• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.223-231
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• 2020

Background: The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. Methods: Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. Results: We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. Conclusion: The incidence of severe and post-extubation bleeding was significantly less with xylometazoline. Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.

• Journal of Oral Medicine and Pain
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• v.41 no.1
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• pp.21-25
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• 2016

Purpose: Burning mouth syndrome (BMS) is a chronic pain condition involving the oral and perioral regions, often characterized by a burning sensation and pain in elderly patients. In this study, we investigated the effectiveness of pharmacological agents for the treatment of BMS patients through a retrospective chart review. Methods: We enrolled 61 BMS subjects (57 females, 4 males; $66.4{\pm}10.9$ years of age) from among consecutive patients treated pharmacologically from January 2014 to June 2015 at Chonnam National University Dental Hospital. Patients with secondary BMS associated with local factors were excluded. The treatment period, number of pharmacological agents tried, and effectiveness of the drugs administered to each subject were analyzed. Results: The mean treatment period for the management of BMS was 2.5 months. More than three agents were tried to control BMS symptoms in 17 subjects (27.9%); two agents were used in 10 subjects (16.4%), and a single agent in 24 subjects (39.3%). Clonazepam was prescribed most frequently and was effective at relieving symptoms in 30 of 39 subjects (76.9%). Paroxetine was moderately effective, relieving symptoms in 7 of 17 subjects (41.2%). Some of the subjects benefited from tricyclic antidepressants, gabapentin, and lipoic acid. A topical local anesthetic used to supplement other systemic agents had ameliorating effects in four of six subjects. Conclusions: Within the study limitations, clonazepam was the most effective drug and antidepressants were efficacious in some subjects for relieving the symptoms of BMS. These pharmacological agents could be considered as first-line drugs for the management of BMS.

• Journal of Oral Medicine and Pain
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• v.20 no.1
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• pp.7-18
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• 1995

The Purpose of this article is to describe the biochemical properties and biological functions of several salivary proteins that possess the unusual properties of inhibiting spontaneous and secondary precipitation of calcium phosphate. This function is very important since human salivary secretion is supersaturated with respect to calcium phosphate. Biological function of statherin, proline rich protein (PRP) and histidine rich protein (HRP) is to inhibit precipitation of calcium phosphate in salivary glands, in the oral fluids, and onto tooth surfaces. The resulting supersaturated state of the salivary secretions contributes a protective and reparative environment which is important for the integrity of the tooth. Beneficial consequences of salivary supersaturation with respect to calcium phosphate are selectively expressed in the oral cavity- that is, protection is provided for the dental enamel-while undesirable consequences, for example, precipitation of calcium phosphates in the salivary glands and onto the teeth do not occur. Purification and structural characteristics of these proteins as well as clinical significance of functions of each protein will be discussed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.145-153
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• 2022

Background: Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods: A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 ㎍) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann-Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results: The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion: Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

• Journal of Oral Medicine and Pain
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• v.37 no.2
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• pp.75-79
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• 2012

Helicobacter pylori(H. pylori) associated with gastritis and gastric cancer is mainly detected dental plaque and saliva in the oral cavity. Most infection is probably acquired in childhood, but the route of transmission is not clear. The oral cavity has been indicated as secondary reservoir of H. pylori, and may therefore be argued in the route of transmission and reinfection of the stomach which follows treatment of H. pylori infection. So this review aimed to discuss about H. pylori in the oral cavity. H. pylori in stomach can appear in the oral cavity by gastroesophageal reflex or vomiting, but infection of stomach and oral cavity is different. Diagnostic methods are serological method, urea breath test, PCR method, urease test, histologic method and so on. Nested PCR recommend for detection of H. pylori in saliva and dental plaque. H. pylori infection in the oral cavity appear variously and is no relation with dental diseases. The antimicrobial mouthrinse recommend in patients with periodontal diseases because of high detection rate fo H. pylori. Thus H. pylori may be considered as the normal oral microflora.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.4
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• pp.271-275
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• 2018

