Predictors for Dental Intervention in Children After Dental Injury: A Retrospective Analysis and Literature Review.

OBJECTIVE: This study aimed to explore risk factors for dental intervention in patients presenting to the pediatric emergency department (PED) after dental injury. METHODS: We retrospectively explored patients aged 0 to 18 years who presented to our PED between 2017 and 2021 after dental injury. RESULTS: Of the total of 830 patients (mean age 7.1 ± 3.9 years, 589 [71.0%] male patients), 237 (28.5%) required dental intervention. All patients with alveolar fractures and those with involvement of permanent teeth with extrusive luxation mandated urgent dental consultation. Additional independent predictors for dental intervention for primary tooth injury were: root fracture (adjusted odds ratio [aOR] 38.4; 95% confidence interval [CI], 3.95-373.22; P = 0.002), facial bone involvement (aOR 12.40; 95% CI, 2.33-65.93; P = 0.003), lateral luxation (aOR 6.9; 95% CI, 4.27-11.27; P < 0.001), extrusive luxation (aOR 6.44; 95% CI, 2.74-15.14; P < 0.001), and avulsion (aOR 2.06; 95% CI, 1.23-3.45; P = 0.006). Additional independent predictors for permanent tooth injury were lateral luxation (aOR 27.8; 95% CI, 6.1-126.6; P < 0.001) and avulsion (aOR 6.8; 95% CI, 2.9-15.9; P < 0.001). CONCLUSIONS: Alveolar fracture is a severe dental injury, requiring intervention, for primary and permanent teeth injuries. Tooth luxation with significant mobility or malocclusion, incomplete avulsion, a suspected root involvement, or facial bone injury in the primary teeth and tooth luxation (extrusive/lateral) and avulsion in the permanent teeth dictate urgent dental consultation and intervention. Clinical algorithms for dental injury management are suggested.

Winds of Change in Antibiotic Therapy following Orthognathic Surgery.

Background and objectives: This retrospective cohort study aimed to compare three postoperative antibiotic protocols of different durations on surgical-site-infection (SSI) rates following orthognathic surgery for the correction of jaw deformities. Materials and methods: An analysis on data collected from the medical files of 209 patients who underwent orthognathic surgery between 2010 and 2019 was conducted. The patients were divided into three groups according to the postoperative antibiotic protocol-Group 1 (24 h), Group 2 (2-3 days), and Group 3 (>3 days). Dependent and independent variables were collected, analyzed, and compared between the three groups. Results: Group 1 included 30 patients (14.3%), Group 2 included 123 patients (58.9%), and Group 3 included 56 patients (26.8%). The vast majority of the postoperative antibiotics were amoxicillinand clavulanic acid (87.1%). The duration of the surgery and the use of a feeding tube were significantly different between Groups 1 and 3 (p < 0.001 and p = 0.005, respectively). There was no significant difference in SSI rates between the three groups (p = 0.642). The use of antibiotics beyond the immediate postoperative period provides no increased benefit regarding infection prevention. Conclusions: In young and healthy patients undergoing orthognathic surgery, a 24hregimen of postoperative antibiotics may be sufficient.

Retrospective Clinicopathological Analysis of 65 Peri-Implant Lesions.

Background and Objectives: Peri-implantitis is a common finding among patients with dental implants. There is no consensus regarding the treatment of this disease, but in many cases, surgical treatment is common practice. A histopathological analysis is not an integral part of suggested protocols. The present study investigated the clinical and histopathological parameters of lesions mimicking peri-implantitis and correlated them with the outcome and follow-up data. Materials and Methods: The study included 65 consecutive biopsies taken from peri-implantitis patients between 2008-2019. Results: The three common diagnoses were fibro-epithelial hyperplasia 20 (30.7%), pyogenic granuloma 16 (24.6%), and peripheral giant cell granuloma 15 (23%). There were 18 cases of recurrent lesions in the study group (27.7%). The recurrence rate was the highest in peripheral giant cell granuloma (8, 12.3%), versus 6% in pyogenic granuloma and fibro-epithelial hyperplasia. These differences in the recurrence rate were statistically significant (p = 0.014). Conclusions: This study emphasizes the necessity of submitting tissue of peri-implantitis cases for histopathological analysis since the more locally aggressive lesions (peripheral giant cell granuloma and pyogenic granuloma), which comprise nearly half of the cases in this study, do not differ in clinical or radiographic characteristics from other peri-implant lesions.

