Do third molars weaken the mandibular angle?

Objective: The purpose of this study is to estimate how is the magnitude of the impact of a mandibular third molar on the mandibular angle stiffness. Study Design: It was performed a literature search on whole MEDLINE and LILACS data base to find articles that match the following inclusion criteria: cohort studies presenting data on patients with mandibular fractures and third molars; that had a similar angle fracture definition; and that present data available to be cross-classified in a statistic analysis. Results: The sample was composed by 4 studies, involving 2533 patients from USA, Nigeria, Germany and Jordan, evaluated between 1976 and 2001. The analysis of the sample shows a relative risk for a mandibula to fracture, comparing patients with and without third molars, ranging from 1,18 to 2,25. The data of the sample was grouped because of the homogeneity of the articles methods. The estimated relative risk across the 4 studies was 1,94 (95% CI 1,6 - 2,35). Conclusions: The presence of a third molar may double the risk of an angle fracture of the mandible to occur. Even with this data, the present study cannot support conditions related to the third molar that may affect this impact. Further studies are necessary to discuss the true indication of removal of these teeth as a prophylactic measure in population groups more predisposed to fracture. © Medicina Oral

Transnasal Removal of Ectopic Supernumerary Tooth from Cleft Patient

Background: The ectopic teeth can be permanent, deciduous or supernumerary and they are changes caused by the morphogenesis and growth of tissue outside their common positions. The ectopic inclusions occur in about 1% of the population. They can occur due to bad position of tooth germs, development disorder such as cleft palate, because of aberrant patterns of eruption, lack of space in the dental arch and tooth dislocation due to trauma or a pathological injury.Case Report: This article had as its main objective to present a clinical case of ectopic supernumerary tooth in the nasal cavity proceeding with its surgical removal from a cleft patient who mainly complained of respiratory obstruction.Conclusion: The importance of a correct diagnosis and suitable treatment through dental extraction through transnasal access was noted, as well as a simultaneous correction of the oralnasal fistula

Craniofacial Fibrous Dysplasia Addressed Through the Intraoral and Nasal Access

Background: The Craniofacial Fibrous Dysplasia is a benign disease, pseudoneoplasic, rare and asymptomatic of slow growth promoting replacement of bone tissue by an amorphous connective tissue, promoting bone deformation that can invade and cause compression of important structures such as the skull base and facial orbital bone. This study aims to present a clinical case of a Craniofacial Fibrous Dysplasia, emphasizing an alternative of an aesthetic surgical access by an intraoral approach. Case Report: We report the clinical case of patient IMS, 21 years of age with craniofacial fibrous dysplasia presenting deformity of the left facial middle third in orbital, nasal and maxilla region who was submitted to surgery for facial recontouring. The surgical access was intraoral associated with access for rhinoplasty. A lesion scrape was realized for facial recontouring and nasal osteotomy for correction of deviation caused by the injury. Conclusions: It was concluded that the surgical technique associated with the intraoral access with nasal extension is an important tool in addressing these lesions, allowing a large surgical field and satisfactory aesthetic and functional results without facial scars

Learning disorders related to exposure to general anesthetic in children

Background: There are many animal studies demonstrating increased neuroapoptose in the first periods of development, especially in stronger neural development regions. In young cobais neuroapoptose also noted, however, more localized area as the dentate nucleus and the olfactory bulb of the brain regions that show sinaptogênse even in adulthood and is responsible for learning. Objective: To describe the current studies about learning disabilities and cognitive impairment related to exposure to general anesthetics in children.  Method: This is a systematic review, performed from the search in the PubMed database using the keywords "general anesthetics," "neurotoxicity", "children", "young child" and "pediatric" with the criterion inclusion, published in the last five years, in English and related exposure to anesthetics in human children . Were excluded from the articles concerning the studies in experimental animals or that they focus on side effects of other substances on the central nervous system, such as alcohol.    Results: So were found 108 articles. All were analyzed by two researchers individually. Only 27 met the inclusion criteria. Discussion: In recent years, several studies have been conducted addressing neurotoxicity triggered by general anesthetics. The vast majority using experimental animals or stem cells. Suggest that both inhaled anesthetics such as venous are able to trigger the activation neuroapoptose with release of caspase 3:09, especially in phases of high growth and neural development. There is a strong association between duration of anesthesia and multiple exposures with learning disabilities and behavior. Conclusion: Currently, you can not say that the damage caused by agents in animals can be replicated humans. However, the severity of outcomes, the FDA recommends avoiding anesthesia and surgery in children under three years, at least those that do not have an emergency basis

