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Damage to the pilot balloon of the nasotracheal tube during orthognathic double-jaw surgery: A case report.

Eun Jung KIM ; Ji Young YOON ; Mi Na WOO ; Cheul Hong KIM ; Ji Uk YOON ; Da Nee JEON

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):101-103. doi:10.17245/jdapm.2015.15.2.101

In oral and maxillofacial surgery, many complications associated with nasotracheal tube can be caused. In this case, we reported ballooning tube damage of nasotracheal tube during orthognathic double-jaw surgery and replacement of tube through cut down of tube and tube exchange using airway exchange catheter. The patient scheduled for high Le Fort I osteotomy and bilateral sagittal split osteotomy was intubated nasotracheally with nasal endotracheal tube. During maxilla osteotomy, air bubble was detected in the oral blood. In spite of our repeated ballooning, the results were the same so we changed damaged tube using airway exchange catheter aseptically. Tiny and superficial cutting site was detected in the middle of pilot tube. As we know in our case, tiny injury impeded a normal airway management and prevention is important.
Airway Management ; Catheters ; Humans ; Intubation ; Maxilla ; Orthognathic Surgery ; Osteotomy ; Surgery, Oral

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The surgical retrieval of a broken dental needle: A case report.

Jiseon LEE ; Min Woo PARK ; Min Keun KIM ; Soung Min KIM ; Kwang Suk SEO

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):97-100. doi:10.17245/jdapm.2015.15.2.97

One complication related to local anesthesia in the dental clinic is a broken needle. Although rare, a broken needle may be difficult to retrieve. Dental radiographs and 3D CT have been used in the past to confirm the location of a broken needle. We present the case of a broken needle, which was successfully removed using a careful, microscopic approach.
Anesthesia, Local ; Dental Clinics ; Needles*

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Diplopia after inferior alveolar nerve block: case report and related physiology.

Tae Min YOU

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):93-96. doi:10.17245/jdapm.2015.15.2.93

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.
Anesthesia ; Blindness ; Dental Clinics ; Diplopia* ; Enophthalmos ; Humans ; Mandibular Nerve* ; Miosis ; Mydriasis ; Physiology* ; Reflex

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Reliability and validity of the Korean version of the Dental Fear Survey.

Ah Hyeon KIM ; Youn Soo SHIM ; So Young PARK ; Hee Won KIM ; So Youn AN

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):85-92. doi:10.17245/jdapm.2015.15.2.85

BACKGROUND: Many people experience varying levels of discomfort when confronted with the prospect of dental treatment. Dental treatment can be a traumatic experience, especially for children and adolescents with dental anxiety. In this age group, dental fear causes a significant problem in dental management and has been related to severe dental caries and dental pain. The Dental Fear Survey ( DFS ) is the most widely used measure of dental fear. This study was undertaken to develop the Korean version of the DFS ( K-DFS ) and test its reliability and validity. METHODS: The K-DFS, which uses projective techniques to measure children's and adolescents' dental fear, was developed. The DFS was translated into Korean and participants were selected via convenience sampling. Reliability and validity were tested using data from a sample of 813 middle school students in Gyeonggi Province, selected from the Self questionnaire survey. The K-DFS was administered twice to 102 adolescents aged 12-15 years. RESULTS: The K-DFS had high internal consistency reliability (99.1%) but low test-retest reliability. CONCLUSIONS: The results indicate that the Korean versions of the DFS have good internal consistency reliabilities and test-retest validities. However, we need to further examine the test-retest reliability of the K-DFS and replicate the current study in different samples covering various age groups.
Adolescent ; Anxiety ; Child ; Dental Anxiety* ; Dental Caries ; Gyeonggi-do ; Humans ; Projective Techniques ; Reproducibility of Results*

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Emergency response team activation in the outpatient clinic of a single dental teaching hospital in Korea: a retrospective study of 10 years' records.

Sang Woon HA ; Yoon Ji CHOI ; Soo Eon LEE ; Seong In CHI ; Hye Jung KIM ; Jin Hee HAN ; Hee Jeong HAN ; Eun Hee LEE ; Hyun Jeong KIM ; Kwang Suk SEO

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):77-83. doi:10.17245/jdapm.2015.15.2.77

BACKGROUND: To prepare for possible emergency situations during dental treatment, it is helpful to know how often and what kinds of emergencies may arise. This study set out to evaluate the incidences, causes, treatments, and outcomes of emergency situations in the outpatient clinic of a dental teaching hospital in Korea. METHODS: We retrospectively reviewed the records of patients who had experienced an emergency situation and emergency response team activated in a selected outpatient clinic between November 2004 and November 2013. Specific information about the emergency cases was collected, including the patient characteristics and the frequency, types, treatments, and outcomes of the emergency situations. RESULTS: We identified 35 instances of emergency situations in 2,890,424 patients (incidence = 0.012 per 10,000 outpatients). The number of cases was as follows: 10 (28.6%) in the Department of Periodontics, 10 (28.6%) in the Department of Oral and Maxillofacial Surgery, 6 (17.1%) in the Department of Oral and Maxillofacial Radiology, 4 (11.4%) in the Department of Prosthodontics, 2 (5.7%) in the Department of Conservative Dentistry, 2 (5.7%) in the Department of Pediatric Dentistry, and 1 (2.9%) in the Department of Orthodontics. Three (8.6%) of the emergency situations arose before treatment, 22 (62.9%) during treatment, 7 (20.0%) after treatment, and 2 (5.7%) in a patient's guardian. CONCLUSIONS: In accordance with the growing elderly population and more aggressive dental procedures, the number of emergency situations may increase in the future. We recommend that clinicians keep in mind airway management and the active control of emergency situations.
Aged ; Airway Management ; Ambulatory Care Facilities* ; Dentistry ; Emergencies* ; Emergency Medical Services ; Hospital Rapid Response Team ; Hospitals, Teaching* ; Humans ; Incidence ; Korea* ; Orthodontics ; Outpatients* ; Pediatric Dentistry ; Periodontics ; Prevalence ; Prosthodontics ; Retrospective Studies* ; Surgery, Oral

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The efficacy of an elevated concentration of lidocaine HCl in impacted lower third molar surgery.

