Effect of plasma rich in growth factors on alveolar osteitis.

INTRODUCTION: The high prevalence of dry socket or alveolar osteitis (AO) is of concern in surgical removal of third molars. The aim of the present study was to assess the preventive effect of plasma rich in growth factors (PRGF) on AO and also its effect on pain management and healing acceleration in third molar extraction sockets of high-risk patients. MATERIALS AND METHODS: This split-mouth, double-blind clinical trial included 40 bilateral third molar extractions (80 sockets) with at least one identified risk factor for AO. PRGF was obtained from patient's own blood, based on manufacturer's instruction, and blindly placed in one of the two bilateral sockets (PRGF group; n = 20) of each patient. The contralateral socket was treated with a placebo (control group; n = 20). Samples were evaluated for AO and pain incidence on days 2, 3 and 4 and healing and infection on days 3 and 7. Data were analyzed in SPSS v16 using Wilcoxon test. RESULTS: There was a significant difference in dry socket and pain incidence and healing rate between the two groups. Intensity of pain and occurrence of dry socket in the study group was lower than the controls. Also the healing rate was higher (P < 0.05) for the PRGF group. No sign of infection was seen in either group. CONCLUSION: The application of PRGF may significantly reduce the incidence of AO or its associated pain and may accelerate healing. The prophylactic use of PRGF following third molar extraction may be suggested especially in the patients at risk of AO.

Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report.

OBJECTIVE: Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment. STUDY DESIGN: We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software. RESULTS: Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P < .001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P < .001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P < .001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients. CONCLUSION: This study supports other similar studies and shows that BTX-A is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery.

Calcified carotid artery atheromas on panoramic radiographs of dental patients with diabetes.

BACKGROUND: Diabetes mellitus accelerates atheromas increasing the risk of a stroke. MATERIALS AND METHODS: Panoramic radiographs of 32 men and 28 women with diabetes mellitus were studied. RESULTS: Radiographs showed 28.5 percent type 2 and 37.5 percent type 1 diabetes mellitus patients had atheromas. CONCLUSION: Compared with the 5 percent atheroma rate reported among healthy people, rates were significantly higher in diabetes mellitus patients. CLINICAL IMPLICATIONS: Dentists treating diabetes mellitus patients may encounter atheromatous lesions on panoramic radiographs and refer them for treatment.

Asymptomatic carotid artery calcifications discovered on panoramic radiography.

This article presents the case of a 50-year-old asymptomatic man whose panoramic radiograph revealed calcium deposits within the left internal carotid bifurcation region. Subsequent duplex ultrasonic examination indicated unilateral low-grade carotid arterial stenosis, a condition associated with a significant risk of stroke, which had not been identified previously. The findings on the panoramic radiograph prompted appropriate and potentially lifesaving treatment. Dentists who are well-versed in diagnosing calcified plaques on panoramic radiographs can play a major role in the early referral and treatment of undiagnosed asymptomatic patients.