Combined Transnasal, Transoral Excision of Odontogenic Cysts Offers Reduced Recurrence Rates and Favorable Sinonasal Outcomes.

Odontogenic cysts impact the adjacent dentition and maxillary sinus. A combined transnasal, transoral approach for removal offers reduced recurrence rates and favorable sinonasal outcomes compared with historic transoral-only approaches.

Is maxillary sinusitis and radiographic maxillary sinus opacification associated with an altered microbiology of MRONJ?

OBJECTIVE: Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. STUDY DESIGN: This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. RESULTS: Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. CONCLUSIONS: Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.

Machine Learning and Artificial Intelligence: A Web-Based Implant Failure and Peri-implantitis Prediction Model for Clinicians.

PURPOSE: To develop a machine learning model that can predict dental implant failure and peri-implantitis as a tool for maximizing implant success. MATERIALS AND METHODS: This study used a supervised learning model to retrospectively analyze 398 unique patients receiving a total of 942 dental implants presenting at the Philadelphia Veterans Affairs Medical Center from 2006 to 2013. Logistic regression, random forest classifiers, support vector machines, and ensemble techniques were employed to analyze this dataset. RESULTS: The random forest model possessed the highest predictive performance on test sets, with receiver operating characteristic area under curves (ROC AUC) of 0.872 and 0.840 for dental implant failures and peri-implantitis, respectively. The five most important features correlating with implant failure were amount of local anesthetic, implant length, implant diameter, use of preoperative antibiotics, and frequency of hygiene visits. The five most important features correlating with peri-implantitis were implant length, implant diameter, use of preoperative antibiotics, frequency of hygiene visits, and presence of diabetes mellitus. CONCLUSION: This study demonstrated the ability of machine learning models to assess demographics, medical history, and surgical plans, as well as the influence of these factors on dental implant failure and peri-implantitis. This model may serve as a resource for clinicians in the treatment of dental implants. Int J Oral Maxillofac Implants 2023;38:576-582. doi: 10.11607/jomi.9852.

A Patient with Severe Anxiety and Episodes of Fainting in Need of Dental Restoration.

Patients with extreme dental anxiety and dental phobia are candidates for syncope attacks in a dental chair. Early recognition and management of these episodes is important. Vasovagal syncope is often preceded by prodromal signs and symptoms like facial pallor, diaphoresis, fainting, dizziness, nausea, or vomiting. If any element of the patient's airway, breathing, or cardiovascular system is no longer intact, the provider should commence emergency basic life support protocols and notify emergency medical services immediately.

A Patient with a History of Myocardial Infarction and a Stent Presenting for Full Mouth Extractions.

The scenario presented is of a patient in the dental chair who had history of myocardial infarction and history of stent placed in the left anterior descending coronary artery who now presents with acute chest pain, chest tightness, and extreme dizziness. Confirming cardiopulmonary arrest and beginning basic life support are the first steps in the management followed by defibrillation, advanced cardiac life support, post-resuscitation care, and long-term management.

A Patient with Epilepsy Presenting for a Dental Hygiene Visit.

All dentists should be trained in the diagnosis and management of seizures in a dental chair. Although epilepsy is a common etiological factor, there are other medical situations whereby seizures are manifested. Once a seizure is suspected and other causes of altered consciousness or involuntary motor movements are ruled out, proper management should commence immediately. The first step in management is to immediately remove/stop all provocative factors, like bright flashing lights, drill sounds, and such. Benzodiazepines remain as the first-line treatment for patients with continued seizures before activating emergency medical services.

Foreign Body Aspiration in an Elderly Male with No Significant Medical History.

Accidental foreign body aspiration is not uncommon during a dental procedure and remains a real risk for many dental procedures. Although approximately 50% of patients are asymptomatic after aspiration of a foreign body, understanding the appropriate next steps in management of these patients is critical in preventing morbid and even lethal outcomes in some instances. Appropriate knowledge of identification and management of such instances is important for all practicing dentists. This article goes into the diagnosis and management of both uncomplicated foreign body ingestion and complicated foreign body aspirations.

Diabetic Patient in the Chair for Implant Surgery.

