Comparison of Two Different Doses of Dexamethasone to Control Swelling and Trismus following Mandibular Third Molar Surgery

Introduction: Third molar surgery is one of the most common procedures performed by dental surgeons in clinical practice, where postoperative sequelae like pain, trismus, and swelling are often encountered. Thus, in this study, we compared medications employed to reduce such complications. Objective: To compare the effect of two different doses (4 and 8 mg) of dexamethasone in the control of swelling and trismus after the surgical extraction of mandibular impacted third molars. Methods: An experimental study consisted of twenty-seven (27) healthy adult patients of both genders with bilateral impacted lower third molars, where surgical extraction was indicated, 4 mg and 8 mg of dexamethasone were given orally to the patients 1 hour before the surgical procedure at both the surgeries. The swelling was recorded by measuring the length of 3 facial planes using a measuring tape. Trismus was evaluated by measuring the maximum interincisal distance. Recording of facial swelling and maximum interincisal distance was done preoperatively and on the 1st and 2nd days postoperatively. Results: Based on statistical analysis (Independent T-test), the results showed a difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4mg of dexamethasone though there was no statistically significant (p-value >0.05) difference between the two doses. Conclusions: 8 milligrams of the dexamethasone had better effectiveness than 4 milligrams of the dexamethasone in reducing the degree of swelling and trismus. Keywords: Dexamethasone; impacted third molars; swelling; trismus.

Comparison Of Collagen-Curcumin Blend (Collaper Rtu)With Intralesional Steroid Injections in Oral Submucous Fibrosis a Randomized, Open-Label Interventional Study.

Introduction: Oral Submucous Fibrosis (OSMF) is a precancerous condition characterized by limited mouth opening, burning sensation, stiffness, and blanching of the oral mucosa induced by areca nut eating. With any of the current therapy regimens, complete regression of the illness has not been accomplished in all patients. Curcumin is a yellow pigment found in curry powder that has antioxidant, anti-inflammatory, and pro-apoptotic properties. As a result, interventional research was conducted to determine the efficacy of Collaper RTu a proprietary collagen-curcumin based product in patients with OSMF.Setting and design: Forty patients with clinically and histologically confirmed Oral Submucous Fibrosis participated in a randomized open label interventional research. Method & materials: For the research, forty patients with clinically and histologically verified Oral Submucous Fibrosis were randomly assigned to one of two groups. The first group was given a weekly intralesional injection of 4 mg Dexamethasone and 1500 I.U Hyaluronidase, whereas the second was given two Collagen-Curcumin pills (Collaper Rtu 60mg Collagen with 100 mg Curcumin) every day for three months. On a weekly basis, the improvement of burning sensation, interincisal distance, and tongue protrusion was assessed.Results: From early to late stages, the burning feeling improved in both groups. Collaper Rtu was found to eliminate the burning feeling. In groups 1 and 2, the mean increase in interincisal distance was 3.13 mm and 1.25 mm, respectively. The interincisal distance improved significantly in both groups by the end of the first month. When compared to group 2, group 1's tongue protrusion recovered faster at the conclusion of the first month. Conclusion: Collaper RTu is useful and effective in lowering the burning feeling in people with early OSMF.

Gape Angle in Asymptomatic Dogs with Normal Occlusion

This study reports the gape angle (vertical temporomandibular joint range of motion for mouth opening) in conscious and anesthetized dogs. Mouth opening was reported as an angle in this study. Additionally, conscious and anesthetized measurements were compared to see if the state of anesthesia affected this measurement in asymptomatic patients. This prospective study evaluated 165 anesthetized dogs. Patients were placed in 1 of 2 groups: dental patients or non-dental patients. Only patients who were reported by owners to be asymptomatic for oral pain were included in the study. All dogs that met inclusion criteria had the maxillary length and interincisal distance measured. There was no difference (p = 0.590) between the mean (+/-SD) gape angle of conscious 44.0o (+/- 4.1+o) and anesthetized patients 43.9o (+/- 3.9o). No difference was seen in the gape angle between dental (44.2o) and non-dental patients (43.2o) (p = 0.183), or between conscious (43.8o) and anesthetized patients (43.7o) (p = 0.610). This study suggests that a consistent gape angle of 44o exists in dogs not exhibiting overt signs of oral pain and the gape angle is easy to measure in conscious patients and may be a useful tool during routine physical examination to identify patients with restricted range of motion. Immediate clinical application of this information can be used to monitor progress of treated patients affected by disorders that cause a decreased gape angle.

