Oral Injuries Research Articles

The Impact of E-Cigarettes on Oral Injuries and Bone Fractures

Introduction The rising prevalence of electronic cigarette (e-cigarette) use has prompted concerns regarding its potential health implications. While much attention has focused on respiratory and cardiovascular effects, injuries, oral trauma, and bone fractures linked to e-cigarette use have received less scrutiny. This paper aims to comprehensively review the landscape of injuries, oral trauma, and bone fractures induced by e-cigarettes, shedding light on this underexplored facet of e-cigarette-related harm. Material and Methods This literature review has analyzed 16 papers. Inclusion criteria: researches and case reports published after 2015. PubMed and Google Scholar has been searched to identify the papers. Analysis of the Literature Existing literature suggests a growing incidence of injuries, oral trauma, and bone fractures associated with e-cigarette use, albeit with limited systematic investigation. Mechanisms underlying these injuries range from device malfunctions to inadvertent impacts during use. Case reports highlight a spectrum of injuries, including oral burns, dental trauma, and skeletal fractures, often involving the face and mouth regions. Conclusions Despite the lack of comprehensive epidemiological data emerging evidence underscores the need for heightened awareness and preventive measures to mitigate e-cigarette-related injuries. Enhanced education, regulation of e-cigarette devices, and promotion of safer usage practices are crucial steps towards reducing the burden of e-cigarette-related harm on oral and skeletal health.

Trauma and its Orthodontic Implications – Comprehensive Review on Diagnosis, Treatment Planning, and Prevention

This article focuses over the factors that an orthodontist should consider before attempting any movement of traumatized teeth. The epidemiology and the mechanisms of traumatic dental injuries are discussed. The article briefly explains the diagnosis and treatment principles in orthodontic patients suffering from traumatic injuries. This article provide insights over the evidence based on existing literature relating to root surface resorption and orthodontic tooth movement in vital and endodontically treated traumatized teeth. Special focus has been given to the interdisciplinary management of tooth related injuries. The article also discusses the various measures for prevention of dental and oral injuries.

3 Oral Valacyclovir-induced Acute Kidney Injury

3 Oral Valacyclovir-induced Acute Kidney Injury

Early Infantile Diagnosis of Hereditary Hemorrhagic Telangiectasia Complicated by Child Abuse

We report a rare case of hereditary hemorrhagic telangiectasia (HHT) in a 4-month-old female with findings of child abuse. She presented with poor feeding, vomiting, and irritability after a short fall from the bed. Initial evaluation found subdural hematomas (SDH), persistent hypoxia, failure to thrive (FTT), a frenulum tear, facial lacerations, and bruising. The patient was admitted and an extensive work-up led to the diagnosis of brain and pulmonary arteriovenous malformations (AVMs) and finally the diagnosis of HHT. The SDH, cutaneous injuries, and oral injury were highly suspicious for child abuse and were reported to Child Protective Services (CPS) and law enforcement for investigation simultaneous to the medical work-up. Her hospital course was complicated by progressive hypoxemia with radiographic evidence of several large pulmonary AVMs for which she underwent successful embolization. Her head injury was indeterminate for physical abuse in the setting of a medical condition pre-disposing to intracranial hemorrhage. A few weeks later, she was re-admitted with repeat abusive injuries in the form of femur fractures. This case demonstrates the unique diagnostic dilemma when two diagnoses are occurring simultaneously – HHT and child abuse – and showcases the importance of a detailed family history, genetic testing, strong multidisciplinary collaboration with a holistic approach and medically informed CPS systems to ensure accurate diagnoses and safe disposition.

A cross-sectional study of the impact of the COVID-19 lockdown on domestic violence-related oral and maxillofacial injuries.

