Evaluation of hemodynamic changes and patient-reported outcome measures in surgical therapy with or without intravenous sedation: a prospective controlled clinical study.

OBJECTIVES: To determine whether intravenous (IV) sedation would contribute to the stabilization of patients' hemodynamics during periodontal and oral surgical procedures, and to evaluate the patient-reported outcome measures (PROMs). MATERIALS AND METHODS: Periodontal or oral surgery patients were recruited and distributed into two groups: (1) sedation group (SG): intravenous sedation plus local anesthesia; (2) control group (CG): local anesthesia only. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and oxygen saturation (SaO2), were monitored at 15-min intervals from sitting in the dental chair (baseline) until the end of the treatment. In addition, a subjective assessment of PROMs was obtained through a post-operative questionnaire. RESULTS: Forty-nine patients (25 in SG and 24 in CG) were included. The highest SBP and DBP were significantly higher in CG compared to the SG (141.1 ± 18.4 and 133.6 ± 15.1, respectively in SBP; and 85.5 ± 11.0 and 82.9 ± 10.1, respectively in DBP), but no mean significant differences were found between groups (P value of 0.85 and 0.72 for systolic and diastolic BP, respectively). HR and SaO2 did not show statistical intra- and inter-group differences. The overall patient satisfaction score was significantly higher in the SG group compared to CG. CONCLUSIONS: Intravenous moderate sedation seems to contribute to the stabilization of patient's hemodynamics, especially the systolic blood pressure, although small differences have been found. CLINICAL RELEVANCE: Intravenous sedation seems to contribute to stabilize the hemodynamic values, and enhances the patient satisfaction after periodontal and oral surgical treatment in the dental office.

Comparison of hemodynamic changes with general or local anesthesia during dental treatment in pediatric patients: A prospective clinical study.

BACKGROUND AND AIM: Severe hemodynamic fluctuations during dental treatment can trigger highly undesirable physical reactions. A study was made to determine whether the administration of propofol and sevoflurane contributes to the stabilization of hemodynamic parameters during dental treatment in pediatric patients versus the use of local anesthesia alone. MATERIALS AND METHODS: Forty pediatric patients needing dental treatment were assigned to either general anesthesia with local anesthesia (study group [SG]) or local anesthesia alone (control group [CG]). Two percent sevoflurane in oxygen (100% oxygen, 5 L/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 µg/mL) were used as general anesthesia agents in SG; and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate, blood pressure and oxygen saturation were measured before starting dental treatment (baseline) and every 10 min during dental treatment. RESULTS: Blood pressure (p < .001), heart rate (p = .021) and oxygen saturation (p = .007) decreased substantially after the administration of general anesthesia. The levels of these parameters subsequently remained low and then recovered at the end of the procedure. On the other hand, the oxygen saturation values remained closer to baseline in SG versus CG. In contrast, the hemodynamic parameters experienced lesser fluctuations in CG than in SG. CONCLUSIONS: General anesthesia affords more favorable cardiovascular parameters during the entire dental treatment in comparison to local anesthesia alone (blood pressure and heart rate decrease significantly and oxygen saturation proves more stable and with values closer to baseline), and allows dental treatment to be performed on healthy, lacking cooperative ability children who otherwise could not be treated with local anesthesia alone. No side effects were observed in either group.

Hemodynamic and ventilatory changes in pediatric patients with special needs: A comparative clinical study.

Background: Very limited data are available on the hemodynamic and ventilatory changes during sedation and general anesthesia using bispectral index (BIS) monitoring in intellectually disabled children. The purpose was to determine the hemodynamic and ventilatory changes after propofol and sevoflurane administration in children with special needs (CSN) versus healthy children (HC) during dental treatment. Material and Methods: Forty pediatric patients needing dental treatment were allocated into two groups: children without systemic disease (healthy children [HC]) and mentally disabled children (children with special needs [CSN]). Sevoflurane in oxygen (100% oxygen, 5 l/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 µg/ml) were used as sedative agents, and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate (HR), oxygen saturation (SaO2), respiratory rate (RR), exhaled carbon dioxide (CO2), blood pressure (BP) and bispectral monitoring (BIS) values were recorded during the entire dental treatment procedure. Results: A statistically significant decrease in systolic BP, diastolic BP and RR was observed, with no significant differences between the healthy and disabled groups. In contrast, the HR and BIS values were lower in the CSN group than in the healthy patients (p ≤ 0.05). Conclusions: Patients with special needs had lower HR and BIS values than healthy patients, while BP, SaO2 and exhaled CO2 showed similar results in both groups. Key words:Bispectral index, hemodynamic changes, ventilatory changes, pediatric patients, special needs.

