A Rare Case: Multiple Mandibular Arteriovenous Malformation with High Output: May a Tooth Extraction Alone Turn to a Catastrophic Condition?

Background: Arteriovenous malformations (AVM) in mandible and neck are potentially life-threatening conditions because of possible massive hemorrhage. They are often first diagnosed by dentists as bleeding. In this case, we report how a tooth extraction turned to a catastrophic condition in a patient with multiple AVMs in the mandibular, submandibular and hyoid region. Case: A 19-year-old male patient diagnosed with AVMs in the mandibular and submandibular regions was admitted to our hospital with the complaint of leaky hemorrhage around the lower left 3rd molar tooth. Tooth extraction was planned after embolization procedure. The patient was intubated uneventfully using video laryngoscope. However, an acute bleeding of more than 1600 ml occurred in one minute just after the mouth opener was inserted. The patient was transferred to the Interventional Radiology and other branches of the high-flow AVM were embolized. The patient was taken back to the operating room and the tooth was extracted uneventfully. Conclusion: In AVM cases, trauma should be minimized during induction of general anesthesia and intubation should be performed gently with fiberoptic bronchoscopy or video laryngoscopy. We conclude that a multidisciplinary approach as applied to our patient would be valuable in such cases.

The Effect of Simvastatin on mRNA Expression of Transforming Growth Factor-β1,Bone Morphogenetic Protein-2 and Vascular Endothelial Growth Factor in Tooth Extraction Socket

Aim To determine the effect of local simvastatin application on the mRNA expression level of transforming growth factor-β1 （TGF-β1）, bone morphogenetic protein-2 （BMP-2） and vascular endothelial growth factor （VEGF） in the tooth sockets of rat. Methodology Forty-eight male Wistar rats were randomly divided into experimental and control groups （n=24）. Polylactic acid/polyglycolic acid copolymer carriers, with or without simvastatin, were implanted into extraction sockets of right mandibular incisors. The expression of TGF-β1, BMP-2 and VEGF mRNA was determined by in situ hybridization in the tooth extraction socket at five days, one week, two weeks and four weeks after implantation. Results The fusiform stroma cells in the tooth extraction socket began to express TGF-β1, BMP-2 and VEGF mRNA in both experimental and control groups from one week after tooth extraction until the end of experiment. The expression of TGF-131 and BMP-2 mRNA in the experimental group was significantly up-regulated after one, two and four weeks, and expression of VEGF mRNA was significantly increased after one and two weeks compared with that in the control group. Conclusion The findings indicate that local administration of simvastatin can influence alveolar bone remodeling by regulating the expression of a school of growth factors which are crucial to osteogenesis in the tooth extraction socket.

Reasons for Permanent Tooth Extraction in the West of Kabul

Background: There has been no study in Kabul on reasons for permanent tooth extraction. This study aimed to determine the prevalence and reasons for tooth loss in a sample from two dental clinics in the west of Kabul. Methods: During a 6-month period (April-September 2019), the reasons for every extraction of a permanent tooth were recorded. Different reasons for tooth extraction were assigned, such as, dental caries, periodontal disease, eruption problems, trauma, orthodontics and others. The data requested for each extraction were: patient age, gender, previous treatment, educational level, type of tooth removed and the reason for its extraction. Results: young people aged between 20 - 29 years old had the highest percentage of extraction. Periodontal disease (39%) followed by caries (20%) was the most common reason for tooth extraction. Maxillary and mandibular first molars were removed most frequently (31%). 29% of patients have treated their teeth before extraction and RCT (Root Canal Treatment) (19%) is the most common previous treatment. Tooth loss has an opposite relationship with education level. People with high education level, loose their tooth less (14%). Conclusion: periodontal disease was the most common reason for tooth loss in Kabul, Afghanistan and a high percentage of tooth loss is seen among young people. Educating and preventive programs need to be implemented in order to reduce tooth loss.

TOOTH EXTRACTION UNDER DIGITAL ACUPOINT PRESSURE ANESTHESIA IN 60 CASES

Tooth extraction was performed in 60 cases under digital acupoint pressure anes-thesia with a remarkable curative effect. The curative effect was higher for loose teeth. The effectiverate was 100%. The tooth extraction under digital acupoint pressure anesthesia has many advantages.Tooth extraction can be performed only by pressing a certain acupoint with safety, convenience and e-conomy. The method avoids the side effects of narcotic and reduces the patient’s fear of an injectionof narcotic.

