Medical emergencies in a dental school clinic - A 12-year review and lessons learned.

PURPOSE: The aims of this study were to estimate the type and frequency of different medical emergencies that occurred over the study period (twelve years) and discuss the lessons learned and the modifications made in the curriculum to better equip dental students and faculty in their management. MATERIALS AND METHODS: A retrospective study was conducted to evaluate all medical emergencies that needed activation of the response team at our school from 2008 to 2020. RESULTS: The emergency response system was activated 250 times during the 12-year period. There were 132 medical emergencies in the pre-doctoral clinic and 105 events in the post-doctoral clinic (p 0.0680). Most of the emergencies occurred in patients between 45 and 64 years of age. Syncope occurs most often followed by adverse cardiovascular, respiratory, anxiety, and hypoglycemic events. CONCLUSIONS: Medical emergencies occurring in a dental school provide a unique opportunity for students to gain experience in their management. The key lies in preparing the students and faculty to prevent them from occurring, but should these occur, then they should be able to promptly recognize symptoms and institute prompt intervention.

Same day access: a viable alternative for outpatient clinical care.

OBJECTIVE: To present our experience with a novel, same-day access (SDA) scheduling model for outpatient clinical care in oral and maxillofacial surgery (OMS). STUDY DESIGN: The primary outcome variable was OMS patient scheduling in a hospital-based outpatient clinic. Patients were given a specific appointment time to be seen the same day they contacted the clinic. This SDA clinic was compared to previous patient scheduling models for patient satisfaction, appointment wait times, annual clinic volume, no-show rates, and access to care. RESULTS: Patient satisfaction increased to 80% with SDA scheduling compared with 20% to 40% with prior models. The average wait time for patients improved to 19 minutes compared with 330 minutes with the walk-in model. Forty patients were scheduled on the same day, and 96% of all patients who called the clinic were seen within 14 days with the SDA approach. Same-day access was the only model that met its volume and budgetary goals. CONCLUSIONS: The incorporation of SDA scheduling improves patient satisfaction and is a viable alternative to more traditional scheduling protocols for clinics suffering from volume, revenue, and access to care issues.

Assessment of Eustachian tube functioning following surgical intervention of Oral Submucus Fibrosis by using tympanometry & audiometry.

Oral Submucus fibrosis has been reported to cause variation in hearing sensitivity & changes in middle ear function. This study was conducted to validate the influence of OSMF and its surgical correction on middle ear function and hearing sensitivity. In this study, 20 patients (40 ears) suffering from biopsy proven OSMF (Group 2 & 3) were tested for Middle ear dysfunction and hearing sensitivity using Tympanometry & Audiometry. On Tympanometry, Type A curve was obtained in 29 ears, Type B curve in 11 ears preoperatively. Immediate postoperatively TYPE A curve was obtained in 27 ears, TYPE B curve in 13 ears. After 1 month and 3 month Type B curve was not obtained in any ear. On Audiometry,28 ears showed normal hearing and 12 ears showed minimal conductive hearing loss preoperatively and Immediate postoperatively. Tests after 1 month and 3 months showed all 40 ears having normal hearing. Results were found statistically significant with p value 0.000 and F value of 11.331 in Tympanometry and 11.143 in Audiometry. Pearson correlation test revealed that results from both the test are highly co related (0.902). OSMF causes fibrotic changes in paratubal muscles which in addition with restricted mouth opening hampers proper Eustachian tube functioning in turn causing changes in Middle ear function. This feature is seldom/infrequently found in Group 2 and 3 and if encountered can be dealt effectively with surgical intervention.

Intra-Lesional Medicaments for the Management of Intra-Osseous Lesions of Maxilla and Mandible - Systematic Review.

AIMS AND OBJECTIVES: This study aimed to review the success or remission of intralesional medicaments in the management of intraosseous lesions in the oral cavity. MATERIALS AND METHODS: A comprehensive search was performed in two databases (PubMed and Scopus). Research articles, case reports, case series, and clinical trials were included. Review articles, lesions not involving the bone, incomplete reporting, any other treatment other than intralesional medicaments to treat intraosseous bone lesions, publications without any treatment, and letter to editor were excluded. Data on remission (complete, partial, or no remission), details and regimen of the intervention, number of participants, and follow-up in months were recorded. RESULTS: A total of 653 publications were available for title and abstract screening after the removal of duplicates. Seven articles were excluded, which were not in English. After title and abstract screening, a total of 88 publications were available for full-text screening. Fifty-five articles were included in qualitative synthesis. A total of 168 patients from 55 publications were evaluated. Minimum follow-up was 1 month and maximum was 264 months. More than two-third (n = 38) of the publications were case reports on single patient. More than two-third (n = 38) of the publications had complete remission. CONCLUSION: Intralesional medications have shown variable success rates. Extensive lesions may undergo intralesional medications followed by surgical management.

Application of Piezosurgery in Surgical Extraction of Impacted Mandibular Third Molars Versus Conventional Rotatory Technique: A Randomized Controlled Trial

Objective: To compare the effectiveness of conventional rotatory and piezosurgery technique for surgical removal of lower third molars. Material and Methods: Twenty patients with impacted lower third molars (with no acute symptoms) were divided into two groups (G1 and G2) and evaluated clinically and radiographically. They were allotted alternately into rotatory (G1) and piezotome (G2). Parameters assessed were the pain, swelling, trismus, comfort, analgesics consumed, the time taken for the procedure, intraoperative soft tissue damage and any other complications. Findings were then tabulated and analyzed. Results: Findings of pain, swelling, trismus, analgesics consumed and tissue damage were favorable in the piezosurgery group. However, the time taken for the procedure was significantly more as compared to the rotatory group. Post-operative trismus, values from the piezosurgery group were found to approach normality by day seven while in the rotatory group, a significant difference was found to exist up to day 14, suggesting that patients tend to return to normal function faster in the piezo group. Conclusion: Piezosurgery was found to be a good alternative to the conventional rotatory handpiece in select cases where extraction of the tooth could be carried out with minimal bone removal.