Evaluation of endovenous sedation using BIS monitoring in dentistry. A systematic review

BACKGROUND: The aim of the present review was evaluate the utility and validity of the Bispectral Index (BIS) in dental treatment carried out under endovenous sedation, and compare its efficacy with clinical sedation scales. MATERIAL AND METHODS: Electronic and manual literature searches were conducted by two independent reviewers for articles published up to April 2017 in several databases, including Medline and Cochrane Library. RESULTS: Sixteen articles met the inclusion criteria. A correlation was identified between BIS and clinical sedation scales. A BIS range between 75 and 84 showed a high probability of corresponding to an Observer's Assessment of Alertness and Sedation Scale (OAA/S) value of 3; a scored 3 on the Ramsay scale corresponds around 85 on the BIS; while BIS values between 57 and 64 corresponded to a University of Michigan Sedation Scale value of 3. BIS monitoring provides continuous measurement of the patient's hypnotic state or state of consciousness, awareness, and recall. It proved impossible to perform an analysis of statistical data drawn from the studies reviewed due to the disparity of inclusion criteria among the works. CONCLUSIONS: BIS for sedation monitoring might make possible to evaluate sedation levels objectively in real time, reducing the dose of the sedative required, increasing safety, and minimizing secondary effects

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No one ever asked us. young people's evaluation of their residential child care facilities in three different programs / Nadie nos ha preguntado nunca. La evaluación de los jóvenes sobre sus hogares de acogimiento residencial en tres programas diferentes

Background: Residential child care is a very complex measure and has been the subject of heated debate in many countries. However, there is a paucity of studies that examine quality assessments of these services, much less that have asked the children and young people receiving those services about their own evaluations. Method: This study interviewed 209 young people between 11 and 20 years of age, in 21 residential facilities, about their degree of satisfaction with the care they receive. These residential facilities are differentiated into three types of programs that will be compared: preparation for adult life (PAL), therapeutic care for behavioral problems (TRC) and general programs for children and young people without any specific profile (GRC). The instrument used is an interview that includes both quantitative and qualitative assessments. Results: The results show a trend toward positive average scores on practically all aspects, highlighting the support from as well as the connection they feel with the educators who care for them. On the other hand, young people in TRC displayed lower scores on almost all aspects evaluated while those in PAL were the most positive. Conclusions: The main implications for the practice will be discussed from these youths' perspective

Antecedentes: el acogimiento residencial es una medida compleja y que ha sido objeto de intensos debates en muchos países. Sin embargo, no existen muchos estudios sobre la evaluación de la calidad de estos servicios y mucho menos que hayan tenido en cuenta la opinión de los niños y jóvenes que los reciben. Método: en este estudio se entrevista a 209 jóvenes entre 11 y 20 años, que se encuentran en 21 hogares de acogimiento residencial, acerca de su satisfacción con la atención que reciben. Estos hogares de acogida se diferencian en tres tipos de programas que se compararán: preparación para la vida adulta (PAL), acogimiento terapéutico para problemas de conducta (TRC) y programas generalistas sin perfil específico (GRC). El instrumento empleado es una entrevista que recoge valoraciones cuantitativas y cualitativas. Resultados: los resultados muestran una tendencia a valoraciones con promedios positivos en prácticamente todos los aspectos, destacando el apoyo y la vinculación con los educadores que los atienden. Por otra parte, los jóvenes en TRC muestran puntuaciones más bajas en casi todos los aspectos, mientras que los jóvenes en PAL presentan las más altas. Conclusiones: se discutirán las principales implicaciones para la práctica desde esta perspectiva de los jóvenes

No one ever asked us. Young people's evaluation of their residential child care facilities in three different programs.