Orbital apex syndrome after tooth extraction in an immunocompromised patient

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.

Oral Health Determinants and Demographic Factors of Permanent Tooth Extraction in Iranian Adults

Preservation of teeth until old ages indicates oral health status. Improving life expectancy in developing countries makes teeth care an important topic. This study assessed reasons of tooth extraction (TE), oral health determinants and demographic factors of permanent TE in Iranian adults. Adult people who referred to dental clinic of Mashhad Medical University in 2012 for dental extraction and lived in Mashhad city, participated in this study by convenient sampling method after obtaining informed consent. Demographic characteristics, oral health status, health habit and reasons of TE of participants were assessed. Data were analyzed by SPSS11.5 by Chi-Square, T-Test, ANOVA, Mann-Whitney and Kruskall-Wallis tests. Totally 254 people participated (383 extracted teeth) that 55% were female. Mean age of participants was 39.3 years;females were 6.1 years younger than males. The main reason of TE was dental caries (55.1%), following by impaction. There was significant difference between average times of tooth brushing in both sexes, but difference was not shown in sugar intake. Except in people with college degrees that dental caries is the main cause of TE. With increase in life expectancy to more than 70 years old in Iranian, the age of TE especially in women is younger than expected. The most common cause of TE is dental caries that seem in spite of improving health indexes in Iran, poor oral hygiene remains as a problem. There is no significant difference between frequency of sugar intake and level of education that indicates unhealthy dietary habits related to tooth decay.

Effect evaluation of artemisia desertorum spreng on ability of daily life after extraction of impacted tooth

AIM:To investigate the effect of locally used Shahaosan on preventing the complication of extraction of impacted tooth.METHODS:274 cases patients with extraction of impacted teeth were randomly devided into 3 groups named A,B and C.Shahaosan and Yunnan white drug were processed into drug A and B by department of pharmacy with the same color, shape and quality which are blind to doctors and patients.When the impacted teeth were extracted, administed group A(92 cases) with drug A,group B(86 cases) with drug B and group C(96 cases ) was a blank control. After the operation,incidence and severe intensity of dry socket in each group were observed and evaluated by scores.RESULTS:The incidence of dry socket in group A,B and C were 0.09%(1/92),2.32%(2/86),8.33%(8/96).There was no significant difference between group A and B, group B and C, while a significant difference showed between group A and C.The PoSSe score in group A, B and C was 19.36,27.80 and 22.83 respectively.Afer the experiment the department of pharmacy informed that drug A is Shahaosan and drug B is Yunnan white drug.CONCLUSTON:Compiments of dry socket induced by extracting of lower jaw impacted teeth can be prevented by locally administered with Shahaosan, but no significant effect of alleviating the symptom of dental extraction.

Fate of root shell after pontic/socket shield techniques,is it better to extract the whole tooth?

A series of changes occur in the remaining alveolar process after whole tooth extraction.The basic question is,why do the bony walls(especially the labial/buccal)get resorbed immediately after the tooth is removed?This could be because,with cementum of the concerned tooth and its periodontal ligament,the supporting bundle bone is dependent on the presence of the tooth.This loss can be compensated using numerous techniques,such as socket grafting using various biomaterials to preserve the alveolar bone and buccal grafting with guided tissue regeneration to increase the thickness of buccal bone or placement of implant immediately.However,none of these techniques prevent the modelling of the alveolar bone post-extraction.Few studies have demonstrated that preservation of the roots in the alveolar process maintains the bone volume and facilitates vertical bone growth.A histological study in animals and humans has shown that the retained root shell does not pose any interference in the osseointegration of the implant(if placed simultaneously).Although various names have been proposed to describe the concept of retaining full or part of the root to prevent the resorption of the ridge,socket-shield and pontic-shield are the two most commonly used terms worldwide.The extraction of the whole tooth might be the choice of therapy when socket-shield or pontic-shield is not possible due to anatomical variations,infections,or lack of clinical expertise.Irrespective of the size,when a whole root or a root fragment(is left in situ),it is the dentist’s ethical duty to advise/inform the patient and ensure repeated clinical and radiographic follow-up.The present study aimed to highlight the current status of these techniques,their benefits,and possible complications and address whether the paradigm of the teeth extraction methods should be altered.