During the COVID-19 lockdown, more domestic violence-related traumas were reported. In this study, we investigated and compared the incidence of domestic violence-related injuries-in particular oral and maxillofacial injuries-in Ulaanbaatar, Mongolia, before and during the COVID-19 lockdown. We conducted a cross-sectional study based on 3974 domestic violence cases registered at the Public Health Department, National Traumatology and Orthopedics Research Center of Mongolia between 2018 and 2022. Descriptive and binary logistic regression analyses were conducted. The victims were categorized according to their age (child, adult, and elderly). The mean age of the victims was children 9.7 ± 5.4 years, adults 34.8 ± 8.3 years, and elderly 64.3 ± 8.7 years. Binary logistic regression analysis (no/yes) showed that oral and maxillofacial injuries during the lockdown increased 1.3 times (OR = 1.3; CI 95% = 1.0-1.6; p = .003) in adults and 2.5 times in children (OR = 2.5; CI 95% = 1.7-3.9; p = .001). Additionally, injuries to upper limbs increased 4.6 times (OR = 4.6; CI 95% = 3.5-6.1; p = .001) in adults and 5.2 times in elderly patients (OR = 5.2; CI 95% = 1.8-16.2; p = .01). Additionally, thorax injury in children increased 3.1 times (OR = 3.1; CI 95% = 1.7-5.7; p = .001). During the lockdown, injury to oral and maxillofacial regions increased in adult and child victims of domestic violence.

Oral pressure injuries in patients hospitalized during the COVID-19 pandemic and associated factors: a cross-sectional study

Background: Patients critically ill with coronavirus disease (COVID) who are admitted to intensive care unit (ICU) are susceptible to a vast number of complications that life-threatening. Objective: To investigate the frequency of oral cavity pressure injuries (OPI) in adult patients hospitalized for COVID in an ICU and associated factors. Method: A retrospective cross-sectional study was carried out using electronic medical records of patients admitted to the ICU, whether due to COVID or other conditions (NO COVID), in São Luís, Maranhão, Brazil. Demographic data, comorbidities, length of stay, intubation time, O2 saturation, use of vasoactive drugs, and hospitalization (due to COVID or NO COVID), and OPI were extracted from the medical records. The data was subjected to descriptive statistics, Chi-square test, Mann-Whitney test and Poisson regression (α=5%). Results: The frequency of OPI in patients hospitalized for COVID was 38.5%. The most frequent comorbidities in both groups were hypertension and diabetes mellitus. The use of vasoactive drugs and OPI was more frequent in the NO COVID group (p=0.010; p=0.021). The average length of stay was significantly longer for the COVID group (15.8 days) compared to the NO COVID group (10.6 days) (p=0.025). The average length of hospitalization and intubation was significantly higher for the group with OPI (p=0.003; p<0.001). In the adjusted regression analysis, the length of intubation was the factor suggestive of explaining to OPI (PR=2.547; CI=1.423-4.558). Conclusion: Longer hospitalization and intubation times were responsible for pressure injuries in the oral cavity, demonstrating the need for continuous assessment of hospitalized patients in order to prevent the establishment of these injuries.

Revisited and innovative perspectives of oral ulcer: from biological specificity to local treatment.

Mouth ulcers, a highly prevalent ailment affecting the oral mucosa, leading to pain and discomfort, significantly impacting the patient's daily life. The development of innovative approaches for oral ulcer treatment is of great importance. Moreover, a deeper and more comprehensive understanding of mouth ulcers will facilitate the development of innovative therapeutic strategies. The oral environment possesses distinct traits as it serves as the gateway to the digestive and respiratory systems. The permeability of various epithelial layers can influence drug absorption. Moreover, oral mucosal injuries exhibit distinct healing patterns compared to cutaneous lesions, influenced by various inherent and extrinsic factors. Furthermore, the moist and dynamic oral environment, influenced by saliva and daily physiological functions like chewing and speaking, presents additional challenges in local therapy. Also, suitable mucosal adhesion materials are crucial to alleviate pain and promote healing process. To this end, the review comprehensively examines the anatomical and structural aspects of the oral cavity, elucidates the healing mechanisms of oral ulcers, explores the factors contributing to scar-free healing in the oral mucosa, and investigates the application of mucosal adhesive materials as drug delivery systems. This endeavor seeks to offer novel insights and perspectives for the treatment of oral ulcers.

