Posttreatment Instructions Research Articles

Velopharyngeal Insufficiency After Botox Injection for Persistent Bruxism.

Botulinum toxin type-A (BTX-A) injections have emerged as a promising treatment for bruxism and temporomandibular joint (TMJ) disorders. However, there is a need for further exploration of optimal dosage, injection techniques, and intervals to maximize treatment effectiveness. Complications, such as velopharyngeal insufficiency, can occur after BTX-A injections, emphasizing the importance of precautionary measures. The utilization of ultrasound guidance and electromyography assistance can aid in precise injections and minimize the risk of complications. In addition, patients should receive appropriate medication and adhere to post-treatment instructions to alleviate symptoms. Follow-up procedures are essential to monitor potential complications, and in some cases, professional mental health care may be required. Further research is warranted to establish the safety and efficacy of BTX-A injections for the treatment of bruxism and TMJ disorders. This case study presents the development velopharyngeal insufficiency in a patient with chronic bruxism 3 days after receiving a BTX-A injection.

Assessing the benefits and drawbacks of cryolipolysis as a noninvasive body sculpting technique: risks, side effects, and future research – an editorial

This article discusses cryolipolysis, a noninvasive body sculpting method that freezes and removes fat cells. It explores the historical context of fat reduction treatments and the development of noninvasive techniques as alternatives to invasive liposuction. Cryolipolysis gained popularity after U.S. Food and Drug Administration (FDA) approval and has become one of the most frequently utilized noninvasive cosmetic procedures globally. The abstract delves into case reports and complications associated with cryolipolysis, such as persistent lumps, frostbite lesions, and skin necrosis, highlighting potential risks and limitations. It also addresses common side effects like erythema, numbness, and bruising, as well as more severe adverse events such as dysesthesia and paradoxical adipose hyperplasia. Safety considerations and relative contraindications are discussed, emphasizing the importance of consulting qualified medical professionals who adhere to pretreatment and posttreatment instructions and use FDA-approved technology. Patience and a healthy lifestyle are stressed for optimal outcomes. In conclusion, cryolipolysis offers a safe and convenient fat removal option with long-lasting benefits. However, it may not be suitable for significant fat loss or certain medical conditions. Consulting medical experts and considering personal preferences are essential in making an informed decision about cryolipolysis as a body sculpting option.

The Caries-Arrest Effectiveness of Silver Diamine Fluoride Treatment with Different Post-Treatment Instructions in Preschool Children: A Study Protocol for a Randomized Controlled Trial.

In this 12-month randomized active-controlled clinical trial, we compare two post-treatment instructions for silver diamine fluoride (SDF) therapy in arresting dentine caries. The trial will include at least 254 kindergarten children with active dentine caries. The children will be randomized into two groups and receive a 38% SDF solution applied topically to their carious lesions. Children in Group A will rinse immediately, whereas those in Group B will refrain from rinsing, eating, and drinking for 30 min. One trained examiner will perform the dental examination at baseline and every six months. The primary outcome measurement will be the proportion of caries lesions that become arrested at the 12-month examination. Potential confounding factors and parents' satisfaction with SDF therapy at baseline and after 12 months will be collected using parental questionnaires. This trial will provide evidence-based information for clinical practitioners to give post-treatment instructions for SDF therapy. This study is registered at ClinicalTrial.gov (USA) (registration number: NCT05655286).

Statistical study on the degree of satisfaction of patients with fixed prosthetic dentures

Abstract Introduction: Edentation is a major emergency and has an echo over the entire stomatognathic system. The treatment of partial edentation has undergone major changes in the last decades for multiple causes, including increasing the level of dental, medical education, introducing new techniques, methods, and materials, increasing the duration of retention of teeth on the arch. Aim of the study: The aim of this study is to determine the degree of satisfaction of patients with a fixed prosthetic denture, to highlight the importance of communication between doctor and patient with repercussions on the results of prosthetic treatment, and evaluate the degree of awareness of oral health and oral hygiene practices. Material and Method: For this study it was used a self-designed questionnaire, which explored both clinical and non-clinical dental services. The questionnaire consisted of three parts: first part (A) includes socio-demographic indices, part two (B) includes questions related to the doctor-patient relationship, and in the third part (C) the questionnaire asks questions regarding the general satisfaction of the patients with reference to the prosthetic tratament. The questionnaire also includes the material (s) from which the prosthetic denture is performed and the area of the edentation. Results: The present study was performed on a batch of 117 people, 48 female, and 69 males between the ages of 21 and 60. Our results show that the majority of patients present metallic-ceramic dentures, located in most cases in the lateral area, and the majority of patients are satisfied with the prosthetic tratament. There were no patients complaining about the result of the tratament. Pacients are delighted by their relationship with medical staff. Conclusions: The most important finding of this study states that a large proportion of patients showed a lack of knowledge regarding oral hygiene measures and the importance of maintaining a fixed prosthetic denture using a dental abutment. Also, the majority of the doctors did not pay attention to the post-treatment instructions regarding the maintenance of a fixed prosthetic denture.

