Quintessence International, 01/2023

Objectives: The objective of this study was to analyze the success of primary molar pulpectomy with a minimum of 1 year and up to 4 years follow-up with focus on the treatment setting (general anesthesia, sedation, local anesthesia alone). Method and materials: Data were retrieved from 92 patients’ records between 2012 and 2020. The pulpectomy treatment using calcium-hydroxide/iodoform paste was performed under general anesthesia (n = 45), nitrous oxide sedation (n = 21), or local anesthesia alone (n = 39). Bivariate and multivariate analyses were performed. Results: The overall success of pulpectomy was 59.5% 4 years post-treatment. The 4-years clinical success rate was clinically relevantly higher under general anesthesia (78.6% vs 57.1% under nitrous oxide sedation, 43.8% with local anesthesia only) and in the mandibular arch (70.8% vs 38.5% in the maxillary arch). This could be related to the strict case selection under sedation and especially general anesthesia. Despite statistically significant differences in the bivariate analysis for most outcomes and follow-up periods, this was not the case in multivariate regression. Conclusion: Pulpectomy performed in primary molars offers a successful long-term treatment option especially with a strict case selection as under general anesthesia. Keywords: general anesthesia, nitrous oxide sedation, primary molars, pulpectomy, success rate

Objective: To determine the minimum volume of infiltrative anesthetic required for pain-free mini-implant placement in the maxillary buccal region by comparing the efficacy of 1.0 mL with 0.5 mL of 2% lignocaine with 1:200,000 epinephrine during mini-implant placement. Method and materials: This split-mouth study involved 19 healthy patients without systemic disease, recent history of allergy, or medications within the age group of 17 to 28 years belonging to both sexes requiring bilateral buccal mini-implants in the posterior maxilla. Lignocaine 2% with 1:200,000 epinephrine (0.5 mL and 1.0 mL) was randomly injected between the right and left side 30 minutes apart for each consecutive patient. Mini-implants were placed 5 minutes after the administration of the infiltrative anesthetic. The pain response was evaluated during mini-implant placement (T1), and 5 minutes (T2) and 10 minutes (T3) after mini-implant placement on both sides using a pain-rating scale. Descriptive statistics and a factorial repeated-measure analysis of variance were calculated for pain response, sex, and side of the jaw. Results: At T1, T2, and T3, 1.0 mL of anesthetic had a lesser pain score by 1.00, 1.00, and 0.58, respectively, compared to 0.5 mL, with 95% confidence intervals of 0.43 to 1.57 (P = .001), 0.49 to 1.51 (P = .000), and 0.08 to 1.08 (P = .024), respectively. Conclusions: 1.0 mL of 2% lignocaine with 1:200,000 epinephrine administered submucosally appears to provide better anesthesia than 0.5 mL during and after insertion of mini-implants. This study will help the operator administer the correct volume of infiltrative anesthetic thereby improving pain response, alleviating patient anxiety, and providing a better patient experience during and immediately after mini-implant placement. Keywords: different time intervals, infiltrative anesthetic, mini-implant, orthodontic anchorage procedure, pain scores

Objectives: To evaluate the benefits of submucosal administration of a dexamethasone and articaine mixture on postoperative pain after mandibular third molar extraction. Method and materials: This was a double-blind randomized controlled pilot trial of consecutive patients requiring surgical removal of mandibular third molars. Immediately post extraction, the surgeon administered a submucosal injection. The surgeon was masked to the content of the injection, which contained either a mixture of 10 mg dexamethasone and 68 mg articaine (“study group”) or the same volume of saline only (“control group”). Pain severity was assessed by questionnaire (postoperative symptom severity [PoSSe] scale) 7 days after the procedure. Results: Sixty subjects were enrolled. Patients in the study group had significantly lower PoSSe pain intensity scores than subjects in the control group (P = .004). The combined postoperative PoSSe pain score was significantly lower in the study group than in the control group (P = .016). There was no significant difference in pain duration between the two groups (P = .237). Conclusion: Submucosal injection of dexamethasone/articaine solution after surgical extraction of mandibular third molars is effective in reducing pain intensity. Keywords: articaine, dexamethasone, pain, third molar surgery