Integrating antimicrobial photodynamic therapy into the adjuvant phototherapeutic approach for orofacial manifestations of toxic epidermal necrolysis and Stevens-Johnson syndrome

Characterized by an immune reaction to medications, toxic epidermal necrolysis (TEN) and Steven-Johnson Syndrome (SJS) are potentially fatal mucocutaneous reactions, and their management remains challenging. Considering the promising studies regarding the use of laser in managing orofacial lesions, this study aimed to report two cases in which children presenting with TEN and SJS were treated using a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) concurrently with conventional supportive care. The treatment proposed herein resulted in significant clinical improvement of the children's oral condition within a few days, enabling the reintroduction of oral feeding. Within the limitations of the study, the cases reported suggest that the adjuvant combination of PBMT and aPDT may be beneficial for improving the oral condition of children afflicted with oral injuries induced by TEN and SJS.

Pediatric Trauma During COVID-19: What Have We Learned?

BackgroundIn December 2019, an outbreak of a novel pneumonia-like illness, COVID-19 (C-19), emerged in Wuhan, China. In March 2020, as the incidence of C-19 rose, the Israeli government, like that of other nations, declared a national state of emergency, and a full, general lockdown was announced. PurposeThe purpose of this study is to determine the incidence and characteristics of pediatric maxillofacial trauma presentation during the 2020 C-19 lockdown restrictions and compare them to periods outside lockdown between 2019 and 2020 (Pre-C-19). Study design, setting, sampleA retrospective cohort study was conducted and included all pediatric patients (0-18 years) referred to the emergency department (ED) at Tzafon Medical Center, Israel, and diagnosed with maxillofacial injuries. Patients with missing demographic data and patients who did not complete the medical examination were excluded. Predictor/exposure/independent variableThe exposure variable is the date of injury – 2020 C-19 lockdown period compared to the previous year (Pre-C-19). Main outcome variable(s)The main outcome variable was the number of pediatric maxillofacial trauma ED arrivals out of total pediatric ED arrivals and out of total maxillofacial ED arrival. CovariatesCovariates included patient demographics, etiology and place of injury. AnalysesThe association between categorical variables was tested using Fisher exact test or Chi-square test for binary variables with relative risk (RR) when appropriate, logistic regression model used to predict outcome variable. P-values were 2-tailed and statistical significance was defined as P < 0.05. ResultsThe study sample comprised 1174 patients. RR of presenting with oral and maxillofacial trauma out of all pediatric ED patients was 1.85 comparing C-19 period to Pre-C-19 period (CI [1.65 ; 2.073], p < 0.0001). Most of the injuries recorded during the C-19 restrictions occurred in the domestic environment (56.1% compared to 47.5% in Pre-C-19, p < 0.001). Incidences necessitating treatment increased from 45.8% to 55% during C-19 (p = 0.002). ConclusionsDuring C-19 there was a higher rate of pediatric injuries compared to Pre-C-19. The incidence of domestic oral and maxillofacial injuries increased despite the considered home safety.

Epidemiology of Oral and Maxillofacial Traumatic Injuries Among the Patients Reporting to the Dental Institute of Western Maharashtra Region, India.