BACKGROUND: Residential child care is a very complex measure and has been the subject of heated debate in many countries. However, there is a paucity of studies that examine quality assessments of these services, much less that have asked the children and young people receiving those services about their own evaluations. METHOD: This study interviewed 209 young people between 11 and 20 years of age, in 21 residential facilities, about their degree of satisfaction with the care they receive. These residential facilities are differentiated into three types of programs that will be compared: preparation for adult life (PAL), therapeutic care for behavioral problems (TRC) and general programs for children and young people without any specific profile (GRC). The instrument used is an interview that includes both quantitative and qualitative assessments. RESULTS: The results show a trend toward positive average scores on practically all aspects, highlighting the support from as well as the connection they feel with the educators who care for them. On the other hand, young people in TRC displayed lower scores on almost all aspects evaluated while those in PAL were the most positive. CONCLUSIONS: The main implications for the practice will be discussed from these youths’ perspective.

Dental implications in oral cancer patients

Objectives. A study is made of the dental implications of oral cancer, with a view to avoiding the complicationsthat appear once oncological treatment is started.Patients and Methods. The study comprised a total of 22 patients diagnosed with oral cancer according to clinicaland histological criteria in the Service of Maxillofacial Surgery (Dental Clinic of the University of Barcelona,Spain) during the period 1996-2005, and posteriorly treated in different hospital centers in Barcelona.Results. Of the 22 patients diagnosed with oral cancer in our Service, the present study finally analyzed the 12subjects who reported for the dental controls. As regards the remaining 10 patients, 5 had died and 5 could notbe located; these subjects were thus excluded from the analysis. All of the smokers had abandoned the habit. Themost common tumor location was the lateral margin of the tongue. None of the patients visited the dentist regularlybefore the diagnosis of oral cancer. T1N0M0 was the most common tumor stage. Surgery was carried outin 50% of the cases, while 8.4% of the patients received radiotherapy and 41.6% underwent surgery with postoperativeradiotherapy. In turn, 66.6% of the patients reported treatment sequelae such as dysgeusia, xerostomia orspeech difficulties, and one patient suffered osteoradionecrosis. Forty-one percent of the patients did not undergoregular dental controls after cancer treatment. As regards oral and dental health, 16.6% presented caries, and 50%had active periodontal disease.Conclusions. Protocols are available for preventing the complications of oral cancer treatment, and thus for improvingpatient quality of life. However, important shortcomings in the application of such protocols on the part ofthe public health authorities make it difficult to reach these objectives (AU)

Dental implications in oral cancer patients.

OBJECTIVES: A study is made of the dental implications of oral cancer, with a view to avoiding the complications that appear once oncological treatment is started. PATIENTS AND METHODS: The study comprised a total of 22 patients diagnosed with oral cancer according to clinical and histological criteria in the Service of Maxillofacial Surgery (Dental Clinic of the University of Barcelona, Spain) during the period 1996-2005, and posteriorly treated in different hospital centers in Barcelona. RESULTS: Of the 22 patients diagnosed with oral cancer in our Service, the present study finally analyzed the 12 subjects who reported for the dental controls. As regards the remaining 10 patients, 5 had died and 5 could not be located; these subjects were thus excluded from the analysis. All of the smokers had abandoned the habit. The most common tumor location was the lateral margin of the tongue. None of the patients visited the dentist regularly before the diagnosis of oral cancer. T1N0M0 was the most common tumor stage. Surgery was carried out in 50% of the cases, while 8.4% of the patients received radiotherapy and 41.6% underwent surgery with postoperative radiotherapy. In turn, 66.6% of the patients reported treatment sequelae such as dysgeusia, xerostomia or speech difficulties, and one patient suffered osteoradionecrosis. Forty-one percent of the patients did not undergo regular dental controls after cancer treatment. As regards oral and dental health, 16.6% presented caries, and 50% had active periodontal disease. CONCLUSIONS: Protocols are available for preventing the complications of oral cancer treatment, and thus for improving patient quality of life. However, important shortcomings in the application of such protocols on the part of the public health authorities make it difficult to reach these objectives.

