This document summarizes a study that compared the effectiveness of serratiopeptidase and dexamethasone in reducing swelling after surgical removal of impacted third molars. The study involved 100 patients randomized into two groups, with one group receiving dexamethasone and the other receiving serratiopeptidase. Facial measurements were taken preoperatively and on postoperative days 1, 2, 5, and 7. The results showed that serratiopeptidase was effective in reducing swelling from days 2 to 5, while dexamethasone was effective in reducing swelling from days 1 to 2 and also from days 2 to 5. Dexamethasone was found to be more effective than serratiopeptidase in reducing postoperative swelling
This study compared the antifungal efficacy of various endodontic irrigants, with and without the antifungal agent clotrimazole, against Candida albicans in extracted human teeth. Teeth were inoculated with C. albicans and irrigated with sodium hypochlorite, chlorhexidine gluconate, doxycycline hydrochloride, or combinations of these with 1% clotrimazole. Colony forming units were significantly lower for sodium hypochlorite and chlorhexidine alone compared to doxycycline or the control. Adding clotrimazole increased the efficacy of all irrigants, with no significant difference between sodium hypochlorite with
This article proposes a new classification system for cleft alveolus based on computed tomography (CT) scans. Existing classification systems do not use preoperative radiographic evaluation like CT scans or classify cleft alveolus separately. The authors reviewed 3000 CT scans and observed 5 types of cleft alveolus depending on the extent of involvement. The new CT-based classification aims to help surgeons better plan cleft alveolus surgery by providing a clear 3D view of the defect. It could also enhance management with technologies like 3D printing and CAD/CAM guided templates.
The document discusses a survey of 56 endodontists on their preferences for root canal obturation materials and techniques. Most endodontists still prefer traditional techniques like lateral compaction (34%) and single cone (15%) due to their simplicity. However, thermoplasticized techniques like Thermafil were also popular (28%) for their ability to provide a three-dimensional seal. Gutta percha remained the most commonly used material (65%) due to its biocompatibility and easy manipulation. Resilon was also widely used (22%) for its similar properties to gutta percha. The study aimed to understand best practices for achieving a tight seal during root canal obturation.
This document summarizes the effects of the COVID-19 pandemic on dentistry practices and procedures. It discusses how dental professionals face an increased risk of exposure due to the generation of aerosols and droplets during common dental procedures. It recommends preventive measures for dental offices such as minimizing non-emergency procedures, pre-screening patients, using personal protective equipment, disinfecting surfaces, and employing techniques to reduce aerosols like rubber dams and high-volume suction. The pandemic has led to changes in dental practices aimed at limiting transmission while still providing necessary care.
This study evaluated digital palmar dermatoglyphic patterns in patients with oral submucous fibrosis (OSMF) and oral leukoplakia. The study included 200 patients divided into 4 groups - group I had patients with oral leukoplakia, group II had patients with OSMF, group III had patients with habits but no lesions, and group IV was a control group without habits or lesions. Fingerprints and palm prints were taken digitally and analyzed qualitatively and quantitatively. The results found an increase in whorls, palmar patterns in the I2-I3 area, total finger ridge count, total triradius count, and a decrease in atd angle and a-b ridge
This document discusses a study that assessed awareness and knowledge of forensic odontology among dental professionals in India. The study found that most participants (93.5%) had studied forensic odontology basics in undergraduate studies. However, around 78.4% were unaware of preserving dental records for future forensic needs. While 75.3% understood signs of child abuse and 56.3% could document bite marks, most (77.9%) did not know that dentists can be expert witnesses. The study concludes there is a general lack of forensic odontology knowledge and practice among Indian dental practitioners.
