Dental Treatment Of Patients Research Articles

Clinical application of diode laser radiation for surgical treatment of patients with dental diseases

Background. Traumatism of surgical operations in dentistry dictates the need to search for minimally invasive methods of tissue alteration. The use of lasers makes it possible to solve this problem, since laser radiation possesses a lower operative injury, selective action and activates the reparative processes in the wound.
 Aim. To increase the effectiveness of surgical treatment of dental patients by using a diode laser.
 Materials and Methods. In a clinic, 134 patients from 18 to 82 years of age with various dental diseases were examined and underwent surgical treatment using a traditional method and a diode «PICASSO Lite» laser with 810 nm wavelength from AMD Lasers (USA), with the radiation power in the range from 0.6 to 1.0 W. The criteria for evaluation of the effectiveness of laser application were the data of clinical examination.
 Results. In comparison with the traditional method of treatment, use of a surgical laser resulted in a less pronounced postoperative edema and pain. The difference between healing time of the operative wound after use of surgical laser and after the traditional treatment was 3±0.5 days in case of suturing of the wound and 7±0.5 days in case of wound healing under the fibrinous film and under the iodoform tampon. The wound defect induced by laser radiation passed all stages of the wound process much faster that with use of scalpel. In addition, selective removal of pathological tissues reduced the likelihood of injury to the oral mucosa, which leads to reduction in the duration of treatment.
 Conclusions. Thus, the use of a diode laser allows to improve the technique of surgical treatment of patients and increases the effectiveness of treatment of patients with dental diseases.

Clinical application of diode laser radiation for surgical treatment of patients with dental diseases

Background. Traumatism of surgical operations in dentistry dictates the need to search for minimally invasive methods of tissue alteration. The use of lasers makes it possible to solve this problem, since laser radiation possesses a lower operative injury, selective action and activates the reparative processes in the wound.
 Aim. To increase the effectiveness of surgical treatment of dental patients by using a diode laser.
 Materials and Methods. In a clinic, 134 patients from 18 to 82 years of age with various dental diseases were examined and underwent surgical treatment using a traditional method and a diode «PICASSO Lite» laser with 810 nm wavelength from AMD Lasers (USA), with the radiation power in the range from 0.6 to 1.0 W. The criteria for evaluation of the effectiveness of laser application were the data of clinical examination.
 Results. In comparison with the traditional method of treatment, use of a surgical laser resulted in a less pronounced postoperative edema and pain. The difference between healing time of the operative wound after use of surgical laser and after the traditional treatment was 3±0.5 days in case of suturing of the wound and 7±0.5 days in case of wound healing under the fibrinous film and under the iodoform tampon. The wound defect induced by laser radiation passed all stages of the wound process much faster that with use of scalpel. In addition, selective removal of pathological tissues reduced the likelihood of injury to the oral mucosa, which leads to reduction in the duration of treatment.
 Conclusions. Thus, the use of a diode laser allows to improve the technique of surgical treatment of patients and increases the effectiveness of treatment of patients with dental diseases.

Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study.

Several novel oral anticoagulants (NOACs) are currently prescribed for patients suffering from atrial fibrillation, pulmonary thromboembolism, and venous thrombosis. However, there is no clinical guideline for dental treatment in patients taking NOACs. This study investigated bleeding events related to various dental treatments. This retrospective study included 120 patients (153 cases) who were prescribed NOACs and received dental procedures in the Department of Advanced General Dentistry at Yonsei University Dental Hospital from January 2014 to June 2017. The indication for NOACs, initiation of NOACs, duration of discontinuance, creatinine clearance, and type of dental treatment were investigated. Bleeding events were assessed at a follow-up visit to the clinic. Postoperative bleeding occurred in only 9 of the 153 included cases; they comprised 2 cases of scaling, 3 cases of simple extraction, 3 cases of the first stage of implant surgery, and 1 case of resin filling. The creatinine clearance (P = .111) and duration of discontinuance (P = .222) did not differ significantly between the groups with and without bleeding events. Our data indicate that most dental treatments may be performed in patients taking NOACs without an increased likelihood of bleeding events regardless of the discontinuance duration. Moreover, any postoperative bleeding can be stopped by applying compressive pressure or local hemostatic agents. Our study suggests that patients taking NOACs who need dental treatments may have a bleeding tendency based on our retrospective data. Preoperative history taking and treatment modification should therefore be considered before performing dental surgery.

