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Dentistry during COVID-19: Engineering analysis offers guidelines to reduce exposure

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Extraction with an electric motor-driven handpiece may still cause subcutaneous emphysema – A case report
Subcutaneous emphysema (SE) in the head and neck region is a rare iatrogenic complication from oral surgery, restorative dentistry, endodontic, and periodontal treatments.1,2 The air-driven air- turbine handpiece was responsible for most SE events. Patients with SE show noticeable swelling and discomfort where air has penetrated into subcutaneous tissue. Differential diagnosis of SE from anaphylactic reactions or angioedema is crepitus on palpation and timing. In severe cases, SE can spread and cause respiratory or cardiac distress.3 However, most SE cases resolve within 3–5 days without complications.
This article reported a case of SE around the paraorbital and submandibular regions through extractions of teeth 28 and 38. This 20-year-old man came to the emergency room at night with the major complaint of pain and discomfort during swallowing. Sudden swelling at his left face during extractions of teeth 28 and 38 three hours ago was mentioned. The original surgeon who performed the odontectomy was aware of the SE after removing the surgical drape and specific post-operation instructions were given as follows: immediate hospital care may be needed if the patient encountered difficulties in swallowing or any worsen complications or discomfort. The surgeon was uncertain whether using the electric motor-driven handpiece during tooth extraction was the main cause of SE. Lacking the ability to differentiate between difficulties in swallowing or post-operation discomfort, the patient decided to visit our hospital for further help. Physical examination revealed that everything was within normal range, except the swelling at the left paraorbital and submandibular regions with typical crepitus on palpation and minor discomfort. Thus, the SE during and after teeth extraction was diagnosed (Fig. 1A). Both the left upper and lower extraction wounds were primarily closed with sutures, no sign of inflammation or swelling was noted at either the tonsil or lingual area, and hemostasis was obtained. Panoramic radiograph showed no obvious jawbone lesion (Fig. 1B). The patient was kept under observation for 1.5 h and then granted permission to leave due to absence of further complications. Oral administration of 1 tablet of amoxicillin/clavulanic acid (875/125 mg/tablet, Curam®) every 12 h, 1 tablet of diclofenac potassium (25 mg/tablet, Cataflam®) three times a day, and dexamethasone (0.5 mg/tablet, Dexazone®) three times a day were prescribed to the patient for 3 days. Patient was later followed at the previous surgeon’s local dental clinic after 3 days and signs and symptoms of SE were resolved.
Figure 1. Clinical and radiographic photographs of the patient. (A) Extra-oral appearance of the patient showing the swelling at the left paraorbital and submandibular regions during and after extractions of teeth 28 and 38. (B) Panoramic radiograph showing intact lamina dura of the extraction sockets and no obvious jawbone lesion.
Tooth extraction-related SE is often caused by using air-driven/air-turbine high speed handpiece. Although some suggestions were raised for preventing extraction complications,4 using electric-driven, sonic/ultrasonic or non-vented high-speed devices for surgical extraction is the best method preventing the occurrence of SE.5 In this case, even though electric motor driven handpiece was used, SE still occurred. That was probably caused by the air from the water-cooling system of the handpiece (from the dental unit) which the surgeon did not notice. This issue was later confirmed by him. It is better to check if there is extra air vented forward from the handpiece before using a new device. By giving antibiotic, analgesic, and corticosteroids, SE can be effectively managed without the need for surgical intervention, but prevention is still the best policy.
#idscologne
IDS 2021: VDDI and Koelnmesse postpone the International Dental Show from March until autumn 2021
Decision to give exhibitors and visitors more planning security
With a view to the unchanged challenges the Corona pandemic is raising in Germany and the anticipated continuation of the extensive restriction of personal contacts by the Government, States and municipalities at the beginning of the new year, the VDDI board, the Gesellschaft zur Förderung der Dental-Industrie mbH (GFDI) (the commercial enterprise of the VDDI) and Koelnmesse have decided to postpone IDS – the International Dental Show. The trade fair that was originally planned to take place from 10 to 13 March, will now be held from 22 to 25 September 2021. The organisers are taking this step in reaction to the currently ongoing Corona policy, which may be extended in Germany into the new year. By postponing the 39th edition of IDS to the September, the organisers are hoping that due to the then anticipated, improved health situation and relaxation of the travel restrictions more international partners and customers will travel to Cologne.
The presently essential political decisions taken by the Federal Government are also affecting trade fairs in Germany. And are also impacting IDS. It will thus be staged in September with the new trade fair concept that was planned for March, which unites hybrid, i.e. physical and digital elements. The #B-SAFE4business concept that is based on the applicable Corona Protection Ordinance will also accompany IDS in September in order to offer the exhibitors and visitors the highest possible level of safety. "The Association of the German Dental Industry and Koelnmesse have kept a close eye on the developments of the pandemic at all times and have analysed the possible consequences on the trade fair activities of all personal involved. The health of our exhibitors, partners and visitors takes top priority for us here. After assessing the current facts, we have had to refrain from staging IDS in March and are postponing the always successful dental show to the autumn of next year," is how Mark Stephen Pace, Chairman of the VDDI and Oliver Freser, Chief Operating Officer of Koelnmesse GmbH, explained the decision.
More planning security: Dental industry to be united again at IDS in Cologne after two and a half years
The exhibitors now have six months longer to prepare their presence at the leading global trade fair and push innovations. The dental industry will meet up again in the exhibition halls in Cologne after two and a half years: This decision will enable the exhibitors and visitors to engage in a physical and personal exchange live again and experience the pronounced community principle, which has distinguished the dental industry for decades. The prospect of a strong and economically attractive re-start after the Corona pandemic thus exists.
About IDS
IDS (International Dental Show) takes place in Cologne every two years and is organised by the GFDI Gesellschaft zur Förderung der Dental-Industrie mbH, the commercial enterprise of the Association of German Dental Manufacturers (VDDI) and is staged by Koelnmesse GmbH, Cologne.
Prim Dent J
Aims: This systematic review aims to identify and synthesise available evidence to determine the clinical and radiographic outcomes of REP involving any disinfection irrigant together with a non-antibiotic intracanal medicament.
Methods: Experimental and observational studies evaluating the outcomes of REP in immature non-vital permanent teeth in 6-16 year olds, where the protocol used any type of disinfectant irrigant together with a non-antibiotic intracanal medicament (non-setting calcium hydroxide) were included. Data was narratively synthesised and presented in respect to the primary outcome (elimination of symptoms and infection) and secondary outcomes (increase in root length/width; positive response to vitality testing; patient-reported outcomes; adverse effects).
Main findings: 1628 studies were identified, of which five met the eligibility criteria for inclusion in the review. Studies included one randomised control trial and four observational studies. All five studies showed an absence of clinical signs and symptoms for all teeth postoperatively with radiographic resolution or absence of pathology following the disinfection stages of the REP used. Choice of secondary outcomes were inconsistent but included further root development, coronal discolouration and root canal calcifications postoperatively. There was a high risk of bias in all five studies and subsequently the quality of the evidence base was judged to be low.
Principle conclusions: REP using a non-antibiotic disinfectant approach appears capable of providing satisfactory outcomes for a non-vital immature permanent tooth. Further high-quality research is required before solid recommendations towards clinical practice guidelines for the disinfection portion of REP can be implemented.