Bushara PING ; Sirichai KIATTAVORNCHAROEN ; Chavengkiat SAENGSIRINAVIN ; Puthavy IM ; Callum DURWARD ; Natthamet WONGSIRICHAT

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):69-76. doi:10.17245/jdapm.2015.15.2.69

BACKGROUND: There have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar. METHODS: This single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation. RESULTS: We recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different. CONCLUSIONS: Our study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.
Anesthesia ; Epinephrine ; Humans ; Lidocaine* ; Mandibular Nerve ; Molar, Third* ; Single-Blind Method ; Volunteers

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Advantages of anterior inferior alveolar nerve block with felypressin-propitocaine over conventional epinephrine-lidocaine: an efficacy and safety study.

Hazuki SHINZAKI ; Katsuhisa SUNADA

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):63-68. doi:10.17245/jdapm.2015.15.2.63

BACKGROUND: Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. METHODS: Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. RESULTS: The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was 233 ± 37 min, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). CONCLUSIONS: The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain.
Anesthesia ; Bicuspid ; Epinephrine ; Felypressin ; Humans ; Incisor ; Lidocaine ; Mandible ; Mandibular Nerve* ; Molar ; Nerve Block

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Dental fear & anxiety and dental pain in children and adolescents; a systemic review.

Youn Soo SHIM ; Ah Hyeon KIM ; Eun Young JEON ; So Youn AN

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):53-61. doi:10.17245/jdapm.2015.15.2.53

BACKGROUND: There are few previous studies investigating the relationship of dental fear and anxiety (DFA) with dental pain among children and adolescents. To address this issue, we examined the literature published between November 1873 and May 2015 to evaluate the prevalence of DFA and dental pain among children and adolescents, and their relationships with age and sex. METHODS: We performed a broad search of the PubMed database using 3 combinations of the search terms dental fear, anxiety, and dental pain and prevalence. A large proportion of the identified articles could not be used for the review due to inadequate end points or measures, or because of poor study design. Thirty-two papers of acceptable quality were identified and reviewed. RESULTS: We found that the prevalence of DFA was estimated to be 10%, with a decrease in prevalence with age. It was more frequently seen in girls, and was related to dental pain. CONCLUSIONS: We concluded that dental fear, anxiety, and pain are common, and several psychological factors are associated with their development. In order to better understand these relationships, further clinical evaluations and studies are required.
Adolescent* ; Anxiety* ; Child* ; Dental Anxiety* ; Female ; Humans ; Prevalence ; Psychology

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Considerations for submucosal midazolam administration in combination with oral and inhaled medications for sedation of pediatric dental patients.

Kwangwoo BAEK

Journal of Dental Anesthesia and Pain Medicine.2015;15(2):47-52. doi:10.17245/jdapm.2015.15.2.47

Sedation allows patients to maintain their airway independently and respond appropriately to physical stimulation and verbal command while maintaining a minimum depressed level of consciousness. Drugs commonly used for sedation of pediatric dental patients include a combination of chloral hydrate, hydroxyzine, and nitrous oxide-oxygen. Midazolam is a benzodiazepine and currently one of the most commonly used intravenous sedative agents. It can be easily titrated to provide a wide range of sedation, from conscious sedation to deep sedation, and exhibits a wide safety margin without severe respiratory and circulatory depression. At an appropriate dose, it also decreases patient anxiety and induces amnesia. We found that the submucosal administration of midazolam combined with chloral hydrate provided increased sedative effects and decreased the postoperative vomiting response compared with conventional chloral hydrate administration, with no significant difference in physiological responses. The depth of sedation can be titrated using this technique.
Amnesia ; Anxiety ; Benzodiazepines ; Chloral Hydrate ; Conscious Sedation ; Consciousness Disorders ; Deep Sedation ; Depression ; Humans ; Hydroxyzine ; Hypnotics and Sedatives ; Midazolam* ; Pediatric Dentistry ; Physical Stimulation ; Postoperative Nausea and Vomiting

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Dental treatment under general anesthesia in an intellectually disabled child with intellectually disabled parents.

Jeong Hwa HAN ; Hong Keun HYUN ; Young Jae KIM ; Jung Wook KIM ; Ki Taeg JANG ; Chong Chul KIM ; Sang Hoon LEE ; Teo Jeon SHIN

Journal of Dental Anesthesia and Pain Medicine.2016;16(3):213-216. doi:10.17245/jdapm.2016.16.3.213

Children with an intellectual disability often demonstrate lack of cooperation during dental treatment and require behavioral management. A child with mild intellectual disability can be managed adequately using restraints and medication. However, in cases of profound intellectual disability, dental treatment under general anesthesia is usually required. In cases where the patient is an intellectually disabled child who has intellectually disabled parents, it is difficult to evaluate the patient's preoperative condition and to obtain consent for treatment under general anesthesia. Furthermore, they are unable to respond to emergencies after treatment. Therefore, dental treatment should be performed under general anesthesia with hospitalization for children with an intellectual disability. This case presents the dental treatment of an intellectually disabled child, who has intellectually disabled parents, and who required general anesthesia and hospitalization.
Anesthesia, General* ; Child ; Dental Care for Disabled ; Disabled Children* ; Emergencies ; Hospitalization ; Humans ; Intellectual Disability ; Parents*

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