Assessment of Relationship between Pain and Anxiety Following Dental Extraction—A Prospective Study

Objective—Anxiety and expected dental pain are the main reasons for avoiding any dental treatment by general population. In this study, we aimed to evaluate the various factors which can in-crease the anxiety and its association with pain perception of patients following dental extraction. Material and Methods—We had included 100 patients in our study who were undergoing orthodontic treatment and required extraction of either 34 or 44. Pain and anxiety levels after extraction were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of eleven questions. Results—The mean VAS score for the entire study group was 16.23 ± 1.28 with statistically significant differences between genders, and was high in females and no statistically significant differences between different age groups. The mean anxiety score was 10.64 ± 3.12. This was significantly higher in women (P = 0.005), but there was no statistically significant differences between different age groups. There was a statistically significant correlation between VAS and total anxiety score (P < 0.001) as well as each question, except for question number 4, 8 and 9 in men. Conclusion—Although most patients had experienced limited pain, there was a significant gender difference in pain and anxiety level. They were anxious because they expected pain, women being more anxious than men. The most provoking factor for anxiety and pain while going for extraction in females was “being seated in dental chair”, while in men the most provoking factor was “uncertainty about proper numbness before extraction”.

牙周系统治疗联合意向性牙再植术治疗重度牙周炎1例

本文报告1例牙周系统治疗联合意向性牙再植术治疗重度牙周炎的临床病例。患者为65岁女性,在牙周系统治疗后,对保留无望的患牙32行意向性牙再植术,随访2年保住了天然牙,取得了良好的治疗效果。

老年患者心电监护拔牙的全流程规范化管理

目的分析全流程规范化管理在口腔外科门诊老年心电监护拔牙管理中的应用效果。方法研究阶段为2023年1月至10月,共纳入研究对象360例,均为口腔外科门诊心电监护拔牙就诊患者,采用随机抽样法进行分组,对照组采用心电监护拔牙管理模式,观察组采取全流程规范化管理模式,比较两组管理效果。结果观察组心率、血压波动、焦虑值均低于对照组,两组比较有显著差异(P<0.05),患者满意率99.7%高于对照组85.7%,差异有统计学意义(P<0.05)。结论通过实施规范化全流程管理,有效优化了老年患者心电监护拔牙的流程,缩短了心电监护拔牙预约时间,进而有助于改善老年患者拔牙预后、提升患者就医体验。

基于任务清单的柔性拔牙CBL病例资料库的构建与应用价值

目的 探讨基于任务清单的柔性拔牙CBL病例资料库的构建与应用。方法 本研究在开展柳传志环(PDF环)结合“以病例为引导”的教学法应用于牙槽外科临床带教的基础上,选择阻生牙微创拔除术为经典案例,应用于临床带教,开展柔性拔牙临床医学人文教育。结果 构建基于任务清单的柔性拔牙CBL病例资料库具有较强的临床实用性和较好的客观性,对实习医师医学人文素养的培育、临床思维能力的培养、自我学习能力的激发、发散思维模式的训练、知识体系的逻辑性归纳等方面有着明显优势。结论 本研究基于任务清单的柔性拔牙CBL病例资料库的构建具有较大的优势,能够使其成为带教教师不断学习和临床带教的手段,值得广泛应用于临床实习带教。

浓缩生长因子在复杂牙拔除后牙槽窝处理中的应用

目的观察浓缩生长因子(CGF)在复杂牙拔除后牙槽窝处理中的应用效果。方法90例接受复杂牙拔除的患者随机分为两组,观察组采用CGF处理牙槽窝,对照组采用牙槽窝常规处理,比较两组的牙槽嵴宽度和高度、牙槽嵴骨量。结果术后30 d、90 d,观察组的牙槽嵴宽度、高度均高于同期对照组(P<0.05)。术后90 d,两组的REC均升高,且观察组的REC高于对照组(P<0.05)。结论CGF用于复杂牙拔除后牙槽窝的处理可有效维持牙槽嵴的高度及宽度,防止拔牙后牙槽骨吸收。

