Cardiovascular Response of Aged Outpatients With Systemic Diseases During Tooth Extraction: A Single-Center Retrospective Observational Study

BackgroundAged people are maintaining many natural teeth due to improved oral health. However, compromised general health and poor oral hygiene habits at earlier ages resulted in poor status of preserved teeth. Therefore, tooth extraction is required in many aged people. More knowledge is needed because there are many risk factors during the surgery in frail aged adults. The aim of this study was to evaluate the cardiovascular response of such a population during tooth extraction and analyze risk factors to provide clinical guidance.MethodsA retrospective study was performed on aged patients with systemic diseases who underwent tooth extraction. Data regarding demographic profiles and cardiovascular parameters of heart rate and blood pressure were collected preoperative, when local anesthesia was administered, at the beginning of tooth extraction, 5 min after tooth extraction, and postoperative. The effects of risk factors, including age, sex, and systemic diseases on these parameters were analyzed with a multilevel model.ResultsHeart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of aged patients increased significantly when performing local anesthesia and tooth extraction. During the operation, the older patients (β = 2.011, P = 0.005) and the diabetics (β = 3.902, P < 0.0001) were associated with higher SBP, while those with more tooth extractions exhibited higher HR (β = 0.893, P = 0.007). Women patients showed both significantly elevated HR (β = 1.687, P < 0.0001) and SBP (β = 2.268, P < 0.0001). However, for coronary artery disease patients, HR (β = −2.747, P < 0.0001) and blood pressure [SBP (β = −4.094, P < 0.0001) and DBP (β = −0.87, P = 0.016)] were markedly lower than those of patients without a diagnosis of coronary artery disease.ConclusionCardiovascular response of aged outpatients with systemic diseases during tooth extraction is quite significant. Age, sex, systemic diseases, and the number of tooth extraction could be risk factors closely associated with cardiovascular response. The findings might provide safety guidance for dentists on tooth extraction in this population

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

Transcutaneous electrical nerve stimulation for acute pain: A review

Background: This is a second update of a Cochrane Review originally published in Issue 2, 2009. Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological agent, based on delivering low voltage electrical currents to the skin. TENS is used by people to treat a variety of pain conditions. Objectives: To assess the analgesic effectiveness of TENS, as a sole treatment, for acute pain in adults. Search methods: We searched the following databases up to 3 December 2014: the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; EMBASE; CINAHL; and AMED. We also checked the reference lists of included trials. Selection criteria: We included randomised controlled trials (RCTs) of adults with acute pain (< 12 weeks) if they examined TENS given as a sole treatment and assessed pain with subjective pain scales. Trials were eligible if they compared TENS to placebo TENS, no treatment controls, pharmacological interventions or non-pharmacological interventions. We excluded trials on experimental pain, case reports, clinical observations, letters, abstracts or reviews. Also we excluded trials investigating the effect of TENS on pain during childbirth (labour), primary dysmenorrhoea or dental procedures. Studies where TENS was given with another treatment as part of the formal trial design were excluded. We did not restrict any articles based on language of publication. Data collection and analysis Two review authors independently assessed study eligibility and carried out study selection, data extraction, 'Risk of bias' assessment and analyses of data. We extracted data on the following: types of participants and pain condition, trial design and methods, treatment parameters, adverse effects, and outcome measures. We contacted trial authors for additional information if necessary. Main results: We included 12 trials in the original review (2009) and included no further trials in the first update (2011). An additional seven new trials met the inclusion criteria in this second update. In total, we included 19 RCTs involving 1346 participants at entry, with 11 trials awaiting classification either because the full text was unavailable or information in the full text failed to clarify eligibility. We excluded most trials because TENS was given in combination with another treatment as part of the formal study design or TENS was not delivered using appropriate TENS technique. The types of acute pain included in this Cochrane Review were procedural pain, e.g. cervical laser treatment, venepuncture, screening flexible sigmoidoscopy and non-procedural pain, e.g. postpartum uterine contractions and rib fractures. We pooled data for pain intensity for six trials (seven comparisons) comparing TENS with placebo but the I2 statistic suggested substantial heterogeneity. Mean difference (MD) with 95% confidence intervals (CIs) on a visual analogue scale (VAS, 100 mm) was -24.62 mm (95% CI -31.79 to -17.46) in favour of TENS. Data for the proportion of participants achieving ≥ 50% reduction in pain was pooled for four trials (seven comparisons) and relative risk was 3.91 (95% CI 2.42 to 6.32) in favour of TENS over placebo. We pooled data for pain intensity from five trials (seven comparisons) but the I2 statistic suggested considerable heterogeneity. MD was -19.05 mm (95% CI -27.30 to -10.79) in favour of TENS using a random-effects model. It was not possible to pool other data. There was a high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions. Seven trials reported minor adverse effects, such as mild erythema and itching underneath the electrodes and participants disliking TENS sensation. Authors' conclusions: This Cochrane Review update includes seven new trials, in addition to the 12 trials reviewed in the first update in 2011. The analysis provides tentative evidence that TENS reduces pain intensity over and above that seen with placebo (no current) TENS when administered as a stand-alone treatment for acute pain in adults. The high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions makes definitive conclusions impossible. There was incomplete reporting of treatment in many reports making replication of trials impossible

