Allergic reactions to local anesthetic mepivacaine in dental procedures: a case report

Local anesthetics are an essential part of pain control during dental treatment. Despite its effectiveness and safety, patients should constantly be aware of potential adverse effects, including allergic reactions. Allergic reactions to amide-type local anesthetics (LAs), such as lidocaine and mepivacaine, are rare compared to those to ester-type LAs. Herein, we report the case of a patient with a history of allergy to lidocaine and mepivacaine, with symptoms of itching, diffuse erythema of the wrists and hands, dizziness, and pectoralgia. This case report emphasizes the importance of collecting medical and dental histories of patients is necessary, and how an allergy test in the allergy and clinical immunology department helps select safe LAs for patients.

Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries

Background@#Dental evaluation and protection are important for preventing traumatic dental injuries when patients are under general anesthesia. The objective of the present study was to develop a questionnaire based on dentition-related risk factors that could serve as a valuable tool for dental evaluation and documentation. @*Methods@#We developed a questionnaire for dental evaluation before administration of general anesthesia, investigated the association between patient-and-dentist responses and mouthguard fabrication, and assessed response agreement between 100 patients. @*Results@#Protective mouthguards were fabricated for 27 patients who were identified as having a high risk of dental injury. There was a strong association between dentists’ responses and mouthguard fabrication, depending on the general oral health status, use of ceramic prosthesis, presence of masticatory pain related to periodontal diseases, gingival edema, and implants (P < 0.05). Response agreement between patients and dentists for items related to dental pain, loss of dental pulp vitality, root canal therapy, dental trauma, aesthetic prosthesis, tooth mobility, and implant prosthesis was high (Cohen’s kappa coefficient κ ≥ 0.6). @*Conclusions@#A high agreement was observed between patient-dentist responses and a strong association with mouthguard fabrication for items pertaining to ceramic prosthesis, masticatory pain, and dental implants. Patients with a “yes” response to these items are recommended to undergo a dental evaluation and use a dental protective device while under general anesthesia.

Conservative orthodontic treatment for severe pathologic migration following total glossectomy: A case report / 대한치과교정학회지

Glossectomy combined with radiotherapy causes different levels of tongue function disorders and leads to severe malocclusion, with poor periodontal status in cancer survivors. Although affected patients require regular access to orthodontic care, special considerations are crucial for treatment planning. This case report describes the satisfactory orthodontic management for the correction of severe dental crowding in a 43-year-old female 6  years after treatment for tongue cancer with total glossectomy combined with radiotherapy, to envision the possibility of orthodontic care for oral cancer survivors. Extraction was performed to correct dental crowding and establish proper occlusion following alignment, after considering the possibility of osteoradionecrosis. Orthodontic mini-implants were used to provide skeletal anchorage required for closure of the extraction space and intrusion of the anterior teeth. The dental crowding was corrected, and Class I occlusal relationship was established after 36 months of treatment. The treatment outcome was sustained after 15 months of retention, and long-term follow-up was recommended.

Foreign body aspiration and ingestion in dental clinic: a seven-year retrospective study

Background@#This retrospective study investigated the incidence rate of accidental foreign body aspiration and ingestion according to patient sex, age, and dental department. This study aimed to verify whether the incidence rate is higher in geriatric than in younger patients and whether it is different among dental departments. @*Methods@#Accidental foreign body aspiration and ingestion cases were collected from electronic health records and the safety report system of Yonsei University Dental Hospital from January 2011 to December 2017. The collected data included patients’ age, sex, medical conditions, treatment procedures, and foreign objects that were accidentally aspirated or ingested. The incidence rate was calculated as the number of accidental foreign body aspirations and ingestions relative to the total number of patient visits. Differences depending on the patients’ sex, age, and dental department were statistically identified. @*Results@#There were 2 aspiration and 37 ingestion cases during the 7-year analysis period. The male to female incidence ratio was 2.8:1. The incidence rate increased with age and increased rapidly among those aged 80 years or older. Seven of the 37 patients with accidental foreign body ingestion had intellectual disability, Lou Gehrig’s disease, dystonia, or oral and maxillofacial cancer. The incidence rate was highest in the Predoctoral Student Clinic and the Department of Prosthodontics. The most frequently swallowed objects were fixed dental prostheses and dental implant components. @*Conclusion@#The incidence rate of accidental foreign body aspiration and ingestion differed according to patient sex, age, and dental department. Dental practitioners must identify high-risk patients and apply various methods to prevent accidental foreign body aspiration and ingestion in dental clinics. Inexperienced practitioners should be particularly careful.

