Management of dry socket: a comparison of two treatment modalities

The objective of this study was to compare the effect of local application of chlorhexidine digluconate and combination of lodoform with Butylparaminobenzoate in the management of dry socket. A Quasi experimental study was carried out on a total of sixty diagnosed cases of dry socket. Patients were randomly distributed among two treatment groups [30 patients in each group] i.e. patients of group A were treated by local application of chlorhexidine digluconate gel and of group B by local treatment with combination of lodoform + Butylparaminobenzoate [Alvogyl]. Both the treatment groups were given the same systemic analgesic i.e., Ibuprofen 400mg TDS along with thorough irrigation of the socket. Patients were followed for five consecutive days by replacing dressing each day and findings were recorded in the pro forma. Out of the sixty patients, forty five were males and fifteen were females [3:1]. In group A there were 22 [73.33%] males and 8 [26.66%] females and in group B there were 23 [76.66%] males and 7 [23.33%] females. Mean age was 31.68 [11.23+S.D]. There was no significant effect of gender [P=0.766] and age [P=0.668] on both of the treatment groups respectively. All patients measured their pain subjectively as S3 i.e. severe pain on day 1 on visual analogue scale. There was a significant difference in pain control of the two treatment groups on 2nd, 3rd and 4th treatment day with P=0.000, P=0.000 and P = 0.02 respectively. Significant difference was noted for sensitivity on gentle probing the extraction socket between the results of two treatment groups on 3[rd] and 4[th] day i.e. p=0.000 for both days. lodoform and Butylparaminobenzoate [Alvogyl] had been the most successful combination in relieving patient's pain

Presentation of maxillofacial injuries in the 2005 earthquake victims

Earthquakes cause a lot of damage to life and property. Maxillofacial injuries constitute an important proportion of injuries in earthquakes and some 13% of the trauma patients after the earthquakes suffer from maxillofacial injuries. The objective of this study was to assess the presentation of maxillofacial injuries in earthquake victims. This descriptive study was conducted at the Department of Oral and Maxillofacial Surgery, Dental Section Ayub Teaching Hospital, Abbottabad from October 8[th], 2005 to January 8[th], 2006. Three hundred and seventy-eight patients were included in this study in the three months following the October 8[th], 2005 earthquake on consecutive nonprobability sampling basis. Isolated facial bone fractures rather than the multiple bone fractures were the commonest type of fractures in earthquake victims. A significant number of patients presented with only soft tissue injuries and no bony fractures. Although considerable number of patients with fracture of multiple facial bones were present in the earthquake victims but isolated facial bone fractures and soft tissue injuries were the commonest type of injuries

Spectrum of trigeminal neuralgia

Trigeminal neuralgia [TN] is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup. This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College, Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience [non probability] sampling technique. All the patients presenting with the clinical features of TN were included in study. Out of 117 cases, 49 [41.9%] were males and remaining 68 [58.1%] were females. Age of the patients ranged from 32-72 [53.90 +/- 10.21] years. Right side was involved in 63 patients [53.8%], while the left side was involved in 51 patients [43.6%]. In only three cases [2%] there was bilateral involvement. The maxillary division was involved in 68 cases [58.1%] and mandibular division was involved in 37 cases [31.6%]. The most common site of involvement was infra-orbital, which was involved in 68 cases [58.11%]. The next common site was the mental nerve which showed involvement in 35 cases [29.9%] followed by inferior alveolar nerve which was affected in 14 cases [12%]. Thirty three [28.2%] patients were having mild pain, 54 [46.2%] patients having moderate, 21 [18%] patients with severe and 9 [7.7%] patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 [88%] patients underwent dental extraction for the same pain. The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions

Root resorption of permanent incisors during three months of active orthodontic treatment

Root resorption is one of the most common and undesirable sequelea of orthodontic treatment. The aim of this study was to evaluate the amount of root resorption in permanent incisors during 3 month active period of fixed orthodontic appliance therapy using periapical radiographs. Periapical radiographs of a total of 138 permanent teeth [n=138, mandibular n1=52, maxillary n2=86] were evaluated for root resorption. All patients were treated with 3M MBT multibonded, pre-adjusted appliances with 0.022 inch slots. Initial levelling and alignment was achieved with 0.0175 inch co-axial wires. All four incisors [maxillary and mandibular] were measured for any change in root length. The change in root length between T[o] [pre-treatment] and T1 [post-treatment] was measured in millimetres and expressed in terms of percentage of original root length. The mean pre treatment [T[o]] root length for the maxillary teeth [n1=62] was 19.27 +/- 2.86 mm and 20.01 +/- 2.57 mm for the mandibular teeth [n2=31]. The post-treatment [T[1]] root length for the maxillary teeth was 18.96 +/- 2.85 mm and 19.49 +/- 2.4 mm for the mandibular teeth showing a mean resorption of 0.31 mm and 0.52 mm for the maxillary and mandibular teeth respectively. Root resorption was strongly correlated with active orthodontic appliance therapy with maxillary and mandibular incisors being most susceptible. It was found that root resorption can be detected even in the early levelling and alignment stages of orthodontic treatment

