Maxillofacial Surgical Practice Research Articles

SCPNB is an adjuvant to local anaesthesia for maxillofacial surgical practice.

The superficial cervical plexus nerve block [SCPNB] procedure is frequently used throughout head and neck surgery because it is simple to learn and has a low rate of complications. The investigation of this method might produce superior outcomes in treating frequent maxillofacial disorders including mandibular fractures and infections of the odontogenic region. The SCPNB is known to play a part in the medical evacuation of head and neck abscesses, the excision of superficial diseases in the perimandibular region, and the therapy of mandibular fracture, despite the dearth of research in this area. Considering this background, it was expected that the SCPNB might be helpful as an adjuvant to regional anaesthesia in maxillofacial surgery. The purpose of this study was to assess the effectiveness of the SCPNB in the treatment of mandibular fractures and infectious diseases in the perimandibular area. 48 patients with either submandibular space infections or mandibular injuries who were anticipated for surgical procedure under regional anaesthesia participated in a prospective randomized clinical study (eg, inferior alveolar nerve block, long buccal nerve block). Administering a combination of a local infiltration and regional anaesthesia was used as the control group. Regional anaesthesia and a SCPNB were administered to the intervention class. The following factors were examined: pain, anaesthesia's duration and onset, waiting period before initial analgesic demand, pulse rate, and blood pressure. The unpaired t-test was used to compare groups. Multiple variables ANOVA (for more than two observations) was used for intragroup analysis, accompanied by a post-hoc analysis of variance. In aspects of intra - operative pain at thirty minutes, time required of anaesthesia, intraoperative anesthetic necessity, duration until first analgesic recommendation, and intra - operative diastolic arterial blood pressure at ten minutes, the SCPNB group demonstrated a substantial (P ≤.01) improved performance. It can be concluded that the use of a regional anaesthetic approach in conjunction with a SCPNB is a good substitute to localized infiltration for patients having surgery for fracture of mandible and perimandibular area infections.

Demographic Factors as Prognostics of Patients’ Morbidity Following Wisdom Tooth Surgery

Background: Surgical removal of impacted mandibular third molars is a common procedure in oral and maxillofacial surgical practice with undesirable consequences such as pain and swelling that have a major concern for most patients. This study aimed to investigate the impact of age and gender on postoperative intensity of pain and swelling experienced by patients following mandibular third molar surgery (M3MS). Material and Methods: The study involved 46 patients underwent surgical extraction of mandibular third molar under local anesthesia. The visual analogue scale measured pain and swelling for seven consecutive days after surgery. Results: After M3MS, patients experienced the most pain severity in the day of surgery, while facial swelling reaching a maximum in the first postoperative day. It was found that the influence of age and gender on the intensity of pain and degree of swelling was insignificant. Conclusion: Pain and swelling after M3MS peaked on the day of surgery and the day after respectively with mild to moderate intensity, it subsided gradually to minimal levels on day 7. Short-term outcomes of M3MS with respect to degrees of pain and swelling were found to be similar, and it seems to be independent of both’ age and gender.

The specialty of oral and maxillofacial surgery (OMFS) in Europe – Part 1: service configuration, regulation, and provision

Oral and maxillofacial surgical (OMFS) practice and training in Europe is supported by the OMFS Section of the Union of European Medical Specialists (UEMS). Across Europe the number of OMFS specialists per 100,000 varies from 3.0 (Switzerland) to 0.28 (Ireland). The two types of OMFS within the European Union (EU) under Directive 2005/36 and European Free Trade Association (EFTA) treaties are dual degree dental, oral and maxillofacial surgery (DOMFS) and single medical degree maxillofacial surgery (MFS). Automatic recognition of OMFS specialist qualifications is possible only between nations which have the same (or both) types of medical OMFS. Otherwise, individual specialists must apply for a Certificate of Eligibility for Specialist Registration (CESR). DOMFS: 20 European nations have dual degree OMFS. Of these, 12 EU nations are DOMFS in Annex V, 3 are DOMFS in the European Free Trade Association (EFTA) Treaty, and one has mandated dual degree OMFS but is a dental specialty. The United Kingdom has dual degree OMFS. Two MFS nations have had mandated dual degree training for more than 10 years and one has both DOMFS and MFS training, with DOMFS recommended. Although no nation with dual degree DOMFS has transitioned back to single degree MFS, there are pressures to do so within Finland and Norway. MFS: 11 EU nations have single medical degree MFS (and 4 DOMFS nations also have MFS as a legacy specialty). Four nations in the EU/EFTA do not yet have a medical specialty of OMFS: Sweden, Iceland, Denmark, and Estonia.

