[Mental disorders in the dental practice. Patients with body dysmorphic disorder]

Oral healthcare professionals are frequently consulted by patients who are dissatisfied with their teeth and/or facial looks. Sometimes, this dissatisfaction takes a pathological form. When someone is preoccupied with a (supposed) abnormality barely or not visible to others, performs certain actions in response to the concerns about their appearance and experiences significant suffering, this may be a case of body dysmorphic disorder. Its prevalence is 0.7-2.4% in the general population, but significantly higher in clinics where cosmetic or orthognathic procedures are performed (10-15%). Procedures aimed at improving the abnormality experienced by the patient rarely lead to a reduction of the symptoms, but more often result in more dissatisfaction and complaints towards the practitioner. It is difficult for practitioners to recognise this condition. An overview of characteristics, co-morbidity and consequences of body dysmorphic disorder for oral health and treatment will result in increased awareness of this condition among oral care providers.

Intraoral management of odontogenic infection associated with severe trismus under local anesthesia

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.

Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature

BACKGROUND

Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin.

METHODS

In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need.

CONCLUSIONS

Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

The Prosthodontic Pathway for Patients with Anomalies Affecting Tooth Structure

There are a number of anomalies that affect the structure of the dental hard tissues which impact upon the form, function and aesthetics of the dentition. Understanding the challenges these conditions pose will enable dentists to manage the functional and aesthetic problems with restorative techniques better. This article will present cases that demonstrate the different conditions, the restorative challenges experienced and a variety of restorative treatments in the management of these conditions. Clinical relevance: Awareness of different anomalies affecting tooth structure that may present to the dental practitioner is necessary. Clinicians should appreciate the specific restorative challenges that may arise in treating such patients and the possible treatment options that may be available.

[Local anesthesia selection algorithm in patients with concomitant somatic diseases]

The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.

Evaluation of the saliva cortisol levels in patients under prosthetic treatment due to functional disorders of the masticatory organ

One of the main etiological factors of the stomatognathic system dysfunction is stress and psychoemotional disorders. During stressful situations, there is an increase in the level of cortisol, the so-called stress hormone. Literature data indicate the existence of a correlation between blood cortisol levels and its amount in the saliva. This spurred an inspiration to undertake open, non-randomised studies, the objective of which was to conduct a comparative assessment of the saliva cortisol levels in patients with functional disorders of the masticatory system and in healthy volunteers, as well as to compare the results of cortisol levels with the results of survey-based tests with the use of Endler and Parker's CISS survey. Cortisol level was assessed due to its association with stress present in the body as one of the primary etiological factors of the stomatognathic system dysfunction, and hence the association of elevated cortisol levels assessed in the morning with the occurrence of dysfunctions of the stomatognathic system. The subject of the study is a group of 30 patients, of both sexes, aged between 20 and 46, who reported to the Dental Prosthetic Out-Patient Clinic of the Institute of Dentistry, Jagiellonian University in Cracow, for prosthetic treatment due to the painful form of functional masticatory organ disorders. The control group consisted of 30 subjects, aged between 19 and 41, in whom dysfunctions of the stomatognathic system were excluded. Collection of saliva for testing was performed at a fixed hour (9 am) into plastic test tubes with a stopper. Immediately after collection, the saliva was frozen at the temperature of -18 °C. The assessment of the cortisol levels was conducted by the high performance liquid chromatography (HPLC) with UV detection at the Department of Analytical Chemistry, Faculty of Pharmacy, Department of Laboratory Medicine of the Gdansk Medical University. Moreover, a 20-minute psychological test was conducted with the use of the CISS (coping inventory for stressful situations) survey in order to assess the patients in terms of their abilities to cope with stressful situations. The results obtained were submitted to a statistical analysis based on the conventional calculation procedures. The test group revealed significantly higher cortisol levels compared with the results obtained by the control group. The findings of the CISS survey confirmed the predominance of the emotion-focused strategy of coping with stressful situations in the test group. The results support the view that the psychoemotional factor is, to a considerable extent, conducive to the development of functional disorders. The elevated cortisol levels in patients with psychological disorders concur with the findings by other authors. The results obtained confirm that psychoemotional disorders may be one of the etiological factors of the stomatognathic system dysfunctions. The CISS survey, which was not used in similar studies before, makes it possible to obtain information on the subject's method of coping with stress, thus allowing for the initiation of a relevant psychological therapy aiding the prosthetic treatment.