The relationship between masseter muscle thickness measured by ultrasonography and facial profile in young Korean adults

PURPOSE: The purpose of this study was to evaluate the relationship between masseter muscle thickness, facial morphology, and mandibular morphology in Korean adults using ultrasonography. MATERIALS AND METHODS: Ultrasonography was used to measure the masseter muscle thickness bilaterally of 40 adults (20 males, 20 females) and was performed in the relaxed and contracted states. Facial photos and panoramic radiography were used for morphological analyses and evaluated for correlations with masseter muscle thickness. We also evaluated the correlations of age, body weight, stature, and body constitution with masseter muscle thickness. RESULTS: In the relaxing, the masseter was 9.8±1.3 mm in females and 11.3±1.2 mm in males. In the contracted state, it was 12.4±1.4 mm in females and 14.7±1.4 mm in males. Facial photography showed that bizygomatic facial width over facial height was correlated with masseter muscle thickness in both sexes in the relaxed state, and was statistically significantly correlated with masseter muscle thickness in males in the contracted state. In panoramic radiography, correlations were found between anterior angle length and posterior angle length and masseter muscle thickness in females, and between body length and posterior angle length, between anterior angle length and body length, between ramal length and body length, and between body length and condyle length in males. CONCLUSION: Masseter muscle thickness was associated with facial and mandibular morphology in both sexes, and with age in males. Ultrasonography can be used effectively to measure masseter muscle thickness.

Creating protective appliances for preventing dental injury during endotracheal intubation using intraoral scanning and 3D printing: a technical note

Digital dentistry has influenced many dental procedures, such as three-dimensional (3D) diagnosis and treatment planning, surgical splints, and prosthetic treatments. Patient-specific protective appliances (PSPAs) prevent dental injury during endotracheal intubation. However, the required laboratory work takes time, and there is the possibility of tooth extraction while obtaining the dental impression. In this technical report, we utilized new digital technology for creating PSPAs, using direct intraoral scanners and 3D printers for dental cast fabrication.

Computer-controlled local anesthetic delivery for painless anesthesia: a literature review

Local anesthesia is administered to reduce pain during dental treatments, but may itself cause pain and contribute to increased dental fear. Computer-controlled local anesthetic delivery (CCLAD) is one the method to reduce patient pain during local anesthesia; it is a device that slowly administers anesthetics by using a computerized device to control the injection speed. This literature review aims to provide an objective assessment of the usefulness of CCLAD for controlling pain by reviewing papers published to date that have used CCLAD.

Computer-controlled local anesthetic delivery for painless anesthesia: a literature review

Local anesthesia is administered to reduce pain during dental treatments, but may itself cause pain and contribute to increased dental fear. Computer-controlled local anesthetic delivery (CCLAD) is one the method to reduce patient pain during local anesthesia; it is a device that slowly administers anesthetics by using a computerized device to control the injection speed. This literature review aims to provide an objective assessment of the usefulness of CCLAD for controlling pain by reviewing papers published to date that have used CCLAD.

Management of hyperthyroid patients in dental emergencies: a case report

The prevalence of thyroid disease, particularly hyperthyroidism, has rapidly increased in Korea in the past 10 years. Therefore, it is important to consider the complete medical history including thyroid disease in patients under dental treatment. Both the drugs used for dental treatment and psychological symptoms associated with treatment can induce emergencies in hyperthyroid patients. This case report considers emergency situations during dental treatment for hyperthyroid patients, and discusses risk factors and related concerns.

Management of hyperthyroid patients in dental emergencies: a case report

The prevalence of thyroid disease, particularly hyperthyroidism, has rapidly increased in Korea in the past 10 years. Therefore, it is important to consider the complete medical history including thyroid disease in patients under dental treatment. Both the drugs used for dental treatment and psychological symptoms associated with treatment can induce emergencies in hyperthyroid patients. This case report considers emergency situations during dental treatment for hyperthyroid patients, and discusses risk factors and related concerns.

