International Poster Journal of Dentistry and Oral Medicine, Supplement Joint Congress/2015

Introduction: Older persons are at risk of chronic diseases of the mouth, including dental infections (e.g., caries, periodontitis), tooth loss, benign tumors, and oral cancer. The aim of this study was to assess the prevalence of oral mucosal lesions, with particular emphasis on the incidence of benign tumors and tumor-like lesions, among Yemeni elderly attending out-patients dental clinic, Sana'a University. Patients and Methods: This cross-sectional study involved 101 elderly aged 60 years and above who attended outpatient dental clinic, Sana'a university, Yemen. The participants were interviewed individually for socioeconomic status, behavioral information, oral risk habits, oral hygiene practices, systemic health, and history and current use of medications. Detailed oral examination of the oral cavity was performed by a single examiner based on international criteria and WHO codes. Results: The mean age for the study population was 64.89 years. Khat chewing was the most common habit (54.5%) followed by cigarette smoking (23.8%). The study showed that 67.3% of the elderly had one or more oral lesion. The most common lesions were fissured tongue (38.6%), tumor and tumor-like lesions (20.8%) and Khat-associated white lesion (5.9%). The frequency of tumor and tumor-like lesions was significantly higher among smokers (45.8%) than none and/or Ex smokers (p0.01). Likewise, the frequency of oral tumors was also higher in males than females and among Khat-chewers than none chewers, but this was not statistically significant. Conclusions: Findings suggest that the occurrence of oral tumors among Yemeni elderly is alarmingly high. Also, there was is an association between occurrence of oral lesions and practicing oral habits. Keywords: Oral lesions, Oral tumors, oral habits, elderly

Introduction:Recently, the importance of the oral care has been recognized to eliminate the oral infection source in the perioperative period of cardiac surgery. Therefore, the general anesthesia for a dental treatment is sometime required before cardiac surgery. We report one case of the general anesthesia for an odontectomy and a cystectomy in a patient with serious heart valve disorder. Patient and Background: The patient is a 63-year-old man with advanced AS and moderate MS, for which double-valve replacement was planned. The guideline of the Japanese Circulation Society suggests that noncardiac surgery is usually recommended after valve replacement. However, the consultation among the related departments resulted that the oral surgery would precede from heart surgery in view of an infection source in this case. Anesthetic Management: The general anesthesia was induced with the propofol and was maintained by the air-oxygen- sevoflurane with fentanyl citrate. The cardiac performance was monitered by the Flo Trac Sensor throughout the operation, and passed satisfactorily. Conclusion: In a near future, it will be expected that a case like this increases in a highly efficient dental institution. Therefore, a closer and more integrated discussion with the sections related about the systemic management including general anesthesia is required. Keywords: General Anesthesia, Heart Disease, Infection Prevention, Double Valve Replacement

Prescription of antibiotics to patients after dental implantation is the main method of prevention postoperative complications, but these drugs have a lot of side effects. Keywords: herbal remedies, dental implantation

The main requirement for local anaesthesia during tooth treatment is deepness and time of anaesthesia and also hight degree of safety defined of tone of peripheral vessels of pulp. Keywords: local anaesthesia, hemomicrocirculation, teeth pulp

Oral cavity sanation of pregnant women is one of the key moments of the normal course of pregnancy and fetal development. Keywords: dentistry pregnancy

Anxiety is the primary reason many patients fail to see a dentist leading to a vicious cycle of failure of attendance, coupled with poor dental health. The (IOSN) 1,2 Indicator of sedation need was created to assess the need for sedation in patients undergoing dental procedures. This helped to identify anxious patients and also in the process of commissioning of services by commissioning groups. It has been quoted that 70% of the high need patients are women. The IOSN consists of an Anxiety questionnaire followed by matrix of scoring system. We at Atlantic dental practice provided sedation to patients for dental extraction and restorative work using intravenous midazolam. Keywords: IOSN, midazolam

Propofol is a short acting hypnotic agent and has many uses both in sedation and general anaesthesia. In sub-anaesthetic doses it has useful sedative and anxiolytic properties. It may be administered by continuous infusion or by Target Controlled Infusion (TCI) systems. The TCI infusion pump incorporates a pharmacokinetic model to calculate and deliver enough propofol to maintain a stable concentration of drug in a patient and maintain an optimum level of sedation. The anaesthetist administering the drug uses a TCI (target controlled infusion) pump which adjusts the rate of delivery according to a pharmacokinetic/pharmacodynamics model, of which there are several models which have been shown to be clinically effective. Keywords: propofol

