Immediate Inferior Alveolar Nerve Reconstruction With Ablative Mandibular Resection Results in Functional Sensory Recovery.

BACKGROUND: Ablative mandibular resection with sacrifice of the inferior alveolar nerve (IAN) results in loss of sensation and decreased quality of life. PURPOSE: The purpose of this study is to evaluate functional sensory recovery (FSR) of immediate IAN allograft reconstruction performed during ablative mandibular resection at 1 year following surgery. STUDY DESIGN, SETTING, SAMPLE: This is a single-center retrospective cohort study that included consecutive subjects who underwent mandibular resection with IAN discontinuity and used a nerve allograft of ≥40 mm. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor variable is the use of an immediate nerve allograft in mandibular reconstruction. MAIN OUTCOME VARIABLE(S): The main outcome variable is FSR at 1 year using the Medical Research Council Scale. COVARIATES: Covariates include subject age, sex, specific pathology, nerve gap length, and development of neuropathic pain. ANALYSES: Statistical analysis of comparison of neurosensory outcomes was measured by bivariate statistics, weighted values, repeated measures, analysis of variance, and McNemar test. RESULTS: The study sample was composed of 164 subjects, of whom 55 (33.5%) underwent nerve allograft reconstruction and 30 (18.3%) did not have nerve reconstruction. Seventy-nine subjects (48.2%) did not meet the inclusion criteria. In the entire nerve allograft group of 55 subjects, FSR was achieved in 80% at 1 year; however, in benign disease alone, 31 of 33 (94%) achieved FSR at 1 year. In the nonallograft group (all benign disease), only 2 of 30 (7%) achieved FSR at 1 year. The significant covariates were age and pathology. Benign pathologic resections were 5.2 times more likely to achieve FSR than malignancies, and all subjects ≤ 18 years of age achieved FSR. After adjusting for age, sex, pathology, nerve gap length, nerve allograft was significantly associated with achieving FSR at 1 year (adjusted odds ratio = 5.52, 95% confidence interval = (1.03, 29.51), P value = .045 < .05). CONCLUSION AND RELEVANCE: Immediate long-span IAN allograft reconstruction is effective in restoration of sensation with an overall 80% of subjects achieving FSR at 1 year, while benign disease resulted in 94% FSR at 1 year. Immediate IAN reconstruction should be considered with mandibular resection involving the IAN, especially for children and benign disease.

Accuracy of Telemedicine Consultations in Oral and Maxillofacial Surgery During the COVID-19 Pandemic.

PURPOSE: Telemedicine has been an emerging trend over the past few years and has seen an exponential rise due to the COVID-19 pandemic. The purpose of the present study was to determine the accuracy of planned oral and maxillofacial surgery (OMS) procedures for patients seen initially by telemedicine in the department of OMS during the pandemic. METHODS: This was a retrospective cohort study. Record review of all patients who received telemedicine consultations during the pandemic time frame of March 1, 2020, to March 1, 2021, was performed. The primary outcome was the accuracy of the planned OMS procedure. Accuracy was defined as the ability to conduct the planned surgery with chosen anesthesia (local anesthesia, diazepam + local anesthesia, intravenous sedation, general anesthesia) at the immediate follow-up appointment without the need for further preoperative testing, evaluation, and consultation. The secondary outcomes were to determine the change in surgical plan, anesthesia plan, and medical plan. Predictor variables included age at the time of telemedicine consultation, gender, race, ethnicity, and the type of consult. Descriptive statistics and logistic regression analysis were executed. RESULTS: The study sample comprised 286 (64.56%) females and 157 (35.44%) males. The age range of the study population was 9 to 92 years, with a mean age of 33.88 years (standard deviation = 16.29 years). In the cohort of 443 patients who obtained telemedicine consultations, 98.19% were successfully treated at the following appointment. Four hundred thirty-one (97.3%) out of the 443 telemedicine consults pertained to dentoalveolar concerns. Logistic regression analysis showed that neither age nor gender had significant effects on the change of surgical and anesthesia plans. CONCLUSIONS: Telemedicine can be effectively utilized in performing consultations for routine OMS procedures, especially dentoalveolar surgeries. Telemedicine consultation can also be used to conduct a preoperative assessment to determine anesthesia and setting of care. However, given the lack of control group and the observational nature of this study, the results must be interpreted with caution.

