Oral manifestations in women using hormonal contraceptive methods: a systematic review

OBJECTIVES

To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods.

MATERIALS AND METHODS

This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined.

RESULTS

Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias.

CONCLUSIONS

Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome.

CLINICAL RELEVANCE

The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.

Hyaluronic acid in tooth extraction: a systematic review and meta-analysis of preclinical and clinical trials

OBJECTIVES

To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment.

MATERIALS AND METHODS

Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies.

RESULTS

Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected.

CONCLUSIONS

HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth.

CLINICAL RELEVANCE

HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.

A modified triangular flap suture method used for inferior third molar extraction: A three-arm randomized clinical trial for the assessment of quality of life

BACKGROUND

The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction.

MATERIAL AND METHODS

This study used a three-arm randomized design that included 90 individuals. Patients were randomized and divided into three groups-the airtight suture group (traditional), the buccal drainage group, and the no-suture group. Postoperative measurements, including treatment time, visual analog scale, questionnaire on postoperative patient quality of life, and details about trismus, swelling, dry socket, and other postoperative complications were obtained twice and the mean values were recorded. To verify the normal distribution of the data, the Shapiro-Wilk test was performed. The statistical differences were evaluated using the one-way ANOVA and the Kruskal-Wallis test with Bonferroni post-hoc correction.

RESULTS

The buccal drainage group showed a significant decrease in postoperative pain and better speech ability than the no-suture group on the 3st day, with a mean of 1.3 and 0.7 (P < 0.05). The airtight suture group also showed similar eating and speech ability, which was better than the no-suture group, with a mean of 0.6 and 0.7 (P < 0.05). However, no significant improvements were noted on the 1st and 7th days. The surgical treatment time, postoperative social isolation, sleep impairment, physical appearance, trismus, and swelling showed no statistical difference between the three groups at all measured times (P > 0.05).

CONCLUSIONS

Based on the above findings, the triangular flap without a buccal suture may be superior to the traditional group and no-suture group in less pain, and better postoperative patient satisfaction in the first 3 days and may be a simple and viable option in clinical practice.

Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis

BACKGROUND

Corticosteroids are used to manage pain after surgical tooth extractions. The authors assessed the effect of corticosteroids on acute postoperative pain in patients undergoing surgical tooth extractions of mandibular third molars.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic review and meta-analysis. The authors searched the Epistemonikos database, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the US clinical trials registry (ClinicalTrials.gov) from inception until April 2023. Pairs of reviewers independently screened titles and abstracts, then full texts of trials were identified as potentially eligible. After duplicate data abstraction, the authors conducted random-effects meta-analyses. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool and certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Forty randomized controlled trials proved eligible. The evidence suggested that corticosteroids compared with a placebo provided a trivial reduction in pain intensity measured 6 hours (mean difference, 8.79 points lower; 95% CI, 14.8 to 2.77 points lower; low certainty) and 24 hours after surgical tooth extraction (mean difference, 8.89 points lower; 95% CI, 10.71 to 7.06 points lower; very low certainty). The authors found no important difference between corticosteroids and a placebo with regard to incidence of postoperative infection (risk difference, 0%; 95% CI, -1% to 1%; low certainty) and alveolar osteitis (risk difference, 0%; 95% CI, -3% to 4%; very low certainty).

PRACTICAL IMPLICATIONS

Low and very low certainty evidence suggests that there is a trivial difference regarding postoperative pain intensity and adverse effects of corticosteroids administered orally, submucosally, or intramuscularly compared with a placebo in patients undergoing third-molar extractions.

The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review

This systematic review answered the guiding question using the PICO system: "What are the effects of advanced platelet-rich fibrin (A-PRF) on alveolar ridge preservation and tissue gain in reconstructive and jaw graft surgery?" Searches were performed in the PubMed|MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and LILACS|bvs databases. In total, 573 articles were found in the initial search, and 564 were evaluated after the removal of duplicates, of which 5 randomized controlled trials met the eligibility criteria and were included 2 studies investigated the effect of A-PRF on the preservation of the bone ridge, 1 study evaluated the tissue repair after tooth extraction with A-PRF, 1 evaluated the peri-implant gap filling with A-PRF-xenograft mixture, and other the A-PRF on the treatment of alveolar osteitis. Advanced-PRF preparation protocol varied between the included studies from 8 to 13 minutes of centrifugation, at 1300 RPM (200 g ). The use of A-PRF provided greater dimensions of height and more favorable maintenance of the ridge profile, probing depth, and gingival margin level after extraction. Advanced-PRF also increased bone density, vital bone, epithelial healing, and control of postoperative pain and swelling after tooth extraction and in the treatment of alveolar osteitis.