To analyze the distribution, etiology, and patterns of oral and maxillofacial trauma among the subjects reporting to a dental institute in the Western Maharashtra region of India. This retrospective study was conducted by manually collecting data from the medical records of subjects who reported to the dental institute with a history of trauma from 1st January 2018 to 31st December 2022. All the injured subjects with complete clinical and radiographical records of maxillofacial injuries were included. The demographic data, etiology & site of trauma, and associated injuries were analyzed. Data were tabulated into four age groups (< 20years, 21-40years, 41-60years, and > 60years). Five etiological factors, i.e. road traffic accidents (RTA), stumble & falls, violence, animal attack, and strike by an object, were further evaluated based on age and gender. Maxillofacial injuries were classified into seven types: maxillary fractures (subcategorized), mandibular fractures (subcategorized), zygomaticomaxillary complex (ZMC) fractures, nasal, frontal, orbital, and naso-orbito-ethmoidal fractures. Data were tabulated and analyzed. A total of 437 subjects were included, consisting of 84.2% males and 15.8% females, with the highest incidence of trauma between 21-40years. Road traffic accident was the main reason for maxillofacial injuries (50.3%), followed by falls (26.5%), and violence (19.9%). ZMC fractures accounted for 55.4% (242 fractures), followed by mandibular fractures (42.3%). RTA is the main factor responsible for maxillofacial injuries in this part of Maharashtra among subjects of both genders. Education and motivation regarding road safety measures are the two factors that need to be focused on to reduce the incidence of maxillofacial injuries.

Oral Complications in Patients With Psychiatric Illness Undergoing Electroconvulsive Therapy in Istanbul, Turkey.

Despite advances in pharmacotherapy, electroconvulsive therapy (ECT) remains a mainstay treatment option in psychiatry. This study aims to determine the occurrence of oral injury from ECT modified with the use of an inexpensive, disposable, hand-made oral protector customized to the dental needs of the individual patient. Based on data collected between January 1, 2013, and December 31, 2018, registered patients who had received ECT were evaluated retrospectively. We investigated the incidence of oral complications such as dental fractures, dental avulsion, temporomandibular joint dislocation, jaw pain, and soft tissue, lip, and tongue injuries in a single center. There were 1750 male patients (59.6%) and 1187 female patients (40.4%), with a mean age of 35.20 ± 11.59 years. The incidence of oral injury was 0.1% per patient (4/2937) and 0.01% per session (4/22135). Oral complication characteristics included mucosal abrasion in 2 patients, dental fracture in 1 patient, and tooth avulsion in one. No dental fracture or avulsion in our patient population has resulted in aspiration. We found no evidence of jaw pain, temporomandibular joint dislocation, or injury to the lip or tongue. Our results demonstrate a minimum risk of oral complications during ECT and also provide additional justification for an adequate oral assessment by the ECT team before the procedure.

Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis.

Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).

The importance of the dentist in paralympic sports

Sports dentistry aims to promote health, improve performance and prevent injuries in athletes. It is necessary for the dental surgeon to participate in the routine of athletes from the youth categories, including athletes with intellectual, physical and visual disabilities, this group presents several changes in the oral cavity because of their limitations. The participation of the Brazilian team in the Paralympic Games since 1972, became essential to evaluate oral health problems in these athletes and rehabilitate them, providing better results in competitions. Methodology: 20 articles were selected between 2005 and 2021, indexed in the Pubmed, scholar and lilacs database, using the descriptors ‘’Dentistry”, “Oral health”, “Sports Medicine”, “Disabled Persons” and “Sports for Persons with Disabilities”. Oral injuries in Brazilian para-athletes, bruxism, mouth breathing and recurrent oral herpes lesions are the most frequent problems and can negatively affect the performance of these athletes. There is a high need dental care practices for patients with special needs at the University Dentistry. There was a significant need for attention and dental treatment for athletes with intellectual disabilities, and it is important to invest in strategies that promote self-care in order to improve daily hygiene. It is necessary for dental surgeons to work in Paralympic sports, meeting the individual needs of athletes with access to quality oral health and adequate monitoring, in order to improve performance and avoid complications that affect the quality of sports practice. The objective for this article is review the literature on the importance of dental surgeons in Paralympic sports.

