Intraoral management of odontogenic infection associated with severe trismus under local anesthesia.

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.

DENTAL DISEASES AND OTHER ORAL PATHOLOGIES OF CAPTIVE JAGUARS (PANTHERA ONCA) FROM BELIZE, CENTRAL AMERICA.

Dental and oral diseases are prevalent in many mammalian species including wild felids. Determining the dental and oral health status of captive animal populations can help establish preventive and therapeutic strategies, leading to improved welfare and conservation efforts. The aim of this study was to assess the prevalence of periodontal disease, endodontic disease, tooth resorption, and other clinically relevant dental and maxillofacial abnormalities in a population of captive jaguars (Panthera onca) using clinical, radiographic, and histopathological findings. Fifteen jaguars, ranging from young adult to geriatric, kept at a private zoo in Belize, Central America, had a detailed oral examination under general anesthesia between January 2015 and March 2019. Periodontitis was present in 3.8% (16/423) of examined teeth and 53.8% (7/13) of jaguars that underwent periodontal probing. Endodontic disease secondary to dentoalveolar trauma was found in 21.0% (89/423) of teeth in 73.3% (11/15) of animals. Tooth resorption, which has not been previously documented in jaguars, affected 1.4% (6/423) of teeth in 13.3% (2/15) of jaguars. Other abnormalities included metallic foreign material (gunshot) identified radiographically in 33.3% (5/15) of jaguars and nontraumatizing malocclusion in 9.1% (1/11) of jaguars that had occlusion evaluated. Much of the oral pathology identified in captive jaguars is suspected to arise from capture and/or captivity-associated behaviors, as suggested by gunshot around the oral cavity, fractures of rostral teeth (canine and incisor teeth), and abrasions consistent with cage-biting on canine teeth. Anesthetized oral examination-including full-mouth intraoral radiographs, periodontal probing, and charting-is recommended for jaguars with clinical signs of oral pain, as well as for routine systemic evaluation.

Equine Oral Extraction Techniques.

This article serves as a template for equine veterinarians to become proficient in basic intraoral premolar and molar extraction techniques of Equidae. Indications, equipment, and methodology are described. Numerous photos and videos are included to achieve a more immersive learning experience than can be accomplished with the written word alone. Clinicians performing these techniques will continue to improve their skillsets to achieve positive outcomes as case specifics become more challenging.

Equine Standing Surgical Extraction Techniques.

Dental repulsion techniques reported in the past decades have a high incidence of complications. Although the practice of surgical extractions in horses is limited because of the training, instrumentation, and experience required to perform these techniques, veterinarians should be aware these procedures are available, general anesthesia is not required, and when performed by skilled veterinary dentists they have low complication rates. Surgical techniques are often used after failure of other extraction techniques to remove retained tooth root and fragments or to debride chronically contaminated orofacial lesions. However, surgical extractions should be considered during initial treatment planning of all complicated cases.

Minimizing Equine Tooth Extraction Complications.

Oral extraction has become the most popular extraction technique owing to its high rate of success with minimal major complication. Repulsion continues to produce unacceptably high iatrogenic complication rates. To avoid tooth repulsion, veterinary dentists have introduced procedures to facilitate difficult intraoral extractions and surgical extraction techniques. Minimizing complications is best achieved preoperatively. A comprehensive preoperative evaluation and treatment plan allows the dentist to predict intraoperative complication and prepare for procedures to produce the best outcome. With proper case selection and adherence to extraction principles, the primary veterinarian and the veterinary dentist can perform equine tooth extractions with minimal complications.

Adjunct Extraction Techniques in Equine Dentistry.

Adjunct extraction techniques are used when the shape or integrity of the tooth, the shape or size of the patient's oral cavity, the location of the tooth, or the location of the proximal teeth prevents or complicates standard oral extraction. Techniques described and discussed include partial coronectomy, tooth sectioning, minimally invasive buccotomy, transbuccal screw extraction, and commissurotomy.

Effect of non-steroidal anti-inflammatory drugs on glomerular filtration rate and urinary N-acetyl-ß-D-glucosaminidase activity in cats after dental surgery.