微创拔牙技术的规范化临床应用专家共识

牙拔除术是口腔颌面外科领域最常见、最基本、应用最广泛的治疗性手术。微创拔牙可减少牙拔除诊疗过程对患者产生的身心创伤,在临床运用中具有重要意义,被广泛推荐用于临床一线诊疗,但当前国内外尚无指南或共识对微创拔牙进行系统性介绍,无法为临床牙拔除整个过程提供实践指导。针对该问题,本共识根据国内外相关资料和临床工作经验,对微创拔牙的临床应用(适应证、适应群体和禁忌证)、整体流程(术前准备、手术步骤、术后处置、术后医嘱、用药及随访)和术后并发症进行系统整合,为微创拔牙临床运用进行全面指导。

拔除下颌近中水平完全埋伏阻生牙保留颊侧骨板的效果探讨

目的:探讨微创手术拔除下颌近中水平完全埋伏阻生牙时保留颊侧骨板的效果。方法 :选取近中低位水平埋伏阻生牙86颗,随机分为2组,试验组以球钻开窗,暴露牙冠远中面,保留颊侧骨板,使用仰角手机配合加长车针行多次T形截冠,去除牙冠,微创拔除。对照组采用球钻去除远中及颊侧骨板,暴露远中及颊部牙冠,T形截冠,其余操作均一致。观察2组患者术后肿胀程度、开口受限程度以及疼痛视觉模拟量表(VAS)评分,检测C反应蛋白水平以及抗溶血链球水平;1个月后检查邻近第二磨牙牙周探诊深度(probing depth,PD)、出血指数(bleeding index,BI)及临床附着丧失(clinical attachment loss,CAL)水平。采用SPSS 25.0软件包对数据进行统计学分析。结果:试验组术后肿胀程度显著轻于对照组(P<0.05),开口受限与疼痛程度无显著差异(P>0.05)。试验组C反应蛋白水平显著高于对照组(P<0.05),抗溶血链球菌水平2组之间比较无显著差异(P>0.05)。术后1个月,对照组PD和CAL均显著高于试验组(P<0.05),2组BI比较无显著差异(P>0.05)。结论:保留颊侧骨板微创拔除下颌近中水平完全埋伏阻生牙患者术后反应更轻,创口愈合更好。

上颌正中埋伏多生牙拔除入路选择的临床研究

目的探求拔除上颌正中埋伏多生牙采取单侧翻瓣和改变手术计划为双侧翻瓣的相关因素。方法回顾性分析拔除上颌正中埋伏多生牙的81例患者。主要结果变量是:计划手术(单侧翻瓣)和计划外手术(双侧翻瓣)。次要结果变量是:手术时间和术后肿胀程度。预测变量为:多生牙距离唇侧和腭侧骨板的最短距离差值,分为差值≥1.5 mm组和<1.5 mm组;邻牙根尖至鼻底距离与多生牙长径比值,记录为≥1和<1。采用SPSS 20统计软件完成统计学分析。结果距离差值<1.5 mm时,计划外手术可能性增大,计划手术的概率是计划外手术概率的0.085倍;年龄每增加1岁,计划手术的概率逐步降低,HR=0.745;腭侧入路术后肿胀仅为唇侧入路的0.374倍;随着年龄的增加其手术时间有逐渐增加趋势,B=1.213。邻牙根尖至鼻底距离与多生牙长径比值并未影响到术中手术计划改变。结论多生牙距离唇侧和腭侧骨板的最短距离差值可作为拔除上颌正中埋伏多生牙选择手术入路的参考依据。

