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Objectives: To compare the accuracy of digital and film panoramic radiographs for determining (1) the position and morphology of mandibular third molars before surgical removal and (2) the prevalence of dental anomalies and pathologies., Methods: Three hundred and eighty-eight third mandibular molars were available for examination. Position and morphology of third molars observed on film radiographs and on digital panoramic images from five systems (DenOptix, DigiDent, Digora, Dimax2 and Orthophos Plus) were recorded by two observers and were compared with surgeons' findings at the time of the operation (gold standard). One observer further recorded the prevalence of dental anomalies and pathologies on both imaging modalities., Results: Few differences were found between the digital and film-based panoramic systems in the assessment of accuracy of position and morphology of mandibular third molars. The prevalence of dental anomalies and pathologies determined with the two modalities was roughly similar., Conclusion: The five digital panoramic systems evaluated in this study were equally as useful for third molar treatment planning and diagnosis of dental anomalies and pathologies as conventional film-based panoramic radiographs.

Objectives: The purpose was to evaluate image quality of two solid-state (charge-coupled device (CCD)) and three photostimulable phosphor (PSP) plate digital panoramic systems, and to assess their utility for treatment planning before mandibular third molar removal., Methods: 433 patients were randomly allocated to five digital systems: Dimax2 and Orthophos Plus (both CCD systems) and DenOptix, DigiDent and Digora (all PSP systems). Image quality was evaluated in six regions on a 4-point scale by three independent observers. In addition, an oral surgeon evaluated image quality in the mandibular third molar region only as well as the utility of the image for treatment planning before removal of that molar., Results: Images from the DenOptix and DigiDent systems had a significantly lower overall quality than images from the Digora, Dimax2 and Orthophos Plus systems (P < 0.005). The oral surgeon's assessment of image utility resulted in rejection rates of 0% for Orthophos Plus, 2% for Digora, 8% for Dimax2, 12% for DigiDent and 14% for DenOptix images. The rates for the DigiDent and DenOptix images were significantly higher than those for the other systems (P < 0.001), and the rate for Dimax2 was significantly higher than that for Orthophos Plus (P = 0.002)., Conclusions: The quality of DenOptix and DigiDent digital panoramic images was found to be inferior to the quality found in images obtained with the Digora, Dimax2 and Orthophos Plus systems. Images from the Digora and Orthophos Plus systems were regarded to be the most useful for treatment planning before mandibular third molar removal.

Oral and maxillofacial surgeons often deal with acute dento-alveolar trauma in hospital or practice surroundings. They are often called upon by dental colleagues to give their advice or help in a given situation of the acute trauma patient with dental or oral injuries. In this article, the practical viewpoints and clinical experiences of an oral surgeon are offered based upon many years of work in hospital emergency rooms around the world.

Gallstone induced colonic ileus is a rare disease. An enormous gallstone was found as the cause of ileus in a previously healthy ninety year-old man. A laparotomy was carried out, and a gallstone measuring 6 x 8 cm was removed from the sigmoideum in a normal looking colon. The stone had been wedged at the ligament of Told after having formed a fistula from the gallbladder to the colon. The fistula was left untouched and the patient was discharged after making a full recovery. A year later the patient developed icterus. Ultrasound examination revealed choledocus stones, which were removed by ERCP papillotomy.

The efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.

A double-blind randomized crossover analgesic trial was carried out on 70 patients undergoing surgical removal of one lower third molar at each visit. The analgesic efficacy of a two-dose regimen of the combination ibuprofen-codeine, 400 to 60 mg, was compared with ibuprofen, 400 mg. Each of the two doses was taken when the patient needed pain relief and the pain intensity was measured on a visual analog scale during the 10-hour period after the first medication. Because of carryover effects between periods 1 and 2, the analysis was carried out only for period 1 according to a parallel group design. Of the 60 patients who were evaluated for analgesic effect, the mean pain reduction of dose 1 was 63% for the 29 patients given ibuprofen-codeine and 50% for the 31 patients given ibuprofen; the mean duration of effect was 7.5 and 6.3 hours, respectively. The difference in pain reduction index (pain reduction X duration of effect) between the two treatments was significant in favor of the combination, whereas the separate variables of pain reduction and duration of effect were not significantly different. The mean pain reduction was 67% after doses 1 and 2 for patients on ibuprofen-codeine and 52% for those on ibuprofen; the mean duration of effect was 9.4 and 9.2 hours, respectively. For doses 1 and 2, the difference in pain reduction index per dose between the two treatments was significant but not the difference for the separate variables, pain reduction, and duration of effect.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficiency of a topical anesthetic occluded with Orahesive Oral Bandage was investigated. Experimental pain was provoked by needle insertions into two palatal test areas in 20 healthy subjects. Pain, estimated on a 100-mm visual analogue scale (VAS), decreased significantly from 23.5 mm to 10.5 mm at the greater palatine foramen and from 51.5 mm to 35.0 mm at the incisive foramen after application of a eutectic mixture of local anesthetics (EMLA). No significant change in pain perception was obtained after placebo application. The EMLA cream and the Orahesive Oral Bandages were well accepted by the subjects, as only two out of 20 subjects experienced slight gagging reflexes and only three considered the taste unpleasant. No other adverse reactions were observed. Occlusion of topical anesthetics seems to be a useful technique for achieving superficial mucosal anesthesia.

A laboratory test of the sharpness and penetration resistance of different brands of dental needles was undertaken. Both properties are essential when pain during injection is discussed. Using a Strograph in combination with a piece of stretched chamois leather resembling the mucous membrane, graphs were obtained for each needle tested and evaluated with reference to maximum penetration resistance at the actual point of puncture and to the smoothness of the further insertion through the leather. The findings gave a relative characteristic of each product based on a trial of 20 needles selected at random from each batch of 100 needles.

A new method is described for interferon therapy. The procedure involves immobilization of interferon with maintained activity to the surfaces of an extracorporeal perfusion chamber made from polymethylmethacrylate, having a surface area of 0.5 m2 and housing 150 ml blood. The interferon activity remains for at least 3 weeks in a chamber used in patients. Three cases of malignant melanoma, stage II, were treated for 35 to 50 h. The treatment induced increased natural killer activity against melanoma target cells (cytotoxicity index +45--65%) which lasted even after cessation of therapy. the drastic reduction in costs for this type of interferon therapy is underlined.

A double-blind, randomized trial was carried out in 90 patients to compare the analgesic and anti-inflammatory efficacy of 500 mg diflunisal twice daily with that of 25 mg codeine phosphate 4-times daily and placebo in relieving pain and swelling after surgical removal of impacted third molars. Diflunisal was found to be superior to codeine and placebo on the first post-operative day, but the difference in efficacy of the drugs had diminished by the third post-operative day. In the diflunisal group of 30 patients, 10 (33%) developed 'dry socket' or alveolitis sicca dolorosa. Only 2 patients in the codeine group and 1 patient in the placebo group developed this very painful condition. The possible explanation of 'dry socket' is discussed.