Significant cases of central cusps, enamel pits, and oral fibromas in tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder in which benign nodular tumors form in the cerebral cortex, cerebellum, and throughout the body causing various symptoms. In this study, we summarized the incidence of dental findings in patients with TSC at our hospital and its association with diseases in various organs. Patients diagnosed with TSC at our hospital between January 2013 and September 2017, and who were examined in the dental and oral surgery department were included in this study. The presence of intraoral manifestations (central cusps, enamel pits, oral fibromas) was examined by means of visual inspection, intraoral photography, and X-ray photography. In addition, the relationship with associated diseases (neurological, cutaneous, cardiac, renal, and pulmonary) according to organ and disease severity was examined. The mean age (± SD) of the 42 TSC patients (19 men and 23 women) was 27.8 ± 14.6 years, of which 24 patients (11 men and 13 women) presented with oral manifestations. Of these patients, seven had central cusps, 10 had enamel pits, and 17 had oral fibromas. The group with central cusps had significantly higher neurological issues in the relationship between intraoral manifestations and associated disease based on the involved organ. The prevalence of central cusps in TSC was 16.7%, which is significantly higher than the 2.6% reported in healthy Japanese subjects. The central cusp is a diagnostic factor alongside the presence of enamel pits and oral fibromas, which can aid in the early diagnosis of TSC by dentists.

Diagnosis and evaluation of 100 dysphagia patients using videoendoscopy at a core hospital of a local city in Japan.

Japan has entered an era of a super-aging population, and given the importance of oral nutrition, the need to evaluate swallowing function has increased. Herein, we contribute to continued developments in evaluating eating and swallowing functions by describing current videoendoscopy (VE) usage and trends to evaluate and diagnose causes of dysphagia. In all, 100 patients (58 men and 42 women; mean age: 79 years) with suspected dysphagia were enrolled; 15 of these were re-examinations. Examinations were conducted according to the Japanese Society of Dysphagia Rehabilitation VE examination guidelines for swallowing. In this study, several patients (77.8 %) with poor vocalization and a saliva reservoir were unable to eat. While evaluating the relationship between aspiration and pharyngeal or laryngeal influx, we found that when pharyngeal and laryngeal influx were present, the risk of aspiration was high. Some patients (38.9 %) were able to eat despite lacking a cough reflex; thus, the absence of a cough reflex does not necessarily equate to an inability to eat, even in patients unable to ingest nutrition orally. One case could ingest nutrition, even with no cough reflex. The 6-month survival rate after the examination of patients on nil per os status was 57.1 %, specifically in patients unable to ingest nutrition orally. These results suggest that decreased eating and swallowing functions indicate a poor prognosis for the patient's quality of life, as eating and swallowing require smooth passage in the oral phase. Therefore, actively requesting a dental intervention and oral rehabilitation is important for a patient presenting these issues.

Computer-assisted preoperative simulation for positioning of plate fixation in Lefort I osteotomy: A case report.

Computed tomography images are used for three-dimensional planning in orthognathic surgery. This facilitates the actual surgery by simulating the surgical scenario. We performed a computer-assisted virtual orthognathic surgical procedure using optically scanned three-dimensional (3D) data and real computed tomography data on a personal computer. It helped maxillary bone movement and positioning and the titanium plate temporary fixation and positioning. This simulated the surgical procedure, which made the procedure easy, and we could perform precise actual surgery and could forecast the postsurgery outcome. This simulation method promises great potential in orthognathic surgery to help surgeons plan and perform operative procedures more precisely.

Risk of post-extraction bleeding with direct oral anticoagulant compared with warfarin: Retrospective cohort study using large scale claims data in Japan.

INTRODUCTION: Comparative safety of direct oral anticoagulants vs. warfarin in patients undergoing tooth extraction remains unclear. We compared the incidence of post-extraction bleeding between patients taking warfarin and those taking direct oral anticoagulants (DOACs) using administrative claims data. MATERIALS AND METHODS: We identified outpatients on anticoagulant therapy who underwent permanent tooth extraction between 2015 and 2020 and categorized them into the warfarin and DOAC groups based on medication prescribed within six months prior to tooth extraction. We used the overlap propensity score weighting method to balance the baseline characteristics between the groups and compared the incidence of post-extraction bleeding within seven days after tooth extraction. RESULTS: Among 5253 eligible patients, those in the DOAC group (n = 3696) were older and less frequently prescribed antiplatelets than those in the warfarin group (n = 1557). The distribution of tooth extraction type and number of teeth extracted in a single procedure did not differ between the groups. The unadjusted incidences of post-extraction bleeding in the warfarin and DOAC groups were 35 (2.2 %) and 71 (1.9 %), respectively. Moreover, the overlap weighting analysis showed that the adjusted odds ratio of post-extraction bleeding in the DOAC group in comparison with that in the warfarin group was 0.84 (95 % confidence interval, 0.54-1.31). CONCLUSION: The incidence of post-extraction bleeding in patients taking DOACs was comparable to that in patients taking warfarin. The findings suggest that dentists and physicians should exercise the same degree of caution when extracting teeth in patients on DOACs and those on warfarin in terms of post-extraction bleeding.