Morbilidad de la extracción de los terceros molares en pacientes entre los 12 y 18 años de edad / Morbidity of third molar extraction in patients between 12 and 18 years of age

Objetivo: El propósito de este estudio fue analizar la incidenciade complicaciones después de la extracción quirúrgica de losterceros molares en pacientes de 12 a 18 años de edad.Pacientes y método: Se realizó un estudio retrospectivo de390 extracciones quirúgicas de terceros molares superiores einferiores en 173 pacientes en edades comprendidas entre los12 y 18 años de edad, intervenidos bajo anestesia locorregionalen el año 2000 en el Máster de Cirugía Bucal e ImplantologíaBucofacial de la Universidad de Barcelona.Los pacientes fueron divididos en tres grupos (A: 12-14 años,B:15-16 años, C: 17-18 años). Se registró la edad y el sexo delpaciente, el motivo de la extracción, el grado de desarrollo dentario,la posición, la angulación y la inclusión del tercer molar.Finalmente se valoró la asociación entre dichas variables y laaparición de complicaciones postoperatorias.Resultados: La mayoría de los pacientes intervenidos fuerondel sexo femenino (66,9%), y el grupo de edad en la que serealizó el mayor número de extracciones (62,8%) fue en elgrupo C (17-18 años). El principal motivo de extracción fuela indicación por parte del ortodoncista (40,5%), seguido porla indicación profiláctica (39,5%). La presencia de clínica fueel motivo de extracción en un 20% de los casos. Se observóuna incidencia del 15,6% de complicaciones postoperatoriastras la extracción de 390 terceros molares. En el grupo A elriesgo de complicaciones fue de 17,4%, en el grupo B de 19% y en el grupo C de 13,7%. Todas las complicaciones fueronreversibles y de corta duración como el dolor y la inflamaciónpersistente, la infección, el trismo y la equimosis. Se presentóun caso de parestesia del nervio dentario inferior y un caso deparestesia del nervio lingual que remitieron a los 2 meses y almes respectivamente.Conclusiones: este estudio demuestra que no hay diferenciassignificativas en las complicaciones observadas entre los tresgrupos de edad, y por lo general, éstas son leves y reversibles. Seobservó una mayor tendencia de complicaciones en las mujeresy el porcentaje de complicaciones aumenta cuanto menor es elespacio disponible para la erupción

Objective: An analysis is made of the incidence of complicationsfollowing third molar surgical extraction in patients between 12and 18 years of age.Patients and method: A retrospective study was conducted of390 surgical extractions of upper and lower third molars in 173patients operated upon under locoregional anesthesia during theyear 2000 in the Master in Oral Surgery and Implantology ofBarcelona University Dental School (Spain).The patients were divided into three age groups (A: 12-14 years,B: 15-16 years, C: 17-18 years). The reason for extraction, thedegree of dental development, and third molar position, angleand impaction were recorded. Finally, the association of thesevariables to the appearance of postoperative complications wasanalyzed.Results: Most patients were females (66,9%), and the age groupin which most extractions were carried out (62,8%) correspondedto Group C (17-18 years). The main reason for extraction wasorthodontist indication (40,5%), closely followed by prophylaxis(39,5%). The existence of clinical manifestations was an indicationfor extraction in 20% of cases. The postoperative complicationsrate after the extraction of the global 390 molars was15,6%. In Groups A, B and C the complication risks were 17,4%,19% and 13,7%, respectively. All complications were reversibleand of short duration. One case each of inferior alveolar nerveparesthesia and lingual nerve paresthesia was recorded, which subsided after one and two months, respectively.Conclusions: There were no significant differences in complicationsbetween the three age groups. An increased tendencytowards complications was observed in females, and the percentageof postoperative problems increased

Morbidity of third molar extraction in patients between 12 and 18 years of age.

