Iatrogenic penetration of the mouth floor during mandibular molar extraction: A case of protracted bleeding in an emergency department and clinico-anatomical considerations

Iatrogenic perforation of the lingual cortical plate of the mandible is uncommon but it may result in injuries to various adjacent structures such as the lingual nerve, sublingual gland, submandibular duct, deep lobe of the submandibular gland, and branches of rich anastomosing plexus supplying the floor of the mouth (FOM). The aim of this article was to highlight an unusual case of protracted postoperative bleeding that was occurred due to a FOM injury during an attempt to extract a mandibular second molar. Various anatomical considerations with clinical relevance were summarized too. Even small and superficial injuries of FOM should be not misjudged but be carefully monitored, since there is a potential risk for significant haemorrhage and hematoma formation leading to airway obstruction.

Medical practitioners' educational competence about oral and oropharyngeal carcinoma: a systematic review and meta-analysis

Medical practitioners' (MP) role is pivotal in primary prevention, early diagnosis, prompt referral and effective management of oral and oropharyngeal carcinomas (OC/OPC), which raises the importance of their effective OC/OPC education at all levels of medical education. The purpose of this systematic review was to summarise the available scientific evidence about their educational competence in dealing with OC/OPC. We made a systematic search of papers in the English language in MEDLINE, Scopus, Cochrane Library CENTRAL and CINAHL databases from their inception until December 2018. Overall, 23 cross-sectional and three interventional studies have been selected for the systematic review and 18 of these were included in the meta-analyses. Excluding tobacco use (synthesised estimate of 95% of respondents identified tobacco as an OC/OPC risk factor, 95% CI of synthesised estimate 92% to 97%) and alcohol consumption (65%, 95%CI 52% to 77%), less than half of MP (approximately) were knowledgeable about important OC/OPC risk factors including human papilloma virus (42%, 95% CI 30% to 54%), poor diet (34%, 95% CI 17% to 54%), and advancing age (45%, 95% CI 21% to 70%). There was a low to moderate level of awareness among MP regarding common precancerous oral lesions involving leukoplakia (56%, 95% CI 32% to 79%), erythroplakia (30%, 95% CI 8% to 58%), and oral lichen planus (13%, 95% CI 0 to 41%). Moderate knowledge was also recorded about frequent sites of OC development involving the tongue (48%, 95% CI 33% to 64%) and floor of the mouth (37%, 95% CI 19% to 57%). Most MP enquired about tobacco use (86%, 95% CI 74% to 96%), and alcohol consumption (73%, 95% CI 47% to 94%) during history taking, and expressed willingness to be given supplementary OC/OPC education (78%, 95% CI 54% to 96%), as well. With regard to the incidence of intraoral screening, 27% of MP (95% CI 12% to 46%) make an intraoral examination as a routine. Interestingly, studies from each continent yielded significantly different outcomes to some research questions in the review. From the MP's perspective, clinical time restrictions and deficiencies in organised training were recognised as the main barriers towards their OC/OPC educational competence. The findings of this systematic review indicated the existence of deficiencies in knowledge and misconceptions, neglected preventive responsibilities, and associated barriers towards OC/OPC. A need for improved OC/OPC training at all levels of medical education is required to increase competence worldwide.

Trismus as a Clinical Manifestation of Tetanus: A Case Report

Although the incidence of tetanus disease has radically declined in developed countries, both dental practitioners and oral and maxillofacial surgeons should be knowledgeable about its diagnosis since initial manifestations of the disease, such as trismus and dysphagia, are observed in the orofacial region. This study reports on a case of generalized tetanus diagnosed in a middle-aged man. Before the tetanus diagnosis, the patient had sought medical advice from seven different health care professionals, including a dentist and an oral and maxillofacial surgeon. The patient reported trismus and dysphagia as his main complaints. The suspicion of tetanus emerged from the patient's manifestations in conjunction with his history of trauma and his agricultural occupation. The patient underwent successful treatment including administration of muscle relaxants, antibiotics, and booster vaccination doses of tetanus toxoid as well as a tracheostomy and aided mechanical ventilation. This case report highlights the significance of taking a meticulous medical history, thoroughly performing a physical examination, and systematically assessing orofacial signs and symptoms.

The Historical Evolution of Dental Impression Materials

The concept of impression making process in dentistry began in the mid 1800s. Dentists realized that the construction of a prosthetic restoration required both a detailed capture of the oral tissues along with stone cast fabrications. To accomplish these goals, impression materials were essential. Beeswax represents the first impression material, while important bechmarks during the historical evolution of dental impression materials are considered to be the introduction of dental trays in the early 1800s and the invention of the gutta-percha, thermoplastic resins and plaster of Paris. The double (corrective) impression technique, along with the functional impression concept that was established after mid 1800s, are also identified as pivotal innovations. During the 20th century, the advances in material development slowed significantly since the majority of the current impression materials had already been invented. However, the introduction of elastomeric impression materials in the field of prosthodontics that offered the advantages of accuracy and dimensional stability substantially upgraded both the impression accuracy and the quality of the final restoration. Presently, the dental practitioner has access to a variety of impression materials and should be aware of their properties, indications and limitations as well. Futhermore, while continuous attempts are being made to enhance these materials, the ideal impression material has yet to be developed. The purpose of this article was to provide a comprehensive review about the historical development of impression dental materials.

