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Journal of the American Dental... Apr 2021It is unknown which procedures account for the most US dental opioid prescriptions. Moreover, few national studies have assessed opioid prescribing patterns for these...
BACKGROUND
It is unknown which procedures account for the most US dental opioid prescriptions. Moreover, few national studies have assessed opioid prescribing patterns for these procedures. These knowledge gaps impede the optimal targeting of dental opioid stewardship initiatives.
METHODS
The authors analyzed claims data from the 2013 through 2018 IBM MarketScan Dental, Commercial, and Medicaid Multi-State Databases. Patients aged 13 through 64 years undergoing 1 of 120 procedures were identified. "Initial prescriptions" were opioid prescriptions dispensed on the date of procedures to 3 days afterward. For the procedures accounting for the 5 highest proportions of initial prescriptions, the authors fitted linear regression models assessing trends in the probability of 1 or more initial prescriptions and mean total morphine milligram equivalents prescribed-a standardized measure of opioid amount. Regressions were adjusted for demographic characteristics and comorbidities.
RESULTS
The 9,482,976 procedures in the sample were associated with 2,721,688 initial prescriptions. Of these prescriptions, 5 procedures accounted for 95.2%: tooth extraction (65.2%), problem-focused limited oral evaluation (17.2%), endodontic therapy (8.4%), alveoloplasty (2.9%), and surgical implant services (1.5%). Among the 5 procedures, the median adjusted annual change in the probability of 1 or more initial prescriptions was -1.3 percentage points. The median adjusted annual change in mean total morphine milligram equivalents was -4.5 (roughly 1 pill containing 5 mg of hydrocodone). In 2018, 45.3% of tooth extractions resulted in 1 or more initial prescriptions.
CONCLUSIONS
Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of those. Opioid prescribing for tooth extractions is declining but remains common, despite the availability of equally effective nonopioid alternatives.
PRACTICAL IMPLICATIONS
Eliminating routine opioid prescribing for tooth extraction could reduce dental opioid exposure substantially.
Topics: Adolescent; Analgesics, Opioid; Humans; Hydrocodone; Insurance, Health; Medicaid; Practice Patterns, Dentists'; Practice Patterns, Physicians'; United States
PubMed: 33637299
DOI: 10.1016/j.adaj.2021.01.001 -
The Angle Orthodontist Apr 2000This paper emphasizes the important role that secondary bone grafting plays on the treatment of patients with alveolar clefts. The authors present a literature review... (Review)
Review
This paper emphasizes the important role that secondary bone grafting plays on the treatment of patients with alveolar clefts. The authors present a literature review and, based on panoramic radiographs, retrospectively and longitudinally analyze the behavior of permanent canines after completion of secondary bone grafting in 50 patients at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil. Twelve patients with unilateral cleft lip and alveolus and 38 patients with complete unilateral cleft lip and palate (n = 50) had undergone bone grafts to repair their residual alveolar clefts before the eruption of their permanent canines. These patients were observed over an average period of 3 years. In 94% of the sample (47 patients), the permanent canines presented intra-alveolar movement toward the oral cavity. In 72% of those 47 patients (36 patients), the permanent canines spontaneously erupted through the grafted area. In 6% of the 47 patients (3 patients), the permanent canines required orthodontic traction.
Topics: Adolescent; Alveolar Process; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Cuspid; Female; Humans; Male; Tooth Eruption
PubMed: 10833007
DOI: 10.1043/0003-3219(2000)070<0174:SBGAEO>2.0.CO;2 -
The Angle Orthodontist 1996Grafting of the alveolar ridge with autogenous bone is an integral stage of contemporary management of complete cleft lip and palate cases. Alveolar bone grafting... (Review)
Review
Grafting of the alveolar ridge with autogenous bone is an integral stage of contemporary management of complete cleft lip and palate cases. Alveolar bone grafting restores continuity of the dental arch, closes oronasal fistulae, supports the alar base, and facilitates spontaneous eruption of permanent teeth adjacent to the cleft. However, timing of the graft and the selection of materials have been topics of much debate in the literature. This article discusses an alternative donor site in cases where rehabilitation has passed the recommended time. Harvesting bone from the third molar regions allows not only the removal of impacted third molars during the same surgical procedure, but also eliminates the morbidity associated with additional surgical sites such as the ilium or mandibular symphysis. This report should not be interpreted as a recommendation for the use of this alternative site in cases where grafting is carried out within the optimal time period, which is usually in the mixed dentition stage. However, when grafting is necessary in young adults suffering from complete cleft lip and palate, the third molar region may provide another acceptable donor site.
Topics: Adolescent; Adult; Alveolectomy; Alveoloplasty; Bone Transplantation; Cleft Lip; Cleft Palate; Female; Humans; Lip; Molar, Third; Nose; Palate; Tooth Extraction; Tooth, Impacted
PubMed: 8678350
DOI: 10.1043/0003-3219(1996)066<0009:ADSFAB>2.3.CO;2 -
Archives of Plastic Surgery Sep 2013The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each...
