anesthesia. The study of patients in case sample shows that all signs of TMD were more common in patients who had undergone extractions in several sessions and under local anesthesia. The temporomandibular joint sounds are significantly more frequent with local anesthesia. In the case group, 85 to 92% of patients have parafunctions and 5 to 11% have malocclusion. This demonstrates the multifactorial etiology of temporomandibular disorders.

Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England.

OBJECTIVES: This study aimed to analyse the characteristics of comprehensive dental care provided under general anaesthesia (CDGA) and to review the additional treatment required by children over the 6 years subsequent to CDGA. METHOD: Information collected from hospital records for the 6-year period following the first CDGA included the types of dental treatment performed at CDGA, the return rates for follow-up appointments, further treatment required subsequent to CDGA and the types of dental treatment performed at repeat DGA. RESULTS: The study population consisted of 263 children, of whom 129 had a significant medical history, with mean age of 6.7 years. The results revealed that the waiting time for CDGA was significantly shorter in children who had a significant medical history, with 49% being admitted for CDGA within 3 months of pre-GA assessment, as compared to 29% of healthy children. 67% of children had follow-up care recorded, with a slightly higher proportion of children with significant medical history returning for follow-up [70% (90/129)] compared with 65% (87/134) of healthy children. Re-treatment rates were 34% (88/263), the majority of cases being treated under local analgesia (42/88). 34 of 263 children had repeat DGA (12.9%). Of these 71% (24/34) were children with significant medical history. The mean age at repeat DGA was 9 years. In 25 of 34 children (74%), repeat DGA was due to trauma, oral pathology, supernumerary removal, hypomineralized teeth or new caries of previously sound or un-erupted teeth at CDGA. The ratio of extraction over restoration (excluding fissure sealants) performed at repeat DGA was 2.8, compared with the ratio of 1.3 in the initial CDGA. CONCLUSIONS: There was a higher ratio of extraction over restorations at the repeat DGA. This suggests that the prescribed treatments at repeat DGA were more aggressive as compared to the initial CDGA in 1997. The majority of the treatment required at repeat DGA was to treat new disease.

Dental management of children with special healthcare needs.

INTRODUCTION: Dental caries is a common condition amongst young children that negatively impacts on their quality of life, It is an added burden on children with special healthcare needs (CSHCN) who have an increased risk of developing caries due to the high sugar contents in their medications, regular consumption of cariogenic foods and a poor salivary flow. AIMS AND OBJECTIVES: to analyse the management of dental caries in CSHCN at a tertiary public hospital in South Africa. METHODS: A retrospective analysis was conducted of the dental and medical records of 374 medically compromised children presenting with dental caries. Dental treatment and anaesthetic techniques used were reviewed. RESULTS: Results indicated that the majority of CSHCN presenting with caries were managed by extractions (96.5%) under either local anaesthesia (73.3%) or general anaesthesia (26.7%). There was a lack of restorative care provided to these compromised children, CONCLUSIONS: Treatment by extractions may relieve discomfort and pain; however, early loss of teeth leads to functional, psychological, aesthetic and orthodontic problems, which can result in a further decline in the quality of life of these already compromised patients, Restorative treatment and prevention strategies are critical in managing caries in CSHCN in order to improve their quality of life,

Toothache among dental patients attending a Nigerian secondary healthcare setting.

INTRODUCTION. Pain intensity and oral health practices among patients with toothache, a major dental public health problem is necessary information for the formulation of preventive and interventional oral health policies. OBJECTIVE. To assess the pain intensity and oral health practices among dental patients attending a Nigerian secondary healthcare setting with toothache. MATERIALS AND METHODS. This study was a prospective study of adult patients attending the dental clinic of Rasheed Shekoni Specialist Hospital, Dutse, Jigawa State, Nigeria. Interviewer-administered questionnaire which elicited information include demography, pain intensity using visual analogue, tooth brushing behaviour and previous dental treatment was the tool of data collection. RESULTS. The majority of the respondents were males and young adults. More than half (60.5%) of the respondents reported pain of moderate to severe intensity and 42.6% have engaged in self medication for the toothache. More than one-third (34.2%) had experienced the pain for ≥ four weeks and the major factor that prompted the decision to visit dentist were unbearable nature of the pain and sleep disturbances. Almost half (46.2%) of the respondents had previously visited the dentist and the common received treatment was tooth extraction. A total of 57.9% of the respondents indulge in twice-daily tooth cleaning. CONCLUSION. Data from this study revealed that respondents with toothache had history of dental visit and visited dental clinic when the pain is unbearable and disturbed sleep. There is a need for proper patient education at any encounter with dentist.

