Endodontic implications of a patient with arteriovenous malformation: a case report and literature review.

AIM: To present the endodontic management of a patient diagnosed with a high-flow arteriovenous malformation (AVM) requiring root canal treatment and to discuss the relevant endodontic literature for this rare but significant problem. SUMMARY: AVM is a complex communication of an artery and a vein in which the oxygenated blood is forced away from the intended tissue. The incidence of its occurrence in the face and neck is rare, and when present, the most common sign is gingival bleeding. Arteriovenous malformation is both a diagnostic and therapeutic challenge for dentists. Also, there is ambiguity regarding the precautions to be taken whilst doing endodontic procedures in such cases. Hence, there is a need to understand the disease process and its implications in order to prevent life-threatening complications during treatment. This case report highlights the successful endodontic management of a cariously exposed right maxillary second premolar in a patient diagnosed with high-flow AVM. On an orthopantomogram, the AVM was spreading in the left submandibular space involving the left ramus area. The clinical findings of limited mouth opening with inter-appointment swelling and trismus during treatment made the case unusual and challenging. This paper addresses the current understanding of the classification, diagnosis, clinical features and endodontic management, together with specific guidelines and recommendations whilst performing endodontic procedures in AVM cases. KEY LEARNING POINTS: The classification and oral manifestations of AVM must be known and understood. Practitioners should be aware of the radiographic appearance of AVM. Recommended precautions should be taken when carrying out restorative and endodontic procedures in a patient with AVM. Antibiotic prophylaxis may be considered before endodontic treatment in a patient with AVM. Multidisciplinary treatment planning may be required.

Evaluation of a 13-Month-Old Anemic Child With Gushing Gums.

While it is common practice for adults to brush their teeth twice a day and instill in their children the importance of setting hygiene routines centered around brushing their teeth, infants and toddlers are often overlooked. Infants begin teething around four to seven months of age; during this period of tooth eruption, their gums are highly susceptible to bacterial build-up, causing problems long before oral hygiene comes to mind. We describe a case of a 13-month-old child presenting with bleeding gums and worsening anemia. After blood tests, iron supplementation, and a referral to a pediatric hematologist-oncologist out of concern for a potential bleeding disorder, this patient was diagnosed with normochromic, normocytic anemia caused by bleeding due to infectious gingivitis. After the completion of antibiotic therapy and changes to the patient's routine to incorporate appropriate oral hygiene, the anemia resolved. Generally benign, gingivitis induced by plaque biofilm can advance to more severe forms of periodontal disease, leading to receding gums and abscesses, thus reinforcing the importance of promoting adequate oral hygiene in all ages regardless of dentition. Additionally, educating primary-care providers on pediatric gingivitis allows for the inclusion of this diagnosis on differentials, limiting extensive blood tests and specialist appointments.

Difficulty with Oral Health Complications in Adolescents with Developmental Disability and Obesity.

INTRODUCTION: Developmental disabilities (DDs), obesity, and dental caries are highly prevalent health conditions among adolescents. Evidence indicates that a significant proportion of adolescents with DDs are obese, and those with obesity and dental caries share common risk factors. OBJECTIVE: In this first-ever US-based cross-sectional national study, we assessed the likelihood of adolescents with DDs and obesity experiencing chronic difficulty with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition among adolescents with DDs and obesity compared to adolescents with no DDs or obesity. METHODS: For this secondary data analysis study, we used data of 68,942 adolescents aged 10 to 17 y from the 2016 through 2019 National Survey of Children's Health. Weighted descriptive and bivariate analyses were conducted. Four multiple logistic regression models predicting chronic difficulty in the past 12 mo with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition were conducted, controlling for other variables. RESULTS: The adjusted odds ratio (aOR) of experiencing chronic difficulty in the past 12 mo for adolescents with no DDs or obesity was significantly lower for decayed teeth (aOR, 0.64; 95% confidence interval [CI], 0.51-0.80; P < 0.0001), toothaches (aOR, 0.43; 95% CI, 0.30-0.60; P < 0.0001), bleeding gums (aOR, 0.48; 95% CI, 0.33-0.70; P < 0.0001), and eating or swallowing due to a health condition (aOR, 0.34; 95% CI, 0.20-0.57; P < 0.0001) compared to adolescents with both DDs and obesity. CONCLUSIONS: Results from this study indicate that DD adolescents with obesity have more/greater impending oral health needs than adolescents with no DDs or obesity. KNOWLEDGE TRANSFER STATEMENT: Results of this study highlight the high oral health needs and the chronic difficulty adolescents with developmental disabilities and obesity experience compared to adolescents without developmental disabilities and obesity. Targeted oral health policies and interventions that will promote oral health among this high-risk group are recommended.

