• Restorative Dentistry and Endodontics
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• v.39 no.3
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• pp.215-219
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• 2014

Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itching or any deviation from normal sensation. Altered sensation and pain in the involved areas may interfere with speaking, eating, drinking, shaving, tooth brushing and other events of social interaction which will have a disturbing impact on the patient. Paresthesia can be short term, long term or even permanent. The duration of the paresthesia depends upon the extent of the nerve damage or persistence of the etiology. Permanent paresthesia is the result of nerve trunk laceration or actual total nerve damage. Paresthesia must be treated as soon as diagnosed to have better treatment outcomes. The present paper describes a case of mental nerve paresthesia arising after the start of the endodontic therapy in left mandibular first molar which was managed successfully by conservative treatment.

• Journal of Oral Medicine and Pain
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• v.38 no.4
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• pp.325-331
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• 2013

Botulinum neurotoxin(BoNT) is a protease exotoxin produced from Clostridium botulinum. It works by blocking the release of acetylcholine from cholinergic nerve endings causing inactivity of muscles or glands. Recently, the therapeutic use of BoNT have expanded to include a wide range of medical and dental conditions. Botulinum neurotoxin type A(BoNT/A) is used off-label in the orofacial region to treat primary and secondary masticatory and facial muscle spasm, severe bruxism, facial tics, orofacial dyskinesias, dystonias, and hypertrophy of the masticatory muscles. Local hematoma, infection, and persistent pain in the injection site are the site-of-injection side effects. Medication-related side effects are adjacent muscle weakness, slurred speech, an alteration in the character of the saliva, and severe headaches. In most cases, these complications are not persistent and bothersome. We reported a case report of a patient who had transient anterior open bite after BoNT/A injection on masseter muscles to treat the refractory myofascial pain.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.85-90
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• 2006

Necrotizing ulcerative gingivitis(NUG), necrotizing ulcerative periodontitis(NUP), necrotizing stomatitis (NS), and Noma (cnacrum oris) are rapidly destructive debilitating and potentially serious oral infection which considered to be different clinical stages of the same process. These have been collectively referred to as: Vincent's infection, infectious oral necrosis, or necrotizing gingivostomatitis(NG). Prevalence of necrotizing gingivostomatitis is $0.19{\sim}0.5%$ and peak incidence is 2-6 years of age. The etiology and pathogenesis of necrotizing gingivostomatitis have been associated with virulent bacteria and impaired host defense and the primary diagnostic signs are pain, interdental ulceration or necrosis, and gingival bleeding. Secondary diagnostic sign is pseudomembrane. This case report was about oral conditions and treatment of the patient who referred from the Dept. of PED and diagnosed a necorotizing gingivostomatitis.

• Journal of Oral Medicine and Pain
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• v.31 no.1
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• pp.27-36
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• 2006

The cases of unidentified individual remains submitted to Forensic dentistry section in National Institute of Scientific Investigation, Korea were analyzed to study the application of forensic dental identification into individual identification in the period 2002-2005. The identification cases of unidentified remains were 405 out of 493, which accounted about 82% of whole cases. The incidence of submission of skeletons at least including the skull was increased from 58% in 2002 to 80% in 2005. The numbers of cases for the full examinations were 4 times more than that for age estimation in 2005. Twenty-four cases were submitted for skull to photographic superimposition and 15 out of 24 cases were examined, and the other 9 cases were examined by DNA analysis only. The submitted cases for dental comparison were 23 cases, 9 cases were positively identified, 4 cases were possible, 7 cases were excluded, and 3 cases ended up with insufficient evidences. The proportion of positive identification by dental methods was increased gradually from 9% in 2002 to 46% in 2005. Forensic dental identification has become important and useful because the availability of dental records and radiographs has been increasing. Compared to DNA analysis, forensic dental identification has several advantages such as no needs for high cost equipments and low expenses. And the interpretation of results is straightforward and speedy. These advantages are based on using primary their own dental records of the individuals rather than secondary DNA reference samples from family members. The application of the forensic dental identification to unidentified individual remains will be increased because the dental comparison can complement the limitation of DNA analysis and skull to photographic superimposition in many cases. In order to obtain positive identifications of unidentified remains, a close collaboration between the police and forensic scientists is important. The systemic approach including legislation to preserve dental records of unidentified remains and missing persons for the identification of unidentified remains should be needed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.4
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• pp.283-309
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• 2021

Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was "What will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients with irreversible pulpitis in human mandibular molars?" We searched electronic databases, including Pubmed, Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis. In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88 (95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34). These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success rate. L'Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.5
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• pp.357-367
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• 2022

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 ㎍/kg for 4 min for induction, followed by maintenance of 0.4 ㎍/kg/h. Group F received an infusion of fentanyl 1 ㎍/kg over 4 min for induction, followed by maintenance at 1 ㎍/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

• Restorative Dentistry and Endodontics
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• v.7 no.1
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• pp.41-45
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• 1981

A 19-year-old Korean woman presented with left mandibular dental pain and swelling. Periapical radiolucencies were associated with the mandibular left first molar, second molar and the mandibular right second molar. The mandibular right second molar root developed incompletely and has the open apex. Clinical examination revealed worn accessory occlusal cusps of premolars. A diagnosis of dens evaginatus with associated periapical lesion secondary to pulpal necrosis was made. The root canal of the lower right second premolar was sealed with Calcium hydroxide paste for apexification. About two months later Calcium hydroxide paste was removed and the canal was resealed with new Calcium hydroxide paste. After four months the canal was sealed permanently with guttapercha and zinc oxide-eugenol sealer. The root canals of the lower left premolars were irrigated every week with 3.5% NaOCl solution for and half month. And the canals were sealed with gutta-percha and ZOE sealer. Preventive endodontic treatment for the lower right first premolar was undertaken.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.84-89
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• 2012

The radicular cyst is the most common odontogenic cyst which is caused by pulpal inflammation, pulp death, and secondary to trauma or dental caries. Usually, the radicular cyst is asymptomatic, but a secondary inflammation can cause pain, swelling and redness. Getting larger, the radicular cyst can cause facial asymmetry and paresthesia by pressure on nerves. It requires conservative endodontic treatment or surgical approach. When the size of cyst is large or invasion of the adjacent tissue is not expected, cyst enucleation is carried out. And most of the case can be completely cured and shows low recurrence. In these radicular cysts cases, by cyst enucleation or apicoectomy after root canal treatment simultaneously, the infected teeth can be preserved successfully.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.3
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• pp.265-269
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• 2010

Radiation therapy for malignancy of head and neck leads to secondary effects, such as mucositis, xerostomia, dental caries and osteoradionecrosis. Osteoradionecrosis is a delayed complication which causes chronic pain, infection and constant deformity after necrosis. It occurs spontaneously or after primary oncologic surgery, dental extraction or by trauma of prosthesis. To reduce the incidence of osteoradionecrosis, appropriate antibiotic usage, atraumic procedure, tension-free primary suture and hyperbaric oxygen therapy are essential. This case is about a 74 years old woman who was treated for osteoradionecrosis after extraction of right lower molar at year 2006. She had received radiation therapy for angiosarcoma on tongue at year 2004. At year 2008 the patient came to our hospital for extraction of the opposite premolar but despite careful treatment, osteoradionecrosis occurred again. She was successfully treated by surgical procedure so we report this case.

• Journal of Periodontal and Implant Science
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• v.47 no.4
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• pp.211-218
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• 2017

Purpose: The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. Methods: Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. Results: The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. Conclusions: The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic long-term periodontitis without treatment should be urged to undergo a TMJ examination.