[Prevention, diagnosis and management of osteoradionecrosis: Where do we stand?] / Prévention, diagnostic et prise en charge de l'ostéoradionécrose : où en est-on ?

Osteoradionecrosis (ORN) is a late secondary iatrogenic complication of external radiotherapy for cancers of the upper aero-digestive tract. Despite the systematization of intensity-modulated radiotherapy and its potential for preserving salivary secretion and limiting the dose delivered to the supporting bone, ORN remains a feared and frequent complication. The objective of this literature review was to provide an overview of the management of ORN and to determine the key points that would make it possible to improve patient care. The diagnosis of ORN requires to eliminate tumor recurrence then is based on clinical arguments and imaging by CT or Cone Beam evolving in a chronic mode (more than 3-6 months). The harmonization of its classifications aims to offer comprehensive and multidisciplinary care as early as possible. Primary prevention is based on pre-therapeutic oral and dental preparation, then associated with fluoroprophylaxis if salivary recovery is insufficient and requires supervision of invasive dental care and prosthetic rehabilitation. Semi-automatic contouring tools make it possible to identify doses delivered to dental sectors and guide dental care with personalized dosimetric mapping. Conservative medical treatment is offered at an early stage where innovative medical treatments, highlighted by early studies, could be of interest in the future. In the event of advanced ORN, a non-conservative treatment is then proposed and frequently consists of interruptive mandibulectomy associated with reconstruction by bony free flap, the conditions of implantation remaining to be defined with the support of prospective clinical trials.

Oral self-inflicted accidental trauma in patients with neurological disorders: a case report of dental management in infants with cerebellar hypoplasia.

Self-inflicted oral injuries, accidental or otherwise, can cause major consequences. Measures need to be taken to protect individuals from chronic self-injurious behaviour; however, there are no official guidelines on the subject. The purpose of this article is to show the case of a 1-year-old patient with neurological disorders who, following the eruption of deciduous teeth, had self-inflicted a traumatic ulcer on his tongue and lower lip. Following a multidisciplinary approach involving several operating units of our hospital to make a diagnosis, an oral device was designed to completely cover the dental elements to prevent recurrence of the trauma and to prevent further worsening of the injuries already caused. The purpose of this work is to demonstrate that although the surgical approach, such as extraction of the dental elements, may be the quickest solution in situations similar to the one presented, the high biological cost and irreversibility of the result lead to seeking alternatives and more conservative solutions such as the one described.

Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. STUDIES REVIEWED: The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT. RESULTS: The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001). PRACTICAL IMPLICATIONS: PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.

A recurrent KCNK4 variant in a dominant pedigree with hypertrichosis and gingival fibromatosis syndrome: Variable phenotypic expressivity and insights on patients' dental management.

Abnormal hyperpolarization of the KCNK4 gene, expressed in the nervous system, brain, and periodontal ligament fibroblasts, leads to impaired neurotransmitter sensitivity, cardiac arrhythmias, and endocrine dysfunction, as well as, progressive cell proliferation. De novo gain of function variants in the KCNK4 gene were reported to cause a recognizable syndrome characterized by facial dysmorphism, hypertrichosis, epilepsy, intellectual/developmental delay, and gingival overgrowth (FHEIG, OMIM# 618381). FHEIG is extremely rare with only three reported cases in the literature. Herein, we describe the first inherited KCNK4 variant (c.730G>C, p.Ala244Pro) in an Egyptian boy and his mother. Variable phenotypic expressivity was noted as the patient presented with the full-blown picture of the syndrome while the mother presented only with hypertrichosis and gingival overgrowth without any neurological manifestations. The c.730G>C (p.Ala244Pro) variant was described before in a single patient and when comparing the phenotype with our patient, a phenotype-genotype correlation seems likely. Atrial fibrillation and joint laxity are new associated findings noted in our patient extending the clinical phenotype of the syndrome. Dental management was offered to the affected boy and a dramatic improvement was noted as the patient regained his smile, restored the mastication function, and resumed his psychological stability.

Endodontic treatment of odontogenic infection in a patient at risk of medication-related osteonecrosis of the jaw: a case report and review of treatment criteria.

Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon and severe condition in patients who are receiving treatment with antiresorptive and/or antiangiogenic drugs, which are frequently used to treat or prevent cancer metastases. The treatment of MRONJ is challenging because the choice of a specific dental treatment depends on several factors, including the systemic condition of the patient, type and dosage of medications, and clinical and radiographic characteristics of the dental lesions. This case report describes the conservative endodontic treatment of an odontogenic infection in a patient at risk of developing MRONJ owing to bisphosphonate treatment. Endodontic retreatment was performed to control the odontogenic infection and avoid tooth extraction. Certain factors favor the use of a conservative approach, such as a localized and small infection, the absence of systemic factors (such as metabolic disorders or medications) that can impair bone healing, and good oral hygiene.

Dental care and oral conditions are associated with the prevalence of sarcopenia in people with type 2 diabetes: a cross-sectional study.

BACKGROUND: Insulin resistance, which is closely associated with type 2 diabetes mellitus (T2DM), is a cause of sarcopenia and people with T2DM have a high risk of sarcopenia. Keeping good oral condition by dental care is important for people with T2DM. Keeping good oral condition by dental care is important for people with T2DM. This study has investigated the association between dental care or oral conditions and sarcopenia in people with T2DM. METHODS: Dental care and oral conditions were evaluated based on a self-reported questionnaire. Individuals with both low handgrip strength and low skeletal muscle mass index were diagnosed with sarcopenia. RESULTS: Among 266 people with T2DM, the proportions of sarcopenia, not having a family dentist, not having a toothbrushing behavior, poor chewing ability, and use of complete dentures were 18.0%, 30.5%, 33.1%, 25.2%, and 14.3%, respectively. The proportions of sarcopenia in people not having a family dentist (27.2% vs. 14.1%, p = 0.017), those with poor chewing ability (26.9% vs. 15.1%, p = 0.047), and use of complete dentures (36.8% vs. 14.9%, p = 0.002) were higher than those in people without. The proportion of sarcopenia in people without toothbrushing behavior tended to be higher than that in people with toothbrushing behavior (25.0% vs. 14.6%, p = 0.057). Not having a family dentist (adjusted odds ratio [OR] 2.48 [95% confidence interval (CI): 1.21-5.09], p = 0.013), poor chewing ability (adjusted OR 2.12 [95% CI: 1.01-4.46], p = 0.048), and use of complete dentures (adjusted OR 2.38 [95% CI: 1.01-5.99], p = 0.046) were related to the prevalence of sarcopenia. CONCLUSIONS: This study revealed that dental care and oral conditions were associated with the prevalence of sarcopenia.

Tooth loss in periodontally treated patients: A registry- and observation-based analysis.

AIM: According to retrospective clinical studies, periodontal treatment retains teeth. However, evidence on the effectivity of periodontal treatment stemming from the general population is lacking. MATERIALS AND METHODS: We analysed data of periodontally treated patients from routine data of a major German national health insurance (BARMER-MV; sub-sample of the Federal State of Mecklenburg-Vorpommern) and from a clinical cohort (Greifswald Approach to Individualized Medicine, GANI_MED), as well as periodontally untreated and treated participants of the Study of Health in Pomerania (SHIP-TREND) with either ≥2 or ≥4 teeth with pocket depths ≥4 mm. Yearly tooth loss (YTL) estimates and incidence rates were evaluated. RESULTS: For moderately to severely affected groups, YTL and incidence rates were higher in BARMER-MV patients (0.35 and 0.18, respectively) than in untreated SHIP-TREND controls (0.19 and 0.08, respectively). In line, treated SHIP-TREND participants exhibited higher YTL rates than untreated SHIP-TREND controls (0.26 vs. 0.19). For severely affected groups, results with respect to tooth loss were inconclusive regarding the beneficial effects of periodontal treatment conducted either in the university (GANI_MED data) or in the general practice. CONCLUSION: Until 2021, periodontal treatment performed in German general dental practices within the national health insurance system was probably not efficient in retaining more teeth in the short- to mid-term. Since reimbursement schemes were changed in 2021 and now cover periodontal treatment to a much larger extent, the future will show whether these new reimbursement codes will improve the quality of periodontal treatment and whether they will lead to more long-term tooth retainment.

Dental Management in Juvenile Idiopathic Arthritis.

Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. It can involve the temporomandibular joint (TMJ) at onset; however, this is frequently overlooked until later stages when pain and dysfunction occur. The purpose of this paper is to discuss the case of a 14-year-old female with malocclusion and TMJ pain who presented for orthodontic treatment. The orthodontist referred her to the orofacial pain specialist to rule out TMJ dysfunction before starting care. After a comprehensive evaluation, the patient was diagnosed with JIA. Dentists can play a key role in the initial detection of systemic diseases causing TMJ pathology. This case report outlines the main orofacial signs and symptoms a dentist needs to be familiar with for the prompt identification of JIA, further reiterating the importance of an early diagnosis for a better prognosis and quality of life of a young patient with JIA.