Effects of salbutamol, montelukast and prednisone on orthodontic tooth movement in rats

Objective: To evaluate the effect of salbutamol, montelukast, and prednisone on orthodontic tooth movement in rats. Material and Methods: In vivo experimental preclinical study. The sample consisted of 48 rats randomly distributed in four study groups. Group A was given saline solution; to group B, salbutamol 4 mg/Kg; to group C, montelukast 2.5 mg/Kg and to group D, prednisone 2.5 mg/Kg. All were fitted with orthodontic devices and the medications were administered intraperitoneally every 12 hours for 5 days. The clinical evaluation (variation in the interincisal distance) was performed at one, three, five, and seven days and the histopathological analysis (cell count) at five and seven days. Results: In the clinical evaluation of the variation in the interincisal distance, a significant difference was found in all the evaluations (p <0.05). It was found that the salbutamol group presented higher variation values in the interincisal distance on all the days evaluated. In the histopathological analysis at five and seven days, it was found that the osteoblast and osteocyte count was significantly higher in the salbutamol group compared to the other groups (p ><0.05). However, in the subgroup analysis, it was found that there was no significant difference in the osteoblast and osteocyte count between the prednisone, montelukast, and control group (p>0.05). Conclusion: The administration of salbutamol increased the magnitude of orthodontic tooth movement; nonetheless, the administration of montelukast and prednisone did not modify the magnitude of orthodontic tooth movement in rats. Keywords Albuterol; Montelukast; Prednisone; Rats; Tooth movement.

Effect of Diclofenac Gel Phonophoresis on Temporomandibular Joint Disorders: A Prospective Quasi-Experimental Study

Background: Temporomandibular disorders (TMD) are a group of pathologies that affect the masticatory muscles, the temporomandibular joint, and related structures and affect more than 25% of the general population. Objectives: This study aimed to demonstrate the effect of ultrasounds (US) plus diclofenac gel 10% (phonophoresis) as a physical therapy available for the management of TMD based on pain amelioration and function recovery. Methods: Prospective quasi-experimental one-group before-after study. Outcome measures consist: (1) pain measured by Visual Analog scale (VAS); and (2) mouth opening by measuring lip to lip distance and interincisal distance in millimeters (mm); evaluated at the beginning/end of treatment. Twenty sessions (1 session per day) of continuous Ultrasound to intensity of 1 W/cm2/1 MHz/5 minutes over the affected joint, with Ultrasound gel (5 mL) and 10% diclofenac gel (5 mL) in a proportion of 1:1 as transducer medium. Results: A total of 50 consecutive patients were analyzed. Phonophoresis protocol was able to improve all outcome measures with a statistical difference. Pain evaluated by VAS was 6.67 ± 0.82 and decreased to 3.48 ± 0.8 points (P = 0.0000). Mouth opening by mean of lip-to-lip distance was 50 ± 8.23 mm that improved to 56 ± 6.2 mm (P = 0.0000) and by mean of interincisal distance was 37.9 ± 7.02 mm and increased to 44 ± 5.5 mm (P = 0.0000). Conclusions: Diclofenac phonophoresis is an effective physical therapy for the management of TMD, evaluated by pain improvement and function recovery.

FRI0238 AUTOLOGOUS FAT GRAFTING IN THE TREATMENT OF FACIAL SCLERODERMA: A SINGLE - CENTRE EXPERIENCE

Background:Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations are disabling and treatment options are limited. Fat Tissue Grafting (FTG) can be used for treating facial manifestations of the fibrosis.Objectives:In this study, we aimed to assess the safety and efficacy of FGT of our cohort of patients with SSc.Methods:We enrolled 20 SSc (18 W, 2 M) patients, from 2016 to 2019, suffering from facial sclerosis and restricted mouth opening capacity. FTG was carried out in accord with modified Colemans’ procedure (1): fat tissue was taken from periumbilical or trochanteric areas and was injected in 8 different points around the mouth. No side effects or adverse reactions have been documented. Evaluations included mouth opening capacity by measuring interincisal distance, oral functionality (MHISS scale) and patient global satisfaction (by Global Health scale).Results:A 11 mm (8 - 18mm range) median increase of interincisal distance was reported at month 6 and in 80% of patients at month 12, too (p<0.03). A significant improvement in MHISS scale was also observed (p<003). The patient satisfaction questionnaire showed 95% positive results and 80% of the patient replied affirmatively to the question about the repetition of FTG but only 2 patients required new FTG after 12 months.Conclusion:Our results showed that FTG improved mouth opening capacity and that aesthetic and functional results were satisfying to about 90% of the patients; long-term effects of this type of treatment are currently unknown. However, our and litterature data at 12 months follow-up seems to confirm the benefits in long term, despite the filling effect is over.This study – that’s one of the largest case series described right now (2) - supports the possible therapeutic role of autologous FTG in improving facial scleroderma both in aesthetic and in functional aspects.References:[1]Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg. 2006; 118: 108S-20S[2]Fat Grafting for the Treatment of Scleroderma.Strong AL, Rubin JP, Kozlow JH, Cederna PS. Plast Reconstr Surg. 2019 Dec;144(6):1498-1507. doi: 10.1097/PRS.0000000000006291.Disclosure of Interests:None declared