OBJECTIVE: To compare the effects of meloxicam or carprofen on glomerular filtration rate (GFR), and to evaluate the effect of meloxicam on urinary N-acetyl-ß-D-glucosaminidase (NAG) activity, of cats after dental surgery. STUDY DESIGN: Randomized, blinded, controlled trial. ANIMALS: A total of 24 mixed breed cats. METHODS: Cats were randomly assigned to one of three groups (n = 8 per group): meloxicam (0.2 mg kg-1); carprofen (4 mg kg-1); or saline (2 mL). Acepromazine (0.04 mg kg-1) and buprenorphine (0.02 mg kg-1) were administered intramuscularly as preanaesthetic medication. Test drugs were injected subcutaneously at the time of preanaesthetic medication. Anaesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. Mean arterial blood pressure (MAP), respiratory rate (fR), heart rate (HR) and haemoglobin oxygen saturation values (SpO2) were recorded. All cats underwent ultrasonic dental scaling with polishing. Teeth extraction involved mucosal flap creation, removal of alveolar bone and flap closure. Plasma iohexol clearance (ICL), a measure of GFR, was estimated before and 24 hours after anaesthesia induction in all cats. Urinary NAG index was estimated in saline and meloxicam groups at the same time points as GFR. Between-group and -time point differences in GFR and NAG index were compared using mixed model analyses. Data are presented as mean ± standard deviation (p < 0.05). RESULTS: There was no significant difference in plasma ICL rate (range: from 1.22 ± 0.05 to 1.27 ± 0.04 mL kg minute-1) between groups or between time points. Urinary NAG index (range: from 1.0 ± 0.19 to 1.36 ± 0.29 Units gram-1) was not significantly different between meloxicam and saline groups. MAP, HR, fR and SpO2 did not differ significantly between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Meloxicam and carprofen appeared to produce nonsignificant effects on GFR, and meloxicam did not affect the urinary NAG activity, of cats after dental surgery.

Dental Topics for Plastic Surgeons, Part Two: Abnormal Tooth Development, Conditions, and Treatment.

Conditions that affect dental and periodontal structures receive sparse coverage in the plastic surgery literature, yet a working knowledge of this subject matter is important in certain areas of clinical practice and a fundamental understanding is part of plastic surgery competency tested on the in-service and written board examinations. This four-part series written to provide plastic surgeons with a working knowledge of dental topics that may be relevant to their clinical practice. This section, Part II, covers abnormal tooth development and related conditions.

Odontogenic chronic rhinosinusitis patients undergoing tooth extraction: oral surgeon and otolaryngologist viewpoints and appropriate management.

OBJECTIVE: This study aimed to propose appropriate management for odontogenic chronic rhinosinusitis. METHOD: Thirty-one adult patients with odontogenic chronic rhinosinusitis undergoing maxillary extraction were retrospectively analysed. Patients with (n = 21) and without (n = 10) oroantral fistula on computed tomography were classified. Functional endoscopic sinus surgery was performed when sinusitis did not improve after extraction. The critical indicators for surgical requirement in the management of odontogenic chronic rhinosinusitis were analysed. RESULTS: Sinusitis significantly improved after extraction in both groups. Patients without oroantral fistula had significantly more severe remnant sinusitis than those with oroantral fistula after extraction on computed tomography (p = 0.0037). The requirement for functional endoscopic sinus surgery was statistically significant for patients without orofacial fistula over those with orofacial fistula (p < 0.0001). The surgical improvement ratio was 93 per cent. CONCLUSION: The absence of oroantral fistula and severe sinusitis can be critical indicators for the requirement of functional endoscopic sinus surgery after extraction in the management of odontogenic chronic rhinosinusitis.

Deep neck infection of dental origin. A case report / Infección cervical profunda de origen dental. Descripción de un caso

INTRODUCCIÓN Y OBJETIVO: Al menos el 36% de las infecciones cervicales profundas pueden tener un origen dental. Descripción del caso: Mujer de 44 años que consultó por disfonía de una semana de evolución. La rinofibrolaringoscopia reveló edema aritenoideo izquierdo y parálisis de la hemilaringe izquierda y cuello normal. Se realizó una tomografía axial computarizada, encontrando absceso parafaríngeo izquierdo. Se realizó tratamiento antibiótico sistémico y quirúrgico con cervicotomía y drenaje del absceso en cuyo cultivo se aisló Prevotella buccae. Comentarios: El resultado del cultivo ayudó a establecer el origen dental de la infección. En la historia dental, se encontró una historia de pericoronitis asociada con 3.8. CONCLUSIONES: el diagnóstico del origen dental de una infección cervical profunda se establece mediante la historia dental, el examen oral, la radiología oral y el cultivo microbiológico

