• Journal of Dental Anesthesia and Pain Medicine
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• 제19권4호
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• pp.191-199
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• 2019

Background: Patients with special health care needs are more likely to develop health problems, including dental problems. Dental treatments require a good level of communication with the patient. Therefore, in these patients, sedation and general anesthesia are an extremely humanistic approach for comfortable and successful treatment. In patients with special needs, there is no standard anesthetic approach due to varying clinical conditions. The aim of this study was to provide literature content about the anesthetic approaches used by us in patients with special needs. Methods: The medical records of 710 patients with special health care needs treated under general anesthesia or sedation were reviewed retrospectively. Demographic data, the American Society of Anesthesiologists classification, Mallampati score, anesthesia duration, anesthesia type, anesthetic and analgesic agents used, dental treatment performed, secondary diseases, and complications in the perioperative period were recorded. Patients were evaluated under five groups: Down syndrome, other syndromes, psychiatric disorders, physical disabilities, and complicated medical story. Results: Among the patients evaluated, 47.5% were females and 52.5% were males (mean age $15.76{\pm}11.17$ years), and general anesthesia and sedation were administered in 72.9% and 22.1% patients, respectively. The mean duration of anesthesia was $43.20{\pm}35.85$ min. Simple dental treatments were performed in all groups, and the most common complications were observed in the other syndromes group. Conclusion: Complications can be reduced by utilizing the appropriate anesthetic approach and taking serious precautions in patients with special needs.

• Imaging Science in Dentistry
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• 제51권2호
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• pp.217-222
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• 2021

Ewing sarcoma in the head and neck is rare, and metastasis from other bones to the mandible accounts for 0.7% of cases. This report presents a case of oral metastasis in a 24-year-old male patient diagnosed with Ewing sarcoma of the femur (p53 gene mutation and EWSR1-ERG fusion). The chief complaint was numbness in the mandible and pain for 1 month and a hardened, ulcerated exophytic lesion in the right retromolar region. Imaging exams revealed an unspecified thinning of the cortical bone of the inferior alveolar canal in the right mandibular ramus, associated with erosion of the alveolar bone. Histopathological analysis confirmed metastasis of Ewing sarcoma. The patient presented an aggressive disease progression and died 1 month after the oral diagnosis. It is important to recognize the signs and symptoms compatible with rare clinical outcomes, leading to an early diagnosis that can improve patients' quality of life and survival.

• Journal of Korean Dental Science
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• 제15권2호
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• pp.101-111
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• 2022

The purpose of laboratory tests in the field of oral medicine can be divided into two categories: (1) medical evaluation of patients with systemic diseases that are planning to receive dental care and (2) diagnosis of patients with certain oral diseases. First, laboratory tests are commonly used to evaluate patients with systemic diseases who need dental management. A combination of multiple tests is usually prescribed as a test panel to diagnose and assess a specific disease. Test panels closely related to oral medicine include those for rheumatoid arthritis, connective tissue disease/lupus, liver function, thyroid screening, anemia, and bleeding disorders. Second, laboratory tests are used as auxiliary diagnostic methods for certain oral diseases. They often provide crucial diagnostic information for infectious diseases caused by bacteria, fungi, and viruses that are associated with pathology in the oral and maxillofacial regions. Laboratory tests for infectious diseases are composed of growth-dependent methods, immunologic assays, and molecular biology. As the field develops, further application of laboratory tests, including synovial fluid analysis in temporomandibular joint disorders, salivary diagnostics, and hematologic biomarkers associated with temporomandibular disorders and orofacial pain conditions, is currently under scrutiny for their reliability as diagnostic tools.

• Imaging Science in Dentistry
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• 제54권2호
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• pp.211-220
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• 2024

Non-secretory multiple myeloma (NSMM) is a rare cancer of plasma cells characterized by the absence of detectable monoclonal M protein in the blood or urine. A 57-year-old woman presented with mandibular pain but without intraoral swelling. Imaging studies revealed multiple osteolytic lesions in her mandible and pronounced root resorption of the left mandibular second molar. Biopsy results showed atypical plasmacytoid cells positive for anti-kappa, CD138, MUM1, and CD79a antibodies, but negative for anti-lambda and CD20. These results were indicative of a malignant plasma cell neoplasm. No abnormalities were revealed by free light chain assay or by serum or urine protein electrophoresis, leading to a diagnosis of NSMM. The patient began chemotherapy in conjunction with bisphosphonate therapy and achieved remission following treatment. This case underscores the critical role of dentists in the early detection and prevention of NSMM complications, as the disease can initially present in the oral cavity.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권1호
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• pp.1-17
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• 2024

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.