Objective: Epidermolysis bullosa (EB) is a rare genetic mucocutaneous disorder characterized by epithelial fragility leading to blister formation on skin and mucous membranes with even minor mechanical trauma. Most EB oral health publications give fragmented information, focusing on only one oral health aspect or one EB type. The aim of this study was to expand the knowledge of the overall oral health status of individuals with dystrophic, junctional, and simplex EB. Method and materials: A comparative multicenter study, including a control group, and based on questionnaires and clinical examinations, was undertaken in three EB expert centers. Results: Most EB (90.2%) participants brushed their teeth at least once a day despite the pain. The prevalence of enamel defects and caries experience did not differ between the 42 EB participants and the 42 age-/sex-matched healthy controls. Gingival inflammation unrelated to dental plaque accumulation was found in EB participants. Blisters, erythema, and erosion/ulceration mainly involved gingiva, buccal mucosa, lips, and palate, with different topographic patterns according to EB type. EB patients whatever the age showed a similar lesion distribution. Simplex and dystrophic EB patients under 12 years old displayed higher lesion severity than junctional EB ones. Only dystrophic type exhibited microstomia and ankyloglossia. Conclusion: Oral health status seemed to benefit from a close collaboration between dental practitioner and dermatologist, and from regular dental examination, starting at a young age and with a focus on prevention. The new appreciation of oral health involvement highlighted by this study is essential for EB patients care, regarding comorbidities and quality of life. Keywords: dystrophic epidermolysis bullosa, gingival inflammation, inherited epidermolysis bullosa, junctional epidermolysis bullosa, oral health, oral lesion, simplex epidermolysis bullosa

Chronic osteomyelitis of the jaw is rare in the healthy populations of developed countries and presents with diagnostic and therapeutic challenges. Clinical presentation: Patient 1 presented with a dull, occasionally throbbing pain in the left mandible of 1.5 years duration. There was associated trismus which alternated between improving and worsening. The patient had features mimicking a variant of temporomandibular disorder (TMD). She was misdiagnosed and treated for myogenous TMD without symptom relief. Patient 2 presented with intermittent dull pain with mastication and facial swelling over the right mandible for 1 year. She was treated by the referring dental practitioner for myogenous TMD without symptom relief. Clinical and radiologic findings confirmed a diagnosis of chronic sclerosing osteomyelitis in both cases, and conservative treatment, including antibiotics, relieved the pain with no signs of recurrence. Conclusion: The importance of including chronic osteomyelitis in the differential diagnosis of idiopathic orofacial pain disorders is emphasized. If the management of myogenous TMD is unsuccessful, there is a possibility of a misdiagnosis, and a differential diagnosis, including chronic osteomyelitis, needs to be reconsidered. Keywords: chronic sclerosing osteomyelitis, orofacial pain, osteomyelitis of the jaw, osteosclerosis, temporomandibular disorder, trismus