Aim: To elucidate the inhibitory effect of oral cares (OC) on the bacterial adhesion to endotracheal tubes, we assessed the bacterial adhesion on extubated endotracheal tubes in relation to preoperative OC. Materials and Methods: The 58 extubated endotracheal tubes were obtained after the operation [24 patients with preoperative OC (OC group) and 34 without OC (NOC group)]. The OC consisted of the professional mechanical tooth cleaning performed on 7 days and 1 day before operation. The whole saliva was obtained from all the patients on the operation day. The extubated tubes were washed and vortexed extensively. The bacterial suspensions and saliva samples were plated onto blood agar plates and Mitis-Salivarius agar plates. After 48h incubation, the total bacteria and oral streptococci were counted. Results: More than 103 CFU per tube of bacteria were detected in all the samples, in which streptococci were predominant. The numbers of total bacteria and streptococci that adhered to the tubes in OC group were significantly lower than those in NOC group. In saliva, however, there was no significant difference in the number of total bacteria in between OC and NOC groups. Conclusion: Taken together, significant number of bacteria, especially oral streptococci can adhere to endotracheal tubes during operation, which may be controlled by preoperative OC. Keywords: Postoperative infection

Aim：While the anti-oxidation and anti-inflammatory effect of dexmedetomidine has been reported, we could not find a case report in which glucose-6-dehydrogenase(G6PD) deficiency was treated with dexmedetomidine. We report a case of the superior labial frenulectomy under the intravenous sedation using fentanyl,midazoram and dexmedetomidine on a pediatric patient with G6PD deficiency. Methods：The patient was a 5-year-old boy (height 115cm,body weight 22kg) with G6PD deficiency. He had no previous medical history of hemolytic anemia. The patient was uncooperative with regard to dental treatment. We planned to perform frenectomy under intravenous sedation. To prevent hemolysis due to stress from certain drugs, metabolic conditions, and infections are the most effective management. Therefore, we decided to perform the procedure under intravenous sedation with fentanyl (25µg), midazolam (2mg) and dexmedetomidine (0.7µg/kg/hr). We also used 2% lidocaine (with 1/80,000 epinephrine) for local anesthesia (0.9ml). Dexmedetomidine has been reported to cause less respiratory depression than the other sedatives and to be effective for pediatric sedation.　 Result: During perioperative period, we did not find any signs of hemolysis, such as fatigue, headache, and dark urine after using this method. Therefore, no hemolysis therapy was necessary.　 Conclusion：Dexmedetomidine was safe and effective for this pediatric patient with G6PD deficiency. We suggest that Dexmedetomidine will be one of the safe drugs that can be used for pediatric patient with G6PD deficiency. Keywords: G6PD deficiency, Dexmedetomidine, sedation, pediatric patient

Aims: The impacts of low concentration carbohydrate of preoperative oral rehydration solution were investigated on perioperative stress in patients undergoing sagittal split ramus osteotomy (SSRO). Methods: The randomized intervention clinical trial was performed. The subjects were divided into three groups by preoperative oral ingestion: ORS groups; low concentration carbohydrate beverage (2.5%), HCHO group: low penetration pressure high concentration carbohydrate (12.5%) drink before entrance, MW groups: mineral water. Oxidative stress (d-ROMs), antioxidant potentials (BAP), cortisol, and insulin resistance (HOMA-IR) were measured at six points: entrance, after osteotomy, wound closure, the first postoperative day, third day, and the starting day of oral ingestion. Results: A total of 25 patients were enrolled. At the time of wound closure, values BAP in ORS group and HCHO group did not drop, but that in MW group did. The values of d-ROMs and cortisol during surgery were lower. The values of d-ROMs in the postoperative measuring phrase rose above the standard zone. However, there were no significant differences among the groups. The maximum value of HOMA-IR in MW group was at the third postoperative day, but there were no significant differences among the groups. Conclusion: It is suggested that preoperative oral rehydration solutions containing of low concentration of carbohydrate could prevent the deterioration of antioxidant potentials during surgery in patients undergoing SSRO. However, surgical stress of SSRO was considered not to be strong enough to affect d-ROMs, cortisol, or HOMA-IR. Keywords: preoperative oral rehydration solution, carbohydrate, perioperative stress, SSRO