Comparative Assessment of a New Holistic-Oriented and an Old Specialty-Specific Undergraduate Curriculum in Removable Prosthodontics: A Study Based on Senior Students' Perceptions

PURPOSE

A survey was conducted in the Dental School, Aristotle University, Thessaloniki, Greece, (i) to assess the perceptions and experiences of senior dental students, Classes of 2014 and 2015, toward the old, specialty-specific (OC) and new, holistic-oriented (NC) undergraduate curriculum, respectively, in removable prosthodontics and (ii) to identify areas of improvement in prosthodontic training.

MATERIALS AND METHODS

Structural components of both curricula were collected, including the total number of (i) laboratory/lecture/clinical training hours, (ii) written examinations, (iii) mandatory clinical cases, and (iv) European Credit Transfer and Accumulation System (ECTS) credits. A 20-item closed-type questionnaire using a five-point Likert scale was distributed in two consecutive groups of seniors, Classes of 2014 (n = 54) and 2015 (n = 57); 54 OC and 57 NC senior students filled out the questionnaire.

RESULTS

A greater percentage of NC students stated that (i) they felt less confident to carry out jaw relation recording and removable partial denture metal framework design and (ii) the time allocated for clinical training was less sufficient. Students of both curricula reported that the laboratory courses and lectures contributed little to their clinical performance. Implant restorations and prosthetic management of patients with craniomandibular disorders were the most popular treatment options that the respondents felt that should be incorporated in the undergraduate curriculum.

CONCLUSIONS

As a general trend, students completing the revised curriculum reported more difficulties during their training and felt more insecure about their clinical competences. To enhance students' self-confidence in prosthodontics, more effective preclinical training methods, introduction of additional treatment options, and alternative educational methods should be considered.

Denture adhesives: a systematic review

STATEMENT OF PROBLEM

Denture adhesives have been the objective of scientific research for over half a century. Although they are used by denture wearers worldwide, investigations of their effectiveness and biocompatibility have led to controversial conclusions.

PURPOSE

The purpose of this study was to review the literature data with regard to the effectiveness and biocompatibility of denture adhesives as well as the attitudes of both patients and dental professionals toward these materials.

MATERIAL AND METHODS

An electronic search of English peer-reviewed dental literature in the Medline database was conducted to evaluate the effectiveness and biocompatibility of denture adhesives. There was no limitation in publication year, so the search included all the available scientific evidence included in that particular database until March 2014. Specific inclusion criteria were used for the selection of the appropriate articles. A manual search of the citations of the obtained articles followed to extend the electronic search.

RESULTS

A full text review was carried out for only 32 articles. Of the 32 articles, 21 examined the efficacy of denture adhesives in terms of retention and stability and masticatory performance, 6 evaluated the issue of the biocompatibility of denture adhesives, and 5 presented the attitudes of either professionals or patients toward these materials.

CONCLUSIONS

The majority of clinical studies supported the fact that denture adhesives enhance the retention, stability, and masticatory performance of a removable prosthesis. In terms of biocompatibility, long-term in vivo studies to investigate potential harmful effects were lacking. Patients are satisfied with denture adhesives that meet their needs.

Agenesis of maxillary lateral incisors: a global overview of the clinical problem

The agenesis of maxillary lateral incisors is a common developmental anomaly and represents a clinical problem impairing dental esthetics and function from a very young age. Several dental specialties deal with the management of this clinical problem because a multidisciplinary approach can cover the complete dental needs of patients with dental agenesis. There is controversy, however, about whether missing lateral incisor spaces should be orthodontically opened or closed using permanent canines to replace the missing teeth. The article presents a review of the existing literature about the prevalence, etiology, diagnostic evaluation, and treatment strategy of maxillary lateral incisor agenesis. Also, this article aims to present the key determinants leading to selection of space opening or closure and to report professional judgments and layperson perception concerning the available treatment alternatives. The English-language literature associated with this topic was searched via PubMed. The articles retrieved were then reviewed with an attempt to fulfill the aims of this review. Maxillary lateral incisors are one of the most common congenitally missing teeth, and to date, the origin of their agenesis has not been completely identified. Prompt diagnosis and careful evaluation of treatment determinants through a multidisciplinary approach are essential for the proper management of clinical problems. Each of the available means of rehabilitation has its own advantages, disadvantages, indications, and limitations. The configuration of the treatment plan should be devoid of clinician biases, whereas patients' realistic expectations should be taken into account.