Does Chlorhexidine Prevent Complications in Extractive, Periodontal, and Implant Surgery? A Systematic Review and Meta-analysis with Trial Sequential Analysis

PURPOSE

This systematic review aimed to assess the effect of chlorhexidine (CHX) in preventing complications after extractive, implant, and periodontal surgery.

MATERIALS AND METHODS

The PICO question set for this systematic review was: "Is the use of chlorhexidine formulations able to prevent complications (safety) in patients undergoing procedures of either oral surgery, dental implantology, or periodontology compared to treatment procedures in patients without a chlorhexidine prescription?" Once inclusion and exclusion criteria were established, a search was carried out independently by two researchers on PubMed/MEDLINE, Scopus, and Web of Science. The primary outcomes investigated were the rate of alveolar osteitis and bacteremia after surgical procedures in oral surgery. Meta-analysis and trial sequential analysis (TSA) were performed in order to evaluate the findings.

RESULTS

After the selection, the 32 studies that fully met the eligibility criteria were considered in this systematic review. A meta-analysis was only possible for data obtained from studies related to extractive surgery. Meta-analysis and TSA showed a statistically significant decrease in the rate of alveolar osteitis after tooth extraction when CHX was employed compared with placebo treatments or treatments not using CHX (RR = 0.49; 95% CI: [0.40, 0.60], P < .001; I² = 8%). Focusing on the rate of bacteremia, meta-analysis and TSA showed how the employment of CHX (RR = 0.87; 95% CI: [0.79, 0.96], P = .004; I² = 4%) decreases the rate of bacteremia after extractive surgery. Data from the literature seem to lack in the evaluation of CHX use for the reduction of complications in periodontology and implant dentistry.

CONCLUSION

This systematic review showed with a good power of evidence that CHX employment reduces alveolar osteitis and bacteremia rates after dental extractions.

Comparison of primary and secondary closure with a buccal mucosal-advancement flap on postoperative course after mandibular impacted third molar surgery

PURPOSE

The purpose of this study was to compare primary and secondary wound closure with a buccal mucosal-advancement flap technique on the postoperative course after mandibular impacted third molar surgery.

METHODS

The study was conducted on 150 patients who required surgical removal of impacted mandibular third molars under local anesthesia. The study subjects were divided into three groups of 50 patients each, based on the type of closure over the third molar socket. Patients in group I underwent primary closure of the socket with hermetic suturing of the flap, including the vertical release. In group II, a secondary closure was performed, leaving the socket communicating with the oral cavity. In group III, a buccal mucosal-advancement flap technique was employed to achieve primary closure of the flap over the socket while leaving the anterior vertical release, generously patent. All the patients were assessed for pain using the visual analogue scale (VAS), swelling, and mouth opening at postoperative intervals of 2, 4, and 7 days. The wound healing was assessed on day 7.

RESULTS

Patients in the buccal mucosal-advancement flap group had significantly less pain and swelling and increased mouth opening compared with primary and secondary closure. Wound dehiscence was seen in 18 patients and alveolar osteitis in 4 patients in primary closure. Delayed wound healing with food accumulation was seen in 6 patients in secondary closure. No complications of flap dehiscence or breakdown were observed in the buccal mucosal-advancement flap group.

CONCLUSION

This study concludes that the buccal mucosal-advancement flap technique was a superior closure technique with less pain, swelling, trismus, and satisfactory wound healing compared with both primary and secondary closure after mandibular third molar surgery.

Choice of the treatment method of the inflammatory process in the alveolar tooth socket

INTRODUCTION

Alveolitis – is one of the most common complications in surgical dentistry after tooth extraction and their roots, accompanied by symptoms, the leading of which are pain in the alveoli with irradiation and partial or complete decay of the blood clot. The aim of our research is to study the clinical efficacy of antihomotoxic drugs and colloidal silver in patients with inflammatory processes in the alveolar tooth socket.