Protective dental splint for oroendotracheal intubation: experience of 202 cases

BACKGROUND: Dental injury as a result of oroendotracheal intubation during general anesthesia is very common. We report our experiences of using mouthguard to prevent dental injury during intubation based on our protocol. METHODS: This retrospective study enrolled patients referred for preanesthetic evaluation, those patients with a history of any of the dental treatments to their anterior teeth listed on our fabrication protocol from January 1, 2009 to June 30, 2010. RESULTS: No cases of dental trauma during oroendotracheal intubation were reported among the 202 patients who used a protective device. 66% of the patients had risk factors for hard tissue damage aged 10-40 years. At the ages of 40-70 years, the incidence of risk group for periodontal damage was higher. CONCLUSIONS: Preanesthetic consultation was effective for preventing dental injury, so preanesthetic questionnaire and proper dental consultation would be helpful.

The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia

BACKGROUND: The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics METHODS: In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed. RESULTS: The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups. CONCLUSIONS: IANB failure could be attributable, in part, to the skeletal characteristics of the mandible. In addition, the failure rate was found to be significantly higher in the retrognathic group.

The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia

BACKGROUND: The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics METHODS: In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed. RESULTS: The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups. CONCLUSIONS: IANB failure could be attributable, in part, to the skeletal characteristics of the mandible. In addition, the failure rate was found to be significantly higher in the retrognathic group.

Mandibular metastasis of cholangiocarcinoma: A case report

Tumors metastasizing from distant regions to the oral and maxillofacial region are uncommon, comprising only 1%-2% of all malignancies. Cholangiocarcinoma is a malignancy that arises from cholangiocytes, which are epithelial cells that line the bile ducts. These cancers are difficult to diagnose and have a poor prognosis. In this paper, we report a rare case of mandibular metastasis of cholangiocarcinoma diagnosed at the primary site and discuss the radiographic findings observed in this case.

Clinical assessment on application of Er:Cr:YSGG laser in dentinal hypersensitivity reduction / 대한구강보건학회지

OBJECTIVES: We aimed to evaluate the effectiveness of Er:Cr:YSGG laser therapy on the reduction of dentinal hypersensitivity while taking into account the length and depth of the cervical abrasion. METHODS: We included adults (age, 20-60 years) with at least 2 hypersensitive teeth. The hypersensitive teeth were stimulated with a pressure-indicating probe and an air syringe. The response of the subjects to this stimulation was quantified using a visual analog scale (VAS) and Schiff air sensitivity score. The patients were treated at baseline, immediately after laser treatment, and at 1, 2, and 4 weeks after the Er:Cr:YSGG laser therapy. The results were analyzed by repeated measure analysis of variance (ANOVA) and Bonferroni's post hoc test. RESULTS: The values of tactile test and air blast test showed statistically significant differences between the following time points: baseline and immediately after laser treatment, baseline and first week after treatment, and immediately after laser treatment and first week after treatment (P0.05). The depth and width of the cervical abrasion was not statistically significant in dentinal hypersensitivity reduction (P>0.05). CONCLUSIONS: The use of Er:Cr:YSGG laser therapy reduced dentinal hypersensitivity, especially immediately after laser treatment. The depth and width of the cervical abrasion is not statistically significant in dentinal hypersensitivity reduction.

A lateral approach to the maxillary sinus for simultaneous extraction of an ankylosed maxillary molar and sinus graft: a case report

Ankylosed tooth is defined as 'the discontinuance of normal passive tooth eruption without any mechanical barrier'. Ankylosed tooth treatment is a challenge to dental clinicians. In treatment of maxillary molar ankylosis cases there are risks of oro-antral fistula, displacement of root fragments into the maxillary sinus, as well as the necessity for providing additional sinus bone augmentation for future implant placement. In this study, we suggested a new technique using a piezoelectric device and a lateral side approach to the maxillary sinus leading to the simultaneous removal of the ankylosed maxillary molar and sinus grafting for the purpose of implant site development.