The purpose of this study was to report and discuss the diagnosis and treatment of obstructive atelectasis secondary to pus obstruction in a patient who had developed a maxillofacial abscess, and to review the literature on similar cases. Persistently discharging pus within the oral cavity can act as an aspirate, and may lead to obstructive atelectasis. Additionally, maxillofacial surgery patients should be carefully assessed for the presence of risk factors of obstructive atelectasis, such as, epistaxis after nasotracheal intubation, oral bleeding, and mucus secretion. Furthermore, patients with these risk factors should be continuously followed up by monitoring $SPO_2$, breath sounds, and chest x-ray.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.3
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• pp.256-259
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• 2007

Abscesses are common in the oral and maxillofacial area. However, secondary thrombosis of the internal jugular vein accompanying the primary abscess is rare. In 1936, Andre Lemeierre studied 20 patients who showed an initial oropharyngeal infection, septicemia, internal jugular vein thrombosis, and secondary spread of the infection, and after then this condition Lemierre syndrome. Clinically, these patients present with tonsilitis lasting several days, continuous fever, and cervical pain. In the past, ligation and excision of the internal jugular vein was often performed. Current therapeutic modality for this condition is appropriate antibiotic prescription and surgical drainage of abscess. This case report presents a patient who showed symptoms of Lemierre syndrome, initiated as an oropharyngeal infection then developed thrombosis of the internal jugular vein. This patient was admitted into Seoul National University Dental Hospital. In addition to routine antibiotic therapy, surgical incision and drainage of the infection site was performed. Without ligation or excision, the thrombosed IJV disappeared eventually. As the Lemierre syndrome is not a common disease, this case report and review of the literature would be useful regarding a treatment of patients with Lemierre syndrome.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.3
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• pp.160-165
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• 2017

Objectives: Dry socket may occur secondary to the removal of any tooth. However, most dry socket cases develop in the third molar region. Dry socket is multifactorial in nature and has been treated using various modalities with varying success rates. This study assessed the efficacy of platelet rich fibrin (PRF) in established dry socket. Materials and Methods: Ten patients of either sex aged from 41 to 64 years with established dry socket according to established criteria were treated using PRF. Evaluation was performed by observing the reduction of pain using visual analogue scale, analgesic tablet use over the follow-up period, and healing parameters. Results: Pain was reduced on the first day in all patients with decreased analgesic use. Pain was drastically reduced during follow-up on the first, second, third, and seventh days with a fall in pain score of 0 to 1 after the first day alone. The pain scores of all patients decreased to 1 by the first day except in one patient, and the scores decreased to 0 in all patients after 48 hours. Total analgesic intake ranged from 2 to 6 tablets (aceclofenac 100 mg per tablet) over the follow-up period of 7 days. Healing was satisfactory in all patients by the end of the seventh day. Conclusion: PRF showed early pain reduction in established dry socket with minimal analgesic intake. No patients had allergic reactions to PRF as it is derived from the patient's own blood. PRF showed good wound healing. Our study suggests that PRF should be considered as a treatment modality for established dry socket.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.4
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• pp.195-198
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• 2014

Cavernous sinus thrombosis not only presents with constitutional symptoms including fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. It is known to occur secondary to the spread of paranasal sinus infections in the nose, ethmoidal and sphenoidal sinuses. However, paranasal sinus infection of dental origin is rare. The following is a case of cavernous sinus thrombosis due to the spread of an abscess in the buccal and pterygomandibular spaces via buccal mucosal laceration.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.397-402
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• 2007

Sjogren's syndrome is a chronic autoimmune disorder of the exocrine glands with associated lymphocytic infiltrates of the affected glands. Primary SS presents alone as xerostomia, keratoconjunctivitis sicca and patotid gland enlargement, secondary SS occurs in connection with other autoimmune disorder such as rheumatitoid arthritis, systemic lupus erythematosus, or progressive systemic sclerosis. Among many other systemic complication, lymphoma is considered seriously. Patient with SS had a 44 times higher relative risk of lymphoma, and clinically identifiable lymphoma occurs in approximately 5% of patients with SS. So, patients with SS should be closely monitored. In dental office, diagnosis of SS is important in view of high risk of lymphoma. When a dentist diagnose and manage dry mouth, he or she should consider possibility of SS all the times and have knowledge of diagnostic criteria of SS.