Treatment of odontogenic infections: An analysis of two antibiotic regimens.

PURPOSE: Retrospective analysis of the efficacy for two commonly used antibiotic regimens in the management of severe odontogenic infections. PATIENTS AND METHODS: Evaluation of records of patients admitted to the Oral and Maxillofacial Surgery service at Boston University Medical Center from 2009 to 2014 with severe infections of odontogenic origin (SOI). Patients were divided into two groups based on the administered intravenous antibiotic: 1) Group I: Clindamycin only and 2) Group II: Penicillin and Metronidazole. Variables evaluated included demographic characteristics, ASA status, and anatomic site of infection risk, length of hospital stay, antibiotic failure, and pharmaceutical treatment cost. RESULTS: 78 patients (46 males and 32 females) were included in the study. There were 57 patients in group I (average age 32.6 years) and 21 in Group II (average age 32.8 years). The average white cell count at time of admission count was higher in Group I (19.3) versus Group II (17.4). Antibiotic failure rate was 3.5% in Group I and 4.7% for group 2 patients. CONCLUSION: Clindamycin alone and combination of Penicillin with Metronidazole are both effective pharmaceutical regimens for SOI. Clindamycin therapy resulted in shorter hospital stay and lower net treatment costs with a slightly higher success rate.

Concomitant Temporomandibular Joint Ankylosis and Maxillomandibular Fusion in a Child with Klippel- Feil Syndrome: A Case Report.

Klippel-Feil syndrome (KFS) is classically characterized by fusion of any of the two of seven cervical vertebrae. It is identified by the presence of a triad of clinical signs including short neck, limitation of head and neck movements and low posterior hairline. Unusual bony malformations leading to facial asymmetry is the most common oral manifestation associated with KFS. Such maxillomandibular fusion can also result in restricted mouth opening in children. It's a challenge to provide complete rehabilitation in such children. This paper presents a report of a type II KFS with both maxillomandibular fusion and temporomandibular joint ankylosis which led to the limited mouth opening in a six-year-old child. Also, the child showed an inadequate development of speech, facial asymmetry and compromised oral health owing to the restricted mouth opening. After thorough investigations, surgery was done which restored limited mouth opening which led to normalizing of speech and oral health.

Mandibular Fractures and Associated Factors at a Tertiary Care Hospital.

OBJECTIVES: The aim of this study was to evaluate the distribution, etiology and type of mandibular fractures in subjects referred to our institution. METHODS: A retrospective study of 689 subjects, during the period from May 2010 to September 2013 with mandibular fractures was conducted. Information on age, gender, mechanism of injury and sites of trauma was obtained from the trauma registry. Data were tabulated and analyzed statistically. RESULTS: A total of 653 subjects had mandibular fractures, out of which 574 were males. The mean age of the participants was 31.54 ± 13.07. The majority of the subjects were between 21-40 years of age, in both males (61.7%) and females (54.4%). The major cause of fractures was road traffic accidents (87.4%) followed by fall (6.9%) and assault (4%), with the least frequent being gunshot injuries (0.3%). Almost half of the patients had parasymphysis fractures (50.2%), followed by angle (24.3%), condyle (20.4%), ramus (2.3%) and coronoid (2%). A total of 115 patients had bilateral fractures out of which 29 had parasymphysis, 12 had body fractures and 74 had bilateral condylar fractures. Double mandibular fractures were reported in 193 subjects; out of which 151 subjects had double contralateral and 42 had double unilateral fractures. Triple unilateral fracture was reported in only one subject. A total of 338 subjects had multiple fractures among the study population. CONCLUSIONS: Mandibular fractures can be complicated and demanding, and have a compelling impact on patients' quality of life. Our study reported that parasymphysis was the most common region involved in mandible fractures.

Tuberculous osteomyelitis of the mandible.

Although tuberculosis can affect any part of the body involving both soft and hard structures with variable measures; such an occurrence in the cranio-facial bones is relatively rare. Once affecting a bone it is rare for a mycobacterial infection to get directed towards the skin and present as multiple draining sinuses. We report a case of tubercular osteomyelitis of the left body of the mandible in a 19 year old male patient who came to us with complains of persisting pus discharge from multiple sinuses on his face (lateral border of mandible and submandibular region) because of its rarity and clinical interest. One should always have a suspicion of mycobacterial infection in the back of mind when dealing with chronic maxillofacial infections not responding to the usual antibiotic course and local debridement.

Ludwig's Angina in Pregnancy Necessitating Pre Mature Delivery.

Ludwig's angina is a potentially life threatening disease that can arise from odontogenic infections if they are not attended well in advance. Its incidence in pregnancy is rare, but has been reported. Pregnancy is associated with complex physiological changes in the body which can make small dental infections assume grave proportions if not treated appropriately. This article presents a case of a 24 year old, 32 week pregnant lady who reported with swelling around the jaws and neck, difficulty in breathing and swallowing since 2 days. She had to be taken up for pre-term delivery to avoid damage to foetus. Subsequently she underwent multiple debridement of the cellulitis affecting the deep neck spaces and superior mediastinum. Surgical debridement and intravenous antibiotics along with adequate hydration improved the health of the patient before she was discharged.