Impact of maxillary teeth morphology on the failure rate of local anesthesia.

OBJECTIVE: To investigate the effect of maxillary single and multiple rooted teeth on the success rate of buccal infiltration anesthesia. SUBJECTS AND METHODS: This clinical study was performed by dividing the participants into three groups. Group one included 30 patients with upper anterior teeth, group two 23 patients with upper premolars teeth and group three 39 patients with upper molars for extraction. Onset time of anesthtic action was evaluted by using electronic pulp tester. Pulp testing assessments were carried out immediately before the injection and at the intervals of 2 mins following the injection until the anesthetic success obtains. RESULTS: Seventy-nine patients in this study secured anesthetic success within study duration time (10 min). However, there were 13 patients with dental anesthesia failures (3 patients with single rooted teeth and 10 patients with multiple rooted teeth). There were no significant differences in the mean onset time of pulpal anesthesia between the anterior, middle and posterior teeth (P value = 0.449). Clinically, patients with single rooted teeth reported faster dental anesthesia and earlier teeth extraction than patients with multiple rooted teeth. CONCLUSION: This study showed that the single rooted teeth have faster pulpal anesthesia and early extraction than teeth with multiple roots but not statistically significant. Administration of extra local anesthetic cartridge or using intraseptal injection technique can be a solution to overcome the failure of anesthesia in the maxillary posterior teeth.

Effect of immediate versus delayed loadings of dental implants on the oral health-related quality of life in Saudi population. Experimental clinical trial.

OBJECTIVES: To assess the effects of immediate and delayed loadings of dental implants on the overall quality of life (QoL) of patients. Methods: The prospective analysis was conducted in the Department of Periodontology Clinics, Faculty of Dentistry Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. The study was conducted from November 2013 to August 2016 and was according to the principles of the Helsinki Declaration. Quality of life in 24 patients (10 males and 14 females), aged between 18-60 years were assessed. Among the patients, 8 were opted for immediate implant loading (Group I), while 16 have opted for delayed implant loading (Group II). The quality of life was analyzed using a QoL assessment scale before and after the implant loading. Results: Overall assessment revealed that the QoL among the patients immediately after loading of dental implant (Group I) was better as compared to the delayed loading of dental implant (Group II). The differences of functional and financial aspects were significant between both groups. The majority of the immediate implant's loadings have been performed in the anterior aesthetic zone and has a significant impact on the QoL. Conclusion: The results concluded that immediate loading of dental implant is better than the delayed loading of a dental implant with a prosthesis.

Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions.

OBJECTIVE: To investigate the speed of action and injection discomfort of 4% articaine and 2% mepivacaine for upper teeth extractions. MATERIALS AND METHODS: Forty-five patients were included in the articaine 4% group, and 45 in the mepivacaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Furthermore, the discomfort of the injections were recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with "no pain" (0 mm) and "unbearable pain" (100 mm). RESULTS: There were significant differences in the meantime of first numbness to associated palatal mucosa and tooth of patients between mepivacaine and articaine buccal infiltration (BI) groups P = 0.01 and 0.01. Patients in the articaine group recorded earlier palatal mucosa and teeth numbness than those in the mepivacaine group. With regards to the discomfort of the needle injections, palatal injection was significantly more painful than BI (t-test: P < 0.001). Articaine buccal injection was significantly more painful than mepivacaine buccal injection (t-test: P <0.001). However, articaine palatal injection was less painful than articaine BI. Clinically, anesthesia onset time was faster in anterior upper teeth than upper middle and posterior teeth. CONCLUSIONS: BIs with 4% articaine was faster in achieving palate and teeth anesthesia than 2% mepivacaine for extraction of upper maxillary teeth. Patients in mepivacaine BI and articaine palatal injection groups reported less pain with needle injection. Failure of anesthesia was noticeable with maxillary multiple-rooted teeth.

Self-reported frequency of temporomandibular disorders among undergraduate students at Taibah University.

