Bite Patient Research Articles

Intraoral scanner-based virtual facebow transferring: A chairside dental technique.

Accurately mounting dental casts on an articulator is an essential step in prosthetic treatments. In digital dentistry, virtual articulator mounting procedures rely on virtual facebow records. However, virtual facebow records usually require devices like face scanners or jaw motion tracking systems that are not commonly available in most dental practices. The present technique report describes a straightforward intraoral scanner-based virtual facebow transfer approach. In this technique, a reference facebow joint support was first scanned and aligned with a virtual articulator. Then, a patient's facebow joint support and bite fork assembly were scanned chairside with an intraoral scanner and aligned with the virtual articulator by matching common features with the reference facebow joint support. After aligning the patient's intraoral scans with the patient's bite fork scan that was already superimposed on the virtual articulator, a virtual mounting process was achieved. Once the corresponding reference facebow joint supports have been generated, this technique can be easily implemented with most facebow systems and be seamlessly integrated into daily clinical practice as only an intraoral scanner and a conventional facebow were required.

Evaluation of optimum dose of anti-snake venom required and its outcome based on severity of envenomation in snakebite case

Background: Snakebite is an important occupational hazard in India as it is always been a land of poisonous snakes. The isssue which the physician confronts while treating a snake bite patient is assesment of degree of envenomation and requirement of ASV dose. Aims and Objectives: This study was taken to evaluate the optimum dose of anti-snake venom (ASV) required based on the severity of envenomation. Materials and Methods: Patients with a history of snakebite brought to the Department of General Medicine, Hassan, were included in this study. The study was conducted during the period from December 2014 to June 2016. The sample size of 80 patients was included in the study after fulfilling the inclusion criteria. Results: A total of 80 patients were included in the study. The majority of the victims were males (70%), age between 21 and 40 years (47.5%), and agriculture was the main occupation (67.3%). 51.25% did not identify the snake. The most poisonous were viper and cobra types which were 36.5% and 12.5%, respectively. A delay in lag time of 8.99±8.2 h was observed in severe envenomation. Overall, 51 cases (63.75%) had cellulitis, and 3 (3.75%) in the severe group required fasciotomy. Twenty percent had hematologic derangements. Ten percent of patients had developed renal failure and one required dialysis. 8.75% of patients developed respiratory failure and all required mechanical ventilation. The average dose of ASV vials used in mild, moderate, and severe envenomation was 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively. The overall mortality rate was 5%. Conclusions: The optimum dose of ASV required in mild, moderate, and severe envenomation is 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively to neutralize the circulating venom and lower the risk of development of serious complications.

Prospective evaluation of implants-supported, tooth-implant supported, and teeth-supported 3-unit posterior monolithic zirconia fixed restorations: Bite force and patient satisfaction.

This study aimed to evaluate the maximum bite force (MBF) and satisfaction of patients restored with implants, combined tooth-implants, and teeth-supported monolithic zirconia fixed dental prostheses (FDPs). Thirty partially edentulous patients in need of three units of FDPs in their mandibular posterior region were divided into three equal groups (n = 10) as follows: Group-1 patients received two implants for each at the second premolar and second molar regions, Group-2 patients received one implant for each at the second molar region, and Group-3 patients with missing lower first molar. All the restorations were constructed from monolithic zirconia. Patients were evaluated 1 week after placement of restorations (baseline) and then after 6, 12, and 24-month intervals for MBF using force transducer occlusal force meter and satisfaction (function, esthetic, and overall satisfaction) using a visual analog scale. The mean MBF for Group 1 was higher than Group 2 (p = .044) but not that of Group 3 (p = .923). Additionally, Group 3 displayed a higher MBF than Group 2, although this difference was not statistically significant (p = .096). Concerning patient satisfaction, all study groups reported high levels of satisfaction across all satisfaction elements, and no significant differences were observed between the groups. Within the limitations of this study, it can be concluded that Group 1 gives comparable anticipated treatment outcomes as Group 3 concerning biting force and patient satisfaction. However, Group 2 gives comparable satisfaction results with biting force value within the normal range; thus, it might be used as a treatment option in a specific situation.

