History Of Toothache Research Articles

Tooth loss from the perspective of studies employing a life course approach: a systematic review.

The life course approach scrutinizes factors that shape the development of diseases over time. Tooth loss, which is influenced by social, behavioral and biological factors, can occur at various stages of life and tends to become more prevalent in later years. This systematic review examined the influence of socioeconomic, psychosocial, biological and behavioral adversities in life on the likelihood of tooth loss. Searches were conducted in the Embase, PubMed, Web of Science, Ovid, PsycINFO, Scopus and LILACS databases. Reference management was performed using EndNote online. The risk of bias was appraised using the Newcastle-Ottawa Scale (NOS). The electronic searches yielded 1366 records, 17 of which (13 cohort and four cross-sectional studies) met the inclusion criteria. According to the NOS, all studies had a low risk of bias. Two studies found a link between a lower education and higher incidence of tooth loss and socioeconomic status exerted a significant influence in 47% of the studies. Disadvantaged socioeconomic trajectories and health-related factors, such as smoking, general health perception and oral health behaviors, increased the likelihood of tooth loss. Factors such as dental visits, a history of toothache and exposure to fluoridated water influenced the likelihood of tooth loss. Individuals who experienced adversities in socioeconomic, behavioral and biological aspects throughout their life course were more prone to tooth loss.

Can oral health have an impact on academic performance and school absenteeism?

Aim: The study aimed to evaluate the association between oral health and academic performance and/or school absenteeism. Methods: Electronic searches were performed of the PubMed, Web of Science, SCOPUS and LILACS/BVS databases. We included observational studies that evaluated the association between dental caries, tooth loss, dental pain or oral health status with school absenteeism or academic performance. The studies had to contain a representative sample of the population: schoolchildren, children or adolescents. After the removal of duplicates, the electronic searches produced 3,789 articles. Of these, 25 studies were included in the systematic review and 13 in the meta-analysis. Results: Considering all the studies evaluated in the meta-analysis, seven articles satisfied 100% of the Joanna Briggs Institute Critical Appraisal checklist, and six contained between 90% and 75% positive answers. The pooled effects showed that the chances of school absenteeism were 31% higher in subjects with dental caries (OR 1.31; 95%CI 1.12-1.54). Students with fair/poor dental health had a 50% higher chance of suffering poor academic performance (OR 1.50; 95%CI 1.22-1.84) and 34% higher chance of having problems at school (OR 1.34; 95%CI 1.06-1.70). Students with a history of toothache had a 3.7 higher chance of being absent from school (OR 6.65; 95%CI 1.60-8.32) and 71% higher chance of missing class due to toothache (OR 1.71; 95%CI 1.15-2.56). Subjects with a history of toothache had a 2.5 times higher chance of suffering poor academic performance (OR 2.58; 95% CI 2.04-3.27). Conclusion: Therefore, students with oral problems were more likely to take time off school and present inferior academic performance.

Uncommon bilateral orbital lesion in leukemic patient: is it cutis leukemia, celullitis or both?

Introduction : Acute Myeloblastic Leukemia can infiltrate any parts of the body including the orbit and periocular area. This article was aimed to report uncommon sign of cutis leukemia representing as orbital cellulitis.
 Case Illustration : Male, 35 yo with chief complained progressive lesion in his bilateral upper and lower eyelid since 4 days before admission. He felt pain and stingy sensation around lesion. There was history of toothache. He was diagnosed with acute myeloblastic leukemia since 2 month before. Ophthalmology examination showed his visual acuity was 6/6 in both eyes with good ocular motility.His bilateral upper and lower eyelid were edematous and spasm with multiple vesicles, papule and pustule. Conjunctival injection was found in both eyes. The reminder of ophthalmology examination was unremarkable. There were other hyperemic nodules in left mandibulae and right mastoid bone. Laboratory examination showed increased leukocyte, procalcitonin and C-Reactive Protein level. Orbital CT scan revealed edema in cutis and subcutis area in both superior and inferior bilateral palpebra. Board spectrum and anaerobe antibiotic along with steroid were administered intravenously. Biopsy was performed. After two weeks medication, lesion around both palpebra was decreased. Unfortunately, because of his poor systemic condition, he was readministered to our hospital and hospitalized in ICU. He was passed away after 8 days of hospitalization.
 Discussion : Male patient is more likely to develop orbital infiltration of leukemia, and it necessitates significant morbidity and mortality condition.
 Conclusion : Leukemia with orbital invasion should bring more awareness from both ophthalmologist and hematooncologist as it indicates more mortality and morbidity.

