Minimal sedation using oral sedatives for multi-visit dental treatment in an adult patient with dental phobia

In adult patients with dental phobia, dental treatment may be difficult, or may not be possible. Depending on the level of fear or anxiety, non-pharmacological or pharmacological behavior management techniques are used in the dental treatment of such patients. Among the pharmacological behavior management techniques, minimal sedation, that is, the lowest depth of sedation, can be easily obtained in adult patients using oral sedatives, does not require special equipment or tools, and does not affect ventilatory and cardiovascular function. Diazepam is an anxiolytic drug belonging to the benzodiazepine family that, in addition to relieving anxiety, produces muscle relaxation, and is a representative drug used in adult patients with fear of dental treatment. Herein, we report the case of a 50-year-old woman with severe dental fear who successfully underwent long-term dental treatment in approximately 20 visits with minimal sedation using oral diazepam. In addition, we reviewed the considerations for the use of benzodiazepines for minimal sedation.

Minimal sedation using oral sedatives for multi-visit dental treatment in an adult patient with dental phobia

In adult patients with dental phobia, dental treatment may be difficult, or may not be possible. Depending on the level of fear or anxiety, non-pharmacological or pharmacological behavior management techniques are used in the dental treatment of such patients. Among the pharmacological behavior management techniques, minimal sedation, that is, the lowest depth of sedation, can be easily obtained in adult patients using oral sedatives, does not require special equipment or tools, and does not affect ventilatory and cardiovascular function. Diazepam is an anxiolytic drug belonging to the benzodiazepine family that, in addition to relieving anxiety, produces muscle relaxation, and is a representative drug used in adult patients with fear of dental treatment. Herein, we report the case of a 50-year-old woman with severe dental fear who successfully underwent long-term dental treatment in approximately 20 visits with minimal sedation using oral diazepam. In addition, we reviewed the considerations for the use of benzodiazepines for minimal sedation.

Tooth hypersensitivity associated with paresthesia after inferior alveolar nerve injury: case report and related neurophysiology

Inferior alveolar nerve (IAN) injury is usually caused by stretching or crushing of the neurovascular structures and postoperative intra-alveolar hematoma or edema after dental procedures. This results in paresthesia in the ipsilateral chin, lip (vermilion border, skin, and mucosa), and labial or buccal alveolar mucosa of the mandibular anterior teeth. However, there are no reports of sensory alterations in the teeth, especially tooth hypersensitivity, after IAN injury. I report a case in which paresthesia of the lower lip and hypersensitivity of the lower anterior teeth occurred simultaneously after the removal of the third molar that was located close to the IAN. In addition, I discuss the reasons for the different sensory changes between the tooth and chin (skin) after nerve injury from a neurophysiological point of view. Since the dental pulp and periodontal apparatus are highly innervated by the inferior alveolar sensory neurons, it seems necessary to pay attention to the changes in tooth sensitivity if IAN injury occurs during dental procedures.

Delayed paresthesia of inferior alveolar nerve after dental surgery: case report and related pathophysiology

Paresthesia is an altered sensation of the skin, manifesting as numbness, partial loss of local sensitivity, burning, or tingling. The inferior alveolar nerve (IAN) is the third branch of the trigeminal nerve and is very important in dental treatment. IAN paresthesia may occur after various dental procedures such as simple anesthetic injections, surgical procedures, and endodontic treatment, and is reported to range from 0.35% to 8.4%. The altered sensation usually follows immediately after the procedure, and reports of late onset of nerve involvement are rare. This report presents a rare case of delayed paresthesia after dental surgery and discusses the pathophysiology of IAN delayed paresthesia.

Pulseless electrical activity during general anesthesia induction in patients with amyotrophic lateral sclerosis

Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia. We report a case of PEA during the induction of general anesthesia in a patient with ALS who presented for dental treatment and discuss the causes of PEA and necessary considerations for general anesthesia in patients with ALS.

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.

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.