3D Resin-coated pressure sensor response for bite force assessment: A pilot study.

Occlusal splints with sensors help in the bruxism diagnosis and monitoring, by recording the patient's bite force. The aim of this study was to evaluate the accuracy of a pressure sensor when it is covered with different thicknesses of a 3D printing resin (Anycubic 405nm Translucent Green UV Resin, Anycubic, UK). In this preliminary study, the evaluated sensor (FlexiForce A201 Sensor, Tekscan) was firstly calibrated without any type of cover material, and later tested with 3D printing resin with different thicknesses (1 mm, 1.15 mm, 1.4 mm and 1.6 mm). The load tests were performed by a force tester (MultiTest 2.5 dV, Mecmesin). When the pressure sensor was covered with resin of 1mm and 1.6 mm thick specimens, a higher difference was found between the applied load and the corresponding sensor reading. It was concluded that it is possible to use this type of pressure sensor and that it showed better accuracy with the 1.15 mm and 1.4 mm 3D printing resin covering.

Russell’s Viper Bite and Its Immediate Outcome In Bangladesh

Background: Russell’s viper (Daboia russelii) is found in Asia, throughout Indian subcontinent, much of South East Asia, Southern China and Taiwan. Russell’s viper was seemed to be rare in Bangladesh. Anecdotes suggest that Russell’s viper (Daboia russelii) was an important cause of mortality in the 1920s, but no case of envenoming by this species has since been reported in Bangladesh. Russell’s viper bite has been reported and it is the one of the common snake bite at Rajshahi region which has great morbidity and mortality as well. Methods: This is a prospective observational study was conducted in the Medicine department of Rajshahi Medical College Hospital. We treated total 171 patients from 2013 to December 2022. Russell’s viper envenomation confirmed either by brought dead or live snake specimen, photograph, bedside 20MWBCT and other symptoms. Results: In the management of RV bite patient in the Rajshahi Medical College Hospital, we found that most of the patients are delayed in getting hospitalization after bite due to visit to traditional healer. In our study 96% were male, and 4% were female, mostly farmer and 90% bite site in the lower limb during work in the paddy field. The clinical presentation was pain and local swelling (100%), blood oozing from local site (77%), bruising (44%), haematuria (25%), hypotension (30%), oliguria and few with DIC. In lab findings, coagulopathy (24%), raised CPK (60%), 67% Patients had AKI (raised creatinine and RBC in urine), among them 50% needed dialysis. Few patients also develop multiorgan failure. All patients received polyvalent Anti-venomsupplied by GOB (Incepta Bangladesh Ltd.) which works against cobra, krait, Russell’s viper bite. Despite maximum available support at RMCH, around 30% patient died. Conclusion: It’s high mortality indicates that this polyvalent antivenom might not be working properly. We may need to increase the initial dose or we need to provide monovalent antivenom specific to RV in Bangladesh and early treatment at Upazila Health Complex to reduce the rate of death due to Russell’s viper bite. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 204

Treatment of an Open Bite Patient with Maxillary Expansion and Micro-Implant Anchorage

The purpose of this case report was to describe the treatment of an open bite patient with palatal expansion and micro-implant anchorage. A 21-year-old female presented with a chief complaint of openbite. Clinical examination showed straight profile with mild crowding. Intraorally, she exhibited both Class I molar relationship, 1.5 mm negative overbite. Due to the transverse discrepancy, upper molars were palatally tipped, while lower molars were buccally tipped. The maxillary arch expansion was performed using rapid palatal expander. After maxillary expansion, orthodontic micro-implants were used for upper molars intrusion. After orthodontic treatment, the patient showed proper overjet and overbite, and good retention after 2 years. Open bite can be corrected by counterclockwise autorotation of the mandible obtained with intrusion of molars and it is critical to eliminate the causative agent.

Replantation of autotransplanted mature third molar in anterior open bite patient: case report

Replantation of autotransplanted mature third molar in anterior open bite patient: case report

COST EFFECTIVENESS OF INTRADERMALANTI-RABIES VACCINATION- A HOSPITAL RECORD BASED STUDY IN CENTRAL INDIA.

