Patient profiles and success rates under different sedation techniques in a tertiary care center.

OBJECTIVES: Sedation is commonly utilized for individuals otherwise unable to receive dental treatment, such as those with disabilities, medically complex conditions, and dentophobics. The aim was to characterize the profiles of patients receiving various types of sedation and assess the corresponding success rates. METHOD AND MATERIALS: This was a 5-year records-based retrospective study. Data regarding the indication for sedation, medical history, sedation type, and treatments performed were recorded. RESULTS: In total, 103 patients underwent 389 treatment sessions under sedation; 42.7% of the patients were disabled. The most commonly administered sedation was moderate sedation, (49.4%), followed by deep (36.8%) and inhaled sedation (13.9%). Successful treatment results were achieved in 96.1% of sessions, with no adverse effects noted during recovery. The high success rates were independent of patient age, sex, and sedation type. There was a positive association between the indication for sedation and the type of sedation. The medically complex patients and the dentophobic patients received mainly moderate sedation (85.3% and 58.2%, respectively), whereas the disabled patients received deep sedation (51.2%). In total, 94% of patients were returning (re-visiting) patients. A statistically significant association was found between the type of sedation administered and the success rate during the first and last sessions (P < .001). The success rate at the first session may be predictive of the success in subsequent sessions. CONCLUSION: A significant positive correlation was found between patient characteristics and the chosen sedation type leading to a high success rate across the various sedation modalities.

Oxidative stress-mediated proapoptosis signaling: A novel theory on the mechanism underlying the pathogenesis of burning mouth syndrome.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic oral pain disorder characterized by a generalized burning sensation in the oral mucosa without apparent medical or dental causes. Despite various hypotheses proposed to explain BMS pathogenesis, a clear understanding of the cellular-level events and associated histologic and molecular findings is lacking. Advancing our understanding of BMS pathogenesis could facilitate the development of more targeted therapeutic interventions. TYPES OF STUDIES REVIEWED: The authors conducted an extensive literature search and review of cellular mechanisms, focusing on evidence-based data that support a comprehensive hypothesis for BMS pathogenesis. The authors explored novel and detailed mechanisms that may account for the characteristic features of BMS. RESULTS: The authors proposed that BMS symptoms arise from the uncontrolled activation of proapoptotic transmembrane calcium permeable channels expressed in intraoral mucosal nerve fibers. Elevated levels of reactive oxygen species or dysfunctional antiapoptosis pathways may lead to uncontrolled oxidative stress-mediated apoptosis signaling, resulting in upregulation of transmembrane transient receptor potential vanilloid type 1 and P2X 3 calcium channels in nociceptive fibers. Activation of these channels can cause nerve terminal depolarization, leading to generation of action potentials that are centrally interpreted as pain. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The authors present a novel hypothesis for BMS pathogenesis, highlighting the role of proapoptotic transmembrane calcium permeable channels and oxidative stress-mediated apoptosis signaling in the development of BMS symptoms. Understanding these underlying mechanisms could provide new insights into the development of targeted therapeutic interventions for BMS. Additional research is warranted to validate this hypothesis and explore potential avenues for effective management of BMS.

Exploring the Effect of Ethnicity on Chronic Orofacial Pain: A Comparative Study of Jewish and Arab Israeli Patients.

The relationship between ethnicity and chronic pain has been studied worldwide. The population of Israel includes two main ethnic groups, 75% Jews and 21% Arabs. The purpose of this study was to compare orofacial chronic pain characteristics and treatment outcomes between Jewish and Arab Israeli citizens. Two hundred patients admitted to the Orofacial Pain Clinic at Hebrew University-Hadassah School of Dental Medicine between 2017 and 2022 were selected randomly for this historical cohort study. Our cohort included 159 (79.5%) Jews and 41 (20.5%) Arabs. Twenty-six pain-related variables were compared of which only two differed significantly between the two groups, awakening due to pain and mean muscle sensitivity; both indicators were higher in the Arab group (p < 0.05). No differences were found in any of the other variables such as diagnosis, pain severity, onset, and treatment outcome. This minimal difference may be explained by the equal accessibility to medical services for all citizens, and the diversity of our staff that includes Jew as well as Arab service providers. These factors minimize or even eliminate racial bias, language, and cultural barriers, and is reflected in the minor differences in orofacial pain characteristics found between the two main ethnic groups in Israel.

