What are the Characteristics of Oral Injuries Caused by Playground Equipment?

PURPOSE: Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury. METHODS: Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level. RESULTS: This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries. CONCLUSION: Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.

What Are Possible Contributors to Associated Dental Injury in Mandibular Fractures?

PURPOSE: Among previous reports on dental injuries associated with mandibular fractures, there are few investigating the conditions under which dental injuries commonly occur. The aim of this study was to determine specific characteristics of mandibular fractures accompanied by dental injuries. METHODS: This retrospective cohort study included dentate patients with mandibular fractures treated at a tertiary trauma center between 2011 and 2019. The data were analyzed according to 2 outcome variables: patients with additional dental injuries and patients without. The predictor variables were patient age, sex, accident mechanism, number and location of mandibular fractures, and presence of submental lacerations. Odds ratios for the risk factors for dental injury were calculated in conjunction with descriptive statistics. Binary logistic regression analysis was also performed to identify the factors associated with dental injuries as dependent variables. RESULTS: Of 252 patients who had only mandibular fractures, 95 (37.7%) had associated dental injuries. In the group with dental injuries, 55.8% of mandibular fractures were caused by a fall (P = .003). Condyle fractures (77.9%) with dislocation (67.6%) and bilateral involvement (41.9%) were more common than in the group without dental injuries (P < .001). In patients with dental injuries, the incidence of 3 or more fractures (29.5%) was significantly higher than in the group without dental injuries. Dental injuries were more likely to occur in patients with concomitant submental lacerations (confidence interval (CI) 1.135-4.983, P = .02), and the risk of dental injury was significantly lower in the presence of angle fractures (CI 0.113-0.999, P = .045). CONCLUSIONS: A frontal impact involving the anterior part of the mandible is often associated with condyle and multiple mandibular fractures. This seems to be the typical mechanism for concomitant dental injuries. Submental laceration can be considered a prime sign of associated dental injuries.

Diverticulum in buccal mucosa: A rare sac-like oral pouch.

OBJECTIVE: This article describes a rare case of oral diverticulum. BACKGROUND: Diverticulum represents a sac-like protrusion of the gastrointestinal tract, commonly arising in the colon wall of elder individuals. Zenker's diverticulum can also occur in the pharyngeal mucosa. However, oral diverticulum appears rare. MATERIAL AND METHOD: The patient was an 88-year-old man with dementia living in a geriatric facility. A dental hygienist incidentally identified a small pouch containing stagnant food residue in the left buccal mucosa during oral hygiene procedures. RESULTS: The small pouch with stagnant food residue was identified as a diverticulum. CONCLUSION: Diverticula may be identified from the stagnation of food residue. Dental specialists who practice oral hygiene should be aware of diverticula as a differential diagnosis.

Effects of loss of consciousness on maxillofacial fractures in simple falls.

BACKGROUND/AIMS: Loss of consciousness while falling is reported to increase the risk of more severe injury. However, few studies of maxillofacial injuries have been reported. The aim of this study was to investigate the effects of loss of consciousness on maxillofacial fractures in falls on a level surface (simple falls). MATERIAL AND METHODS: Patients with maxillofacial fractures caused by simple falls were subdivided into two categories: patients who fell without loss of consciousness and patients who fell with loss of consciousness, according to the Guidelines for the Diagnosis and Management of Syncope (version 2009). The severity of the injuries was compared between these two groups. RESULTS: In 413 patients with maxillofacial fractures, 58 cases were falls without loss of consciousness, and 44 cases were falls with loss of consciousness. In falls with loss of consciousness, 54.5% were reflex syncope, followed by syncope due to orthostatic hypotension (15.9%), epilepsy (15.9%), and cardiac syncope (9.1%). The average number of fracture lines in the mandible was significantly lower in falls without loss of consciousness (1.53 ± 0.7) than in falls with loss of consciousness (2.00 ± 1.00) (P = 0.045). The average Facial Injury Severity Scale score was lower in falls without loss of consciousness (2.24 ± 1.20) than in falls with loss of consciousness (2.68 ± 1.39). Fractures of other parts of the body were significantly more common in falls without loss of consciousness (22.2%) than in falls with loss of consciousness (9.1%) (P = 0.0135). CONCLUSIONS: Patients with loss of consciousness and maxillofacial fractures due to simple falls showed a tendency to sustain more severe maxillofacial injuries than those without loss of consciousness.

Adult-onset Still's disease initially thought to be an odontogenic infection: A case report.

OBJECTIVE: To present a case of Adult-onset Still's disease (AOSD) initially suspected to be odontogenic inflammation. BACKGROUND: Adult-onset Still's disease is a rare, complex autoinflammatory disease and a known cause of fever of unknown origin. MATERIALS AND METHODS: The patient had both a fever and dental pain. Following meticulous examination, the patient was diagnosed with AOSD. CONCLUSION: Clinicians should keep in mind that a patient such as AOSD may visit their clinics.