Review: An overview and analysis of novel oral anticoagulants and their dental implications.

Dabigatran, rivaroxaban, apixaban and edoxaban are approved novel oral anticoagulants (NOACs) as alternatives to Vitamin K antagonists (VKA). Physicians are prescribing an ever-increasing amount these drugs to their patients due to various advantages over existing medications. The objective of this review is to provide the dental professional with current literature surrounding the emergence of NOACs, as well as various case studies on the subject, in an effort to guide clinical decision making regarding these medications. The pharmacological profiles of these NOACs and idarucizumab, a reversal agent for dabigatran, will be detailed in this review. A review of the literature on NOACs was undertaken and the Pubmed, Medline, and Embase databases were used to identify articles published in the English language. Additionally, major dental medicine journals were hand searched, followed by a review of the ClinicalTrials.gov database. Due to minimal research regarding dental treatment of patients on NOACs and minimal clinical experience of practitioners treating these patients, there is currently insufficient data to establish an evidence-based NOAC management protocol in a dental setting. In this review, the most significant advantages of NOACs over VKAs was found to be limited interactions with other drugs as well as rapid onset and offset of action. Despite these benefits, as well as various others, NOACs still lack specific management parameters as well as antidotes or reversal agents. Therefore, dental professionals must use caution when treating patients currently taking these specific anticoagulants.

Restorative Treatment in Patients with Amelogenesis Imperfecta: A Review

To summarize the contemporary scientific evidence available regarding restorative dental treatment in patients with Amelogenesis imperfecta (AI). An electronic literature search was conducted using the search term "Amelogenesis imperfecta" and the PubMed/MEDLINE database as well as Google Scholar. Prospective and retrospective clinical studies that investigated the outcome of direct and/or indirect dental restorative treatment in patients with AI, were published in English, and had an observation time of at least 1 year were included in this review. The articles identified were screened and analyzed by two reviewers according to inclusion and exclusion criteria in three review rounds. Six prospective or retrospective clinical studies analyzing longevity and complications associated with dental restorative treatment in patients with AI met the inclusion criteria. Extracted data suggest that in patients with AI, indirect restorations feature superior predictability and longevity than direct restorations. As endodontic complications were infrequently observed and periodontal parameters regularly improve with the insertion of indirect restorations, dental treatment in patients with AI should focus on indirect restorations as soon as possible. While adhesive bonding techniques to enamel surfaces in patients with AI feature merely limited predictability and longevity and as the available data is scarce, further laboratory and clinical studies should be performed to investigate the performance of minimally invasive indirect restorations bonded to enamel in patients with AI. Scientific evidence indicates that indirect restorations should be preferred over direct restorations in patients with AI.

Participation of students in the examination and treatment of dental patients

Participation of students in the examination and treatment of dental patients

Проблема ортопедического лечения больных с концевыми дефектами зубного ряда

Проблема ортопедического лечения больных с концевыми дефектами зубного ряда

Xerostomia and Hyposalivation in Patients with Physical and Psychological Disabilities