Evaluation of Surgical Glove Perforation and Sharps Injury in Oral and Maxillofacial Surgery.

The risk of exposure to infections during surgery is partly mitigated by gloving. However, perforation can reduce the effectiveness of gloving as a barrier to exposure. This study aimed at investigating the frequency of surgical glove perforation and factors predictive of these in our oral and maxillofacial surgical practice. The study was carried out at the National Hospital and the University of Abuja Teaching Hospital, Abuja, Nigeria. Consenting patients requiring oral surgical interventions were consecutively recruited into the study. Similarly, surgeons and their assistants who consented to the study were also enlisted in the study. At the end of every surgical procedure, gloves used by the surgeons and the assistants were tested for perforation. Variables investigated included the rate of perforations, the influence of the type of gloving, single versus double gloving, type of anaesthesia, and duration of surgery on rates. At a minimum of three operators per procedure, a total of 154 participants were involved in the study and 895 gloves were used. The number of glove perforations was 117(13.1%) with 82 (70.1%) involving the surgeons. There were 58/117 (49.6%) cases of perforation involving the dominant hand. Forefinger glove perforation accounted for 62 (52.9%) cases. Wire-related perforations were 72 (61.5%). Overall, nine cases of percutaneous injury were recorded. Duration of operation and double gloving were the predictive factors for perforations. Risk of sharps injury was relatively high due to the high incidence of glove perforation.

An Update on Diagnosis and Pharmacologic Therapy for Headache in the Oral and Maxillofacial Surgery Practice.

Headaches are synonymous with neurovascular pain (cephalalgias), which comprise a heterogeneous group of pain disorders that share a common anatomic region (head and neck). Headaches are often a "universal" disease presentation that is evaluated by the oral and maxillofacial surgeon. Pharmacologic therapy of headaches is most often based on the severity of symptoms and the degree of disability experienced by the patient. This article describes the epidemiology of neurovascular headaches, their pathophysiologic mechanisms/presentation, the workup of patients, and an up-to-date overview of pharmacologic approaches that can be applied in the oral and maxillofacial surgical practice to treat this patient population.

Sialendoscopy: A Four-Year Single Center Experience

Sialendoscopy is a relatively new technique designed to diagnose and treat benign obstructive salivary gland disease using a minimally invasive approach. The purpose of this study is to present our experiences regarding the use of sialendoscopy in the form of a 4-year, single center experience and to demonstrate its usefulness in oral and maxillofacial practice. We collected data on patients who underwent sialendoscopy at the Oral-Maxillofacial Surgery Department of UZ Leuven between November 2015 and August 2019, including age, gender, sex, initial clinical presentation and symptoms, gland involvement, type of diagnostic investigations, diagnosis, localization of the obstruction, therapeutic intervention, surgeon, type of anesthesia, materials used, complications, secondary treatment, duration of follow-up, and outcome. Statistical analyses were performed, chi-squared was used to compare the different variables with P < .05 being considered significant. During the 4-year timeframe, a total of 44 patients (31 female, 13 male) underwent sialendoscopy in a total of 47 procedures. The average age at time of sialendoscopy was 47.4 years. The most frequent cause of obstruction was sialolithiasis (70%). Cone-beam computed tomography (CBCT) was the most accurate preoperative investigation for the diagnosis of lithiasis (57%). Symptom improvement occurred in 57.9% of patients, with a complication rate of 11%. None of the complications were permanent. Sialendoscopy can be considered safe and effective for both the diagnosis and treatment of benign obstructive salivary gland disease, with a useful place in oral and maxillofacial surgical practice. We recommend the inclusion of CBCT and/or ultrasound in the diagnostic workup prior to endoscopy.

