A Patient with Severe Anxiety and Episodes of Fainting in Need of Dental Restoration.

Patients with extreme dental anxiety and dental phobia are candidates for syncope attacks in a dental chair. Early recognition and management of these episodes is important. Vasovagal syncope is often preceded by prodromal signs and symptoms like facial pallor, diaphoresis, fainting, dizziness, nausea, or vomiting. If any element of the patient's airway, breathing, or cardiovascular system is no longer intact, the provider should commence emergency basic life support protocols and notify emergency medical services immediately.

A Patient with a History of Myocardial Infarction and a Stent Presenting for Full Mouth Extractions.

The scenario presented is of a patient in the dental chair who had history of myocardial infarction and history of stent placed in the left anterior descending coronary artery who now presents with acute chest pain, chest tightness, and extreme dizziness. Confirming cardiopulmonary arrest and beginning basic life support are the first steps in the management followed by defibrillation, advanced cardiac life support, post-resuscitation care, and long-term management.

A Patient with Epilepsy Presenting for a Dental Hygiene Visit.

All dentists should be trained in the diagnosis and management of seizures in a dental chair. Although epilepsy is a common etiological factor, there are other medical situations whereby seizures are manifested. Once a seizure is suspected and other causes of altered consciousness or involuntary motor movements are ruled out, proper management should commence immediately. The first step in management is to immediately remove/stop all provocative factors, like bright flashing lights, drill sounds, and such. Benzodiazepines remain as the first-line treatment for patients with continued seizures before activating emergency medical services.

Foreign Body Aspiration in an Elderly Male with No Significant Medical History.

Accidental foreign body aspiration is not uncommon during a dental procedure and remains a real risk for many dental procedures. Although approximately 50% of patients are asymptomatic after aspiration of a foreign body, understanding the appropriate next steps in management of these patients is critical in preventing morbid and even lethal outcomes in some instances. Appropriate knowledge of identification and management of such instances is important for all practicing dentists. This article goes into the diagnosis and management of both uncomplicated foreign body ingestion and complicated foreign body aspirations.

Diabetic Patient in the Chair for Implant Surgery.

Although dental treatment in a patient with well-controlled type 2 diabetes mellitus is uncomplicated, hypoglycemia is one of the most dreaded complications among diabetics and remains as one of the leading causes of endocrine medical emergencies. Identification and prompt treatment is important to all dental practitioners. This scenario goes into the diagnosis and management of medication-induced hypoglycemia.

Penicillin Allergy in a Patient Presenting for Scaling and Root Planing.

Dentists should be equipped to treat any allergic reaction in a dental office and in this scenario, anaphylaxis is noted after administration of a penicillin derivative given before a dental procedure. Identification of signs and symptoms related to anaphylaxis is vital and appropriate management of the patient is the key. The dental management of the scenario goes into the diagnosis and management of anaphylaxis in a dental office.

A Patient with Known Allergy to Local Anesthesia Presenting for a Dental Restoration.

Dentists should be equipped to treat an allergic reaction in a dental office, and in this scenario, the potential allergic reaction is noted after administration of a common local anesthetic lidocaine with epinephrine. The allergic reaction quickly escalates to a full-blown anaphylaxis, and the management of such an episode is detailed in this article.

Enlargement of Inferior Alveolar Nerve Canal and Mental Neuropathy Associated With B-Cell Lymphoma: A Case Report and Literature Review.

Enlargement of an inferior alveolar nerve canal (IANC) on radiographic imaging can indicate the presence of a wide variety of pathologic entities. Oral and maxillofacial surgeons have the unique opportunity to regularly examine panoramic radiographs and must exercise proficient clinical judgment when noting abnormal findings on imaging. While malignant processes associated with IANC enlargement are uncommon, these pathologies do occur and may be associated with significant sequelae, especially when accompanied by a delay in diagnosis and in treatment. The purpose of this case report is to describe a case in which a patient presented with mental nerve neuropathy associated with unilateral IANC enlargement on radiography, which was found to be a B-cell lymphoma on biopsy. More importantly, we aim to remind oral and maxillofacial surgeons of this rare presentation of a malignant process so as to promote prompt recognition and referral for appropriate treatment.