Implications for clinical dental practice during the coronavirus disease pandemic: A scoping review.

PURPOSE: It is over a year since the first case of coronavirus disease (COVID-19) was confirmed in China. This paper reviews and summarizes the characteristics of COVID-19, as understood of December 2020, from a dental perspective. STUDY SELECTION: The PubMed and Scopus online databases were searched using a combination of free words and Medical Subject Headings terms: "dentist" OR "oral care" AND "COVID-19" OR "SARS-CoV-2." RESULTS: Older people and those with underlying medical conditions have an increased risk of serious illness due to COVID-19. The virus enters the body by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. It is common for people with COVID-19 to have mild or no symptoms. Moreover, the disease is not contagious in most infected people; it is only highly contagious in some infected people, thereby forming clusters. Due to the large number of virus particles that are shed prior to the onset of symptoms of the disease, retrospective surveys are important. Appropriate personal protective equipment against corona vortices is also important in clinical practice. Although polymerase chain reaction tests are useful for confirming infection in suspected individuals, their reliability is questionable. In addition, concerns regarding long-term sequelae have been reported. CONCLUSION: There are few high-quality reports on the implications of COVID-19 in dental practice. However, reports suggest that insufficient oral hygiene may be a risk factor for infection. Reports that ACE2 receptors are abundant in the oral cavity also suggest the importance of oral care.

Cost of establishing a general dentistry department in a small or medium-sized hospital.

To contribute to future dental healthcare policies, this study compiled data on hospital expenses and follow-ups conducted after a hospital dentistry department was established. In addition, the management status and reports on the utility and challenges of establishing a dentistry department were analyzed. The dentistry department was established through fund raising and inaugurated in May 2009. The depreciation period was set at 7 years, and income and expenditure during the 7 years 8 months after opening were compiled. In total, 17.22 million yen was needed for the dentistry department. The average income from dental care was 21.59 million yen per year, and expenditure amounted to 21.54 million yen per year. The findings indicated that a general dentist able to systemically manage patients was essential in a chronic-care hospital. Moreover, the present findings indicate that if general dentistry consultations were performed without excessive investments, after adjusting for personnel expenses, such an initiative would neither yield considerable income nor produce a substantial deficit. Finally, it is imperative to develop staff who are familiar with the costs and management of hospital dentistry and to increase medical fees for consultations with elderly patients.

Investigating the Efficacy of Intraoral Wet Sheets.

OBJECTIVE: It is important that oral care is effective, efficient, and economical. Herein, we investigated the efficacy of intraoral wet sheets for oral care in comparison with sponge brushes. METHODS: We completed a Plaque Control Record (PCR) after observing intraoral plaque using a plaque disclosure test in healthy volunteers. After the teeth were cleaned for 3 minutes using a wet sheet, the test was repeated and the PCR was completed. The same method was performed using a sponge brush on the same subject under the same conditions 1 week later. The t test was used to analyze PCR findings. RESULTS: Ten healthy subjects were enrolled (mean age, 28.6 years). The PCR values improved from 44.0% before to 30.9% after use of the wet sheet. The post-cleaning PCR was significantly lower. The PCR values improved from 55.0% before to 50.2% after use of the sponge brush. CONCLUSIONS: The PCR improvement was greater when using the wet sheet. In all cases, the wet sheet was highly effective at smoothing tooth surfaces. Intraoral wet sheets may be an option for oral care performed by nurses and caregivers. Compared to the sponge brush, the intraoral wet sheet can save time and reduce costs.

Computer-assisted preoperative simulation for positioning and fixation of plate in 2-stage procedure combining maxillary advancement by distraction technique and mandibular setback surgery.

INTRODUCTION: Computer-assisted preoperative simulation surgery is employed to plan and interact with the 3D images during the orthognathic procedure. It is useful for positioning and fixation of maxilla by a plate. We report a case of maxillary retrusion by a bilateral cleft lip and palate, in which a 2-stage orthognathic procedure (maxillary advancement by distraction technique and mandibular setback surgery) was performed following a computer-assisted preoperative simulation planning to achieve the positioning and fixation of the plate. A high accuracy was achieved in the present case. PRESENTATION OF CASE: A 21-year-old male patient presented to our department with a complaint of maxillary retrusion following bilateral cleft lip and palate. Computer-assisted preoperative simulation with 2-stage orthognathic procedure using distraction technique and mandibular setback surgery was planned. DISCUSSION: The preoperative planning of the procedure resulted in good aesthetic outcomes. The error of the maxillary position was less than 1mm. CONCLUSION: The implementation of the computer-assisted preoperative simulation for the positioning and fixation of plate in 2-stage orthognathic procedure using distraction technique and mandibular setback surgery yielded good results.