• 구강회복응용과학지
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• 제27권3호
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• pp.327-336
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• 2011

치과에서 임상적으로 신경병성 통증이 발생하는 경우는 주로 하악신경이 손상 받은 경우이며 그 원인으로는 발치, 인공치아매식, 악안면 수술, 치주치료 및 근관치료 등이 있다. 본 연구는 근관치료 후 발생한 하악신경 손상 환자의 신경병증의 원인과 증상에 따라 약물치료를 통해 개선된 정도를 분석해 보고자 하였다. 근관치료 후 발생한 이상감각 또는 통증을 주 증상으로 2004년부터 2011년까지 연세대학교 치과대학병원 구강내과에 내원한 환자 중 32명의 의료기록을 분석하였고, 약물치료를 시행한 경우 환자의 증상이 개선된 정도를 평가하였다. 초진시 감각저하 또는 감각부전의 증상을 호소한 총 32명의 환자 (남자 9명, 여자 23명, 평균나이 44세)를 분석하였다. 신경병증의 발생 원인은 근관치료 시 마취 (46.9%), 근관 내 적용한 약재에 의한 화학적 손상 (25%), 근관수술 (15.6%), 기타 원인이 불분명한 경우 (12.5%) 순으로 많았다. 처방된 약물은 스테로이드, 항경련제, 항우울제, 진통제 등이었고, 환자의 증상이 개선될 때까지 약물 용량은 조절되었으며, 약물 복용 기간은 1주일에서 11개월까지 다양하였다. 증상이 나타난 부위에 따라 하치조신경 손상으로 인한 증상을 나타내는 환자가 25명, 설신경 손상으로 인한 증상을 나타내는 환자가 7명이었으며, 약물치료 후 증상이 개선된 경우가 21명 (66%), 증상 개선이 미미하거나 없는 경우가 11명 (34%)이었다. 그 증상은 감각저하와 감각부전으로 분류하였고, 감각저하는 67%, 감각부전은 65% 개선을 보였다. 근관치료와 연관된 하악신경 손상으로 인해 신경병증이 발생된 경우 약물치료를 통한 증상 개선을 도모해 볼 수 있다. 다만, 신경병증의 종류와 회복 수준은 신경 손상의 원인, 정도와 손상 발생 후 치료 시기, 처치 방법 등에 의해 영향을 받으며, 각각의 변수에 따라 통증 강도나 회복 정도에 차이가 있을 것으로 예상되므로 향후 더 많은 개체 수에서 다양한 변수에 대한 정량적인 연구가 필요할 것으로 생각된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권2호
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• pp.167-173
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• 2001

Cystic lesion of the jaw are frequently encountered clinically. Although they rarely lead to development of tumors, they can result in resorption of the jaw bone or asymmetry of the face may occur. The purpose of this study is to find the clinical and histopathological pattern of cysts and to help better understanding for the diagnosis and treatment of jaw cysts. The hospital chart, out-patient chart, panorama X-ray, histopathological report and operation report of 246 patients were reviewed who had been diagnosed as cyst. Sex distribution, age distribution, classification, anatomic distribution, clinical sign & symptoms, treatment, post-operation complications, recurrence rate were studied. Then significant difference between the diameter of cyst with bone graft and none-bone graft was calculated with SAS program. The results were as follows. 1. Among the total patient of 246 cases, male were 163 case(67.0%), and female were 83 case(37.0%), male predominated by the ratio of 1.98. 2. By age group, the 20's accounted for the largest proportion of the cases(27.2%) and the 30' accounted for the 2nd largest proportion of the case(19.5%). 3. Radicular cyst and dentigerous cyst were most common cysts, irrespective of 166 case(67.5%) and 62 case(25.2%). 4. Clinical sign & symptoms were swelling(167case), pain(85case), pus discharge(53case), teeth discoloration(28case), indicating that most complaints were related to inflammation and facial asymmetry. 4.9% of the total cases were discovered accidentally. 5. The primary site of cysts were maxillary anterior area(43.9%), the others were, in descending order, mandibular posterior area(25.6%), maxillary posterior area(14.6%). 6. Enucleation with endodontic treatment was a main treatment method(133 case, 54.1%) and 38 cases(15.4%) were enucleation with extraction, and 37 cases(15.0%) were only enucleation, and 21 cases(8.5%) were enucleation with bone graft. 7. The average diameter of cysts with bone graft was significally greater than with non-bone graft(p<0.05). 8. Post-operation complications occurred in 10 case(4.1%), all of this were due to secondary infection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권5호
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• pp.497-506
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• 2000

