Emergency Drugs for the Oral and Maxillofacial Surgeon Office.

This article illustrates the indications and mechanism of action of core emergency medications as well as emergency medications for intravenous sedation in the oral and maxillofacial surgeon office. The recognition of medical emergencies and comprehensive knowledge of pharmaceutical medical intervention can prevent deterioration in medical emergencies. In addition, this article also reviews common dosages as well as administration techniques that should be regularly reviewed and be fundamental knowledge to the oral surgeon and staff.

Pharmacologic Treatment for Temporomandibular and Temporomandibular Joint Disorders.

Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures. Treatments include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery. Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants. Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose. With many pharmacologic treatment options and modalities available to the oral and maxillofacial surgeon, mild to moderate temporomandibular joint disorder can be managed safely and effectively to improve symptoms of pain and function of the temporomandibular joint.

Pharmacologic Management of Neuropathic Pain.

This article aims to provide the practitioner with therapeutic options to treat a broad spectrum of acute and chronic orofacial pain syndromes. The focus will be nonsurgical that the oral health care physician can implement to treat this population of patients. The World Health Organization estimated that more than 1 in every 3 people suffers from acute or chronic pain. This article is primarily devoted to medication management once the diagnosis of neuropathic pain, a true trigeminal neuralgia, or a variant of trigeminal neuralgia often referred to as traumatic neuropathic pain or traumatic trigeminal neuralgia.

The Psychological Well-Being of Medical Versus Dental GME Residents During the COVID 19 Pandemic: A Cross-Sectional Study.

PURPOSE: Trainees are facing isolation and burnout, due to the fear of contracting and transmitting novel coronavirus-19 (COVID-19). There has been a reduction in clinical activities of residents. The purpose of this paper is to measure and compare the psychological well-being of dental versus medical residents during the COVID-19 outbreak. METHODS: This is a cross-sectional study whereby trainees of a hospital in New York City were sent a questionnaire. Participants were from the dental and medical departments. Psychological measures of depression and post traumatic stress disorder were assessed utilizing the Patient Health Questionnaire-9 (PHQ-9) and The Impact of Event Scale-Revised (IES-R) questionnaire. Other variables compared were age, gender, smoking status, living situation and comorbidities. Data analysis utilized chi-squared (X2) and t-tests. Bivariate correlation and linear regression analyses were also utilized. RESULTS: The survey was sent to 19 dental (Dental) and 171 medical (MD) residents. There were 66 participants. The response rate was 63.16 and 35.09% for the Dental and MD residents, respectively. The mean age for the Dental and MD residents, respectively, was 29.62 ± 2.09 and 34.82 ± 9.32 (P = .014). Eighty-one percent of the Dental respondents were male and 33.3% of the MD respondents were male (P < .001). The mean PHQ-9 score was 18.29 ± 2.88 vs 7.24 ± 7.41 for Dental and MD residents, respectively (P < .001). A higher score represents increased severity of depression. The Dental residents scored 61.9 ± 3.90 on the IES-R vs 30.36 ± 24.67 (P < .001). A higher score indicates a greater frequency of intrusive thoughts and avoidance. Forty-two percent of Dental and 13.3% of MD residents tested positive; 25% of Dental and 28.9% of MD residents self-reported symptoms for COVID-19. Being positive or symptomatic resulted in statistically significant higher IES-R and PHQ-9 scores. CONCLUSIONS: Dental residents and being positive or symptomatic for COVID-19 resulted in higher PHQ-9 and IES-R scores. Being aware of the impact of COVID-19 is an important step in providing intervention.

Management of Oroantral Communications.

Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma.

Maxillofacial Bone Grafting Materials: 2021 Update.

For successful outcomes in bone grafting, it is important to have a clear and detailed understanding of the fundamentals and basics in regenerative science. This article summarize the grafting materials and growth factors that are now in use to provide an improved understanding of the properties of each material and indications for subsequent use. The article gives an overview of the fundamentals of bone healing, including the physiology of regeneration. It is hoped that clinicians can make improved decisions that are based in literature when considering treatment options for restoring patients' functional dentition.

Update on Maxillary Sinus Augmentation.

Implant stability is critical to implant success, and the amount of available bone is vital to achieving that end. Because of low-lying maxillary sinuses, adequate alveolar height on the posterior maxilla is often lacking in many patients in need of implant replacement. This chapter reviews both the traditional lateral sinus lift maxillary approach to achieve vertical augmentation as well as the transcrestal osteotome intraoral approach. A discussion of osseodensification will also be mentioned as an alternative approach.

Zygomatic Implants: A Solution for the Atrophic Maxilla: 2021 Update.

Restoring the dentition of an edentulous patient is often challenging. Endosseous dental implants have allowed for far more versatility in this area but still require adequate maxillary and mandibular alveolar bone. Often, unless significant bone grafting techniques are used, true restoration of the dentition can be impossible with traditional endosseous implants. The advent of zygomatic implants, however, may provide a viable, predictable, and stable alternative for the restoration of the dentition in patients with severe maxillary alveolar bone loss.

