Pneumomediastinum After Coronectomy

An interesting article titled “Surgical emphysema and pneumomediastinum after coronectomy” appears in the 2015 British Journal of Oral and Maxillofacial Surgery and written by C. Wong and et al. (vol. 53, pp. 763-764). The article describes a case of emphysema and pneumomediastinum occuring in an otherwise healthy 48 year old women after coronectomy of a lower wisdom tooth. This was determined by a chest x-ray after she presented with swelling and impaired eye opening. No surgery was necessary and after staying in the hospital several hours she was discharged. Around a week later the swelling had resolved. The authors say they do not know of any other cases of pneumomediastinum occuring after coronectomy; however, it is known to occur after wisdom teeth removal. See http://www.teethremoval.com/complications.html where a discussion of this occurs. It appears that an air turbine drill was used in this women’s case and introduced air into the mediastinum through the parapharyngealand retropharyngeal spaces. The authors state “Although pneumomediastinum usually resolves spontaneously in 3 to 10 days, potential complications include mediastinitis, cardiac tamponade, obstruction of the airway, simple or tension pneumothorax, and pneumoperitoneum.” The women appears to have recovered without any problems. In the article a picture of the women is provided shortly after coronectomy and then again 1 week after […]

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Exploring Mandibular Wisdom Teeth Roots after Coronectomy

Coronectomy involves the removal of part of the mandibular wisdom teeth but retention of the root. It is believed to cause less risk to the inferior alveolar nerve than extraction. An article on this topic titled “Histological evaluation of mandibular third molars roots retrieved after coronectomy,” appears in the 2015 British Journal of Oral and Maxilofacial Surgery and written by Vinod Patel and et. al (vol. 52, pp. 415-419). In the article the authors sought to find out the pulpal and periradicular status of retained roots of mandibular wisdom teeth and histologically evaluated coronectomy roots that were removed because of persistent symptoms. It is possible the roots had become infected. A total of 21 patients (with 26 roots) were included in their study with persistent symptoms after the roots had been retrieved. Of the 26 symptomatic roots, radiographic assessments showed coronectomy had been sufficient in twenty, but a shard of enamel had been retained on the root fragment in six. All roots were retrieved with no complications except for 1 which had persistent dsyfunction of the nerve. In their discussion the authors sate “This report is seminal as it shows that all the roots retrieved had a vital vascularised pulp, and in all cases the […]

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Should bilateral inferior alveolar and lingual nerve blocks be given for wisdom teeth surgery?

An interesting article titled “Should we be giving bilateral inferior alveolar and lingual nerve blocks for third molar surgery,” appears in the British Journal of Oral and Maxillofacial Surgery and written by J. Jabbar and et al. (2014, vol. 52, pp. 16-17). The article discusses how when someone is having their wisdom teeth extracted they are usually given general anesthesia and 2 inferior alveolar nerve blocks or local anesthesia in one or two visits. The authors feel there is controversy over whether 2 inferior alveolar nerve blocks should be given to patients in a single visit. The authors say the most common complications thought to be associated with bilateral inferior alveolar nerve blocks are injury to the tongue during anesthesia, unpleasant effects, loss of control of the tongue, and bilateral anaesthesia of the tongue, which can lead to collection of fluid in the oral cavity and aspiration. The authors mention a few past studies that have been conducted to look at lingual movement from bilateral anesthesia. Possible speech and articulation problems can arise. It is also possible the delay of lingual movement can cause a week bolus propulsion during swallowing. The author state that as of the study being published there is only anecdotal evidence on the incidence and complications that can happen from bilateral inferior alveolar nerve […]

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Is the health news you are reading accurate?

An interesting article titled “Keeping up with the news: Separating fact from fiction,” appears in the Oct. 2015 issue of JADA and written by the American Dental Association (vol. 146, no. 10, pp. 792). The article encourages dental patients to make sure that they know the source they are receiving their news from is trustworthy. The article discusses a few things to look for to make sure this occurs. The article tends to focus on receiving information from websites. If you are looking at a website, the first thing to look for is an about us section. This is because you want to know who is responsible for the article. It is good to know who pays for or sponsors the website. Also if you are looking at a website the domain name can give a hint. If it ends in .gov it is a government website, if it ends it .edu it is an educational institute website, or if it ends in .org it is usually a non-profit organization. These types of sites are generally more trustworthy. The article states “…[some websites] may have a particular position on a topic that causes them to slant the story in their favor. […]

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How safe is deep sedation or anesthesia in dentistry?

An interesting article titled “How safe is deep sedation or general anesthesia while providing dental care?” appears in the Sept. 2015 issue of JADA (volume 146, issue 9, Pages 705–708) and written by Jeffrey D. Bennett and et al. The article discusses how deep sedation and general anesthesia are given daily in dental offices or practices and this is usually done by oral and maxillofacial surgeons and dentist anesthesiologists. Sedation and anesthesia is given to patients to be able to more easily perform procedures and keep the patient safe and comfortable. Unfortunately in rare cases problems can happen and hence the authors were interested in exploring this. The authors state “Using the available data and informational reports, the authors estimate that the incidence of death and brain injury associated with deep sedation or general anesthesia administered by all dentists most likely exceeds 1 per month.” The authors feel that a patient safety database for anesthetic management in dentistry would provide a more complete assessment of the mortality and morbidity involved. This would be beneficial to developer safer anesthetic care. The authors further state “Optimization of patient care requires appropriate patient selection, selection of appropriate anesthetic agents, utilization of appropriate monitoring, and a highly trained […]

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