Utilization of emergency services for non-traumatic dental disease.

PURPOSE: To identify and characterize children who utilize emergency dental services for non-traumatic dental disease. STUDY DESIGN: Caregivers of children under 12 years old who seek out emergency services for the treatment of non-traumatic dental disease will be surveyed regarding their child's current oral health status. Patient's clinical data will be obtained and they will be further followed for a period of 2 months to determine if they follow-up with recommendations for comprehensive dental care. RESULTS: One hundred and ninety-eight people participated in the study (97% response rate). Eighty-three percent of the children were diagnosed with dental caries. Seventy-four percent of patients of record presented with an emergency at least once before and 73% had a history of one or more broken appointments. Patients with a history of previous emergency visits (OR = 3.45, CI = 2.05, 5.81) or a history of missed appointments (OR = 2.21, CI = 1.42, 3.58) were significantly more likely to fail to return for comprehensive care (P < .01). CONCLUSION: This study shows that those who utilize emergency services more than once, or have a history of missed appointments are more likely to continue to utilize emergency dental services as their primary means for dental care.

[Socioeconomic indicators and oral health services in an underprivileged area of Brazil]. / Indicadores socioeconômicos e serviços odontológicos em uma região brasileira desfavorecida.

OBJECTIVE: To evaluate the association between the proportion of tooth extractions, socioeconomic indicators, and the availability of oral health services in an underprivileged area of Brazil. METHODS: An ecological study was carried out in 52 municipalities in the state of Minas Gerais, Brazil. The socioeconomic indicators employed were criteria for health care resources allocation, municipal human development index, Theil index, Gini coefficient, and sanitation conditions. Concerning the availability of oral health services, the following were considered: number of inhabitants, number of dental surgeons living in the city, number of dentists working in the public services, and number of municipal oral health care teams. The utilization of oral health services was evaluated using the indicators recommended by the Health Ministry's Basic Care Package (Pacto da Atencão Básica in Portuguese) and the number of procedures carried out in the primary care setting. The 17 variables assessed were grouped into factorial components, which were then analyzed in terms of their relationship with the dependent variable, tooth extractions. RESULTS: The following six components explained 73.5% of the overall variance: socioeconomic conditions, social inequality, Basic Care Package indicators, number of procedures carried out, ratio of dentists to inhabitants, and coverage of the Family Health Strategy. Inequalities in income distribution (P = 0.031) and coverage by the Family Health Strategy (P = 0.015) contributed significantly to explain the difference in the proportion of tooth extractions in the different municipalities under study. CONCLUSIONS: The dental loss observed in the region is largely explained by socioeconomic factors and aspects related to the organization of oral health services.

Endodontic application of cone-beam computed tomography in South Korea.

INTRODUCTION: This study aimed to investigate the incidence of cone-beam computed tomography (CBCT) associated with endodontic procedures during 2009 in South Korea and to retrospectively evaluate information from CBCT with large field of view (FOV), which is popular in South Korea. METHODS: The Health Insurance Review and Assessment agency, which reviews all medical and dental expenses covered under the Korean National Health Insurance (NHI) system, was queried for data on the nationwide number of CBCTs associated with some treatment procedures. To compare digital periapical radiography and CBCT retrospectively, 470 roots of 257 root canal-infected teeth were enrolled. RESULTS: In total, 13,209 cases of NHI-covered CBCT were performed in South Korea during 2009, excluding cases for implant restoration and orthodontics. In total, 1253 and 95 CBCT cases were combined with root canal length measuring and apicoectomy, respectively. In a retrospective comparison, CBCT with large FOV provided more information about the presence of apical periodontitis, distortion of cortical bone, and identification of root compared with digital periapical radiography. CONCLUSIONS: CBCT with large FOV is useful in nonsurgical endodontic treatment and provides more information compared with digital periapical radiography.

Dental treatment needs in Dutch nursing homes offering integrated dental care.

The purpose of this study was to determine the dental treatment needs of the residents in nursing homes (NHs) where integrated dental care has been offered without financial barriers. The dental status and surgical, prosthetic, restorative, and periodontal treatment needs were determined for 432 residents (average age 78.8 years) in three Dutch NHs. Although the subjects had no complaints, 72% had dental treatment needs. It was determined that treatment was necessary for 64% of the edentulous subjects (N = 316), 100% of the partially dentate subjects (N = 76), and 87% of the fully dentate subjects (N = 40). We concluded that when residents can no longer carry out oral hygiene independently, it is very difficult for them to maintain a level of oral health where their dental treatment needs have been met, especially for dentate residents.