Early dental treatments for patients with cleidocranial dysplasia

OBJECTIVE

To explore the early dental interventional strategies for adolescent patients and a child patient with cleidocranial dysplasia (CCD).

METHODS

Surgical exposure using the apically repositioned flap technique combined with orthodontic traction was used in the adolescent patients whose ideal treatment time for initiating treatment was missed. For the child patient whose ideal treatment time for initiating treatment was not missed, the simple surgical exposure method was carried out in order to promote the eruption of the impacted incisors.

RESULTS

All the impacted maxillary incisors of the three CCD patients were successfully positioned into a proper alignment either through the two stages of crown exposure and the elastic traction or simple surgical exposure.

CONCLUSION

Crown exposure surgery combined with light force orthodontic traction provides an effective approach to treat the typical dental abnormalities of adolescent CCD patients. Simple surgical exposure was also an effective way for a child CCD patient for whom the most ideal time for initiation of treatment was not missed.

Management of dental-oral procedures in patients with hereditary angioedema due to C1 inhibitor deficiency

BACKGROUND

Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) has considerable implications for dental health care providers, since dental procedures may trigger severe and even life-threatening episodes. The aim of the present study was to analyze the efficacy and safety of premedication with attenuated androgens (AAs), plasma-derived human C1 esterase inhibitor concentrate (pdhC1INH), or both to prevent the development of upper airway angioedema after dental-oral procedures in patients with HAE-C1-INH.

MATERIAL AND METHODS

All dental-oral procedures performed on patients with HAE-C1-INH who were followed up at La Paz University Hospital, Madrid, Spain were reviewed. Demographic data, maintenance treatment, preprocedure prophylaxis, disease severity, and occurrence of upper airway angioedema were recorded.

RESULTS

Twenty-four patients (14 male/10 female; mean age, 42.6 years) underwent 66 procedures. Most procedures were performed on patients with severe HAE-C1-INH (20 procedures) or moderate HAE-C1-INH (26 procedures). Only 9 procedures were performed without short-term prophylaxis. Mild upper airway angioedema developed after 3 procedures performed without short-term prophylaxis in patients with minimal or asymptomatic HAE-C1-INH. A statistically significant association was found between development of mild postprocedure upper airway angioedema and lack of maintenance treatment with AA, lack of increased dose of preprocedure AA, and failure to administer preprocedure pdhC1INH (P = .002, Fisher exact test).

CONCLUSIONS

Increased doses of prophylactic AA, administration of pdhC1INH, or both were good options for ambulatory management of dental-oral procedures in patients with HAE-C1-INH. Prophylaxis with pdC1INH or increased doses of AA is advisable before dental-oral procedures, even in patients with low disease severity.

[Guidelines for dental care in hemophilia patients]

Dentist usually lacking knowledge about congenital blood-clotting disorders. That leads to unreasonable limitations in use of modern dental care techniques. The following study result obtained in specialized center for blood-clotting disorders treatment should serve as guidelines for dental care in hemophilia patients.

[Peculiarities of endotracheal anesthesia in patients with severe odontogenic phlegmon]

The paper describes the preoperative care in 260 patients with severe phlegmons of maxillofacial area with participation of anesthesiologist and maxillofacial surgeon, allowing to lower considerably risk of anesthesia, intraoperative and early postoperative complications.

[Dental-radical cysts, a rare aetiology of maxillary sinus opacity]

OBJECTIVE

To specify CT scan roll in diagnosis of radicullar cyst invading maxillary sinus.

METHODS

Two cases of 23 and 34-year-old men presented with facial injury and sinusitis was explored by CT scan.

RESULTS

CT scan showed in both patients a cystic lesion, developing into the maxillary sinus around a tooth apex and limits by a double dense thin rim.

CONCLUSION

CT scan permits diagnosis of radicular cyst invading maxillary sinus, in the event of obscured maxillary sinus, when double dense thin rim corresponding to the repulsed wall of the sinus is looking.