Effects of Anesthetic Choice on the Incidence of Transcranial-Motor Potential-Induced Oral Trauma

ABSTRACT Transcranial motor-evoked potentials (TcMEPs) play an integral role in assessing motor tract function in surgical procedures where motor function is at risk. However, transcranial stimulation creates a risk for oral trauma. Several studies have reported on distinct factors that can influence the rate of TcMEP-induced oral trauma, but little is known about how an anesthetic regimen can influence this rate. In this retrospective review, we investigated the incidence of oral injury under total intravenous anesthesia (TIVA) and balanced anesthesia in 66,166 cases from 2019 to 2021. There were 295 oral injuries in our sample, yielding an incidence of 0.45%, which is in line with ranges reported in the literature. A total of 222 of the injured patients were sedated with balanced anesthesia, while the remaining 73 were under TIVA anesthetics. This difference in distribution was statistically significant (p < 0.0002). Our findings suggest TIVA is associated with lower risk of oral trauma when TcMEPs are monitored, thereby improving patient safety.

A New Hypothesis Describing the Pathogenesis of Oral Mucosal Injury Associated with the Mammalian Target of Rapamycin (mTOR) Inhibitors.

It has been 24 years since rapamycin (sirolimus) was approved to mitigate solid organ transplant rejection and 16 years since mTOR (mammalian/mechanistic target of rapamycin) inhibitors reached patients as a cancer therapy. While the clinical benefits of mTOR inhibitors (mTORi) are robust, so too are their toxicities. Among the most common issues is the development of ulcers of the oral mucosa (mTOR-inhibitor associated stomatitis; mIAS). These lesions are distinct from those of other anti-cancer agents, occur with regularity, and impact patient outcomes. mIAS' pathogenesis has been the subject of speculation, and its similar presentation to recurrent aphthous stomatitis (RAS) has led to the hypothesis that it might serve as a surrogate to better understand RAS. Based on a review of the literature, the current manuscript provides a hypothesis regarding the mechanisms by which mTORis uniquely initiate mucosal injury and an explanation for the observation that steroids (also an immunosuppressive) are effective in its treatment through a non-immunologic mechanism. Unexplained unique features of mIAS are discussed in this review in the context of future investigation.

Oral Health Statuses of Children and Young Adults with Autism Spectrum Disorder: An Umbrella Review.

This study aimed to comprehensively evaluate the oral health statuses of children and adults within the autism spectrum disorder (ASD) population through an umbrella review approach. The prevalence of dental caries, periodontal disease, and associated variables were investigated across selected studies. A systematic search was conducted across databases including PubMed, Scopus, EMBASE, Science Citation Index, Science Direct, Web of Science, MEDLINE, and Wiley Online Library to identify relevant studies. The assessed variables included dental caries prevalence, periodontal disease prevalence, oral hygiene indicators, and the necessity of dental treatment. The pooled prevalence rates, odds ratios, and standardized mean differences were calculated where applicable. The pooled prevalence of dental caries among ASD individuals ranged from 60.6% to 67.3%, while the periodontal disease prevalence ranged from 59.8% to 69.4%. High rates of dental treatment under general anesthesia were reported. Heterogeneous dental caries and periodontal disease prevalence rates were identified, highlighting the need for collaboration and preventive care. Several studies also reported higher prevalence rates of dental trauma and self-inflicted oral injuries among individuals with ASD. However, the review also identified significant methodological limitations in the included studies, including inconsistency in oral health assessment methods and potential bias. The necessity for targeted policies due to high prevalence rates and the requirement for integrated care systems in high DMFT regions were also observed. The umbrella review synthesized diverse findings, revealing variations in dental caries and periodontal disease prevalence among ASD individuals. This review underscores the need for tailored interventions and policies to address oral health disparities. It highlights the necessity of integrated care systems, methodological improvements, and longitudinal studies to comprehensively address the multifaceted oral health challenges within the ASD population.

