Cardiovascular effect of dental anesthesia with articaine (40 mg with epinefrine 0,5 mg % and 40 mg with epinefrine 1 mg%) versus mepivacaine (30 mg and 20 mg with epinefrine 1 mg%) in medically compromised cardiac patients : a cross-over, randomized, single blinded study.

Objectives: The aim of the present study is to compare cardiovascular safety profiles of two dental anesthetics: articaine versus two standard mepivacaine solutions used during etiological periodontal treatment in cardiovascular patients. Study Design: Using a cross-over study design, ten cardiovascular patients were randomly assigned to dental treatment with 1.8mL of a local anesthetic injected on each quadrant of the mouth: Articaine (40mg with Epinephrine 0.5mg % and 40mg with Epinephrine 1mg %) or Mepivacaine (30mg and 20mg with Epinephrine 1mg %). A computer programme enabled continuous longitudinal data collection: O2 saturation, blood pressure (BP) and heart rate (HR). Results: No severe clinical side effects were observed. During the treatment period, we observed statistically significant differences as regards HR between injections with and without adrenalin (p< 0.039) and as regards systolic (p< 0.046) and diastolic (p < 0.046) blood pressure during the stabilization period. In both cases, the parameters under study increase. Age, gender, jaw treated, treatment duration and the rest of cardiovascular variables did not affect the results. None of the patients underwent ischemic alterations or any other complication derived from the treatment or the anesthesia. Conclusions: According to the results of our study, dental anesthetics with standard concentrations of Epinephrine seem to alter HR and BP. Although no cardiac ischemic alterations or any other cardiovascular complications have been observed, we must be cautious with the administration of anesthetics containing vasoconstrictors in patients with cardiovascular disease

Impact of rare diseases in oral health

Rare diseases (RD) are those that present a lower prevalence than 5 cases per 10.000 population. The main objective of this review was to study the effect on oral health in rare diseases, while the secondary objective of the study is theme upgrade. Comparative observational case-control studies were analysed and a systematic review was conducted in PubMed. Each rare disease listed on the statistical data record of the Health Portal of the Ministry of Equality, Health and Social Policies Board of Andalusia was associated with ?oral health?. The variables studied included dental, oral mucosa and occlusion alterations, oral pathologies (caries, periodontal disease) and other alterations (mouth breathing, parafunctional habits, etc). A bias analysis of the variable caries was conducted. Six RD were selected through our inclusion and exclusion criteria (hypogammaglobulinemia, Rett syndrome, Marfan syndrome, Prader-Willi syndrome, cystic fibrosis and Cri du chat syndrome) in a total of 8 publications, of which four trials were classified as high risk of bias and one of them as medium risk. There were not trials with low risk of bias. The main statistically significant differences found by Syndrome compared to a control group were in Hypogammaglobulinemia with a greater tendency to enamel hypoplasia and dry mouth. The Rett syndrome had, as well, a greater tendency to an anterior open bite, ogival palate, bruxism, mouth breathing and tongue thrusting. Prader-Willi syndrome had a tendency of dental erosion, and Cri du chat syndrome showed a higher association to Tannerella forsythia

Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies: review of the literature published in the last decade

Objective: The use of local anesthetics associated to vasoconstrictor agents in dentistry is thoroughly justified and is widely extended, but we cannot ignore the fact that anesthetic infiltration poses risk of complications throughout the dental treatment period. The objective of the present review is to document the reported effects the use of the local anesthetics most widely employed in dentistry, with or without association to vasoconstrictor agents may have in patients with any sort of cardiopathy. Study Design: We have searched for randomized clinical trials on the assessment of the cardiovascular effects of local anesthetics used in dentistry, without limits as regards age or sex, conducted in patients with any type of cardiopathy which were published during the last decade and were index-linked in Cochrane, Embase and Medline. Results: We have found six randomized clinical trials index-linked in Medline and Cochrane in the past ten years. These trials compare different types of anesthetics: lidocaine 2%, mepivacaine 2%, prilocaine 2% , associated or not to different vasoconstrictor concentrations such as adrenaline or felypressin. The cardiopathies affecting the patients included in the different trials range from hypertension, ischemic heart disease, arrythmias, chronic coronary disease to heart transplantation. Conclusions: The use of anesthetics associated to vasoconstrictor agents is justified in the case of patients with cardiopathies (once we get over the period in which any type of dental manipulation is contraindicated) and in controlled hypertensive patients. In any case, we must be very careful with the choice and execution of the anesthetic technique, being it possible to use a dose between 1.8 and 3.6 ml, on a general basis. Further studies are necessary to establish the effects of these drugs on severe hypertensive patients or in patients with other more advanced cardiopathies

Dental treatment for handicapped patients: sedation vs general anesthesia and update of dental treatment in patients with different diseases

Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. Ac - cording to this situation we can opt for an outpatient treatment without any kind of previous medication, a treat - ment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment

Bone loss around narrow implants versus standard diameter implants : retrospective 2-years case-control study

The objectives were to evaluate the bone loss (BL) around narrow diameter implants (3.3 mm) 2 years after implant loading and compare with the bone loss around conventional-diameter implants (4.1 mm), as well as with clinical and anatomical variables. 2-years follow-up. Cases: 20 patients either gender-age, narrow implants (Straumann TM-SLA, diameter 3.3 mm); Control: 20 patients matching for gender-age, conventional implants (Straumann TM-SLA, diameter 4.1). Total 82 implants (31 narrow implants and 51 conventional implants) in 40 patients. To avoid statistical bias, a cluster of one implant per patient was randomly selected (20 narrow implants and 20 conventional implants). To evaluate changes resulting from bone loss around the implants, a total of 80 panoramic radiographs were taken of all 40 patients; the first panoramic image was taken at the time of implant loading and the second one 2 years later. Clinical and demographic variables were obtained from the patients? medical records. Statistical method: Spearman?s correlation coefficient, chi-squared (Haberman?s post hoc), Mann-Whitney U and Kruskal-Wallis tests. Statistical significance p< 0.05. No significant differences in bone loss around were found around narrow implants versus conventional implants. Differences linked to tobacco use were found after studying one implant per patient (p< 0.05). With the limitations of the present study, no significant differences in BL were found when comparing narrow implants with conventional implants after 2 years of implant loading. There were also no differences found when accounting for other demographic and clinical variables, with the exception of tobacco use

Influence of marginal bone loss on peri-implantitis : systematic review of literature

The marginal bone of dental implants is subjected to slight load modifications over time, conditioning implant survival. Objective: Perform a systematic review of the literature analyzing the factors that contribute to marginal bone loss (MBL) and the subsequent development of peri-implantitis. Bibliographic research in the databases PubMed, Medline and Scopus between 2010 and 2018 was performed. The inclusion criteria were articles published in the last 10 years and that were in English or Spanish, that were carried out on humans, that were cohort studies, that included cases and controls or that used randomized clinical trials. Exclusion criteria removed articles that contained clinical cases, case series or systematic reviews. A total of 90 articles were analyzed that examined all the factors reported in the literature, such as idiosyncratic factors, toxic habits, systemic drugs and implant characteristics (diameter, length, type surface, implant connection, implant design and type of platform at the moment of the prosthetic load). Discussion: Patient characteristics and associated pathologies must be taken into account when assessing MBL. MBL in all dental implants can be considered independent of the type of prosthetic rehabilitation and the moment of load; this was emphasized. The MBL is smaller in dental implants with rough surfaces, switch platforms and infracrestal localization, as they are of multifactorial origin. All the reviewed articles maintain a common criterion regarding the concept and measurement of the MBL and highlighting the importance of radiodiagnosis for quantification. Longterm prospective studies with unified criteria are needed to reduce bias by identifying the most relevant factors in MBL

Oral manifestations of Wolf-Hirschhorn syndrome: genotype-phenotype correlation analysis

Background: Wolf-Hirschhorn syndrome (WHS) is a rare disease caused by deletion in the distal moiety of the short arm of chromosome 4. The objectives of this study were to report the most representative oral findings of WHS, relate them with other clinical characteristics of the disease, and establish possible phenotype-genotype correlation. Methods: The study was conducted at 6 reference centers distributed throughout Spain during 2018–2019. The study group consisted of 31 patients with WHS who underwent a standardized oral examination. Due to behavioral reasons, imaging studies were performed on only 11 of the children 6 years of age or older. All participants had previously undergone a specific medical examination for WHS, during which anatomical, functional, epilepsy-related, and genetic variables were recorded. Results: The most prevalent oral manifestations were delayed tooth eruption (74.1%), bruxism (64.5%), dental agenesis (63.6%), micrognathia (60.0%), oligodontia (45.5%), and downturned corners of the mouth (32.3%). We detected strong correlation between psychomotor delay and oligodontia (p = 0.008; Cramér’s V coefficient, 0.75). The size of the deletion was correlated in a statistically significant manner with the presence of oligodontia (p = 0.009 ; point-biserial correlation coefficient, 0.75). Conclusion: Certain oral manifestations prevalent in WHS can form part of the syndrome’s phenotypic variability. A number of the characteristics of WHS, such as psychomotor delay and epilepsy, are correlated with oral findings such as oligodontia and bruxism. Although most genotype-phenotype correlations are currently unknown, most of them seem to be associated with larger deletions, suggesting that some oral-facial candidate genes might be outside the critical WHS region, indicating that WHS is a contiguous gene syndrome