This document discusses a study comparing the efficacy of placentrex and hydrocortisone injections as adjunct treatments for oral submucous fibrosis (OSMF). 60 patients with stage II or III OSMF were divided into two groups. Group A received placentrex injections while Group B received hydrocortisone injections over 2 months. Mouth opening and burning sensation were measured before and after treatment. Results found a statistically significant greater increase in mean mouth opening for Group B compared to Group A. Burning sensation was reduced more in Group A than Group B. Overall, hydrocortisone seemed to be more effective at improving mouth opening and mucosal health, while placentrex was better at reducing burning
The study aimed to assess healthcare professionals' knowledge of personal protective equipment (PPE) for coronavirus protection. A survey of 200 professionals found that while 80% believed PPE prevents infection, only 32% of community health workers correctly identified adequate PPE. Further, only 36% of nurses understood PPE change frequency guidelines. The study highlights knowledge gaps around PPE usage among different provider groups managing COVID-19 patients.
This study compared the antifungal efficacy of various endodontic irrigants, with and without the antifungal agent clotrimazole, against Candida albicans in extracted human teeth. Teeth were inoculated with C. albicans and irrigated with sodium hypochlorite, chlorhexidine gluconate, doxycycline hydrochloride, or combinations of these with 1% clotrimazole. Colony forming units were significantly lower for sodium hypochlorite and chlorhexidine alone compared to doxycycline or the control. Adding clotrimazole increased the efficacy of all irrigants, with no significant difference between sodium hypochlorite with
This article proposes a new classification system for cleft alveolus based on computed tomography (CT) scans. Existing classification systems do not use preoperative radiographic evaluation like CT scans or classify cleft alveolus separately. The authors reviewed 3000 CT scans and observed 5 types of cleft alveolus depending on the extent of involvement. The new CT-based classification aims to help surgeons better plan cleft alveolus surgery by providing a clear 3D view of the defect. It could also enhance management with technologies like 3D printing and CAD/CAM guided templates.
The document discusses a survey of 56 endodontists on their preferences for root canal obturation materials and techniques. Most endodontists still prefer traditional techniques like lateral compaction (34%) and single cone (15%) due to their simplicity. However, thermoplasticized techniques like Thermafil were also popular (28%) for their ability to provide a three-dimensional seal. Gutta percha remained the most commonly used material (65%) due to its biocompatibility and easy manipulation. Resilon was also widely used (22%) for its similar properties to gutta percha. The study aimed to understand best practices for achieving a tight seal during root canal obturation.
This document summarizes the effects of the COVID-19 pandemic on dentistry practices and procedures. It discusses how dental professionals face an increased risk of exposure due to the generation of aerosols and droplets during common dental procedures. It recommends preventive measures for dental offices such as minimizing non-emergency procedures, pre-screening patients, using personal protective equipment, disinfecting surfaces, and employing techniques to reduce aerosols like rubber dams and high-volume suction. The pandemic has led to changes in dental practices aimed at limiting transmission while still providing necessary care.
This study evaluated digital palmar dermatoglyphic patterns in patients with oral submucous fibrosis (OSMF) and oral leukoplakia. The study included 200 patients divided into 4 groups - group I had patients with oral leukoplakia, group II had patients with OSMF, group III had patients with habits but no lesions, and group IV was a control group without habits or lesions. Fingerprints and palm prints were taken digitally and analyzed qualitatively and quantitatively. The results found an increase in whorls, palmar patterns in the I2-I3 area, total finger ridge count, total triradius count, and a decrease in atd angle and a-b ridge
This document discusses a study that assessed awareness and knowledge of forensic odontology among dental professionals in India. The study found that most participants (93.5%) had studied forensic odontology basics in undergraduate studies. However, around 78.4% were unaware of preserving dental records for future forensic needs. While 75.3% understood signs of child abuse and 56.3% could document bite marks, most (77.9%) did not know that dentists can be expert witnesses. The study concludes there is a general lack of forensic odontology knowledge and practice among Indian dental practitioners.
