Incidental treatment of maxillary dysesthesia with maxillary sinus lift procedure--a case report.

A 54-year-old woman presented with an 8-month history of dysesthesia to the left palate with referred pain to the left infraorbital distribution after extraction of the left maxillary first and second premolars. The clinical and radiologic examination revealed an alveolar crestal bone dehiscence suggestive of an occult oral antral communication (OAC) that had spontaneously healed. Stimulation of the mucosa at this bony dehiscence consistently reproduced the dysesthesia. A sinus lift procedure was performed in this region for implant site development and also resulted in resolution of the dysesthesia. This case represents an instance in which surgical alteration of a trigger zone of neuropathic pain can result in its resolution.

Thyroid crisis in the maxillofacial trauma patient.

Thyroid crisis, also known as thyroid storm, is a rare complication of thyrotoxicosis that results in a hypermetabolic and hyperadrenergic state. This condition requires prompt recognition and treatment because the mortality from thyroid crisis approaches 30%. Thyrotoxicosis alone will usually not progress to thyroid crisis. Thyroid crisis will typically be precipitated by some concomitant event such as infection, iodine-containing contrast agents, medications such as amiodarone, pregnancy, or surgery. Trauma is a rare precipitator of thyroid crisis. Several published studies have reported thyroid crisis resulting from blunt or penetrating neck trauma. Significant systemic trauma, such as motor vehicle accidents, has also been reported to precipitate thyroid crisis. It is very unusual for minor trauma to precipitate thyroid crisis. In the present study, we report the case of a patient who had incurred relatively minor maxillofacial trauma and developed thyroid crisis 2 weeks after the initial trauma.

Pharmacological Management of Common Soft Tissue Lesions of the Oral Cavity.

Soft tissue lesions commonly seen in the oral cavity tend to overlap in their onset, presentation, and location making it difficult to appreciate their etiology. In some instances, common oral soft tissue lesions can create confusion due to similar clinical appearance or unusual presentation; therefore, proper diagnosis of the lesion is key in pharmacologic management. In ulcerative conditions, topical steroids can decrease the symptoms and improve healing time, but do not affect the recurrence rate. Always be suspicious of soft tissue lesions that are nonresolving or recurrent lesions as they may warrant further investigation to rule out malignancy or associated systemic conditions. This article discusses key clinical presentations and the proper topical and systemic pharmacologic treatments.

Update on Medications for Oral Sedation in the Oral and Maxillofacial Surgery Office.

Dental anxiety is a leading cause of postponing treatment and/or complete avoidance of professional oral care. Therefore, effective sedation and pain control are integral components of dental care for the fearful and anxious patient. The application of oral sedation aids the trained practitioner to provide care to the anxious dental patient and remains the safest, most established, and most commonly used route of drug administration. Proper training and understanding of pharmacologic properties allows for safe and effective application of analgesics and sedatives for oral sedation.

Mouth Gags: Advantages and Disadvantages.

Mouth gags have been in use since 1220 as a solution to the cumbersome limitations encountered when visibility and access to the oral cavity, pharynx, and larynx are needed. The instruments being used today range from the simple but effective design of the bite block to the sophisticated and intricate design of the Feyh-Kastenbauer. This article highlights the most frequently used well-designed mouth gags and the applications for which they provide the most benefit. Disadvantages and risks of their use are explored, especially those that clinicians should be aware of for patient and operator safety.

Implant Surgery Update for the General Practitioner: Dealing with Common Postimplant Surgery Complications.

It is essential for practitioners who place dental implants to be able to diagnose and treat common complications or know when to refer to a specialist. Common complications can include nerve injuries, infections, sinus membrane perforations, and edema. This article discusses these complications, incidence rates, tips to avoid common complications, and management options when a patient returns with a complication.

How to Avoid Life-Threatening Complications Associated with Implant Surgery.

Life-threatening complications of dental implant surgery are rare, but include hematoma/hemorrhage of the floor of the mouth, aspiration, and ingestion. Prevention of lethal hemorrhagic complications stem from knowledge of anatomic structures and precise surgical planning. Prevention of aspiration and ingestion can be improved by simple techniques while understanding clinical settings and factors that put patients at higher risk. In the event of these potential lethal situations, early recognition of signs and symptoms along with immediate action followed by transfer to an emergency department is often necessary.

Soft Tissue Injury in Preparation for Implants.

Diagnosis and treatment planning are critical in preparation for implant placement. Adequate evaluation, preoperative imaging, and surgical planning minimize early and late-stage soft tissue injuries. Correct placement of dental implants can be challenging with several contributing factors such as lack of proper preoperative soft tissue evaluation and surgical experience in dealing with soft tissue incisions and flap reflection, resulting in injury and complications involving the soft tissues.

Atypical Facial Pain.

Atypical facial pain (AFP), or persistent idiopathic facial pain, is a chronic and diffuse distribution of facial pain along the territory of the trigeminal nerve. This condition occurs in the absence of any neurologic deficit or any other obvious etiology. AFP is one of the most challenging conditions to diagnose due to lack of clear diagnostic criteria. Diagnosis of this condition is made by exclusion of other known etiologies. Specific disease modalities cannot be targeted, resulting in a deficiency of clear treatment protocol. Despite the limitations of evidence-based literature, tricyclic antidepressants have proved effective and are considered the treatment choice for AFP.

Botox and Dermal Fillers: Review and Its Role in the Dental Office.