Introduction:Rabies a 100% fatal disease is completely preventable with timely post exposure prophylaxis. According to the Gold standard Essen intramuscular regimen, ve doses of 0.5 ml of anti rabies vaccine is required as compared to Updated Thai Red Cross intradermal regimen which requires four doses of only 0.1 ml each at 2 sites . Hence the present study was conducted to determine the cost effectiveness and compliance of 4 dose intradermal regimen of antirabies vaccine over 5 dose intramuscular regimen of anti rabies vaccine for post exposure prophylaxis. Methods: The present study is a hospital record-based study of 1020 cases attending antirabies vaccination clinic who received IM regimen of ARV in the year 2015 and 2256 cases who received ARVunder ID regimen during 2021. The cost effectiveness and compliance of both regimen was estimated. Results : A total of 3276 animal bite patient were studied. Antirabies vaccine by the Intramuscular route was administered to 1020 patients in the year 2015. While around 2256 patients were administered the Antirabies vaccine by the Intradermal route in the year 2021 costing Rs.14,18,352. If same number of cases were to be given intra muscular vaccination then the cost of vaccination would be Rs. 35,19,360. Thus a saving of Rs. 21,01,008 was effected in ID regimen over IM regimen. 53.72% patients completed the Intramuscular route of Antirabies vaccine schedule and 73.04% patients completed the Intradermal route of Antirabies vaccine schedule. Conclusion: Intradermal regimen is more cost effectiveness than intramuscular (Essen) regimen. And the compliance to post-exposure vaccination is better in case of ID regimen as compared to IM regimen

Investigation of a Symptomatic Tick Bite Patient Confirms Borrelia burgdorferi in Ixodes scapularis and White-Footed Mice in Ashe County, North Carolina.

In June 2021, a traveler to Ashe County, North Carolina, was bitten by an Ixodes scapularis tick. The patient experienced axillary lymphadenopathy and an erythematous rash near the bite site. We confirmed Borrelia burgdorferi sensu stricto through PCR testing and DNA sequencing in the attached tick and later from mice trapped inside the cabin where the patient stayed.

A STUDY OF INCIDENCE OF ACUTE KIDNEY INJURY IN SNAKE BITE

Background Snakebite is one of the commonest occupational hazards in our country, especially among the rural population. It leads to a multitude of complications starting from localized cellulitis to even death. AKI is a signicant as well as an under reported complication in patients of snake bite which has a tremendous impact on the nal outcome. The unfavourable outcome in snake envenomation can be predicted early with the development of AKI. In this study, we wanted to assess the clinical prole of snakebite patients and determine the incidence of AKI in patients of snakebite. Aim 1. To study the incidence of acute kidney injury in patients following snake bite. 2. To study the clinical and renal prole in patients following snake bite with AKI. Study Design This was a prospective observational study conducted in a teaching hospital over a period of 12 months. Materials And Methods The study included 100 patients of snakebite admitted in the Department of Medicine, Rajah Muthiah Medical College & Hospital done over duration of 12 months. The various data regarding clinical features of the patients, serum creatinine levels, other blood parameters of the patients selected for participation in the study were analysed using simple statistical methods. Majority of the snakebite victims were males. 30 % (N = 30 Results ) of the cases developed AKI. The mortality in patients of snakebite developing AKI was 25 % (n = 4). From our study Conclusion we conclude that, the most common manifestation of snake bite was cellulitis (95%) followed by regional lymphadenopathy (60%). The incidence of acute kidney injury in snake bite patient was 30% (N=30). Abnormal coagulation prole was present in 36.6% (N=11) patients with acute kidney injury. Bite to needle time more than 6 hours, oliguria, bleeding manifestations have signicant association with acute kidney injury. Snakebite envenomation is associated with a considerable burden of AKI in the developing countries especially among the rural population. Prompt initiation of aggressive treatment improves the nal outcome.