Role of Superficial Cervical Plexus Nerve Block as an Adjuvant to Local Anesthesia in the Maxillofacial Surgical Practice

Infiltration techniques are used as an adjuvant to regional anesthesia. In this study, we evaluated the efficacy of the superficial cervical plexus nerve block, as an alternative to local infiltration techniques; in the management of mandibular fractures and peri-mandibular space infections. A prospective randomized controlled trial was conducted on 24 patients having either mandibular fractures or peri-mandibular space infections; and were scheduled for surgery under regional anesthesia (eg, inferior alveolar nerve block, long buccal nerve block). The control group involved delivering a combination of regional anesthesia along with local infiltration. The experimental group received regional anesthesia with a superficial cervical plexus nerve block. The following parameters were studied: pain, onset and duration of anesthesia, time interval until first analgesic request, pulse rate and blood pressure [at different time intervals]. Intergroup comparison was done using unpaired t-test. Intragroup comparison was done using repeated measures ANOVA (for >2 observations), followed by a post hoc test. The superficial cervical plexus nerve block group showed highly statistically significant (P < .01) improvement in terms of intra-operative pain at 30 minutes, duration of anesthesia, intraoperative anesthetic requirement, time interval until first analgesic request and intraoperative diastolic blood pressure at 10 minutes. It can be concluded that the combination of a regional anesthesia technique with a superficial cervical plexus nerve block is an alternative and safe technique for patients undergoing surgery for mandible fractures and perimandibular space infections, with clear advantages over local infiltration.

Open Treatment of Mandibular Condyle by Direct Transparotid Approach: Our Experience.

The fractures of the mandibular condyle are commonly encountered in maxillofacial surgical practice. The controversies to open or not to open are still ongoing. We have used both techniques, to successfully manage our patients. Open treatment of condyle fracture with or without dislocation is technically challenging. We used a "Direct Transparotid" approach in treating 13 condyle fractures over a period of 4 years. The patients were evaluated for facial nerve injury, salivary fistula, scar, function, and occlusion over a period of 12 months. There were no major complications with acceptable scar, both intraoperatively and postoperatively. The script aims at presenting our experience of direct transparotid approach surgical technique.

Gadgets and Armamentarium of Maxillofacial Surgeons during Coronavirus Pandemic.

Introduction:We all know about the grave situation caused by the novel coronavirus in recent times. Although the maxillofacial surgeons are not at forefront of dealing with the coronavirus directly, they are at increased risk due to their working area on face, mouth, and oral cavity. There is an urgent need to upgrade the already set guidelines and follow them stringently. Any procedure done within the oral cavity is a high-risk procedure and this upgradation is necessary because present means are insufficient to prevent infection from this deadly virus. This article aims to review and discuss all the new gadgets and armamentarium required to deal with patients during and post coronavirus pandemic.Materials and Methods:The authors performed a thorough literature search on various armamentarium and new gadgets introduced into the field of dentistry during the coronavirus pandemic worldwide. The relevant armamentarium is discussed under three broad headings, namely, those required before, during and after the procedures for easy understanding.Results:A total of 15 gadgets and armamentarium related to oral and maxillofacial surgical practice are named and discussed in the literature review.Discussion:We are particularly vulnerable to the transmission of diseases easily both due to the field of interest of work and type of instrumentation. Thus, we need to be extremely cautious about the procedure. Since, the literature is scarce about the sequelae of the coronavirus disease; shift to the automated, contactless gadgets is the way to look forward to a healthy dental practice.Conclusion:These gadgets are user friendly for any small dental set-up as well. The choice of these upgraded instruments are prerogative of the individual professionals according to their exclusive practice. Yet, the authors encourage all health care professionals to focus on better training in infection control and cross-contamination.

Ergonomics among Oral and Maxillofacial Surgeons in the Indian States of Telangana and Andhra Pradesh - An Evaluative Study.

Introduction:This study is designed to evaluate the work-related musculoskeletal disorders among oral and maxillofacial surgeons in the states of Telangana and Andhra Pradesh.Materials and Methods:This study was conducted to disclose the incidence, location, and intensity of musculoskeletal pain among oral and maxillofacial surgeons in the states of Telangana and Andhra Pradesh. A questionnaire study was designed. One hundred and fifty-six oral and maxillofacial surgeons participated in the survey working in different centers of Telangana and Andhra Pradesh. Demographic information, type of professional practice, duration of working hours, and posture of working were collected. If occupation-induced musculoskeletal pain was present, its location, intensity, and the preventive measure employed were noted.Results:It was observed that majority of the oral and maxillofacial surgeons were practicing exclusive oral and maxillofacial surgical practice, and they employ both sitting and standing postures to carry out their professional work. Lack of availability of a well-qualified/trained assistant in addition to the lack of sophisticated equipment was noted to be the cause for occupation-induced musculoskeletal disorders. Majority of the participants have lower back pain with a visual analog scale score of 4. The pain occurred more often in younger individuals. It was believed by most of the participants that a good physical exercise in the morning helps prevent such occupation-induced musculoskeletal disorders.Discussion:Oral and maxillofacial surgeons due to their unique work are more prone to muscle imbalances, and hence, ergonomic interventions are essential to maintain optimal health during the course of their professional career.