Simplification on the Reduction of Comminuted Mandibular Fractures for Stable Internal Fixation

Background: The fractures of the comminuted type have a prevalence of 30 to 50% when related to the ones affecting the mandibular bone. They are characterized by the presence of multiple bone fragments involving several lines of fracture, resulting in small fragments within the same area. Usually resulting from high-energy trauma, they cause large displacements, tooth loss, as well as associated lesions in soft tissues. Cases Reports: This study aimed to report two cases addressing the simplification method in the reduction of comminuted fractures treated by the method of open reduction and functionally stable fixation, which emphasized the importance of establishing a sequence of reduction maneuvers and application of osteosynthesis for a functional, occlusal and aesthetic result of the lower facial third. Conclusion: The simplification of mandibular comminuted fractures proves to be an excellent ally when one intends to reduce difficulties of reduction of the fracture and the dental occlusion on the transoperative, as well as to facilitate the application of 2.4 reconstruction plates

Evaluation of knowledge of the lay public and health professionals about the oral and maxillofacial surgery.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgicoO presente trabalho descreve um estudo da avaliaÃÃo do conhecimento do pÃblico leigo e de profissionais de saÃde sobre a cirurgia e traumatologia buco-maxilo-facial na cidade de Fortaleza, CE. Por meio de questionÃrios, foram abordados grupos diferentes, incluindo cirurgiÃes-dentistas (grupo 1, n=100) acadÃmicos de odontologia (grupo 2, n=100), mÃdicos (grupo 3, n=100), acadÃmicos de medicina (grupo 4, n=100), enfermeiros (grupo 5, n=100) acadÃmicos de enfermagem (grupo 6, n=100), e o pÃblico leigo (grupo 7, n=100) nÃo pertencente à Ãrea da saÃde com nÃvel superior concluÃdo ou em curso. Foram descritos vÃrios casos clÃnicos de competÃncia da cirurgia e traumatologia buco-maxilo-facial e outros nÃo, e solicitado aos entrevistados a escolha de um especialista para tratar cada caso, dentre eles o cirurgiÃo plÃstico, o otorrinolaringologista, o cirurgiÃo buco-maxilo-facial, o cirurgiÃo de cabeÃa e pescoÃo e a opÃÃo âoutrosâ. A anÃlise dos resultados consistiu na construÃÃo de tabelas de contingÃncia, aplicando o teste do Qui-Quadrado (XÂ) e a medida de associaÃÃo V de Cramer. Nas comparaÃÃes, utilizaram-se testes bilaterais, onde o valor do nÃvel de significÃncia adotado no presente estudo foi de α= 0,05. Verificou-se que para fratura de nariz, cÃncer de lÃngua, aumento de volume no pescoÃo, cirurgia estÃtica do nariz e insatisfaÃÃo com a estÃtica facial, que todos os grupos foram classificados com conhecimento RUIM. Fazendo a anÃlise com relaÃÃo ao nÃvel de conhecimento dos grupos estudados, pode-se verificar que, quando o assunto abordado era sobre cirurgia estÃtica do nariz nÃo houve diferenÃa estatÃstica significante com relaÃÃo ao conhecimento dos grupos. Em contrapartida, na avaliaÃÃo do nÃvel de conhecimento com relaÃÃo à fratura dentoalveolar, seis grupos foram classificados como ÃTIMO, e o outro (grupo 7, pÃblico leigo) foi classificado como BOM. Quando avaliados a remoÃÃo de glÃndula salivar, a biÃpsia de lesÃes na boca, o tumor benigno de mandÃbula, o aumento de volume na mandÃbula, crianÃa com fissura labial, palatal e lÃbio-palatal, os grupos 3 e 4 (mÃdicos e acadÃmicos de medicina) foram classificados com conhecimento RUIM. Para fratura de zigomÃtico, tratamento de cistos nos maxilares, enxerto mandibular, excesso de mandÃbula, deficiÃncia de mandÃbula e excesso de maxila, houve classificaÃÃo REGULAR. Concluiu-se que a amostra do resultado do estudo da avaliaÃÃo do conhecimento sobre a CTBMF revela dados de conhecimento insatisfatÃrio em relaÃÃo aos grupos estudados, por falta de instruÃÃo da sociedade, percepÃÃo deficiente da populaÃÃo acerca da CTBMF no que se refere a Ãrea de atuaÃÃo, esclarecimentos, formaÃÃo e educaÃÃo continuada. Em relaÃÃo aos profissionais de saÃde, mais especificamente da Ãrea mÃdica, foi constatado desconhecimento sobre diagnÃstico e tratamento cirÃrgico; encaminhamento e orientaÃÃes de tratamento acerca da Ãrea de atuaÃÃo da especialidade (CTBMF).This paper describes a study assessing the knowledge of the lay public and health professionals about the oral and maxillofacial surgery in the city of Fortaleza, CE. Through questionnaires, were addressed to different groups including dentistry (group 1, n = 100) academic dentistry (group 2, n = 100), medical (group 3, n = 100), academic of medicine (group 4, n = 100), nurses (group 5, n = 100), academic of nursing (group 6, n = 100) and the lay public (group 7, n = 100) non-health professional with higher level or in course. It described several cases of clinical competence of oral and maxillofacial surgery and other not, and asked the respondents to choose a specialist to treat each case, including the plastic surgeon, the ENT, the oral and maxillofacial surgeon, the head and neck surgeon and the "other" option. The analysis consisted in the construction of contingency tables, applying the chi-square (X Â) and the extent of association of Cramer V. In comparison, bilateral tests were used where the value of the level of significance adopted in this study was α = 0.05. It was found that for fracture of nose, tongue cancer, increase in volume in the neck, cosmetic surgery of the nose and dissatisfaction with facial aesthetics, that all groups were classified as knowledge BAD. The analysis with the level of knowledge of groups, you can verify that when raised on aesthetic surgery of the nose there was no statistically significant difference with respect to knowledge of the groups. However, in assessing the level of knowledge regarding the dentoalveolar fractures, six were classified as OPTIMUM, the other (group 7, lay public) was rated as GOOD. When evaluated the removal of salivary gland, biopsy of lesions in the mouth, benign tumor of mandible, increase in volume in the mandible, children with cleft lip, palate and lip-palate, groups 3 and 4 (medical and academic medicine) were classified with knowledge BAD. To zygomatic fracture, treatment of cysts in the maxillary, mandibular graft, excessive jaw, jaw deficiency and excess of maxilla, there was also REGULAR. It was concluded that the sample of the results of the study assessing the knowledge of the data reveals CTBMF of poor knowledge in relation to groups, lack of education of society, poor perception of the population about the CTBMF with regard to area of operation, information, training and continuing education. For health professionals, especially the medical field, was found knowledge on diagnosis and surgical treatment, routing and guidance of treatment on the area of operation of the specialty (CTBMF)