Disabilities are complex, dynamic, multidimensional and also contested; one or more key functions of the organism can be affected so to diminish an individual�s freedom of expression and of action. The transition from an individual, medical perspective to a structural, social perspective was described as a shift from a medical model to a social model where individuals are more likely considered disabled by the society then by their own bodies. Disabilities represent a part of the human condition due to its bidirectional connection with poverty: the existence of disabilities can increase the risk of poverty, and poverty can increase the risk of disability. The experience of disability that results from the interaction of the state of health, personal factors and environmental factors varies greatly. Stress, anxiety or different unpleasant moments can cause a temporary decrease in salivary flow but a constant decrease can indicate the existence of a serious health problem. Xerostomia represents the subjective sensation of dry mouth. It can be accompanied by hyposalivation, an objective phenomenon but this is not always the case. Even if the patient declares the existence of xerostomia, this does not necessarily imply the existence of hyposalivation. Xerostomia can be determined by modifications in the oral cavity, as the sensitivity level to moistening, adverse reactions to certain drugs (anti-depressants, inhibitors of the conversion enzyme). The handicap, now called disability represents a special condition of the individual, reason why he must benefit of the support of the society and of those around him. Dental treatment in patients with psychiatric disabilities must consider the general and local involutive modifications, the existent overlay polypathologies that can influence the dental treatment. The study was conducted practically and included the direct interaction as part of the medical team and the registration of 145 patients presented on request with various types of psychological disorders, sometimes covered by the mask of somatic disorders, indicating a masked depression, or a physical depression, where the emotional condition of yesterday and today differ very much. Pointing out the role of the dentist in approaching patients with physical and psychical disabilities, motivating and making them aware of the necessity of adopting a proper oral hygiene for preventing oral disorders. The dramatic impact on the psyche and the well-chosen words stressed by the clinician increase patient awareness and motivation in order to make him collaborate during the treatment.

INFORMATION SIGNIFICANCE OF ELECTROMIOGRAPHIC RESEARCH IN THE STRUCTURE OF DIAGNOSTICS AND ORTHOPEDIC DENTISTRY TREATMENT OF PATIENTS WITH HIGHLY EXPOSED TEETH

Article describes electromyographic studies as an important part in the structure of diagnostics and orthopedic dental treatment of patients with increased erasure of teeth. The results of the correlations between elecrocromyography revealed strong reliable connections during the work of the actual chewing and temporal muscles on the right and left. It is confirmed that muscle dysfunction does not occur in the area of only one isolated group, but involves muscles on both sides and often depends on the parafunctional habits of the patient and the use of one side or another during chewing.

The influence of dental treatment on the development of osteoradionecrosis after radiotherapy by modern irradiation techniques.

The aim of this study was to analyze the influence of dental treatment on the development of osteoradionecrosis (ORN) of the jaw. This study included the data of 776 patients who underwent 3D-CRT or IMRT because of head and neck cancer. Sex, dental status before and after radiotherapy (RT), tumor site, bone surgery during tumor operation, concomitant chemotherapy, and the development of an advanced ORN were documented for each patient. The patients' dentitions before and after RT were classified into four groups with regard to the number and localization of the remaining teeth. Differences between the patients with ORN and patients without ORN with regard to the teeth's condition before and after RT, and with regard to the extent of dental treatment were determined descriptively. Cox proportional hazards regression to study the association between dentition and the development of ORN. The extent of dental treatment in patients with and without ORN did not differ in a clinically relevant way. The highest risk of developing ORN was observed in patients who had undergone primary bone surgery during the tumor operation (HR=5.58, 95%CI 2.91-10.7) and patients who had a tumor in the oral cavity (HR=4.84, 95%CI 1.37-17.11). Based on the results of this study, tumor localization and its required treatment are prognostic factors for the development of ORN. After implementing a consequent dental treatment scheme, no influence of dentition on the risk of developing ORN could be demonstrated. Patients with a lower risk could prospectively benefit from a more moderate dental treatment scheme.

The use of general anesthesia to facilitate dental treatment in adult patients with special needs.

General anesthesia is commonly used to facilitate dental treatment in patients with anxiety or challenging behavior, many of whom are children or patients with special needs. When performing procedures under general anesthesia, dental surgeons must perform a thorough pre-operative assessment, as well as ensure that the patients are aware of the potential risks and that informed consent has been obtained. Such precautions ensure optimal patient management and reduce the frequency of morbidities associated with this form of sedation. Most guidelines address the management of pediatric patients under general anesthesia. However, little has been published regarding this method in patients with special needs. This article constitutes a review of the current literature regarding management of patients with special needs under general anesthesia.

Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial.