Gastroesophageal reflux disease and oral symptoms: A two-sample Mendelian randomization study.

Background: The association between Gastroesophageal reflux disease (GERD) and oral symptoms has been reported in observational studies, but the causality of GERD to oral symptoms remained unknown. We aimed to assess the causal effect of GERD on five oral symptoms (mouth ulcers, toothache, loose teeth, bleeding gums, and periodontitis) using the two-sample Mendelian randomization (MR) method. Methods: Summary-level statistics for GERD and five oral symptoms were obtained from large-scale genome-wide association studies. Rigorous quality control of genetic instruments was conducted before MR analysis. Several analytical methods, including the inverse-variance weighted (IVW) method, MR-Egger regression, weighted median, maximum likelihood, and robust adjusted profile score (RAPS) were utilized, and the results of IVW were taken as the main results. The MR-Egger intercept test, Cochran's Q test, and leave-one-out test were used as sensitivity analysis for quality control. Results: After Bonferroni, IVW detected a significant effect of GERD on mouth ulcers (OR = 1.008, 95% CI = 1.003-1.013, p = 0.003), loose teeth (OR = 1.009, 95% CI = 1.005-1.012, p = 9.20 × 10-7), and periodontitis (OR = 1.229, 95% CI = 1.081-1.398, p = 0.002). Consistent patterns of associations were observed across several MR models and sensitivity analysis found little evidence of bias. Nominal significant associations were observed in toothache and bleeding gums (p < 0.05), and heterogeneity was detected. Conclusion: Our MR analyses supported the positive causal effect of GERD on oral symptoms, especially for mouth ulcers, loose teeth, and periodontitis. Our findings might shed light on the mechanism of oral disease and might imply that oral care should be enhanced in patients with GERD.

Clinical efficacy of "Bhadra Mustadi Paste" and "Nagaradi Kwatha Gandusha" in Shitada (Gingivitis).

Shitada is one of the Dantamulagata Rogas mentioned by Acarya Susruta under the heading of Mukha Rogas. It is characterized by symptoms like spontaneous bleeding, halitosis, blackish discoloration of gums, and so on. The symptomatology of Shitada can be compared with gingivitis, which is caused mainly by the accumulation of debris, plaque, and calculus at the tooth margin due to ignorance of oral care. It can progress into periodontitis - the disease in which the firmness, contour, and position of the gums are altered and teeth become mobile. The prevalence of gingivitis is as high as 50% in most of the population. In the present study, a total of 33 patients were registered in three groups. Bhadramustadi yoga has been used in paste form for local application along with Nagaradi Kwatha Gandusa in Group A and in powder form for Pratisarana along with Nagaradi Kwatha Gandusa in Group B. In Group C (Control) Sphatika Jala was used. The patients were diagnosed and assessed on the basis of Ayurvedic as well as modern classical signs and symptoms. Further assessment was done with the different indices used in modern dentistry. All the signs and symptoms were given a score depending upon the severity, to assess the effect of the drugs objectively. The effect of therapy was highly significant in group A in most of the signs, symptoms, and indices; and in group B it was highly significant in some signs and symptoms.