Psychological Considerations in Orthognathic Surgery

More adolescents and young adults are requiring facial skeletal surgical procedures. They are vulnerable in emotional development, and the stress of surgery adds to this. Interaction between adolescent patients and caregivers must be assessed in treatment planning for a successful outcome. Focus is on correcting the morphologic deformity, but assessment and planning should also include psychosocial aspects of the patient. Adolescents and young adults who need psychological support should be followed closely from the beginning, until at least 1 year postsurgery. Success of surgical intervention should be measured both in terms of the occlusal function and morphological improvement, and changes in psychosocial interaction and an improved quality of life for the patient.

[Present-day problems and state of fundamental dentistry in Russia]

The article deals with present-day problems of domestic stomatological science and its management in the light of modern tasks. The main directions, successes and drawbacks of theoretical studies on stomatological problems in our country are considered.

[Surgical treatment of diseases in the oral cavity and jaws]

Surgical treatment of diseases in the oral cavity and the jaws has been performed since ancient times. However, in the beginning there were mostly simple tooth extractions and treatment of oral infections which could be done. The therapists consisted of a heterogenic group (physicians, barber-surgeons, dental surgeons, smiths, monks etc.). In the beginning of the 20th century great progress was made. Dental surgeons were employed as consultants in hospitals. And when the national dental servIce in Sweden (Folktandvården) was established 1938, departments of oral surgery were built in these hospitals. The department of oral surgery at the University hospital in Linköping started 1947 and is presented in this paper. Dr. Helge Hed, originator of the department, was chief oral surgeon the first 24 years. The surgical activity was gradually increased from 389 operations in 1950 to 1.514 in 1999, and the number of jaw fractures treated in 1948 were 21 and in 1999 73. The treatment panorama has changed during the years. At first the poor dental status of the patients characterized the situation and minor dentoalveolar surgery was usually performed. Later more advanced oral surgery e. g. trauma-surgery, orthognatic surgery and dental implantology has been done - and in addition a lot of scientific research and programmed instructions in oral surgery for dental surgeons and medical students. To sum up, the development of the department of oral surgery at the University hospital in Linköping has been well adjusted to the gradually more demanding treatment and it is representative of the successful development of Swedish oral surgery during the 20th century.

Residual deformities after repair of clefts of the lip and palate

Every effort should be made to achieve the best possible results at the time of lip and palate repair. Appropriate and extensive evaluation, short- and long-term planning with optimal timing for each procedure, close cooperation with the members of the craniofacial team, selection of the most appropriate technique(s), careful execution, and close follow-up are prerequisites for success. Additional surgical procedures or revisions are required to improve appearance and function and to manage unfavorable results of previous interventions. Such procedures should be also planned carefully, taking into consideration all aspects of the deformity to provide our patients with superior habilitation.

[Morphological criteria of treatment efficiency in patients with acute pyoinflammatory diseases of the maxillofacial area]

Morphological parameters (tissue necrosis area, area of connective tissue sites, neutrophil/round cells ratio, activities of the nucleolar organizer areas) are suggested as criteria for evaluating the treatment efficiency in patients with maxillofacial pyoinflammatory diseases.

[The use of nitatsid and gipozol'-N in the combined treatment of acute inflammatory diseases of the maxillofacial area]

Combined drugs with a hydrophilic base, nitacide and hyposol-n, were used in combined therapy of acute purulent inflammations of the maxillofacial area. Time course of clinical parameters and changes in microflora were studied in patients administered different local treatments with different inflammatory reactions. The data indicate a high efficiency of the drugs, which optimized local therapy of suppurative wounds and are recommended for wide practical use.

[Endoscopic technologies in maxillofacial surgery]

Endoscopic operations in 107 patients with numerous maxillofacial diseases are analyzed. Endoscopic technologies were used in diseases of the maxillary sinus, temporomandibular joint, injuries to the facial nerve, and cysts of the jaws. New methods for surgical treatment of mandibular fractures, zygomatico-orbital complex, cysts of the jaws are proposed. The results of utilization of endoscopic technologies in maxillofacial surgery are analyzed and their high efficacy and good prospects are demonstrated.