Oral lacerations during motocross: A case report.

Motocross is a high-risk sport that can cause serious injuries including oral injuries. However, mouthguard use is not mandatory in motocross. This report describes a case of an oral laceration with exposure of bilateral inferior alveolar nerves as a result of a motocross accident in which the patient was not wearing a mouthguard.

Acute exacerbation of chronic disseminated intravascular coagulation associated with thoracoabdominal aortic aneurysm after tooth extraction.

OBJECTIVE: To present a rare case of persistent bleeding from the tooth extraction socket in a patient with chronic disseminated intravascular coagulation (DIC). BACKGROUND: Acute exacerbation of chronic DIC occurs by various trigger factors. CLINICAL REPORT: The patient's chronic DIC in association with thoracoabdominal aortic aneurysm was activated by tooth extraction, resulting in persistent bleeding from the socket. CONCLUSION: Patients with chronic DIC may have persistent bleeding following tooth extraction.

Huntington's disease with severe neck infection.

OBJECTIVE: To present a case of Huntington's disease (HD) with severe neck infection. BACKGROUND: Huntington's disease (HD) is a progressive neurodegenerative genetic disorder and is often accompanied by dysphagia. MATERIALS AND METHODS: The patient was a 64-year-old man with HD. The severe neck infection was considered as one of the symptoms of HD. CONCLUSION: Clinicians should remember that patients with HD are apt to delay dental consultation, resulting in serious oral infections.

Do maxillary dentures protect the skull base from penetration injury?

Key Clinical Message: Foreign bodies penetrating from the oral cavity can damage surrounding tissues. This case is considered an extremely rare and fortunate instance in which a maxillary denture appeared to weaken the external force and change the direction of the scissors, preventing damage to vital organs. Abstract: The patient was a 73-year-old man. While on a ladder pruning a plant, he accidentally fell. The gardening scissors passed through the maxillary sinus from the maxillary alveolus and penetrated below the zygomatic arch. At the time of injury, the patient was wearing a metal-frame denture on the maxilla, and contact between the cutting edge and the denture was speculated to have weakened the piercing force of the blade and changed the direction of the cutting edge. This extremely rare case demonstrates how a maxillary denture could reduce the severity of a penetrating injury caused by scissors.

Molar luxations caused by holding water taps. Report of five cases.

Luxation of a primary molar occurs rarely. Here, we describe five cases of primary molar luxation caused by holding a water tap pipe in the mouth during bathing. The patients were aged 16 to 19 months and the mandibular first primary molar was affected in all five cases. The second primary molar had not erupted. It is assumed that the flange of the pipe got stuck in the interdental space between the mandibular primary canine and first primary molar and the affected first molar was pushed out by force with the flange acting as a lever.

Laugier-Hunziker Syndrome: A Rare Cause of Oral Mucosa Pigmentation.

Introduction: Various diseases cause pigmentation of the oral mucosa. Among them, however, Laugier-Hunziker syndrome is not well known to dentists. Laugier-Hunziker syndrome is a benign pigmentary disorder characterized by the unique expression of pigmentation of the mucosa, nails and skin. In this report, we present a rare case of Laugier-Hunziker syndrome that occurred in an elderly person. Case Presentation: The patient was an 84-year-old female resident of an elderly care facility. The institutional dental hygienist reported that she was concerned about the discoloration of the oral mucosa. On examination, she had pigmentation of her oral mucosa and nails. She had no history of any disease or medication that would cause pigmentation. Although this condition was initially unknown to us, a diagnosis of Laugier-Hunziker syndrome was made. Conclusion: We report a case of Laugier-Hunziker syndrome in an elderly woman, which is not a well-known condition among dental professionals. More knowledge about diseases that cause pigmentation of the oral mucosa would be helpful in dental practice, especially at external facilities.

Denture Clasp Injury of the Oral Mucosa.

Purpose: Clasp-penetrating oral injury caused by removable partial dentures is basically a minor injury but can also cause complications such as continuous bleeding. No systematic investigations of clasp injury have been undertaken. The aims of this study were to reveal the characteristics of clasp injury and estimate variables associated with clasp injury of the oral mucosa. Methods: This retrospective study used clasp injury as the outcome variable, with primary predictor variables of demographic characteristics, medical history, local characteristics, and denture design, including the site of the affected clasp. Denture type was examined according to the classification of Kennedy. Collected data were statistically analyzed using the χ2 test or Fisher's exact test and the level of significance adopted was 5%. Results: This report consists of 73 cases (36 men and 37 women), of which 31 cases had precise denture information. Among them, clasp injuries were more common with Class I (51.6%) and Class II (32.3%) dentures (p < .001). Premolar (64.5%) and canine clasps (32.3%) were significantly more frequently involved (p < .001). Conclusion: Clasp injury of the oral mucosa was significantly more common on the tongue, and mandibular free-end saddle dentures with premolar or canine clasps were the most notable risk factor for clasp-penetrating injury of the oral mucosa.