Brown Recluse Spider Bite: A Case Report of Severe Hemolysis and Sepsis

Abstract Introduction/Objective The brown recluse spider, Loxosceles reclusa, is commonly found in the southern and central United States and is known for its venomous bite. It has six eyes, uniformly colored abdomen and legs, is around 1 cm in length and prefers to live in warm, dark and dry places. Its bite in humans can cause skin necrosis as well as more severe manifestations including acute hemolytic anemia, disseminated intravascular coagulation (DIC), rhabdomyolysis and renal failure. Methods/Case Report We present a case report of a 27 year old male with no known past medical history who was referred from another medical center with a critical hemoglobin of 3.6 g/dl and acute hemolytic anemia that was not responsive to packed red blood cell transfusion and intravenous immunoglobulin treatment. He reported of having bitten by a brown recluse spider 8 days ago on the right scapular region. He started developing wound and pain in the area 2 days later when he was admitted to the hospital for a day and treated with antibiotics. His white blood cell count (WBC) at the time was mildly elevated with near normal hemoglobin and was incidentally found to have COVID 19 positivity. After being discharged, he developed fever with chills, dark urine, body ache, headache, nausea and vomiting. When presented to our hospital, laboratory review exhibited normocytic normochromic anemia with elevated bilirubin and decreased haptoglobin showing a hemolytic picture. The patient also displayed severe leukocytosis (WBC count: 53.50) with absolute neutrophilia, lymphocytosis, and monocytosis. Monocyte distribution width (MDW) was 30.02. These changes were attributed to be reactive to venom effect and sepsis. The patient showed significant improvement with plasmapheresis. Results (if a Case Study enter NA) NA. Conclusion The diagnosis of systemic loxoscelism is often difficult and delayed. Brown recluse spider bites may not always present with sharp stings to be noticed and reported by the patient. Presence of another infectious condition, like COVID 19 in this case, may divert the diagnosis. An elaborate patient history, physical examination for bite wound and patient education may help in identifying the cause early. Spider bites should be considered as a differential diagnosis in a patient with dermonecrosis and abrupt onset hemolysis or sepsis. Prompt treatment can prevent development of DIC, renal failure and life threatening conditions.

Can bite-force measurement play a role in dental treatment planning, clinical trials, and survival outcomes? A literature review and clinical recommendations.

Bite force (occlusal force) may play a significant role in patient treatment outcomes. However, as a diagnostic risk assessment tool, it has been examined in the literature but is not commonly utilized by practicing clinicians and in academic studies. This diagnostic evaluation may assist the dental clinician in planning tooth- and implant-supported restorations, as damage to the tooth, implant, or restoration may be dependent upon a restoration's resistance to loading conditions. The overall bite force has been estimated to be up to 2,000 N, with a clear sexual dimorphism and age dependence. The magnitude of these forces along the dental arch have been shown to be elevated in the posterior compared to the anterior region. The bite force magnitude has been inversely related to the proprioception, as a significant increase in bite force is seen in patients with endodontically treated teeth as compared to their vital teeth. Bite force has been linked to chewing efficiency, quality of life, and implicated in the life expectancy of the restorations. Restoration life expectancies have been associated with the material selection and preparation design parameters, both of which may be affected by masticatory bite force. Treatment planning criteria for preparation strategies affected by bite force include tooth location, material selection, occlusion pathways, and subsequent occlusal reduction amounts. When implants are used in patients with elevated magnitude of bite force, an increase in the number and diameter of the implants as well as occlusions with reduced occlusal tables buccolingually and lighter contacts may be recommended. An understanding of the magnitude and load of a patient's bite force can assist the dental clinician in the design of dental treatments along with other standard risk assessment criteria.