改良信封皮瓣和三角形皮瓣用于下颌阻生第3磨牙拔除术的效果对比

目的 比较改良的信封皮瓣和传统的三角形皮瓣用于下颌阻生第3磨牙拔除手术的效果。方法 前瞻性选取2023年12月至2024年2月在首都医科大学附属北京天坛医院口腔科进行牙槽外科手术拔除的100例下颌近中向阻生第3磨牙患者作为研究对象。按照随机数字表法将患者分为三角形皮瓣组和改良信封皮瓣组,每组各50例。记录和比较两组的手术时间、术后疼痛持续时间、术后止痛药服用数量、术后面部肿胀程度变化、第2磨牙牙周探诊深度变化和术后疼痛程度评分的情况。结果 改良信封皮瓣组的手术时间、术后疼痛持续时间分别为(14.56±2.47) min、(2.48±0.65) d,均明显短于三角形皮瓣组[(25.76±5.82) min、(3.48±0.68) d],术后止痛药服用数量为(1.22±0.82)片,明显少于三角形皮瓣组[(2.72±0.93)片],差异均有统计学意义(P<0.05)。术后第3天和术后第5天,改良信封皮瓣组面部肿胀程度分别为(12.24±4.06)、(4.98±4.03) mm,均低于三角形皮瓣组[(35.64±9.97)、(16.06±8.09) mm],差异均有统计学意义(P<0.05)。术后24、48和72 h,改良信封皮瓣组视觉模拟评分法(VAS)评分分别为(4.20±0.93)、(2.20±2.00)、(0.72±0.71)分,均低于三角形皮瓣组[(7.22±2.08)、(5.98±3.79)、(2.64±1.41)分],差异均有统计学意义(P<0.05)。术后7 d,改良信封皮瓣组患者第2磨牙颊面远中部探诊深度为(1.37±0.74) mm,明显大于三角形皮瓣组[(0.39±0.59) mm],差异有统计学意义(P<0.05)。结论 与三角形皮瓣比较,改良信封皮瓣对第2磨牙牙周组织的损伤较重,但可以有效缩短手术时间,减轻患者术后疼痛和肿胀程度,在临床工作中值得推荐。

个性化方案矫治先天性下颌恒切牙缺失临床分析

本文患者为年轻女性,骨性Ⅱ类,下颌先天性缺失一颗恒切牙,因面突、牙齿前突、不齐求治。根据患者的具体情况,采取个性化治疗方案。拔除14、24、26,35、45、47,矫正28、48,关闭所有拔牙间隙。患者治疗后前牙覆牙合覆盖正常,右侧尖牙及磨牙Ⅰ类关系,左侧尖牙及磨牙为Ⅲ类关系。

新型交叉颊面管对第二前磨牙拔除后的支抗效果评估

目的评价新型交叉颊面管(XBT)关闭上颌第二前磨牙拔牙间隙支抗控制的临床效果。方法选取15例牙列中重度拥挤、骨性Ⅰ类、上颌第二前磨牙缺失或临床检查难以保留的青少年患者,应用生理性支抗技术,减数上颌第二前磨牙,解除拥挤、内收前牙。治疗前后拍摄头颅侧位片并进行头影测量,观察与磨牙支抗和前牙内收相关的骨性、牙性指标变化。结果所有患者治疗结束后牙齿排列整齐,咬合关系良好,侧貌改善。治疗前后,骨性指标∠SNA、∠SNB、∠ANB和垂直向高度∠MP-SN变化差异无统计学意义(P>0.05)。牙性指标上下颌中切牙角度∠U1-SN、∠U1-NA、∠L1-MP、∠L1-NB减小,∠U1-L1增大(P<0.05);上切牙切缘点远中移动(P<0.05),上切牙根尖点和上颌磨牙位置无明显改变。结论应用新型交叉颊面管有利于青少年患者关闭上颌第二前磨牙拔牙间隙的支抗控制。

拔牙后的感染与防治

术后感染是牙拔除术最常见的并发症之一,拔牙术后感染可表现为局部感染,也可扩散为全身感染。临床上口腔外科医生可通过督促患者加强口腔卫生保健、合理应用抗生素和选择适当的拔牙手术方式来预防拔牙术后感染。对于感染的治疗策略,口腔外科医生应根据不同的临床表现和诊断来制定。对于干槽症、迟发性感染、间隙感染、边缘性颌骨骨髓炎等局部组织感染,可通过局部清创处理、治疗性运用抗生素、必要时切开引流等方法来控制感染;对于怀疑发生坏死性筋膜炎的患者,应广泛清创,以减少组织坏死面积;对于接受过放疗或者抗骨吸收类药物治疗的患者,拔牙应遵循相关临床指南或专家共识的建议,以减少颌骨坏死等风险;对于全身基础情况较差或免疫功能不全的患者,应注意鉴别感染性心内膜炎和颅内感染,以保障患者的生命安全。本文中笔者结合文献回顾和临床经验,总结了拔牙后感染的预防与治疗策略,以期为口腔外科同行提供参考。