Optimal protocol for teleconsultation with a cellular phone for dentoalveolar trauma: an in-vitro study

PURPOSE: Dental trauma is frequently unpredictable. The initial assessment and urgent treatment are essential for dentists to save the patient's teeth. Mobile-phone-assisted teleconsultation and telediagnosis for dental trauma could be an aid when a dentist is not available. In the present in-vitro study, we evaluated the success rate and time to transfer images under various conditions. MATERIALS AND METHODS: We analyzed the image quality of cameras built into mobile phones based on their resolution, autofocus, white-balance, and anti-movement functions. RESULTS: The image quality of most built-in cameras was acceptable to perform the initial assessment, with the autofocus function being essential to obtain high-quality images. The transmission failure rate increased markedly when the image size exceeded 500 kappaB and the additional text messaging did not improve the success rate or the transmission time. CONCLUSION: Our optimal protocol could be useful for emergency programs running on the mobile phones.

Impacted supernumerary tooth in coronoid process: a case report / 대한구강악안면방사선학회지

Impaction of tooth is a situation in which an unerupted tooth is wedged against another tooth or teeth or otherwise located so that it cannot erupt normally. The supernumerary tooth is also called as hyperdontia and defined as the condition of having additional tooth to the regular number of teeth. The most common supernumerary tooth is a mesiodens, which is a mal-formed, peg-like tooth that occurs between the maxillary incisors. The supernumerary tooth is commonly impacted but they are frequently impacted on maxilla. Ectopic impaction of supernumerary tooth on mandibular condyle, coronoid process, ascending ramus, and pterygomandibular space is very rare condition. In this case, we report a case of impacted supernumerary tooth on mandibular sigmoid notch without definite pathologic change.

Comparative evaluation of computed tomography for dental implants on the mandibular edentulous area / 대한구강악안면방사선학회지

PURPOSE: The purpose of this study was to evaluate the clinical usefulness of the recently developed multi-detector computed tomography and cone beam computed tomography in pre-operative implant evaluation, by comparing them with the single detector computed tomography, already confirmed for accuracy in this area. MATERIALS AND METHODS: Five partially edentulous dry human mandibles, with 1x1 mm gutta percha cones, placed in 5 mm intervals posterior to the mental foramen on each side of the buccal part of the mandible, were used in this study. They were scanned as follows: 1) Single detector computed tomography: slice thickness 1 mm, 200 mA, 120 kV 2) Multi-detector computed tomography: slice thickness 0.75 mm, 250 mA, 120 kV 3) Cone beam computed tomography: 15 mAs, 120 kV Axial images acquired from three computed tomographies were transferred to personal computer, and then reformatted cross-sectional images were generated using V-Implant 2.0(R) (CyberMed Inc., Seoul, Korea) software. Among the cross-sectional images of the gutta percha cone, placed in the buccal body of the mandible, the most precise cross section was selected as the measuring point and the distance from the most superior border of the mandibular canal to the alveolar crest was measured and analyzed 10 times by a dentist. RESULTS: There were no significant intraobserver differences in the distance from the most superior border of the mandibular canal to the alveolar crest (p>0.05). There were no significant differences among single detector computed tomography, multi-detector computed tomography and cone beam computed tomography in the distance from the most superior border of the mandibular canal to the alveolar crest (p>0.05). CONCLUSION: Multi-detector computed tomography and cone beam computed tomography are clinically useful in the evaluation of pre-operative site for mandibular dental implants, with consideration for radiation exposure dose and scanning time.

Characteristics of a new cone beam computed tomography / 대한구강악안면방사선학회지

PURPOSE: To determine the physical properties of a newly developed cone beam computed tomography (CBCT). MATERIALS AND METHODS: We measured and compared the imaging properties for the indirect-type flat panel detector (FPD) of a new CBCT and the single detector array (SDA) of conventional helical CT (CHCT). RESULTS: First, the modulation transfer function (MTF) of the CBCT were superior to those of the CHCT. Second, the noise power spectrum (NPS) of the CBCT were worse than those of the CHCT. Third, detective quantum efficiency (DQE) of the indirect-type CBCT were worse than those of the CHCT at lower spatial frequencies, but were better at higher spatial frequencies. Although the comparison of contrast-to-noise ratio (CNR) was estimated in the limited range of tube current, CNR of CBCT were worse than those of CHCT. CONCLUSION: This study shows that the indirect-type FPD system may be useful as a CBCT detector because of high resolution.