A Minimally Invasive Technique for the Management of Physiologic Gingival Melanin Hyperpigmentation: A Case Series.

An attractive smile enhances an individual's self-confidence. The overall harmony of a smile can be attributed to the interplay of the teeth's shape, color, and position along with the gingival tissue. Gingival pigmentation is observed across all human races, exhibiting variations from one race to another. Typically, gingival hyperpigmentation results from the abnormal buildup of melanin in the gingival tissue, imparting a dark appearance on the gums. Various procedures, collectively known as gingival depigmentation, are employed to address gingival hyperpigmentation. While the initial outcomes of depigmentation procedures are often promising, one common issue associated with them is the potential for re-pigmentation. This article aims to evaluate the clinical effectiveness and patient-reported outcomes of intraepidermal (oral mesotherapy) vitamin C injection for nonsurgical management of physiologic gingival melanin hyperpigmentation.

We Are All in This Together-Whole of Community Pain Science Education Campaigns to Promote Better Management of Persistent Pain.

Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public health setting seems a promising approach to explore.

A Minimally Invasive Approach to Managing Isolated Gingival Recession.

Gingival recession (GR), the apical shift of the gingival margin, results in root surface exposure. Its etiology is multifactorial, including teeth position within the dental arch, bony dehiscence, alveolar mucosa thickness, incorrect toothbrushing, orthodontic treatment, and periodontal disease. Coronally advanced flap (CAF) with a subepithelial connective tissue graft (SCTG) is the gold standard for managing GR. With the introduction of minimally invasive surgery, various techniques proposed for managing GR minimize patient morbidity and maximize surgical outcomes. The present case report is that of a 26-year-old male patient with the primary complaint of sensitivity in the upper right and left back teeth regions. Emdogain was used with SCTG for managing recession on the left side and with the xenogeneic collagen matrix (Mucograft) to cover recession on the right side. Post-operative healing was uneventful, with significant recession reduction and an increase in the width of the attached gingiva at both sites. GR, apart from posing as an esthetic complication, also results in tooth sensitivity. This makes the management of GR very important for which multiple treatment modalities are available. The current case report highlights the success of the minimally invasive tunneling technique in managing isolated GR.

The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care.

Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.

Pain priors, polyeidism, and predictive power: a preliminary investigation into individual differences in ordinary thought about pain.

According to standard philosophical and clinical understandings, pain is an essentially mental phenomenon (typically, a kind of conscious experience). In a challenge to this standard conception, a recent burst of empirical work in experimental philosophy, such as that by Justin Sytsma and Kevin Reuter, purports to show that people ordinarily conceive of pain as an essentially bodily phenomenon-specifically, a quality of bodily disturbance. In response to this bodily view, other recent experimental studies have provided evidence that the ordinary ('folk') concept of pain is more complex than previously assumed: rather than tracking only bodily or only mental aspects of pain, the ordinary concept of pain can actually track either of these aspects. The polyeidic (or 'many ideas') analysis of the folk concept of pain, as proposed by Emma Borg et al., captures this complexity. Whereas previous empirical support for the polyeidic view has focused on the context-sensitivity of the folk concept of pain, here we discuss individual differences in people's 'pain priors'-namely, their standing tendencies to think of pain in relatively mind-centric or body-centric ways. We describe a preliminary empirical study and present a small number of findings, which will be explored further in future work. The results we discuss are part of a larger programme of work which seeks to integrate philosophical pain research into clinical practice. For example, we hypothesise that variations in how patients with chronic pain are thinking about pain could help predict their responses to treatment.

LASER Assisted Excision of Solitary Neurofibroma in the Gingiva.

Neurofibromatosis (NF) is a genetic disorder that presents as benign tumours of the nervous system originating from the nerve sheath. It is of three types: Type I, Type II and Schwannomatosis. Type I Neurofibromatosis or von Recklinghausen's disease is the most common type of neurofibromatosis seen and it accounts for 90% of all cases seen. It can be seen as light brown pigmentation spots (Café-au-lait) on the skin and multiple small tumours among the nerves. Oral manifestations of NF are very rare and can be seen as sessile lesion in the tongue or the gingiva. The major complaints of the oral manifestations include difficulty in speech and mastication which it results in progression of periodontal disease. Here, we present a case report of Type I NF which presented as a sessile lesion in the right maxillary gingiva, for which we performed an excisional biopsy using LASER.