BACKGROUND
The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft.
METHODS
Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT.
RESULTS
Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001).
CONCLUSIONS
An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.
PubMed: 24086807
DOI: 10.5999/aps.2013.40.5.542 -
International Journal of Environmental... Aug 2021Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the gene. This disorder affects the connective tissue and...
BACKGROUND
Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the gene. This disorder affects the connective tissue and is characterized by severe bone resorption. Hajdu-Cheney syndrome most frequently affects the head and feet bones (acroosteolysis).
CASE REPORT
We present an extremely rare case of a 34-year-old male with Hajdu-Cheney syndrome. The patient was admitted to the Department of Oral Surgery, Medical University of Gdańsk, in order to perform the extraction of three teeth. These teeth were not eligible for conservative treatment and prosthetic reconstruction. The patient was treated with denosumab (angiogenesis and receptor activator of nuclear factor-κB RANK ligand inhibitor, RANKL).
DISCUSSION
Denosumab is a monoclonal antibody against RANKL. This drug works through a suppression of osteoclast activity. In cases of patients in which the pathway of the RANK/RANKL/osteoprotegerin is dysregulated, denosumab has been approved for the treatment off-label. In patients receiving denosumab, a delayed wound healing in the oral cavity and osteonecrosis may occur. Dental procedures involving the alveolar bone process (tooth extractions and bone alveoloplasty) may be a risk factor for medication-related osteonecrosis of the jaw (MRONJ). Spontaneous osteonecrosis is rarely observed. MRONJ consists of the destruction of exposed bone, with the exposure persisting for a minimum of 6-8 weeks. This is the first article about an HCS patient treated with denosumab who underwent invasive oral surgery procedures. This case report highlights the difficulties for professionals occurring during the oral surgery procedures in such patients.
Topics: Acro-Osteolysis; Adult; Bone Density Conservation Agents; Denosumab; Hajdu-Cheney Syndrome; Humans; Male; Tooth Extraction
PubMed: 34501688
DOI: 10.3390/ijerph18179099 -
Plastic Surgery International 2012Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane...
Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice.
PubMed: 23213503
DOI: 10.1155/2012/562892 -
Cureus Apr 2023Background Dental implants are increasingly being used in the rehabilitation of the edentulous areas in the maxilla and mandible. The anterior mandible is considered a...
Background Dental implants are increasingly being used in the rehabilitation of the edentulous areas in the maxilla and mandible. The anterior mandible is considered a safe zone for implant placement, but clinicians often find it challenging to control bleeding in this area. This is due to the presence of the sublingual artery, which can be of varying dimensions and can cause severe bleeding. This can be of higher significance in patients with high or uncontrolled blood pressure and in patients on blood thinners like Aspirin or Coumadin where establishing a clot can be difficult. With newer guidelines recommending that medication be discontinued only a few hours before surgery and that bleeding be managed locally, this issue has become even more challenging. With three-dimensional (3D) imaging using cone beam computed tomography (CBCT) becoming more common for implant planning, the presence of the sublingual artery can be evaluated and incorporated into the treatment plan. The objective of this study is to evaluate the 3D location of the sublingual artery in the edentulous anterior mandible of CBCT scans of patients referred for dental implant therapy. Methodology A total of 50 de-identified CBCT scans with an edentulous anterior mandible referred for dental implant therapy were evaluated for this study. Cross-sectional images were generated using a CBCT reconstruction program INVIVO-5 (Anatomage, San Jose, CA, USA). After the sublingual artery was localized, measurement was conducted from a standardized point on the alveolar crest to the artery's entry point on the lingual aspect. Measurements were also obtained from the terminal point of the artery's course to the buccal cortical plate. Alveolar crest can either resorb or be subjected to alveoloplasty during implant placement, similar measurements were also done from a standardized point on the inferior cortical border of the mandible to the artery's entry points on the lingual aspect. Two oral and maxillofacial radiologists conducted all measurements. Results It was found that the median value of the sublingual artery from the alveolar crest to the level of entry (V1) was 6.78, the vertical measurement of the artery coursing into the alveolar bone was ~4.03 mm (V2), the vertical measurement of the artery's position within the alveolar bone at the terminal point form the crest was ~11.71 (V3), and the inferior vertical measurement from the course of the artery to the inferior border of the mandible was 9.60 mm. The artery extended about ~8.3 mm within the alveolar bone from the lingual cortex (H1), and the artery was located about 4.97 mm away from the buccal cortex (H2). Cronbach's Alpha test showed high interoperator reliability. Conclusions In this retrospective study, the sublingual artery was noted to be at a critical location in the potential implant site. A site-specific evaluation using CBCT can help in localizing and avoiding perforation of the sublingual artery.
