This study aimed to analyze the types and frequencies of panoramic technical errors in pediatric patients with special needs, as compared to matching images of patients with normal developmental ...patterns. Panoramic images of 100 pediatric patients, with equal numbers of either special needs or healthy controls, referred to our Oral Maxillofacial Imaging unit, were retrospectively examined by four blinded observers for the presence of four common technical errors: palatoglossal air space, movement, positioning errors, and foreign bodies appearance. In addition, they subjectively determined the image quality on an ordinal scale. The statistical examination included inter-observer correlation and correlations between demographic factors (age, gender, developmental status) and the number and types of errors. The frequencies of demonstrated errors were, in descending order: movement, positioning, palatoglossal air space, and foreign bodies' appearance. The special needs group images showed significantly more errors and were rated as low-quality radiographs. Younger patients in both groups showed more movement and positioning errors. Technical errors in panoramic images of patients with special needs were more frequently found. Therefore, increased awareness of the staff and appropriate pre-imaging instructions to the patients, are required when imaging pediatric patients, especially those with special needs.
This study aimed to analyze the associations of gustatory dysfunction as measured by validated taste strips with demographics and co-morbidities. This cross-sectional study retrospectively analyzed ...records of patients who attended the Orofacial Chemosensory Center of Hadassah Medical Center between 2017 and 2020. Taste strips were used as a validated method to determine taste dysfunction. A total of 272 subjects were included, 137 (50.4%) women and 135 (49.6%) men, with a mean age of 53.5 ± 19.3 years and age range of 18-98 years. The total taste score among the study population was 8.53 ± 4.03 (scale range 0-16). Age had a significant negative correlation with the total taste score (
= 0.001), and men exhibited worse total (
< 0.001), salty (
= 0.003), and bitter (
< 0.001) scores. Major trauma was associated with worse total (
< 0.001) and specialized taste assessments (sweet (
= 0.001), sour (
= 0.002), salty (
= 0.016), and bitter (
< 0.001)). Chemotherapy was associated with reduced total (
< 0.001), salty (
= 0.003), and bitter (
= 0.001) taste scores. Zinc deficiency exhibited worse salty (
= 0.027) and total (
= 0.038) taste scores. Patients with burning mouth syndrome (BMS) showed higher salty scores (
= 0.017). Patients who experienced exposure to toxic chemicals exhibited worse salty scores (
= 0.024). We conclude that gustatory dysfunction is associated with older age, male sex, and co-morbidities of major trauma, current chemotherapy, zinc deficiency, BMS, and exposure to toxins. The study highlights the importance of systemic evaluation and quantitive gustatory dysfunction assessment as part of the diagnostic process of patients with subjective complaints of taste disorders.
Soft tissue oral biopsies (STOB) are commonly performed in the medical field to obtain tissue samples for diagnostic purposes. However, like all invasive procedures, these biopsies may carry risks, ...such as the development of chronic long-lasting neuropathic pain. This study aims to examine the occurrence of chronic pain following STOBs. A retrospective study was conducted on the medical records of 695 patients who underwent STOBs at the Maxillofacial Surgery Department of Hadassah Medical Center between the years 2013 and 2022. Demographic information, details of the procedure, histopathological diagnosis, and data related to post-procedure pain in the biopsy area were collected and analyzed. Out of the 695 patients, only 4 reports of chronic pain with mild intensity lasting more than three months following oral biopsy were documented, with incidence rate of 0.57%; all were females with a median age of 59 ± 2.0 years. The biopsies were taken from various sites and the common diagnoses were lichen planus, venous malformation, and fibromas. In conclusion, chronic pain after oral soft-tissue biopsies is rare, generally mild, and typically does not require extra therapy. These insights can aid clinicians and patients in making informed decisions about these procedures.
The relationship between ethnicity and chronic pain has been studied worldwide. The population of Israel includes two main ethnic groups, 75% Jews and 21% Arabs. The purpose of this study was to ...compare orofacial chronic pain characteristics and treatment outcomes between Jewish and Arab Israeli citizens. Two hundred patients admitted to the Orofacial Pain Clinic at Hebrew University-Hadassah School of Dental Medicine between 2017 and 2022 were selected randomly for this historical cohort study. Our cohort included 159 (79.5%) Jews and 41 (20.5%) Arabs. Twenty-six pain-related variables were compared of which only two differed significantly between the two groups, awakening due to pain and mean muscle sensitivity; both indicators were higher in the Arab group (
< 0.05). No differences were found in any of the other variables such as diagnosis, pain severity, onset, and treatment outcome. This minimal difference may be explained by the equal accessibility to medical services for all citizens, and the diversity of our staff that includes Jew as well as Arab service providers. These factors minimize or even eliminate racial bias, language, and cultural barriers, and is reflected in the minor differences in orofacial pain characteristics found between the two main ethnic groups in Israel.
