Incidence of dentoalveolar injuries in hospital emergency room patients

A retrospective survey over one year of a hospital emergency room population, seen at an oral and maxillofacial surgery clinic, found 271 patients (4.6% of the total population) with dentoalveolar injuries. A very large number of injuries occurred to children between the ages of 0 and 5 years (42.1%), and there was a significant number of injured patients in the adult population (19.1%). The ratio of male to female was 1.9:1. The leading cause of injury was falls (59.8%). The largest number of injuries was seen during summer. The diagnoses were lateral luxation (27.3%), concussion (17.3%), exarticulation (14.3%), tooth fracture (12.5%), intrusive luxation (11.1%), fracture of alveolar process (7.4%), extrusive luxation (3.7%), and cases with more than one diagnosis (6.3%). Most of the involved teeth were maxillary central incisors, in both dentitions.     

Generalized joint laxity and temporomandibular disorders

Syntheses of 4-chloro-2-mercapto-5-methyl-N-(5-R1-6-R2-benzimidazol-2-yl) benzenesulphonamides [II-V], their disulfides [IIa-IVa] and S,N-substituted derivatives [VI-IX] were described. The probable mechanism for the reactions was suggested. The moderate anticancer activity was observed in vitro for compounds [II-IV].     

Temporomandibular joint disorders and surgery of the temporomandibular joint

Surgery of the TMJ is a useful tool in Temporo Mandibular Disorders (TMD). After have been identified what is part of TMD and what isn't, this article lay stress upon the fact that surgery of the TMJ is the appropriate treatment only when the nonsurgically therapy had failed. Indications, danger and complications are discussed. Procedures of arthrotomy and arthroscopy are explained. Various surgical procedures and staging of TMD are discussed.     

Etiologic factors in temporomandibular joint disorders and pain

Parallel to the construction of better classifications and the identification of subgroups of temporomandibular disorders, an important development has taken place in research concerning its etiology. The etiological factors implied in muscle problems refer to more generalised disorders as myofascial pain syndrome and fibromyalgia. The role of occlusal and articular factors has been brought down to realistic proportions, indicating a minor contribution. Similarly, doubt has arisen concerning the existence of a vicious cycle of pain/spasm/pain. With regard to internal derangements, emphasis has been put on the high prevalence in an otherwise normal population and the fluctuating character of the symptom. Also here, developments point towards constitutional and systemic factors, more than local influences. Trauma, however, seems to play an increasing role. The development of osteoarthrosis has been studied more in depth revealing local processes of inflammation, neurogenic inflammation and the existence of specific markers which might be important in the future. The relationship between disc derangement and the development of osteoarthrosis remains unclear.     

Common problems seen by the plastic surgery emergency room service

This article covers many issues of particular interest to the care of the child who presents to the emergency department with a traumatic wound. General concepts regarding the staffing of an emergency department, staff qualifications, and their consultation patterns are reviewed. Issues pertaining to the management of children in the emergency setting, including an update on outpatient sedation and analgesia and some infectious disease considerations are also discussed.     

The utilization of a paediatric emergency room in a general hospital in Kuwait

The objective of the study was to describe the ultrasonographic findings of urinary bladder urolithiasis and to determine the diagnostic value of the technique in feline lower urinary tract diseases (LUTD). Physical examination of the urinary system and routine clinicopathological analysis of the blood and urine were performed on 32 cats presented with clinical symptoms of LUTD. Cystosonography was done on all of the cats, while plain radiography was performed on 8 and double contrast cystography on 2 cats. Sonography of the bladder provided the following diagnoses: urolithiasis and chronic cystitis: 24 cases, chronic cystitis without urolithiasis: 4 cases, bladder neoplasm: 1 case, negative sonographic finding: 3 cases. Bladder calculi and/or plugs were diagnosed easily, up to a size of 2 mm, according to acoustic shadowing and/or reverberation and gravitation. When the bladder was empty, it was filled up with physiologic saline solution to visualise its contents more easily. Sonography proved to be a useful technique for diagnosing urinary bladder calculi and/or plugs even when they were radiolucent and for distinguishing among the different causes of LUTD. Although ultrasonography is a valuable diagnostic tool, radiography is still necessary to explore lower urinary tract diseases, especially when cystosonography provides negative results or urethral obstruction is suspected.     