Repeat general anaesthesia, a 6-year follow up.

OBJECTIVE: To investigate the number of children who subsequently required further dental general anaesthesia (DGA) following the baseline DGA for exodontia in 1997 over the next 6 year period, and identify any common factors related to these repeat DGAs. DESIGN: A retrospective longitudinal analysis. MATERIALS AND METHODS: Records from a UK teaching hospital for patients who had extractions under DGA within the calendar year of 1997 were identified and analysed. The individual's demographic details, reasons for the baseline DGA, teeth extracted, number of subsequent DGAs, the reasons for repeat DGA and finally any episodes of pain and/or infection after 1997 were recorded. RESULTS: During 1997, a total of 484 children with mean age of 6.35 (ranged between 1 and 16 years) received a DGA for exodontias. The most common reason for the exodontias carried out at this baseline DGA was dental caries and mean number of exodontias was 4.24. Of the total study population 8.9% subsequently had at least one unplanned repeat DGA, with dental caries being a factor in 84% of the cases. Of the subsequently extracted teeth 71.9% were caries free or unerupted at the time of the initial DGA. Of the children who had a repeat DGA, 61% had experienced at least one episode of pain and/or infection subsequent to the first episode of DGA. The pattern of the child's attendance and the recorded experience of oral pain and infection after the baseline DGA in 1997 were variables proved to be strongly associated with the risk of having an unplanned repeat DGA, with the children who were irregular attenders having a four times increased risk. CONCLUSIONS: Two common factors were identified which might predict the potential for a child requiring a repeat DGA; irregular attendance and oral pain and infection.

A comparison of dental service use among commercially insured women in Minnesota before, during and after pregnancy.

BACKGROUND: The authors examined and compared dental services used by women before, during and after pregnancy. METHODS: In their study, the authors combined medical and dental claims data for 3,462 pregnant women in Minnesota with commercial dental insurance who had been pregnant between Jan. 1, 2004, and Dec. 31, 2005. The authors used McNemar pairwise comparisons, with each subject serving as her own control and her use of various dental services before pregnancy as her own baseline, to evaluate and compare the dental services used during and after pregnancy. RESULTS: During pregnancy, subjects' use of several dental services-radiographs, restorative services, third-molar extractions and anesthesia-decreased significantly (P < .001) in comparison with their prepregnancy use. After pregnancy, subjects' use of checkups, radiographs and restorative services showed significant increases (P < .001). CONCLUSIONS: The significant decreases in use of these services during pregnancy and significant increases after pregnancy may suggest that these women and their dentists were using these services only conservatively during pregnancy or postponing their use altogether until after delivery. CLINICAL IMPLICATIONS: This study's findings may provide useful background information to medical and dental providers, health care plan administrators and policymakers as they consider recommendations regarding oral health care for women during pregnancy.

The frequency of repeat general anaesthesia for teeth extractions in children.

AIM: The purpose of this study was to determine the frequency of repeat extractions under general anaesthesia (GA) in children. METHODS: The dental hospital records of patients attending for outpatient GA extractions at Liverpool University Dental Hospital, Liverpool, UK, between January and March 2003 were examined retrospectively. A data collection form was used to record the relevant information. RESULTS: A total of 278 patients with a mean age of 6.5 years (SD = 2.2 years) were seen for GA extractions. Of those, 33 patients (11.9%) with a mean age of 4.9 years (SD = 2 years) at the time of their initial GA had had a previous or would undergo a subsequent episode of GA extraction. The mean interval between repeat GA was 2.3 years (SD = 1.6 years). Fifteen cases (45.5%) had the repeat GA within 2 years. Radiographs were available as part of the assessment process for 84 (34.3%) of the 245 patients who had had a single episode of GA. However, of the 33 patients who had had a repeat GA, only seven (21.2%) had radiographs available at the time of the initial GA. Regarding the number of teeth extracted, a significant difference (P < 0.01) was found between the number of teeth extracted in patients who had had a single GA (mean = 4.6, SD = 2.5), compared with those extracted at the initial GA for the repeat GA group (mean = 3.2, SD = 2). CONCLUSION: The frequency of repeat GA is relatively low, but there is a need for appropriate treatment planning incorporating the use of radiographs to reduce this even further.

Survey of the use of hyperbaric oxygen by maxillofacial oncologists in the UK.

