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The Journal of Emergency Medicine Oct 2020Cervicofacial subcutaneous emphysema can occur rarely after a dental procedure, especially tooth extraction, and can be misdiagnosed as an allergic reaction or... (Review)
Review
BACKGROUND
Cervicofacial subcutaneous emphysema can occur rarely after a dental procedure, especially tooth extraction, and can be misdiagnosed as an allergic reaction or post-procedure swelling.
CASE REPORT
We report a rare case of a 29-year-old man who developed extensive cervicofacial subcutaneous emphysema after a dental hygiene procedure. A review of the relevant literature is presented in our report. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early identification and management of this potentially life-threatening condition is particularly important and can prevent serious complications, leading to improved patient outcomes.
Topics: Adult; Dental Care; Edema; Humans; Male; Mediastinal Emphysema; Neck; Subcutaneous Emphysema; Tooth Extraction
PubMed: 32694012
DOI: 10.1016/j.jemermed.2020.06.021 -
Medicina (Kaunas, Lithuania) Oct 2019Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due...
Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due to fear. In fact, in dentistry, there is often a widespread condition of odontophobia among patients. A clinician's knowledge of this condition, and an accompanying understanding of how to successfully manage it, is surely one of the first steps to gaining a patient's trust and maintaining his or her patronage. Being able to manage a dental phobic patient in the best way is the key to successful therapy. Psychological techniques often have to work alongside dentistry in managing these patients. A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of the latter.
Topics: Dental Anxiety; Dental Care; Fear; Humans; Psychology
PubMed: 31597328
DOI: 10.3390/medicina55100678 -
Journal of the American Dental... Jan 2022There is little published research on whether public and private dental benefits plans affect the types of oral health care procedures patients receive. This study...
BACKGROUND
There is little published research on whether public and private dental benefits plans affect the types of oral health care procedures patients receive. This study compares the dental procedure mix by age group (children, working-age adults, older adults), dental benefits type (Medicaid and Children's Health Insurance Program, private), and level of Medicaid dental benefits by state (emergency only, limited, extensive).
METHODS
The authors extracted public dental benefits claims data from the 2018 Transformed Medicaid Statistical Information System. To compare procedure mix with beneficiaries who had private dental benefits, the authors used claims data from the 2018 IBM MarketScan dental database. The authors categorized dental procedures into specific service categories and calculated the share of procedures performed within each category. They analyzed procedure mix by age, plan type (fee-for-service, managed care), and adult Medicaid benefit level.
RESULTS
Aside from orthodontic services, the dental procedure mix among children with public and private benefits is similar. Among adults with public benefits, surgical interventions make up a higher share of dental procedures than routine preventive services.
CONCLUSIONS
Children with public benefits have a procedure mix comparable with those with private benefits. There are substantial differences in procedure mix between publicly and privately insured adults. Even in states that provide extensive dental benefits in Medicaid, those programs primarily finance invasive surgical treatment as opposed to preventive treatment.
PRACTICAL IMPLICATIONS
There is a need to assess best practices in publicly funded programs for children and translate those attributes to programs for adults for more equitable benefit design and care delivery across public and private insurers.
Topics: Aged; Child; Dental Care; Fee-for-Service Plans; Health Services Accessibility; Humans; Medicaid; Oral Health; United States
PubMed: 34615607
DOI: 10.1016/j.adaj.2021.07.024 -
Head & Face Medicine Jul 2016To review the cases of accidental aspiration and ingestion of foreign objects during dental procedure, and to emphasize the importance of thorough documentation of the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To review the cases of accidental aspiration and ingestion of foreign objects during dental procedure, and to emphasize the importance of thorough documentation of the accidents.
METHODS
A comprehensive search on (dental procedure/treatment/practice), (aspiration/inhalation), and (ingestion/swallow) was performed for all years before 1st October 2014 available. The statistic analysis was made on the variables including journals and reported year, patients' age, gender, general conditions, dental procedure and location for procedure, foreign objects, site of involvement, possible causes, anesthesia during procedure and treatment, symptoms, treatment time and treatment modality, follow-up, and so on.
RESULTS
A total of 617 cases reported by 45 articles from 37 kinds of journals were included and analyzed. Most reports made detailed record. While some important variables were recorded incompletely, including patient's general conditions, location for procedure, clinical experience of the involving dentists, tooth position of procedure, possible causes, and anesthesia during procedure and treatment for the accident.