Oral health-related quality of life in patients with disorders of nutrition.

BACKGROUND: Researchers demonstrated a correlation between nutrition and health-related quality of life (HRQoL). Little is known about the correlation between disorders of nutrition (DON) and Oral HRQoL (OHRQoL). OBJECTIVES: (a) To measure OHRQoL in DON patients compared to patients attending nutritional counselling for other reasons (eg, systemic diseases or general dietary counselling) (NCOR) and to healthy controls attending routine dental screenings. (b) To analyse associations between OHRQoL and demographics, health-related behaviours and nutritional practices. We hypothesised that OHRQoL is impaired in DON patients and correlates with poor health-related behaviours and nutritional practices METHODS: Demographic, smoking, alcohol and physical activity habits, verbal pain scale, oral health impact profile-14 (OHIP-14) and nutritional practice data were collected from 63 DON, 35 NCOR and 100 controls. RESULTS: Compared to controls, DON patients exhibited poorer OHIP-14 global scores and had more functional limitation, physical disability, psychological disability, social disability and handicap. OHIP-14 global score was positively associated with maternal origin, oral symptoms, eggs and eggplant consumption, avoiding seasoning, hot drinks and fibrous food and negatively associated with physical activity and fresh vegetable consumption. In the conceptual hierarchical multiple regression model, verbal pain scale, eggplant consumption and physical activity were mediators in the relationship between DON and OHIP-14. DON, physical activity and eggplant consumption also directly associated with OHRQoL. CONCLUSIONS: Oral HRQoL was impaired in DON patients and correlated with poor health-related behaviours and nutritional practices. Routine workup of DON patients should include OHRQoL assessment.

Outcome of isolated and combined direct feminization laryngochondroplasty: Our first 20 cases.

This retrospective study describes the surgical outcomes of our first 20 transgender women to undergo feminization thyroid laryngochondroplasty (FLC) by a direct transvestibular FLC (DTV-FLC) approach from December 2019 to October 2023. The medical records of all patients were retrieved and reviewed. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic outcomes were retrieved. The cosmetic results were evaluated by four independent facial plastic surgeons. Thirteen patients underwent DTV-FLC combined with genioplasty or genioplasty with mandibular angle reduction and seven underwent isolated DTV-FLC. DTV-FLC was feasible in all planned cases. Complications (skin flap perforation, thyroid cartilage fracture, mental hypoesthesia, hematoma, dehiscence of the vestibular incision, vestibular scar adhesions, and anemia) were minor and resolved spontaneously. The preoperative grade of thyroid cartilage protrusion was 1.9 ± 0.9 on a scale from 1 to 3. The postoperative cosmetic results of 18 patients were judged as having improved (a score of 2.1 ± 0.8 on a scale from -1 to 3). Eighteen patients were satisfied with the cosmetic result, one was dissatisfied (the revision surgery patient), and one was lost to follow-up. In conclusion, DTV-FTLC is a valid surgical approach for FLC, yielding high patient satisfaction and good cosmetic results.

Early outcomes of osteofascial versus osteocutaneous fibula free flap mandibular reconstruction.

