Current methods of sedation in dental patients - a systematic review of the literature

OBJECTIVE: The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. Study DESIGN: A systematic literature review of the PubMed MEDLINE database was carried out using the key words "conscious sedation", "drugs", and "dentistry". A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review. RESULTS: A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2 O) are also effective sedative drugs. CONCLUSIONS: Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective

Survival of dental implants in patients with Down syndrome: A case series.

STATEMENT OF PROBLEM: The need for tooth replacement in individuals with Down syndrome (DS) is explained by the high prevalence of dental agenesis and by the premature loss of teeth through severe periodontal disease. Dental implants may be the dental procedure of choice in some of these patients. PURPOSE: The purpose of this clinical study was to analyze dental implant survival in a series of patients with DS. MATERIAL AND METHODS: This was a multicenter, retrospective, observational study. Information on patients was gathered using a standardized questionnaire designed specifically for this study, including personal details, oral health status, information on the surgical and prosthetic phases, and follow-up visits. The questionnaire was sent to centers registered with the research network of the Spanish Society of Special Needs Dentistry (SEOENE). Patients with DS aged 18 years or older were included in the study if they had at least 1 dental implant and the corresponding prosthesis and had been followed up for at least a year. RESULTS: The study population was formed of 25 adult patients (13 men and 12 women) aged between 19 and 60 years. The interventions were performed by 5 different dental surgeons, usually under general anesthesia or deep sedation (n=17 patients). A total of 73 implants were inserted, 30 in the maxilla and 43 in the mandible, most commonly in the anterior region (n=51). The mean time to loading the implants was 4.1 ±1.3 months after surgery (range, 1 to 7 months). All patients completed prosthetic rehabilitation; the most frequent design used was the single fixed prosthesis (n=13 patients). A total of 17 (23.2%) implants failed in 8 (32%) patients; the majority (n=14 implants) failed in the postsurgical period before implant loading. The distribution by patients was 1 implant failure in 6 patients, 3 failures in 1 patient, and 8 failures in 1 patient. CONCLUSIONS: Dental implant survival is lower in individuals with DS than in the general population. The reasons for early implant failure in these patients have still not been clearly identified.

State anxiety and depression as factors modulating and influencing postoperative pain in dental implant surgery. A prospective clinical survey

OBJECTIVES: To determine whether preoperative state anxiety and depression modulate or influence objective and subjective postoperative pain following dental implant insertion. Study DESIGN: Prospective, clinical study with 7-day follow-up of a sample of 105 subjects who preoperatively completed the state anxiety questionnaire (STAI-E) and Beck Depression Inventory (BDI) and postoperatively, at 2 and 7 days, recorded objective pain with the Semmes-Weinstein mechanical esthesiometer (SW test) and subjective pain with the Visual Analog Scale (VAS).RESULTS: 85.6% and 81.5% of patients, respectively, recorded no signs of state anxiety or depression. The correlation between anxiety and depression for both maxillary bones was the lower (P=0.02). The correlation between subjective and objective pain at 2 and 7 days, and the anatomic regions intervened, was statistically significant in the mandible at day (P<0.01), and highly significant (P<0.001) for the other variables. The correlation between state anxiety and objective pain at day 7 was nearly statistically significant (P=0.07). CONCLUSIONS: The correlation between state anxiety and depression, and objective and subjective pain at day 7 was not statistically significant. A strong correlation was found between objective and subjective pain in the immediate postoperative period

Implants in disabled patients: A review and update

The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients

Indications and contraindications of dental implants in medically compromised patients: Update

The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words "implant" AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication

Consensus Report of the XI Congress of the Spanish Society of Odontology for the Handicapped and Special Patients

This article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haematological disorders, the dental implications of cardiovascular disease and hospital dentistry

State anxiety and depression as factors modulating and influencing postoperative pain in dental implant surgery. A prospective clinical survey.

