The role of third molar surgery in the exacerbation of eating disorders.

PURPOSE: Eating disorders are a major public health problem. This study was undertaken to investigate the role of dental surgery in the etiology and clinical course of these serious and occasionally life-threatening disorders. METHODS: Three questions concerning dental therapy were included in a pretreatment assessment of 97 consecutive patients entering an eating disorder therapy program during a 22-month period. These questions were designed to determine the influence of dental surgery, including frequency and severity, on eating disorders. RESULTS: All 97 patients, of which 96 were female, complied with the questionnaire. Seventy-five of 97 were 25 years or younger, and 53 of 97 were diagnosed as having anorexia nervosa. Sixteen patients (16.5%) reported having had orthodontic therapy, and 21 (21.6%) had undergone third molar surgery. Nine patients (9.3%) (1 orthodontic, 8 third molar surgery) indicated that dental procedures had caused exacerbation or relapse of their eating disorders; 8 of 21 (38%) who had undergone third molar surgery were positive respondents. None of the patients linked dental care to the initial onset of their eating disorders. CONCLUSIONS: These data reveal that dental procedures, specifically third molar surgery, can significantly alter the course of eating disorders, causing exacerbation or relapse. No patient indicated that dental therapy was the primary cause of these multifactorial psychonutritional disorders. A history of eating disorder should alert the practitioner to the risks of performing third molar surgery without a medical or psychotherapy consultation unless there is documentation of remission. Delay of surgical intervention is recommended if third molars are asymptomatic. If surgery is necessary, the surgeon and other members of the psychotherapy team should establish clear guidelines regarding behavior and postoperative nutrition and should monitor the patient's nutritional status.

Late mandibular fracture after third molar surgery: a survey of Connecticut oral and maxillofacial surgeons.

PURPOSE: This study investigated the incidence and causative factors involved in late mandibular fractures after third molar surgery. MATERIALS AND METHODS: A questionnaire was sent to 106 oral and maxillofacial surgeons in Connecticut, asking them about their experience with late fractures over a 10-year period. RESULTS: A 79% response indicated 28 fractures occurring in 611,000 extractions, for an incidence of 0.0046%. The cause was found to be multifactorial and included age, gender, type of impaction, preexisting infection, and failure to maintain a soft diet in the postoperative period. Most fractures occurred between the 1st and 21st days postoperatively. Three of the fractures resulted in malpractice litigation. CONCLUSION: Men over the age of 25 years should be specifically informed about the risk of late mandible fracture after third molar surgery. This group of patients should be educated about the quality and duration of a soft diet.

Chronic lymphocytic leukemia of B-cell origin: oral manifestations and dental treatment planning.

Chronic lymphocytic leukemia, or CLL, is the most common form of leukemia in the Western Hemisphere, accounting for approximately 30 percent of all cases. With patients having an expected life span of more than seven years, CLL is a relatively indolent hematologic malignant disease that, while incurable, often has a prognosis compatible with relatively normal dental treatment planning. The authors present four case reports of CLL in a dental setting, as well as an update on the diagnosis, prognosis and dental treatment of patients with CLL of B-lymphocyte origin.

Facial fractures occurring in a medium-sized metropolitan area: recent trends.

A retrospective 3-year survey of 311 patients sustaining 564 facial fractures in a medium-sized metropolitan area is presented. Etiology, distribution and treatment of these facial fractures are reported and compared with earlier studies, where changing patterns of etiology and treatment were noted. Contemporary knowledge of facial injuries is important if diagnosis and treatment are to be accurate and treatment optimal.

Correction of facial-skeletal deformities in two patients with facio-scapulo-humeral muscular dystrophy.

The genetic etiology, pathophysiology, natural progression, prognosis, and complications of Landouzy-Dejerine facio-scapulo-humeral benign muscular dystrophy are presented, as well as the risks of anesthesia and surgery. Patients with relatively benign myopathies may be candidates for reconstructive orthognathic surgery to improve oral function, facial esthetics, social interchange, and general quality of life. The surgery can be a gratifying experience for the patient, the family, and the surgeon, but the procedure, the anesthesia, and the postoperative care must be carefully planned to minimize the genuine risks.

Lymphangioma and cystic hygroma. Correction of facial growth disharmony and obstructive sleep apnea.

Soft tissue tumors and masses of the mouth and face can adversely affect the growth of facial bones. Cystic hygroma and lymphangioma, when massive, can create serious deformities of the maxilla and mandible. These deformities are correctible, surgically, and may be preventable if surgery and orthodontics are coordinated early in life. During and after surgery, airway management is paramount, but paradoxical effects such as obstructive sleep apnea may be observed.