Background: Iodinated contrast media allergy is considered as a strong contra-indication for performing sialography. There is little evidence to support this approach. Objective: To evaluate the rate ...of iodinated contrast media (ICM) allergy in subjects undergoing sialography and to assess the risk for allergic responses in patients with a previous diagnosis of allergy. Methods: We retrospectively reviewed sialo-CBCT studies performed from 2014 to 2019. During the study period we implemented a protocol for performing sialo-CBCT in patients with a prior diagnosis of allergy: 1) Clinical data were collected from a questionnaire and medical records. 2) No premedication was administered but, instead, oxygen, epinephrine and a resuscitation cart were accessible. 3) Following the procedure, each patient was observed for one hour and contacted by telephone 24 hrs later. Results: No allergic responses were documented in the medical records of 1515 subjects following sialo-CBCT studies, including 13 individuals previously diagnosed with ICM allergy. Investigation of the subgroup with prior allergy disclosed that the range of injected volume was between 2 ml to 6.2 ml per patient and that complete secretion of ICM was detected in 7 of 13 patients. In the remainder of subjects, retention rates of 5-50% were observed. Conclusions: Allergic reactions are exceedingly rare following sialo-CBCT studies regardless of a previous diagnosis of allergy. Pre-medication with corticosteroids and antihistamines is usually not warranted.
BACKGROUNDIodinated contrast media allergy is considered as a strong contra-indication for performing sialography. There is little evidence to support this approach. OBJECTIVETo evaluate the rate of ...iodinated contrast media (ICM) allergy in subjects undergoing sialography and to assess the risk for allergic responses in patients with a previous diagnosis of allergy. METHODSWe retrospectively reviewed sialo-CBCT studies performed from 2014 to 2019. During the study period we implemented a protocol for performing sialo-CBCT in patients with a prior diagnosis of allergy: 1) Clinical data were collected from a questionnaire and medical records. 2) No premedication was administered but, instead, oxygen, epinephrine and a resuscitation cart were accessible. 3) Following the procedure, each patient was observed for one hour and contacted by telephone 24 hrs later. RESULTSNo allergic responses were documented in the medical records of 1515 subjects following sialo-CBCT studies, including 13 individuals previously diagnosed with ICM allergy. Investigation of the subgroup with prior allergy disclosed that the range of injected volume was between 2 ml to 6.2 ml per patient and that complete secretion of ICM was detected in 7 of 13 patients. In the remainder of subjects, retention rates of 5-50% were observed. CONCLUSIONSAllergic reactions are exceedingly rare following sialo-CBCT studies regardless of a previous diagnosis of allergy. Pre-medication with corticosteroids and antihistamines is usually not warranted.
Sedation is commonly utilized for individuals otherwise unable to receive dental treatment, such as those with disabilities, medically complex conditions, and dentophobics. The aim was to ...characterize the profiles of patients receiving various types of sedation and assess the corresponding success rates.
This was a 5-year records-based retrospective study. Data regarding the indication for sedation, medical history, sedation type, and treatments performed were recorded.
In total, 103 patients underwent 389 treatment sessions under sedation; 42.7% of the patients were disabled. The most commonly administered sedation was moderate sedation, (49.4%), followed by deep (36.8%) and inhaled sedation (13.9%). Successful treatment results were achieved in 96.1% of sessions, with no adverse effects noted during recovery. The high success rates were independent of patient age, sex, and sedation type. There was a positive association between the indication for sedation and the type of sedation. The medically complex patients and the dentophobic patients received mainly moderate sedation (85.3% and 58.2%, respectively), whereas the disabled patients received deep sedation (51.2%). In total, 94% of patients were returning (re-visiting) patients. A statistically significant association was found between the type of sedation administered and the success rate during the first and last sessions (P < .001). The success rate at the first session may be predictive of the success in subsequent sessions.
A significant positive correlation was found between patient characteristics and the chosen sedation type leading to a high success rate across the various sedation modalities.
To evaluate, in an open trial, the pharmacotherapeutic efficacy of tricyclic antidepressant (TCA) drugs and gabapentin in patients with persistent myofascial pain and to identify patient and pain ...characteristics that may predict treatment outcome.
A stepped pharmacotherapeutic protocol was employed. All 42 patients having persistent facial pain with tenderness of regional muscles were first prescribed amitriptyline, but those with side effects were subsequently transferred to nortriptyline. In patients where no response to TCAs was observed, gabapentin was initiated. Outcome was assessed by employing prospective diaries recording pain intensity measured with an 11-point (0-10) verbal pain scale (VPS). Individual characteristics in these patients and their influence on drug response and outcome were analyzed; specifically, patients treated with TCAs were compared with those subsequently treated with gabapentin. Chi-square and t tests were used to analyze the data.
A total of 23 patients responded to TCAs and continued on this regimen, while 19 were resistant to TCAs and were subsequently treated with gabapentin. Their mean (± SD) VPS score at baseline was 6.5 ± 1.9 on an 11-point scale. In TCA-treated patients, 43% showed ≥ 50% reduction in pain intensity. This was achieved with a mean amitriptyline dose of 16 ± 1.1 mg/d and a mean nortriptyline dose of 25 ± 2.1 mg/d. Patients who did not respond to TCAs were characterized by a significantly higher age, more comorbid medical illness, and evidence of more regional pain spread (P < .05). In spite of not responding to TCAs, 36.8% of this group showed ≥ 50% reduction in pain intensity following gabapentin therapy at a mean daily dose of 973.7 ± 68.8 mg. Overall, a stepped approach employing TCAs and gabapentin resulted in 54.8% of all treated patients reporting improvements of ≥ 50% in VPS scores.
This study has demonstrated the good pharmacotherapeutic response of persistent myofascial pain, even in more severe cases. Not being a randomized controlled trial, the results may be biased and should be interpreted with caution. Patients who do not respond to TCAs may be a distinct subgroup and this needs further investigation. The results also suggest that gabapentin, at a lower dose than previously reported, is a good alternative in TCA-resistant patients.
PDF