Craniofacial pain syndromes that mimic temporomandibular joint disorders

Undiagnosed pain in the face, head and neck is very frustrating to all parties involved: the patient, the family of the patient, and the clinician. Simple pains may be treated with ease; however, chronic pain is a different matter. Often, patients consult numerous doctors, clinics, and hospitals in their search of pain relief. The patient may then undergo extensive and at times, unnecessary invasive treatment with the hope that the relentless agony of their suffering will be relieved. The purpose of this article is primarily one of education. Physicians and dentists alike encounter these unfortunate sufferers and yet, are confounded by the multitude of symptoms and complaints. Therefore, it was felt that an article such as this was needed. Many concepts presented within are either new or revised. It will be interesting to the reader just how similar many of these pain syndromes appear. Yet, when a systematic diagnostic approach is attempted, it will become clear just how different these syndromes are as well.     

The role of bruxism in the appearance of temporomandibular joint disorders

Bruxism is a parafunction observed both in young and adult populations. The mean prevalence is about 20% and is decreasing with age. Women appear to clench more frequently than men. Often, bruxism is understood as both clenching with occasional tooth contact or grinding. A correct and validated definition has only recently been suggested. Many symptoms are assigned to this process, although few symptoms scientifically can be used as specific diagnostic criteria. The symptoms most often associated with bruxism like muscle-stiffness and -pain, limitation of mouth opening. TMJ-internal derangements, toothwear, are also found in TMD-patients. Because the bruxism-process is not only a problem for the patient, who suffers from pain, dysfunction and possible toothwear, it concerns also the dentist. It is essential that those who treat the bruxist-patient, have an understanding of the etiology, diagnosis and management of bruxism, of the many described oral parafunctional behaviors (oromotor behavior). This literature-review could not find a causal etiological mechanism between the occurrence of TMD-symptoms and the bruxism although a relationship between those two conditions has been described.     

Clinical evaluation and psychological aspects of temporomandibular joint disorders]

Establishing the patient's clinical diagnosis depends on gathering as much information of the patient and his or her signs and symptoms as possible. This information can be gathered from history, physical and psychological examination, diagnostic analysis. It is also important to look upon pain as a disorder and to consider the relationship between pain and psychological factors. The differential diagnosis is constructed through a biopsychological model of illness rather than through a more traditional biomedical model of disease. To arrive at a consistently accurate clinical diagnosis in patients with TMJ and craniofacial pain, the technique of clinical diagnosis must be well defined, reliable and include examination of the head and the neck, cranial nerves and the stomatognathic system. The craniomandibular index provides a standardized examination of the stomatognathic system that has been tested on validity and reliability. This chapter focuses on the techniques of history taking clinical and psychological examination and diagnostic criteria for temporomandibular joint disorders and muscle pain.     

Clinical characteristics and natural history of human immunodeficiency virus infected patients seen at a general hospital in Singapore

The number of patients with human immunodeficiency virus (HIV) infection in Singapore has risen over the years. A considerable proportion of them present with acquired immunodeficiency syndrome (AIDS). In this study, we document the clinical characteristics and natural history of a consecutive series of 50 patients who were found to have HIV infection when they were seen at a tertiary care hospital. The majority were in the 30 to 49 age group and the most common mode of acquisition was heterosexual contact. The patients presented with a variety of symptoms to 11 different clinical departments. Fifty-eight per cent of the patients had AIDS-defining illnesses at presentation, with Pneumocystis carinii pneumonia being the most common. On follow-up, the most frequently occurring opportunistic infection that developed was Cytomegalovirus retinitis. Most patients had multiple subsequent admissions--for both AIDS-defining and non AIDS-defining conditions. The median CD4 count of the cohort at presentation was 72/mm3. The median survival was 399 and 822 days in those who had and those who did not have an AIDS-defining illness at presentation, respectively. Mortality was most commonly attributed to pneumonia. HIV infection has protean manifestations and patients may present to various specialty departments; hence, doctors need to be aware of the spectrum of disease in order to make a diagnosis.     