Managing the oral and maxillofacial surgical patient during the SARS-CoV-2 pandemic: A review of guidelines

Management of the oral and maxillofacial surgical patient during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is quite challenging. This paper assesses the impact of coronavirus disease-2019 (COVID-19) on oral and maxillofacial surgical practice and lays down various guidelines employed to counter the pandemic. Separate protocol and guidelines are formulated for examining the patients in the Outpatient Department (OPD), minor surgical procedures in the clinics, and for managing patients in the triage and operation theatres. Particular emphasis should be given to disinfection and infection control measures to minimize the risk of COVID-19. Infection control in the clinical, hospital, and operation theatre setup is the most essential factor in the prevention of spread of COVID-19 disease in the workplace. The use of Personal Protective Equipment (PPE), barrier techniques, proper hand wash practices, surface disinfection, and proper sterilization of instruments help in infection control. Providing effective treatment to patients with conditions that cannot be deferred or controlled by pharmacological management and taking care to minimize the risk of COVID-19 to the hospital personnel is the primary concern in the present scenario.

A preliminary study on plasma concentration achieved following intrapterygomandibular space injection of dexamethasone as a route of drug delivery with lignocaine inferior alveolar nerve block-correlation of clinical effects.

To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase. A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations. Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix). Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8ml of 2% lignocaine with adrenaline (1:200000) and 1ml (4mg) dexamethasone [2.8ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)-(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS). The mean plasma dexamethasone concentration at 30min postinjection in group IM was 226.41 ± 48.67ng/ml and for IS group it was 209.67 ± 88.13ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P = 0.605). Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.

Comparison of Frontozygomatic versus Sigmoid Notch Approach for Extraoral Maxillary Nerve Block Anesthesia: A Prospective Clinical Trial

With definitive indications, extraoral techniques of achieving regional nerve blocks are a boon to oral and maxillofacial surgical practice. Though less commonly practiced, since general anesthesia is more favored, certain medical conditions favor the use of regional nerve blocks over general anesthesia. To block the maxillary nerve extraorally, sigmoid notch approach and frontozygomatic approach have been previously described in the literature, but a clinical trial comparing these techniques is sparse. This study attempts to compare both the approaches for their efficacies while paying an equal attention to the associated complications. Two hundred patients aged between 40-90years of ASA 1 and 2 category were equally divided into two groups and underwent extraction of maxillary teeth under local anesthesia using 2% lignocaine with 1:80,000 adrenaline. Frontozygomatic approach to reach the foramen rotundum was employed in group A (n=100) and sigmoid notch approach in group B (n=100). Pain during injection, time required for onset of subjective and objective symptoms of anesthesia and duration of anesthesia were the study parameters. Associated complications were documented and discussed. Student's unpaired t test was used for statistical evaluation. Although both the techniques were found to be feasible, statistical evaluations favored the frontozygomatic approach with respect to faster onset and a longer duration of the anesthetic effect. The anatomical considerations in either techniques suggested that the incidence of potential complications of accidental entry of the needle into the orbit, skull and vessel injuries was higher when using sigmoid notch approach as against the frontozygomatic approach. Though sigmoid notch approach, described widely in the literature, can be employed successfully, certain anatomical considerations and technical modifications in the frontozygomatic approach have made the latter a more practical and feasible approach. When both the maxillary and the mandibular nerves need to be blocked simultaneously, sigmoid notch may be employed, but isolated maxillary nerve block is better achieved using frontozygomatic approach.

Controversies in the Management of Oral and Maxillofacial Infections.

The management and treatment of odontogenic infection, and its frequent extension into the head and neck, remains an important section of oral and maxillofacial surgical practice. This area of maxillofacial expertise is widely recognized by the medical community and an essential component to the hospital referral system. Although the general principles of infection management have not changed, there have been modifications in the timing of treatment sequences and treatment techniques. These modifications are influenced by the development of diagnostic methods and advances in bacterial genetics and antibiotic usage. This article reviews treatment considerations and controversies surrounding this subject.