DETERMINANT FACTORS OF DENTAL AND ORAL SELF-CARE FOR ADOLESCENTS IN THE COASTAL AREA OF CILACAP CITY

Background: The prevalence of oral health problems in Indonesia is 25.9%. The incidence of oral and dental diseases in Central Java in 2019 was recorded at 126,225 cases and 39,759 of them occurred in Cilacap District. Based on data taken from the Kampung Laut Community Health Center, there were a total of 164 confirmed cases of oral health in 2022, dental and oral diseases that are often found in the community include caries and periodontal disease. Oral health care efforts are the main preventive measures to prevent oral disorders in order to avoid oral diseases, which can be carried out by each individual through self-care, such as brushing teeth, using dental floss, and using mouthwash. The purpose of this study was to determine the relationship between factors of knowledge, behavior, attitude, age, gender, parents' occupation, social history, and history of toothache with oral self-care in adolescents at Kampung Laut 1 Senior High School.Method: This type of observational analytic study uses a cross-sectional design. The sample in this study were 82 students. Data collection was carried out by providing questionnaires which were filled out independently by students.Result: The results of the analysis of the relationship between factors of knowledge (p = 0.037), behavior (p = 0.018), attitude (p = 0.046), age (p = 0.037), gender (p = 0.025), parents' occupation (p = 0.049), social history (p = 0.037) and history of toothache (p = 0.018) on dental and oral self-care in adolescents where the p value of each variable is <0.05 which means it is significant.Conclusion: There is a relationship between knowledge, behavior, attitudes, age, gender, parents' occupation, social history and history of toothache on dental and oral self-care in adolescents.

PREDICTION CLASSIFICATION AND MODELLING USING DECISION TREE WITH ORDERED REGRESSION AND ITS APPLICATION TO SOCIO-BEHAVIORAL FACTORS ASSOCIATED WITH TOOTHBRUSHING FREQUENCY IN CHILDREN

Toothbrushing is considered the best self-care behavior for the prevention of oral diseases. Brushing teeth twice a day is considered the social norm, but the development of such habits is dependent on psychosocial, economic, and environmental factors. Recognizing the significance of statistical modeling in medical sciences, this study will use decision trees and ordinal regression to predict frequency of toothbrushing in children. The methodology will be harmonized in the R syntax. The study illustrated the development of the method using 527 observations from WHO oral health questionnaire for children. Before regression analysis, the clinical relevance and significance of each of the 28 variables will be assessed using decision tree analysis and tested for accuracy. The classification obtained will be used as an input for the ordinal regression modeling. According to decision tree analysis, smoking, maternal education, dietary habits, history of toothache and self-rated tooth health contributed significantly to the children’s overall toothbrushing frequency. These six variables were used as input for ordinal regression analysis and the developed syntax was used to assess the goodness of fit for the model. Our proposed method achieves the highest level of forecasting precision possible. The process is an alternate to ordinal regression modelling as the selection of appropriate variables is based on computational analysis, forecasting the importance of the independent variables chosen for the final model. This process demonstrates the possibility of developing prediction models which can then be used to formulate clinical hypothesis and inform future researchers.

Prevalence of painful temporomandibular disorders in endodontic patients with tooth pain.

Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown. This cross-sectional study investigated the prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed. Patients reporting tooth pain in the 30 days before attending university clinics for nonsurgical root canal treatment or retreatment were enrolled. Before endodontic treatment, they completed questionnaires and a board-certified orofacial pain specialist/endodontic resident diagnosed TMD using published Diagnostic Criteria for TMD. Log-binomial regression models estimated prevalence ratios to quantify associations with patient characteristics. Among 100 patients enrolled, prevalence of painful TMDs was 54%. In 26% of patients, TMD pain was unrelated to endodontic pain; in 20%, TMD contributed to their chief pain complaint; and in 8%, TMD was a sole aetiology for pain. TMD prevalence was associated with greater intensity, frequency and duration of the chief pain complaint; pain in more than one tooth; tenderness to tooth percussion and palpation; a diagnosis of symptomatic apical periodontitis; pain medication use; and psychological distress. A majority of patients with tooth pain seeking endodontic treatment had painful TMDs; one quarter had TMD as a component or sole cause of their pain. TMD prevalence was associated with more severe symptoms and signs of tooth pain and with psychological factors. The high frequency of TMD comorbidity warrants consideration in management of endodontic patients with history of toothache.