Optical Diagnostics in Human Diseases

Optical technologies provide unique opportunities for the diagnosis of various pathological disorders. The range of biophotonics applications in clinical practice is considerably wide given that the optical properties of biological tissues are subject to significant changes during disease progression. Due to the small size of studied objects (from μm to mm) and despite some minimum restrictions (low-intensity light is used), these technologies have great diagnostic potential both as an additional tool and in cases of separate use, for example, to assess conditions affecting microcirculatory bed and tissue viability. This Special Issue presents topical articles by researchers engaged in the development of new methods and devices for optical non-invasive diagnostics in various fields of medicine. Several studies in this Special Issue demonstrate new information relevant to surgical procedures, especially in oncology and gynecology. Two articles are dedicated to the topical problem of breast cancer early detection, including during surgery. One of the articles is devoted to urology, namely to the problem of chronic or recurrent episodic urethral pain. Several works describe the studies in otolaryngology and dentistry. One of the studies is devoted to diagnosing liver diseases. A number of articles contribute to the studying of the alterations caused by diabetes mellitus and cardiovascular diseases. The results of all the presented articles reflect novel innovative research and emerging ideas in optical non-invasive diagnostics aimed at their wider translation into clinical practice

Laser treatment and disease characteristics of peri-implantitis

Peri-implantitis is an inflammatory disease which affects the soft and hard tissues surrounding dental implants. Current theory is that peri-implantitis is a counterpart to periodontitis, which is the inflammatory disease that destroys the tooth’s supporting tissues. However, there are some key discrepancies and there is a need for more studies on the characteristics of peri-implantitis. If the disease is not stopped, there is a risk that the dental implant is lost. It has proven difficult to treat peri-implantitis with conventional nonsurgical or surgical treatments. This is also an area of peri-implantitis that needs further research. The overall aim was to evaluate laser treatment of peri-implantitis, as well as explore the patients’ experiences and disease characteristics. In study I, we tested the safety of using diode lasers on dental implants by evaluating two different wavelengths 445 nm and 970nm. The temperature increase in dental implants were tested in two different models, one being a PM. Rigorous amounts of cooling water and limiting the continuous irradiation time to a maximum of 15-20s seemed to be key factors, depending on the power setting. We also assessed potential surface alterations on titanium discs in SEM but did not see any. In study II, the patient’s experiences and sensations were explored qualitatively in semi-structured interviews. We confirmed previous findings of positive associations of dental implants and added some perspectives to them with some negative experiences. In this group of patients, already diagnosed with peri-implantitis, some reported feeling symptoms, which could mean that with education on early signs of inflammation, the patient can also monitor their peri-implant health. The experiences of laser treatment and mucosal flap surgery were that of slight discomfort and for both the localized anesthesia was described as the worst part. Those that received surgery mentioned the sutures as a main source of discomfort. This we confirmed quantitatively in study III, where the surgery patients rated their discomfort significantly higher during the first week of healing than those in the laser group. In study III, we could not establish equivalence in change of PPD and RBL between the laser treatment and mucosal flap surgery. Both treatments had similar numbers of unresponsive peri-implantitis lesions, but in the patients that improved in their PPD, the surgery had significantly higher pocket reduction. There was basically no difference in change of RBL, BOP, biomarkers, and bacteria between the treatments. In study IV, we found that the inflammatory profile and immune cell composition were similar between peri-implantitis and periodontitis. In homogenized soft tissue, peri-implantitis lesions had significantly higher levels of IL-1β, TNF-α, IL-4 IL-17A, IL-23, G-CSF, and BAFF, whereas periodontitis only had significantly higher levels of IL-1β, IL-4, and G-CSF, compared to non-disease controls. Although, peri-implantitis and periodontitis did not significantly differ, there was a tendency towards a stepwise increase in proportion of B cells, from lowest in controls to highest in peri-implantitis. The results in this thesis show the potential for 970 nm diode laser in treating peri-implantitis. With unique clinical data a suggested role for the treatment modality could be initial stages of peri-implantitis where extensive pocket elimination is not as needed. The findings also support the need for further studies in assessing the patients self-monitoring of peri-implant conditions as well as the potential difference in B cell proportion and activity between peri-implantitis and periodontitis