Russian fundamental researches have been allowed to use the xenon for anesthesia since 1999. Oxygen-xenon mixture with the help of specially created device was allowed to use for removing of painful syndrome of outpatient since 2010. Since 2011 under the leadership of professor Rabinovich S.A. have been carried out clinical approbation of different methods oxygen-xenon inhalations in outpatient dentistry. Research objective: to estimate efficiency and safety oxygen-xenon inhalations, to define indications for application in out-patient dentistry. Methods: by means of the device for inhalation anesthesia «СТАКИ» of «Биология Газ сервис» carried out anesthesia and sedation by oxygen-xenon 1/1 («Ксемед», Russia) to ambulatory patients at various interventions. Indicators of haemodynamics (AD, cardiac rate), breath (breathing rate, SpO2), analgesia level (definition of the pain threshold) and sedation (Bis) were estimated. Results: 80 patients with anesthetic risk of the I-II ASA and dentophobia were enclosed in researches. Indicators of haemodynamics didn't exceed admissible norm, respiratory violations and discomfort didn't observe, the analgesia and an operated sedation managed to be achieved through 2-3 minutes from the inhalation beginning. Discussion: xenon is an independent anesthetic, it also increase efficiency and duration of the local anesthesia, reduce psychoemotional pressure, dentophobia and stressful reactions, save identical contact with patient, edema tissue at the postoperative period is less denominated, the regeneration speeds up, the recovery period becomes shorter. The xenon may be used under sharp surgical disease, traumatic damages, painful neurological syndrome, pains at dysfunctions of tempomandibular joint, for preventing of postoperative pain and high emetic reflex, endodontic and orthopedic treatment (the period of adaptation to dentures). Conclusion: this study suggest that xenon could be used in practical dentistry. Keywords: xenon

Aim: To compare airway potency with laryngeal mask (LM) and intranasal airway (IA) during dental surgery at oligofren patient. Methods: 32 ambulatory dental patients with oligophrenia (ASA I-II) were randomly allocated in group A (n=15) used LM and group B (n=12) used IA. Both groups received propofol and N2O/O2=2/1 from spontaneous breathing with infiltration anesthesia articaine (4%). Clinical studies (BP, heart rate, SpO2, breath frequency) were analyzed: before and after induction, the most traumatic stage, after anaesthesia and surgical intervention. Results: After induction was observed mild hypotension-less 8% of basic level (p0,05), decreased tidal volume (p0,05). During other stages of significant changes of haemodynamic and breath wasn't. LM was successfully placed after first attempt in 100% cases. LM tolerability was satisfactory and did not demand anaesthesia depth. There were no ventilatory or gas exchange complications. Spontaneous ventilation was 16±0,1 dreath per min. SpO2 98-100%. IA installation required more time. Fixing of the lower jaw by the anesthesiologist for maintenance of possibility of airways was required for all patients. Spontaneous ventilation was adequate SpO2 98-100% but with mild tachypnea 22±0,3 dreath per min. IA did not provide prophylactic of aspiration. Conclusion: LM demands less time than IA for installation, less traumatic, prevent possible translocation of the soft tissues, provide better airway potency and ventilator control. Keywords: laryngeal mask, oligofren patient

Background: Although lidocaine is a commonly used local anesthetic in dental treatment, the effects of lidocaine on calcium release in craniofacial arteries such as the lingual artery are not well known. Aims: The aim of this study was to examine the effects of lidocaine on calcium release and the role of pathways in swine lingual artery contraction induced with agonists. Materials and Methods: We measured intracellular Ca2+ concentration ([Ca2+]i) and tension using front-surface fluorometry in sections of swine lingual artery with denuded endothelium. Results: The [Ca2+]i and tension induced with adrenaline and histamine in the absence of extracellular Ca2+ with lidocaine added were low compared with or without lidocaine, while the [Ca2+]i and tension induced with caffeine were the same with or without lidocaine. Treatment with lidocaine before and during the application of adrenaline significantly inhibited the increase in [Ca2+]i and tension induced with adrenaline in the presence of extracellular Ca2+ after depletion of the intracellular Ca2+ store. Conclusions: Lidocaine depressed increases in [Ca2+]i and tension that were dependent on the Ca2+ via inositol trisphosphate channel-operated Ca2±entry channels, and lidocaine did not attenuate Ca2±induced Ca2+ release in KCl- and agonist-induced smooth muscle contraction. Lidocaine depressed the increase of Ca2+ influx from extracellular Ca2+ through RACC or nonselective cation channels. Keywords: lidocaine, caffeine, intracellular Ca2+ concentration, inositol trisphosphate channel, L-type channel