IntroductionIndividuals with cerebral palsy (CP) often present with oral alterations that impact oral health and require dental treatment.AimThis study aimed to evaluate the use of conscious sedation with nitrous oxide (N2O) to control stress during dental treatment in individuals with CP using as parameters: Venham score (VS), heart rate (HR), and respiratory rate (RR).Materials and methodsA total of 77 CP patients >3 years of age with a mean age of 11.8 (± 6.4) years were evaluated in a rehabilitation center. Stress control was measured at the following time points: T1 (presedation), T2 (induction), T3 (sedated patient), and T4 (end). Student’s t-test, the Chi-squared test, analysis of variance (ANOVA), and the McNemar test were used. The significance level was 5%.ResultsSedation ranged between 10 and 60% N2O, with an average of 35.6% (± 10.4). The RR did not vary among the times (p = 0.12). The HR and VS varied significantly between times (p < 0.001), as significantly higher values of HR were observed at T1.ConclusionConscious sedation with N2O during dental care controls stress in CP patients, as verified by a decrease in HR, and does not promote respiratory depression. Higher concentrations of N2O are recommended for CP patients with tachycardia.Clinical significanceSedation modifies behavior during dental procedures, facilitating patient collaboration.How to cite this article: Baeder FM, Silva DF, de Albuquerque ACL, Santos MTBR. Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial. Int J Clin Pediatr Dent 2017;10(4):384-390.

Capnography Prevents Hypoxia during Sedation for Dental Treatment: A Randomized Controlled Trial.

Intravenous sedation is useful for dental treatment in patients with intellectual disabilities. However, it is often necessary to manage such patients with deep sedation because their cooperation cannot be obtained. During deep sedation, undetected hypoventilation can lead to severe complications, such as hypoxia. Recently, capnographic monitoring has been advocated as a useful technique for preventing hypoxia during sedation. This randomized control trial evaluated whether the use of capnography reduces the incidence of hypoxia during the deep sedation of patients for dental treatment. This study involved patients with intellectual disabilities who underwent dental treatment under sedation. The subjects were randomized to the intervention group (I-group) or control group (C-group). All of the patients underwent routine monitoring, as well as bispectral index (BIS) and capnographic monitoring; however, only an independent observer had access to the patients' capnographic data during the dental procedures. Sedation was maintained at a BIS of 50 to 70 by administration of propofol. In the I-group, the independent observer signaled to the dental anesthesiologist if the capnogram indicated that the patient had been suffering from alveolar hypoventilation or apnea for >15 s. In the C-group, the observer signaled to the dental anesthesiologist if the capnogram indicated that the patient had been suffering from alveolar hypoventilation or apnea for >60 s. In both groups, the dental anesthesiologists responded to the signals using appropriate airway management strategies. The primary endpoint of this study was the incidence of hypoxia during dental treatment, which was defined as oxygen saturation of <95%. Hypoxemic episodes occurred in 13.4% and 34.8% of cases in the I-group and C-group, respectively. The incidence of hypoxia was significantly lower in the I-group. These results suggest that capnographic monitoring during deep sedation for dental treatment prevents hypoxemic episodes by allowing the early detection of hypoventilation. Knowledge Transfer Statement: This is the first randomized controlled trial to examine whether the use of capnography reduces the incidence of hypoxia during deep sedation for dental treatment. The findings of this study can be used by clinicians to aid decision-making regarding dental sedation standards at individual clinics. Moreover, they can be used as high-level evidence during the production or updating of clinical guidelines for dental sedation by leading associations.

Nitrous oxide for dental treatment in patients with infantile autism: a literature review

Childhood autism is a neurodevelopment disorder with characteristic symptoms, e.g.: impairments in social interaction and communication, restricted interests and repetitive behaviors. The dental care of these individuals is challenging because of the difficulty in social relationship presented, so that the use of auxiliary pharmacological means, as the use of conscious sedation with nitrous oxide and oxygen is indicated in managing the behavior of the patient with infantile autism. Objective: To perform comprehensive literature review on the use of conscious sedation with nitrous oxide as an adjunct in the behavior of the patient with infantile autism. Literature review: The following descriptors were used: autistic disorder, conscious sedation and nitrous oxide in national and international databases at the period from 2006-2014. Conclusion: The conscious sedation with nitrous oxide and oxygen, as an auxiliary method in the behavior management of children with autism is a secure and effective option, through previous evaluation of the individual, in order to achieve the expected results.