OBJECTIVES: This study aimed to evaluate the prevalence and severity of temporomandibular joint (TMJ) disorders among undergraduate students. In addition, the severity of TMD was examined in terms of its relationship with gender, age and field of study. METHODS: A total of 439 undergraduate students of both genders (age range: 20-27 years) who were studying at various colleges at Taibah University were invited to participate in this study. Each student was provided with a questionnaire, and the significance and purpose of the study were explained. The data were collected using Fonseca's questionnaire, an instrument that assessed the demographic characteristics of the students and included ten key questions. The severity of TMD was categorized as no, mild, moderate or severe. The data were analysed using SPSS Version 22 (IBM, Illinois, USA). The chi-square test was used to compare the data from different groups and to determine whether the differences were statistically significant. RESULTS: Of those who were invited, 78 students did not return the questionnaires, whereas another 11 were excluded due to their submitting an incomplete questionnaire. A majority of the students reported no TMD (46.7%) or mild TMD (42.7%). A moderate level of TMD was reported by 8.8% of students. Only 1.7% of students reported severe TMD. No significant differences were observed in the severity of TMD in terms of student age or field of study. CONCLUSION: TMD is more prevalent among female students than male students. However, its occurrence is not affected by the age and field of study of the student.

A randomized control trial comparing the visual and verbal communication methods for reducing fear and anxiety during tooth extraction.

PURPOSE: To evaluate the value of using the visual information for reducing the level of dental fear and anxiety in patients undergoing teeth extraction under LA. METHODS: A total of 64 patients were indiscriminately allotted to solitary of the study groups following reading the information sheet and signing the formal consent. If patient was in the control group, only verbal information and routine warnings were provided. If patient was in the study group, tooth extraction video was showed. The level of dental fear and anxiety was detailed by the patients on customary 100 mm visual analog scales (VAS), with "no dental fear and anxiety" (0 mm) and "severe dental distress and unease" (100 mm). Evaluation of dental apprehension and fretfulness was made pre-operatively, following visual/verbal information and post-extraction. RESULTS: There was a substantial variance among the mean dental fear and anxiety scores for both groups post-extraction (p-value < 0.05). Patients in tooth extraction video group were more comfortable after dental extraction than verbal information and routine warning group. For tooth extraction video group there were major decreases in dental distress and anxiety scores between the pre-operative and either post video information scores or postoperative scores (p-values < 0.05). Younger patients recorded higher dental fear and anxiety scores than older ones (P < 0.05). CONCLUSION: Dental fear and anxiety associated with dental extractions under local anesthesia can be reduced by showing a tooth extraction video to the patients preoperatively.

Role of enamel deminerlization and remineralization on microtensile bond strength of resin composite.

OBJECTIVE: This study is aimed to establish the microtensile bond strength of enamel following exposure to an aerated drink at various time intervals with/without application of remineralization agent. In addition, degree of remineralization and demineralization of tooth enamel has been assessed using polarized light microscopy. MATERIALS AND METHODS: Seventy extracted human incisors split into two halves were immersed in aerated beverage (cola drink) for 5 min and stored in saliva until the time of microtensile bond testing. Prepared specimens were divided randomly into two study groups; remineralizing group (n = 70): specimens were treated for remineralization using casein phosphopeptides and amorphous calcium phosphate (CPP-ACP) remineralization agent (Recaldent™; GC Europe) and control group (n = 70): no remineralization treatment; specimens were kept in artificial saliva. All specimens were tested for microtensile bond strength at regular intervals (1 h, 1 days, 2 days, 1 week, and 2 weeks) using a universal testing machine. The results statistically analyzed (P = 0.05) using two-way ANOVA test. RESULTS: Results showed statistically significant increase in bond strength in CPP-ACP tested group (P < 0.05) at all-time intervals. The bond strength of remineralizing group samples at 2 days (~13.64 megapascals [MPa]) is comparable to that of control group after 1 week (~12.44 MPa). CONCLUSIONS: CPP-ACP treatment of teeth exposed to an aerated drink provided significant increase in bond strength at a shorter interval compared to teeth exposed to saliva alone.

Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review.

