Increased postoperative pain and consumption of analgesics following acupuncture.

Acupuncture was given to patients before (preoperative-acupuncture group, PRE-ACU, n = 25) or after (postoperative-acupuncture group, POST-ACU, n = 25) operative removal of impacted mandibular third molars. Sixty patients did not receive acupuncture and participated as a control group (CG). All patients completed a questionnaire in order to characterize state tension and stress, degrees of neuroticism, extroversion, depression and psychosomatic disorders. We also recorded intraoperative discomfort and pain intensity, postoperative pain intensity and consumption of analgesics for 72 h. The PRE-ACU was significantly more tense following surgery and found the operative procedure more unpleasant than the other two groups. The PRE-ACU further rated intraoperative pain intensity higher than the CG and experienced higher pain intensity immediately postoperatively compared with POST-ACU and CG. Of the PRE-ACU patients 15/24 needed additional local anesthesia intraoperatively while none in the POST-ACU or CG requested extra lidocaine. Postoperatively patients in both PRE- and POST-ACU reported a higher total sum of pain scores (pain intensity) and the PRE-ACU consumed more analgesics compared with the CG. A significantly larger number of patients suffering from "dry socket" (a complication during wound healing) was found in both PRE- and POST-ACU compared with the CG. No correlation was found between assessed personality characteristics and reported postoperative pain/consumption of analgesics in any group and could thus not explain the observed differences between the groups. The reason for our unexpected "negative" findings is unclear but some hypothetical explanations are discussed.

Pain development and consumption of analgesics after oral surgery in relation to personality characteristics.

In the present study a survey has been performed of the pain development and analgesic intake in 100 patients following elective oral surgery of impacted third molars in relation to preoperative assessment of personality characteristics. Our results show that no sex differences existed preoperatively concerning personality characteristics, concerning postoperative pain development or analgesic consumption. Fourteen patients reported no pain at all and 40 patients did not use any analgesics in the postoperative period. We also found a good correlation between total sum of pain scores and analgesic intake. Patients undergoing surgery in the morning reported a lower total sum of pain scores, reported pain at fewer occasions and tended to require less analgesics than patients being subjected to surgery in the afternoon. The patients who reported a total sum of pain scores in the upper percentile during the postoperative period rated their general health worse, as rated on the General Health (GH) questionnaire, and used more analgesics than did patients in the lower percentile. Also, patients not using any analgesics reported less symptoms of distress according to the GH scale as compared to patients using analgesics. In general, however, less than 10% of the variance in postoperative pain and consumption of analgesics could be explained by the preoperative factors studied.

Ectodermal dysplasia with partial anodontia: prosthetic treatment with implant fixed prosthesis.

In cases with severe hypodontia, it is necessary to make a treatment plan in collaboration with different disciplines in dentistry, with the treatment plan formed in such a way that many possibilities for treatment could be used in the future. Partial and full dentures combine simple methods with good esthetic and functional results in the growing individual. They also afford time to assess the patient with regard to more extensive restorative treatment. Patients suffering from severe hypodontia have so far been very dependent on their remaining teeth. The case reported covers a twenty-year period of dental treatment, and shows a new possibility provided by osseointegrated implants.

Miniplate osteosynthesis of infected mandibular fractures.

Miniplate osteosynthesis in cases of infected mandibular fractures in patients with reduced healing capacity and lack of cooperation has been evaluated. Thirty seven patients with 42 potentially infected mandibular fractures were treated by internal fixation with miniplates. Healing occurred in all cases. Postoperative infection was noted in 9 patients. Aspects of healing and indications for the method are discussed.

Is acupuncture sufficient as the sole analgesic in oral surgery?

Twenty-six patients who were undergoing operative removal of an impacted third molar were given acupuncture as an alternative to conventional local analgesia. Pain ratings during different stages of the surgical procedure showed that gingival and periosteal incisions were tolerated, with only minor pain experienced by 18 of the patients. During mucoperiosteal flap dissection 12 patients experienced unacceptable pain. In total, only 2 of the patients tolerated the entire procedure; however, they reported severe pain during the final part of the operation. In conclusion, it seems that acupuncture as performed in the present study could not subserve as a routine method for analgesia in this type of operative procedure.

Diagnosis and treatment of the unicystic ameloblastoma.

Two cases of unicystic ameloblastoma are presented. The lesions were pain-free and expanded the mandible. They were removed by curettage. Recurrent lesions had similar clinical appearances and histological pictures compared to the original lesions. The unicystic ameloblastoma manifested itself as a cystic cavity without solid neoplastic features, which differs from the solid ameloblastoma with regard to the age of the patients and the rate of recurrence. The behavior of the unicystic ameloblastoma was similar to that of the primordial cyst. Despite the obvious risk of recurrence, conservative treatment with enucleation and curettage seemed to be justified in preference to mutilating radical surgery.

Influence of naloxone on relief of acute oro-facial pain by transcutaneous electrical nerve stimulation (TENS) or vibration.

Twenty-eight patients suffering acute pain following operative removal of impacted third molars took part in the present study. In 20 patients who reported pain reduction exceeding 25% of the initial pain intensity during vibratory stimulation (100 Hz) or TENS (2 or 100 Hz), only 1 patient (given 2 Hz TENS) reported pain increase after injection of 0.8 mg naloxone (i.v.). In 8 patients, not treated with afferent stimulation, 2 experienced increase in pain intensity after naloxone injection. The results show that pain relief using TENS or vibration is not influenced by naloxone.

A clinical and radiographic evaluation of cultivated and autotransplanted human teeth.

A vital periodontal membrane (PDM) is of ultimate importance for a successful periodontal healing of auto-transplanted teeth. It has been suggested that a damaged PDM may heal during an intermediate tissue culture period. In the present study, 26 canines, bicuspids and third molars were surgically removed and cultivated in a modified Eagle's medium for 3 to 17 weeks. The teeth were then transplanted to their new positions. 11 out of 18 (61%) transplanted teeth with complete root formation and 7 out of 8 (88%) transplanted teeth with incomplete root formation healed with an apparently normal periodontal ligament. 5 teeth, all canines, became ankylotic. Tissue cultivation of teeth to be transplanted resulted in approximately the same healing rate as has been reported for autotransplanted teeth without the tissue culture procedure.