Anxiety in Dental Patients Before and After Tooth Extraction

An interesting article titled “Assessment of general pre and post operative anxiety in patients undergoing tooth extraction a prospective study,” appears in the British Journal of Oral and Maxillofacial Surgery and written by Pia López-Jornet and et al. (vol. 52, pp. 18-23, 2014). The article sought to explore the amount of anxiety and fear before, immediately after, and one week after dental extraction. The researchers included 70 patients in their study. It is known that fear and anxiety in dentistry is usually associated with poor oral health and poor oral health related quality of life. Some studies have shown that those with lower socioeconomic status and with less education have more anxiety but others have shown those with more education have more anxiety. The researchers believe that oral surgery is stressful for patients and that anxiety fluctuates over time. They feel dental anxiety can be assessed with self-reported scales including the Spielberger’s State-Trait Anxiety Inventor (STAI), the Modified Dental Anxiety Scale (MDAS), and the Dental Fear Survey (DFS). The patients included in the study were healthy, with no serious medical conditions or blood dyscrasias. Patients who presented with acute infections were excluded, as well as those with psycho-organic or behavioural disorders, or those with language or cognitive problems. The teeth were extracted under normal conditions (local […]

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Exploring Antibiotic Use with Lower Wisdom Teeth Surgery

An interesting article titled “Correlation of antibiotic prophylaxis and difficulty of extraction with post operative inflammatory complications in the lower third molar surgery” appears in the 2014 British Journal of Oral and Maxillofacial Surgery and written by J. Y. Lee and et al. (vol. 52, pp. 54-57). The article set out to investigate the correlation between antibiotic prophylaxis, difficulty of extraction, and postoperative complications of lower wisdom teeth. The authors say that indiscriminate antibiotic prophylaxis can lead to antimicrobial resistance and a shift in the microbial population. The authors performed a retrospective analysis of extraction of lower wisdom teeth performed at Korea University Guro Hospital over a two year time frame starting in January 2010. The authors only included cases in which cefditoren pivoxil was prescribed as an antibiotic. In addition, patients that were kept in a hospital due to postoperative complications were excluded from the study. The patients were divided into two groups those given antibiotics and those not given antibiotics. A total of 1222 extractions in 890 patients were included in the study. The authors found that overall the difficulty of extraction and post operative complications were significantly associated (p=0.03). In cases grouped by similar class of difficulty, it was found that there was no significant correlation […]

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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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