General dentistry
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For this first of a two-part article, anesthetic treatment modalities and specific drugs administered for third molar extractions were assessed to determine current office-based therapeutic practices. Questionnaires were mailed to a random national sample of 850 practicing oral surgeons. Survey design and pilot testing was conducted to assure clarity of questions and usefulness of responses. ⋯ Practicing oral and maxillofacial surgeons were estimated to have performed an average of 52.7 third molar extraction surgery cases per month, using either general anesthesia (46.3%), intravenous conscious sedation (33.4%), nitrous oxide sedation (5.8%), oral sedation (1.7%), or local anesthesia alone (12.9%). For intravenous conscious sedation, a three-drug technique using midazolam, fentanyl, and propofol was reported most commonly. The most frequently selected local anesthetic formulations were 2% lidocaine, 1:100,000 epinephrine for surgical anesthesia and 0.5% bupivacaine, 1:200,000 epinephrine for postoperative pain management.
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Sialolithiasis is the phenomenon of blockage of the salivary glands. It frequently is associated with swelling, pain, and infection of the affected gland. ⋯ This article presents a case involving a 23-year-old woman with Down syndrome who demonstrated sialolithiasis in the parotid duct gland. The sialolith was radiographed and removed surgically.
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Case Reports
Subcutaneous cervicofacial emphysema and pneumo-mediastinum: a rare complication after a crown preparation.
Subcutaneous cervicofacial emphysema and pneumo-mediastinum are relatively rare complications from different dental procedures (including oral surgery and restorative treatment). Many cases go unrecognized or are misdiagnosed. ⋯ This article presents a case report of subcutaneous and mediastinal emphysema following a routine restorative dental procedure. The differential diagnosis and management of this condition is discussed.
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The mineralized and elongated styloid process and Eagle's syndrome are similar processes of elongation in which mineralization of the stylohyoid ligament leads to styloid process of the temporal bone. The mineralized and elongated styloid process and Eagle's syndrome differ significantly in terms of the symptoms displayed and the treatment modalities that are sought. The mineralized and elongated styloid process refers to unilateral or bilateral elongation of the styloid process that does not result in any significant pain, discomfort, or limitation of neck movement. ⋯ Eagle's syndrome refers to pain and discomfort in the cervicofacial region resulting specifically from the elongated styloid process. Surgical shortening may be the only treatment that will alleviate the patient's symptoms. This article reviews the entire process of elongation pertaining to the styloid process and discusses the associated syndromes, including current knowledge of the theories of elongation, diagnostic criteria, and treatment strategies.
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The periodontal ligament (PDL) injection is used primarily when conventional anesthesia is not fully effective, when dentists require only a short duration of anesthesia, and when a patient wants to avoid the lip and tongue numbness associated with mandibular block injections. To provide effective anesthesia and to lessen adverse reactions associated with the injection, it is important to understand the proper technique for administering a PDL injection. This article provides a literature review of the PDL injection and a review of the author's techniques, including indications and contraindications, patient considerations, site and syringe preparation, administration of the injection, and possible postoperative effects.