Diplopia after inferior alveolar nerve block: case report and related physiology

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.

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.

The Healing of Exposed Implant Surfaces in A Maxillary Sinus Cavity / 대한치주과학회지

OBJECTIVE: The aim of this study was to investigate whether dental implant exposure to the maxillary sinus cavity increases the risk of maxillary sinus complications. STUDY DESIGN: An implant was placed bilaterally in the maxillary sinus of eight adult female mongrel dogs in a way that it penetrated the bone and mucous membrane of the maxillary sinus floor to the extent of 2 mm, 4 mm, or 8 mm. The implants were left in place for six months. RESULTS: Radiographic and histologic examinations did not show any signs of pathologic findings in the maxillary sinus of the eight dogs. CONCLUSION: This study indicates that implant protrusion into the maxillary sinus cavity is not related to the development of sinus complications.

Epithelial-myoepithelial carcinoma of the parotid gland: a case report

Epithelial-myoepithelial carcinoma(EMC) of the salivary glands is a rare tumor first discribed in 1972. The EMC comprises approximately 1% of all salivary gland tumors. It is characterized by tubular and solid growth pattern with a dual cell population including an inner layer of epithelial cells, which is peripherally bounded by a layer of clear myoepithelial cells. It is demonstrated that tumor with solid slowly growing pattern, generally have a higher frequency of local recurrence. We report a case of parotidic EMC in a 30 years old woman with literature review

Management of oral mucositis owing to chemical burn by intoxication of agricultural chemicals(gramoxon): report of cases

Chemical burns onto oral mucosa which are infrequent, may result from contact with a wide variety of chemical agents. The degree of injury depends on the chemical, its concentration, duration of contact, and the natural penetrability and resistance of the tissues involved. Chemicals do not usually "burn" in that they do not cause destruction by hyperthermic activity. Rather, they damage tissue by causing coagulation of protein by one of several processes, reduction, oxidation, desiccation, corrosion, or vesication. Paraquat(Gramoxon) is the most frequently agricultural chemicals that induce the severe toxic reactions onto the organs of human body in Korea. The toxic reaction are composed of pulmonary edema and fibrosis, formation of hyaline membrane, inflammatory reaction and bleeding tendency, owing to the cell damage by the production of superoxide radicals. The contents of essential treatment in paraquat intoxication are commonly airway and breathing maintenance, gastric lavage, much hydration and diuresis, hemoperfusion and medications for the removal of the chemicals and the prevention of various complications. The sedative oral dressings, such as, orabase ointment application, warm saline gargling, lidocaine viscous gargling and oral gargling by the mixed solutions(tetracycline, prednisolone and 10% dextrose water) are important for the improvement of chemical oral mucositis and the comfortable feeding of diet. The authors managed properly two cases of oral chemical mucositis that were occurred by the incorrect use of agricultural chemicals(paraquat) and report the cases with the review of literatures about care of the chemical intoxication and oral mucositis.

Effect on explanation of pathogenesis and stress management as primary care of tmj disorder

PURPOSE: Authors attempted to evaluate the effect on explanation of pathogenesis and stress management as the initial care of temporomandibular disorders. MATERIALS AND METHODS: The materials were 634 patients with temporomandibular disorder, who had been referred to our Department of Dentistry, Wonju Christian Hospital during recent 5 years. We examined about clinical aspects of temporomandibular disorders, such as, major signs of temporomandibular joint disor-der, life environment and habits, radiological findings of temporomandibular joint and electromyography of masseter muscle. The patients were treated by explanation of TMJ pathogenesis and stress management. After that, the patient were evaluated about the effect in third week. RESULTS: The result was more favorable (96.5% success rate) without intolerable signs of temporomandibular joint disorder. CONCLUSIONS: The explanation of TMJ pathogenesis and stress management were thought as the very effective care in management of patients with temporomandibular disorder.

Effect On Endodontic Drainage Of The Luxated Tooth In Reduction And Fixation Of Compound Alveolar Bone Fracture