Global Burden of Head and Neck Cancer.

Head and neck cancer is increasing globally owing to rising rates of tobacco use and human papillomavirus infection. Today, cancer is the leading cause of death and disabilities in developed countries and the second leading cause of death in countries with developing economies. Understanding the global landscape of head and neck cancer will empower oral and maxillofacial surgeons to play a critical role among patients and societal education regarding the importance of addressing modifiable risk factors and continuing to play an important role in the diagnosis and management of head and neck cancer.

What characteristics do orthodontists desire in orthognathic surgeons?

OBJECTIVE: The purpose of our study was to report and rank orthognathic surgeon characteristics as valued by referring orthodontists. STUDY DESIGN: This was a cross-sectional study surveying orthodontists registered with the American Academy of Orthodontists' Partners in Research program. Survey items gathered information on both orthodontist characteristics and perceptions across 9 surgeon characteristics. Descriptive statistics were computed for all survey items, and linear regression models were used to evaluate the association between orthodontist characteristics and number of orthognathic surgeries performed. RESULTS: Among the 1300 surveyed orthodontists, there were 172 respondents (13% response rate). The majority of orthodontists (66.9%) had had at least 15 years of practice experience, completed between 1 and 5 surgical cases in the past year (55.6%), and referred their orthognathic cases to an oral and maxillofacial surgeon (99.4%). Among orthodontists, only practice experience (P < .01) was independently associated with the number of surgeries performed. An understanding of preoperative and nonoperative orthodontics was the most highly valued surgeon characteristic, and 50% of all respondents listed it as one of the most important characteristics. The next most valued surgeon characteristics were the ability to lead surgical treatment planning, acceptance of patient insurance plans, and sharing of strong personal and professional relationships. CONCLUSIONS: The most desirable characteristic in an orthognathic surgeon, as stated by the surveyed orthodontists, was an understanding of both preoperative and nonoperative orthodontics. Surgeons seeking to increase orthognathic referrals should work to increase insurance coverage and actively initiate strong personal and professional relationships with orthodontists.

Cardiovascular considerations for the dental practitioner. 2. Management of cardiac emergencies.

Medical emergencies are not uncommon in dental practices. Syncope has commonly been found to account for the majority of these emergencies in a dental setting, but some studies have reported cardiovascular events as the most common type of emergency. It is critical that every dentist be prepared with the knowledge and equipment necessary to respond in emergency situations. This article aims to provide dentists with essential knowledge about management of cardiovascular emergencies.

Pre-Radiation dental considerations and management for head and neck cancer patients.

Treatment of head and neck cancer (HNC) is accompanied by a high rate of morbidity, and complications can have a lifelong, profound impact on both patients and caregivers. Radiation-related injury to the hard and soft tissue of the head and neck can significantly decrease patients' quality of life. The purpose of this study is to provide patent-specific guidelines for managing the oral health and related side effects of HNC patients treated with radiation therapy. Based on reviewed articles retrieved on the PubMed database, guidelines for management of the oral health of this patient population were organized into three separate categories: cancer, patient, and dentition. The location, type, and staging of the cancer, along with the radiation used to treat the cancer significantly impact dental treatment. Several unique patient characteristics such as motivation, presence of support system, socioeconomic status, nutrition, and race have all been found to affect outcomes. Dental disease and available supportive dental management was found to significantly impact treatment and quality of life in this patient population. By comprehensively assessing unique cancer, patient, and dental-related factors, this review provides individualized evidence-based guidelines on the proper management of this complex and vulnerable patient population.

A treatment algorithm for the management of intraoral burns: A narrative review.