BACKGROUND: This study compares early outcomes of osteofascial fibula free flap (OF-FFF) with donor-site primary closure and osteocutaneous (OC) FFF with donor-site skin grafting in segmental mandibular reconstruction. METHODS: A retrospective chart review of FFF mandibular reconstruction patients (2006-2022) divided into OF-FFF and OC-FFF groups. Clinical data, operative parameters, and early postoperative outcomes (≤ 90 days) were analyzed. RESULTS: The study included 67 patients (39 OF-FFF, 28 OC-FFF). OF-FFF had significantly lower donor-site complications (12.8% vs. 53.6%, p < 0.001) and revision surgeries (7.7% vs. 35.7%, p = 0.004) compared to OC-FFF. Recipient-site (28.2% vs. 25%, p = 0.77) and flap (15.4% vs. 17.9%, p > 0.99) complications were comparable. CONCLUSIONS: OF-FFF mandibular reconstruction with donor-site primary closure is a safe and reliable technique associated with superior donor-site and comparable flap and recipient-site outcomes to OC-FFF, thus may be considered as a viable alternative to OC-FFF for selected patients.

Vertical Ramus Osteotomy, Is It Still a Valid Tool in Orthognathic Surgery?

The purpose of this study is to evaluate mandibular osteotomy procedures during orthognathic surgery, with an emphasis on the complications of the two leading procedures: intraoral vertical ramus osteotomy (IVRO) and sagittal split osteotomy (SSO). We conducted a retrospective cohort study by extracting the records of patients who underwent either IVRO or SSO procedures during orthognathic surgery in a single center between January 2010 and December 2019. A total of 144 patients were included (median age of 20.5 years, 52 males). The IVRO:SSO ratio was 118:26 procedures. When referring to all surgeries performed, IVRO procedures were associated with shorter hospitalization than the SSO procedures, while the overall durations of surgery and follow-up periods were comparable. In contrast, when referring only to bimaxillary procedures, the duration of the IVRO bimaxillary procedures was significantly shorter than the SSO bimaxillary procedures. There were 53 complications altogether. Postoperative complications consisting of skeletal relapse, temporomandibular joint dysfunction, sensory impairment, and surgical-site infection were significantly fewer in the IVRO group. Both types of osteotomies have acceptable rates of complications. IVRO appears to be a safer, simpler, though less acceptable procedure in terms of patient compliance.

Orthognathic surgery complications: The 10-year experience of a single center.

The retrospective cohort study aimed to assess the incidence and characteristics of these complications in patients who underwent orthognathic procedures. Data on the intraoperative and the postoperative complications were extracted from the patients' medical files. Procedures were further subdivided into single-jaw procedures and bimaxillary procedures. A total of 209 orthognathic procedures were carried out in 190 patients. 184 (88%) were performed to treat angle class III malocclusion, while 25 (12%) aimed to treat class II malocclusion. A total of 94 complication events were observed (44.9% of 209 procedures). 22 of them occurred in single-jaw procedures (28.2% of 78 single jaw operations), and 72 occurred in bimaxillary procedures (55% of 131 bimaxillary operations). When compared regarding the type of complication, complication rates were comparable between the study groups with the exception of late-stage malocclusion. A significant difference (p-value = 0.028) in malocclusion incidences between the bimaxillary and single-jaw groups were observed (9 events, 4.3% and zero events, 0%, respectively). The majority of the complications during and following orthognathic surgical procedures are temporary or minor and require little or no treatment at all.

Short Versus Extended Antibiotic Prophylaxis for Maxillary Sinus Floor Augmentation Via a Lateral Window Approach: A Randomized Controlled Trial.