Laser-assisted Excision of Gingival Overgrowth in an Endodontic Perforation: A Case Report.

With the increase in preventive and restorative dentistry, there is also an increase in the iatrogenic conditions that occur in modern dental practice. The goal of modern dentistry is to provide patients with a holistic solution by providing functional restoration. This case report will highlight one such case where a tooth was diagnosed as having a gingival overgrowth through a perforation during prior endodontic treatment. Proper diagnosis and treatment planning helped restore a tooth that would have been lost.

Chronic postsurgical pain: prevention and management.

Chronic postsurgical pain (CPSP) is a common problem, with up to a third of patients reporting persistent or intermittent pain 1 year after common operations. A proposed definition is pain that develops after a surgical procedure, which lasts at least 2 months, and where other causes and preexisting pain have been excluded. A variety of preoperative, intraoperative, and postoperative factors are thought to contribute to the pathogenesis of CPSP. Preventive strategies include effective postsurgical acute pain management, preoperative administration of gabapentin or pregabalin continued postoperatively, and considering the necessity of the surgical procedure itself and exploring alternatives.

The efficacy of flapless implant surgery on soft-tissue profile comparing immediate loading implants to delayed loading implants: A comparative clinical study.

AIMS AND OBJECTIVES: To assess the efficacy of flapless implant surgery on soft-tissue profile and to compare the clinical outcomes of flapless implant therapy on immediate loading (IL) implants to delayed loading (DL) implants. MATERIALS AND METHODS: The study sample consisted of 20 patients who were partially edentulous in the anterior maxillary region. They were divided into two groups. In group I (IL) 10 implants were placed and immediately provisionalized and restored with a metal ceramic crown on the 14th day. In group II (DL) 10 implants were placed and loaded after 4 months. Single-piece implants were used for the IL group and two-piece implants were used for the DL group. All soft tissue parameters i.e., modified plaque index (mPI), modified bleeding index (mBI), papillary index (PPI), marginal level of soft tissue (ML) and width of keratinized mucosa (WKM) were recorded at baseline, Day 60, Day 120 and Day 180. RESULTS: The success rate in group I was found to be 80%, which was lower than the success rate in group II which was found to be 90%. On comparison, there is no statistically significant difference in success rate between the two study groups. There was no statistically significant difference between the groups over time in parameters like mPI, mBI, ML and WKM. The mean PPI score in group II showed a significant increase from when compared to group I. CONCLUSION: The results of this study indicated that flapless implant surgery using either immediately loading implants or DL implants, demonstrate enhancement of implant esthetics.

Perioperative use of nonsteroidal anti-inflammatory drugs: results of a UK regional audit.

BACKGROUND AND OBJECTIVE: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is well established as a part of multimodal perioperative analgesia treatment, especially in day-case surgery where opioid sparing is important. The aim of this study was to assess the current perioperative use of NSAIDs, the specific drugs used, and the route by which they were administered. METHODS: A pilot study was undertaken, followed by a second, larger study. Numbered questionnaires were sent to all members of the anaesthetic departments of six target National Health Service Hospitals within the south of the UK. The questionnaires asked specific questions relating to the use of NSAIDs in their departments during the preoperative, perioperative and postoperative periods. Responses to the questionnaires were anonymous except for the identity of the hospital concerned. RESULTS: The pilot study indicated that perioperative NSAIDs continue to be used by anaesthetists and this was confirmed by the second audit. In total, 371 questionnaires were sent out, with 51% of recipients (189/371) responding. All of the respondents reported using NSAIDs (diclofenac, ibuprofen, ketorolac, ketoprofen and parecoxib), with many of the respondents using more than one NSAID. Diclofenac was the most commonly used NSAID overall. However, some of the NSAIDs - notably ketorolac (41% of respondents), diclofenac (61% of respondents) and ketoprofen (7% of respondents) were not used according to the manufacturer's recommendations. CONCLUSION: These data reveal that NSAIDs were still widely used as analgesics for many surgical procedures at the time of the audit. Intravenous (IV) NSAID administration is the preferred route because of its reliability and speed of onset. The results of this audit indicated significant use of IV NSAIDs (ketorolac, diclofenac and ketoprofen) not in accordance with manufacturers' recommendations, with some NSAIDs even being used in the absence of a product licence for use by the IV route. This may be due to a lack of a satisfactory licensed product. A new formulation of IV diclofenac may fulfil this currently unmet need.