Microvascular anastomosis in oral reconstructive surgery: a comparative study of recipient vessels between Japanese and German patients

Specimens of recipient vessels were obtained from the oral and maxillofacial regions when carrying out microsurgery and the condition of the vascular wall was analyzed histopathologically. This study was performed in both Japan and Germany and the results were compared. A higher percentage and a more advanced abnormality of the recipient vessel seemed to exist in the German patients as compared to the Japanese patients. This difference could be due to the preoperative multimodal chemo- and radiotherapy more often applied in Germany and the higher incidences of systemic diseases such as hypertension and diabetes in the German population. The success rate of the surgery is, however, the same in both countries. It could be concluded that the viability of the flaps was not affected by preoperative damage to the recipient vessel.

[The use of demineralized bone brephomatrix in the plastic repair of different postoperative defects in the jaws]

The aim of this research was assessment of the results of bone brephoplasty of the jaws. Bone tissue defects after cystectomy, granulectomy, and tooth removal were filled with fragmented transplant, demineralized osseous brephomatrix. Low-frequency ultrasound was used for antibacterial treatment of the recipient osseous bed. A total of 103 patients were operated on, brephoplasty was carried out in 60. Demineralized osseous brephomatrix is characterized by excellent plastic and osteoinductive properties, due to which bone regeneration processes are completed 1.5-2 times sooner in comparison with the control.

[Proposal for a new multifactor screening score of difficult intubation in ORL and stomatognathic surgery: preliminary study]

This study assessed prospectively in 295 ENT adult patients the predictive value of clinical indicators for difficult intubation and of a new multifactorial score, established by the allocation of points (0, 3, 5 or 7) depending on the degree of presence of seven factors: pathology known to be associated with a difficult intubation, clinical signs of airways' pathology, inter-incisors gap and mandible's luxation, submental mandibular-thyroid distance, normal or short and broad neck, head and neck movements, and Mallampati's test. The incidence of difficult laryngoscopy was 14% and the use of particular techniques for tube insertion was required in 8% of patients. The presence of malformation or pathology often associated with a difficult intubation and the presence of functional signs of airways' pathology predict the difficulties of laryngoscopy and tracheal intubation with a good sensitivity and specificity. The analysis of the "Receiver Operating Characteristic curves" showed that a score higher or equal to 11 allows the prediction of difficult intubations with a sensitivity of 96% and a specificity of 90%.

[Use of Diprivan in ENT and stomatology]

Irrespective of the type of surgery, patient monitoring, including ECG-automated non-invasive blood pressure measurements, SpO2, FIO2 and capnography, is compulsory. Sedation: no initial bolus injection of propofol; continuous infusion of propofol at a rate of 1 to 4 mg.kg-1.h-1, using a syringe pump, combined with a short-acting opioid such as alfentanil. General anaesthesia: initial bolus injection of propofol between 2 and 3.5 mg.kg-1, combined with 10 mg of lidocaine in the same syringe; maintenance with a syringe pump: 6 to 9 mg.kg-1.h-1 combined with an opioid, with or without coadministration of muscle relaxants. Intubation avoiding respiratory depression: syringe pump with a fast infusion rate (50 to 100 mg.min-1), which allows induction with propofol and intubation without co-administration of muscle relaxants.

Pattern assembly--an aid to flap design during oral microsurgical reconstruction

Surgical ablation of tumors within the oral cavity results in a three-dimensional defect and a potential puzzle for the reconstructive surgeon. Although a myriad of papers discussing the relative advantages and disadvantages of various methods of reconstruction are readily available for consultation, very few publications have provided the surgeon with a guide either to visualization of the defect or to how to reconstruct a three-dimensional defect with an essentially two-dimensional flap. Our intention is not to provide the answer for every oral reconstructive problem--after all, no two patients are alike--but we will demonstrate that an appreciation of the defect in three-dimensions, together with an understanding of oral function, provides a template for flap design and inset. This is achieved by simplifying the complex anatomical shape of the oral cavity into a geometric form from which a series of simple, easily recognisable shapes can be derived and assembled as necessary into a pattern that reproduces the defect, providing a template for flap design and inset.