For the general dentist, the use of BTA and dermal fillers confers the ability to exert control over the soft tissues surrounding the mouth to better create a harmonious smile. The injection of BTA and fillers into the facial musculature and dermis requires a level of finesse to achieve the desired outcomes. A sound understanding of the mechanisms of action and the ability to manage potential complications are also necessary, because the dentist administering BTA and dermal fillers must be competent to the same level as other providers who have traditionally been the gatekeepers of such agents.

Treatment of the Dental Patient with Bleeding Dyscrasias: Etiologies and Management Options for Surgical Success in Practice.

The oral health care provider sees a significant number of patients in his or her practice who suffer from systemic diseases affecting the ability to clot. These medical issues can be acquired or inherited bleeding dyscrasias requiring pharmacologic therapy during the perioperative period. Patients with inherited or acquired bleeding disorders require careful attention with respect to the assessment of bleeding risk. This article develops algorithms to manage acquired and inherited bleeding dyscrasias. These approaches include a discussion of the epidemiology of bleeding disorders in surgical patients, mechanism of hemostasis, and strategies for patient management based on the etiology of bleeding disorder.

Management and marketing for the general practice dental office.

This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

Oral Viral Infections: Diagnosis and Management.

This article focuses on common viral infections in the oral cavity with associated systemic manifestations. Discussed are the clinical features, histopathology, diagnosis, treatment, and prevention of viral infections in oral cavity. This will be a useful aid for general practitioners and other dental personnel wanting to expand their pathologic knowledge. This article discusses herpes simplex, varicella zoster, mononucleosis, cytomegalovirus, enteroviruses, rubeola, rubella, mumps, and human papillomavirus. After reviewing this topic, the dentist or hygienist will minimally be competent to diagnose the appropriate oral cavity viral infectious diseases and help patients get the appropriate care they need.

Perioperative management of the patient with liver disease and management of the chronic alcoholic.

Each year millions of Americans undergo surgical procedures requiring local, general, or spinal epidural anesthesia. A disproportionate number of the patients are older than age 65, and up to 10% of the patients have end-stage liver disease. Most patients do not suffer complications as a result of the surgical procedure or the anesthetic. However, about 3% to 10% of patients experience significant morbidity, often caused by infections or cardiac or pulmonary complications. Patients who have serious liver disease are generally believed to be at increased risk for perioperative morbidity and mortality. Appropriate preoperative evaluation is the cornerstone of successful intra- and postoperative management of the effects of anesthesia and surgery and is necessary for combating complications that may result from preexisting liver disease.

Botulinum Toxin Type A: Review and Its Role in the Dental Office.

For the general dentist, the use of botulinum toxin type A (BTA) confers the ability to exert control over the soft tissues surrounding the mouth to better create a harmonious smile. The injection of BTA into the facial musculature requires a level of finesse to achieve the desired outcomes. A sound understanding of the toxin's mechanism of action and the ability to manage potential complications are also necessary, as the dentist administering BTA must be competent to the same level as other providers who have traditionally been the gatekeepers of such agents.

Basic concepts and techniques of dental implants.

Dental implants provide completely edentulous and partial edentulous patients the function and esthetics they had with natural dentition. It is critical to understand and apply predictable surgical principles when treatment planning and surgically restoring edentulous spaces with implants. This article defines basic implant concepts that should be meticulously followed for predictable results when treating patients and restoring dental implants. Topics include biological and functional considerations, biomechanical considerations, preoperative assessments, medical history and risk assessments, oral examinations, radiographic examinations, contraindications, and general treatment planning options.

Use of recombinant factor VII for tooth extractions in a patient with severe congenital factor VII deficiency: a case report.

BACKGROUND AND OVERVIEW: Patients with factor VII deficiency have an increased risk of prolonged perioperative hemorrhage. In this article, the authors present a case of severe factor VII deficiency in a patient who required tooth extraction. CASE DESCRIPTION: A 44-year-old woman with severe congenital factor VII deficiency sought care for a symptomatic, carious, and nonrestorable maxillary right second molar that required extraction. The authors obtained hematologic consultation, and the patient underwent the extraction under general anesthesia in the inpatient setting. Perioperative management included performing relevant laboratory studies, preoperative recombinant factor VII infusion, and postoperative intravenous aminocaproic acid administration. No hemorrhagic complications occurred throughout the perioperative course. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The degree of factor VII deficiency correlates poorly with bleeding risk. Perioperative management is variable, requiring preoperative consultation with a hematologist.

Risk of airway embarrassment during root canal therapy.

BACKGROUND: Root canal therapy (RCT) is a commonly performed dental procedure that has a good success rate. Complications of RCT usually are minor, but severe complications can occur. CASE DESCRIPTION: A 59-year-old Hispanic man with no history of coagulopathy started to hemorrhage profusely from the mesiolingual canal of the right mandibular first molar (tooth no. 30) during RCT. The general dentist practitioner briefly controlled the hemorrhaging by packing a gutta-percha point into the mesiolingual canal. Shortly afterward, the patient developed an expanding hematoma in the submandibular space. The authors extracted tooth no. 30, raised buccal and lingual flaps, and evacuated the hematoma. PRACTICAL IMPLICATIONS: It is possible for clinicians to encounter significant hemorrhaging and airway compromising swelling when performing root canal therapy. Clinicians must recognize and understand how to manage such complications when they occur.