Comparison of the Effects of Articaine and Lidocaine Anesthetics on Blood Pressure after Maxillary Infiltration Technique: A Triple-Blind Randomized Clinical Trial.

BACKGROUND: Many dental procedures begin with local anesthesia. Subsequent increase in blood pressure in healthy individuals commonly occurs and may be affected by several factors such as mental and physical stress, painful stimuli, and action of catecholamines present in local anesthetic solutions. The aim of the present study is to compare the effects of 4% articaine with 1 : 100000 epinephrine and 2% lidocaine with 1 : 80000 epinephrine on blood pressure after maxillary infiltration technique. MATERIALS AND METHODS: In this randomized clinical trial, 102 patients were randomly assigned into two groups. One group received 4% articaine with 1 : 100000 epinephrine and the other group received 2% lidocaine with 1 : 80000 epinephrine for local maxillary infiltration. Systolic and diastolic blood pressure of both groups was determined twice: once before anesthetic injection and once 10 minutes after injection. The data were statistically analyzed using descriptive statistics, Shapiro-Wilks test, Levene test, chi-square test, independent t-test, and paired t-test. RESULTS: The mean systolic blood pressure after anesthetic injection in the articaine and lidocaine groups was 125.00 ± 5.67 and 123.16 ± 6.417 mmHg, respectively, showing no statistically significant difference (p=0.127). The mean diastolic blood pressure after injection was 85.02 ± 7.331 in the articaine group and 81.35 ± 12.815 mmHg in the lidocaine group. These values show no statistically significant difference (p=0.080). In both groups, the mean systolic and diastolic blood pressures have increased significantly (p < 0.001). CONCLUSION: Articaine can be regarded as a suitable alternative for lidocaine for maxillary local infiltration, as no significant difference was observed between the effects of the two anesthetic solutions on blood pressure.

Rapid Palatal Expansion to Treat Nocturnal Enuretic Children: a Systematic Review and Meta-Analysis.

STATEMENT OF THE PROBLEM: Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported. PURPOSE: This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children. MATERIALS AND METHOD: A sensitive search of electronic databases of PubMed (since 1966), SCOPUS (containing EMBASE, since 1980), Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings (MeSH) keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included. RESULTS: Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 (28.12) months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval (CI) 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk (RR): 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep (RR: 5.1, CI 95%: 1.44-18.04) significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model. CONCLUSION: Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce (Level of evidence: C).

Can the Follicle-Crown Ratio of the Impacted Third Molars be a Reliable Indicator of Pathologic Problem?

STATEMENT OF THE PROBLEM: The presence of impacted third molars in the jaws is a common finding in the routine dental examination of patients. Concerning the odontogenic components of the dental follicle, it can be the origin of different types of odontogenic cysts and tumors. PURPOSE: The aim of this study was to find feasible radiographic criteria to help differentiate between normal and pathological dental follicles. MATERIALS AND METHOD: 134 asymptomatic impacted third molars were recruited in this study. Then, based on the radiographic measurements, the ratio between the diameter of the dental follicle and the mesiodistal width of the tooth crown was calculated. After surgical removal of impacted third molars, the related dental follicles were evaluated histopathologically. Statistical analyses were performed by adopting chi-square test, t-test, receiver oprating characteristic (ROC) curve, and logistic regression using SPSS-19 software. RESULTS: The mean ratio of the dental follicle's diameter to the mesiodistal width, in the normal and cystic follicle group was 1.18 ± 0.07 and 1.18 ± 0.08, respectively. There was no statistically significant difference between this ratio and the histopathological evaluation. Based on the logistic regression analysis, only the age >20 years and inflammation had predictive value in identifying cystic changes in dental follicle. CONCLUSION: According to the findings of the current study, the ratio of dental follicle diameter to the mesiodistal width of the teeth cannot not be employed as a diagnostic index to differentiate between normal and pathological dental follicle.

Availability of emergency drugs and equipment in general and specialist dental settings in Babol, Iran.