Antibiotic Prophylaxis for Prosthetic Joint Patients Undergoing Invasive Dental Procedures: Time for a Rethink?

BACKGROUND: In the United States, it has been common practice to recommend that dentists provide antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent late periprosthetic joint infections (LPJIs) in patients who have prosthetic arthroplasties despite lack of evidence for a causal relationship between IDP and LPJI and a lack of evidence for AP efficacy. METHODS: A recent study quantified the IDP incidence over the 15-month period prior to LPJI hospital admissions in the United Kingdom for which dental records were available. A case-crossover analysis compared IDP incidence in the 3 months before LPJI admission with the preceding 12 months. The English population was used because guidelines do not recommend AP and any relationship between IDPs and LPJI should be fully exposed. RESULTS: No significant positive association was identified between IDPs and LPJI. Indeed, the incidence of IDPs was lower in the 3 months before LPJI hospital admission than that in the preceding 12 months. CONCLUSION: In the absence of a significant positive association between IDPs and LPJI, there is no rationale to administer AP before IDPs in patients with prosthetic joints, particularly given the cost and inconvenience of AP, the risk of adverse drug reactions, and the potential for unnecessary AP use that promotes antibiotic resistance. These results should reassure orthopedic surgeons and their patients that dental care of patients who have prosthetic joints should focus on maintaining good oral hygiene rather than on recommending AP for IDPs. Moreover, it should also reassure those in other countries where AP is not recommended that such guidance is sufficient.

Sudden Sensorineural Hearing Loss in 6 Patients Following Dental Procedure.

This study investigated the etiology and treatment outcome in sudden sensorineural hearing loss (SSHL) patients following dental procedure. During the past 2 decades, only 6 patients with SSHL following dental procedure were experienced including tooth extraction in 5 and endodontic treatment in 1. Three were males and 3 were females, with ages ranging from 10 to 75 years (median, 47 years). All patients underwent an inner ear test battery. Types of audiogram consisted of total deafness in 3 ears, flat-type loss in 2 ears, and high-tone loss in 1 ear. The pretreatment mean hearing level from 4 frequencies was 76 ± 37 dB for the lesion ears, significantly higher than 23 ± 15 dB for the opposite healthy ears. The treatment outcome is unsatisfactory. Five patients remained hearing unchanged 3 months after treatment. Only 1 (17%) patient had hearing improvement who was proved as having reactivation of the varicella-zoster virus. In conclusion, reactivation of the varicella-zoster virus may be one of the etiologies for SSHL patients following dental procedure. Serological assay coupled with MR imaging may help identify the etiology, determine the medication, and predict the outcome.

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.

Procedimientos dentales y broncoaspiración de instrumental quirúrgico / No disponible

No disponible

Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature. PURPOSE: A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO. METHODS: PubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model. RESULTS: The RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.

Subacute Cavernous Sinus Thrombosis following a Dental Procedure: Case Report and Review of the Literature.

OBJECTIVES: Cavernous Sinus Thrombosis is a rare but serious condition. Despite increasingly effective treatment, the mortality and risk of long-term sequelae remains significant. The objective of this study is to describe the case of a 62 year old female presenting to a cardiovascular clinic with symptoms indicating an atypical subacute cavernous sinus thrombosis secondary to a dental procedure, and review the literature regarding cavernous sinus thrombosis following dental procedures and dental infections. METHODS: The study design is a Case Report and Systematic Review. A PubMed literature search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, and limited to studies published between 2015 and 2020 (April). RESULTS: The case describes a 62 year old female with a 5 month history of left upper eyelid swelling, diplopia, chemosis, ptosis, and left sided cluster headache who was diagnosed with subacute cavernous sinus thrombosis treated with oral anticoagulation. The search strategy yielded a total of 15 titles, and of these, 9 were included in the qualitative synthesis. These demonstrated that cases of CST occur acutely, and clinical symptoms are variable, depending on the structures involved. Most cases are treated with IV antibiotics, and corticosteroids may be added. Anticoagulation therapy shows contradicting information regarding reduced mortality, but reduced morbidity is seen when used early and combined with antibiotics. CONCLUSION: Not all cases of CST present typically and acutely, so it is advisable to have a high clinical suspicion and obtain an MRV to rule out CST when stumbling upon ocular symptoms or infections in the danger triangle of the face following a dental procedure or infection. Despite the conflicting views on the benefits of anticoagulation in the setting of CST, the addition of oral anticoagulation yielded a positive outcome in our patient.