The Safety and Effectiveness of Superficial Cervical Plexus Block in Oral and Maxillofacial Surgery as an Alternative to General Anesthesia in Selective Cases: A Clinical Study.

To assess the safety and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases. The total number of patients was 10, out of which 6 were male and 4 were female patients. Five patients had incision and drainage of perimandibular space infections, two patients had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture, and two patients had submandibular lymph node biopsies. Informed& written consent were obtained from the patients after they had the procedure explained to them. Medically compromised patients and those who were excessively anxious and apprehensive, patient who did not want the procedure to be done under regional anesthesia, and patients with a history of allergy to local anesthetic were excluded. All patients had their surgical procedures under regional anesthesia (SCP block with supplemental nerve blocks) performed by the same surgeon under the supervision of anesthesiologist with continuous monitoring. SCP block with concomitant mandibular nerve and long buccal nerve block has a high success rate, low complication rate, and high patient acceptability as shown in the study. Superficial cervical plexus block anesthesia is a safe and useful anesthetic technique with the low risk of accidents and complications, thus a good alternative for regional anesthesia in selected cases in oral and maxillofacial surgery.

The use of superficial cervical plexus block in oral and maxillofacial surgical practice as an alternative to general anesthesia in selective cases

Aim:(1) To assess the feasibility, safety, and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases. (2) To assess any associated complication specifically related to the procedure.Subjects and Methods:The total number of patients was 10, out of which 6 were male and 4 were female patients. Six patients had incision and drainage of perimandibular space infections, two patients had Level Ib cervical lymph node biopsies, one patient had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture. Informed written consent was obtained from the patients after they had the procedure explained to them. Exclusion criteria included patient's refusal to undergo the procedure under regional anesthesia, allergy to local anesthetic, excessively anxious, and apprehensive patients, significant upper airway compromise warranting an endotracheal intubation to secure airway. All patients had the procedure done by the same operating surgeon. All patients had their surgical procedures under regional anesthesia (SCP block with supplemental nerve blocks) performed by the same surgeon with satisfactory anesthesia and analgesia without any complication.Results:SCP block with concomitant mandibular nerve and long buccal nerve block has a high success rate, low complication rate, and high patient acceptability as shown in the study.Conclusion:The notable anesthetic effect and adequate working time, summed with the low risk of accidents and complications, make this technique a good alternative for sensitive blockage of part of the cranial and cervical regions and have positive outcomes in selective OMFS cases.

Prevalence of Sinus Membrane Thickening and Association With Unhealthy Teeth: A Retrospective Review of 831 Consecutive Patients With 1,662 Cone-Beam Scans

The purposes of this retrospective review of cone-beam computed tomographic (CBCT) scans were to 1) determine the prevalence of sinus membrane thickening in a consecutive series of patients; 2) identify the prevalence of healthy or unhealthy teeth associated with sinus membrane thickening; and 3) document changes of the sinus membrane after the removal of unhealthy teeth. Consecutive patients had CBCT scans examined and the sinuses were graded. Grade 1 represented membrane thickening of 0 to less than 2mm; grade 2 represented thickening of 2 to 5mm; grade 3 represented membrane or material thickening greater than 5mm to the level of the ostium; and grade 4 represented soft tissue material superior to the ostium. Cross-sectional images were examined using software by the manufacturer of the CBCT scanner. Unhealthy teeth were identified. The examiner used a standardized approach in viewing the CBCT scans. Intraexaminer error was determined. Eight hundred thirty-one patients had 1,662 sinuses evaluated, with thickening of at least 1 sinus membrane in 46.7% (388 patients) and 30.1% (469) of all sinuses evaluated. The prevalence of patients and sinuses with sinus membrane thickening according to the grading criteria was grade 2 for 36.8% of patients and 24.3% of sinuses, grade 3 for 6.0% of patients and 3.7% of sinuses, and grade 4 for 3.6% of patients and 2.2% of sinuses. Unilateral sinus disease was more common than bilateral disease. Of those sinuses with thickening, 80.6% were grade 2, 12.2% were grade 3, and 7.2% were grade 4. Of the 469 sinuses with membrane thickening, 210 were adjacent to unhealthy teeth, 233 were adjacent to healthy teeth, and 26 were in edentulous maxillas. Of the 210 unhealthy teeth, 30 had postextraction CBCT scans available for evaluation. Grade 2 sinus membrane thickening showed a 75% resolution to grade 1 after adjacent tooth removal. Grade 3 sinuses resolved in 25% to grade 1 and grade 2, with 50% remaining at grade 3. There were 2 grade 4 sinuses with follow-up scans, with 1 resolving to grade 2 and the other remaining at grade4. Sinus membrane thickening is present in 46.7% of patients presenting to an oral and maxillofacial surgical practice. The prevalence of sinus membrane thickening was almost equal in association with unhealthy and healthy teeth. The removal of unhealthy teeth decreased, but did not completely resolve sinus membrane thickening.

