General dentistry
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Temporomandibular disorders (TMDs) represent a broad spectrum of conditions associated with the temporomandibular joints and the neuromuscular system. Evidence-based diagnostic criteria for various TMDs are emerging, while corresponding treatment procedures remain less clear. As a result, the clinician may be uncertain how to best care for TMD patients. ⋯ Stabilization splints are effective as a reversible treatment for patients with TMD. Other therapies and occlusal devices may be beneficial when used for a specific TMD diagnostic protocol. A treatment rubric based on diagnostic criteria and condition severity may assist the clinician.
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Review Case Reports
Cervicofacial subcutaneous emphysema: a clinical case and review of the literature.
Cervicofacial subcutaneous emphysema is a known, rare complication of both dental and surgical procedures. Cervicofacial subcutaneous emphysema arises when air is forced beneath the tissues, leading to swelling, crepitus on palpation, and the potential of the air to spread along the fascial planes. This report presents a case of cervicofacial subcutaneous emphysema in a patient who had undergone surgical extraction of the mandibular right first molar. ⋯ This forced air, under high pressure, into the subcutaneous tissue spaces. The patient presented with severe hemifacial swelling and crepitus on palpation. Computed tomographic examination revealed air subcutaneously, and a diagnosis of cervicofacial subcutaneous emphysema was made.
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The timeliness of treatment after dental trauma is crucial to successful tooth preservation. This article focuses on the emergency treatment of common forms of dental trauma in athletes, both at the site of the injury and at the dental office. When dental injuries happen to young patients, saving the tooth is an absolute priority, because few long-term replacement solutions can be performed in a growing child. Preserving pulpal vitality of immature teeth is essential to allow continued root development.
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Local anesthetic systemic toxicity (LAST) is a rare but avoidable consequence of local anesthetic overdose. This article will review the mechanism of action of local anesthetic toxicity and the signs and symptoms of LAST. Due to physiologic and anatomic differences between children and adults, LAST occurs more frequently in children; particularly when 3% mepivacaine is administered. The calculation of the maximum recommended dose based on mg/lb body weight, Clark's rule, and the Rule of 25 in order to prevent LAST will also be reviewed, as well as the appropriate treatment procedures for a local anesthetic overdose.
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Randomized Controlled Trial
Role of mouthguards in reducing mild traumatic brain injury/concussion incidence in high school football athletes.
There is continued speculation on the value of mouthguards (MGs) in preventing mild traumatic brain injury (MTBI)/concussion injuries. The purpose of this randomized prospective study was to compare the impact of pressure-laminated (LM), custom-made, properly fitted MGs to over-the-counter (OTC) MGs on the MTBI/concussion incidence in high school football athletes over a season of play. ⋯ Twenty-four MTBI/concussion injuries (5.8%) were recorded. When examining the MTBI/concussion injury rate by MG type, there was a significant difference (P = 0.0423) with incidence rates of 3.6% and 8.3% in the LM MG and OTC MG groups, respectively.