Medical information

  TAKE-HOME MESSAGE A randomized controlled trial was conducted to compare coronoidectomy with coronoidotomy to improve mouth opening in oral submucous fibrosis (OSMF) patients. A total of 32 OSMF patients with grade III (moderately advanced with an interincisal opening between 15 and 25 mm) and grade IVa (advanced cases with 15 mm or less incisal opening) were randomized into two groups of 16 to undergo either coronoidectomy (surgical removal of the coronoid process) or coronoidotomy (surgical detachment of the coronoid process). Significant mouth opening was achieved in both groups, and the maximal incisal opening in both groups was comparable (approximately 30 mm in coronoidectomy group and 29 mm in coronoidotomy group at 1 year). The authors found a statistically significant difference in duration of surgery and volume of blood loss, with coronoidotomy requiring much less time (approximately 2 hours vs 3.5 hours) and leading to much less blood loss (approximately 90 mL vs 393 mL) c

  TAKE-HOME MESSAGE In this randomized, double-blind, crossover study, 25 children aged 10 to 12 years old participated to evaluate the anesthetic and physiologic differences between buffered 1% lidocaine and unbuffered 2% lidocaine (both with 1:100,000 epinephrine) for inferior alveolar nerve block. No significant differences were found in terms of onset time of soft tissue anesthesia, duration of anesthesia (although a trend was found for longer pulpal anesthesia with the buffered solution), and pain upon injection. The serum concentration of lidocaine was over twice as high in the 2% unbuffered group compared with the 1% buffered group. Both traditional 2% lidocaine and buffered 1% lidocaine injections are safe in children when using the appropriate technique. The primary advantage of a buffered solution was the reduction in lidocaine blood plasma concentration, as no significant differences on pain or anesthesia duration were found. –   James Boynton, DDS, MS PURPOSE Buffered local

  TAKE-HOME MESSAGE In this study, 668 adolescents in the UK were assessed at age 15 to 16 for dental injury history, and these findings were analyzed with data regarding socioeconomic disadvantage. The point was to determine if adolescents with socioeconomic disadvantage are at an increased risk of dental injury. Parental unemployment and parents' not having owned a car were associated with a significant increased risk of child dental trauma by adolescence. Vulnerable children have many health disadvantages, including a significantly increased risk of dental trauma. Dentists should advocate for appropriate policy and resources to allow for prevention and treatment of traumatic dental injuries in this vulnerable population. –   James Boynton, DDS, MS BACKGROUND/AIM Studies on the association between socio-economic circumstances and traumatic dental injuries (TDIs) are cross-sectional and inconclusive. The aim of this study was to investigate the association between cumulative socio

  TAKE-HOME MESSAGE In this case–control study designed to establish the extent to which periodontitis is associated with COVID-19 complications, after adjusting for potential confounders and comorbidities, multivariate analysis showed an adjusted odds ratio of 3.67 for all COVID-19 complications, 8.81 for death, 3.54 for ICU admission, and a 4.57 for need of assisted ventilation. Concentrations of D-dimer (P < .001), white blood cell count (WBC; P < .001), and C-reactive protein (CRP; P < .001) were significantly higher in COVID-19–deceased patients compared with surviving patients, while concentrations of lymphocytes (P < .005) were significantly lower in deceased patients. Patients admitted to the ICU and patients requiring assisted ventilation also had significantly higher D-dimer, WBC, and CRP serum levels than patients not admitted to the ICU or requiring assisted ventilation. Even though periodontitis and COVID-19 have both been associated with common comorbidities,

  TAKE-HOME MESSAGE This randomized controlled trial enrolled 130 children between age 3 and 7 years with at least one white spot lesion on a primary maxillary anterior tooth. Participants were randomized to topically use Colgate Total toothpaste (fluoride and triclosan), Remin Pro toothpaste (fluoride, hydroxyapatite, and xylitol), or MI Paste Plus (fluoride, CPP-ACPF, and xylitol) twice daily after toothbrushing. DIAGNOdent readings were taken after day 10 and day 21. It was found that all toothpastes used improved DIAGNOdent readings. Remin Pro and MI Paste Plus both showed statistically significantly better DIAGNOdent improvement than Colgate Total, but no difference was found between Remin Pro and MI Paste Plus. All approaches showed remineralized white spot lesions within 21 days. Providers with young child patients should encourage toothbrushing with fluoride toothpaste. Providers can consider adjunctive remineralizing agents in children with a high caries risk, but longer studi

  TAKE-HOME MESSAGE In this retrospective cohort study, the authors have studied the risk factors for post-extraction bleeding in 55 patients with either haemophilia A (48 patients) or haemophilia B (7 patients). All patients undergoing extractions were given antifibrinolytics and coagulation factor concentrates before extraction in addition to local hemostatic measures such as gelatin sponge, fibrin glue, and/or oxidized cellulose. A mouth splint was also given for 7 days. Unstoppable bleeding even with biting down on gauze and that occurred between 30 minutes and 14 days from the time of extraction requiring medical treatment was defined as post-extraction bleeding.    Post-extraction bleeding was noted in 9 patients (16.3%) averaging on the fifth day after extraction despite systemic and local hemostatic measures. Use of mouth splints was noted to be significantly associated with a reduced risk of post-extraction bleeding. Other factors including severity of hemophilia, factor repla