Endovascular coils mimicking accidental ingestion of a dental-related foreign body in radiographic imaging.

If a foreign body is seen on chest or abdominal radiographs, accidental aspiration or ingestion of a dental-related foreign body may be suspected. This report describes a case in which vascular embolization coils seen on radiography were suspected to represent a swallowed dental prosthesis. A 72-year-old man with a history of endovascular embolization of portosystemic shunt was admitted for mandibular fracture. On hospital day 2, a foreign body was noted on chest radiographs taken to confirm pleural effusion. No foreign body had been evident on radiographs of the same area the previous day. The foreign body was suspected to be a dental prosthesis, but intraoral examination ruled out this possibility, and the foreign body turned out to be metal coils used to embolize the shunt. Dentists and oral surgeons should be aware that medical devices such as vascular embolization coils can produce images similar to a dental-related foreign body on chest or abdominal radiographs, and dental-related foreign body ingestion or aspiration should be considered in the differential diagnosis.

New bone formation in nongrafted sinus lifting with space-maintaining management: a novel technique using a titanium bone fixation device.

PURPOSE: Sinus lifting without graft materials allows new bone formation in the sinus, but the amount of bone formation varies. This study aimed to investigate whether nongrafted sinus lifting using a titanium bone fixation device can promote bone formation in the sinus. MATERIALS AND METHODS: Patients with atrophic posterior maxillae jeopardizing implant stability were included. After nongrafted sinus lifting in combination with implant placement, repositioning of the bone window and additional space-maintaining management were performed by use of the bone fixation device. The primary variables recorded retrospectively included implant survival and preoperative and postoperative alveolar crest height with and without Schneiderian membrane perforation. Independent variables included patient demographics, position and dimension of the implants, complications, and follow-up period. The t test was used for comparing differences in bone levels. The implant survival rate was estimated by uses of Kaplan-Meier statistics. RESULTS: The study included 11 patients (4 men and 7 women) and a total of 21 implants. Radiographically, new bone formation around the implant was generally observed in accordance with the implant apex. Postoperative alveolar crest height (mean, 10.9 ± 2.2 mm) was significantly higher compared with residual alveolar crest height (mean, 4.7 ± 1.4 mm), and no significant difference in bone formation was seen according to membrane perforation. The cumulative survival rate was 95.2%. CONCLUSIONS: This nongrafted sinus-lifting procedure using a bone fixation device could attain predictable bone formation. Additional space-maintaining management using a bone fixation device in a nongrafted sinus lift offers a useful technique for promoting bone formation in the sinus.

Current Denture Loss in Geriatric Facilities.

Purpose: Denture loss is still being reported as a problem in geriatric facilities, although losses seem less frequent than in the last decade. However, there have been no reports that have examined recent losses of dentures in detail. The aim of this study was to clarify the actual situation of recent denture loss, together with the denture loss rate in Japan. Materials and methods: This retrospective study investigated the number of cases of denture loss, the denture loss rate for denture wearers, and the details of losses in geriatric facilities during the 1-year period from 1 April 2020 to 31 March 2021. Results: Eleven special elderly nursing homes and four group homes participated in this research. The number of residents from each was 315 and 40 and the number of denture wearers was 165 and 33, respectively (p < 0.001). The loss of dentures was found in one case from a special elderly nursing home and in one case from a group home. The loss rate for denture wearers was 1.01% in total, with 0.61% for special elderly nursing homes and 3.03% for group homes, with no significant differences between the two types of facilities. Conclusion: In geriatric facilities in Japan, the current 1-year denture loss rate for denture wearers was 1.01%. This seems to represent a considerable decrease when compared with the previous report. Further, proper denture management and staff efforts appear to have contributed to a reduction in denture loss against a background of promoting oral healthcare.

Cancer Chemotherapy-Induced Oral Adverse Events: Oral Dysesthesia and Toothache - A Retrospective Study.