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature.

BACKGROUND: Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections. CASE PRESENTATION: We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces. CONCLUSION: As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.

Avaliação in vitro da microdureza e porosidade de duas resinas compostas fotopolimerizáveis / Evaluación in vitro de la microdureza y porosidad de dos resinas compuestas fotopolimerizables / In vitro evaluation of the microhardness and porosity of two photopolymerizable composite resins

RESUMO Introdução: Os estudos científicos acerca das propriedades físicas e mecânicas apresentadas pelas resinas compostas são cada vez mais necessários diante da grande variedade de produtos disponíveis no mercado atual, resultante do aumento de sua demanda dentro da odontologia que preza por preparos minimamente invasivos com a devolução das características estéticas e funcionais do elemento dentário. Objetivo: Avaliar e comparar a microdureza e porosidade das resinas compostas fotopolimerizavéis Filtek Z350 XT 3M e Zirconfill Technew. Métodos: Foram confeccionados 10 corpos de prova por amostra (n= 10) submetidos a teste microdureza Vickers e porosidade por microtomografia computadorizada. Resultados: Com relação à presença de porosidades, dada em porcentagem, o grupo da Filtek apresentou os menores valores médios. Quando comparado estatisticamente, os grupos apresentaram diferença estatística (p= 0,019), com uma magnitude de efeito alta. Com relação aos valores de microdureza, o grupo da Filtek apresentou os maiores valores médios. Quando comparados estatisticamente, os grupos não apresentaram diferença estatística (p > 0,05). Conclusões: A porosidade foi significativamente diferente entre os grupos estudados, sendo o grupo Filtek Z350XT de menor percentual. No entanto, os grupos não apresentaram diferença estatística para microdureza, apesar do grupo Filtek Z350XT ter apresentado maior valor médio(AU)

RESUMEN Introducción: Los estudios científicos sobre las propiedades físicas y mecánicas presentadas por las resinas compuestas son cada vez más necesarios ante la gran variedad de productos disponibles en el mercado actual, resultante del aumento de su demanda dentro de la odontología que aprecia por preparaciones mínimamente invasivas con la devolución de las características estéticas y funcionales del elemento dental. Objetivo: Evaluar y comparar la microdureza y porosidad de las resinas compuestas fotopolimerizables Filtek Z350 XT 3M y Zirconfill Technew. Métodos: Se han confeccionado 10 cuerpos de prueba por muestra (n= 10) sometidos a prueba de microdureza Vickers y porosidad por microtomografía computarizada. Resultados: Con respecto a la presencia de porosidades, dada en porcentaje, el grupo de Filtek presentó los menores valores medios. Cuando se comparó estadísticamente, los grupos presentaron una diferencia estadística (p= 0,019), con una magnitud de efecto alto. Con respecto a los valores de microdureza, el grupo de Filtek presentó los mayores valores medios. Cuando se comparó estadísticamente, los grupos no presentaron una diferencia estadística (p> 0,05). Conclusiones: La porosidad fue significativamente diferente entre los grupos estudiados, siendo el grupo Filtek Z350XT de menor porcentaje. Sin embargo, los grupos no presentaron diferencia estadística para microdureza, a pesar de que el grupo Filtek Z350XT presentó un valor medio más alto(AU)

ABSTRACT Introduction: Scientific studies about the physical and mechanical properties of composite resins are increasingly needed in view of the wide variety of products available in the market today, resulting from the increase in their demand for dental care purposes, with a preference for minimally invasive preparations aimed at restoring the esthetic and functional characteristics of the treated element. Objective: Evaluate and compare the microhardness and porosity of the photopolymerizable composite resins Filtek Z350 XT and Zirconfill Technew. Methods: Ten test bodies were developed per sample (n= 10) and subjected to Vickers microhardness and porosity testing by computerized microtomography. Results: With respect to the presence of porosity, expressed in percentages, the Filtek group had the lowest mean values. When compared statistically, the two groups showed a statistical difference (p= 0.019) with a high effect magnitude. Regarding microhardness, the Filtek group had the highest mean values. Statistical comparison did not find any difference between the groups (p> 0.05). Conclusions: Porosity was significantly different in the groups studied, the Filtek Z350XT group exhibiting the lowest percentage. However, the groups did not show any statistical difference concerning microhardness, despite the fact that the Filtek Z350XT group had a higher mean value(AU)

Perceived vulnerability to Coronavirus infection: impact on dental practice.