PubMed: 37122981
DOI: 10.7759/cureus.38084 -
Anesthesia Progress 2014Stroke, or cerebrovascular accident (CVA), is a medical emergency that may lead to permanent neurological damage, complications, and death. The rapid loss of brain...
Stroke, or cerebrovascular accident (CVA), is a medical emergency that may lead to permanent neurological damage, complications, and death. The rapid loss of brain function due to disruption of the blood supply to the brain is caused by blockage (thrombosis, arterial embolism) or hemorrhage. The incidence of CVA during anesthesia for noncardiac nonvascular surgery is as high as 1% depending on risk factors. Comprehensive preoperative assessment and good perioperative management may prevent a CVA. However, should an ischemic event occur, appropriate and rapid management is necessary to minimize the deleterious effects caused to the patient. This case report describes a patient who had an ischemic CVA while under general anesthesia for dental alveolar surgery and discusses the anesthesia management.
Topics: Adult; Alveoloplasty; Anesthesia, Dental; Anesthesia, General; Arrhythmia, Sinus; Bradycardia; Brain Ischemia; Carotid Stenosis; Electroencephalography; Female; Humans; Hypotension; Intraoperative Complications; Intubation, Intratracheal; Magnetic Resonance Imaging; Oral Surgical Procedures; Stroke; Tomography, X-Ray Computed; Tooth Extraction; Ventricular Premature Complexes
PubMed: 24932981
DOI: 10.2344/0003-3006-61.2.73 -
The Angle Orthodontist 1997This retrospective study was undertaken to describe and compare frontal craniofacial dimensions in alveolar-bone-grafted and nongrafted complete unilateral cleft lip and... (Comparative Study)
Comparative Study
This retrospective study was undertaken to describe and compare frontal craniofacial dimensions in alveolar-bone-grafted and nongrafted complete unilateral cleft lip and palate (CUCLP) patients and in noncleft subjects with normal occlusions and good facial balance. Clinical data were obtained from the files of the Hospital for Sick Children, Toronto. Patients were eligible for inclusion if they had posteroanterior cephalograms (PA) taken at adulthood and no congenital anomalies other than CUCLP. A total of 86 adult Caucasian CULCP patients were studied, including 58 who had not received grafts, 28 who had received secondary alveolar bone grafts, and, for comparison, 60 noncleft Caucasian adults. The PA cephalometric radiographs were traced, digitized, and measured. Analysis of variance (ANOVA) was used to test for among-groups differences in the means of the ratios, proportions, and angular measures. Tukey-Kramer HSD procedure was used to conduct post-hoc pairwise comparisons following significant (p < or = 0.05) F-ratios from ANOVA. Sexual dimorphism was a common finding, with males demonstrating greater facial width. Despite primary surgical repairs, the anterior nasal spine in the nongrafted CUCLP patients was deviated to the noncleft side, and the alar base was depressed on the cleft side. The maxillary incisors close to the cleft site were irregularly inclined, and this irregularity was more severe in the nongrafted CUCLP patients. The long-term effects of secondary alveolar bone grafting on transverse craniofacial growth appears to be minimal and limited to the immediate area of the cleft.
Topics: Adolescent; Adult; Alveoloplasty; Analysis of Variance; Bone Transplantation; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Humans; Image Processing, Computer-Assisted; Incisor; Male; Malocclusion; Maxilla; Maxillofacial Development; Nasal Bone; Nose; Retrospective Studies; Sex Characteristics
PubMed: 9347113
DOI: 10.1043/0003-3219(1997)067<0389:ARCOFF>2.3.CO;2 -
Archives of Plastic Surgery Sep 2012The bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture...
BACKGROUND
The bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture and size of the bone defect in alveolar cleft has been considered helpful for increasing the success rate of bone grafting because those features may vary with the cleft type. Recently, some studies have reported on the usefulness of three-dimensional (3D) computed tomography (CT) assessment of alveolar bone defect; however, no study on the possible implication of the cleft type on the difference between the presumed and actual value has been conducted yet. We aimed to evaluate the clinical predictability of such measurement using 3D CT assessment according to the cleft type.
METHODS
The study consisted of 47 pediatric patients. The subjects were divided according to the cleft type. CT was performed before the graft operation and assessed using image analysis software. The statistical significance of the difference between the preoperative estimation and intraoperative measurement was analyzed.
RESULTS
The difference between the preoperative and intraoperative values were -0.1±0.3 cm(3) (P=0.084). There was no significant intergroup difference, but the groups with a cleft palate showed a significant difference of -0.2±0.3 cm(3) (P<0.05).
CONCLUSIONS
Assessment of the alveolar cleft volume using 3D CT scan data and image analysis software can help in selecting the optimal graft procedure and extracting the correct volume of cancellous bone for grafting. Considering the cleft type, it would be helpful to extract an additional volume of 0.2 cm(3) in the presence of a cleft palate.
PubMed: 23094242
DOI: 10.5999/aps.2012.39.5.477