For fearful and uncooperative children behavioral management techniques are used. In order to control the pain and anxiety in pedodontic patients, pharmacologic sedation, anesthesia and analgesia are commonly used. Midazolam is commonly used as an oral sedation agent in children; it has several features such as safety of use, quick onset and certain degree of amnesia that makes it a desirable sedation agent in children. This review paper discusses various aspects of oral midazolam, ketamine and their combinations in conscious sedation including, advantages of oral route of sedation, pharmacokinetics, range of oral doses, and antagonists for clinical dental treatment procedures.

Distraction osteogenesis for correction of post ankylosis mandibular deformities.

Temporomandibular joint ankylosis, a debilitating disease mainly affecting children, is characterized by progressive restriction of mouth opening and maxilla-mandibular developmental deformities. Craniofacial distraction osteogenesis has been developed as a standard surgical strategy for rectification of craniofacial deformities. The purpose of this study was to assess mono-planar distraction devices for the correction of various mandibular asymmetries in patients with unilateral temporomandibular joint ankylosis who developed restricted mouth opening and mandibular retrognathia. All patients were treated using one-stage distraction osteogenesis followed by temporalis fascia interpositional arthroplasty under general anesthesia. A significant increase in mandibular ramus and base length was observed. Although an increase in anterior lower facial height was observed, it was not significant statistically. A decrease in posterior lower facial height and corpus was observed. Oblique distraction with angular osteotomy allowed lengthening of both the ramus and corpus, yielding satisfactory results and hence eliminating the need of secondary surgery. In conclusion, univector internal distractors are effective for correction of multi-planar mandibular deficiencies by optimizing its placement through meticulous planning.

Molecular and genetic aspects of odontogenic tumors: a review.

Odontogenic tumors contain a heterogeneous collection of lesions that are categorized from hamartomas to benign and malignant neoplasms of inconstant aggressiveness. Odontogenic tumors are usually extraordinary with assessed frequency of short of 0.5 cases/100,000 population for every year. The lesions such as odontogenic tumors are inferred from the components of the tooth-structuring contraption. They are discovered solely inside the maxillary and mandibular bones. This audit speaks to experiences and cooperation of the molecular and genetic variations connected to the development and movement of odontogenic tumors which incorporate oncogenes, tumor-silencer genes, APC gene, retinoblastoma genes, DNA repair genes, onco-viruses, development components, telomerase, cell cycle controllers, apoptosis-related elements, and regulators/conttrollers of tooth development. The reasonable and better understanding of the molecular components may prompt new ideas for their detection and administrating a better prognosis of odontogenic tumors.

Effectiveness of gaseous and intravenous inductions on children's anxiety and distress during extraction of teeth under general anesthesia.

CONTEXT: Anxiety and distress regarding dental treatment is a major issue for dental patients and can be exaggerated in pediatric dental patients. AIMS: The aim was to investigate how different methods of induction for general anesthesia affect children's distress for dental procedures such as extraction of teeth. SUBJECTS AND METHODS: This was an observational clinical study conducted at Manchester University Dental Hospital. The induction of anesthesia in children was achieved with either intravenous (I.V.) or a gaseous induction. The Modified Child Smiley Faces Scales were completed for children at various times intervals. STATISTICAL ANALYSIS USED: There were statistically significant differences between the mean distress scores for the I.V. and inhalation groups (P values from independent t-test: P < 0.001) was applied. RESULTS: In gaseous induction group, the number of children who scored severe and very severe distress was greater than those who were in I.V. group. Gaseous induction was used for 23 children. Preoperatively, 56.5% children were in very severe distress, 17.4% in severe distress, 13% in moderate distress, 8.7% in mild distress and only one (4.3%) showed no distress. For I.V. induction, 11.2% children were in very severe distress, 9% in severe distress, and 9.6% in moderate distress, 24.2% in mild distress and 46.1% showed no distress. CONCLUSIONS: Gaseous induction anesthesia for extractions of teeth does produce high levels of distress than I.V. induction in children for dental extractions. There was no significant difference between both induction methods in terms of distress levels at the time of recovery and 15 min postoperatively.