Medical emergencies in a dental school clinic - A 12-year review and lessons learned

PURPOSE

The aims of this study were to estimate the type and frequency of different medical emergencies that occurred over the study period (twelve years) and discuss the lessons learned and the modifications made in the curriculum to better equip dental students and faculty in their management.

MATERIALS AND METHODS

A retrospective study was conducted to evaluate all medical emergencies that needed activation of the response team at our school from 2008 to 2020.

RESULTS

The emergency response system was activated 250 times during the 12-year period. There were 132 medical emergencies in the pre-doctoral clinic and 105 events in the post-doctoral clinic (p 0.0680). Most of the emergencies occurred in patients between 45 and 64 years of age. Syncope occurs most often followed by adverse cardiovascular, respiratory, anxiety, and hypoglycemic events.

CONCLUSIONS

Medical emergencies occurring in a dental school provide a unique opportunity for students to gain experience in their management. The key lies in preparing the students and faculty to prevent them from occurring, but should these occur, then they should be able to promptly recognize symptoms and institute prompt intervention.

Massachusetts Dental Schools Respond to the Prescription Opioid Crisis: A Statewide Collaboration

The prescription opioid crisis has involved all sectors of U.S. society, affecting every community, socioeconomic group, and age group. While federal and state agencies are actively working to deal with the epidemic, medical and dental providers have been tasked to increase their awareness of the issues and consider ways to safely prescribe opioids and, at the same time, effectively treat their patients' pain. The Commonwealth of Massachusetts, under the leadership of Governor Charles D. Baker and his administration, challenged the state's four medical schools and three dental schools to improve their curricula to prepare the next generation of clinicians to deal with this crisis in an evidence-based, effective, and sympathetic way. This Perspectives article outlines the national prescription opioid crisis, details its effects in Massachusetts, and describes the interdisciplinary collaboration among the Commonwealth, the three dental schools, the Massachusetts Dental Society, and a concerned student group. The article also describes the efforts each dental school is undertaking as well as an assessment of the challenges and limitations in implementing the initiative. The authors hope that the Massachusetts model will be a useful resource for dental schools in other states.

Use of 3-d stereolithographic models in oral and maxillofacial surgery

OBJECTIVE

To assess the feasibility of the use of 3-dimensional (3-D) stereolithographic (SLA) technology in complex maxillofacial reconstructive surgery.

MATERIALS AND METHODS

3-D SLA technology was used in the treatment planning of complex maxillofacial procedures performed by the Department of Oral and Maxillofacial Surgery at Boston University. Specialized 3-D models were ordered and utilized for surgical treatment of a variety of indications including trauma surgery, temporomandibular joint surgery, orthognathic surgery, secondary correction of facial and skull deformities, and extensive jaw pathology. This technology was also used in one patient for jaw reconstruction using novel bone and tissue engineering techniques.

RESULTS

The use of 3-D models in Oral and Maxillofacial Surgery significantly improved predictability of clinical outcomes when compared to similar treatments without its use. Total operating time was reduced which had the benefit of decreasing the duration of general anesthesia and reducing wound exposure time. They allowed for assessment of extensive traumatic and pathologic defects in three-dimensions prior to surgical reconstruction. The models were also useful in the design and fabrication of custom prostheses, sizing of bone grafts and allowed for manufacturing of scaffolds for bone regeneration.

CONCLUSIONS

3-D SLA models can be very effectively used in oral and maxillofacial surgery for multiple indications and diverse clinical scenarios. Successful incorporation of this technology for jaw bone regeneration using tissue engineering techniques offers exciting new prospects for the future.

A clinico-pathologic correlation

Bisphosphonates (BPs) have been in clinical use for performing bone imaging, treating different metabolic bone diseases, and managing osteolysis and the hypercalcemia associated with some cancers since the late 1960s. Although these agents are extremely effective at treating these conditions, recent publications have noted a possible sequela of treatment with BPs is bisphosphonate-related osteonecrosis (BRON) of the jaws. In the past few years, a great deal of attention has been paid to recognition and management of different issues surrounding patients being treated with bisphosphonates by many health care providers, including dentists and dental specialists. This article will review some of the basic principles behind bisphosphonate therapy and its side effects, and summarize the management guidelines used in BP therapy. We will also report one of the 11 cases that we have identified and managed in our clinic in the past five years.

Familial paracentric inversion of chromosome 15 (q15q24)

A paracentric inversion of chromosome 15 was observed in the father of two infants who died 29 days and 24 hours, respectively, after birth. The same inversion was found in two sisters of the proband.