Amyand’s Hernia with Appendicitis: A Case Report and Integrative Review

Introduction. Inguinal hernia is a common disorder with an estimated prevalence of 1.2% of the entire population and it is 12 times more common in males. Objective. To describe a case of appendix with signs of inflammation in the hernia sac, condition that is rare and difficult to diagnose, and to perform literature review, describing the most relevant aspects and the main controversies. Method. Report of a case and search in PubMed on June 1, 2015, using the terms “Appendix” [MeSH term] AND “hernia, inguinal” [MeSH term]. Results. The search resulted in 38 articles in total, and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Discussion. The search resulted in a total of 38 articles and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Conclusion. Amyand’s hernia is a rare and difficult to diagnose condition, being commonly found occasionally in surgical procedures. It should be remembered in the presence of cases of incarcerated hernia, due to its possible complications if not diagnosed

Non-linear indices of heart rate variability during endodontic treatment

Abstract Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0–10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation

Comparative Analysis of the Effectiveness of the Topical Administration of Benzocaine and EMLA® on Oral Pain and Tactile Sensitivity

Objectives. To compare the effectiveness of the topical administration of benzocaine and EMLA on oral pain and tactile sensitivity. Materials and Methods. A randomized, double-blind, split-mouth clinical trial was carried out with 20 volunteers. The sensorial and quantitative tests were applied before the contact with topical anesthetic and after the application. Results. In the superficial tactile perception test, when we compared each group singly, there were statistically significant values in the decrease of superficial tactile perception when compared to the moment prior to the application of anesthetic agents. For the sensitivity to mechanical pain, no statistical significant difference was observed at evaluated times. In the needle penetration test, in an intergroup analysis, we found a decrease in the pain sensitivity to needle penetration at 5 min (p=0.053) and at 10 min (p=0.019) after the contact of the anesthetic drug with the oral mucosa. Conclusion. The application of topical anesthetic drugs reduces the discomfort associated with this procedure, mainly until the first 10 minutes. Only the needle penetration sensitivity test showed sufficient sensitivity to reveal a difference in the anesthetic effect between EMLA and benzocaine. This trial is registered with RBR-2N2GSW