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Medication related osteonecrosis of the jaw is a heterogeneous clinical entity with common pathology features and their diagnosis and management remains a dilemma for many clinicians. During the current SARS-CoV-2 virus pandemic, an extensive therapeutic arsenal is being used that includes traditional immunosuppressive and repurposed drugs, so it is important to understand their possible adverse effects. We describe the diagnosis, clinical course, and management of a 65-year-old female patient undergoing previously intravenous bisphosphonates (BPs) therapy and recently was treated with corticosteroid for the prevention of multi-inflammatory syndrome during the course of COVID-19. In this context, possible pathophysiological links between osteonecrosis of the jaw and medication used to treat non-severe COVID-19 infection are discussed. It should be underlined that osteonecrosis of the jaw unrelated to BPs may be a rare complication associated with concomitant corticotherapy. This case highlights the need for rapid dissemination of clinical information related to the multidisciplinary care of patients with COVID-19 who were managed by corticosteroids.

Objective. This study examined the potential use of computed tomography panoramic mandibular indices on cone beam CT (CBCT) for assessing bone density in postmenopausal women with low bone mass. Study design. The study enrolled 104 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen region CBCT alongside the NewTom VGi EVO Cone Beam 3D system. We assessed the relationship between the following DXA parameters: lumbar, femoral neck, and total hip T score, bone mineral density (BMD), and lumbar trabecular bone score (TBS). The following panoramic mandibular indices were also considered: the computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)), and computed tomography mental index (CTMI). Results. The study revealed moderate correlations between CBCT indices and BMD/TBS scores: CTMI showed the highest correlation with the femoral neck T-score (r = 0.551, p < 0.0001). TBS scores were also moderately correlated with CBCT indices: CTMI showed a moderate positive correlation with TBS (r = 0.431, p < 0.0001); CTI(S) had a similar moderate positive correlation with TBS (r = 0.421, p < 0.0001). AUC values ranged from 0.697 to 0.733 for osteoporosis versus the osteopenia/normal group and from 0.734 to 0.744 for low versus normal bone quality groups, p < 0.0001. The comparison of the values of the studied indices between low versus normal bone quality (quantified with TBS) groups showed high sensitivity but low specificity. Conclusions. CBCT-measured indices CTI(S), CTI(I), and CTMI are useful in assessing patients with low bone mass to improve, by specific treatment, the prognosis of dental implants.

Background: As implant treatment cases increase, many cases of failure/side effects also occur. Generally, dental clinics determine the density of the jawbone using cone beam CT (CBCT). Considering the known potential role of this tool for bone assessment in primary osteoporosis, this study evaluated patients with secondary endocrine causes of low bone mass. Methods: The study included 83 patients with endocrine causes of osteoporosis who were evaluated by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and mental foramen (MF) region CBCT. The following CBCT indices were measured: anterior (A)—thickness of inferior mandibular cortex 10 mm anterior from MF; molar (M)—thickness of inferior mandibular cortex 10 mm posterior from MF; posterior (P)—thickness of inferior mandibular cortex 25 mm posterior from MF; symphysis (S)—thickness of inferior mandibular cortex equidistant from the centers of right and left MF. Results: The highest correlation coefficient in the secondary causes group was between the A index and the lumbar BMD (r = 0.375, p = 0.001) and the P index and the femoral neck BMD (r = 0.38, p = 0.001). Hypercortisolism seems to be the most predictable cause of secondary osteoporosis using the A, M, and P indices. The A, M, and P indices showed predictive values of the bone micro-architecture that was evaluated using TBS score, and were statistically significant. The symphysis index does not significantly predict osteoporosis or impaired bone micro-architecture. Conclusions: These findings support the potential usefulness of A, M, and P CBCT-derived radiomorphometric mandibular indices in secondary osteoporosis, underlining the well-known effects of these pathologies on bone micro-architecture rather than bone quantity.

Aim of the study The use of nitrous oxide/oxygen conscious sedation in American Society of Anesthesiologists (ASA) II dental patients has been regarded as controversial. The aim of this study was to investigate cardiovascular effects of nitrous oxide-oxygen mixture conscious sedation in ASA II patients undergoing tooth extraction. Material and methods The purpose of this study was to determine differences in heart rate (HR) and blood pressure (BP), comparing nitrous oxide/oxygen with no sedation in a sample of ASA II patients. Physiologic parameters measured were heart and respiratory rate, systolic and diastolic blood pressure and oxygen saturation. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results Results did not indicated differences for any physiologic parameters, including heart rate and diastolic blood pressure. Significant differences across procedures were found for systolic blood pressure. Conclusions Although the effects of nitrous oxide/oxygen may not be statistically significant, generally it produces an attenuation in physiological responses as measured under the conditions of this study in ASA II patients.