OBJECTIVES: To determine whether preoperative state anxiety and depression modulate or influence objective and subjective postoperative pain following dental implant insertion. STUDY DESIGN: Prospective, clinical study with 7-day follow-up of a sample of 105 subjects who preoperatively completed the state anxiety questionnaire (STAI-E) and Beck Depression Inventory (BDI) and postoperatively, at 2 and 7 days, recorded objective pain with the Semmes-Weinstein mechanical esthesiometer (SW test) and subjective pain with the Visual Analog Scale (VAS). RESULTS: 85.6% and 81.5% of patients, respectively, recorded no signs of state anxiety or depression. The correlation between anxiety and depression for both maxillary bones was the lower (P=0.02). The correlation between subjective and objective pain at 2 and 7 days, and the anatomic regions intervened, was statistically significant in the mandible at day 7 (P<0.01), and highly significant (P<0.001) for the other variables. The correlation between state anxiety and objective pain at day 7 was nearly statistically significant (P=0.07). CONCLUSIONS: The correlation between state anxiety and depression, and objective and subjective pain at day 7 was not statistically significant. A strong correlation was found between objective and subjective pain in the immediate postoperative period.

Implants in disabled patients: a review and update.

The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients.

Indications and contraindications of dental implants in medically compromised patients: update.

The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words "implant" AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication.

Consensus report of the XI Congress of the Spanish Society of Odontology for the handicapped and special patients.

This article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haematological disorders, the dental implications of cardiovascular disease and hospital dentistry.

MT1 melatonin receptor expression in Warthin's tumor.

We contribute the first immunohistochemical study of MT1 melatonin receptor in Warthin's tumor and normal parotid gland. All 14 Warthin's tumors studied showed intense cytoplasmic positivity for MT1 receptor in all cylindrical epithelial cells lining spaces and a less intense positivity in basal cells. The lymphoid component accompanying the tumor was always negative for MT1 receptor. The parotid structure surrounding the tumor showed intense cytoplasmic positivity in all cells lining excretory ducts (lobar and lobulillar), with a lesser and focal positivity in cells of the acinar component. The biological activity of MT1 receptor in epithelial cells lining parotid excretory ducts may resemble its activity in Warthin's tumor cells. Hence, we propose Warthin's tumor as a useful positive control in immunohistochemical studies of MT1 melatonin receptor.

Bibliometric analysis of research on regenerative periodontal surgery during the last 30 years.

OBJECTICS: The evolution of research activity during the last thirty years on regenerative periodontal surgery is studied. RESULTS: A small number of authors are highly productive with more than 10 publications on the subject each. 79,6% of authors have only produced one article on the subject. The co-authorship average is of 2,68 authors per paper, with a collaboration between 2 and 6 authors. Main journals on the field of regenerative periodontal surgery are Journal of Periodontology and Journal of Clinical Periodontology, which are ranked 14th and 1st in their category according to the Journal Citations Reports. The most used language is English, followed by Japanese and Italian, Spanish occupying the eighth position. CONCLUSIONS: A significant increase on scientific literature is observed, similar to the one Dentistry has had. A reduced number of authors account for most production. In the same token, there is a scarce professionalization of researchers in this field, where most of the authors are occasional. On the other hand, there are two very specialized journals on this topic. Key words:Bibliometrics, scientometrics periodontal regeneration, surgical periodontal treatment, scientific literature, scopus, scientific output.

Effects of growth hormone on initial bone formation around dental implants: a dog study.

OBJECTIVE: The aim of this study was to evaluate the effects of topical application of growth hormone (GH) on the osteointegration of dental implants in dogs at 5 and 8 weeks after surgery. MATERIALS AND METHODS: Mandibular premolars and molars were extracted from 12 Beagle dogs. Four screw implants were placed in each mandible. Before implant placement, 4 IU of GH were applied to the test sites (TS); no treatment was applied to control sites (CS). Morphometric parameters, bone-to-implant contact (BIC), peri-implant connective tissue, interthread bone and newly formed bone were measured. The Student's t-test for was used for statistical analysis of data obtained. RESULTS: After 5 weeks of treatment, BIC values varied slightly between 34.33 ± 2.35% (CS) and 35.76 ± 2.96% (TS). Interthread bone tissue was 64.08 ± 8.68 at CS and 72.86 ± 2.93 at TS, with statistical significance (P<0.05). Bone neoformation was 72.53 ± 4.54 at the CS and 80.74 ± 1.65 for the GH group, these being statistically significant differences (P<0.05). After 8 weeks, BIC had slightly increased for the GH group (36.47 ± 3.09 vs. 39.61 ± 2.34). Interthread bone was 80.57 ± 2.28 at the CS and 82.58 ± 2.44 at the GH site, which was statistically significant. Bone neoformation was 88.09 ± 1.38 at CS and 91.01 ± 1.52 at TS, showing statistical significance (P<0.05). CONCLUSION: Topical application of 4 IU of GH like a biomimetic agent at the moment of implant placement has no significant effects on the BIC at 5 and 8 weeks, although bone neoformation and inter-thread bone values did increase significantly.