Assessing The Quality of Life Among Older Adults Having Oral Health Problems

Oral health refers to the health of the oral cavity of an individual. Oral health is the most important part of general healthcare. The oral cavity or mouth make a major part of human body and considered to be the beginning of gastrointestinal and respiratory systems. The concept of Oral Health-Related Quality of Life (OHQoL) is focused on the idea that oral health issues can harm a person's self-esteem and self-image, create other health problems, hinder social contact, and cause pain, stress, and sadness. Objective: To assess the Quality of Life (QoL) among older adults having oral health problems. Methods: A Cross-sectional study was carried out from ‘Heaven Old-Age home’, Ferozepur Road, Lahore. Middle age to older adults aged between 45 to 80 years suffering from oral health problems were selected through a non-probability convenient sampling technique, and the sample size of 100 was enrolled. Participants were assessed through a self-constructed questionnaire. The data was analyzed by SPSS version 21.0. Results: Out of 100 participants, 45 were males while 55 were females while 96 participants were married. Socioeconomically, 72 participants belonged to the middle class in which 67 participants were educated, while 33 were uneducated. Result showed that 39 felt almost inability of chewing, 51 felt uncomfortable eating, 61 were feeling difficulty in biting hard food, and 54 were feeling difficulty while taking a big bite. Moreover, 77 were feeling difficult or restricted smiling, 74 were feeling difficulty in relaxing while 71 were feeling tense, and 83 were feeling irritable. 75 were embarrassed because of oral issues. However, 65 had pain in the mouth while 35 did not. 68 individuals had history of toothache in the previous 12 months, while 32 had not. Conclusion: It was concluded that there is an association between quality of life and oral health. Older adults face problems in chewing and swallowing food, feel pain while chewing or biting the food, and face nutritional deficiencies affecting their quality of life.

Case report: A rare case of herpes zoster with trigeminal and vestibulocochlear nerves involvement

Background : The distinguishing characteristic of Herpes Zoster (shingles) is its limitation to a single dermatome. The involvement of more than one dermatome is unusual, while the involvement of more than one spinal nerve is a rare find. The case presented is a 70 year old woman with herpes zoster of two cranial nerves: the trigeminal and the vestibulocochlear; the three divisions of the trigeminal nerve were also involved.Methods : A 70-year-old woman who complained of a week old history of blisters on the face and mouth and three (3) weeks history of toothache on the left side is presented. The patient also complained of ringing, pain in the left ear, and rotational dizziness. She admitted that she was treated for malaria fever a week before the onset of these symptoms. On examination, there were ulcers involving the skin of the left side of the face up to the left auricle and the scalp. The left maxillary and mandibular mucous membrane and left side of the tongue also had ulcers. There was no facial muscle weakness.Laboratory investigation included Full Blood Count, fasting blood sugar (FBS), and retroviral screening (RVS). The FBS was within normal limits, while RVS was non-reactive. Treatment was with oral prednisone -dosage tapered-; antibiotics, and diazepam.Results : Healed erosions were observed on the 3rd week of treatment.Conclusion : Multiple dermatome distribution of vesicular rash due to more than one spinal nerve involvement is an uncommon finding in herpes zoster. Early diagnosis and prompt treatment can result in complete resolution.

