A Comparison of Pain Management Protocols Following Total Knee Arthroplasty: Femoral Nerve Block versus Periarticular Injection of Liposomal Bupivacaine with an Adductor Canal Block.

BACKGROUND: Total knee arthroplasty (TKA) results in significant postoperative pain and a demanding postoperative path for recovery. This study was conducted to determine whether a femoral nerve block (FNB) or a periarticular injection of liposomal bupivacaine with an adductor canal block (LB+ACB) is superior for pain management. MATERIALS AND METHODS: A total of 557 consecutive primary TKA cases performed at a single hospital between 2010-2014 were retrospectively reviewed. After enrollment criteria were met, 390 cases remained (FNB=181, LB+ACB=209). Inpatient and post-discharge variables related to pain, narcotic use, healthcare resource utilization, and cost were compared. RESULTS: There were no significant differences in demographics between the two groups. There was also no significant difference in inpatient postoperative pain between the two groups. The FNB group consumed fewer narcotics overall compared to the LB+ACB group (p<0.001). However, the LB+ACB group experienced fewer opioid-related adverse events (p<0.001). The LB+ACB group had a shorter length of stay (p<.001), fewer readmissions (p=0.017) and reoperations (p=0.025), and lower costs (p<0.001). DISCUSSION: LB+ACB proved to be an equally effective postoperative TKA pain management tool compared to FNB while displaying superiority in other increasingly important areas such as length of stay and cost. The larger amount of narcotic consumption is a concern, however, and there may be a small population of patients for whom LB+ACB is not the best option.

A dental student view on learning gained through Inter-Professional Engagement with people experiencing homelessness.

Community engagement is an important element of the undergraduate programme at the Faculty of Medicine and Dentistry, University of Plymouth, United Kingdom. This report presents a project that a group of second year dental students undertook with people experiencing homelessness, and provides an in-depth reflective account of its impact on the students' learning. The project formed part of the students' inter-professional engagement module and delivered an intervention to enable residents at a temporary accommodation centre to access dental treatment. As a result of the project, 14 residents received dental treatment. The groups' confidence in engaging with people experiencing homelessness and their understanding of the complex needs of this group also significantly improved. Community engagement modules can be an important learning tool for students' future practice and can help promote access to dental care for vulnerable populations.

Prognosis of teeth in the line of jaw fractures.

BACKGROUND/AIM: The decision as to whether teeth in the line of jaw fractures should be extracted or retained remains a controversial issue. The aim of this study was to assess the prognosis of teeth directly in the line of, and adjacent to, jaw fracture sites. MATERIALS AND METHODS: The study consisted of 50 patients with facial fractures in the dentate region, the diagnosis of which was made on the basis of clinical and radiographic examinations. A total of 124 teeth were present in 69 fracture sites (50 patients), of which 89 teeth were evaluated both, clinically (tooth mobility, pocket depth, pulp sensibility) and with periapical radiographs (degree of fracture displacement, marginal bone loss, root resorption). RESULTS: The results revealed that 61.9% of teeth in directly in the line of fractures showed no response to electric pulp testing compared with 48.9% teeth adjacent to fractures. The maximum frequency of non-responsive teeth was observed in Type I fractures followed by Type II fractures. Response to pulp tests was highly significant at postoperative 3- and 6-month periods (Wilcoxon's test). There was continuous reduction in the measurement for mean pocket depth at both test and control sites of teeth. The measurement of marginal bone levels of teeth in the line of fractures revealed a significant reduction (P < 0.01) from preoperative to postoperative 7-day period only. In teeth adjacent to fracture sites, the mean marginal bone levels of control site and test sites were not significant at any time interval. There was no difference in postoperative complications pertaining to whether the tooth at the fracture site was extracted or retained. CONCLUSIONS: Teeth in line of jaw fractures should not be removed on a prophylactic basis and should be followed up clinically and radiographically to determine any treatment needs.

Radiographic study of the positional changes and eruption of impacted third molars in young adults of an Asian Indian population.

