ABSTRACT
Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This case report describes a 37-year-old male patient with previously undiagnosed DM1 who received dental care under minimal sedation using intravenous midazolam. During the case, the patient experienced 2 brief episodes of hypoxemia, the second of which required emergency intubation after propofol and succinylcholine and resulted in extended hospital admission. A lipid emulsion (Liposyn II 20%) infusion was given approximately 2 hours after the last local anesthetic injection due to slight ST elevation and suspicion of local anesthetic toxicity (LAST). Months after treatment, the patient suffered a fall resulting in a fatal traumatic brain injury. Complications noted in this case report were primarily attributed to the unknown diagnosis of DM1, although additional precipitating factors were likely present. This report also provides a basic review of the literature and clinical guidelines for managing myotonic dystrophy patients for dental care with local anesthesia, sedation, or general anesthesia.
Subject(s)
Myotonic Dystrophy , Propofol , Adult , Male , Infant, Newborn , Humans , Child, Preschool , Myotonic Dystrophy/complications , Myotonic Dystrophy/diagnosis , Myotonic Dystrophy/therapy , Anesthetics, Local , Hypnotics and Sedatives , Anesthesia, LocalABSTRACT
Introduction: Several techniques such as using citric acid, plastic curettes, ultrasonic devices, and lasers have been suggested for debridement of contaminated implant surfaces. This comparative investigation aimed to assess and compare the effects of Er, Cr: YSGG laser and super-saturated citric acid on the debridement of contaminated dental implant surfaces. Methods: In this in-vitro study, 12 contaminated failed implants were collected and randomly divided into 2 groups (6 in group A, and 6 in group B). Also, one implant was considered as the control. The implants were horizontally sectioned into coronal and apical portions and subsequently irradiated by Er, Cr: YSGG laser in coronal and citric acid in apical in group A and the opposite in group B. In order to evaluate the effect of water spray on the laser section, half the laser portion of the implants was irradiated using water, while the other half was irradiated without water with an irradiation time of 1 minute. Results: Results revealed that calculus and plaque removal was greater in the laser part of both groups (with and without water) compared to citric acid parts and the correlation between calculus removal and surface roughness were statistically significant. Furthermore, the surface roughness in the citric acid parts was significantly higher than in laser parts. Water spray during irradiation had a very small influence on understudy factors. Conclusion: Based on the results of this study, the Er, Cr: YSGG laser was more effective in calculus removal and caused less surface roughness compared with citric acid application.