EMERGENCY TREATMENT OF SEVERE ODONTOGENIC INFECTION EXTENDING TO THE FOUR MAXILLOFACIAL SPACES: CASE REPORT

Severe odontogenic infection involving multiple maxillofacial spaces can lead to complications and even life-threatening. Immediate treatment is needed, mainly to prevent airway obstruction and sepsis. This case report aims to describe and discuss the immediate treatment of a severe odontogenic infection that extends to the submandibular, submental, buccal, and parapharyngeal spaces. Case report: A 52-year-old male patient came to the Emergency Department (IGD) Hasan Sadikin Hospital, Bandung, with complaints of swelling in the lower jaw and right neck, painful swallowing, and difficulty opening the mouth wide preceded by a history of toothache. Extraoral; facial asymmetry, right submandibular swelling, right cheek, neck, and chest, redness, warm, localized, fluctuating, and painful palpation. Intraoral; trismus generalized hyperemia of the gums, pulp necrosis of tooth 46, and impacted tooth 48. Routine blood laboratory count of leukocytes 18,280 mm3 and platelets 510,000 mm3. Neck Soft Tissue AP-Lat radiograph shows soft tissue swelling in the right submandibular with multiple air density radiolucency in it, suggesting an abscess. The patient's diagnosis was a right odontogenic submandibular abscess that extended to the right submental, buccal, parapharyngeal, and clavicle. Immediate management includes fluid regulation, administration of antibiotics, analgesics, and incision drainage. Conclusion: In this case of severe odontogenic infection, the patient was saved by prompt treatment of a pus drainage incision to prevent the expansion of infection and airway obstruction. Keywords: odontogenic infection, maxillofacial space, incision drainage, emergency

Bacterial Profile and Risk Factors Associated with Dental Caries in Enugu Metropolis, Southeast Nigeria

Dental caries is one of the most prevalent and costly diseases that are a challenge to health care providers. There is limited data on the bacterial profile and risks associated with dental caries in Nigeria. The study aimed to isolate and identify bacteria and risk factors associated with dental caries in Enugu. It was a case-controlled study. A total of 336 samples were randomly collected comprising of 125 healthy subjects and 211 patients with dental caries attending various hospitals and dental clinics in Enugu, Nigeria. Samples were subjected to standard microbiological and biochemical techniques. Standardized questionnaires were used to record demographic variables and risk factors. A total of 635 and 254 microorganisms were isolated from carious lesions and healthy subjects respectively. Of these 635 isolates, 218 (34.4%) Gram-positive bacilli, 210 (33.0%) Gram-positive cocci, 46 (7.2%) Gram-negative cocci, and 43 (6.8%) yeasts were recovered. Two hundred and seven samples were (98.1%) polymicrobial while 4 samples (1.9%) were monomicrobial. Among the organisms recovered, anaerobic Lactobacillus spp (141, 66.8%) was the most prevalent followed by Streptococcus mutans (104, 49.2%), and the least were Actinomyces israelii and Capnocytophaga spp (1, 0.05%) respectively. Of the 254 isolates from apparently healthy subjects, Streptococcus sanguis ranked highest and the least was Porphyromonas gingivalis. The factors that were found to be significantly associated with dental caries were level of education P=0.005, feeding habit P= 0.001, Favourite snack P=0.004, sweet consumption P< 0.0001, type of gum P < 0.0001, history of toothache P < 0.0001, visit dentist P< 0.0001, and the bleeding gum P < 0.0001. This research highlighted the polymicrobial nature of carious lesions and associated predictors of dental caries. Hence public enlightenment and the implementation of oral health education in schools are crucial.

Association between domestic violence and oral health conditions among adolescents

This study surveyed the oral health conditions of adolescents aged 15 to 19 years and their association with exposure to domestic violence. The study sample consisted of 333 adolescents enrolled in the State School System in the city of Olinda, PE, Brazil. Sociodemographic data, information on the participant’s oral health conditions, and their history of domestic physical violence were collected. The health-related variables analyzed included self-perceived oral health, history of toothache, and the frequency of toothbrushing and visits to the dentist. The data were entered into the Epi data 3.1 and analyzed in the SPSS program 23.0 by Pearson's Chi-square or Fisher's exact tests. There was a significant association of history of toothache and domestic violence with physical aggression from the mother (P = 0.001; OR = 2.39), a relative (P = 0.001; OR = 2.41) and any family member and/or with witnessing violent acts between the parents (P = 0.011; OR = 1.88). However, no association between physical violence and self-perceived oral health or the frequency of visits to the dentist was observed. To conclude, our findings indicate that the oral health conditions of adolescents may be directly associated with domestic violence.