Aims: We infuse fentanyl at 1µg/kg/h and propofol to maintain moderate sedation at OAA/S Score 2 -3 for minor but relatively long and invasive oral surgeries. However, details regarding the intra- and postoperative process using this sedation method are unknown. Therefore, we aimed to evaluate the usefulness of this method in intraoperative pain control, postanesthetic recovery, and occurrence of side effects in this retrospective study. Methods: Anesthesia records from 75 patients were included in this study, and intraoperative respiratory and circulatory changes were investigated. The frequency of body movement, complaint of pain, and rescue dose of local anesthetic were evaluated in each patient. Results of the postanesthetic recovery process, which had already been evaluated by Post Anesthesia Discharge Scoring System1), were used. Results: Intraoperative respiration and circulation were stable. The median (maximum, minimum) value of the duration of body movement, complaint of pain, rescue dose of the local anesthetic, and dosage of postoperative analgesics were 0 (6, 0), 0 (4, 0), 0 (7, 0), 1 (3, 0) times per patient. The median postanesthetic recovery time was 30 (120, 15) min. The incidence of postoperative nausea and vomiting was 2.8%. Conclusion: Sedation by propofol with low-dose infusion of fentanyl is useful for intra- and postoperative pain-control, leads to prompt recovery, and has few side effects after relatively long and invasive minor oral surgeries. 1) Yamada M, et al: Aichi Gakuin J. Dent. Sci, 37(3): 551-560, 1999 Keywords: infusion of fentanyl, propofol sedation, minor oral surgeries

Aim: Diabetes can be associated with a number of peripheral neuropathies, which include painful diabetic neuropathy and cardiovascular autonomic neuropathy. Therefore, patients with diabetes may have complicated cardiovascular responses to noxious stimulation. However the details are unclear. Methods: Diabetic model (DM) rats were prepared by administering streptozotocin (STZ). Three weeks after STZ, a pressure sensor and needle electrodes were implanted and connected to telemetry system for measurement of blood pressure (BP) and ECG. Four weeks after STZ, formalin test was conducted on upper lip. Pain related behavior (face-rubbing; PRB), BP, and heart rate (HR) were recorded for 60 min. Two hours after the formalin test, brain was perfused and expression of c-Fos in the caudal part of spinal trigeminal nucleus (Vc) was evaluated. Furthermore, BP and HR variability were analyzed using the MemCalc method. Control rats (no STZ treatment) were also examined. Results: There were no significant differences in the PRB and HR-HF between the DM and control rats. The elevation in BP and HR in the DM rats was smaller than that in the control rats (p 0.01). Changes in SBF-LF in the DM rats were significantly less than those in the control rats (p 0.01). Expression of c-Fos in Vc was higher in the DM rats than in the control rats (p 0.05). Discussion: Although increased expression of c-Fos in Vc reflects hyperalgesia to noxious stimulation, hemodynamic and autonomic responses were smaller in the DM rats. Response to noxious stimuli was complicated by neuropathy in DM rats. Keywords: diabetes mellitus, autonomic nerve, cardiovascular response, c-Fos, formalin test

Objective: Purpose of this retrospective clinical study was to determine differences in bone level changes by using butt and conical implant abutment junctions. The comparison of CAMLOG and CONELOG implants should allow comparable conditions concerning outer implant geometry. Material and Methods: Inclusion criteria: All patients were treated by the same surgeon, the same prosthodontist, the same dental technician, and with single crown restorations. Mesial and distal distances from the crestal bone level to the implant shoulder were measured radiographically after surgery as well as after prosthetic rehabilitation. Bone level changes were determined. Results: Thirty CAMLOG (without platform switch) and 30 CONELOG implants were investigated. Mean follow-up time after surgery was 25 months in the CAMLOG group and 18 months within the CONELOG group. The mean marginal bone level change for CAMLOG was significant from surgery to follow-up (p0.002; p0.008). CONELOG showed no significant difference (p0.992; p0.999). The comparison of CAMLOG and CONELOG revealed a significant difference between the groups (p0.001). Bone loss was noted for 67 % of the CAMLOG implants. Bone gain was noted for 47 % and no bone loss for further 30 % of the CONELOG implants. Conclusions: Within the limits of this study conical connections may prevent peri-implant bone loss and have a positive effect on marginal bone in comparison to butt connections. Keywords: Dental Implant, Camlog, Conelog, Conical Joints, Crestal Bone Level Changes