CONCLUSIONS
Aspiration and ingestion of foreign objects are rare and risky complication during dental procedure. Each accident should have thorough documentation so as to provide enough information for the treatment and prevention.
Topics: Deglutition; Dental Care; Documentation; Female; Foreign Bodies; Humans; Incidence; Lung; Male; Prognosis; Respiratory Aspiration; Risk Assessment; Stomach
PubMed: 27449659
DOI: 10.1186/s13005-016-0120-2 -
Clinical Neurology and Neurosurgery Oct 2020Cavernous Sinus Thrombosis is a rare but serious condition. Despite increasingly effective treatment, the mortality and risk of long-term sequelae remains significant.... (Review)
Review
OBJECTIVES
Cavernous Sinus Thrombosis is a rare but serious condition. Despite increasingly effective treatment, the mortality and risk of long-term sequelae remains significant. The objective of this study is to describe the case of a 62 year old female presenting to a cardiovascular clinic with symptoms indicating an atypical subacute cavernous sinus thrombosis secondary to a dental procedure, and review the literature regarding cavernous sinus thrombosis following dental procedures and dental infections.
METHODS
The study design is a Case Report and Systematic Review. A PubMed literature search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, and limited to studies published between 2015 and 2020 (April).
RESULTS
The case describes a 62 year old female with a 5 month history of left upper eyelid swelling, diplopia, chemosis, ptosis, and left sided cluster headache who was diagnosed with subacute cavernous sinus thrombosis treated with oral anticoagulation. The search strategy yielded a total of 15 titles, and of these, 9 were included in the qualitative synthesis. These demonstrated that cases of CST occur acutely, and clinical symptoms are variable, depending on the structures involved. Most cases are treated with IV antibiotics, and corticosteroids may be added. Anticoagulation therapy shows contradicting information regarding reduced mortality, but reduced morbidity is seen when used early and combined with antibiotics.
CONCLUSION
Not all cases of CST present typically and acutely, so it is advisable to have a high clinical suspicion and obtain an MRV to rule out CST when stumbling upon ocular symptoms or infections in the danger triangle of the face following a dental procedure or infection. Despite the conflicting views on the benefits of anticoagulation in the setting of CST, the addition of oral anticoagulation yielded a positive outcome in our patient.
Topics: Cavernous Sinus Thrombosis; Dental Care; Factor Xa Inhibitors; Female; Humans; Middle Aged; Pyrazoles; Pyridones; Treatment Outcome
PubMed: 32836064
DOI: 10.1016/j.clineuro.2020.106135 -
Journal of Otolaryngology - Head & Neck... Aug 2020Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections. (Review)
Review
BACKGROUND
Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections.
CASE PRESENTATION
We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces.
CONCLUSION
As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.
Topics: Aged; Dental Care; Dental Instruments; Dental Restoration, Permanent; Diagnosis, Differential; Fasciitis, Necrotizing; Humans; Male; Mediastinal Emphysema; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 32811562
DOI: 10.1186/s40463-020-00455-0 -
Oral Diseases Jul 2020Mortality on the dental chair is a rare and underreported event. This study aimed to identify all deaths that occurred during dental procedures in Italy. (Review)
Review
OBJECTIVES
Mortality on the dental chair is a rare and underreported event. This study aimed to identify all deaths that occurred during dental procedures in Italy.
METHODS
We searched PubMed/Medline, Scopus, and Internet archives looking for patients who died before, during, or after a dental procedure in Italy from 1990 to 2019.
RESULTS
All the 36 identified fatal events were reported by national or regional newspapers, and none was reported by scientific databases. Interestingly, no cases regarding patients ≤16 years old were found and there was no variation in the number of reported deaths over the years. Most of the cases (n = 29) occurred in out-of-hospital private dental offices. Tooth extraction represented the most frequent culprit operation (39%), while myocardial infarction (28%) was the leading cause of death, followed by cardiac arrest (25%), allergies (11%), and infections (8%). In four cases, death was preprocedural, in 10 intraprocedural and in 21 postprocedural. In 17 cases, a temporal association between injection of anesthesia/sedation and death was observed.
CONCLUSION
This is the first report on Italian dental procedure-related deaths. Most of these deaths were only temporally associated with a dental procedure and could not to be attributed to malpractice.