The Use of Virtual Reality to Reduce Pain and Anxiety in Surgical Procedures of the Oral Cavity: A Scoping Review.

PURPOSE: Virtual reality (VR) is considered a nonpharmacological intervention to manage pain and anxiety for different procedures. We aimed to review the literature about the role of VR in reducing pain and anxiety in surgical procedures performed in the oral cavity. METHODS: A literature review was conducted using Medline and Embase with no restrictions on language or publication date. Our inclusion criteria were articles related to the use of VR to manage perioperative pain and anxiety on procedures in the oral cavity. RESULTS: Twenty-seven articles met the inclusion criteria. The number of publications increased significantly from 2 studies between 2000-2010 to 25 between 2011 and 2021. Of the 27 included studies, 22 (81.4%) studied patients undergoing dental procedures, and 5 (18.5%) in oral and maxillofacial surgery (OMS). There was heterogeneity in the VR software used in the different studies. Thirteen studies (41.9%) evaluated self or observational assessments of pain and anxiety. Pain alone was evaluated in 9 studies (29%) and anxiety alone in 8 studies (25.8%). Also, 6 studies (19.3%) evaluated physiological parameters such as heart rate and respiratory rate as objective measures of pain and anxiety. In oral surgery studies, VR was effective at reducing acute pain, fear, and anxiety levels. CONCLUSIONS: There is a paucity of research in OMS compared to dentistry. Given that this specialty involves highly stimulating and anxiety-provoking procedures, OMS could benefit from VR intervention for improved patient care.

Gender Gap in Leadership in Academic Medicine and Dentistry: What Are the Barriers? What Can Be Done To Correct It?

PURPOSE: The present study aimed to report the main barriers to women's advancement in leadership and high-rank academic positions in the fields of medicine and dentistry. MATERIALS AND METHODS: An electronic search was conducted of the MEDLINE database using the PubMed search engine. The Google Scholar search engine was also used to access scholarly articles across all disciplines. A total of 173 reports and abstracts published in the English language were retrieved and evaluated for their content. Of these, 32 were initially selected and reviewed. Finally, 16 studies focusing on gender-related discrepancies in healthcare concerning leadership and academic advancement were included. RESULTS: The following themes emerged as the main contributors to the gender disparity in academic medicine and dentistry: 1) the lack of appropriate role models and mentorship for successful socialization of female faculty; 2) the lack of peer support for women's promotion through the academic ranks and their selection for executive administrative roles at equal rates as their male counterparts; and 3) implicit bias and negative stereotypes. CONCLUSIONS: A need exists to increase the number of female role models and enhance mentorship to increase the attraction toward academic careers in medicine and dentistry. Cultural changes also are required at an institutional and organizational level to embrace diversity. The implicit biases against women's promotion to higher academic ranks must be addressed.

Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits?

PURPOSE: On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS: A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts. RESULTS: Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million. CONCLUSION: After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.

Selective serotonin reuptake inhibitors and dental implant failure-A significant concern in elders?

OBJECTIVE: Depression is a significantly prevalent health concern in geriatric populations. Selective serotonin reuptake inhibitor drugs (SSRI) are the most commonly prescribed antidepressant agents, with increasing rates of prescription. The present report aimed to present a concise review of the current understanding regarding SSRI effects on bone and dental implant outcomes. MATERIALS AND METHODS: A broad-based review and summary of literature pertaining to the effects of SSRI on bone metabolism and on dental implant survival was performed. RESULTS: The available literature indicates that serotonin plays a significant role in bone metabolism and experimental reports demonstrate adverse impacts of SSRI on multiple pathways of bone metabolism. Early clinical reports suggest detrimental effects of SSRI on dental implant survival. The type of SSRI drug, dosage and host-related genetic and metabolic factors could be potential modulating factors. There is a paucity of data regarding SSRI usage and dental implant survival specific to geriatric cohorts. CONCLUSION: As older individuals comprise a high-risk group for both high oral rehabilitation and SSRI use, clinicians should be aware the potential association between SSRI and dental implant failures. Well-designed investigations specific to geriatric cohorts are essential to understand the implications of SSRI use on dental implant prognosis.

Why Do Women Choose to Enter Academic Oral and Maxillofacial Surgery?