MATERIAL AND METHODS

58 patients with inflammatory process in the alveoli after extraction of teeth or their roots (38 - female, 20 - male), aged 18-60 years, were examined with the help of clinical and microbiological, cytological study. The main group consisted of 38 patients who were prescribed complex drug therapy after diagnosis of alveolitis. 20 patients were referred to the control group where allopathic treatments were used.

RESILTS

The main observation group in 93% ± 0.07% of patients with serous form alveolitis already on the 2nd day disappear pain, redness, swelling of the soft tissues. Gradually, the function of the mandible and the temperature response were restored. In purulent alveolitis, the function of the jaw was restored on days 3 and 4. Patients in the control group experienced a slow course of the inflammatory process in the wound, a late decrease in local pain response, swelling and hyperemia of the wound edges. Jaw function recovery averaged 3.4 ± 0.1 days longer.

CONCLUSIONS

The complex effect of drug and surgical treatment of alveolitis was studied. The combined use of colloidal silver, Traumeel® S, Polymic®, makes it possible to eliminate the inflammatory process in the alveoli faster and to reduce the period of active disease up to 2 - 3 days.

[Research of TC-PHBHHx/β-TCP compounds for treatment of dry socket in SD rats]

PURPOSE

The effects of different compounds on dry socket were evaluated in order to find a new method that can both be antibacterial and osteogenic,providing experimental evidence for future clinical application.

METHODS

Seventy-two male SD rats, with upper left anterior teeth been extracted, were infected by pus to result in dry socket.Seven days later, they were allocated randomly and evenly into 4 groups and received different treatment, i.e. group A: debridement; group B: debridement and filled with iodoform gauzes; group C: debridement and filled with periocline; group D: debridement and filled with TC-PHBHHx/β-TCP. After being treated for 1,4,8 weeks, sequential fluorescent labeling was performed. The animals were sacrificed after the procedure and hard tissue and decalcified sections were harvested for histological and histomorphometrical evaluation. Statistical analysis was performed using SPSS 19.0 software package.

RESULTS

At the same time point, the results of osteogenesis in group A, B and C were not significantly different while the results in group D was significantly different from other groups; accordingly, significant new bone formation was observed. At different observation time, the bone area in group B and C were not significant different over time. In group A, little new bone formation was found but surrounded by a large amount of inflammatory cells at 8 week. However, group D showed bone area increasing gradually with time.

CONCLUSIONS

TC-PHBHHx/β-TCP has significant anti-inflammatory and osteogenic effects. Iodoform gauzes and periocline have good anti-inflammatory results but not significant osteogenic effects.

[Alveolar osteitis treatment using Holisal gel]

The aim of the study was to estimate efficiency Holisal in treatment of the alveolar osteitis. 30 patients with the diagnosis of alveolar osteitis with clinics of dry socket, aged from 25 to 69 years entered a research. Patients were divided into 2 groups: in the 1st group (n=15) patients received treatment by a standard technique with the use of the iodoform gauze. In the 2nd group patients (n=15) after preliminary training used Holisal 4 times a day applying it in the socket. In both groups dynamics of clinical indicators, complaints, biochemical indicators on the 3, 5 and 10 day after the beginning of treatment were estimated. The use of Holisal for treatment of the alveolar osteitis presenting as a dry socket is effective and has advantages in comparison with a conventional technique of alveolar osteitis management.

[Comparison of minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar]

PURPOSE

To compare minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar.

METHODS

One hundred and sixty patients with impacted mandibular third molar were equally divided into two groups. Patients in the experimental group were treated with minimally invasive extraction, using implant machine and luxator, while patients in the control group were treated with traditional methods including use of orthodox chisel. The operation time, intraoperative and postoperative complications including deformation of extraction sockets, dry socket, limitation of mouth opening, pain and swelling, and fear were observed and compared between the two groups. The data were analyzed with SPSS18.0 software package.

RESULTS

The operation time was (17.32±1.01) min in the experimental group, significantly shorter than the control group which was (33.46±1.12）min (P<0.05); significant difference was found in the incidence of root fracture, medium or severe tooth sockets deformation and incidence of psychological fear during operation between the control group and experimental group(P<0.05); the degree of mouth opening after surgery, the incidence of moderate or severe pain after surgery was significantly lower in the experimental than in the control group(P<0.05).