PURPOSE: The purpose of this randomized controlled trial was to compare the surgical site infection rate with short (24 hours) vs extended (7 days) antibiotic prophylaxis for maxillary sinus floor augmentation surgery. MATERIALS AND METHODS: Eighty-five patients who were candidates for unilateral or bilateral maxillary sinus floor augmentation surgery were randomly assigned to short or extended antibiotic prophylaxis. Patients were evaluated on days 7, 14, 30, 60, and 180 after surgery for symptoms and signs of infection. The primary study endpoint was the development of surgical site infection up to day 180 postoperatively. RESULTS: Patients underwent a total of 117 maxillary sinus floor augmentation surgeries, 62 in the short prophylaxis arm and 55 in the extended prophylaxis arm. Fifty-three patients (62%) had unilateral surgery, and 32 (38%) had bilateral surgery. Three patients developed a surgical site infection by 180 days postsurgery (overall rate, 2.6%): one patient (1.6%) in the 24-hour arm and two (3.6%) in the extended prophylaxis arm. All three patients received antibiotic treatment, and the infections resolved entirely. CONCLUSION: A low rate of surgical site infection was observed after maxillary sinus floor augmentation, and there was no apparent advantage to extended (7 days) vs short (24 hours) duration of antibiotic prophylaxis. The findings do not support the use of extended postprocedural chemoprophylaxis for patients undergoing maxillary sinus floor augmentation.

Knowledge and Associated Factors about Rare Diseases among Dentists in Israel: A Cross Sectional Survey.

Aim: The current study aims to assess levels of knowledge among Israeli dentists about rare diseases with orofacial manifestations, and whether occupational, regional and social factors influence those levels. Materials and Methods: A total of 309 Israeli dentists participated in an online survey that provided basic demographic information pertaining to their knowledge about rare diseases, their clinical experience with rare diseases, what further information they considered necessary, and which sources of information they most frequently utilize. Results: Young age, country of dental education, practicing in both public and private settings, as well as the number of hours allocated to dental studies and the opportunity to acquire information on rare diseases with orofacial manifestations, all seem to affect the level of knowledge. Conclusions: Developments in the field of rare disease are constantly ongoing, and improvements in post-graduate dental studies about them should keep pace. The results of the current study reveal the areas upon which such curricula should focus with respect to dental practitioners.

Oral adverse reactions associated with etoricoxib, a common pain medication.

BACKGROUND AND OVERVIEW: There have been reports of cutaneous adverse reactions to etoricoxib, a frequently used anti-inflammatory and antipain medication. In this report, the authors describe the first series of patients with adverse reactions to etoricoxib restricted to the oral mucosa. CASE DESCRIPTION: The series comprised 7 men and 4 women, aged 25 through 81 years, 10 of whom had only oral lesions, 1 with mucocutaneous involvement. Lesions were erosive and aphthouslike or erythema multiformelike. In most of the cases, bilateral involvement of the palate was reported. Lips, tongue, and buccal mucosa were also involved. All lesions resolved after drug discontinuation. In 6 patients, repeated use resulted in recurrence of signs and symptoms similar to the first attack. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The dental and medical community should be aware of the oral adverse effects of etoricoxib, recognize them in time, recommend drug-use cessation, and warn patients against repeated use.

Fluorescence based measurements of Fusobacterium nucleatum coaggregation and of fusobacterial attachment to mammalian cells.

Fusobacterium nucleatum is a common oral anaerobe associated with gingivitis, periodontal disease and preterm deliveries. Coaggregation among oral bacteria is considered to be a significant factor in dental plaque development. Adhesion to host cells was suggested to be important for the F. nucleatum virulence associated with oral inflammation and with preterm births. An uncharacterized fusobacterial galactose inhibitible adhesin mediates coaggregation of F. nucleatum 12230 and F. nucleatum PK1594 with the periodontal pathogen Porphyromonas gingivalis. This adhesin is also involved with the attachment of both fusobacterial strains to host cells. However, it has been suggested that additional unidentified fusobacterial adhesins are involved in F. nucleatum virulence associated with preterm births. In this study, a fluorescence-based high throughput sensitive and reproducible method was developed for measuring bacterial coaggregation and bacterial attachment to mammalian cells. Using this method we found that coaggregation of F. nucleatum 4H with P. gingivalis and its attachment to murine macrophages is less inhibitible by galactose than that of F. nucleatum PK1594. These findings suggest that F. nucleatum 4H can serve as a model organism for identifying nongalactose inhibitible F. nucleatum adhesins considered to be involved in fusobacterial attachment to mammalian cells.