This study is comprised of data obtained from the files of 346 patients with temporomandibular disorders. All patients were diagnosed, treated and followed in the Department of Dentistry at the Inha university hospital, Incheon, Korea. The patients had treated with medications, physical therapy, occlusal splint and arthrocentesis. The study data were obtained from the medical records and telephone interviews that were conducted by research assistants. The results were as follows 1. The patient's main complaint was pain(77%), and mouth opening limitation was 17%. 2. An analysis of the medical records of the 346 patients disclosed that 82% were improved and 17% had no improvement when they were dismissed. 1% of the patients had become worse during therapy. 3. A success rate of 82% was achieved when medication assisted physical therapy was included. In the current status at the telephone interview, 270 patients(89%) reported that they were doing well with 56% describing themselves as asymtomatic and 32% experiencing only minor residual or recurrent symptoms. 11% regarded themselves as unimproved and worse. 4. In the current status of the unsuccessfully treated patients by medications and physical therapy, 64% of patients were doing well(3% as asymptomatic and 56% as only minor residual or recurrent symptom). But 36% of patients was reported as unimproved and worse. 5. TMJ has a remarkable adaptive potential and TMJ disorder has a natural history of spontaneous fluctuations and favorable prognosis during the subsequent natural course. 6. In the treatment of the temporomandibular disorders, there is a treatment ladder, starting with the simplest and least expensive treatment, that is ascended until resolution of the patient's symptoms occur. These findings suggest that conservative reversible therapies are both sufficient and appropriate for management of temporomandibular disorder in most patients. Major alterations of mandibular position or dentoalveolar relationships do not appear to be necessary for obtaining either short term or long term success and therefore they can be generally regards as inappropriate treatment for this disorder. The fact that physical therapy is non-invasive and does not appear to be fraught with irreversible changes, makes it a very applicable vehicle in the area of clinical TMJ disorder management.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.2.1-2.9
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• 2015

Background: The aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs. Material and Methods: Six minipigs were used in this study. Four molars were extracted in the right mandibular dentition and sent to the Korea Tooth Bank for fabrication of autogenous tooth bone. Ten days later, each extraction site was implanted with MS Implant Narrow Ridge $3.0{\times}10mm$ fixture (Osstem, Seoul, Korea) after standardized 2mm-sized artificial vertical bony defect formation. Pineappleshaped Root-On type autogenous tooth bones were applied to the vertical defects around the neck area of the posterior three fixtures and the fore-most one was not applied with autogenous bone as a control group. Each minipig was sacrificed at 4, 8, 12 weeks after fixture installation and examined radiologically and histologically. Histological evaluation was done under light microscope with Villanueva osteochrome bone staining with semi-quantitative histomorphometric study. Percentage of new bone over total area (NBF) and bone to implant contact (BIC) ratio were evaluated using digital software for area calculation. Result: NBF were $48.15{\pm}18.02%$, $45.50{\pm}28.37%$, and $77.13{\pm}15.30%$ in 4, 8, and 12 weeks, respectively for experimental groups. The control group showed $37.00{\pm}11.53%$, $32.25{\pm}26.99%$, and $1.33{\pm}2.31%$ in 4,8,12 weeks, respectively. BIC ratio were $53.08{\pm}19.82%$, $45.00{\pm}28.37%$, and $75.13{\pm}16.55%$ in 4,8,12 weeks, respectively. Those for the control groups were $38.33{\pm}6.43%$, $33.50{\pm}29.51%$, and $1.33{\pm}2.31%$ in 4, 8, 12 weeks, respectively. Conclusion: Autogenous tooth bone showed higher score than control group in NBF and BIC in all the data encompassing 4,8,12 weeks specimens, but statistically significant only 12 weeks data in both NBF and BIC.

• 대한소아치과학회지
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• 제39권2호
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• pp.186-191
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• 2012

차아염소산나트륨은 근관 세척 시 널리 쓰이는 약제이다. 근관계의 멸균에는 효과적이나, 부작용에 대해서는 알려진 바가 많지 않으며 특히 유치에서 근관세척제로 사용 시 부작용에 대한 보고는 거의 없었다. 본 증례는 차아염소산나트륨이 유치의 치근단을 통과하였을 때 심각한 부작용을 일으킬 수 있음을 보여준다. 만 4세 여아가 치과의원에서 차아염소산나트륨을 이용한 상악 유중절치의 재근관 치료 중 급격한 안면 부종과 통증으로 본원 응급실로 의뢰되었다. 전신적 스테로이드제, 항히스타민제, 항생제 및 진통제를 투여하고, 해당 치아는 2차 감염 예방을 위해 발거하였다. 2일 후 부종이 감소하기 시작하였다. 차아염소산나트륨에 대한 알레르기 반응 검사 결과 음성을 나타내었다. 유치의 근관 세척 시에는 차아염소산나트륨이 치주조직으로 압출되지 않도록 철저히 주의해야 하며, 부작용이 일어날 경우 통증 및 부종 완화와 약물 치료가 필요하다.