Dental Management of Special Needs Patients: A Literature Review

The dental management of special needs patients creates doubt and anxiety among dentists. The theme is underexplored throughout the undergraduate course and the dentists have not enough theoretical foundation to work on this field. Special needs patients are those individuals who have permanent or transitory mental, physical, organic social and / or behavioral impairments. Thus, the aim of this study was to assist dentists in the best dental management choice for special needs patients. It was revised and more specifically detailed the management on dental base office, the management under sedation and under general anesthesia, and home care treatments for patients with special needs, with the aim of developing guidelines on management of dental patients with special health care needs to facilitate the execution of dental treatment of these patients. From this literature review, we proposed a guideline to assist the dentist in choosing the best therapeutic approach for the dental treatment of patients with special needs.

Dental treatment in patients with cardiac pacemakers: Is it a risky affair?

Cardiac pacemakers are the implanted devices used to treat patients with damaged heart muscles. These electronic devices are sensitive to strong electromagnetic signals. The dental literature also included articles regarding electromagnetic interferences to pacemakers, due to dental devices such as ultrasonic scalers, electrosurgical unit, ultrasonic bath cleaners, and battery driven light cure composite unit. Although pacemakers of new generation have more protective features than those of past, but still precautionary measures should be taken in dental clinics for the safety of cardiac patients with pacemaker. The aim of this paper is to identify the possible sources from dental clinics which can adversely interfere with the pacemaker activity and to provide some guidelines for safe dental practice in this high-risk group.

Effects of adrenaline on circulatory dynamics and cardiac function in rats administered chlorpromazine.

We aimed to elucidate changes in circulatory dynamics and cardiac function during concomitant use of chlorpromazine (CPZ) and adrenaline (AD). An arterial line and left intraventricular pressure-volume measurement catheter were inserted in rats. CPZ 10mg/kg was administered to the left great adductor muscle, followed by normal saline (NS) or AD 50μg/kg through the tongue 20min later. End-diastolic volume (V ed), end-systolic pressure (P es), stroke volume (SV), stroke work (SW), end-systolic volume elastance (E es), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) were measured. Following AD administration, V ed significantly decreased at 2-4 and 10min than that in control rats; P es significantly decreased at 1min; E es significantly increased from 2 to 10min; SV did not change significantly, and SW significantly reduced at 1 and 2min; SBP and DBP were lower at 1-3min than in the control; and PR increased at 10min. These findings suggest that when AD-containing local anesthetics are administered during dental treatment of patients taking CPZ, there is a risk of a temporary drop in blood pressure. However, the blood pressure is recovered a few minutes later by the increase in afterload and the myocardial contractile force.

Fact-finding survey among general dental practitioners in A City on dental treatment of patients with disabilities

Fact-finding survey among general dental practitioners in A City on dental treatment of patients with disabilities

Management of avulsed permanent maxillary central incisors during endotracheal intubation

Avulsion is serious injury that may encounter during endotracheal intubation and its management often presents a challenge. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. The present article describes the management of air-dried maxillary permanent incisors that have been avulsed due to direct laryngoscopy during the induction of general anesthesia for tonsillectomy procedure. The replanted maxillary central incisors had maintained its function and esthetic for 1 year after replantation. Children in a mixed dentition phase are high-risk group children for traumatic dental injury during laryngoscopy; therefore, Anesthetic Departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma.

Novel Oral Anticoagulants: Comparative Pharmacology and Dental Implications

Novel Oral Anticoagulants: Comparative Pharmacology and Dental Implications Novel oral anticoagulants (NOACs), direct thrombin inhibitor (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) are available in market as an alternative to warfarin. They are widely being prescribed by medical practitioners as these drugs overcome some of the major drawbacks with the existing medications. Absence of any specific management guidelines and lack of antidote are major concern for dental treatment of patients on NOACs. This review details the pharmacological profile of vitamin K anticoagulants and emerging NOACs. In order to assist dental professionals in decision making, case studies showing management of patients on NOACs undergoing dental treatment are also summarized. Since available data are not sufficient to establish an evidence-based dental management, the dentist must use caution and attention when treating patients taking dabigatran, rivaroxaban, apixaban and edoxaban.