OBJECTIVE: An analysis is made of the incidence of complications following third molar surgical extraction in patients between 12 and 18 years of age. PATIENTS AND METHOD: A retrospective study was conducted of 390 surgical extractions of upper and lower third molars in 173 patients operated upon under locoregional anesthesia during the year 2000 in the Master in Oral Surgery and Implantology of Barcelona University Dental School (Spain). The patients were divided into three age groups (A: 12-14 years, B: 15-16 years, C: 17-18 years). The reason for extraction, the degree of dental development, and third molar position, angle and impaction were recorded. Finally, the association of these variables to the appearance of postoperative complications was analyzed. RESULTS: Most patients were females (66.9%), and the age group in which most extractions were carried out (62.8%) corresponded to Group C (17-18 years). The main reason for extraction was orthodontist indication (40.5%), closely followed by prophylaxis (39.5%). The existence of clinical manifestations was an indication for extraction in 20% of cases. The postoperative complications rate after the extraction of the global 390 molars was 15.6%. In Groups A, B and C the complication risks were 17.4%, 19% and 13.7%, respectively. All complications were reversible and of short duration. One case each of inferior alveolar nerve paresthesia and lingual nerve paresthesia was recorded, which subsided after one and two months, respectively. CONCLUSIONS: There were no significant differences in complications between the three age groups. An increased tendency towards complications was observed in females, and the percentage of postoperative problems increased.

Day case oral surgery in pediatric patients during the year 2000 in the University of Barcelona Dental Clinic (Spain).

AIM: A study is made to show that most pediatric oral surgical interventions can be performed on a day case surgery or ambulatory basis, and to describe the activity of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Spain) in the year 2000. DESIGN: The study documents the surgical activity of the Units of Oral Surgery and Laser Surgery in pediatric patients, in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Spain). RESULTS: Of the 3187 operations carried out in our Service in this period, 489 involved patients under 18 years of age. The surgical removal of third molars was the most common intervention (55.6%), followed by other surgical or non-surgical tooth extractions (33.6%) and other interventions (10.6%) comprising fenestration of impacted canines or other teeth, frenectomies, the removal of mucoceles, and tooth relocations. Complications after surgical third molar extraction were recorded in 15.93% of cases, the most frequent problem being the pain and swelling (4.35% each) characteristic of postoperative inflammation. CONCLUSIONS: Our experience shows that day case oral surgery can be safely performed in pediatric patients, provided the required means and health care personnel resources are available.

Cirugía Bucal Ambulatoria en pacientes pediátricos. Casuística del año 2000 en la Clínica Odontológica de la Universidad de Barcelona / Day case oral surgery in pediatric patients during the year 2000 in the University of Barcelona

Objetivos: Este trabajo pretende demostrar que se pueden realizarla mayoría de las intervenciones quirúrgicas de la cavidadbucal en la población pediátrica en un medio ambulatorio, asícomo valorar y mostrar la actividad realizada en el Máster deCirugía e Implantología Bucal de la Facultad de Odontologíade la Universidad de Barcelona durante el año 2000.Diseño del estudio: Para la realización de este trabajo se ha contabilizadola actividad quirúrgica de las unidades de cirugía bucal ycirugía con láser en la población pediátrica en el Máster de Cirugíae Implantología Bucal de la Universidad de Barcelona.Resultados: De las 3187 intervenciones quirúrgicas realizadas ennuestro servicio, 489 fueron en pacientes menores de 18 años.La exodoncia quirúrgica de terceros molares inferiores fue lamás frecuente (55´6%), seguida de otras extracciones dentarias(33´6%), quirúrgicas o no, y del resto de intervenciones (10´6%)que incluyeron: fenestraciones de caninos u otros dientes incluidos,exéresis de frenillos, de mucoceles y reubicacionesdentarias. Se presentaron complicaciones tras la extracciónquirúrgica de los terceros molares en un 15Ê93% de los casos,siendo las más frecuentes el dolor (4´35%) y la tumefacción(4´35%), signos propios de la inflamación postoperatoria.Conclusiones: Nuestra experiencia muestra que la cirugía bucalambulatoria puede practicarse de forma segura en la poblaciónpediátrica siempre y cuando se disponga de los medios y delpersonal sanitario adecuados

