Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America.

PURPOSE: To assess the occupational risk of hepatitis C virus (HCV) infection among dental personnel. METHODS: Three hundred forty-three oral surgeons and 305 general dentists were recruited at national meetings of the American Dental Association and matched by gender, age, years of practice, and location of practice. Each participant completed a detailed questionnaire designated to measure occupational risk of blood-borne infections and supplied a sample of blood. Antibodies to HCV (anti-HCV) were assessed by second-generation enzyme immunoassay and recombinant immunoblot assay. As a marker of occupational exposure to blood-borne viruses, hepatitis B virus (HBV) surface antigen and antibodies to HBV surface and core antigens were measured by enzyme immunoassay. RESULTS: Anti-HCV was found in 2.0% of oral surgeons and 0.7% of general dentists (odds ratio [OR] = 3.2, P = 0.133). Anti-HCV was more prevalent (P < 0.01) in dental personnel who were older, had more years of practice, and had serologic markers of HBV infection. Serologic markers of HBV infection were found in 7.8% of general dentists and 21.2% of oral surgeons (OR 3.1, P < 0.001). CONCLUSIONS: These data confirm high rates of HBV infection among dental personnel, but suggest that the risk of HCV infection is considerably lower.

Occupational blood exposure and HIV infection among oral and maxillofacial surgeons.

OBJECTIVE: The purpose of this study was to examine occupational blood exposure and the seroprevalence of HIV infection among oral and maxillofacial surgeons. STUDY DESIGN: Three hundred twenty-one oral and maxillofacial surgeons attending an annual meeting voluntarily and anonymously participated in an HIV serosurvey and completed a questionnaire assessing practice and demographic factors. Statistical tests included the Wilcoxon rank-sum test and the chi-squared test. RESULTS: Eighty percent of those who completed the survey reported one or more blood-skin contacts within the previous month. The mean number of percutaneous injuries within the previous year was 2.36 +/- 0.2. Wire was most commonly associated with percutaneous injuries. Oral maxillofacial surgeons who reported three or more percutaneous injuries performed more fracture reductions than oral and maxillofacial surgeons reporting no percutaneous injuries (p < 0.01). No participant was HIV-positive; the upper limit of the 95% confidence interval was 1.15%. CONCLUSION: The findings suggest that the occupational risk for HIV infection in oral surgery is very low even though most oral and maxillofacial surgeons experienced blood contact. Associations of percutaneous injuries with fracture reductions and wire may assist in the development of new techniques and equipment to minimize blood exposures.

Psychological, physiological, and pharmacological management of pain.

It has been the intent of the authors to impress upon the clinician the multifaceted nature of the human pain experience. We have sought to create an understanding of the emotional nature of pain. The treatment of pain as a pure sensation without directing attention to its behavioral and psychological aspects will generally lead to failure in understanding and ultimately in treating this ubiquitous problem in our profession. The use of drugs alone will have only a minor effect on the treatment of pain. Knowledge of environmental control and an understanding and empathetic approach to the patient in pain or in stress will carry the dentist a long way toward his goal of dental treatment without pain or emotional upset.

Zomepirac sodium vs APC with codeine for oral surgery pain.

In this double-blind, repeat-dose study, 323 outpatients with moderate to severe pain after oral surgery assessed zomepirac sodium, a new oral, single-entity, nonnarcotic analgesic, and APC with codeine, 30 mg, a reference standard. Pain relief obtained with 100 mg of zomepirac sodium was significantly superior to that of APC with codeine, 30 mg; 50 mg of zomepirac sodium was as effective as the reference drug. The analgesic acceptability was highest for 100 mg of zomepirac sodium. Both doses of this new drug produced significantly fewer adverse reactions than APC with codeine, 30 mg.

Desmoplastic fibroma of the mandible in a 3-year-old child.

A 3-year-old white girl was seen because of an enlarging mass in the left side of the mandible. The mass was 10 cm in diameter and the entire left hemimandible was involved. Examination of tissue after incisional biopsy showed desmoplastic fibroma. Surgical removal of the tumor required a hemimandibulectomy. The mandible was replaced immediately with a stainless steel mesh prosthesis with an acrylic condyle. A year later, there was no evidence of recurrence. Though the mesh became exposed in one area, we believe that esthetics and function were best served by its use.

Complications following removal of impacted third molars: the role of the experience of the surgeon.

The incidence of complications associated with the removal of impacted third molars in a group of 500 patients treated by oral surgery faculty were compared with the incidence of complications in 208 patients treated during the same period by residents of oral and maxillofacial surgery. The results show that complications were more numerous after the removal of third molars classified as partial bony or complete bony impactions, and that less-experienced surgeons had a significantly higher incidence of such complications.

Solitary neurofibroma of the maxilla.

A case of a large central neurofibroma of the left posterior maxilla is presented. This lesion was treated by a left radical maxillectomy because of the extensive nature of the tumor. The surgical defect was reconstructed with a latissimus dorsi myocutaneous flap. The incidence and clinical features of intraosseous benign nerve sheath tumors are discussed.