Enhancing predicted fluoride varnish efficacy and post-treatment compliance by means of calcium-containing gummy bears

ObjectivesThis study determined whether consumption of calcium-containing gummies prior to fluoride varnish application enhances plaque fluoride retention and compliance with post-varnish application instructions. MethodsThe present study followed a multi-center, parallel, randomized, and laboratory analyst-blind design. Following IRB approval, parent consent and child assent, 44 subjects (7–12 years), were randomized to either gummy or no-gummy study groups. A baseline plaque sample was obtained after a wash-out period. Fluoride varnish (5% NaF) was applied; subjects in the gummy group received two calcium-containing gummies prior to varnish application. Subjects were given two questionnaires to complete (subject and parent) to investigate adherence to post-treatment instructions. Three days later, a second plaque sample was obtained. Plaque was analyzed for plaque fluid and solid fluoride concentrations. Fluoride data were analyzed using Wilcoxon Rank Sum tests, questionnaire data using Pearson chi-square tests. ResultsPlaque fluid fluoride did not change pre- to post-treatment in the gummy group (mean ± sd: 8.8 ± 5.7 μmol/l vs. 10.0 ± 6.3 μmol/l; p = 0.265) or in the no-gummy group (8.1 ± 4.4 μmol/l vs. 16.1 ± 20.0 μmol/l; p = 0.058). Groups were not different for plaque fluid fluoride pre-treatment (p = 1.000), post-treatment (p = 0.904), or change (p = 0.904). Plaque solid fluoride did not change pre- to post-treatment in the gummy group (0.89 ± 1.10 μmol/g vs. 1.37 ± 1.77 μmol/g; p = 0.073) or in the no-gummy group (0.68 ± 0.77 μmol/g vs. 2.01 ± 5.00 μmol/g; p = 0.190). Groups were not different for plaque solid fluoride pre-treatment (p = 1.000), post-treatment (p = 0.466), or change (p = 0.874). No significant differences were found between groups for questionnaire responses. ConclusionThis study failed to demonstrate an effect of calcium-containing gummies in enhancing plaque fluoride retention. Clinical significanceThe consumption of calcium-containing gummies prior to fluoride varnish application does not promote greater intra-oral fluoride retention or better adherence to post-treatment instructions.

5-year study of a polyacrylamide hydrogel-based filler for rehabilitation of HIV-related facial lipoatrophy.

Lipoatrophy of the face negatively impacts the quality of life and body image of individuals on antiretroviral therapy. Facial fillers can minimize the stigma associated with the human immonodeficiency virus (HIV). In this 5-year follow-up study, the author assessed the safety and efficacy of a permanent, non-biodegradable, polyacrylamide hydrogel for facial volume restoration, and compared the results with those of a previous 18-month follow-up study. Thirty-one HIV-positive individuals, initially enrolled in the study between January 2008 and January 2009, received treatment of facial wasting by injection of the polyacrylamide gel until complete volume restoration was achieved. Asepsis rules were strictly observed before and during each injection session. Patients evaluated their aesthetic outcomes on a visual analog scale. Patient satisfaction was high. There was no occurrence of local infection, foreign-body reaction, or product during the 5 years of follow-up. Small, palpable, nonvisible nodules were recorded in nine cases. It appears that these same nodules were present in the 18-month study. It is believed that the nodules were caused by overfilling in the same site. As supported by the initial 18-month study, polyacrylamide hydrogel filler appears safe and effective for the treatment of HIV-related lipoatrophy. With strict observation of asepsis rules and patient adherence to posttreatment instructions, this filler can be ideal for treating facial wasting in patients with HIV. 3 Therapeutic.

Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV)

Benign paroxsymal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo associated with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology (ENT) clinics. BPPV of the posterior canal is a specific type of BPPV for which the Epley (canalith repositioning) manoeuvre is a verified treatment. A range of modifications of the Epley manoeuvre are used in clinical practice, including post-Epley vestibular exercises and post-Epley postural restrictions. To assess whether the various modifications of the Epley manoeuvre for posterior canal BPPV enhance its efficacy in clinical practice. We searched the Cochrane ENT Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 15 December 2011. Randomised controlled trials of modifications of the Epley manoeuvre versus a standard Epley manoeuvre as a control in adults with posterior canal BPPV diagnosed with a positive Dix-Hallpike test. Specific modifications sought were: application of vibration/oscillation to the mastoid region, vestibular rehabilitation exercises, additional steps in the Epley manoeuvre and post-treatment instructions relating to movement restriction. Two authors independently selected studies from the search results and the third author reviewed and resolved any disagreement. Two authors independently extracted data from the studies using standardised data forms. All authors independently assessed the trials for risk of bias. The review includes 11 trials involving 855 participants. A total of nine studies used post-Epley postural restrictions as their modification of the Epley manoeuvre. There was no evidence of a difference in the results for post-treatment vertigo intensity or subjective assessment of improvement in individual or pooled data. All nine trials included the conversion of a positive to a negative Dix-Hallpike test as an outcome measure. Pooled data identified a significant difference from the addition of postural restrictions in the frequency of Dix-Hallpike conversion when compared to the Epley manoeuvre alone. In the experimental group 88.7% (220 out of 248) patients versus 78.2% (219 out of 280) in the control group converted from a positive to negative Dix-Hallpike test (risk ratio (RR) 1.13, 95% confidence interval (CI) 1.05 to 1.22, P = 0.002). No serious adverse effects were reported, however three studies reported minor complications such as neck stiffness, horizontal BPPV, dizziness and disequilibrium in some patients.There was no evidence of benefit of mastoid oscillation applied during the Epley manoeuvre, or of additional steps in the Epley manoeuvre. No adverse effects were reported. There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised. Specific patients who experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright may be treated with the Epley manoeuvre alone and still expect to be cured in most instances.There is insufficient evidence to support the routine application of mastoid oscillation during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither treatment is associated with adverse outcomes. Further studies should employ a rigorous randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike test as an outcome measure and longer-term follow-up of patients.

Complications of Foam Sclerotherapy

Foam sclerotherapy may result in drug and/or gas-related complications of a generalized or localized nature. Significant complications include anaphylactic/anaphylactoid reactions (very rare), deep vein thrombosis (1-3%), stroke (0.01%), superficial venous thrombosis (4.4%), tissue necrosis (variable frequency), oedema (0.5%) and nerve damage (0.2%). Cosmetic complications include telangiectatic matting (15-24%) and pigmentation (10-30%). Patent foramen ovale and other cardio-pulmonary right-to-left shunts seem to play a role in the systemic gas-related complications. In conclusion, foam sclerotherapy is characterized by an overall high degree of safety, though special attention should be given to the embolic and thrombotic complications. Good technique, adequate imaging, general precautions and compliance with post-treatment instructions may help avoid some of the adverse events and an appropriate early intervention may minimize possible sequelae. Higher volumes of sclerosant foam have been attributed to local and distant thrombotic complications and should be avoided.

The Role of Postural Restrictions after BPPV Treatment: Real Effect on Successful Treatment and BPPV’s Recurrence Rates

Background. Canalith repositioning techniques are adequately established in the literature, as the treatment of choice for benign paroxysmal positional vertigo. However, the role of the posttreatment instructions is still not clearly defined. Patients and Methods. A retrospective chart review of 82 patients was conducted in order to determine the efficacy of postural restrictions, when combined with the classic canalith repositioning techniques, in terms of successful treatment and recurrence rates. Follow-up period reached at least 12 months after the initial treatment. Results. In this study, postural restrictions did not appear to significantly affect the outcomes of repositioning maneuvers, as well as the recurrence rate. Conclusions. Although this study, as well as most recent control studies, states that there is no significant effect of postmaneuver postural restrictions on both treatment and recurrence rates, larger multicentric research projects, adopting improved methodology, are still necessary in order to determine the contribution of such restrictions to both the therapeutic results and the prevention of recurrence. Adequate followup, focusing on the first six months after the initially successful repositioning maneuver, is also of paramount importance.

