Tag Archives | wisdom teeth removal

Does Midazolam Impact the Recovery Room Stay for Wisdom Teeth Surgery?

An interesting article titled “Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?” appears in the 2015 Journal of Oral and Maxilofacial Surgery written by Kyle S. Ettinger and et al. (vol. 73, pp. 2287-2293). Midazolam is very commonly used for patients undergoing wisdom teeth surgery and the authors set out to determine if it impacts the length a patient stays in the recovery room. Intravenous (IV) midazolam has a rapid onset of effect, short duration of action, minimal impact on cardiac function, minimal effect on respiratory depression, and it produces anterograde amnesia. Some more recent literate has shown that IV midazolam might be associated with prolonged recovery time for oral surgery. Midazolam can cause postoperative cognitive impairment. The study used patients who had all four wisdom teeth removed at the Mayo Clinic in Rochester Minnesota between the ages of 14 and 29. The primary predictor variable for the study was the total dose of IV midazolam administered. The primary outcome variable was the duration of recovery room length of stay (LOS) documented in the electronic anesthesia record. A total of 2,610 patients were eventually included in this retrospective study. The mean dosage of midazolam administered was 4.1 mg (SD, 1.1 mg; range, 0.5 to 10.0 mg). The […]

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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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Painkiller Overdose in Michigan: Are Wisdom Teeth Extractions Contributing?

Before on this blog I have talked about how oral surgeons prescribe powerful painkillers for use after wisdom teeth removal. It is possible some of these painkillers are instead used for non-medical use. See the posts http://blog.teethremoval.com/comparing-narcotic-prescribing-habits-for-oral-surgeons-in-the-u-s-and-canada/ and http://blog.teethremoval.com/do-oral-surgeons-prescribe-too-many-narcotics-for-use-after-wisdom-teeth-removal/. An interesting article titled “Synder officials take on painkiller overdose ‘epidemic’” located at  http://www.detroitnews.com/story/life/wellness/2015/10/12/prescriptions/73798342/ and written by Gary Heinlein and Joel Kurth, discusses a surge in overdose deaths in Michigan linked to the abuse of pain and anxiety medications (Oct. 12, 2015). One of the cases describe how a man’s addiction to painkillers was aided by a 30-day prescription for Vicodin after his wisdom teeth extraction. The article states “The state’s health department has said overdose deaths linked to opioids were increasing at a faster rate than for illegal drugs such as heroin — also on the rise — and cocaine. A state report also noted that another class of medications called benzodiazepines — prescribed for anxiety — accounted for about 9 percent of deaths.” The governor of Michigan Rick Snyder has created a task force to explore the issue of painkiller overdose deaths. The drugs included those such as fentanyl, codeine and hydrocodone, or brand names such as OxyContin, Demerol and Vicodin. The article later says “According […]

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