CONCLUSIONS

Minimally invasive extraction of mandibular impacted wisdom tooth is better than traditional method, with shorter operation time and less intraoperative and postoperative complications, which should be widely applied in clinic.

[Evaluation of the results of high-speed handpiece and minimally invasive extraction in impacted mandibular third molar extraction]

PURPOSE

To compare the results of high-speed handpiece and minimally invasive extraction in impacted mandibular third molar extraction.

METHODS

From May 2011 to May 2014, 83 patients undergoing impacted mandibular third molar extraction were enrolled into the study and randomly divided into 2 groups: 42 patients in group A (experimental group) and 41 patients in group B (control group). Group B underwent extraction with traditional method and group A underwent high-speed handpiece and minimally invasive extraction of the impacted mandibular third molar. The occurrences of the root fracture, gingival laceration, tooth mobility, lingual bone plate fracture, jaw fracture and dislocation of temporomandibular joint during operation and lower lip numbness, dry socket, facial swelling and limitation of mouth opening after operation were observed and compared between 2 groups. The operation time, integrity of extraction sockets, VAS pain score and satisfaction from patients were collected and compared. SPSS 19.0 software package was used for statistical analysis.

RESULTS

The occurrences of root fracture, gingival laceration, tooth mobility, lingual bone plate fracture, jaw fracture, and dislocation of temporomandibular joint during operation in group A significantly decreased compared with group B (P<0.05). The occurrences of lower lip numbness, dry socket, facial swelling and limitation of mouth opening after operation in group A significantly decreased compared with group B (P<0.05). The operation time, integrity of extraction sockets, VAS pain scores and satisfaction scores in group A improved significantly compared with group B (P<0.05).

CONCLUSIONS

High-speed handpiece and minimally invasive extraction should be widely used in impacted mandibular third molar extraction, due to the advantages of simple operation, high efficiency, minimal trauma, and few perioperative complications.

[Comparison of two different flap designs in removal of impacted wisdom tooth]

PURPOSE

The purpose of this study was to compare the effect of two different flap designs on surgical removal of impacted mandibular third molars.

METHODS

Four hundred patients who required removal of impacted mandibular third molars were included in the study. They were divided into group A and group B randomly. Patients in group A received distal incision flap and group B underwent angular incision flap. The effect of flap design on surgical time, incidence of dry socket, pain, swelling and trismus was evaluated postoperatively. Data analysis was carried out with SPSS 13.0 software package.

RESULTS

The surgical time was longer in group A than in group B 3 days postoperatively. Facial swelling and trismus were less in group A than in group B 3 days postoperatively. There was no significant difference in two groups 7 days postoperatively.

CONCLUSIONS

The distal incision flap design can release facial swelling and trismus in surgical removal of impacted mandibular third molars.

[Effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar]

OBJECTIVE

To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

METHODS

Ninety-Six patients had their bilateral third molars removed through a split-mouth, double-blind, controlled, clinical trial in two visits. On one side amoxicillin (or clindamycin) was used (antibiotics group) from 1 h pre-operation to 3 d post-operation. On the other side, placebo was used (placebo group) the same time. Postoperative inflammatory complications including alveolar osteitis (AO), surgical site infection (SSI), pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery. The pain, swelling, and trismus were also recorded.

RESULTS

All 96 patients completed the study. Two AO (2.1%), one SSI (1.0%) and seven other infections were observed in the treatment group. Also three AO (3.1%), one SSI (1.0%) and eleven other infections were observed in the placebo group. However, no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups (P > 0.05). There was no significant difference on the postoperative reaction, except pain on 10 d. Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment.

CONCLUSIONS

The use of amoxicillin (or clindamycin) cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

[Use of "gelatamp" colloidal silver gelatin sponge to prevent dry socket after extracting mandibular impacted teeth]

PURPOSE

To study the clinical effect of "gelatamp" colloidal silver gelatin sponge on preventing dry socket after extracting the mandibular impacted teeth.

METHODS

1350 teeth extracted from 976 patients who needed to extract the mandibular impacted teeth were divided into group A, group B and group C randomly. "Gelatamp" colloidal silver gelatin sponge was implanted into alveolar socket after teeth extraction in group A, with absorbable gelatin sponge was implanted into alveolar socket in group B and nothing was implanted into alveolar socket in group C. The incidence of dry socket was observed, the data was analyzed using SPSS10.0 software package.