Maximum mouth opening in healthy children and adolescents in Istanbul

Objectives: Mouth opening capacity is often regarded as one of the important parameters for evaluating the function of the temporomandibular joint (TMJ) and masticatory muscle status. A reduced mouth opening capacity may be one of the first clinical signs of TMJ involvement. The purpose of this study was to create age related percentiles for the maximal interincisal distance (MID) of healthy children. Methods: The patients admitted for routine dental examinations to Istanbul University Faculty of Dentistry, Department of Pedodontics were included in this study. The interincisal measurements were performed with metallic calliper and also malocclusions were recorded for all children. Oneway Anova test, Tukey HDS test, Tamhane’s T2 test and Student t test were used for statistical analysis. Results: The study population comprised of 1059 (569 males, 490 females), 3-to 15-year-old (mean age 8.82±3.06) children. The mean score of maximal inter-incisal distance was found 33.24±5.54 for females; 33.32±5.71 for males. There was no statistically significant difference according to gender (p=0.815; p>0.05). The mean score of maximal inter-incisal distance was found 28.63±4.34 for 3-5 years; 33.52±4.84 for 6-11 years; 37.35±5.52 for 12-15 years children. Statistically significant differences were found between age groups (p: 0.001; p<0.01). The mean score of maximal inter-incisal distance was found 32.9±5.6 for class I; 34.92±5.51 for class II; 35.2±5.36 for class III malocclusions. Statistically significant differences were found between malocclusion groups (p:0.001; p<0.01). Conclusion: The result of this study indicated that positive relationship between the maximum mouth opening and age and malocclusion.

Jaw Opening Decreases Window to the Deep Parotid Lobe

To describe the relationship between jaw opening and access to the deep parotid window, we identified the following distances in 10 human skulls: symphysis to angle of mandible, mastoid tip to angle of mandible, angle of mandible to condylar process, and mastoid tip to condylar process. With the jaw closed and open, these distances were measured with 1 to 3 wooden blocks, each measuring 1 cm, between the upper and lower incisors. The triangular deep parotid area formed by the last 3 distances was calculated. A repeated measures analysis of variance showed a significant decrease in the deep parotid area with increasing interincisal distance ( P < .01). A generalized estimating equation model demonstrated a statistically significant decreasing area of the deep parotid window with increasing interincisal distance. These results suggest that nasal intubation may improve access to the parotid window.

Single-Needle Arthrocentesis with Upper Compartment Distension versus Conventional Two-Needle Arthrocentesis: Randomized Clinical Trial

The objective of this study was to compare single-needle arthrocentesis with distension of the upper compartment of the temporomandibular joint (TMJ) with the conventional two-needle arthrocentesis. Twenty-six patients with articular disc displacement without reduction (DDWOR) were included in the study and assigned to two groups (n=13): single-needle arthrocentesis with distension of the upper compartment of the TMJ (1N) and conventional two-needle arthrocentesis (2N). The maximum interincisal distance (MID) and TMJ pain as measured by the visual analog scale (VAS) were compared. MID and VAS data were obtained: before (T1), seven days after (T2), fifteen days after (T3), one month after (T4), three months after (T5), six months after (T6), nine months after (T7), and one year after the arthrocentesis procedures (T8). Considering each group individually, results of the VAS scores and MID measurements showed a significant difference between T1 and T2–T8 (p<0.001) in both groups. Between two groups, results show no significant differences (p>0.05). Both techniques tested were effective in reducing pain and increasing MID. Due to the advantages over the conventional two-needle arthrocentesis, single-needle arthrocentesis with distension of the upper compartment should be considered as the first treatment option for patients with painful hypomobilized TMJ of DDWOR.