One Health Surveillance for Rabies: A Case Study of Integrated Bite Case Management in Albay Province, Philippines

Canine rabies is a significant public health concern and economic burden in the Philippines. Animal Bite Treatment Centers (ABTCs) that provide post-exposure prophylaxis (PEP) to bite patients have been established across the country, but the incidence of bite patient presentations has grown unsustainably, whilst rabies transmission in domestic dogs has not been controlled. Moreover, weak surveillance leads to low case detection and late outbreak responses. Here we investigated the potential for Integrated Bite Case Management (IBCM) to improve rabies detection in Albay province. Using information obtained from animal bite histories combined with phone follow-ups and field investigations, we demonstrated that IBCM resulted in a fourfold increase in case detection over 13 months of study compared to the prior period. Bite patient incidence across Albay was very high (>600/100,000 persons/year) with PEP administered mostly indiscriminately. Clinic attendance reflected availability of PEP and proximity to ABTCs rather than rabies incidence (<3% of patient presentations were from “probable” or confirmed rabies exposures) and is therefore not a suitable indicator of rabies burden. Further analysis of the IBCM data suggests that rabies transmission is mostly localized with focal cases from the previous month and current cases in neighbouring villages being most predictive of future rabies occurrence. We conclude that investigations of suspicious biting incidents identified through IBCM have potential to foster intersectoral relationships, and collaborative investments between public health and veterinary services, enabling the One Health ethos to be applied in a more sustainable and equitable way. Triage of patients and investigations of suspect dogs offer an effective tool for improved PEP provisioning and reduction of unnecessary expenditure, whilst targeted field investigations should lead to increased and earlier detection of rabid dogs. Given the enduring risk of re-introductions from neighbouring populations, enhanced surveillance is critical to achieving and maintaining rabies freedom.

Positive Outcomes of Inpatient Rehabilitation in a Snake Bite Patient with Pulmonary Complications: A Case Report

Snake bites are a common medical emergency and workplace danger, particularly in tropical India, where farming is a key source of income. We report case of 55 year old female patient reported to medicine department on 25\09\2021 with an alleged history of snake bite over her right ankle in evening when she was the working in the farm. She undergone 2 weeks of In-hospital rehabilitation along with medical management and had shown positive outcomes. This case report’s purpose was to focus on the significance of prompt surgical treatment and essential physiotherapy rehabilitation to attain the functional goals with to respect to patient and its prognosis.

A tick bite patient with fever and meningitis co-infected with Rickettsia raoultii and Tacheng tick virus 1: a case report

BackgroundIncreasing numbers of tick-borne pathogens are being discovered, including those that infect humans. However, reports on co-infections caused by two or more tick-borne pathogens are scarce.Case presentationA 38-year-old male farmer was bitten by a hard tick, presented with fever (37.7 °C), severe headache and ejection vomiting. Lumbar puncture was performed in the lateral decubitus. The cerebrospinal fluid (CSF) was clear, and analysis showed severe increased pressure (320 mm H2O), mild leukocytosis (126.0 × 106/L, mononuclear cells accounting for 73%) and elevated total protein concentration (0.92 g/L). Bacterial cultures of CSF and blood were negative. The diagnosis of Rickettsia raoultii and Tacheng tick virus 1 (TcTV-1) co-infection was confirmed by amplifying four rickettsial genetic markers and the partial small (S) RNA segment of TcTV-1 from the patient’s blood. The patient gradually recovered after treatment with levofloxacin and ribavirin.ConclusionsThis is the first reported co-infection case with fever and meningitis caused by R. raoultii and TcTV-1. It is vital to screen for multiple pathogens in tick-bitten patients, especially in those with severe complex symptoms.

Three-dimensional volumetric evaluation of dental pulp cavity/tooth ratio in anterior open bite malocclusion using cone beam computed tomography.

To assess and compare pulp cavity/tooth volume ratio of maxillary permanent teeth between patients exhibiting anterior open bite malocclusion and those exhibiting anterior normal overbite using cone beam computed tomography (CBCT). 3D dental images from 44 patients aged between 15 and 29years were analyzed. The DICOM files of all dental images were imported into an image processing software for calculating pulp cavity volume and tooth volume. Differences of pulp cavity volume, tooth volume, and pulp cavity/tooth volume ratio of each tooth type from both types of occlusions were analyzed using the independent t test. The intra-class correlation coefficient was used to evaluate intra-examiner reliability. The means of pulp cavity/tooth volume ratio in anterior open bite group were significantly greater than those in anterior normal overbite group (central incisor p = 0.001; lateral incisor p = 0.00025 and canine p = 0.004). The means of root canal/root volume ratio in anterior open bite group were significantly greater than anterior normal overbite group (central incisor p = 0.00001; lateral incisor p = 0.00007; and canine p = 0.001), whereas there were no significant differences of the means of pulp chamber/crown volume was observed. Anterior open bite malocclusion might lead to an increase of the pulp cavity volume and decrease of the tooth volume due to occlusal hypofunction. Orthodontic force should be carefully determined in anterior open bite patient due to the greater root canal volume and lesser root volume.

