Role of ultrasonography in differentiating facial swellings of odontogenic origin

Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications

BACKGROUND

Ultrasound is a non-invasive, cross-sectional imaging technique emerging in dentistry. It is an adjunct tool for diagnosing pathologies in the oral cavity that overcomes some limitations of current methodologies, including direct clinical examination, 2D radiographs, and cone beam computerized tomography. Increasing demand for soft tissue imaging has led to continuous improvements on transducer miniaturization and spatial resolution. The aims of this study are (1) to create a comprehensive overview of the current literature of ultrasonic imaging relating to dentistry, and (2) to provide a view onto investigations with immediate, intermediate, and long-term impact in periodontology and implantology.

METHODS

A rapid literature review was performed using two broad searches conducted in the PubMed database, yielding 576 and 757 citations, respectively. A rating was established within a citation software (EndNote) using a 5-star classification. The broad search with 757 citations allowed for high sensitivity whereas the subsequent rating added specificity.

RESULTS

A critical review of the clinical applications of ultrasound in dentistry was provided with a focus on applications in periodontology and implantology. The role of ultrasound as a developing dental diagnostic tool was reviewed. Specific uses such as soft and hard tissue imaging, longitudinal monitoring, as well as anatomic and physiological evaluation were discussed.

CONCLUSIONS

Future efforts should be directed towards the transition of ultrasonography from a research tool to a clinical tool. Moreover, a dedicated effort is needed to introduce ultrasonic imaging to dental education and the dental community to ultimately improve the quality of patient care.

The applications of ultrasound, and ultrasonography in dentistry: a scoping review of the literature

OBJECTIVES

This scoping review aims to summarize the available literature on the clinical applications of ultrasonography and ultrasound in diagnostic, therapeutic, and interventional dental applications.

MATERIALS AND METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for Scoping Reviews checklist and conducted a protocol-driven scoping review of randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, and case series that assessed ultrasonography or ultrasound use as a stand-alone diagnostic, therapeutic, and interventional tool in dentistry. We included studies published after 1980, study samples ≥ 10, with diagnostic, concordance, or therapeutic outcomes. We searched Ovid MEDLINE, Embase, and others (up to April 2021) and extracted information regarding study level, patient level, test or treatment level, and outcome level data.

RESULTS

Five interventional studies (related to oral medicine, temporomandibular disorders, and dental anesthesia), eight therapeutic studies (related to surgery and orthodontics), and seventy-five diagnostic studies (related to orthodontics, surgery, endodontics, oral medicine, temporomandibular disorders, restorative dentistry, and periodontology) were identified and presented in this review.

CONCLUSION

Ultrasonography has a well-established niche in diagnostic dentistry, while therapeutic and interventional ultrasounds have a smaller, yet present, niche in dentistry. However, further research is needed to report the precise estimates of the diagnostic, therapeutic, and interventional effects.

CLINICAL SIGNIFICANCE

Dentists are mostly unfamiliar with ultrasonography and ultrasound and their potential uses. This review maps the diagnostic and therapeutic applications of ultrasonography and ultrasound technology in dentistry and highlights the current challenges, gaps of knowledge, and research status of ultrasound technology in this regard.

Medical Infrared Thermography in Odontogenic Facial Cellulitis as a Clinical Decision Support Tool. A Technical Note

Background: Odontogenic cellulitis are frequent infections of the head and neck fascial spaces that can sometimes spread and be life-threatening, requiring urgent hospitalization. Early diagnosis of facial cellulitis with diffuse inflammatory process is crucial in patient management but not always obvious in the field. Medical infrared thermography (MIT) is a noninvasive tool increasingly used to evaluate skin temperature maps and delineate inflammatory lesions. Objective: The aim of this work was to evaluate the use of MIT to improve the clinical examination of patients with facial cellulitis. Methods: Image processing work was carried out to highlight the thermal gradient resulting from inflammation linked to infection, in 2 patients with facial cellulitis. Results: In real-time, MIT allowed to precisely locate the inflammatory focus linked to cellulitis with no propagation to danger areas such as infraorbital space or around pharyngeal axis. Conclusions: Here, we show the first cases using MIT as a powerful complementary tool in the clinical evaluation of patients with facial cellulitis. Significance: This technology could help optimize the hospitalization decision through a facilitated assessment of infection spread in head and neck tissues and helping to incision for drainage.

Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging

BACKGROUND

The introduction of modern diagnostic tools has transformed the field of maxillofacial radiology. Odontogenic infection and fascial space involvement have been evaluated with many diagnostic tools, including ultrasonography (USG) and magnetic resonance imaging (MRI).

AIM

To explore USG as an alternative model to MRI in the detection of fascial space spread of odontogenic infections.

METHODS

Among 20 patients, 50 fascial spaces were clinically diagnosed with odontogenic infection and included in this prospective study. Fascial space infection involvement was examined by USG and MRI. Results were compared for both and confirmed by microbiological testing.

RESULTS

Ultrasonography identified 42 (84%) of 50 involved fascial spaces. Whereas MRI identified all 50 (100%). USG could stage the infections from edematous change to cellulitis to complete abscess formation.

CONCLUSION

MRI was superior in recognizing deep fascial space infections compared to USG. However, USG is a significant addition and has a definite role in prognosticating the stage of infection and exact anatomic location in superficial space infections.

An Inventory of Current Available Ultrasound Devices for Dental Use

Objective : The first aim of the study was to make an inventory of the currently available ultrasound imaging devices on the market. The second aim was to identify portable ultrasound devices which could be used in general dental offices to image salivary glands, masticatory muscles and lymph nodes. Material and Methods : A list of ultrasound devices was collected from 11 international and American manufacturers using company websites and ultrasound retailer’s websites using the search engine Google^®. Results : A total of 86 ultrasound machines from 11 different manufacturers were identified, of which only 14 devices are portable. Transducers are usually transferrable between devices of the same brand, and the non-portable machines have multiple transducer ports (three or four), while portable machines typically have only one or two ports. Portable machine weights range from 10 to 20 pounds, and often resemble large laptops, which are convenient to carry and take up minimal space in clinics. Conclusion : Some manufacturers provide portable and non-portable ultrasound devices. The first ones could be valuable in dental settings, as they can easily be moved around in the office.

Efficacy of a Buffered 4% Lidocaine Formulation for Incision and Drainage: A Prospective, Randomized, Double-blind Study

INTRODUCTION

Incision and drainage of symptomatic emergency patients with facial swelling is painful even after local anesthetics are administered. The purpose of this prospective, randomized, double-blind study was to compare the pain of infiltration and the pain of an incision and drainage procedure of a buffered versus a nonbuffered 4% lidocaine formulation in symptomatic emergency patients presenting with a diagnosis of pulpal necrosis, associated periapical area, and an acute clinical swelling.

METHODS

Eighty-eight emergency patients were randomly divided into 2 groups to receive 2 intraoral infiltration injections (mesial and distal to the swelling) of either 4% lidocaine with 1:100,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate using the Onpharma (Los Gatos, CA) buffering system or 4% lidocaine with 1:100,000 epinephrine. Subjects rated the pain of needle insertion, needle placement, and solution deposition for each injection using a 170-mm visual analog scale. An incision and drainage procedure was performed, and subjects rated the pain of incision, drainage, and dissection on a 170-mm visual analog scale.

RESULTS

No significant differences between the buffered and nonbuffered 4% lidocaine formulations were found for needle insertion, placement, and solution deposition of the infiltration injections or for the treatment phases of incision, drainage, and dissection.

CONCLUSIONS

Buffering a 4% lidocaine formulation did not significantly decrease the pain of infiltrations or significantly decrease the pain of the incision and drainage procedure when compared with a nonbuffered 4% lidocaine formulation in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.