Acute Pain Management.

Control of acute pain in oral and maxillofacial surgery is important for patient care and comfort. Oral surgical procedures are associated with tissue injury and inflammation. Acute pain can arise directly from a surgical procedure or from problems such as dental caries, infection, perforation of maxillary sinus, pericoronitis, and jaw fractures. The major factor in acute pain management is deciding on an appropriate intervention and/or analgesics that will provide the best pain relief. Multimodal pain control has taken a leading role in effectively managing acute pain. This article covers the different options available to dental clinicians.

Excision of Sublingual Gland.

There are 2 types of ranulas: oral ranulas and plunging (cervical) ranulas. The management of the cervical ranula involves surgical excision of the oral portion of the ranula along with the associated sublingual salivary gland. The sublingual gland is easily removed from an intraoral approach. Significant anatomic structures associated with the removal of the sublingual gland are the submandibular duct, lingual nerve, and sublingual artery. Knowledge of the anatomy makes the surgery easier and without complications.

Vertical and Horizontal Augmentation of Deficient Maxilla and Mandible for Implant Placement.

Ridge augmentation for implant procedures has been shown to be highly successful. There are several techniques available to the dentist, but they require some degree of surgical expertise and experience. No particular technique has been shown to be superior. This article presents the indications, techniques, and complications of the various procedures for alveolar ridge augmentation. This information will educate the general dental practitioner of the techniques available and provide information on the surgical procedures that could be used to discuss with patients when they are being referred to a specialist.

New Approaches to Pain Management.

Opioid addiction has reached epidemic proportions in the United States and it is thought that the problem started with the prescription for legal pain medications by health care professionals, particularly for treating patients who had undergone surgery. To reduce the reliance on opioids in dental pain management, increase use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other adjunctive techniques have emerged. The use of NSAIDs, transdermal and transmucosal patches are presented. Understanding the rational for these different approaches requires a basic knowledge of the molecular biology of dental pain.

Odontogenic Tumors.

Odontogenic tumors are a group of neoplastic growths that originate from the tissues responsible for tooth formation and the periodontal apparatus of the jaw. Odontogenic tumors usually present as radiolucent defect, which makes diagnosis somewhat confusing while differentiating them from cysts. Although cystic lesions are surrounded by sclerotic borders, few odontogenic tumors share similar features. This article reviews clinical concepts of several odontogenic tumors that occur in the proximity or in association with teeth and not merely focusing on relatively common conditions.

Salivary Gland Diseases.

A variety of diseases ranging from obstructions, infections, to benign and malignant tumors occur in salivary glands. The most common problem is painful blockage of ducts by stones that prevents drainage of saliva. Sialadenitis can be due to either infectious or noninfectious factors. Bacterial or viral infections are the most common causes of acute sialadenitis. Staphylococcus is the usual bacterial cause, whereas paramyxovirus (mumps) is the common viral cause. Eighty percent of salivary tumors are benign, whereas about 20% are malignant. Most tumors occur in the parotid gland and on the hard palate. Classifications, imaging, and suggested treatment are described.

Epidemiology of Oral and Maxillofacial Infections.

Dental caries and periodontal disease are the most common dental infections and are constantly increasing worldwide. Distribution, occurrence of dental caries, gingivitis, periodontitis, odontogenic infections, antibiotic resistance, oral mucosal infections, and microbe-related oral cancer are important to understand the public impact and methods of controlling such disease. Distribution of human papilloma virus and human immunodeficiency virus -related oral cancers in the US population is presented.

Odontogenic Infections.

The pathogenesis of odontogenic infection is polymicrobial, consisting of various facultative and strict anaerobes. The dominant isolates are strictly anaerobic gram-negative rods and gram-positive cocci. The periapical infection is the most common form of odontogenic infection. Although odontogenic infections are usually confined to the alveolar ridge vicinity, they can spread into deep fascial spaces. Cavernous sinus thrombosis, brain abscess, airway obstruction, and mediastinitis are possible complications of dental infections. The most important element in treating odontogenic infections is elimination of the primary source of the infection with antibiotics as adjunctive therapy.

Medication Management of Jaw Lesions for Dental Patients.

