Permanent vision loss in one eye following administration of local anesthesia for a dental extraction.

Prilocaine Plain, an amide local anesthetic (LA), is somewhat less potent than lidocaine and considerably less toxic after injection into peripheral tissues. Clinically, it produces less vasodilation and is similar to other amide LA in relative freedom from allergic reactions. It is reliably used in a plain solution for cardiac patients receiving short procedures. In this report a patient with a known diagnosis of bacterial endocarditis suffered permanent visual loss in the left eye immediately following dental extraction surgery prior to mitral valve surgery. The clinical implications indicate that the delivery of LA must be done with aspiration before and during the injection. This will possibly prevent intravascular injection, which can lead to fluid emboli occluding the ophthalmic artery with the devastating result of vision loss.

Treatment of temporomandibular joint ankylosis: a case report.

Bony ankylosis of the temporomandibular joint (TMJ) in a male patient was not diagnosed until the patient reached his early teens, at which time the condition was treated with a costochondral graft. At the time of treatment, there was an expectation that further orthognathic surgery would be required to correct the skeletal deformity. However, with the release of the ankylosis and growth of the costochondral graft, a good functional and esthetic result was achieved without further surgery. It is important that family dentists be aware of the clinical signs and symptoms of TMJ ankylosis, to allow early diagnosis and treatment.

Basal cell carcinoma: what dentists need to know.

BACKGROUND: Basal cell carcinoma, or BCC, is a malignant epithelial tumor of the skin, commonly seen in the head and neck. Because dentists routinely evaluate the head and neck, the authors present three examples of BCC of the face and jaw to help clinicians recognize the condition. They also provide a literature review regarding BCC's etiology, classification, treatment and prevention. DESCRIPTION OF THE DISEASE: Sun exposure plays an important role in the development of BCC. The most susceptible people are those with minimal skin pigmentation. BCC is more frequently seen in men than in women. The most common form of BCC is the nodular type, which, if untreated, eventually ulcerates and may result in extensive local tissue destruction. The three cases described in this article highlight the range of BCC severity. CLINICAL IMPLICATIONS: Oral health care providers may play an important role in the recognition and diagnosis of BCC involving the head and neck. Early recognition and diagnosis may lead to management that results in improved cure rates, with reduced morbidity and reduced treatment costs.

The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radiation therapy.

Changes in the quantity of Streptococcus mutans, Lactobacillus species, and yeast Candida species were assessed in a cancer population undergoing head and neck radiation. The purpose of this study was to evaluate the effectiveness of a custom vinyl tray-applied fluoride gel to control cariogenic bacteria in a group experiencing hyposalivation because of radiation treatment. Twenty-two subjects participated in the study and served as their own controls. Whole resting and whole stimulated saliva were collected at weekly appointments beginning 1 week before and concluding 4 weeks after radiation therapy. Colony-forming units per mL of Streptococcus mutans and Lactobacillus species and semiquantitative counts of Candida species (0 = none; 1 = light; 2 = moderate; 3 = heavy) were determined from collected saliva. All patients were provided with custom vinyl vacuform mouthguards to be used daily with neutral fluoride gel (1.1% sodium fluoride). Whole stimulated and resting saliva productions decreased by 36.67% and 47.9%, respectively, by the end of 1 week of radiation therapy, and they remained low. No significant changes in cariogenic oral flora were seen during and early after radiation therapy, despite xerostomia. However, colonization by Candida albicans increased during radiation therapy for oropharyngeal cancers. Findings from this study suggest that changes in cariogenic flora may be suppressed through the use of daily topical neutral sodium fluoride gels and that colonization by Candida albicans increase during radiation therapy.