Objectives: When performing CBCT sialography (sialo-CBCT), space-occupying lesions may be identified incidentally. The objective was to describe their radiologic-clinical-histopathologic correlations. Method and materials: The archive of sialo-CBCT scans was retrospectively searched for suspected space-occupying lesions. Based on the scan and clinical-histopathologic data, the cases were divided into “pathologic” vs “normal,” “intra-parenchymal” vs “extra-parenchymal,” and “benign” vs “malignant.” Two precalibrated, blinded radiologists performed a survey of the radiographic features of each scan. Cohen kappa, chi-square, Kruskal–Wallis, and Mann–Whitney tests assessed inter-observer agreement and radiologic-clinical-histopathologic correlations. Results: In total, 27 (1.5%) suspected space-occupying lesions were found in 1,758 reports. Full follow-up data were available for 15 cases: four were “malignant,” six were “benign,” and the remaining five were “normal.” Kappa showed substantial inter-observer agreement (0.8 to 1.0). Constant swelling correlated with “pathologic” cases (P = .003). Lesion diameter was greater in “pathologic” than “normal” (P < .001) cases, with a cut-off of 12.6 mm. Clinical and radiographic features were similar in “benign” and “malignant” lesions. “Intra-parenchymal” and “extra-parenchymal” space-occupying lesions correlated with “no-fill-region” (P = .01) and “main-duct-displacement” (P = .002), respectively. Conclusions: Suspected space-occupying lesions in sialo-CBCT with a diameter greater than 12.6 mm are likely to be “pathologic.” No radiographic features were able to differentiate between “malignant” and “benign” space-occupying lesions. Keywords: cone beam computed tomography, salivary gland diagnosis, sialo-CBCT, sialography

Objectives: To assess self-reported population oral health conditions amid the COVID-19 pandemic using user reports on Twitter. Method and materials: Oral health-related tweets during the COVID-19 pandemic were collected from 9,104 Twitter users across 26 states (with sufficient samples) in the United States between 12 November 2020 and 14 June 2021. User demographics were inferred by leveraging the visual information from the user profile images. Other characteristics including income, population density, poverty rate, health insurance coverage rate, community water fluoridation rate, and relative change in the number of daily confirmed COVID-19 cases were acquired or inferred based on retrieved information from user profiles. Logistic regression was performed to examine whether discussions vary across user characteristics. Results: Overall, 26.70% of the Twitter users discussed “Wisdom tooth pain/jaw hurt,” 23.86% tweeted about “Dental service/cavity,” 18.97% discussed “Chipped tooth/tooth break,” 16.23% talked about “Dental pain,” and the rest tweeted about “Tooth decay/gum bleeding.” Women and younger adults (19 to 29 years) were more likely to talk about oral health problems. Health insurance coverage rate was the most significant predictor in logistic regression for topic prediction. Conclusion: Tweets inform social disparities in oral health during the pandemic. For instance, people from counties at a higher risk of COVID-19 talked more about “Tooth decay/gum bleeding” and “Chipped tooth/tooth break.” Older adults, who are vulnerable to COVID-19, were more likely to discuss “Dental pain.” Topics of interest varied across user characteristics. Through the lens of social media, these findings may provide insights for oral health practitioners and policy makers. Keywords: attitude, big data, data mining, dental anxiety, logistic models, social media

Objectives: There is a high demand for dental treatment in a hospital setting for patients with severe intellectual disability (ID), due to their inability to cooperate. The objective was to determine the types of dental treatment carried out on patients with severe ID, as well as the possibility of performing clinical and radiographic examinations prior to treatment and to identify their characteristics. Method and materials: A retrospective observational study was performed, based on the medical histories of patients with severe ID or a disability included in the portfolio of dental services of Community of Madrid, who underwent dental treatment at the Stomatology Service of the Gregorio Marañón General University Hospital from the year 2009 to 2019. Data on age, sex, etiology of disability, and dental treatment were obtained. Results: A total of 1,845 patients were included. The type of disability in the majority of cases was unknown, followed by encephalopathy, cerebral paralysis, and Down syndrome. In total, 8,439 dental extractions were performed on 1,548 patients (83.9%). Clinical and radiographic exploration were carried out on 874 patients (47.4%). Conclusions: Ultrasonic scaling was the most frequently performed treatment in patients. Dental extractions were the next most common treatment. An increase in age showed a higher demand for surgical procedures and extractions. Over half of the patients (52.6%) did not tolerate clinical or radiographic examinations. Keywords: dental treatment, disabled patient, general anesthesia, hospital care, intellectual disability