RESULTS

The incidence of dry socket was 0.44% in group A, 2% in group B and 4.44% in group C. There was significant difference in the incidence of dry socket between group A and group C(P<0.01). There was also significant difference between group B and group C(P<0.05) and between group A and group B(P<0.05).

CONCLUSIONS

The results demonstrate that "gelatamp" colloidal silver gelatin sponge can prevent the occurrence of dry socket after teeth extraction, which is of wide clinical use.

[The preliminary study on nursing the extraction of mandibular mesioangular impacted third molar using reversal high-speed air turbine]

OBJECTIVE

To study the nursing methods and its effect in mandibular mesioangular impacted third molar extraction with reversal high-speed air turbine.

METHODS

60 patients with mandibular mesioangular impacted third molar were selected in this study, who were treated in Department of Senior Dentists, West China School of Stomatology, Sichuan University, between June to December 2010. They were randomly and equally divided into control group and experimental group (n=30). The former was treated with tradition chisel splint method while the latter was treated with reversal high-speed air turbine extraction and provided appropriate nursing interventions. Postoperative reactions and wound healing status were evaluated through consultation.

RESULTS

There were significant differences between control group and experimental group in terms of postoperative bleeding wound, swelling, dry socket and so on (P<0.05).

CONCLUSION

Mandibular mesioangular impacted third molar extraction with reversal high-speed air turbine is effective, and the corresponding nursing measure is worthy further promotion.

[Comparative study of complications among routine method,high speed turbine handpiece and piezosurgery device after extraction of impacted wisdom teeth]

PURPOSE

To investigate complications in extraction of complicated impacted wisdom teeth whose root apex near to the inferior alveolar nerve(IAN) by using routine method(chisels),high speed turbine handpiece and piezosurgery device respectively.

METHODS

Three hundred qualified patients with impacted wisdom teeth were divided into three groups randomly,one hundred patients in group A were extracted by routine method, one hundred patients in group B were extracted by high speed turbine handpiece, and one hundred patients in group C were extracted by piezosurgery device. The operation time, postoperative pain duration,dry socket and IAN injury were compared between each two groups. All statistical analysis was performed using SPSS 13.0 software package. Differences between groups were compared using a paired t test (quantitative data) or Chi-square test (qualitative data).

RESULTS

The operation time in group A was(14.12±0.12)min, (7.22±0.15)min in group B, (25.23±0.32)min in group C; Significant difference was found between group A and group B(P<0.05), group B and group C(P<0.05),group A and group C(P<0.05).Postoperative pain duration was(62.15±1.51)h in group A, (48.23±1.23)h in group B, (14.34±O.80)h in group C; Significant difference was found between group A and group B(P<0.05), group B and group C(P<0.05),group A and group C(P<0.05).9 patients developed dry socket in group A, 2 in group B, and 1 in group C; Significant difference was found between group A and group B(P<0.05), group A and group C(P<0.05). Six patients had IAN injury in group A, 2 in group B, 0 in group C. Significant difference was found between group A and group C.

CONCLUSIONS

Compared with routine method, high speed turbine is better in extraction of impacted wisdom teeth, which can shorten operation time, lessen postoperative complications. Although there was longer operation time compared with group A and B, piezosurgery device is more effective in reducing postoperative complications.

[A clinical study of gelatamp colloidal silver gelatin sponge on preventing the complication of teeth extraction]

OBJECTIVE

To study the clinical effect of Gelatamp colloidal silver gelatin sponge on preventing the complication of teeth extraction.

METHODS

672 teeth were divided into experimental group and control group semi-randomly. All teeth were extracted after local anesthesia and sockets were cleaned. Gelatamp colloidal silver gelatin sponge was implanted into socket in experimental group and nothing was implanted into alveolar socket in control group. The complication of teeth extraction was observed on 0.5 h, 2 d and 7 d after extraction. The incidence rate of complication was calculated.

RESULTS

The incidence rate of complication of teeth extraction in experimental group was 7.72%, which was lower than that of control group (24.43%). There was significant difference in the incidence rates of complication between experimental group and control group (P < 0.05). The incidence rate of bleeding, infection, pain, swelling and dry socket after teeth extraction in experimental group was lower than those of control group, and the difference between them was statistically significant (P < 0.05).

