Resolution of Implant-Induced Neurosensory Disturbance: A Procedural Failure.

PURPOSE: This case report describes the improvement of a patient's neurosensory symptoms after the removal of a mandibular implant within 24 hours of initial placement. After 1 year, neurosensory symptoms resolved, and a different sized dental implant was successfully placed at the same surgical site. MATERIALS AND METHODS: A 45-year-old woman experienced neurosensory disturbance along the inferior alveolar mandibular nerve after a dental implant surgery. A panoramic radiograph, obtained within 24 hours of implant placement, suggested a possible case of implant intrusion into the inferior alveolar nerve canal. After thorough evaluation, the implant was removed within 24 hours of initial placement, and the patient was followed up for 1 year. The neurosensory functions of the patient's chin and lower lip regions were assessed before implant removal, and 1 month and 1 year after the removal of the implant. RESULTS: Almost complete resolution of altered sensation occurred 1 year after implant removal. A second, shorter implant was placed at the same site with no subsequent symptoms of impaired sensation. CONCLUSION: This report highlights the plausible placement of a different size dental implant in the same area of previous-implant-induced nerve injury. The authors report that a lack of postoperative radiograph by the surgeon was considered to be a procedural failure.

The practice of oral medicine in the United States in the twenty-first century: an update.

OBJECTIVE: The aim of this study was to describe the practice characteristics of Oral Medicine trained dentists in the United States. METHODS: This study was a cross-sectional survey of members of the American Academy of Oral Medicine. Patient demographic characteristics, referring providers, medical comorbidities, diagnoses, and practitioner information were collected during a 5-day practice week. The survey was open during the years 2011 and 2012. RESULTS: Information from 916 patients was entered by 74 practitioners from 20 states. The mean number of practitioners seen before consulting Oral Medicine providers was 2.2, and patients had experienced symptoms for 16.8 months before the initial encounter. Common chief complaints were nonulcerative mucosal lesions, orofacial pain, and dry mouth. Patients with cardiovascular disease were at a higher risk of developing lichenoid lesions, and those with psychiatric conditions were at higher risk of reporting burning mouth symptoms. CONCLUSIONS: Diagnoses and procedures performed by Oral Medicine practitioners complement practice characteristics of general and specialty dentists in the United States.

Persistent pain and neurosensory disturbance after dental implant surgery: pathophysiology, etiology, and diagnosis.

Many studies have documented the successful outcomes of dental implants, but have also reported the association of sensory disturbances with the surgical implant procedure. Postsurgical pain is a normal response to tissue injury, and usually resolves after the tissue heals. However, some patients who receive dental implants experience persistent pain even after normal healing. This article describes the basic anatomy and pathophysiology associated with nerve injury. The incidence and diagnosis of these problems, in addition to factors that result in the development of chronic persistent neuropathic pain and sensory disturbances associated with surgical implant placement, are discussed.

Persistent pain and neurosensory disturbance after dental implant surgery: prevention and treatment.

Nerve trauma caused by dental implant placement is associated with altered sensation and chronic pain. Complete or partial loss of sensation is often reported by patients who have experienced nerve trauma during implant surgery. Some patients report persistent pain and neurosurgery disturbance long after the normal healing time has passed. In addition, neuropathic pain is reported after implant surgery. Practitioners who place dental implants must be familiar with the differential diagnosis, prevention, and management of neuropathic pain. This article provides insights into the prevention and management of neurosensory deficits and chronic persistent neuropathic pain and considerations for patient referral.

Pre-liver transplant protocols in dentistry.

The number of adults with end stage liver disease in the U.S., awaiting liver transplantation, has maintained a steady upward trend in recent years. Concurrently, the survival rate of liver transplant recipients has also been on the rise. To be able to safely treat this population, dentists should have familiarity with special management requirements of patients with end stage liver disease. This article reviews the historical background on liver transplantation and provides updated information on indications and evaluation protocols, treatment considerations in end stage liver disease, clinical dental management protocols prior to surgical procedures and dental considerations in the pre-liver transplant candidates.

Risk of adrenal crisis in dental patients: results of a systematic search of the literature.

BACKGROUND: The authors performed a systematic search of the literature to identify the frequency of, risk of experiencing and factors associated with adrenal crises in dental patients. METHODS: The authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for English-language articles related to cases of adrenal crisis in dentistry and extracted and analyzed data from the articles. The six authors determined whether the cases identified met a consensus definition of adrenal crisis. RESULTS: Of 148 articles identified in the initial screening, 34 articles were included in the final review, from which six cases met the criteria of adrenal crisis. The authors categorized four cases as "suggestive of adrenal crisis" and two cases as "consistent with adrenal crisis." Risk factors were significant adrenal insufficiency, pain, infection, having undergone an invasive procedure, having received a barbiturate general anesthetic, and poor health status and stability at the time of presentation. The authors estimated risk to be less than one in 650,000 in patients with adrenal insufficiency. CONCLUSIONS: Adrenal crisis is rare in dental patients, with only six reports of it having been published in the past 66 years. Risk is associated with unrecognized adrenal insufficiency, poor health status and stability at the time of treatment, pain, infection, having undergone an invasive procedure and having received a barbiturate general anesthetic. CLINICAL IMPLICATIONS: Risk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.

Chronic focal Langerhans cell histiocytosis of the left mandibular condyle presenting as limited jaw opening: a case report.

Temporomandibular joint (TMJ) disorders are common in the general population, with a particularly high prevalence among girls and women aged 15 to 25 years. The presence of chronic focal Langerhans cell histiocytosis in the mandibular condyle is rare, as only a few cases have been reported in the literature. We present the case of a 23-year-old woman who was referred to the Orofacial Pain Center at the University of Kentucky College of Dentistry with a chief complaint of limited jaw opening of 7 months' duration. She had previously received a preliminary diagnosis of a TMJ disorder and had been treated conservatively, but she did not improve. An initial panoramic film revealed a suspicious radiolucent area at the head of the left mandibular condyle. She was eventually diagnosed on histopathology with chronic focal Langerhans cell histiocytosis. She was treated with condylectomy and surgical curettage of the lesion.