PURPOSE: To determine why women choose to enter an academic career in oral and maxillofacial surgery (OMS). MATERIALS AND METHODS: An online questionnaire was developed and e-mailed to female OMS surgeons to assess the reasons women choose to pursue an academic career, the perceived positive and negative features of academia for women, and proposed measures to increase the percentage of women choosing to specialize in OMS and pursue an academic career. RESULTS: Thirty-one female OMS surgeons completed the questionnaire; 1 additional participant accessed the survey but did not respond to any of the questions. There were 25 full-time academics and 6 part-time academics (≥50% time commitment). Of the responders, 72% were married, and of these, 72% were married before entering academics. Forty-seven percent of the women had children, all during their academic tenure. Among the full-time academicians with children, only 2 (7.7%) reported moderate difficulty finding the time for childbirth and maternity leave, whereas 3 of the 5 part-time academics with children reported moderate or significant difficulty with childbirth and maternity leave. Factors associated with choosing and enjoying an academic career are involvement in resident-student teaching (78%), followed by colleague camaraderie and collaboration (65.6%), research potential (50%), time flexibility, and not having to deal with excessive "business" practice issues (33%). The main reason for considering leaving an academic OMS career and/or among the least enjoyable aspects of being in academics was the potential for a higher income in private practice (56%). Less significant reasons for considering leaving an academic OMS career were a more flexible work schedule in the private sector and less institutional red tape (37.5%), as well as independence/being in control and more family time (22%). Engaging residents and students by female OMS surgeons, better mentorship from academic OMS surgeons, and increasing the number of women serving in leadership positions in organized OMS were identified as the most important measures to increase female involvement in academic OMS. CONCLUSIONS: This study shows that among the major motivating factors for choosing an academic career are involvement in resident-student teaching and colleague camaraderie and collaboration. Additional important factors for making this career choice are the research potential in academia, time flexibility, and not having to deal with excessive business practice issues. The reasons that deter women from entering OMS as a specialty and choosing a full-time academic OMS career are not significantly related to childbirth and family life. The main reason for potentially considering leaving an academic OMS career and/or among the least enjoyable aspects of being in academics is the potential for a higher income in private practice. Other reasons for potentially considering leaving an academic OMS career indicated by this study are independence/being in control and more family time, as well as the lack of institutional red tape. It appears that engaging female residents and students by female OMS surgeons, better mentorship by (both male and female) academic OMS surgeons, and increasing the number of female surgeons who can serve as role models may be beneficial in increasing the number of female OMS surgeons interested in an academic career.

Outcomes of Immediate Allograft Reconstruction of Long-Span Defects of the Inferior Alveolar Nerve.

PURPOSE: Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but also restoration of neurosensory function. The goal of this study was to determine the outcomes of immediate reconstruction of long-span defects (≥50 mm) of the inferior alveolar nerve (IAN) after ablative mandibular resection using allogeneic nerve grafts. MATERIALS AND METHODS: A retrospective cohort study of patients who underwent immediate reconstruction of IAN gaps of at least 50 mm with allogeneic nerve graft (AxoGen Avance, Alachua, FL) at a single academic medical center by a single surgeon (M.M.) from September 2013 to March 2015 was completed. Demographic and clinical data were collected for each patient and analyzed using clinical neurosensory testing and were reported using the Medical Research Council Scale (MRCS) for functional sensory recovery. In addition, patient subjective perception of neurosensory recovery was recorded using a visual analog scale (VAS). Subjective (VAS) and objective (MRCS) measurements of functional sensory recovery were recorded and compared across the study population. In addition, examined demographic and clinical data included patient age, gender, pathology, length of nerve allograft, and follow-up period. RESULTS: Of 12 with nerve repairs, 7 patients met the inclusion criteria. The average age was 34.7 years (range, 18 to 61 yr) and 71.4% were men. All IAN defects resulted from resection of mandibular pathology (6 benign lesions, 1 malignant lesion). Six of the 7 IAN defects were reconstructed with a 70-mm nerve allograft, and 1 nerve defect was reconstructed with a 50-mm graft. Mean follow-up time was 17.7 months (range, 10 to 27.5 months). Mean VAS score reported was 3.7 (range, 0 to 7). In addition, 85.7% of patients displayed return of some superficial pain and tactile sensation without over-response (S3), with 14.3% displaying good stimulation localization (S3+). The patient who displayed S3+ recovery underwent reconstruction with the 50-mm graft. Only 1 of the 7 patients had no neurosensory recovery (S0). CONCLUSIONS: Immediate reconstruction of the IAN with allogeneic nerve grafting of long-span defects (≥5 cm) is a viable and predictable option to achieve useful functional sensory recovery.