Topics: Dental Care; Humans; Italy; Mortality; Tooth Extraction
PubMed: 31310434
DOI: 10.1111/odi.13158 -
The Mount Sinai Journal of Medicine,... 2012Typically, a patient's intraoral condition is not a chief perioperative concern. The need for proper dental care is often unmet prior to a surgical procedure.... (Review)
Review
Typically, a patient's intraoral condition is not a chief perioperative concern. The need for proper dental care is often unmet prior to a surgical procedure. Consequently, patients presenting for surgery may possess untreated decayed teeth and/or periodontal disease. These individuals may be harboring a quiescent and potent odontogenic infection. In the perioperative period, the deleterious effects of such an infection can not only compromise surgical outcome, but also magnify treatment and expenses. This article will elaborate on the connection between oral health and systemic disease, and discuss the barriers that exist with improving oral health. It will review pertinent dental nomenclature and anatomy, as well as emphasize the practice and value of a preoperative dental evaluation. Various compromised intraoral conditions are presented among a range of patient populations. The importance of treating an acute odontogenic infection before surgery is also discussed. Healthcare providers who recognize significant perioperative dental conditions can implement effective and preventive actions that can contain costs and achieve optimal patient care.
Topics: Dental Care; Humans; Oral Health; Perioperative Care; Postoperative Complications; Tooth Diseases
PubMed: 22238037
DOI: 10.1002/msj.21292 -
Journal of Public Health Dentistry Sep 2021To determine the patterns and time trends of dental services received and access to dental care among immigrant and US-born children living in the United States.
OBJECTIVES
To determine the patterns and time trends of dental services received and access to dental care among immigrant and US-born children living in the United States.
METHODS
We analyzed the nationally representative Medical Expenditure Survey data for 2007-2015. Survey weighted mean and frequency were calculated for all the years and for each year for the complete cohort and for the four subgroups of children categorized based on the child's and parents' birthplace (United States or Foreign). These groups were compared to detect differences in dental service received.
RESULTS
Overall 34,482 children aged <18 years were included in the analysis representing the weighted sample size of 564,255,643. Utilization of preventive dental services increased from 37.2 percent in 2007 to 44.4 percent in 2015 overall (P < 0.0001), with similar trend seen within all subgroups. Immigrant children compared to US-born children had higher numbers of surgical and restorative procedures (17 versus 16 per 100-person years, P = 0.03), fewer had at least one preventive dental visit in a year (32.8 percent versus 43.0 percent, P < 0.0001) and were less likely be unable to access dental care (3.0 percent versus 1.7 percent, P = 0.005). Fewer children had delayed access to dental care in recent years (2.0 percent in 2007 to 1.5 percent in 2015) and the decline was consistent in all the subgroups.
CONCLUSION
Stratification into the different subgroups allowed for improved understanding of dental procedure utilization and dental services utilization in all subgroups increased over time. Immigrant children had lower utilization of preventive procedures and higher utilization of surgical and restorative procedures.
Topics: Child; Dental Care; Emigrants and Immigrants; Health Expenditures; Humans; Parents; Surveys and Questionnaires; United States
PubMed: 33258107
DOI: 10.1111/jphd.12432 -
Special Care in Dentistry : Official... Mar 2022Wolf-Hirschhorn syndrome is a polymalformative chromosomal disorder caused by a deletion in the distal region of the short arm of chromosome 4. The disease is considered... (Review)
Review
Wolf-Hirschhorn syndrome is a polymalformative chromosomal disorder caused by a deletion in the distal region of the short arm of chromosome 4. The disease is considered rare (1/50,000 births) and predominantly affects females (2:1). In addition to the characteristic facial phenotype ("Greek warrior helmet"), its clinical manifestations include epilepsy, developmental and psychomotor delay, intellectual disability, cardiac and respiratory complications, and eating problems. The most prevalent oral manifestations are hypodontia, delayed tooth eruption, morphological dental abnormalities, dental malocclusions, cleft lip/palate and ogival palate. Based on our clinical experience, Wolf-Hirschhorn syndrome does not represent an absolute contraindication for any type of dental procedure. The feasibility of dental treatment will depend mainly on the degree of epilepsy control and on the level of collaboration, this latter conditioned by the severity of the intellectual disability and communication difficulties.
Topics: Cleft Lip; Cleft Palate; Dental Care; Female; Humans; Intellectual Disability; Wolf-Hirschhorn Syndrome
PubMed: 34538003
DOI: 10.1111/scd.12644