  TAKE-HOME MESSAGE This prospective interventional longitudinal trial used 16S rRNA sequencing to assess the taxonomic profile of biofilms found on single-unit implants using titanium or zirconia abutments compared with contralateral teeth as an internal control, and its correlation to clinical and radiological peri-implant conditions over a 3-year period. Microbiomes of both abutment substrates had high alpha diversity indices throughout the study period, irrespective of the time of sampling, with significant differences in species richness and diversity between substrates. The microbiomes of the two substrates were very different over time, differing about 30% after 3 years of loading. The similarity of microbiomes between abutments and contralateral teeth ranged from 45% to 50% after 3 years of loading. Periodontal pathogens associated with peri-implantitis were found with both substrates. A more complete understanding of the microbial communities around implants restored with tita

  TAKE-HOME MESSAGE A prospective multicultural cohort of 4146 children in the Netherlands was followed to evaluate the relationship between breast and bottle feeding and the incidence of childhood dental caries. It was found that prolonged breast feeding (past the first 4 months) and nocturnal bottle feeding were associated with a higher incidence of dental caries. The authors concluded that health education and oral hygiene instruction should be given to parents regarding the risks of prolonged breast or bottle feeding, especially when nocturnal feeding is employed. –   Sompop Bencharit, DDS, MS, PhD, FACP Previous studies showed that prolonged breastfeeding increases the risk of caries. However, the observed associations were mainly based on non-European populations, and important confounding and mediating factors like socioeconomic position (SEP) and diet were often neglected. The aim of this study was to investigate the role of breastfeeding and bottle-feeding practices on dental

  TAKE-HOME MESSAGE The authors of this study examined the association between cognitive impairment and paramagnetic rim lesions in 27 patients with radiologically isolated syndrome. Overall, 9 patients had global cognitive impairment. Paramagnetic rim lesions (activated microglia and macrophages around demyelinating lesions) were associated with decreased performance in both verbal memory (P = .04) and processing speed (P = .03). Lesions with central vein signs were associated with decreased performance in verbal memory (P = .03). This was a small preliminary study demonstrating that some patients with radiologically isolated syndrome have global cognitive impairment despite not having overt neurologic deficits. If replicated, the results could indicate that paramagnetic rim lesions could be a marker of cognitive impairment in these patients. –   Kyle Binder, MD   Multiple Sclerosis Written by     María   I.   Gaitán   MD Around 20% to 30% of patients presenting with radiologically is

  TAKE-HOME MESSAGE This in vitro study was designed to determine the effects of blue light generated from light-emitting diode (LED) and quartz-tungsten-halogen (QTH) curing lights on the proliferation of human gingival epithelial cells. Both lights generate heat, but the LED light generates significantly less heat than the QTH light at 1 mm (P = .004) and reduces curing time by two-thirds. The LED light inhibited cell proliferation at a 39-second exposure at 6 mm and at 1 and 6 mm for 60-, and 120-second exposures (P  < . 05). The QTH light inhibited cell proliferation at 72 hours after 120-second exposure at a distance of 1 mm. While insufficiently cured dental materials cause cytotoxicity, it has been shown that prolonged exposure to curing lights inhibits the proliferation of human gingival epithelial cells and may damage oral tissues. The authors concluded that an appropriate curing time suitable for the curing light unit and power output be used and that a balance be struck b

  April 17, 2021—Using rimegepant as needed or at least every other day reduced the need for medications that relieve the pain and nausea/vomiting associated with migraines among patients with a history of moderate-to-severe migraines. The findings were presented at the virtual meeting of the American Academy of Neurology, which took place from April 17 to 22. “Nonsteroidal anti-inflammatory drugs, acetaminophen, caffeinated analgesics, and antiemetics are widely used therapies for the acute treatment of migraine,” wrote the authors in their study poster. “The clinical benefits these nonspecific drugs provide can be inadequate for severe migraine pain and associated symptoms. They also have safety issues and the potential to cause medication overuse headache.” The study was led by David Kudrow, MD, from the California Medical Clinic for Headache in Santa Monica. The idea behind the present study was that reducing the use of such nonspecific medications, with administration of rimegepan

  How can we see into the future? The simple answer is that we can’t. We are left only with guesses as to what may be. Some of these are educated and informed; others are wild speculation. It is the former that I will focus on today; informed predictions of what may happen with the global pandemic of COVID-19 in the coming weeks and months. At present, we have no vaccines for SARS-CoV-2 and no evidence-based therapeutics for COVID-19. What we do have are public health measures, such as “social distancing,” for prevention and medical interventions consisting of supportive care. Leveraging our public health tools, however, buys time for the development and testing of vaccines and therapeutics. A very thoughtful and thorough projection is available, based on sophisticated modelling by Kissler and colleagues. 1  Their efforts take into account the possible contributions of seasonality, duration of immunity, and cross-protection imparted by prior infection with the two other betacoronavirus