Bibliometric Analysis of Medication-Related Osteonecrosis of the Jaw: High Citation Rates but Low Evidence.

PURPOSE: Citation analysis is one of the most commonly used bibliometric tools for measuring the academic importance of a report in a specific area of knowledge. The objective of the present study was to identify the 100 most cited reports on medication-related osteonecrosis of the jaw (MRONJ), determine their main bibliometric characteristics, and identify the bibliometric variables that affected the citation rates. MATERIALS AND METHODS: We performed a data search in the Scopus database to determine the number of MRONJ article citations up to September 30, 2018. We next selected the 100 most referenced studies and recorded the following information: ranking according to the number of citations; citation density; number and names of authors; language and year of publication; country and institution of origin; financial support; journal name, impact factor, category, and quartile; type of research; evidence level; and area of study. RESULTS: The 100 most cited reports had a mean citation density of 21.7 ± 20.7 (range, 6.2 to 99.4) and an h-index of 96. The 100 most cited reports on MRONJ had been published in 42 scientific journals, classified into 10 separate categories of the Journal Citation Reports; 56% of the articles were in the first quartile of their category. Most of the studies had been classified with a level of evidence of 4 (n = 45) or 5 (n = 29). In the bivariate analyses, only the conflict of interest (P = .002) was associated with citation density. After adjusting for numerous variables, conflict of interest (r = 0.27; P = .020) and country of the first author (r = 0.23; P = .043) were significantly associated with citation density. CONCLUSIONS: The 100 most cited studies of MRONJ had a large number of citations and had been reported in journals with a high impact factor; however, the studies had a generally low evidence level and randomized clinical trials were lacking.

Discrepancy in medications reported by elderly patients in the dental office and in their electronic medical records: A pilot study.

AIMS: This study's main objective was to analyze the discrepancy between the dental medication record (DMR) and the physician-prescribed active medications recorded in the medical medication record (MMR). METHODS: The study group consisted of 100 adults who attended the University Dental Clinic (Santiago de Compostela, Spain) requesting dental care. A dental history was created for all participants that included the DMR. The MMR were compiled from their electronic medical records. RESULTS: About 80% of the patients consumed at least one drug (94.2% of those >65 years) and 19% took more than five drugs (26.4% of those > 65 years). In total, 54% of the patients had some discrepancy between the medications recorded in the DMR and those in the MMR (48.4% for those ≤65 years and 64.7% for those >65 years). The rate of participants who omitted some drugs was higher for those >65 years. The drugs most omitted from the DMR were analgesics/opioids, antihypertensives and anxiolytics/hypnotics/sedatives. CONCLUSIONS: It is imperative to access the MMR of patients requesting dental care because a significant number of medications are not reflected in their DMR. These discrepancies may be particularly common and relevant in elderly patients, in whom multimorbidity and polypharmacy are more frequent.

Evaluation of the surgical difficulty in lower third molar extraction.

The ability to predict the surgical difficulty of lower third molar extraction facilitates the design of treatment plans by minimizing complications and improving the preparation of patients and assistants in terms of the postoperative management of inflammation and pain. The aims of this study were to evaluate the value of panoramic radiographs in predicting lower third molar extraction difficulty and technique and to determine if the experience of the practitioner had any influence on this predictive ability. Fourteen dental practitioners with varying levels of experience evaluate the difficulty of lower third molar extraction in a group of patients using a 100-mm visual analog scale (VAS) and a modified version of a surgical difficulty scale. The results were then compared to postoperative scores calculated using the same scale. A tendency to underestimate the difficulty of procedures that was more pronounced in observers with greater levels of experience was observed. A low level of agreement between preoperative and postoperative evaluations using the surgical difficulty scale as well as an association between difficulty assessed preoperatively using the VAS and difficulty assessed postoperatively using the surgical difficulty scale was also found. The use of panoramic radiographs does not allow practitioners to accurately predict lower third molar extraction difficulty and technique, regardless of their level of experience.

Pederson scale fails to predict how difficult it will be to extract lower third molars.

We report a consecutive series of 105 extractions of impacted lower third molars, in each of which operative difficulty was predicted preoperatively using the Pederson scale (radiographic appearance of the anatomical position of the lower third molar), and postoperative difficulty was scored with a modified version of the Parant scale (operative manoeuvres that were needed for extraction of the third molar). Preoperative classification as "difficult" on the Pederson scale was not an accurate predictor of true difficulty (postoperative classification as "difficult" on the modified Parant scale). There was no significant association between the Pederson score and duration of operation, but high Parant scores were significantly associated with longer operations. We suggest that scales for the prediction of operative difficulty in the extraction of impacted lower third molars should take into account factors other than the anatomical position of the tooth.

Postoperative recovery after removal of a lower third molar: role of trait and dental anxiety.

OBJECTIVE: The aim of this study was to evaluate trait and dental anxiety influence on postoperative recovery after lower third molar surgery and to determine the effect of anxiety on surgery duration. STUDY DESIGN: A prospective study was performed of 145 patients who underwent lower third molar extractions. Dental anxiety was evaluated using the Corah Dental Anxiety Scale (DAS), Kleinknecht Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. Surgery duration, postoperative pain, swelling, and trismus were also recorded. RESULTS: Patients with high trait anxiety showed more pain according to all of the postoperative measures and to a significant degree in the last 2 postoperative days evaluated. Patients with high dental anxiety had greater trismus according to the DAS and to the dental stimuli dimension of the DFS. The average surgery time was higher in patients with high anxiety, for all of the measures used, although this difference was not statistically significant. CONCLUSION: Patients with high trait or dental anxiety may tend to require longer surgery times and have poorer postoperative recovery.

Relationships between surgical difficulty and postoperative pain in lower third molar extractions.

PURPOSE: To investigate the influence of surgical difficulty on postoperative pain after extraction of mandibular third molars. MATERIALS AND METHODS: A prospective study was performed of 139 patients who underwent a total of 157 mandibular third molar extractions. For evaluation of surgical difficulty, a 4-class scale was completed after surgery: I, extraction with forceps only; II, extraction requiring osteotomy; III, extraction requiring osteotomy and coronal section; IV, complex extraction (root section). The duration of surgery was also recorded. Postoperative pain was evaluated using a visual analog scale that each patient completed daily until day 6 postsurgery, at which time the sutures were removed. RESULTS: A statistically significant relationship was observed between surgical difficulty (as rated on the scale) and postoperative pain. Longer interventions generally produced more pain. CONCLUSIONS: Pain after extraction of a mandibular third molar increases with increased surgical difficulty and duration of the intervention.

Dental anxiety before removal of a third molar and association with general trait anxiety.

PURPOSE: The aim of the present study was to evaluate dental anxiety in patients consulting for third molar removal, and to assess possible relationships with general trait anxiety. MATERIALS AND METHODS: Dental anxiety was measured using Corah's Anxiety Scale (DAS), the Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. RESULTS: Trait anxiety showed significant positive correlations with both DAS score and DFS score. The 3 measures of dental anxiety all showed significant positive correlations with each other. The difference between men and women was only statistically significant in the case of trait anxiety. CONCLUSION: These results suggest that trait anxiety may be a useful predictor of a patient's predisposition to dental anxiety.