Patient's perception of recovery following surgical removal of mandibular third molars. A prospective european multi-center study.

This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.

Saliva changes in Parkinson's disease patients after injection of Botulinum neurotoxin type A.

Patients with Parkinson's disease (PD) are compromised by poor oral condition due to oropharyngeal bradykinesia, dysphagia, and the side effects of treatment. Intrasalivary gland injections of Botulinum neurotoxin type A (BNT-A) have been known to treat sialorrhea effectively in these patients. However, the decreased amount of saliva reduces self-cleaning ability that deteriorates oral hygiene and increases dental caries. The aim of this study was to determine the changes in the oral microflora and saliva in patients with PD treated for sialorrhea by means of sonography-controlled BNT-A injections into the bilateral parotid and submandibular glands. Altogether, 38 persons participated in the study: 12 PD patients who were injected with BNT-A for treatment of sialorrhea and passed salivary tests before and 1 month after the injections; and 13 PD patients and 13 healthy subjects who were not injected with BNT-A and passed salivary tests once. The condition of oral health was measured by the amount of saliva, salivary flow rate, and salivary composition. A good outcome with a significant decrease in salivary flow rate occurred at 1-month follow-up in the BNT-A-treated group while no significant change was found in salivary composition. BNT-A treatment did not change the Streptococcus mutans levels in saliva but there was statistically significant increase in levels of Lactobacilli. BNT-A injections can effectively treat sialorrhea while considering the change of oral microflora, and the patients should be under dentists' care more frequently. EudraCT clinical trial number: 2015-000682-30.

Does Botulinum neurotoxin type A treatment for sialorrhea change oral health?

OBJECTIVES: Botulinum neurotoxin type A (BNT-A) intrasalivary gland injections in patients with neurological disorders have been known to effectively treat hypersalivation. However, oral health can be compromised with increasing the dose. The aim of this study was to find out the therapeutic effect of low-dose, ultrasonography-controlled BNT-A injections into the bilateral parotid and submandibular glands on oral health in the treatment of sialorrhea. MATERIAL AND METHODS: Twenty patients diagnosed with Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and other neurological disorders, including stroke or birth trauma, received BNT-A injections with salivary tests before and 1 month after the injections. Drooling was evaluated using subjective scales and objective assessment of salivary flow rate and oral health (salivary composition and cariogenic bacterial counts). RESULTS: A significant decrease was found in salivary flow rate at 1- and 3-month follow-up in the BNT-A treated group. There was no significant change in salivary composition or cariogenic bacterial counts. CONCLUSION: BNT-A injections according to the current protocol can effectively manage sialorrhea while maintaining oral health. CLINICAL RELEVANCE: Oral health can be considered the mirror of general human health, as the cause of many diseases. Saliva plays a crucial role in protecting the oral cavity. The present study is of high clinical relevance because, although earlier research has proved the effect of Botulinum neurotoxin type A injections on reduction in saliva flow, data about the risks of the treatment method to the oral condition through affecting saliva composition has so far been missing.

The effect of prednisolone on reduction of complaints after impacted third molar removal.

UNLABELLED: Nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids are able to effectively reduce postoperative sequels after impacted third molar removal. The purpose of this study was to evaluate whether a single dose of prednisolone, taken orally immediately after the operation, would increase the effects of etorikoxib (Arcoxia(R)) NSAID in preventing trismus and swelling after surgical removal of impacted third molars. PATIENTS AND METHODS: This prospective study was conducted in a half-year period on 78 patients who had undergone third molar surgery under local anaesthesia. They were divided into two groups: prednisolone group (38 patients) and control (40 patients). In the prednisolone group 30 mg prednisolone was given to each patient immediately after surgery. Both groups had received Etorikoxib 120 mg 30 minutes before operation. They had to complete a questionnaire evaluating postoperative symptoms. Postoperative pain, facial swelling and trismus were evaluated. RESULTS: Postoperative administration of 30 mg prednisolone to the patients relieved trismus, swelling and pain more than non-administration of prednisolone in the control group. There was significantly less swelling on the first four postoperative days in the prednisolone group compared to control (p<0.05). The values of the maximal interincisal opening (MIO) and visual analogue scale (VAS) were higher for the prednisolone group than for the control group (p<0.05). No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted. CONCLUSION: It was found that a combination of a single dose of prednisolone and Etorikoxib is well-suited for treatment of postoperative pain, trismus, and swelling after third molar surgery and should be used to diminish postoperative swelling of soft tissues.