Most pathologic lesions of the jaws or of oral mucosa are treated successfully by surgical interventions. For treatment of the central giant cell lesion, aneurysmal bone cysts, histiocytosis of the mandible, hemangioma, odontogenic keratocyst, Paget disease, oral submucous fibrosis, and oral lichen planus, medical management consisting of intralesional injections, sclerosing agents, and systemic bisphosphonates is as successful as surgical procedures with fewer complications. Pharmacology of agents used and protocols are presented.

Tissue response: biomaterials, dental implants, and compromised osseous tissue.

Tissue response represents an important feature in biocompatibility in implant procedures. This review article highlights the fundamental characteristics of tissue response after the implant procedure. This article also highlights the tissue response in compromised osseous conditions. Understanding the histologic events after dental implants in normal and abnormal bone reinforces the concept of case selection in dental implants.

Implant surface material, design, and osseointegration.

The structural and functional union of the implant with living bone is greatly influenced by the surface properties of the implant. The success of a dental implant depends on the chemical, physical, mechanical, and topographic characteristics of its surface. The influence of surface topography on osseointegration has translated to shorter healing times from implant placement to restoration. This article presents a discussion of surface characteristics and design of implants, which should allow the clinician to better understand osseointegration and information coming from implant manufacturers, allowing for better implant selection.

Violence and abuse: core competencies for identification and access to care.

Violence and abuse (V/A) is recognized as a significant public health problem, especially in females. Injuries to the head, neck, and/or mouth are clearly visible to the dental team during examination. This article provides compelling evidence that supports the pivotal position occupied by oral health care professionals within the arena of detection, intervention, and prevention of V/A. This article reviews the epidemiology of orofacial risk factors for V/A, diagnostic tools and surveys for identifying victims of all ages, and suggests interdisciplinary educational curricula/specific algorithms to provide the necessary core competencies for identifying victims in the oral health care environment.

Bisphosphonate-related osteonecrosis of the jaws--a case report.

Bisphosphonates are commonly prescribed for the treatment of osteoporosis and bone cancers. These drugs come in both intravenous and oral forms. Because these drugs have become more prevalent, there have been increased reports of bisphosphonate-related osteonecrosis of the jaws (BRONJ). This case presentation focuses on a 50-year-old woman with a 10-year history of monthly Zometa (zoledronic acid) use for treatment of multiple myeloma, resulting in BRONJ with a very unfavorable outcome. Its purpose is to depict how the chronic use of intravenous (i.v.) bisphosphonates can lead to bisphosphonate-related osteonecrosis of the jaw (BRONJ), and to present treatment options, including conservative measures, the dentist may be able to employ in the early phases of the disease, along with the indications for jaw resection. Osteonecrosis of the jaws in association with bisphosphonate therapy is a very serious condition with which all dentists should be familiar. When the osteonecrosis begins, it can be very painful to the patient, difficult to treat, and can lead to very deleterious sequelae.

Surgical anatomy of the nasal cavity and paranasal sinuses.

The oral cavity and its bony components (maxilla and mandible), along with the nose and its related sinuses, constitute most of the face. Because of their proximity, disease in one may affect the other, whereas trauma of the midface will involve bones common to the oral cavity, nose, and paranasal sinuses. The two serve important life-supporting functions, being the portals for nutrition and respiration. The paranasal sinuses are pneumatic cavities lined by mucous membrane and communicate directly with the nasal cavity. This article presents a brief but relevant view of the surgical anatomy of the nasal cavity and paranasal sinuses.

Anxiety control in the dental patient.

Oral sedation with benzodiazepines and anxiolysis with nitrous oxide are 2 effective methods to help alleviate anxiety and fear of dental procedures. Many patients would prefer to have their dentistry performed with sedation if it were offered to them. This article presents a detailed discussion on minimal sedation that should give the reader a good understanding of this valuable aspect of clinical care.

Local anesthesia: agents, techniques, and complications.

This article outlines the different classes of local anesthetics available for dental procedures. It also gives an overview of the mechanism of action and metabolism of each different class of local anesthetic. Furthermore, it discusses indications and contraindications of each local anesthetic and the proper dosage of each. The techniques for the administration of local anesthetics with the relevant anatomy are explained. An overview is given of the possible complications that can occur because of local anesthetic use and their possible treatment options.