Although dental treatment in a patient with well-controlled type 2 diabetes mellitus is uncomplicated, hypoglycemia is one of the most dreaded complications among diabetics and remains as one of the leading causes of endocrine medical emergencies. Identification and prompt treatment is important to all dental practitioners. This scenario goes into the diagnosis and management of medication-induced hypoglycemia.

A Patient with an Unknown Latex Allergy Presenting for Sealant Placement.

Dentists should be trained to treat any allergic reaction in a dental office, and in this scenario, allergic reaction to latex-based product (rubber dam) is illustrated. Identification of signs and symptoms related to latex allergies is vital, and all dentists should be trained in the appropriate management of such a patient. The dental management of the scenario describes details of the diagnosis and management of latex-related allergies in a dental office for both adults and children.

Penicillin Allergy in a Patient Presenting for Scaling and Root Planing.

Dentists should be equipped to treat any allergic reaction in a dental office and in this scenario, anaphylaxis is noted after administration of a penicillin derivative given before a dental procedure. Identification of signs and symptoms related to anaphylaxis is vital and appropriate management of the patient is the key. The dental management of the scenario goes into the diagnosis and management of anaphylaxis in a dental office.

A Patient with Known Allergy to Local Anesthesia Presenting for a Dental Restoration.

Dentists should be equipped to treat an allergic reaction in a dental office, and in this scenario, the potential allergic reaction is noted after administration of a common local anesthetic lidocaine with epinephrine. The allergic reaction quickly escalates to a full-blown anaphylaxis, and the management of such an episode is detailed in this article.

What is the impact of veterans affairs rotations in oral and maxillofacial surgery residency?

PURPOSE: Oral and maxillofacial surgery (OMS) residencies commonly affiliate with Veterans Affairs Medical Centers (VAMC) to extend care for veterans. This study quantifies the surgical experience of residents at the Corporal Michael J. Crescenz (CMC) VAMC in Philadelphia, Pennsylvania and determines the number of programs affiliated with VA Medical Centers, to enumerate the educational benefits and improve veteran healthcare. METHODS: The dental project manager logs from 2012 through 2021 of the CMC VAMC operating room were analyzed, and cases were categorized into 12 groups. The implant cases from 2012 through 2021 were quantified. Program affiliations were determined using a VA Office of Academic Affiliation report. RESULTS: There were 1359 procedures (760 cases) performed. Dentoalveolar (n = 967) was the most common category, and extractions (n = 384) were the most common procedure. The least cases and procedures were performed in 2012 (n = 14; n = 23). The most cases were performed in 2019 (n = 137), and the most procedures were performed in 2019 and 2021 (n = 255). There were 3133 implants placed. There are 40 OMS programs affiliated with VA Medical Centers; more dual degree (n = 24) than single degree (n = 16) programs having an affiliation. CONCLUSION: The CMC VAMC offers robust dentoalveolar experience and is increasing in surgical volume, representing the expected needs of an aging veteran population. An increasing budget and millions of eligible veterans indicates VA medical centers nationally will continue to provide valuable surgical experiences.

A Snapshot on Oral and Maxillofacial Surgery Resident Scholarly Activity: Can We Do Better?

BACKGROUND: The Commission on Dental Accreditation (CODA) requires oral and maxillofacial surgery (OMS) residents to engage in scholarly activity. Currently, it is unknown how this mandate translates into research output. PURPOSE: The purpose of this study was to quantify the research output of OMS residents. In addition, we sought to identify characteristics associated with resident productivity. STUDY DESIGN: This was a cross-sectional study of all OMS residents during the 2021-2022 academic year. Attempts were made to obtain resident rosters from every CODA-accredited OMS program. Resident names were searched in PubMed (https://pubmed.ncbi.nlm.nih.gov/) to identify peer-reviewed publications. Postgraduate year (PGY), program name, and total publication count during residency were recorded for each resident. Academic status and fellowship affiliation of the residency program were also included. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor was PGY level of each resident. MAIN OUTCOME VARIABLE: The main outcome variable was the publication count of each OMS resident during the 2021-2022 academic year. COVARIATES: The covariates were the academic status and the fellowship affiliation of the residency program. A program was determined academic if they were associated with a dental or medical school. A program was determined fellowship associated if they had any CODA approved fellowship. ANALYSES: Simple bivariate comparisons were performed using Wilcoxon signed-rank tests. RESULTS: Complete resident rosters were identified for 87 residency programs. One thousand one hundred thirty two residents were queried and a total of 548 peer-reviewed publications were identified. There was a mean of 6.30 publications per program and 0.43 publications per resident. More than half of all residents had no identifiable publication. PGY5 residents averaged the most publications per resident (1.45) followed by PGY6 (1.04) and PGY4 (0.63). Academic programs had significantly more publications per resident than nonacademic programs (median of 3.00 vs 0.00, P = .02). Programs with a fellowship association also had more publications per resident (median of 5.00 vs 2.00, P < .01). CONCLUSION: Current CODA research requirements do not translate into resident publications. Publication counts appeared to slightly increase with PGY level; however, OMS resident productivity still lags far behind that of other surgical subspecialties.