Oral Trauma and Tooth Avulsion Following Explosion of E-Cigarette.

Electronic cigarettes (E-cigarettes), or personal vaporizers, were introduced in 2003 and have been available in the United States since 2007. In addition to the health and safety concerns of the aerosol delivery of nicotine through E-cigarettes, during the past 8 years, reports of explosions and fires caused by the E-cigarette devices have led the US Fire Administration to evaluate the safety of these devices. These explosions have been observed frequently enough that the US Department of Transportation has recently banned E-cigarette devices in checked baggage aboard airplanes. This report contributes to existing knowledge about the hazards related to E-cigarettes by describing oral hard and soft tissue injuries from an E-cigarette explosion.

How do general dentists and orthodontists determine where to refer patients requiring oral and maxillofacial surgical procedures?

PURPOSE: This study investigated the influence of specific criteria on referral selection among general dentists and orthodontists in deciding referrals to oral and maxillofacial surgeons. MATERIALS AND METHODS: A cross-sectional study was designed to examine the importance of criteria used by 2 groups of practitioners, general dentists and orthodontists, for deciding on referrals to oral and maxillofacial surgeons. Data were collected by 2 multiple-choice surveys. The surveys were e-mailed to general dentists and orthodontists practicing in the state of Illinois and to graduates from the University of Illinois at Chicago (UIC) College of Dentistry and the UIC Department of Orthodontics. Participants were asked to rate referral criteria from most important to least important. Analysis of variance was used to examine the data for any differences in the importance of the criteria for each question and linear regression analysis was used to determine whether any 1 criterion was statistically meaningful within each group of practitioners. RESULTS: In total, 235 general dental practitioners and 357 orthodontists completed the survey, with a 100% completion rate. The most important criterion for referral to oral and maxillofacial surgeons in the general dentist group was the personal and professional relationship of the referring doctor to the specialist. In the orthodontist group, no single criterion was statistically meaningful. CONCLUSION: General dentists tend to develop long-term relationships with their patients, and when deciding the appropriate referrals it appears that personal and professional relationships that promote trust and open communication are key elements. General dentists favor these relationships when making referral decisions across a wide spectrum of procedures. Orthodontists do not place a substantial value on a specific criterion for referral and therefore may not develop the same relationships between patient and doctor and between doctors as general dentists.

Is immediate reconstruction of the mandible with nonvascularized bone graft following resection of benign pathology a viable treatment option?

PURPOSE: The purpose of this study was to address the following clinical question: Is immediate reconstruction of the mandible with a nonvascularized bone graft after resection of benign pathology a viable treatment option? Another purpose was to determine whether any variables affect the success of this treatment approach. MATERIALS AND METHODS: The authors implemented a retrospective cohort study from a sample of patients diagnosed with a benign tumor of the mandible who were treated with segmental resection and primary reconstruction with an autogenous nonvascularized bone graft. The predictor variables were age, gender, lesion size, and diagnosis, and the outcome variable was graft success determined by re-establishment of mandibular continuity with sufficient bone for implant placement. The χ(2) test was used for statistical analysis of the categorical data and P values less than .05 were considered statistically significant. RESULTS: Twenty patients with benign mandibular tumors were treated with transoral resection and immediate reconstruction with nonvascularized bone grafts. The mean age was 28.3 years (range, 9 to 63 yr) and 55% (11 of 20) were men. The most common lesion type was ameloblastoma (13 of 20) and all patients underwent reconstruction with autogenous anterior iliac crest bone grafting. Ninety percent of patients (18 of 20) had successful reconstruction. Ten patients underwent successful implant placement and restoration. CONCLUSIONS: Using careful patient selection, treatment of benign pathology with transoral resection and immediate reconstruction with a nonvascularized bone graft from the anterior iliac crest can be successful. In addition, the total treatment time from implant restoration to return to preoperative function is minimized. Therefore, this method of treatment is a viable treatment option and an alternative to delayed reconstruction or reconstruction with vascularized bone flaps.

Salivary Biomarkers Associated With Bone Deterioration in Patients With Medication-Related Osteonecrosis of the Jaws.