INTRODUCTION: Due to the development of newly developed anticancer drugs, oral dysesthesia and toothache other than conventional oral mucositis, dry mouth, and dysgeusia are increasing among oral adverse events. The objective of this study was to assess the characteristics of chemotherapy-induced oral dysesthesia and toothache. MATERIALS AND METHODS: Subjects were patients referred to the oral surgery clinic for oral adverse events related to cancer chemotherapy and with an observation period of more than 1 month after the last course of chemotherapy. Oral adverse events were divided according to the categories of the National Cancer Institute Common Terminology Criteria for Adverse Events, v5.0. Statistical comparison was made using the binomial test. RESULTS: A total of 180 patients were referred to the oral surgery clinic. Oral dysesthesia and/or toothache was found in 15 cases, which included 13 with oral dysesthesia, 4 with toothache, and 2 with both oral dysesthesia and toothache. Of these 15 cases, 13 had concomitant occurrence of peripheral neuropathy (PN) (86.7%, P = 0.0037) and 12 cases had dysgeusia (80.0%, P = 0.0176). Symptoms of oral dysesthesia and/or toothache continued after chemotherapy in 10 of 15 cases with the continuation of accompanied PN (66.7%) and/or dysgeusia and persisted for more than 6 months in 5 cases (33.3%). DISCUSSION: Although oral dysesthesia and toothache are low-grade chemotherapy-induced adverse events, it is suggested that they may be nervous system disorders rather than gastrointestinal disorders. Clinicians should understand that they potentially persist for a long period after the end of chemotherapy.

A Rare Case of Pyogenic Granuloma in the Tooth Extraction Socket.

Pyogenic granuloma (PG) refers to a common, acquired, benign, and vascular tumor that arises in tissues such as the skin and mucous membranes. However, it is extremely rare for PG to arise from an empty socket after tooth extraction. Herein, we describe a rare case of PG that arose from the empty extraction socket of the second molar adjacent to a dentigerous cyst of the left mandibular wisdom tooth in a 57-year-old man. The patient's second molar was extracted during the same procedure in which the wisdom tooth and cyst were removed. Subsequently, at 42 days after surgery, an exophytic mass was found in the socket of the second molar. An excisional biopsy was performed, and the histopathological diagnosis was PG. Since the PG recurred 90 days after the surgery, a complete excision with bone curettage was performed. During the 12 months of follow-up, there has been no recurrence observed. In conclusion, as tooth extraction is a routine dental practice, clinicians should be aware that PGs can also develop from an extraction socket.

Change of body composition, physical strength, and nutritional status of patients with mandibular fractures.

The aim was to determine changes in various parameters indicating physical conditions and nutritional status of patients during surgical and conservative treatment of mandibular fractures. A round by a nutrition support team was done once postoperatively for the surgical treatment group. For the conservative treatment group, three rounds were performed during the period of intermaxillary fixation. Data obtained from the rounds were compared between the groups. There were 29 patients surgically and 30 patients conservatively treated. A significant weight loss was observed in both groups postoperatively. The mean weight loss of the surgical treatment group measured at the postoperative round was 1.73 kg (SD ± 1.78) (P < 0.001) and that of the conservative treatment group at the third round was 2.74 kg (SD ± 2.35) (P < 0.001). During the entire treatment period, weight loss, body fat percentage, skeletal muscle percentage, grip strength and parameters indicating body composition and nutritional status of the conservative treatment group did not substantially differ from those of the surgical group. The influence of the conservative procedure on the nutritional condition of the patients seems to be limited and reversible at the end of the treatment. The weight loss observed here suggests that systematic nutrition support is necessary during both surgical and conservative treatment.

Microscopic Polyangiitis Initially Presumed to Be Endocarditis.

The antineutrophil cytoplasmic antibody- (ANCA-) associated vasculitides (AAVs), which include fever of unknown origin (FUO), are rare diseases characterized by necrotizing inflammation of small blood vessels and the presence of ANCAs. Microscopic polyangiitis (MPA) is a subtype of the AAVs. Although the prevalence of AAVs has generally increased over the last 20 years, there have been rare reports from the dental and oral surgery field. In this article, we present a case of MPA suspected to be infective endocarditis (IE) following tooth extraction.

Delayed Healing of Tooth Extraction Sockets with Ramucirumab Use.

OBJECTIVE: An angiogenesis inhibitor can cause medication-related osteonecrosis of the jaw (MRONJ). To our knowledge, there has been no report that an angiogenesis inhibitor causes delayed healing of tooth extraction socket. Here, we describe a case of delayed healing of tooth extraction sockets associated with an angiogenesis inhibitor, ramucirumab, which showed characteristics similar to MRONJ. MATERIALS AND METHODS: A 76-year-old male patient, who was diagnosed with gastric cancer with liver metastasis, received tooth extraction twice during continuous chemotherapy comprising paclitaxel and ramucirumab. RESULTS: The first extraction was performed 30 days after ramucirumab discontinuation without complication. The second extraction was conducted without ramucirumab discontinuation. Although tooth socket healing was finally achieved, it took about 150 days. Discussion. This case was considered to be delayed healing of dry sockets rather than MRONJ due to ramucirumab. Dentists and oral surgeons need to be aware that angiogenesis inhibitors can cause not only MRONJ but also dry sockets after tooth extraction.