Traumatic injuries of the permanent maxillory incisors at dental department, Pakistan institute of Medical Sciences Islamabad: a retrospective study

The study aims to ascertain the prevalence of traumatic dental injures of the maxillary permanent incisors at Dental Department, Pakistan Institute of Medical Sciences Islamabad during the years 2003-2005. Information concerning age, sex, cause, type of tooth, number of injured teeth and patterns of tooth injury were recorded retrospectively from 336 patients aged between 8-40 years, comprising 498 traumatized teeth. The dental records of all the patients presenting with dental trauma were examined for collection of data relating to age, sex, cause, number of injured teeth, type of tooth and type of tooth trauma. Type of tooth trauma was recorded according to the Andreason classification. The data was subsequently processed and analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. Of the 336 patients, 227 were males [67.6%] and 109 were females [32.4%]. The gender difference was statistically significant [P < 0.0001]. The patients had a total of 498 traumatized teeth. A large number of dental trauma occurred in patients aged between 9-11 years. Most injuries involved one tooth in 227 patients [67.6%]. However two teeth in 90 patients [26.7%], three teeth in 11 patients [3.2%] and only in 8 patients [2.3%] four teeth were involved. Fractures in enamel only occurred in 74 teeth [14.6%]. Uncomplicated crown fractures in 208 teeth [41.9%] were the most commonly encountered dental trauma. 137 teeth [27.6%] suffered complicated crown fractures, 44 teeth [8.9%] uncomplicated crown-root fractures, 19 teeth [3.8%] complicated crown-root fractures and avulsion in 16 teeth [3.2%] only. The main causes were falls in 225 patients [66.9%], collision with objects in 40 patients [11.9%], road traffic accident in31 patients [9.2%] violence in 21 patients [6.2%], and sports in 19 patients [5.6%]. The maxillary central incisor was traumatized in 384 teeth showing a high percentage of 77%. Raising public dental awareness regarding the serious outcome of traumatic dental injuries is mandatory to improve the prognosis of dental trauma and to avoid complications

Use of silastic as interpositional material in the management of unilateral temporomandibular joint ankylosis

Ankylosis is a very common condition developed mainly after damage to mandibular condyles or temporomandibular joint [TMJ] at a growing age. Different autogenous and alloplastic interpositional materials have been attempted after the resection of the ankylotic bone to achieve desirable results. This condition is relatively common in Pakistan. We treated TMJ ankylosis with alloplastic medical grade silicone "silastic" interpositional arthroplasty. Eight joints accompanied ipsilateral or contralateral coronoidectomy to achieve desirable results. All patients were presented at Punjab Dental Hospital Lahore. Sixty-one joints with unilateral TMJ ankylosis were underwent surgery after careful examination and final radiographic confirmation. The preoperative CT scan was also performed in few patients. The postoperative measurements of the interincisal opening with lateral and protrusive jaw movements were criteria for success of surgery. The lateral and protrusive jaw movements were assessed as excellent, good and poor. Less than 25 mm interincisal opening was considered as poor jaw opening. The overall success rate was 98.4% with 84% desirable interincisal jaw opening. Less than 5% patients were observed with poor jaw opening. The immediate late complications were transient and were included oedema, weakness of a branch of the facial nerve on the operated side. Two implants were infected along with one wire in the first month of surgery and were removed under local anaesthesia without further complication

Spectrum of mandibular fractures at a tertiary case dental hospital in Lahore

Mandible being the only mobile bone of the facial skeleton plays a major role in mastication, speech and deglutition. Among the maxillofacial trauma, mandible is the high risk exponent. Its fractures result in severe loss of function and disfigurement. The increased vehicular accidents, conditions of our roads and other assaults have focused attention in recent years to prevent injuries. Method: A descriptive case series of 126 patients with mandibular fractures attending a tertiary referral centre over a six-month period is presented. Data concerning the patients' demographics, aetiology and pattern were obtained and analysed. Approximately 56% of the patients sustained fractures from road traffic accidents and 34% of the fractures occurred in the 21'30 year age range. There was a male preponderance with a male to female ratio of 9:1. Parasymphyseal fractures were the most common followed by those of the condylar and subcondylar regions. Conclusions: We need to encourage further research work in this field to provide better record keeping and quality of services to the injured people. Amendments in the traffic rules and legislation about seat-belt usage and traditional kite flying to reduce frequency of fractures are required