This document discusses a study comparing the efficacy of placentrex and hydrocortisone injections as adjunct treatments for oral submucous fibrosis (OSMF). 60 patients with stage II or III OSMF were divided into two groups. Group A received placentrex injections while Group B received hydrocortisone injections over 2 months. Mouth opening and burning sensation were measured before and after treatment. Results found a statistically significant greater increase in mean mouth opening for Group B compared to Group A. Burning sensation was reduced more in Group A than Group B. Overall, hydrocortisone seemed to be more effective at improving mouth opening and mucosal health, while placentrex was better at reducing burning
The study aimed to assess healthcare professionals' knowledge of personal protective equipment (PPE) for coronavirus protection. A survey of 200 professionals found that while 80% believed PPE prevents infection, only 32% of community health workers correctly identified adequate PPE. Further, only 36% of nurses understood PPE change frequency guidelines. The study highlights knowledge gaps around PPE usage among different provider groups managing COVID-19 patients.
The document summarizes a study that assessed knowledge about robotics and minimally invasive robotic surgeries amongst otolaryngologists and head & neck onco-surgeons through a questionnaire. The study found that most surgeons viewed robotic surgery as the future of minimally invasive procedures due to advantages like improved visualization, precision, and reduced complications. However, many surgeons also noted that current robotics technology is not yet cost effective, requires specialized training, and more studies are needed to prove beneficial outcomes compared to traditional surgery.
This study evaluated the knowledge and concerns of 124 dentists in southern India regarding COVID-19 through a questionnaire. The results showed good knowledge of COVID-19 itself and oral manifestations, but less awareness of appropriate testing and disinfection procedures. While most dentists understood risk levels and emergency procedures, some lacked knowledge of ideal mouthwashes or managing contaminated air. Overall, the study found that while knowledge of COVID-19 was fairly good, greater education was still needed on testing, prevention and infection control practices.
The document discusses the management of oro-craniofacial abnormalities, which have increased in incidence over recent decades. A multidisciplinary team approach is needed to diagnose and treat these deformities, which usually begin at birth and may continue into a patient's 20s. Treatment involves various surgical and non-surgical procedures at different ages, with the overall goals of improving patient aesthetics, confidence, and quality of life.
This document discusses using fractal dimension analysis to detect dysplasia in oral leukoplakia. It begins by providing background on fractals and fractal dimension. The study aimed to determine if fractal dimension analysis could help detect malignant transformation in oral leukoplakia. 121 patients with oral leukoplakia had digital images taken before and after staining, which were analyzed using fractal dimension analysis software. Results found fractal dimension values were higher in dysplastic leukoplakia compared to nondysplastic. Values also increased with patient age and were higher in those using surti/khaini tobacco. The study concludes fractal dimension analysis may be a useful noninvasive screening tool for early detection of
A study was conducted among 1256 dental professionals to assess their knowledge and attitudes regarding conservative and endodontic practices during the COVID-19 pandemic. It was found that while the participants had good basic knowledge of COVID-19, areas for improvement were identified. For example, only 43% knew the accurate incubation period. Rubber dams were recognized as useful by 83% but techniques like low-speed handpieces were preferred by only 25%. While PPE kits were seen as important by 72%, only surgical masks were deemed sufficient by 37%. The study concluded that dental professionals need to be cautious when treating patients during the pandemic and limit disease spread.
EFFICACY IN REDUCING BACTERIAL CONTENT IN ORAL CAVITY BY CANNABINIODS IN ORAL...DrHeena tiwari
The document discusses a study that compared the efficacy of cannabinoids and popular oral care products (Oral-B and Colgate) in reducing bacterial content in dental plaque. Plaque samples were collected from 30 participants and exposed to cannabinoid toothpaste, Oral-B, and Colgate. Cannabinoids were found to significantly reduce bacterial colony counts compared to the other products. The results suggest cannabinoids may be more effective at controlling oral bacteria and could provide a personalized alternative to traditional oral care products.