Aim of the study Patients with comorbidities have often difficulties tolerating in-office dental treatment; therefore, they often require sedation to facilitate dental treatment. When deciding on dental treatment under sedation, the plan should be carefully determined because compared to general patients, ASA Class II patients are more likely to experience complications because of their underlying medical conditions and potential drug interactions. The purpose of this study was to evaluate the Ramsay Sedation Score on nitrous oxide-oxygen mixture conscious sedation in a sample of ASA II patient’s. Material and methods 114 ASA II patients scheduled for elective tooth extraction under local anesthesia were enrolled in this randomized controlled trial. The patients were divided into two groups: the Study group – patients that agreed to receive nitrous oxide/oxygen inhalation sedation (n = 54) and the Control group (n = 60) that included patients unwilling to be sedated. Ramsay sedation scale was used to assess adequacy of sedation. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results There was significant difference after surgery between patients exposed to nitrous oxide/oxygen inhalation sedation and the control group. Conclusions The results of this study show that nitrous oxide/oxygen sedation is a useful method for ASA Class II dental patients, who needs lower doses of sedative to obtain an adequate level of sedation.

Aim of the study Oral anticoagulants are effective therapies for reduction of stroke risk in patients with atrial fibrillation. However, blocking elements of the clotting cascade carries an inherent risk of bleeding. Also, anticoagulated patients sometimes require tooth extractions and other invasive procedures. The purpose of the present study was to compare the relationship between the risk factors and postoperative hemorrhage among dental patients with atrial fibrillation receiving acenocumarolum versus new oral anticoagulants users. Material and methods A sample of consecutive patients exposed to oral anticoagulants who required tooth extraction at our institution were retrospectively reviewed. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results The overall bleeding rate was higher in new anticoagulant users than in acenocumarolum users (26.72% vs 12%, p = 0.03) and similar (17.8% vs 14.1%, p = 0.129) between the two groups. There were no significant differences between atrial fibrillation patients and non-atrial fibrillation patients regarding bleeding rate. The highest rates were observed in patients with congestive cardiac failure exposed to new oral anticoagulants. Conclusions According to the results of our study, patients exposed to new oral anticoagulants had higher rates of overall bleeding events than chronic acenocumarolul users.

Aim of the study Oral anticoagulants have been used to prevent first or recurrent stroke, especially among patients with arterial fibrillation and y atherosclerotic disease. Despite the widespread use in dental patients, safety of anticoagulants are controversial. The uncertainty is due to the lack of definitive clinical data. In the present review, we have attempted to compare the relationship between the risk factors and postoperative hemorrhage after tooth extraction among patients with recent stroke receiving acenocumarolum versus new oral anticoagulants users. Material and methods This is a retrospective study of all patients exposed to oral anticoagulants who required tooth extraction treated in Clinic of Oral and Maxillofacial Surgery, Carol Davila University Bucharest – Hospital of Oral and Maxillofacial Surgery from 2019 to 2020. Clinical and operative records of all patients were retrieved and reviewed from the hospital’s medical records. All data were analyzed using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results In our study, there were no significant differences between continuous oral anticoagulation use prescribd for antecedents of stroke and bleeding rate (32.14% vs. 20.92%, p > 0,05). Additionally, post-extraction bleeding was statistically significant associated with the type of anticoagulant used among concomitant diabetes patients. Conclusions In patients with prior cerebrovascular accident, concomitant use of new oral anticoagulants was associated with increased risk of postoperative bleeding. Concomitant diabetes contribute to the risk of bleeding.

Introduction: Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass density. Materials and methods: A systematic review of the literature was performed using the PubMed and SCOPUS databases, with terms referring to low bone mass and cone-beam computed tomography (CBCT). Results: Sixteen studies were included in the review. The results show different perspectives, but the evidence favors the use of CBCT, combined with dual-energy X-ray absorptiometry bone density scan (DXA) evaluation, for the assessment of the osteoporosis status of the aging population and, more specifically, in postmenopausal women. Radiographic density (RD) values of the dens and the left part of the first cervical vertebra show the strongest correlation coefficients and the highest sensitivity, specificity, and accuracy for predicting osteoporosis (OP) in the lumbar vertebrae and the femoral neck. Conclusions: Our review suggests the potential of CBCT as a screening tool for patients with low bone mass using different radiomorphometric indices. Linear measurements of the inferior mandibular cortex were lower in osteoporotic individuals, indicating the perspective of CBCT also as a diagnostic tool for this disease.

Sebaceous adenoma is an extremely rare tumor located in the parotid gland. In the English literature, less than 10 cases have been reported. Sebaceous adenoma represents 0.5% of all monomorphic adenomas. The authors are presenting a case of sebaceous adenoma of the parotid gland in a 65-year-old female who presented a mass on the left parotid area that had been gradually enlarging for one year without symptoms of pain. On imaging (ultrasound), a well-defined mass lesion in the left parotid area was seen. Histopathological findings were consistent with sebaceous adenoma. Surgical excision is curative. The prognosis is excellent, with a low recurrence rate. The present case report will increase the awareness and possibility of this rare tumor occurring at an unusual site, thereby avoiding any chance of misdiagnosis.