INTRODUCTION AND OBJECTIVE: At least 36% of deep cervical infections may have a dental origin. CASE DESCRIPTION: A 44-year-old woman who consulted for dysphonia of a week of evolution. Rhinofibrolaryngoscopy revealed left arytenoid edema and paralysis of the left hemilarynx and normal neck. A computerized axial tomography was performed, finding left parapharyngeal abscess. Systemic and surgical antibiotic treatment was performed with cervicotomy and drainage of the abscess in whose culture Prevotella buccae was isolated. COMMENTS: The result of the culture helped establish the dental origin of the infection. In the dental history, a history of pericoronitis associated with 3.8 was found. CONCLUSIONS: The diagnosis of the dental origin of a deep cervical infection is established by dental history, oral examination, oral radiology and microbiological culture

The use of enamel matrix derivative for the treatment of the apically involved tooth: A case report.

INTRODUCTION: The aim of this report is to present a case of an apically involved tooth with successful regeneration by only applying enamel matrix derivative. The root of the tooth was planed and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler, and the root surface of the tooth and the defect area were loaded with enamel matrix derivative. PATIENT CONCERNS: A 32-year-old man visited the clinic due to a referral for the evaluation of his mandibular left first molar. DIAGNOSIS: The clinical and radiographic assessment displayed the loss of the periodontium around the tested tooth with apical involvement of the mesial root. Bleeding upon probing was noted at the mandibular first molar, with the deepest periodontal probing depth of 15 mm. INTERVENTIONS: A nonsurgical approach was firstly performed on the tooth, and the deepest probing depth was reduced to 12 mm. After re-evaluation, elevation of a full-thickness flap was done, the root of the tooth was planed, and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area on the mandibular left first molar was grafted with enamel matrix derivative. OUTCOMES: The 7-month postoperative clinical and radiographic evaluation showed healthy gingiva and an increase in radiopacity. The final 1-year and 9-month postoperative evaluation showed that regeneration of bony defect was well maintained up to the final evaluation with reduction of probing depth. CONCLUSION: In conclusion, a case of apically involved tooth can be treated only with enamel matrix derivative after meticulous debridement with curettes and an ultrasonic scaler.

[Blood gas analysis in rabbits during a completely antagonizable anesthesia with special focus on oxygen management]. / Blutgasanalyse beim Kaninchen während einer vollständig antagonisierbaren Anästhesie unter besonderer Berücksichtigung des Sauerstoffmanagements.

OBJECTIVE: The aim of this study was to evaluate the consequences of different oxygen supplementation methods on arterial blood gas analysis during an injectable anesthesia. MATERIAL AND METHODS: A total of 29 rabbits with dental diseases (tooth elongation) were sampled before, during and after coronal reduction. Oxygen was provided either via the flow-by method or with a nasal oxygen tube; the control group breathed room air. RESULTS: All patients receiving oxygen developed respiratory acidosis that intensified during the course of anesthesia. Furthermore, these groups experienced reduced respiratory rates intraoperatively, nevertheless they showed elevated oxygen parameters (hyperoxemia) in the arterial blood gas analysis. No significant differences could be demonstrated between the 2 oxygen providing methods. In the control group, pH remained stable, the oxygen parameters however decreased to less than 80 mmHg (hypoxemia). CONCLUSIONS: Although there were no clinical consequences of hypoxemia or hyperoxemia, moderate oxygen support during an injectable anesthesia is recommended due to the development of hypoxemia. A balance between oxygen supply and oversupply needs to be established to aid in avoiding oxygen toxicity.

Radicular cyst associated with primary molar: Surgical intervention and space management.

Radicular cysts associated with primary teeth are rare. This case report describes radicular cyst associated with carious primary mandibular second molar in a 5-year-old patient and discusses its surgical intervention, space management, and follow-up for 3½ years.

Acutely infected teeth: to extract or not to extract?

Not only laymen but also dentists generally believe that extraction of acutely infected teeth should be avoided until the infection subdues by using systemic antibiotics. The aim of this study was to compare perioperative complications in routine extractions of acutely infected teeth with extractions of asymptomatic teeth. This prospective study was performed with 82 patients. Severe pain on percussion of the relevant tooth was considered as basic criteria for acute infection. The acutely infected teeth were labeled as the study group (n = 35) and the asymptomatic teeth as the control group (n = 47). The extractions were done using standard procedures. The amount of anesthetic solution used and duration of extractions were recorded. Postoperative severe pain and exposed bone with no granulation tissue in the extraction socket were indications of alveolar osteitis (AO). The level of statistical significance was accepted as 0.05. Symptoms that could indicate systemic response, including fever, fatigue, and shivering were not found. There was no statistically significant difference between groups in terms of AO, amount of anesthetic solution used, and duration of extraction. The presence of an acute infection characterized by severe percussion pain is not a contraindication for tooth extraction. Infected teeth should be extracted as soon as possible and the procedure should not be postponed by giving antibiotics.