Oral mucosa follows a distinctly different trajectory of wound healing than skin. Although there are contemporary guidelines regarding treatment of burns to the skin, there is no standard of care specific to intraoral burns. This narrative review proposes an evidence-based treatment algorithm for the management of intraoral burns. Data was collated through a comprehensive review of the literature and only included studies that have reported particular success with favorable short- and long-term prognoses. In order to critically appraise the strength of the treatment recommendations, the GRADE criteria was applied to each arm of the algorithm. The algorithm was initially subdivided into the four primary etiologies of intraoral burns - thermogenic, cryogenic, chemical, electrical. Our findings emphasize the importance of conservative modalities of intra-oral burn treatment.

Cardiovascular considerations for the dental practitioner. 1. Review of cardiac anatomy and preoperative evaluation.

Cardiovascular disease is the most prevalent chronic medical condition in patients treated in a dental setting. Therefore, dental practitioners must have a sound understanding of cardiovascular anatomy and physiology. Dentists also should be equipped to perform an effective preoperative cardiovascular examination and determine when medical consultation is necessary in higher risk patients. This article provides an overview of cardiovascular anatomy and physiology and discusses evaluation of cardiac risk factors with the aim of enabling dentists to effectively assess patients for potential cardiovascular events, thereby avoiding cardiovascular emergencies in the dental setting.

Ameloblastic Fibro-Odontoma of the Maxilla in a Pierre-Robin Sequence Patient.

INTRODUCTION: Pierre Robin sequence (PRS) is a rare disorder classically observed as a triad of features including micrognathia, glossoptosis, and upper airway obstruction. It is associated with a syndrome in about 60% of cases. While odontogenic tumors are common findings in patients with familial adenomatous polyposis and nevoid basal cell carcinoma syndromes, PRS has not been found to be consistently associated with any tumors of the jaw. CASE REPORT: The current report aims to describe a patient with PRS who presented with an extensive ameloblastic fibro-odontoma (AFO) of the maxilla. CONCLUSION: Continued observation for odontogenic tumors in PRS is necessary.

Massive Middle Cerebral Artery Infarction After Surgically Assisted Rapid Palatal Expansion: A Case Report.

Dentofacial deformities have a marked impact on a patient's quality of life. Fortunately, these deformities often can be corrected through orthodontic and surgical treatment. In adults, transverse maxillary discrepancies are often corrected by performing a surgically assisted rapid palatal expansion (SARPE) procedure. This procedure is accompanied by many of the same complications involved in performing a Le Fort I osteotomy. Although major complications from maxillary surgery are uncommon, severe hemorrhage and cerebrovascular accidents are real risks accompanied by serious sequelae. The purpose of this case report is to describe a case in which a patient developed a massive middle cerebral artery infarct after a SARPE procedure. The authors discuss the possible etiology and pathogenesis of the complication. They also aim to remind surgeons of this rare complication to ensure prompt recognition and management to prevent delays in care.

Components of Patient Satisfaction After Orthognathic Surgery.

The purpose of this study was to compare overall patient satisfaction after orthognathic surgery with the following specific categories: appearance, functional ability, general health, sociability, and patient-clinician communication. A 16-question survey was developed and administered to include patients at either 6 or 12 months after orthognathic surgery between June 2013 and June 2014 at the University of Pennsylvania and Massachusetts General Hospital. The predictor variables included age, sex, type of procedure, medical comorbidities, intra- or postoperative complications, and presence of paresthesia. The outcome variable was patient satisfaction overall and in each category based on a Likert scale (0: not satisfied at all to 5: very satisfied).A total of 37 patients completed the survey and had a high overall rate of satisfaction (100% of responses were 4 or 5 on Likert scale). Overall satisfaction had the highest correlation with appearance (ρ=0.52, P=0.0009) followed by sociability (ρ=0.47, P=0.004), patient-clinician communication (ρ=0.38, P=0.02) functionality (ρ=0.19, P=0.26), and general health (ρ = -0.11, P = 0.51). Patients had high satisfaction scores for orthognathic surgery. Satisfaction with postoperative appearance had the strongest correlation with overall satisfaction.