PURPOSE: The aim of the study was to assess changes in the angular position and eruption status of third molars in students of an Asian Indian population during a 4-year follow-up period. PATIENTS AND METHODS: The series consisted of 43 students (11 males, 32 females). Standardized panoramic radiographs were taken at baseline (mean age, 19.1 +/- 0.7 years) and at the end of study (mean age 23.1 +/- 0.7 years). Angulation and degree of impaction of third molars were determined by their sagittal relationship to the adjacent second molar and eruption to the occlusal plane. Root formation was also assessed. RESULTS: During the 4-year follow-up period, 11 of 72 of the mandibular teeth (15%) and 17 of 74 of the maxillary teeth (23%) changed their sagittal inclination. Thirty-one of 118 impacted teeth (26%; level B + C) achieved level A eruption more so in the mandible, ie, 15 of 52 (29%), than in the maxilla, ie, 16 of 66 (24%). In the mandible, 9 of 24 impacted vertical teeth (37.5%), 3 of 6 distoangular teeth (50%), and 3 of 22 mesioangular impacted teeth (13.6%) erupted to the occlusal plane. In the maxilla, 9 of 36 impacted vertical teeth (25%) and 7 of 27 distoangular teeth (26%) erupted to the occlusal plane during the follow-up. The number of teeth with complete root formation increased in mandible from 61% to 93% and in maxilla from 62% to 94.5%. CONCLUSIONS: Unpredictable changes in the position and angulation of teeth continued to occur even after the age of 19 years, more so in vertical and distoangular teeth than in mesioangular teeth.

Aspergillosis: a rare case of secondary delayed mandibular involvement.

Invasive aspergillosis in healthy hosts is a very rare occurrence, but it may become pathogenic under certain circumstances. In the head and neck region, aspergillosis usually involves the maxillary sinus. This case report describes secondary Aspergillus infection of the mandible in a 35-year-old female patient in whom the maxillary sinus was primarily involved 5 years previously.

Odontogenic infections: Microbiology and management.

OBJECTIVE: The aim of this retrospective study was to evaluate the involvement of fascial spaces, their bacteriology, sensitivity to antibiotics and management of odontogenic infection in 100 patients of age less than 60 years. RESULS: The mandibular 3(rd) molar was found to be the most commonly offending tooth, followed by the mandibular 2(nd) molar. The submandibular space was the most frequently involved fascial space both in single fascial space infections and multiple fascial space infections. Mixed growth (aerobic and anaerobic) was seen in culture smears of 60 patients, only aerobic bacterial growth was seen in 25 patients and anaerobic bacterial growth was seen in culture smears of 15 patients. Streptococcus viridans was the most frequently isolated bacteria among the aerobes, whereas Bacteroides and Prevotella were the most common bacterial species among anaerobes. Empirical antibiotic therapy in the form of Co amoxiclav and Metronidazole was given. Incision and drainage followed by extraction of the offending tooth/teeth was carried out. CONCLUSION: It was concluded that odontogenic infections were mixed aerobic-anaerobic infections. Anaerobic as well as aerobic cultures were necessary to isolate all pathogens. Successful management of these infections depends on changing the environment through decompression, removal of the etiologic factor and by choosing the proper antibiotic.

Radiographic evaluation of the status of third molars in the Asian-Indian students.

PURPOSE: The purpose of this study is to assess the prevalence and agenesis of third molars, their impaction status, and the time and sequence of their eruption in the students of Asian-Indian population. PATIENTS AND METHODS: One hundred students with ages ranging from 17.5 to 20.0 years were randomly selected. This age group was selected because this is the age at which third molars normally begin to erupt. Students who had undergone any tooth extraction or orthodontic treatment previously were not included in the study. RESULTS: The incidence of congenital missing third molars was 11.5%, with a higher incidence in females. Of the third molars present, 31% were in mesioangular position, 42% were in the vertical position, 27% were in the distoangular position, and none were in the horizontal position. Of the 354 teeth examined, 24% of teeth were found to be erupted and 76% were in various stages of eruption. The level of eruption of third molars was 27% at A; 39%, B; and 34%, C. CONCLUSIONS: The present study showed that at the baseline (mean age, 19.3 years), 24% of third molars were erupted, 76% were in various stages of eruption, and 11.5% were congenitally missing in the Asian-Indian student population.