SARS-CoV-2 is a new virus responsible for the outbreak of the respiratory disease COVID-19, which has spread to several countries around the world, causing considerable consternation and a fear of contagions in global healthcare settings. The objective of this study is to identify, among Madrid's adult population, the impact of COVID-19 on self-perceived vulnerability, infectiousness, aversion to germs, and other behaviors in the current situation regarding dental practice. This cross-sectional observational study involves 1,008 persons randomly surveyed on the streets of Madrid, Spain between March 1 and March 8, 2020. Their perceived vulnerability to disease was measured using the perceived vulnerability to disease scale. An additional questionnaire evaluated basic sociodemographic aspects, medical history, personal hygiene behavior, willingness to go to certain places and the perception of the risk of contagion when going to a dental practice. There are significant differences by sex on the germ aversion subscale (p < 0.05) and in the risk of waiting in the waiting room (p < 0.01), tooth extraction ((p < 0.05), endodontics (p < 0.05) and fillings ((p < 0.05). Women consider the risk to be higher than men do. The risk group (over 60 and with systemic disease) has significant differences on the subscales of infectivity (p < 0.01) and germ aversion (p < 0.01). Our study shows high levels of vulnerability regarding contracting COVID-19 and avoiding dental care as perceived by the population over 60 years old and with a systemic disease.

Exposures to Dental Products, Stomatological Preparations, and in Dental Care and Toothache reported to the PIC Erfurt (1997 to 2017).

We examined human exposures to dental products (EDP), stomatological preparations (ESP), and in the context of dental care (EDC) or toothache (ETA) registered by the Poisons Information Centre (PIC) Erfurt from 1997 to 2017. Dental products like dental technical and filling materials belong to medical devices. Stomatological preparations were classified according to the ATC code and symptom severity to the Poisoning Severity Score (PSS). In total, 156 cases of EDP (136 cases with different tooth filling materials), 1167 cases of ESP (55.6% fluoride containing products), 979 cases of EDC, and 331 cases of ETA were registered. Symptom severity in EDP and ESP were asymptomatic or mild. In ETA and EDC, however, 35 cases with moderate and 5 cases with severe symptoms were detected. 5 moderate and 3 severe cases were caused by prolonged paracetamol overdose. Severe bleeding occurred following tooth extraction in a 41 year-old phenprocoumon treated patient after self-medication with acetylsalicylic acid and metamizole. Gingival injection of lidocaine plus epinephrine in a 37 year-old healthy woman resulted in severe bradycardia and cardiac arrest. Acute toxicity of EDP and ESP appears to be low. Prolonged paracetamol overdose because of toothache, and some dental treatment can result in severe symptoms.

Dental management of patients with congestive heart failure before and after implantation of ventricular assist devices: linking the missing protocol.

Objectives: There are no studies that have reviewed the pre- and post-operative dental protocols for the management of congestive heart failure (CHF) patients before and after implantation of the left ventricular assist device (LVAD). The aim of the present study was to review the pre- and post-operative dental protocols reported in indexed literature related to the management of CHF patients before and after implantation of ventricular assist devices (VAD). Design: The addressed focused question was "Is there a protocol for the dental management of end-stage CHF patients before and after VAD implantation?" Indexed databases were searched using various keywords. Letters to the Editor, review articles, and commentaries/expert opinions were excluded. Results: Seven studies were included and processed for data extraction. The number of participants ranged between 1 and 32 individuals, with age ranging between 14 and 66 years. Dental extractions were performed in 5 studies, and in 2 studies scaling and root planing was done for the treatment of periodontal diseases. One study assessed odontogenic infective foci and other lesions of the oral soft and hard tissues as a preoperative protocol. Six of the 7 studies did not report a dental therapeutic protocol, which was followed for the pre and/or post-LVAD implantation. Conclusions: It is recommended that standardized protocols should be adopted that allow the delivery of safe and effective pre- and postoperative dental care to VAD patients. Such protocols may help influence the morbidity and mortality rates and simultaneously improve the overall quality of life in vulnerable patients.