Clinical Features, Laboratory Characteristics and Outcome from Oral Contraceptives-induced Liver Injury in 43 Consecutive Patients and a Brief Review of Published Reports

Hormonal oral contraceptive (OC) agents such as estrogen or progesterone, either as single agents or in combination, and a non-hormonal drug like ormeloxifene are used for various conditions. However, estrogen and progesterone-containing OC as well as ormeloxifene are seldom associated with hepatotoxicity. We prospectively studied the clinical, demographic, liver injury pattern, complications, and outcome of the hepatotoxicity from OC and ormeloxifene. We analyzed and compared the aforementioned characteristics among consecutive patients with OC and ormeloxifene-induced drug-induced liver injury (DILI) from two university hospitals in India. Cases fulfilling established DILI criteria and the Roussel Uclaf causality assessment method were identified and followed up until recovery/death. We identified 43 (3.5%) amongst 1226 patients with DILI; 19 (44%) from estrogen and progesterone combination, 21 (49%) from progesterone monotherapy, and 3 (7%) due to ormeloxifene. Seven cases were identified from 1998 to 2014 and 36 cases from 2015 to 2023. All were due to oral tablets. The mean age was 36 years (range 21-75). Nineteen patients (44%) developed jaundice and 5 (11.6%) developed itching. The liver injury pattern was hepatocellular in 19 (44%), mixed in 13 (30%), and cholestatic in 11 (26%). Four patients (9%) died, three from acute liver failure and one due to acute on chronic liver failure. Liver biochemical tests normalized after a mean of 66 days after stopping the implicated agents. Contrastingly, literature search yielded 24 cases of progesterone DILI reported between 1962 and 2019 with no mortality. In contrast to published literature on oral contraceptives, a majority of oral contraceptive-induced DILI in our series were from progesterone monotherapy and a smaller number with ormeloxifene, that often resulted in clinically significant jaundice or liver test abnormalities and rarely in fatality.

Use of mouthguards in Latin American field hockey athletes during the ODESUR 2022 Games.

Athletes are susceptible to oral injuries. To reduce the incidence and severity of oral trauma, a custom-made mouthguard, a device positioned in the mouth to prevent damage to teeth and surrounding structures, is recommended. In field hockey, according to the international rules of this sport, using mouthguards is not mandatory, but it is recommended to wear them at all times while practicing this discipline. We aimed to determine characteristics and differences regarding mouthguard usage among field hockey players from different countries participating in the XII ODESUR Games. We conducted a cross-sectional study that included 78 voluntary hockey athletes that met the inclusion criteria. The questionnaire used was validated by Panam Sports, collecting information on the type of mouthguard (custom-made or prefabricated), and the time of use of the mouthguard (range of 5 years). Of the total number of athletes, 96% used mouthguards, of which 64% were custom-made type, and 32% were prefabricated (p < .001). Custom-made mouthguards were used by 100%, 89%, and 64% of athletes in Argentina, Chile, and Peru, respectively, while only 40% of athletes in Paraguay and Uruguay used them. It has also been observed that more than 50% of the individuals have not controlled and replaced their intraoral devices for more than 10 years. Our results reveal a problem with a public health dimension and thus invite the standardization of guidelines with an educational approach to promoting and adopting good sports practices. This report is the first on using mouthguards in high-performance athletes during an international multisport event.

Salbutamol toxicosis in dogs

Salbutamol exposure in dogs typically occurs when they bite and pierce a salbutamol inhaler. Onset of clinical signs can be rapid. Dogs may appear anxious and distressed, and common signs include tachycardia, tachypnoea and hypokalaemia. Transient hyperglycaemia may occur. Potential complications include muscle weakness, flaccid paralysis, arrhythmias, rhabdomyolysis and oral injury from the compressed gas in some inhalers. Any dog exposed to salbutamol requires examination and evaluation. The heart rate, blood pressure, electrocardiogram and electrolytes should be monitored. Treatment is aimed at correcting tachycardia and hypokalaemia, for which the treatment of choice is a non-selective beta-blocker. Salbutamol exposed dogs require hospitalisation until the heart rate and rhythm, central nervous system status and electrolytes normalise. Recovery generally occurs within 24 hours, but there is risk of persistent cardiac injury.

P138 Oral and maxillofacial injuries associated with e-scooter use at Broomfield Hospital: a cohort study of 24 months of data since e-scooter legalisation in the UK

P138 Oral and maxillofacial injuries associated with e-scooter use at Broomfield Hospital: a cohort study of 24 months of data since e-scooter legalisation in the UK