CONCLUSION

The results demonstrate that Gelatamp colloidal silver gelatin sponge can prevent the occurrence of complication of teeth extraction, this can be used in clinic.

[Application of low intensity ultrasound in the extraction of totally impacted mandibular third molars]

PURPOSE

To observe the clinical effects of low intensity ultrasound in extraction of totally impacted third molars.

METHODS

40 patients with totally impacted third molars on both sides of the mandible verified by X-ray were selected. After extraction of the teeth, the socket on one side was treated with low intensity ultrasound while the other side underwent no treatment. Statistical analysis was performed with SPSS 10.0 on all patients in form of pain, swelling, dry socket and bone healing.

RESULTS

In the experimental group, 4 patients complained of severe pain while 16 patients in the control group (P < 0.05). Moderate or severe swelling were not uncommon in both experimental and control groups (P > 0.05); No patients suffered from dry socket in the experimental group and 4 patients suffered from dry socket in the control group (P < 0.05); There were 35 patients with complete bone healing in the experimental group while 21 patients with complete bone healing in the control group (P < 0.01).

CONCLUSIONS

The use of low intensity ultrasound in extraction of totally impacted mandibular third molars reduced the severity of post-operative pain and the incidence dry socket, and it also stimulated bone healing, but it showed no effect on relieving post-operative swelling.

Chronic osteomyelitis of the mandible: case report

Chronic osteomyelitis is a devastating disease of unknown etiology. The primary cause is usually thought to be microbiological. The diagnosis of osteomyelitis of the mandible is arduous, particularly in the early stages, and this disease is almost always difficult to cure. Clinical symptoms, radiographic changes and histologic findings are characteristic of this disease. Treatment modalities have been directed toward eradicating microbes and improving circulation, in the early stages. In the case presented, surgical debridement and IV antibiotics were the treatment of choice. The bone biopsy histopathology report in this case, revealed normal bone, which was inconsistent with chronic osteomyelitis. This article delves into the literature providing history and current research trends in the diagnosis, treatment and follow up care for chronic osteomyelitis.

Healing after dental extractions in men with HIV infection

To determine the incidence of delayed healing after dental extractions in men with HIV infection, a retrospective audit was conducted of all extractions performed in a dedicated dental clinic over a 26-month period. The incidence of delayed healing in patients with HIV was compared with the incidence in those patients without HIV. Eighty men with HIV had 163 teeth extracted, which resulted in five dry sockets (3.01%). Thirty-six men thought not to have HIV had 70 extractions and three dry sockets (4.28%). All three dry sockets in the control group occurred in men who had tested negative for HIV antibodies in the year before their extraction. There were no other incidents of delayed healing. These findings contrast with other reports since they reveal no increase in delayed healing after extractions in men with HIV and do not support recommendations that prophylactic antimicrobials are required for extractions in this group of patients.

[Paget's disease of the bone. Review, clinical case and stomatologic considerations]

Updating information regarding the concept, etiopathogenesis, histopathology, clinical picture, and treatment of Paget's disease of bone (osteitis deformans) is presented. A symptoms is described, and the therapeutic approach for patients with disabling disturbances of the oral cavity dueto Paget's disease is recommended.

The effect of sulfonamides on pain and swelling following removal of ectopic third molars

A double-blind, placebo-controlled trial was carried out to study the value of cones containing sulfanilamide and sulfathiazole in the healing of third molar sockets. On the seventh postoperative day, 94 patients were examined regarding pain, swelling and the overall effect of the operation. Trials were run to compare sulfa cones directly with a placebo: in addition, the placebo and sulfa drugs were each compared with the effects of no medication. Pairs were made of the left and right mandibular third molars in the same patient and the results assessed by sequential analysis. It was found that although sulfa cones were better than the placebo, they themselves were no better or worse than leaving the socket alone.

Extraction socket healing in the calcium deficient rat

The healing of extraction sockets was studied in normal and calcium deficient rats. New bone formation occurred earlier and proceeded more rapidly in the deficient rats, and the newly formed trabeculae were sparse and delicate but with a similar osteoporotic appearance to the alveolar bone.