The Impact of Expectation for Pain Relief on Orofacial Pain Treatment Outcomes.

Aims: To examine the effects of expectations for pain relief on the objective and subjective outcome of chronic orofacial pain (OFP) treatment. Materials and Methods: Sixty individuals referred to the Orofacial Pain Clinic at the Hebrew University-Hadassah School of Dental Medicine between 2015 and 2017 with OFP reported their expectation for pain relief upon initial consultation. They were also interviewed by telephone after treatment and asked to recall their expectations, referred to as "recalled expectations" (RE). Correlations between RE and treatment success were calculated from pain diaries, and from subjective pain improvement rates (PIR) reported by the patients. Results: 21 males (35.0%) and 39 females (65%), mean age of 46.90 ± 15.77 years and mean pain duration of 49.07 ± 51.95 months participated in the study. All participants rated their expectations as "10" on a 0 to 10 scale during their first visit. RE did not correlate with diary ratings, (P = 0.773) but inversely correlated (-0.3) with PIR (P = 0.020) treatment outcomes. Conclusions: Expectations for pain relief, reported as 10 on a 0-10 scale during the first appointment, may reflect the patient's desire for complete relief of their pain rather than their expectations. Clinicians should therefore be aware of the need for clear communication and wording when examining for expectations. Inverse correlation between recalled expectations and subjective outcome may be due to the nature of recalled expectations when patients already knew their treatment outcomes, and may be explained by the concept of cognitive dissonance.

Long-term adherence to oral stabilization splints: does pain matter?

OBJECTIVE: Occlusal stabilization splints (OSSs) are first-line therapy for temporomandibular disorder (TMD) and sleep-related-bruxism (SRB). The main goal of this study was to quantify adherence rates to OSS therapy in TMD patients and among non-painful conditions such as clenching and bruxism. It was hypothesized that adherence rates would be similar to those for other chronic conditions. METHOD AND MATERIALS: Medical records of 99 patients seen in the Orofacial Pain Clinic between 2006 and 2014 were reviewed. Patients meeting the inclusion criteria were interviewed over the telephone regarding OSS adherence. RESULTS: Of the 99 patients interviewed, 80 had chronic orofacial pain related to TMD and 19 received OSS due to (non-painful) SRB. Patients were divided according to usage; the USER group (58 patients, 58.6%) used their OSS for more than 1 year; the NUSE group was the remaining 41 (41.4%) patients who used their device for less than 1 year. Of the patients with pain as the reason for OSS use, 50 (62.5%) were in the USER group and 30 (37.5%) were in the NUSE group. The most common diagnosis was masticatory muscle disorders (MMD) with a 71.4% adherence rate, representing 60.3% of the USER group, which was significantly higher than those with SRB and other facial pain (P = .039). The most common reasons for non-adherence were sleep difficulties with OSS (31.6%) and resolution of the problem (25%). CONCLUSIONS: Patients reporting mild to major pain reduction had higher adherence rates than those with complete pain relief or none at all. Patients with MMD exhibited higher adherence rates than those with other facial pain types and SRB.

Inhalation Sedation During the COVID-19 Outbreak: An Expert Opinion.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the pathogen that causes coronavirus disease-2019 (COVID-19), is thought to be transmitted via droplets and aerosols, and was detected in saliva of infected individuals. These droplets from the upper airway may infect the inhalation sedation mask and tubing. The authors determined the adequate measures needed to prevent the transmission of COVID-19 by nitrous-oxide (N2O) system during inhalation sedation in dentistry and provided evidence on mask and tubing sterilization. Additional measures to protect patients and healthcare workers from COVID-19 that may be transmitted by the inhalation sedation system are discussed. The authors recommend minimal use of a N2O system during inhalation sedation in dentistry. In case of need, the practitioners should have more than one scavenger kit and nasal masks for each N2O/O2 mixer. Biologic barriers should be mounted between the scavenger's tubing and the central evacuation system. Strict cleansing and sterilization should be performed for all parts of the N2O system. The use a disposable scavenger system and nasal mask should be considered as a viable option.