Temporary Implants and Particulate Dentin Graft Protecting Traditional Implants in Severe Periodontal Patient

Provisional implants (PIs) can offer a total contribution to a patient's esthetic comfort and chew during the integration of standard implants. Although temporary implants are not intended for osseointegration and have to withdraw at there or 4 months, most of them begin to move during this process, and most of them had extracted before standard implants integration. Resin fixed prosthesis attached to temporary implant abutments gives the patient stability, gives esthetics, and gives protection to traditional implants, compared to removable prostheses, which more quickly leads to the loosening and loss of these temporary implants. Temporary implants could be used with cemented or screwed resin prosthesis or with titanium framework, depending on the patient's bite, bruxism, or clenching. All PIs are made in one piece, titanium grade 5, with V threads and a Bioetched surface (rough surface) to increase the insertion torque and bone to implant contact in soft and hard bone. Temporary upper fixed denture, relined with resin, is the easiest solution for protecting and reducing the risk of failure of some of the standard implants. The possible solution in such cases is the use of temporary implants as support for the fixed structure, acting as protection of traditional implants and bone grafts. Our clinical case was made with six temporary implants TR® 2.7 mm diameter by 13 mm length, grinding extracted teeth using smart dentin grinder, and fixed temporary denture for 3 months. At 4 months, a complete zirconium denture was screwed in standard implants.

Dog bite Emergency department presentations in Brisbane metro south: Epidemiology and exploratory medical geography for targeted interventions

Dog bites are a recognized public health issue due to their impact on human and animal health/welfare. This study aimed to investigate demographic and geographic disparities in the epidemiology of dog bites presentations reported to the emergency departments of the four main public hospitals in the Metro South region of Brisbane, Queensland, Australia.Dog bite patient hospitalization data geolocated to the street address were collected from clinical records management systems from the four main public hospitals in the Metro South Hospital Health Service region of Queensland for a 5-year period (ie. 01/07/2013 to 30/06/2017). We investigated the epidemiology of three clinical outcomes including probability of paediatric cases (paediatric vs. adult), probability of dog bites to the head (head injury vs. other injury), and probability of re-presentation to the ED following their initial dog bite (yes or no) by way of univariable then multivariable Bernoulli logistic regression models including patient postcode as a random effect. Residual semivariograms were created to identify spatial trends in the medical geography of dog bites and binomial geostatistical models were created to predict the probability of the outcomes of interest in Brisbane Metro south and surrounding suburbs.Our results demonstrate that compared to adult dog bite cases, paediatric dog bite cases were significantly associated with bites to the head or face or neck (OR 14.65, P < 0.001), bites to the lower body (OR 4.95, P = 0.035) and larger dogs (OR 0.25, P = 0.030 for small dogs). The probability of head injuries was greater in younger age groups (17–39 OR 0.25, P = 0.001; 40–64 OR 0.15, P = 0.001; 65-above OR 0.14, P = 0.029). Attacks by small dogs were more likely to inflict head wounds than large dogs (OR 6.12, P < 0.001). The probability of re-presentation was lower in patients bitten by medium sized dogs (OR 0.29, P = 0.027) than larger dogs. Our predictive maps showed significant clustering of paediatric case probability in the Logan city and Redlands councils associated with socioeconomic status of the places of residence.In conclusion, our findings demonstrate significant demographic and geographic heterogeneity in dog bite ED presentations. Public health interventions to reduce the burden of dog bites should be targeted to the populations most at-risk in the areas identified in this study.

Letter to the Editor.