MANAGEMENT OF INFRATEMPORAL ABSCESS : SERIAL OF 3 CASES

Introduction: Infratemporal abscess due to odontogenic infection is a rare case, because most dental infections spread through the submandibular space or to the deep neck spaces. Abscess formation in this area may lead to dangerous complications, which infection from this area might spread through the pterygoid plexus to the cavernous sinus or through the valveless ophthalmic veins into the orbit, and may result in intracranial and orbital complications. Case report: We reported 3 cases of infratemporal abscess which were handled at the Oral and Maxillofacial Surgery department of Dr. Hasan Sadikin Hospital Bandung. Patients were two males and one female. They all had a history of toothache in the left lower jaw region. All of the patients underwent surgical incision drainage. Conclusion: Diagnosis of an infratemporal abscess can be confirmed by careful history taking and clinical examination. Early detection and aggressive treatment of infratemporal abscess due to odontogenic infection can avoid mortality and minimized complication caused by delay in treatment.

Awake Nasal Fiberoptic Intubation in Diffuse Para-pharyngeal Abscess

This is a case report on awake fibreoptic intubation for a patient with a deep neck space infection. Intubation in this group of patients is considered difficult. It is challenging to anaesthesiologists, emergency physicians and otorhinolaryngologists because there is no consensus for airway management in these patients. We present a 30-year-old gentleman with swelling over the right cheek, difficulty breathing and severe trismus. He had a history of toothache one month prior to admission. Upon clinical examination, there was a diffuse swelling over the right mandible. Other examinations were unremarkable. Provisional diagnosis of a right para-pharyngeal abscess was made secondary to a possible infected right lower 3rd molar, with a differential diagnosis of a right parotid abscess with para-pharyngeal extension. Radiological assessment using computed tomography (CT) of the head and neck region showed an abscess over the right para-pharyngeal area, soft palate and right submandibular region. The narrowest part of the airway was at the region posterior to the soft palate, measuring approximately 1 cm. All staff and equipment were prepared for intubating a difficult airway. The patient was transferred to the control environment (operation theatre) for intubation. Awake nasal fibreoptic intubation (AFOI) was successfully performed for this patient using intravenous dexmedetomidine alone as the sedative.

Dental Caries Prediction Based on a Survey of the Oral Health Epidemiology among the Geriatric Residents of Liaoning, China.

Background Dental caries is one of the most common chronic diseases observed in elderly patients. The development of preventive strategies for dental caries in elderly individuals is vital. Objective The objective of the present study was to construct a generalized regression neural network (GRNN) prediction model for the risk assessment of dental caries among the geriatric residents of Liaoning, China. Methods A stratified equal-capacity random sampling method was used to randomly select 1144 elderly (65-74 years) residents (gender ratio 1 : 1) of Liaoning, China. Data for the oral assessment, including caries characteristics, and questionnaire survey from each participant were collected. Multivariate logistic regression analysis was then performed to identify the independent predictors. GRNN was applied to establish a prediction model for dental caries. The accuracy of the unconditional logistic regression and the GRNN early warning model was compared. Results A total of 1144 patients fulfilled the requirements and completed the questionnaires. The caries rate was 68.5%, and the main associated factors were toothache history, residence area, smoking, and drinking. We randomly divided the data for the 1144 participants into a training set (915 cases) and a test set (229 cases). The optimal smoothing factor was 0.7, and the area under the receiver operating characteristic curve for the GRNN model was 0.626 (95% confidence interval, 0.544 to 0.708), with a P value of 0.002. In terms of consistency, sensitivity, and specificity, the GRNN model was better than the traditional unconditional multivariate logistic regression model. Conclusion Geriatric (65-74 years) residents of Liaoning, China, have a high rate of dental caries. Residents with a history of toothache and smoking habits are more susceptible to the disease. The GRNN early warning model is an accurate and meaningful tool for screening, early diagnosis, and treatment planning for geriatric individuals with a high risk of caries.