Overlap between dental anxiety, gagging and Blood-Injection-Injury related fears - A spectrum of one multidimensional phenomenon.

BACKGROUND AND OBJECTIVES: Dental anxiety (DA) and gagging (GAG) are prevalent problems that severely impact social behavior and quality of life. Furthermore, because dental phobia is considered a Blood-Injection-Injury (B-I-I) phobia, the present study contrasted DA, GAG and control subjects regarding the severity of dental anxiety and investigated the comorbidity of GAG, DA and B-I-I fears. METHODS: Demographics, Verbal Pain Scale (VPS), Oral Health Impact Profile-14 (OHIP-14), Decay, Missing and Filled Teeth (DMFT), Dental Anxiety Scale (DAS) and response to phobic stimuli were collected from 53 GAG, 68 DA and 80 control subjects. RESULTS: GAGs exhibited results between DA and controls regarding the likelihood to have high-anxiety/phobia (DA group: OR=55.56; GAG group: OR=17.24), self-assessed dental anxiety (OR=29.14; OR=17.48), fear of dental injections (OR=8.51; OR=2.91) and dental drills (OR=12.02; OR=5.82). DA and GAG had similar results regarding: DAS score (p=0.13), fear of blood tests (OR=4.68; OR=4.09) and blood donations (OR=3.13; OR=3.10). Overlap between GAG, DA and a B-I-I fear was observed. GAG and DA patients and worse maximal VPS and OHIP-14 scores retained their significant positive association with the DAS score in the multivariate analysis. CONCLUSIONS: The co-occurrence of DA, GAG and B-I-I-related fears suggests these entities are linked. However, different anxiety levels, symptoms and triggers, reflect the broad spectrum of fear of medical/dental situations.

Ultrasound identification and quantitative measurement of blood supply to the anterior part of the mandible.

OBJECTIVE: Recent studies suggest that the main blood supply to the bony chin may be through a single arterial branch of the 2 sublingual arteries that anastomose at the midline and penetrate the bone through the lingual foramen, approximately 13 mm from the lower border of the mandible. The objective of this study was to demonstrate the validity of this hypothesis in vivo, to identify clinically the main blood supply to the bony chin, and to measure its parameters: diameter of vessel, direction of flow, and its volume. Materials and method Ultrasound/doppler measurements and periapical radiographs were taken on 20 healthy volunteers, randomly divided into 2 equal groups in order to compare the method's validity. In the first group, the lingual foramen was identified on periapical radiographs and then ultrasound/doppler measurements were performed. In the second group, this procedure was reversed. RESULTS: Positive identification of the lingual foramina on the periapical radiograph was obtained in 13 subjects compared to 20 subjects by ultrasound/doppler examination. Blood volume measurements were obtained in only 17 subjects. The diameter of the artery was 0.18-1.8 mm and the blood flow from 0.7-3.7 mL/min. CONCLUSIONS: Ultrasound/doppler imaging is a reliable method to visualize and measure the blood supply to the bony chin. It can become an important tool in presurgical assessment of patients who undergo genioplastic procedures, vestibuloplasty, or insertion of dental implants.

Use of dental implants in patients with Down syndrome: a case report.

Down syndrome is caused by trisomy of the 21st chromosome and is associated with well-described physical and systemic problems. Most people with Down syndrome have some degree of mental retardation as well as malformation of head and neck. Oral structures that are commonly affected include the tongue (macroglossia), abnormalities in the number and shape of teeth, and poor quality (osteoporotic-like) of alveolar bone and jaw. These oral malformations as well as a tendency toward poor cooperation in the dental office contribute to the belief among dentists that people with Down syndrome are not good candidates for oral rehabilitation with dental implants. This article describes the use of dental implants in the oral rehabilitation of a 16-year-old boy with Down syndrome. Although more experience is needed before dental implants can be considered a suitable option during oral rehabilitation in people with Down syndrome, this case report shows a promising beginning.