Oral and maxillofacial surgeons often use hyperbaric oxygen (HBO). Our aim was to find out the referral pattern of these surgeons for HBO. We contacted oral and maxillofacial units in England, Wales, and Scotland and identified 125 consultants who are involved in the management of patients with cancers of the head and neck. We sent these surgeons a postal questionnaire and 91 (73%) replied. Eighty-five of these consultants (93%) saw patients with osteoradionecrosis and only five of these never referred patients for HBO. About half the respondents (57%) saw patients for the insertion of osseointegrated implants after radiotherapy to the jaw, and seven of these never referred patients for HBO. All the respondents saw patients who required mandibular molar extractions after radiotherapy and 30 (33%) never referred these patients for HBO. Most consultants were unaware of the method of delivery of HBO. This survey suggests that most surgeons consider HBO to be part of the management of osteoradionecrosis, but their knowledge about delivery is weak and protocols vary.

Estudio clínico comparativo entre articaína y lidocaína / A clinical comparative study between articaine and lidocaine

El propósito de este estudio fue comparar el efecto anestésico entre la lidocaína y el clorhidrato de articaína. Hipótesis: el clorhidrato de articaína tiene mejor efecto anestésico. Materiales y métodos: cartuchos comerciales de lidocaína (xylocaína) y articaína (medicaína) fueron usados para algunos procedimientos en pacientes sanos. La edad fue de 18 a 30 años, con una media de 26 años. Solamente un cartucho de anestesia fue utilizado por procedimiento por el mismo operador. Fue registrada la información sobre tiempo de latencia, duración de la anestesia, así como el grado de dolor obtenido por el paciente. Resultados: mayor eficacia del clorhidrato de articaína sobre la lidocaína con mayor tiempo de duración, bien tolerada por los pacientes y con reportes al dentista de ausencia de dolor. Conclusión: el clorhidrato de articaína tiene algunas ventajas sobre la lidocaína en relación al control de dolor y menor tiempo operatorio

Effect of clinical guidelines on practice for extraction of lower third molars: study of referrals in 1997 and 2000.

We made a retrospective study of patient records for 3-month periods during 1997 and 2000 to assess changes in referral patterns and decision-making for extraction of lower third molars after publication of national guidelines. A total of 277 patients were referred to the department for extraction of lower third molars in 1997 and 234 in 2000 while overall referrals increased from 884 to 979. The number having extractions dropped from 243/277 (88%) to 190/234 (81%) of those referred (P=0.05) and of those operated on, bilateral removal dropped from 120/243 (49%) to 65/190 (34%) (P=0.002). The number of patients operated on under general anaesthesia reduced from 161/243 (66%) to 103/190 (54%) (P=0.01). However, women remained more likely to get treatment under general anaesthesia than men. In conclusion, there was a reduction in referrals for extraction of third molars, the proportion of referred patients having extractions, the number of bilateral operations, and changes in the choice of anaesthesia over the period of introduction of national guidelines on operations for third molars.

Terceros molares incluidos: ¿cuál es la realidad dentro del contexto sistémico? / Impacted third molars: which is the truth into the systemic context?

En la práctica odontológica, los terceros molares incluidos han sido un tema de particular controversia por las implicaciones que pueden presentar, tanto a nivel local como sistémico(1,22). En este trabajo se analizó el comportamiento de éstos desde el punto de vista de la medicina bioenergética, confirmando que los individuos se comportan de manera distinta frente a un factor común. La odontología neurofocal ha postulado una teoría según la cual los dientes tienen una relación clara con cada uno de los órganos del cuerpo(28), lo que ha sido comprobado a través del método denominado electroacupuntura según Voll (EAV). El estudio de tipo exploratorio descriptivo buscó corroborar si esta relación se cumple de manera estricta teniendo en cuenta factores externos como el medio ambiente, e individuales como enfermedades sistémicas, estados de ansiedad y de estrés. Se evaluaron 15 pacientes con un rango de edad entre 18 y 33 años. El criterio de inclusión fue tener exodoncia indicada del tercer molar incluido; se realizaron mediciones del EAC, una pre y otra postquirúrgica, las cuales clasificaban el tipo de lesión tisular que pudo ser causada por la presencia del tercer molar incluido, según la clasificación propuesta por el Dr. Reinhold Voll(18). Los valores obtenidos demuestran que esta técnica sirve como marcador de funcionalidad celular de un órgano, pero no es adecuada para dar un diagnóstico orgánico. Por medio de este trabajo se da un paso para demostrar que la teoría de la relación directa entre los dientes y los distintos órganos del cuerpo no siempre se cumple, o que no siempre se afecta el trayecto directo de la relación diente órgano demostrado por Voll, evidenciando que el tercer molar incluido afecta de manera distinta a cada individuo, en el que influyen factores externos e individuales, como su propia predisposición a desarrollar enfermedades.