Clinical Uses of Platelet-Rich Fibrin in Oral and Maxillofacial Surgery.

Platelet-rich fibrin (PRF) is an autogenous material that is derived from a person's own platelets and is used to enhance wound healing and tissue regeneration. Platelet concentrates have been applied in dermatology, pain management, sports medicine, plastic surgery, cardiac surgery, urology, and also dentistry. PRF has garnered significant interest in the dental community because of its proposed regenerative properties and its ability to aid in wound healing. PRF is proposed to have a direct effect on enhancing a patient's wound healing by suprasaturating the wound with growth factors that promote tissue healing. Clinically, PRF is easily produced chairside from the patient's own blood. The autologous nature of PRF makes it preferred over a variety of allografts used in dentistry today. Therefore, PRF has significant potential in being applicable to all areas of dentistry, including oral and maxillofacial surgeries.

Diagnosis and Treatment Approaches to a "Gummy Smile".

Excessive gingival display or "gummy smile" is a growing concern to dental patients and often considered detrimental to an esthetic smile. Gingival display of more than 4 mm of gingiva is considered by many to be unattractive. The cause of the gummy smile can be multifactorial and must be accurately diagnosed to render appropriate treatment. Factors that contribute to the gummy smile include altered passive eruption, lip length, lip hypermobility, incisal wear/crown length, and vertical maxillary excess and gingival hyperplasia. The purpose of this article is to review the etiology, diagnosis, and surgical approaches in treating the gummy smile.

Role of Piezo Surgery and Lasers in the Oral Surgery Office.

Surgical adjunctive instruments and devices are now available for the up-to-date dental/oral surgical office to help mitigate possible surgical complications. Both the laser and Piezo instruments are unique devices that can offer the clinician certain advantages that may prove beneficial in the treatment of his or her patients.

Neuropathic Pain and Burning Mouth Syndrome: An Overview and Current Update.

Burning mouth syndrome/glossodynia and trigeminal neuropathic conditions can have serious negative impact on a patient's overall quality of life. These conditions are often hard to diagnose and even harder to fully treat and manage, but it is important for dentists/oral and maxillofacial surgeons to be aware of these conditions and modalities of their treatment. Often the only method for arriving at the proper diagnosis is for patients to undergo traditional approaches for treatment of presenting signs and symptoms, and it is the unexpected failure of interventional therapies that leads ultimately to a proper diagnosis.

Zygomatic Implants: A Solution for the Atrophic Maxilla.

Even with the great strides made in the techniques for placement of traditional endosseous dental implants, restoration of the dentition in patients with a severely resorbed or resected maxilla can prove challenging. For many decades, significant bone grafting was the mainstay of treatment for these patients. However, zygomatic implants have been shown to provide a stable and predictable alternative for the restoration of the dentition for patients with severe bone loss of the maxilla.

Maxillofacial Bone Grafting Materials.

The goal of bone grafting is to replace normal bone volume and structure with healthy, well-vascularized bone that will undergo normal remodeling. The ideal bone will regenerate bone and not repair it. Currently four types of grafting material are available to clinicians for regenerative use in oral and maxillofacial surgery: autologous bone, allogeneic bone, xenogenic bone, and alloplastic bone. Additionally, bioactive agents, growth factors, are now being used to stimulate osteoinductive properties of native bone for bone regeneration. This article reviews the literature and summarizes the benefits and disadvantages of each respective graft and illustrates its use in clinical practice.

Oral Manifestation of Systemic Diseases.

The US Surgeon General's report Oral Health in America highlighted ways in which oral health and systemic conditions are associated with each other. An oral examination can reveal signs and symptoms associated with systemic diseases. In this article, multiple systemic diseases including but not limited to viral and immune modulated conditions and associated oral symptoms are discussed.

Silent Sinus Syndrome: Interesting Clinical and Radiologic Findings.

Silent sinus syndrome (SSS) describes enophthalmos and hypoglobus in association with disease of the maxillary sinus. This syndrome has rarely been presented in the dental literature. Many dentists are not familiar with the syndrome and its associated clinical and radiologic features. A 57-year-old female patient presented to the Oral and Maxillofacial Surgery Outpatient Clinic at The Brooklyn Hospital Center for a routine dental examination. During this examination, she indicated that she felt her right eye had been sinking. Routine dental panoramic radiography showed opacification on the right maxillary sinus. Maxillofacial computed tomography showed a small maxillary sinus with retraction of the sinus walls. The floor of the orbit was thinned, causing hypoglobus. Obstruction of the right ostiomeatal complex was noted, with complete opacification of the right maxillary sinus. A diagnosis of SSS was made. SSS usually occurs in individuals in the third to fifth decade of life. It presents with enopthalmos and hypoglobus. On imaging, a small and opacified maxillary sinus is visualized with retraction of the orbital floor and a blocked ostiomeatal complex. Management includes functional endoscopic sinus surgery. The orbital floor can be reconstructed during the same operation, at a later date, or not at all. Knowledge about SSS can lead to prompt diagnosis and treatment recommendations while avoiding unnecessary diagnostic tests.