Clinical features and imaging analysis of primary bone lymphoma of the jaw

Objective: To investigate the clinical characteristics and imaging manifestations of primary bone lymphoma (PBL) located in the jaw. Methods: Clinical data of 14 PBL patients admitted to The First Affiliated Hospital of Zhengzhou University from January 2014 to April 2019 were retrospectively analyzed, which including age, gender, location, chief complaint, laboratory test, imaging manifestations and so on. Results: Among the 14 PBL patients, 10 were male and 4 were female. Age range from 4 to 79 years, median age was 56 years old. There were 6 cases involved maxillary, 7 cases involved mandible and 1 case involved mandible and maxillary simultaneously. Twelve patients were admitted with local mass as the chief complaint, 3 had a history of toothache, 4 had loosen tooth and 2 had numbness of lips and cheeks. Two cases of oral mass with mucosal surface ulcer or abscess formation. One case complained of fever, night sweats and other systemic symptoms. The imaging findings showed 8 cases of osteolytic lesions, 1 case of sclerosis, 4 cases of mixed lesions and 1 case of cystic lesions. One case had periosteum reaction. In 12 cases, there was an obvious mass, which was characterized by the large soft-tissue mass and marrow changes were associated with surprisingly little cortical destruction. Conclusions: PBL is more common in middle aged male. The upper and lower jaw bones can be involved. Clinical and imaging manifestations lack characteristics, and common dental or periodontal symptoms such as toothache, tooth loosening, and paresthesia may occur. However, the imaging characteristics of large soft tissue masses with small degree of bone destruction can be used as an important basis for the differential diagnosis of osteomyelitis, squamous cell carcinoma, osteosarcoma and other diseases.

Tooth pain and associated factors among adolescents of a large population municipality in Northeastern Brazil.

The aim of this study was to describe and analyze history of toothache and associated factors among adolescent students enrolled in public schools of a city in Northeastern Brazil. An observational, descriptive, quantitative and cross-sectional study was conducted through the application of 4 questionnaires with 458 adolescents. By bivariate analysis, the prevalence of toothache in life was higher among younger adolescents (76.9%; p = 0.004), who have visited the dentist at least once (74.8%; p = 0.001) and who reported fear (74.9%; p = 0.006). The occurrence of dental pain in the last 6 months was low, where male (77.4%; p = 0,001) and older adolescents (73.1%; p = 0.031) reported no occurrence of pain. Through multivariate analysis, the highest prevalence of dental pain in life remained among younger adolescents (76.9%; p = 0.003) and who reported dental fear (74.9%; p = 0.006). The prevalence of toothache in the last 6 months remained low through multivariate analysis, among male and older adolescents. It could be concluded that the prevalence of toothache in life was higher than in the last 6 months, showing significant association with gender, age, visit to the dentist and dental fear.

Orbital cellulitis as a complication of odontogenic infection

Orbital cellulitis is uncommon sequelae of the spread of odontogenic infection to adjacent maxillary sinuses or to distant sites such as the orbits. Once it happened, the spread of such infection can be of serious complication such as complete blindness or even more serious and life threatening situations as cavernous sinus thrombosis, intra-cranial abscess, or even death. This paper aimed to expose the guideline treatment of orbital cellulitis as a complication of odontogenic infection. It reported one case of orbital cellulitis in the emergency unit of Hasan Sadikin hospital Bandung, with complaints of pain, swelling at cheek and periorbital region, and the history of toothache. The treatment include incision drainage, extraction of tooth, and parenteral administration of antibiotic and analgesic. Odontogenic infections are derived from dental infection and can potentially spread rapidly to be ascending infection like orbital cellulitis. Odontogenic infection and orbital cellulitis should be adequately treated with incision drainage, extraction of tooth and parenteral administration of antibiotic, steroid and analgesic. Without immediate treatment, odontogenic infection can lead to ascending infection. Orbital cellulitis due to spreading of odontogenic infection is a rare case. In this case report, the patient had a significantimprovement due to immediate and proper treatment.