Alopecia areata of dental origin.

The association of alopecia areata and infectious foci of dental origin is relatively common, and may be explained by the autoimmune nature of the disorder. We describe a case of alopecia areata with no apparent cause and that was effectively resolved by eliminating a focalized dental infection via endodontic treatment. The presence of common immune mediators in the pathogenesis of both alopecia areata and dental infection could account for the dental origin of the hair loss. In this sense, patients with localized alopecia should be subjected to careful exploration of the oral cavity in search of possible dental infections.

Alopecia areata de origen dental / Alopecia areata of dental origin

La relación entre la presencia de alopecia areata y focos infecciosos de origen dental es relativamente frecuente. Clásicamente se ha relacionado con la presencia de focos infecciosos, con factores endocrinos, genéticos, psicológicos y otros como irritaciones reflejas de origen ocular o dental y traumatismo en la cabeza con posteriores pérdidas del pelo localizadas. Actualmente se le considera una enfermedad básicamente autoinmune, lo que puede explicar el nexo de unión con las infecciones dentales. Presentamos un caso de alopecia areata, sin causa aparente, y cuya resolución definitiva pasó por la eliminación de un foco infeccioso dental mediante endodoncia. La presencia de mediadores comunes inmunológicos en la etiopatología de la infección dental y la alopecia areata puede ser la explicación del origen dental de la alopecia. Sería deseable, en caso de pacientes que presenten pérdidas de pelo localizadas, derivarlo a su dentista para una exploración exhaustiva de la cavidad oral en busca de focos infecciosos dentales (AU)

Thalassemias and their dental implications.

Thalassemias constitute a form of anemia that pose clear problems in relation to dental treatment. Dental professionals must be aware of the treatment adaptations required in patients with severe forms of beta-thalassemia. Until medical research is able to afford a definitive solution to these diseases (thereby greatly simplifying the dental management of such patients), effort will continue to center on the improvement of available therapeutic modalities, with the aim of obtaining effective and inexpensive oral chelators and drugs that either individually or in combination allow increases in fetal hemoglobin levels. Undoubtedly, the use of such measures together with serial blood transfusions has made it possible for an ever increasing number of patients with beta-thalassemia to reach adult age, where the provision of integral rather than merely palliative dental treatment must be seriously considered. At present, the clinical orofacial manifestations caused by the erythroid mass expanding the facial bones - resulting in dental malocclusions and protrusions tend to be less intense as a result of early medical treatment. In the future, gene therapy may be expected to allow a normal facial appearance thanks to complete healing of the patient.

Las talasemias y sus implicaciones odontológicas / Thalassenias and their dental implications

Las talasemias son un tipo de anemias con clara problemática a la hora de realizar un tratamiento dental. Debemos conocer cómo adaptar nuestros tratamientos dentales a las formas graves de las beta talasemias. Mientras que las investigaciones médicas se orientan a conseguir tratamientos definitivos que solucionen y no que traten la enfermedad, momento en el cual el tratamiento odontológico será muy sencillo, debemos de conocer los intentos en mejorar los tratamientos actuales, los cuales se encaminan a conseguir quelantes orales eficaces y baratos así como fármacos que en forma individualizada o combinada consigan aumentar los niveles de hemoglobina fetal. El hecho incuestionable es que la utilización de las medidas anteriores junto a las transfusiones seriadas han permitido alcanzar cada vez a más pacientes con beta talasemia, la edad adulta en donde la solicitud de tratamientos odontológicos que no sean exclusivamente paliativos, sino integrales, deben de ser muy seriamente considerados. Actualmente los signos clínicos orales-faciales motivados por la masa eritroide que expansiona los huesos faciales causando protusiones y maloclusiones dentales suelen estar disminuidos en intensidad por los tratamientos médicos tempranos. En el futuro la terapia génica conseguirá un aspecto facial normal por la curación completa del paciente (AU)