Does implant placement using a minimally invasive technique increase early failures among trainees at an academic center?

PURPOSE: This study aims to identify whether dental implants placed using a flapless technique have a higher early failure rate, defined as failure within 6 months of placement, compared to implants placed with flap elevation when a surgical guide is not used. METHODS: A retrospective cohort study was conducted to evaluate implants placed with either flapless (FL) or mucoperiosteal flap (MF) surgery between 2006 and 2012 at the Philadelphia VA Medical Center (PVAMC). Implant status after FL or MF surgery was assessed using dental encounter and radiographs at subsequent follow-up appointments to assess for early implant failures within 6 months of implant placement. RESULTS: The FL technique was used to place 89 implants in 38 subjects, while the MF technique was used to place 381 implants in 139 subjects. Early failure occurred in 37 implants, of which 13 occurred in the FL group and 24 occurred in the MF group. FL surgery was found to be associated with a 265% increase in early implant failure (OR 2.653; 95% CL 1.287-5.469) and was statistically significant (p = 0.0064). Residents were over 200% more likely to have an early implant failure when using the FL technique (OR 2.314; 95% CL 1.112-4.816), CONCLUSIONS: Analysis revealed flapless implant placement was associated with higher early implant failure rates. In addition, early failures were more likely to occur when residents placed an implant using the flapless technique. While FL surgery can result in long-term success, it is a more technique-sensitive approach that requires greater clinical skill and stricter case selection to perform.

Cervicofacial hidradenitis suppurativa: A case report and literature review.

Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the apocrine glands primarily affecting the axillae, perineum, and inframammary regions. It is characterized by painful, inflamed cutaneous lesions causing nodules, sinus tracts, and abscesses. Cervicofacial HS is an atypical presentation of HS in the head and neck region and is scarcely reported in the literature. We present a 34-year-old male who developed a large facial swelling overlying the left inferior mandibular border. Management included surgical incision and drainage, antibiotic therapy, followed by infliximab (Remicade). The purpose of this case report was to highlight the presentation, pathophysiology, interdisciplinary approach to treatment and follow-up of patients with cervicofacial HS, and finally, review the cervicofacial HS literature.

Strategies for managing dental care for refugee patients.

AIMS: To outline key factors that contribute to oral health issues of refugees and asylum seekers and provide management strategies for dental providers to teach desensitization and fear reduction for this special population. METHODS AND RESULTS: We researched published literature in the PubMed database and incorporated lessons gained from treating refugee and asylee patients at a Vulnerable Populations Clinic (VPC) at an urban academic dental school. Refugees and asylees are at high risk for oral conditions due to a tendency to not seek routine dental treatment, psychological stressors, and various systemic factors. Oral health providers can teach patients desensitization and fear reduction by working to gain patients' trust by having effective communication and prioritizing comfort in the dental operatory. Providers should also utilize translation, psychological, and/or multicultural support services during their management of care. CONCLUSION: By having a stronger understanding of the key causes of oral health issues among refugees and asylees in the United States, dental providers can better approach managing care for this vulnerable patient population. The concepts of teaching desensitization and fear reduction utilized for this special population can be applied to managing care for the wider special needs patient community.