Trigeminocardiac Reflex: A Reappraisal with Relevance to Maxillofacial Surgery.

The purpose of this paper was to undertake a review of literature on trigeminocardiac reflex in oral and maxillofacial online data-base and discuss the pathophysiology, risk factor assessment, presentation of the reflex, prevention, management with emphasis on the role of the attending anaesthetist and the maxillofacial surgeon. The available literature relevant to oral and maxillofacial surgery in online data-base of the United States National Library of Medicine: Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/) was searched. The inclusion criterion was to review published clinical papers, abstracts and evidence based reviews on trigeminocardiac reflex relevant to oral and maxillofacial surgery. Sixty-five articles were found with the search term "trigeminocardiac reflex" in the literature searched. Eighteen articles met the inclusion criteria for this study. The relevant data was extracted, tabulated and reviewed to draw evidence based conclusions for the management of trigeminocardiac reflex. Conclusions were drawn and discussed based on the reviewed maxillofacial literature with emphasis on the anaesthetist's and the surgeon's role in the management of this detrimental event in maxillofacial surgical practice.

Antidepressants relevant to oral and maxillofacial surgical practice

Background:Depression is commonly associated with a high-carbohydrate diet, lack of interest in proper oral hygiene and xerostomia connected to the use of antidepressants. Patients often consult their dentists as a result of changes affecting the hard dental substance and the soft-tissues.Aim:The aim of this study was to identify adverse drug interactions between the antidepressants and medications commonly administered in dentistry in order to give practicing dentists an overview of the scientific literature.Objective:The objective is to identify the adverse drug interactions between antidepressants and medication commonly administered in dentistry.Study Design:The literature search was performed using PubMed, Cochrane and the specific search items. The review (1984-2009) focused on medicines used in dental practice (vasoconstrictors, non-opioid analgesics, non-steroidal anti-inflammatory drugs, antibiotics, antifungals and benzodiazepines).Results:There are various drug interactions between antidepressants and medicines used in dentistry. When two or more drugs are co-administered, a drug interaction must always be anticipated though many of the interactions are potential problems, but do not seem to be real clinical issues.Conclusion:The probability of a drug interaction can be minimized by careful history-taking, skillful dose adjustment and safe administration of the therapeutic agent.

Sublingual piroxicam in the management of postoperative pain after surgical removal of impacted mandibular third molar

Surgical removal of impacted mandibular third molar is one of the most commonly performed procedures in oral and maxillofacial surgical practice. The role of preoperative and postoperative medications for management of postoperative complications has been extensively evaluated. To assess the therapeutic effect of a single dose of 40 mg sublingual piroxicam (study group) vs 150 mg oral diclofenac (50 mg thrice a day) (control group) in patients undergoing surgical removal of impacted mandibular third molar. A total of 100 patients with asymptomatic impacted mandibular third molars were randomized into two groups. One group received two 20-mg tablets of piroxicam once daily on the first and second postoperative days, followed by one 20-mg tablet on the third post-operative day. The other group received one tablet of diclofenac 50 mg orally thrice daily on the first, second, and third post-operative days. Repeated extraoral examinations were done for continuous assessment of swelling, trismus, and reduction in pain. Overall impression of the treating physician and the patient regarding efficacy of study drugs were recorded at the end of the study. In the piroxicam group there was >50% reduction in pain on all three days postoperatively. The incidence of swelling and trismus was found to be higher in the control group as compared to the study group. Adverse events, such as gastrointestinal (GI) disturbances, were significantly higher in the diclofenac group (11%) as compared to the piroxicam group (0%). Two sublingual piroxicam 20 mg tablets once daily has better efficacy and tolerability profile than diclofenac 50 mg one tablet thrice daily in the management of pain after surgical removal of impacted mandibular third molar.