Bone
Joseph Kovi, Hung Dinh Duong in Frozen Section In Surgical Pathology: An Atlas, 2019
A 40-year-old man visited his dentist because of a painless swelling in his jaw of 6 months duration. The patient was referred to dental surgery. On palpation, a hard mass was felt in the angle of the mandible on the right side. Radiographs of the mandible revealed a mul-tilocular radiolucent lesion. A biopsy was performed and frozen section examination requested. Microscopically, varying sized epithelial islands were noted embedded in a loose, fibrous stroma. The central portion of the epithelial nests was made up of a loose network of fusiform cells, resembling the so-called stellate reticulum of the developing tooth bud. » The outermost layer of the epithelial islands consisted of a single row of tall, columnar cells, the nuclei of which were polarized away from the distinct basement membrane. These cells were similar to those found in the ameloblastic layer of the developing tooth follicle. Cystic degeneration of the central stellate reticulum was common (Figures 77 and 78).
Using the placebo effect
Michael Dixon, Kieran Sweeney, Sir Denis Pereira Gray in The Human Effect in Medicine, 2017
There has also been a lot of research showing a marked and complex placebo effect in pain relief. For instance a double-blind trial on patients with pain from bony metastases showed that placebo was effective for 57% of patients with a mean improvement of 30–40%. The improvement was maintained after the seven-day treatment and it was found that responders tended to be younger than non-responders.27 A study on pain following dental surgery compared ultrasound therapy, mock ultrasound therapy and self-massage. Self-massage (e.g. no treatment group) showed no improvement, but placebo ultrasound showed a beneficial analgesic and anti-inflammatory effect – equal to that of real ultrasound. In particular facial swelling, trismus, pain and C-reactive protein were all reduced significantly.28 In a similar study, placebo TENS was given following appendicectomy was shown to be as effective as active TENS. The placebo provided a significant decrease in both pain severity and anal-gesic intake. It is interesting to note that having proved that placebo TENS was effective, this paper in the Annals of the Royal College of Surgeons concluded that `its use in this situation cannot be recommended’. In the name of ethical and intellectual honesty, we feel obliged to offer our patients treatments, which may sometimes be more expensive and harmful than placebos that work as well.
Historical Perspective
Gwyn Bevan, Harold Copeman, John Perrin, Rachel Rosser in Health Care, 1980
B, d, e and f show that in terms of treatment the population was served more intensively by the NHS in 1977 than in 1949, but the proportion of people on the waiting list – c – was virtually the same. Surgical specialties (including gynaecology) account for most of patients waiting for treatment (85 per cent of the total list in 1949 and 95 per cent in 1973). The weighted average time for these specialties initially declined from 117 days in 1949 to 76 days by 1956 and stood at 71 days in 1973. Within this group in 1973 the longest average waiting times were for plastic surgery (268 days), ENT (146 days) and dental surgery/orthodontics (110 days).2 There has been more efficient and intensive use of resources: these are indicated by reductions in the number of beds – a – and by reductions in length of stay (see later in this chapter). But the reduction in numbers of beds is largely due to closing of beds for tuberculosis and the mentally ill, and the reduction of the average length of stay seems to have flattened out. There may not be much scope for further savings or for significant further reductions in the length of stay. But the core of the problem is that since demand for health care is not self-limiting, but open-ended, increases in supply and/or more efficient use of resources will not in many cases remove excess demand.
Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis
Published in Annals of Medicine, 2018
Baoxin Ma, Jingwu Sun, Shuling Diao, Bo Zheng, Hua Li
Our analysis had some limitations. First, although 12 studies were included in our meta-analysis, the total number of participants was still small. Second, various types of surgery, such as vascular, urological and dental surgery, were performed in all studies. We performed subgroup analyses based on the type of surgery, but we were unable to draw a precise conclusion about the impact of the type of surgery on postoperative outcomes because of the limited number of included studies. Another limitation was that varying doses of two different intervention drugs (atorvastatin and rosuvastatin) were employed in the studies included in our meta-analysis. Because the number of included participants was small, we could not perform subgroup analyses to assess the effects of different types and doses of statins on outcomes.
Hypnosis as Sole Anesthesia for Dental Removal in a Patient with Multiple Chemical Sensitivity
Published in International Journal of Clinical and Experimental Hypnosis, 2020
Mauro Cozzolino, Giovanna Celia, Kathryn L. Rossi, Ernest L. Rossi
Dental surgery is particularly suited for hypnosis because of the high levels of anxiety and pain usually involved in the procedure. In fact, clinical hypnosis can allow dentists and patients to replace such discomfort with confidence and comfort (Rucker, 2018). Moreover, recent research shows that hypnosis is an effective pain relieving method during and after dental procedures and can also bring about physical and psychological changes such as hemodynamic alteration, an increased pain threshold, and activity changes in specific areas of the brain (Abdeshahi et al., 2013; Dilmahomed & Jovani-Sancho, 2018; Facco et al., 2013). In particular, it was found that hypnosis as a sole therapy can increase the patient’s pain threshold with special regard to low pain procedures, whereas when used as an adjunct to local anesthesia, it reduces postoperative analgesic pain, improves general discomfort, and reduces anxiety levels in patients (Dilmahomed & Jovani-Sancho, 2018).
Risk of bleeding with dental implant surgery in patients on anticoagulant or antiplatelet drugs: a systematic review and meta-analysis
Published in Acta Odontologica Scandinavica, 2023
Lilin Zou, Li Hua
Much research has been conducted on the bleeding risk with dental surgery in patients under OAC or AP therapy. However, most of it has been focussed on dental extraction as it is the most common minor oral surgical procedure [7,8]. Shi et al. [7] in a recent meta-analysis of 12 studies have indicated that the risk of bleeding is greater in anticoagulated patients undergoing minor oral surgery as compared to healthy controls. The majority of studies in their review were on dental extraction with just four studies focussing on dental implants. In another study, Bajkin et al. [9] have reviewed the literature on bleeding tendencies after implant placement in anticoagulated patients but no meta-analysis was conducted in their review. Despite the widespread use of OAC and AP drugs as well as dental implantation procedures in the general population, it is still not clear how these medications influence the risk of bleeding following surgical placement of a dental implant. There is a need for evidence on the risk of bleeding with AP, OAC, different types of OAC (Vitamin K antagonists [VKAs] and direct oral anticoagulants [DOACs]), and between AP vs. OAC to guide clinical practice. Thus, this study aimed to conduct a systematic literature search and pool evidence on the risk of bleeding in patients under AP and OAC therapy undergoing dental implant surgery.
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