Aim: A study is made to show that most pediatric oral surgicalinterventions can be performed on a day case surgery or ambulatorybasis, and to describe the activity of the Master of OralSurgery and Implantology (Barcelona University Dental School,Spain) in the year 2000.Design: The study documents the surgical activity of the Unitsof Oral Surgery and Laser Surgery in pediatric patients, in thecontext of the Master of Oral Surgery and Implantology (BarcelonaUniversity Dental School, Spain).Results: Of the 3187 operations carried out in our Service inthis period, 489 involved patients under 18 years of age. Thesurgical removal of third molars was the most common intervention(55.6%), followed by other surgical or non-surgical toothextractions (33.6%) and other interventions (10.6%) comprisingfenestration of impacted canines or other teeth, frenectomies,the removal of mucoceles, and tooth relocations. Complicationsafter surgical third molar extraction were recorded in 15.93% ofcases the most frequent problem being the pain and swelling(4.35% each) characteristic of postoperative inflammation.Conclusions: Our experience shows that day case oral surgerycan be safely performed in pediatric patients, provided the requiredmeans and health care personnel resources are available

Fibroma osificante maxilar: Presentación de un caso y revisión de la literatura / Ossifying fibroma of the upper jaw: Report of a case and review of the literature

Existe un conjunto de procesos que han sido denominados genéricamente lesiones fibroóseas benignas, entre las que se encuentran la displasia fibrosa, la osteomielitis esclerosante y el fibroma osificante o cementificante. Todos estos procesos tienen un estroma fibroblástico vascular y producen una matriz calcificada que comprende desde el hueso hasta el cemento. El fibroma osificante se caracteriza por presentar un crecimiento y una tumefacción deformante de evolución lenta que generalmente aparece en la mandíbula y puede producir desplazamiento dentario precoz. Desde el punto de vista radiológico aparece generalmente como un área radiotransparente unilocular bien definida y demarcada o como una radiotransparencia con opacidades centrales o como una radiolucidez multilocular. Excepcionalmente puede ser radioopaca. Presentamos el caso de un paciente varón de 22 años que acude a nuestro Servicio para valorar una tumoración de tres meses de evolución localizada en la zona anterior del maxilar superior, asintomática y que radiológicamente se presentaba como un área radiotransparente rodeada por un halo esclerótico mal delimitado. El diagnóstico definitivo tras la exéresis quirúrgica de la lesión fue el de fibroma osificante. Realizamos la discusión del caso presentado junto con una revisión de la literatura (AU)

A number of processes generically referred to as benign fibro-osseous lesions comprise different disorders such as fibrous dysplasia, sclerotizing osteomyelitis and ossifying or cementing fibroma. These processes are all characterized by the existence of a vascular fibroblastic stroma, with the production of a calcified matrix ranging from bone to cementum. Ossifying fibroma involves slow-evolving growth with deforming swelling generally arising in the mandible, with possible early dental displacement. From the radiological perspective the disorder generally manifests as a well defined and delimited, unilocular radiotransparency, as a radiotransparent image with central opacifications, or as multilocular transparencies. The lesions exceptionally can be radiopaque. We present the case of a 22-year-old male presenting for evaluation of a three-month, asymptomatic tumor mass in the anterior sector of the upper jaw. Radiologically, the lesion appeared as a radiotransparent zone surrounded by a poorly delimited sclerotic halo. The definitive diagnosis following surgical resection of the lesion was ossifying fibroma. The case is discussed, and a review is provided of the literature on the subject (AU)

Ossifying fibroma of the upper jaw: report of a case and review of the literature.

A number of processes generically referred to as benign fibroosseous lesions comprise different disorders such as fibrous dysplasia, sclerotizing osteomyelitis and ossifying or cementing fibroma. These processes are all characterized by the existence of a vascular fibroblastic stroma, with the production of a calcified matrix ranging from bone to cementum. Ossifying fibroma involves slow-evolving growth with deforming swelling generally arising in the mandible, with possible early dental displacement. From the radiological perspective the disorder generally manifests as a well defined and delimited, unilocular radiotransparency, as a radiotransparent image with central opacifications, or as multilocular transparencies. The lesions exceptionally can be radiopaque. We present the case of a 22-year-old male presenting for evaluation of a three-month, asymptomatic tumor mass in the anterior sector of the upper jaw. Radiologically, the lesion appeared as a radiotransparent zone surrounded by a poorly delimited sclerotic halo. The definitive diagnosis following surgical resection of the lesion was ossifying fibroma. The case is discussed, and a review is provided of the literature on the subject.