Mental disorders of Eskimos seen at a community mental health center in western Alaska

The charts of 343 Eskimos seen at a community mental health center in northwestern Alaska were reviewed, and data on demographic characteristics, DSM-III-R diagnoses, and history of suicide attempts were collected. Substance use disorders were the most common group of mental disorders. Substance use patterns differed substantially according to age and gender. Both children and adults had high rates of attempted suicide (66 percent and 67 percent). Rates of bipolar disorder and eating disorders were substantially lower than those seen in mental health clinics serving the general U.S. population.     

Evaluation of acupuncture and occlusal splint therapy in the treatment of temporomandibular joint disorders

One hundred patients showed signs and symptoms of temporomandibular joint disorder, were participated in a one year follow up study. The patients were randomly divided into four groups: Acuhealth treatment (group A), occlusal splint therapy (group B), Acuhealth and occlusal splint therapy (group C), and control (group D). Each group comprised 25 patients. The patients were examined before and 3, 6, and 12 months after treatment. At the three month evaluation, the patients who were not satisfied with the treatment outcome were offered additional treatment. The result showed that 87% of the patients treated by Acuhealth unit, 77.3% of the patients treated with occlusal splint therapy, and 91.3% of the patients received Acuhealth and occlusal splint therapy were improved subjectively and clinically after 3 months follow-up. The patients who responded well to treatment initially also responded well in the long run. The study showed that the Acuhealth unit proved to be an ideal early therapy for TMD, and complemented later with occlusal splint.     

Management of temporomandibular disorders in a restorative practice

Various disorders related to the masticatory muscles or to the temporomandibular joints may be encountered in a restorative dental practice. Most of them can be managed by the restorative dentist whose primary interest may not lie in the area of temporomandibular disorders. The term temporomandibular disorders is used in this discussion to denote the group of diseases of the masticatory system that involves primarily the temporomandibular joints, the masticatory muscles, and the occlusion of the teeth. The learning objective of this article is to describe temporomandibular disorders encountered in general practice. Managing these disorders in the general practice of restorative dentistry is not difficult and adds to the comfort of the patient and possibly to the success of the restorations.     

Functional state of the masticatory system in healthy individuals (control group) and in patients with temporomandibular joint disorders

The functional status of the masticatory system was investigated in a sample of 68 self-defined controls without any treatment need and 82 craniomandibular disorder patients. Among the parameters investigated were measures of mandibular mobility, the presence of joint noises and palpation tenderness of 17 muscle and 3 TMJ sites. These data allowed for calculation of Fricton's Craniomandibular Index (CMI) and Helkimo's Clinical Dysfunction Index (Di). Several socalled signs of dysfunction were found in the normal control group: 38% of the joints had some kind of noise and several muscle sites were tender to palpation (splenius capitis muscle 50%, anterior masseter and temporal muscle 45%, insertion of the trapezius muscle 40%). In addition, according to Helkimo's Di. 90% of the controls would be classified as having mild to moderate dysfunction. The high prevalence of positive signs in the control sample calls for a less rigid definition of what is called a normal craniomandibular status and refutes the a priori establishment of a narrow set of criteria for normality. Some parameters showed a highly statistically significant difference among the control and patient group (p < .001): active range of motion, deviation upon opening, pain on mandibular movement, number of tender palpation points and the CMI and Di.     

Incidence of human immunodeficiency virus antibody in a prenatal population at a community hospital

Prenatal human immunodeficiency virus (HIV) screening may reduce vertical HIV transmission. We screened 4,419 prenatal sera and found 38 repeatedly reactive specimens with an HIV-1-HIV-2 enzyme-linked immunosorbent assay. Western blot analysis confirmed four of these specimens as positive for HIV-1 antibodies. Screening detects previously unidentified HIV infections, but false-positive results may also occur.     

The possible role of nitric oxide in the physiopathology of pain associated with temporomandibular joint disorders

Temporomandibular joint disorders (TMD) pose a significant challenge to the practice of oral and maxillofacial surgery. When painful, TMD are generally associated with hyperthermia of the overlying skin. It is hypothesized that this skin hyperthermia, caused by regional vasodilation, is induced by nitric oxide (NO) produced in the extravascular space of the joint. Extravascular NO can be produced by osteoblasts, chondrocytes and macrophages, or by stimulated neurons. It is suggested that this kind of pain is associated with NO-enhanced sensitivity of the peripheral nociceptors. Verification and clinical implications of the proposed mechanism are discussed.