AIM: Medical emergencies can frequently happen in dental settings and it is critical to outfit the clinic by emergency drugs and equipment. The aim of this study was to evaluate the emergency drugs and equipment in general and specialist dental settings in Babol, Iran. MATERIALS AND METHODS: A questionnaire containing closed ended questions about the available emergency drugs and equipment was used in this descriptive-analytical study. Data were subjected to descriptive analysis using SPSS 18.0 to identify the most frequent drugs and equipment. Chi-square and t-test were used to evaluate the correlation between the variables. p < 0.05 was considered statistically significant. RESULTS: One hundred and twelve dentists answered the questionnaire. The most available drug and equipment were epinephrine (67%) and single use syringe (81.3%) respectively. Significant correlation was found between degree of education and availability of first group of emergency drugs and between sex and possession of second group of emergency equipment (p < 0.05). CONCLUSION: Degree of availability of emergency drugs and equipment was moderate to low and training about emergencies should be included in the didactic topics of universities and workshops. CLINICAL SIGNIFICANCE: Information about emergency drug and equipment would help to manage the unwanted emergency situations.

A Comparative Study of the Effect of Prednisolone and Celecoxib on MMO (Maximum Mouth Opening) and Pain Following Removal of Impacted Mandibular Third Molars.

OBJECTIVE: The purpose of this study was to compare the effects of prednisolone and celecoxib on pain and maximum mouth opening (MMO) after surgical removal of mandibular third molars. METHODS AND MATERIALS: This double-blind clinical study was conducted upon 60 subjects. These patients received 4 tablets of either 100 mg celecocxib or 5 mg prednisolone: one tablet before surgery and the rest for every 8 h post-operation. The subjects were asked to take acetaminophen codeine as rescue dose. Interincisal distance of upper and lower central teeth and pain measurements (according to Visual Analogue Scale) were taken before surgery, 24 h, 48 h and 7 days after surgery. RESULTS: Average pain intensity in 24 h after surgery in patients receiving celecoxib was 3.6 ± 2.5 with significant difference to the other group (p = 0.041), but in subsequent evaluations prednisolone group reported less pain intensity, but the differences were not significant. MMO in 48 h after surgery was lower in prednisolone group (p = 0.640) and in further evaluations the groups were almost similar. Analyzing the data revealed no significant difference between groups in MMO. CONCLUSION: According to this study there is no significant difference in the effects of prednisolone or celecoxib upon MMO, while celecoxib had better results for pain relief in 24 h after surgery in comparison to prednisolone.

Lack of elevated HER2/neu expression in epithelial dysplasia and oral squamous cell carcinoma in Iran.

PURPOSE: The role of the HER family in oral squamous cell carcinomas (OSCCs) is not well-defined. This study was aimed to assess the frequency of HER2/neu overexpression in oral carcinogenesis. MATERIALS AND METHODS: Expression of HER2/neu oncoprotein in OSCCs (N= 18), oral epithelial dysplasia (N= 18) and normal oral mucosa (N= 18) was assessed by immunohistochemistry using a cerbB2 antibody kit. RESULTS: HER2/neu was almost undetectable in normal oral mucosa and only 1/18 (0/05) of cases was positive. In oral epithelial dysplasia, 2/18 (11.1%) demonstrated staining, as did 3/18 OSCCs. Membrane staining was observed in all cases and there was no significant variation in frequency/intensity between normal oral mucosa / oral epithelial dysplasia and OSCCs (p>0.05). CONCLUSIONS: Aberrant expression of HER2/neu apparently does not contribute to carcinogenesis in the oral epithelium. The lack of overexpression in OSCCs indicates that molecular targeting is not feasible for adjuvant treatment.

Ameloblastomatous calcifying odontogenic cyst: a case report of a rare histologic variant.

Calcifying odontogenic cyst is an uncommon developmental odontogenic cyst first described by Gorlin in 1962. It is considered as an extremely rare cyst and accounts for only 1% of jaw cysts reported. Because of its diverse histopathology, there has always been confusion about its nature as a cyst, neoplasm, or hamartoma. In this report, we present a rare case of calcifying odontogenic cyst with ameloblastic proliferation--an extremely rare histologic variant in a 22-year-old male in the right mandibular molar region. The lesion was surgically removed. After enucleation no recurrence has been recorded in the ensuing 14 months.