Counseling patients on facial volume replacement and adherence with posttreatment instructions

Use of injectable volume replacement products has increased dramatically in the US in recent years. An optimal outcome with volume replacement depends on a thorough knowledge of the products on the part of the dermatologic/aesthetic physician specialist, identification of patients with a likelihood of benefiting from volume replacement procedures, selection of an appropriate product for the individual patient, and effective patient counseling to ensure adherence to posttreatment care instructions. Adherence to physician instructions in the field of dermatology appears limited, and there is very little published information on adherence to physician instructions following facial volume replacement procedures. The purpose of this review is to provide strategies for understanding and overcoming the barriers to adherence with the widely used dermal fillers. Strategies include using patient-centered techniques, such as a motivational interview encouraging the patient to follow postprocedure care instructions, eg, massage. In this case, demonstrating massage techniques while the patient is still in the office, with patient participation and detailed feedback, also contributes to good adherence with posttreatment care instructions. Telephone counseling, reminder postcards, and text messages may help improve clinic attendance for follow-up. Motivated patients who demonstrate good adherence to physician instructions generally respond well to volume replacement treatments, and usually experience fewer adverse events than patients who do not follow instructions. Although promoting adherence to pretreatment and posttreatment protocols remains a challenge, patient counseling throughout the treatment process can lead to successful results.

Retrospective Comparison of Outcomes for Patients with Benign Paroxysmal Positional Vertigo Based on Length of Postural Restrictions

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. The effectiveness of the repositioning maneuver as an intervention has been established in the literature; however, the efficacy of the posttreatment instructions has not been established. The purpose of this retrospective study was compare treatment outcomes for patients receiving 24 hour postural restrictions posttreatment versus 48 hour restrictions. Medical records of 76 patients diagnosed with BPPV at an outpatient physical therapy practice were reviewed. The average age was 61.05 years (SD 16.16). A positive outcome was determined by partial or complete resolution of symptoms, defined as a reduction in the number of special tests or positions that provoked symptoms from initial examination to discharge, as well as a reduction in vertigo intensity ratings. Patients in both groups experienced significant reductions in the number of symptom provoking positions, positive special tests, and ratings of vertigo intensity following treatment. Mean ratings of vertigo intensity on a 10 point scale were 5.71 pre and 1.83 post for the 24 hour group, and 6.75 pre and 3.00 post for the 48 hour group. Positive treatment outcomes were experienced by 95.4% of patients in the 24 hour group (n=63), with 53% (n=35) achieving complete resolution. Patients experienced positive treatment outcomes regardless of the length of postural restrictions following repositioning maneuver for BPPV. Therapists can reduce the length of postural restrictions to 24 hours upright following a repositioning maneuver without adversely affecting patient outcomes.

Continuing Medical Education Article—Skin Treatment: Photodynamic Therapy: Indications and Treatment

Learning Objectives: The reader is presumed to have a broad understanding of aesthetic and/or dermatologic procedures and concepts. After studying this article, the participant should be able to: Review the history of photodynamic therapy using 20% 5-aminolevulinic acid (ALA-PDT) and its use in modern medicine.Describe clinical uses of ALA-PDT that have been studied and shown to be effective.Discuss ALA-PDT pretreatment regimens.Avoid potential complications of ALA-PDT treatment, and provide appropriate posttreatment instructions to patients. Review the history of photodynamic therapy using 20% 5-aminolevulinic acid (ALA-PDT) and its use in modern medicine. Describe clinical uses of ALA-PDT that have been studied and shown to be effective. Discuss ALA-PDT pretreatment regimens. Avoid potential complications of ALA-PDT treatment, and provide appropriate posttreatment instructions to patients. Physicians may earn 1 AMA PRA Category 1 Credit™ by successfully completing the examination based on material covered in this article. The examination begins on page 553. ASAPS members may also complete this CME examination online by logging into the ASAPS Members-Only website (http://www.surgery.org/members) and clicking on “Clinical Education” in the menu bar. Photodynamic therapy using 20% 5-aminolevulinic acid (ALA-PDT) has become a standard therapy to treat a wide variety of clinical disorders, including actinic keratoses with or without photorejuvenation, moderate to severe inflammatory acne vulgaris, sebaceous gland hyperplasia, and hidradenitis suppurativa. The author reviews the evidence-based medicine that supports the use of ALA-PDT in clinical practice and discusses ways to optimize use of ALA-PDT in the clinical setting. (Aesthetic Surg J 2008;28:545–552.) Disclosures: Dr. Gold is a consultant for, performs research for, and speaks on behalf of DUSA Pharmaceuticals, Lumenis, Aesthera, Sciton, and Cynosure. He also owns stock in DUSA Pharmaceuticals.

Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo

Purpose To determine if using more head rotation during the Epley maneuver or specific posttreatment instructions for sleeping position would affect treatment effectiveness, compared with the usual maneuver without extra instructions. Materials and methods Patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were randomized to a standard Epley maneuver group, a group that received an additional 45° head rotation during the maneuver (Augmented Epley), and a group that received instructions about sleeping position after treatment. Results Posttests from 1 week to 6 months showed no differences in vertigo intensity or frequency or responses to the Dix-Hallpike maneuver. All groups showed significant decreases in vertigo and Dix-Hallpike responses. Some subjects in each group had abnormal pretreatment scores on computerized dynamic posturography. Those subjects in the Augmented Epley group who had abnormal pretreatment posturography scores had significantly better posttreatment scores than those subjects in the Home Instruction group who had abnormal pretreatment scores. All subjects with abnormal responses, however, showed improvement. Conclusions Although clinicians continue to give patients home instructions and to use additional head rotation during the maneuver, these variations are not essential for achieving improvement in symptoms.

Sclerotherapy treatment of telangiectasias and varicose veins

Telangiectasias and/or varicose veins are present in about 33% of adult women and 15% of adult men. Although they may be only of cosmetic concern, superficial varices often cause significant symptoms such as pain, aching, heaviness, and pruritus. Venous ulceration is commonly caused solely by superficial venous insufficiency. Superficial thin-walled veins may rupture and hemorrhage. Sclerotherapy is a nonsurgical procedure that can be used to treat both small and large varices of the superficial venous system and perforators. This involves injecting a sclerosant intraluminally to cause fibrosis and eventual obliteration of a vein. The most common sclerosants used in the U.S. include sodium tetradecyl sulfate, polidocanol, 23.4% saline, and a combination of 25% dextrose with 10% saline. Treatment generally proceeds from proximal to distal and largest to smallest vein, based on a reflux map developed from physical examination, Doppler, and duplex ultrasound. Sclerotherapy results can be optimized and the risk of complications minimized by choosing the proper sclerosant, sclerosant concentration, sclerosant volume, and injection sites for the vein(s) being treated. Post-treatment instructions, particularly compression and ambulation, are designed to improve the results and safety of sclerotherapy. Adequate understanding of an appropriate history and physical, ultrasound evaluation, anatomy, pathophysiology, knowledge of sclerosing solutions, patient selection, and post-treatment care, as well as the ability to prevent, recognize, and treat complications are required before embarking on treatment. © 2003 Elsevier Inc. All rights reserved.

Randomized Trial of the Canalith Repositioning Procedure

Thirty-six subjects with confirmed, unilateral benign paroxysmal positioning vertigo of at least 2 months' duration were randomly assigned to one of two treatment groups. After complete informational counseling and explanation of the posttreatment instructions, subjects were randomly assigned to receive either Epley's canalith repositioning procedure or a placebo maneuver. All subjects completed a daily diary for 1 month to document any dizzy spells and their adherence to the posttreatment instructions. Follow-up Dix-Hallpike testing was performed after 1 month by an audiologist who was blinded to the patient's treatment group status. Analysis of Dix-Hallpike results confirmed that those who received the canalith repositioning procedure had significantly more negative responses (88.9%) than did those in the placebo group (26.7%).

Randomized trial of the canalith repositioning procedure

Thirty-six subjects with confirmed, unilateral benign paroxysmal positioning vertigo of at least 2 months' duration were randomly assigned to one of two treatment groups. After complete informational counseling and explanation of the posttreatment instructions, subjects were randomly assigned to receive either Epley's canalith repositioning procedure or a placebo maneuver. All subjects completed a daily diary for 1 month to document any dizzy spells and their adherence to the posttreatment instructions. Follow-up Dix-Hallpike testing was performed after 1 month by an audiologist who was blinded to the patient's treatment group status. Analysis of Dix-Hallpike results confirmed that those who received the canalith repositioning procedure had significantly more negative responses (88.9%) than did those in the placebo group (26.7%). (OTOLARYNGOL HEAD NECK SURG 1995;113:712-20.)