Effects of Quartz Splint Woven fiber periodontal fixtures on evaluating masticatory efficiency and efficacy.

Masticatory efficiency is altered by mobile teeth resulting from periodontal disease. The goal of our study was to investigate changes before and after fixation of mobile teeth with a Quartz Splint Woven high-strength quartz fiber splint and evaluate the fixation effect.Forty-two patients with chronic severe periodontal disease and 2 to 3 degree tooth mobility underwent fixation with Quartz Splint Woven quartz fiber splints. Masticatory efficiency was determined before and 1 month after periodontal treatment, and 1 month after fixation. Changes in periodontal probing depth (PD) and periodontal attachment level (AL) were measured and clinical efficacy was evaluated.Masticatory efficiency significantly increased from 39.32% to 50.95% after treatment (P < .001). One month post-fixation, mastication efficiency increased to 67.99% (P < .001). At 3 months post-fixation, efficacy was 100% and at 6 months it was 95.24%; PD decreased from (4.91 ±â€Š0.63) to (4.19 ±â€Š0.60) mm at 1 month post-periodontal treatment, and significantly decreased to (3.73 ±â€Š0.60) mm 1 month post-fixation (P < .001); AL decreased from (4.43 ±â€Š0.58) to (3.96 ±â€Š0.51) mm 1 month after periodontal treatment. One month post-fixation, AL reduced to (3.64  ±â€Š0.46) mm (P < .001).Masticatory efficiency improved after periodontal treatment. Using Quartz Splint Woven quartz fiber periodontal splint for mobile tooth fixation can further improve mastication efficiency and periodontal condition. A stable and ideal fixation can be achieved within 6 months, which provides a clinical basis for treatment and preserving mobile teeth in severe periodontal disease. Mastication efficiency may be recommended as the index for evaluating curative effects of periodontal disease treatment.

Taking heed of the 'danger space': acute descending necrotising mediastinitis secondary to primary odontogenic infection.

Descending necrotising mediastinitis (DNM) is an uncommon clinical entity which may arise secondary to primary odontogenic or neck infection in susceptible patients. Infection may spread contiguously via the alar or 'danger' space, a potential anatomical space posterior to the true retropharyngeal space.1 Spread of infection to the mediastinum almost always necessitates urgent cardiothoracic surgical intervention.2-4 This case report describes a male patient whose clinical deterioration following the diagnosis of submandibular abscess was investigated with CT imaging of the chest, where a diagnosis of DNM was made. Diagnosis was confirmed following surgical intervention and aspiration of pus from the mediastinum.

Compliance of Randomized Clinical Trials in Noncarious Cervical Lesions With the CONSORT Statement: A Systematic Review of Methodology.

The literature was reviewed to evaluate the compliance of randomized clinical trials (RCTs) with the CONsolidated Standards of Reporting Trials (CONSORT ) and the risk of bias of these studies through the Cochrane Collaboration risk of bias tool (CCRT). RCTs were searched at Cochrane Library, PubMed, and other electronic databases to find studies about adhesive systems for cervical lesions. The compliance of the articles with CONSORT was evaluated using the following scale: 0 = no description, 1 = poor description, and 2 = adequate description. Descriptive analyses about the number of studies by journal, follow-up period, country, and quality assessments were performed with CCRT for assessing risk of bias in RCTs. One hundred thirty-eight RCTs were left for assessment. More than 30% of the studies received scores of 0 or 1. Flow chart, effect size, allocation concealment, and sample size were more critical items, with 80% receiving a score of 0. The overall CONSORT score for the included studies was 15.0 ± 4.8 points, which represents 46.9% of the maximum CONSORT score. A significant difference among countries was observed ( p<0.001), as well as range of year ( p<0.001). Only 4.3% of the studies were judged as at low risk; 36.2% were classified as having unclear risk and 59.4% as having high risk of bias. The adherence of RCTs evaluating adhesive systems to the CONSORT is low with unclear/high risk of bias.

Flared Roots Reinforced With Bulk-fill Flowable Composite - Case Report.

This article presents a case report for the treatment of a patient with a flared root. The patient was treated with a bulk-fill flowable composite. This innovative approach seems to be efficient in reinforcing flared roots. The advantages and disadvantages of the technique are presented.