Ludwig’s Angina: An Update of Clinical Features and Management

Background & objective: Ludwig’s angina (LA) is a potentially life-threatening, rapidly spreading, bilateral cellulitis of the submandibular spaces in children. In the preantibiotic era, the airway obstruction was almost inevitable and case fatality rate was as high as 60%. With the introduction of antibiotics in 1940s the LA has become an uncommon disease. As such, many physicians have limited experience of it. But its early recognition and aggressive management still carries utmost importance to avoid life-threatening acute airway obstruction. Therefore, the present study was undertaken to update the physicians with clinical features and management of Ludwig’s angina.
 Methods: The present descriptive study was conducted in Bangladesh Institute of Child Health & Dhaka Shisu Hospital, Sher-e-Bangla Nagar, Dhaka between January 2012 to December 2016. Having obtained approval from the Institutional Review Board of the Institute, we retrospectively analyzed the clinical course and management of Ludwig’s angina. During the period a total of 27 patients’ record were found available. Data were collected on demographic and clinical characteristics, causes and predisposing factors, investigations, complications developed and outcome of LA. Penicillin with or without additional anaerobic coverage with clindamycin or metronidazole were used as key patient management strategy. Steroid was given for faster recovery of the patients having airway compromise. Patients who did not recover with conservative treatment underwent surgical treatment with incision and drainage.
 Result: In the present study children with Ludwig’s angina presented with bilateral swelling of the neck and submandibular region accompanied by pain and induration in the affected region. Systemic symptoms, such as, fever and malaise were also frequently present. Two-thirds (66%) of the children had dehydration and almost half (48%) had toxic look. Over one-third (37%) of the children exhibited, restricted backward and upward elevation of tongue and over half with trismus. Of the systemic signs, high temperature, tachycardia, and tachypnoea were common presentation. One-third of the children exhibited signs of airway obstruction. Fifty percent of the children had the history of toothache (lower molar) one or two weeks prior to the development of Ludwig’s angina, 40% had history of mumps and 3.7% had history of trauma to the mandible. Over one-quarter developed pneumonia with mediastinitis. Airway obstruction, manifested as unable to swallow saliva, dyspnoea, stridor and cyanosis, was exhibited by over 55% of the children and received intravenous steroid for faster recovery from the condition. More than three-quarters (77.7%) of the patients responded to Penicillin with or without clindamycin or metronidazole and those who did not respond to it (22.3%) underwent operative treatment.
 Conclusion: Despite modern medical and surgical interventions have improved the outcomes of Ludwig’s angina to a great extent, it still remains a potentially lethal disease in the pediatric population. Early recognition of the disease with identification of airway obstruction and prompt intravenous antibiotic therapy could resolve the disease without any complications or need for surgical intervention.
 Ibrahim Card Med J 2017; 7 (1&2): 51-56

Toothache and Non-Clinical Individual and School Factors in Five-Year-Old Children: Multilevel Analysis.

The objective of the present study was to evaluate the influence of individual and contextual factors on the occurrence of toothache in five-year-old children. A cross-sectional study was conducted with 756 five-year-old children from public and private preschools in a city in the countryside of the northeast of Brazil. The sample was determined through probabilistic sampling in two stages (preschools and children). The children included could not have systematic diseases, permanent tooth or orthodontic treatment. Parents/caregivers were required to spend at least 12 hours per day with their children. The history of toothache during the life of the child was reported by parents/guardians. Socioeconomic and psychological questionnaires were completed by parents/guardians. Variables related to social context were obtained from the preschools in which the children studied and the official publications of the municipal region. Unadjusted and adjusted multilevel Poisson regression models were used to investigate the association between individual and contextual characteristics and history of toothache. The history of toothache was found for 23.8% of the children. Among the individual determinants, gender of the child, order of birth, and schooling of parent/guardian were associated with toothache in children. The individual variables remained associated with the outcome after the addition of the contextual variables to the model. The type of preschool was the contextual determinant associated with toothache in the final model. Both individual (gender, order of birth and schooling of parents/guardians) and contextual (type of preschool) determinants were associated with history of toothache in five-year-old children.

Perception of Treatment Needs and Use of Dental Services for Children and Adolescents with Sickle Cell Disease.

To evaluate the perception of treatment needs and the use of dental services for children/adolescents with sickle cell disease. A cross-sectional study was conducted with 250 children/adolescents with sickle cell disease at a reference center in the city of Recife, Brazil. Data on the use of dental services were collected using a 13-item questionnaire administered to parents/guardians. The examiner in charge of determining l caries and periodontal status had previously undergone a training and calibration exercise. Descriptive statistics and Poisson regression analysis were also performed (α = 5%). A total of 47.2% of the children/adolescents with sickle cell disease were diagnosed with caries and 14.0% were diagnosed with some periodontal problems. The following variables were statistically significantly associated with the perceptions of parents/guardians regarding the treatment needs of their children: caries (PR = 1.24; 95%CI: 1.09-1.42), periodontal problems (PR = 1.10; 95%CI 1.01-1.20) and history of toothache in the previous six months (PR = 1.17; 95%CI 1.06-1.29). Only a lower level of mothers' schooling (PR = 1.64; 95%CI 1.06-2.53) was statistically significantly associated with the mean number of caries among the children/adolescents with sickle cell disease. Mean dmft/DMFT indices were higher among children/adolescents who sought dental care. Based on our results, a predomination of curative treatment was found, as seeking out dental treatment was more frequent among children/adolescents with a greater number of caries.