PURPOSE: The purpose of this study was to investigate the use of saliva as a medium for the identification of biomarkers associated with bone resorption and formation. The authors hypothesized that biomarkers, such as N-telopeptide of type I collagen (NTX) and bone-specific alkaline phosphatase (B-AP), could be identified in saliva. They further hypothesized that there would be a difference between these biomarkers in the saliva of patients with medication-relation osteonecrosis of the jaws (MRONJ) and those who have no risk factors for the development of MRONJ. PATIENTS AND METHODS: This case-and-control study compared 2 salivary biomarkers, NTX and B-AP, in a group of patients with MRONJ and a control group. The predictor variable was the presence or absence of the disease (MRONJ or control group); the outcome variables were the levels of the 2 salivary biomarkers, NTX and B-AP. Saliva samples from 20 patients with a diagnosis of MRONJ and 14 control participants who were comparable to the study group with no history of antiresorptive medication use were collected. The saliva samples were analyzed using 2 commercially available assays for NTX and B-AP to evaluate for levels of each marker. A 2-tailed t test for 2 groups of unequal distribution was used for statistical analysis, with P values less than .05 considered statistically. RESULTS: The 2 biomarkers, NTX and B-AP, were detected in saliva samples from the MRONJ and control groups. A statistically significant difference was found in the levels of NTX in saliva of patients with MRONJ compared with the control participants (P = .0067). CONCLUSIONS: In this exploratory study, the 2 bone deterioration biomarkers (NTX and B-AP) were detected in saliva. There was a statistical difference in the levels of salivary NTX between patients with MRONJ and controls. Saliva evaluation could provide a novel method to detect, diagnose, stage, and potentially guide treatment decisions and monitor outcomes for patients with MRONJ in the future.

Does decompression of odontogenic cysts and cystlike lesions change the histologic diagnosis?

PURPOSE: The purpose of this study was to report the histopathologic findings after postdecompression definitive treatment of odontogenic cystlike lesions and determine whether the diagnosis was consistent with the pretreatment diagnosis, thereby answering the clinical question: does decompression change the histologic diagnosis? MATERIALS AND METHODS: The authors implemented a retrospective cohort study from a sample of patients diagnosed with a benign odontogenic cystlike lesion and who underwent decompression followed by definitive surgery as part of their treatment. The predictor variable was treatment by decompression and the dependent variable was change in histologic diagnosis. Age, gender, and lesion location were included as variables. The χ(2) test was used for statistical analysis of the categorical data and P values less than .05 were considered statistically significant. RESULTS: Twenty-five cysts and cystlike lesions in 25 patients were treated with decompression followed by enucleation and curettage. The mean age was 34 years (range, 13 to 80 yr) and 56% (14) were male patients. Lesions were located in the mandible in 76% (19 of 25) of patients. Postdecompression histologic examination at the time of definitive surgical treatment was consistent with the preoperative biopsy diagnosis in 91% (10 of 11) of keratocystic odontogenic tumors, 67% (2 of 3) of glandular odontogenic cysts, 75% (3 of 4) of dentigerous cysts, and 100% (7 of 7) of cystic ameloblastomas. CONCLUSIONS: The histologic diagnosis at time of definitive treatment by enucleation and curettage is consistent with the predecompression diagnosis. Therefore, all lesions should be definitively treated after decompression based on the initial lesion diagnosis, with all patients placed on appropriate follow-up protocols.

Metastatic pancreatic adenocarcinoma to the mandibular condyle: a rare clinical presentation.

Metastatic disease to the oral cavity is rare, representing only 1-8% of oral malignancies, and involvement of the mandibular condyle is even less prevalent. In a recent literature review of 796 cases of metastatic disease to the oral cavity, only 39 (13.8%) involved the condyle. This report is a unique case of metastatic pancreatic adenocarcinoma to the condyle. There are only 5 documented cases of metastatic pancreatic adenocarcinoma to the oral cavity, one of which metastasized to the condyle. This is an important case because metastatic lesions to the condyle may mimic temporomandibular joint disorders making clinical diagnosis and decision-making extremely challenging for the oral and maxillofacial surgeon. The requirement for arrival at an appropriate and prompt diagnosis is crucial for determining the most appropriate treatment regimens and improved outcomes. Additionally, in approximately 33% of cases, the oral metastatic lesion may be the first indication of an undiscovered distant primary tumor, making timely evaluation and treatment critical from an oncologic perspective.