Dear Editor,The oral implantologist's goal is a long term functional and esthetic outcome.1 In planning for this, various data are collected and evaluated. One parameter that has not been seriously considered in the past is the patient's bite force capability (BFC).Treatment planning centers around function, esthetics, and loading. This is accomplished by implant size selection, implant positioning, and prosthetic design. Jaw bite force is generally 2–3 times greater in the posterior jaws than the anterior. Overloading the supporting bone is a basic caveat. Thus, implant size and position are important to prevent an overload of the supporting bone.2–6 Nonetheless, the patient's BFC is the vector behind this occlusal load. It is important, then, for the clinician to have this value to consider implant size, position, and prosthetic occlusal scheme.2–6Patient bite force capability ranges from 50 to 300 N. Thus, a patient with a low BFC may not require a large long diameter implant in the anterior jaw, but a large BFC may require a long large diameter implant to resist a greater load: larger diameter, long implants may be necessary to prevent an overload. The wider the implant, the less per square millimeter load there is on the supporting bone.2–6 However, implants placed in the anterior Class I maxilla will be subjected to a lingual off-axial load from the mandibular anterior teeth. There may not be generous site length in this area for a large implant. A smaller diameter implant may be required. The prudent clinician may measure the BFC as a guide to implant length and width. A prophylactic lingual relief may be needed to ensure mitigation from that load.2–6Implants placed in the posterior jaws can be subjected to extreme functional and parafunctional loads. Thus, larger diameter and longer length implants may be required to resist these loads and BFC may be appropriate for proper planning.2–6 A patient with a low BFC may do well with almost any occlusal scheme, but a greater BFC may require an anterior guided occlusal scheme to protect posterior implants from an off-axial load.2–6A tooth size may present a lever to the opposing dentition. The force on such a lever may impart a magnified load on the supporting bone, thus the clinician should take BFC into account during planning.2–6Of all the diagnostic parameters, the most important datum may be the BFC. This value influences all the other parameters to a minor or major extent. It may be the primary consideration for a long-term function and esthetic outcome.2–6

Using Surveillance of Animal Bite Patients to Decipher Potential Risks of Rabies Exposure From Domestic Animals and Wildlife in Brazil.

Direct contact with domestic animals and wildlife is linked to zoonotic spillover risk. Patients presenting with animal-bite injuries provide a potentially valuable source of surveillance data on rabies viruses that are transmitted primarily by animal bites. Here, we used passive surveillance data of bite patients to identify areas with high potential risk of rabies transmission to humans across Brazil, a highly diverse and populous country, where rabies circulates in a range of species. We analyzed one decade of bite patient data from the national health information system (SINAN) comprising over 500,000 patients attending public health facilities after being bitten by a domestic or wild animal. Our analyses show that, between 2008 and 2016, patients were mostly bitten by domestic dogs (average annual dog bite patients: 502,043 [436,391–544,564], annual incidence per state: 258 dog bites/100,000 persons) and cats (76,512 [56,588–97,580] cat bites, 41 cat bites/100,000/year), but bites from bats (4,172 [3,351–5,365] bat bites, 2.3/100,000/year), primates (3,320 [3,013–3,710] primate bites, 2.0/100,000/year), herbivores (1,908 [1,492–2,298] herbivore bites, 0.9/100,000/year) and foxes (883 [609–1,086] fox bites, 0.6/100,000/year) were also considerable. Incidence of bites due to dogs and herbivores remained relatively stable over the last decade. In contrast bites by cats and bats increased while bites by primates and foxes decreased. Bites by wild animals occurred in all states but were more frequent in the North and Northeast of Brazil, with over 3-fold differences in incidence between states across all animal groups. Most bites reported from domestic animals and wildlife occurred in urban settings (71%), except for bites from foxes, which were higher in rural settings (57%). Based upon the Ministry of Health guidelines, only half of patients received the correct Post-Exposure Prophylaxis following a bite by a suspect rabid animal. We identified areas and species of high-risk for potential zoonotic transmission of rabies in Brazil and reveal that, despite increasing human encroachment into natural ecosystems, only patients reporting bites by bats increased. Our study calls for future research to identity the socio-ecological factors underlying bites and the preventive measures needed to reduce their incidence and potential risk of rabies transmission.