A brief virtual reality intervention for pre-operative anxiety in adults.

OBJECTIVE: Virtual reality (VR) is a promising non-pharmacologic tool for managing health care anxiety. We assessed the feasibility and acceptability of a pre-operative VR intervention by adult patients and medical staff and measured anxiety in adult patients pre- and post-VR intervention. STUDY DESIGN: We recruited 30 patients scheduled to undergo oral surgery and 8 medical staff as participants. The patients completed a verbal demographic survey and rated their anxiety before the VR intervention and at 1 minute and 2 minutes post-intervention. We administered the Acceptability of Intervention Measure to the patients to measure their perceptions of the VR intervention and the Feasibility of Intervention Measure to the medical staff to assess their perception of VR implementation. We performed an analysis of variance to compare pre-operative anxiety over time and assess demographic differences. RESULTS: The patients showed high and consistent acceptability of the pre-operative use of VR among patients, but acceptability varied among medical staff. The patients experienced a statistically significant reduction of pre-operative anxiety (P = .003). CONCLUSION: A brief VR pre-intervention is highly accepted by and very beneficial for patients undergoing oral surgery, positively affecting anxiety reduction. The perception of VR by health care providers needs to be explored to increase acceptability.

Enrichment of polycyclic aromatic hydrocarbon metabolizing microorganisms on the oral mucosa of tobacco users.

Certain soil microbes resist and metabolize polycyclic aromatic hydrocarbons (PAHs). The same is true for a subset of skin microbes. In the human mouth, oral microbes have the potential to oxidize tobacco PAHs, thereby increasing these chemicals' ability to cause cancer of adjacent epithelium. We hypothesized that we could identify, in smokers, the oral mucosal microbes that can metabolize PAH. We isolated bacteria and fungi that survived long-term in minimal media with PAHs as the sole carbon source, under aerobic conditions, from the oral mucosa in 17 of 26 smokers and two of 14 nonsmokers. Of bacteria genera that survived harsh PAH exposure in vitro, most were found at trace levels, except for Staphylococcus, Actinomyces, and Kingella, which were more abundant. Two PAH-resistant strains of Candida albicans (C. albicans) were isolated from smokers. C. albicans was a prime candidate to contribute to carcinogenesis in tobacco users as it is found orally at high levels in tobacco users on the mucosa, and some Candida species can metabolize PAHs. However, when C. albicans isolates were tested for metabolism of two model PAH substrates, pyrene and phenanthrene, they were not capable, suggesting they cannot metabolize PAH under the conditions used. In conclusion, evidence for large scale microbial degradation of tobacco PAHs under aerobic conditions on the oral mucosa remains lacking, though nonabundant PAH metabolizers are certainly present.

Prosthetic temporomandibular joint replacement (TJR): Stock or custom? A single institution pilot comparison.

OBJECTIVE: The aim of this study was to compare stock (Biomet-Lorenz Stock, Parsippany, NJ) and custom (TMJ Concepts, Inc., Ventura, CA) total temporomandibular joint (TMJ) replacement prosthetics. METHOD: This was a retrospective cohort study of 17 consecutive patients operated by the same surgeon from 2015 to 2020 comparing stock and custom options for total joint replacement (TJR). The inclusion criteria were patients who documented 1 year of follow-up post-TJR without previous TMJ replacement surgery. The predictor variable was the TMJ prosthetic replacement. The primary clinical outcome variables was pain via Visual Analog Scale (VAS) measured at 1, 3, and 6 months postoperatively and maximum incisal opening measured pre and post-surgery. The other variables were grouped into the following categories: surgery time, length of stay, and unilateral vs bilateral replacements. RESULTS: Our review showed no statistically significant difference in maximum incisal opening, subjective pain score, hospital stay, surgical time, or complication rate between Biomet-Lorenz stock and TMJ Concepts, Inc. custom total joint replacement. Bilateral TJR, irrespective of prosthesis type, did have greater improvement in maximal incisal opening (MIO) compared with unilateral that was statistically significant (P < .05). CONCLUSIONS: There was no statistically significant difference in the pain VAS or MIO using either stock or custom TJR. Both should be considered good surgical options for improvements in patient function and long-term jaw stability.