This case report describes a 34-year-old male patient who presented with pain and pus discharge from a recently extracted tooth. Radiographs revealed two distinct radiolucencies - a large cyst in the left mandible and a smaller cyst in the right mandible. Histological examination found the left cyst to be a radicular cyst and the right cyst to be a dentigerous cyst. This presented a diagnostic dilemma due to the unusual presentation of multiple cysts occurring bilaterally and with atypical features for the cyst types.
Radiographic Evaluation of the MB2 Canal in Permanent Maxillary Molars- An Or...DrHeena tiwari
This study evaluated the presence and location of the MB2 canal in maxillary first molars using CBCT scans. The scans of 296 patients were analyzed, showing MB2 canals in 43.8% of teeth. No significant gender difference was found. The angle between the mesiobuccal, distobuccal and palatal canals (ƒMDP) was greater in teeth with MB2 canals. A moderate positive correlation was found between ƒMDP and the angle between mesiobuccal, distobuccal and MB2 canals (ƒMDMB2). If ƒMDP was over 90.95 degrees, there was a 78% probability of finding an
ASTHMA CORRELATES AMONG ADOLESCENCE IN COUNTRY: AN ORIGINAL RESEARCHDrHeena tiwari
The document summarizes a study on asthma correlates among adolescents in a country. The study involved a cross-sectional survey of 1200 children to examine health risks and lifestyle factors. The results found that the prevalence of self-reported asthma was 8.2%. Asthmatic adolescents were more likely to be male, overweight or obese, consume soft drinks and energy drinks more frequently, and less likely to consume milk compared to non-asthmatic adolescents. The study aims to establish how lifestyle factors are associated with increased asthma incidence among adolescents.
The document provides information on the COVID-19 pandemic as of April 2020. It discusses the epidemiology and spread of the virus globally. Key points include:
- COVID-19 originated in Wuhan, China in late 2019 and has since spread to over 210 countries. As of April 2020, there were over 29 lakh confirmed cases and 200,568 deaths worldwide, with the US becoming the new epicenter.
- The virus spreads mainly person-to-person via respiratory droplets. Common symptoms include fever, cough and shortness of breath, though many cases are asymptomatic. Chest CT scans show bilateral lung involvement like ground-glass opacities or consolidation.
- While most cases are mild, the elderly and those
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
Efficacy and safety of a diode laser in second stage implant surgeryharitha sridharan
- The study compared the efficacy and safety of using a 970nm diode laser versus a surgical blade for second-stage dental implant surgery in 30 patients.
- Patients were randomly divided into two groups - the study group underwent laser surgery while the control group used a surgical blade.
- The laser group did not require local anesthesia while the blade group did, but there were no significant differences in duration of surgery, postoperative pain, healing time, or implant success between the two techniques.
- The diode laser can effectively uncover dental implants with advantages over conventional blade techniques in reducing the need for anesthesia.
This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
The document summarizes a study that assessed knowledge about robotics and minimally invasive robotic surgeries amongst otolaryngologists and head & neck onco-surgeons through a questionnaire. The study found that most surgeons viewed robotic surgery as the future of minimally invasive procedures due to advantages like improved visualization, precision, and reduced complications. However, many surgeons also noted that current robotics technology is not yet cost effective, requires specialized training, and more studies are needed to prove beneficial outcomes compared to traditional surgery.
This study evaluated the knowledge and concerns of 124 dentists in southern India regarding COVID-19 through a questionnaire. The results showed good knowledge of COVID-19 itself and oral manifestations, but less awareness of appropriate testing and disinfection procedures. While most dentists understood risk levels and emergency procedures, some lacked knowledge of ideal mouthwashes or managing contaminated air. Overall, the study found that while knowledge of COVID-19 was fairly good, greater education was still needed on testing, prevention and infection control practices.
The document discusses the management of oro-craniofacial abnormalities, which have increased in incidence over recent decades. A multidisciplinary team approach is needed to diagnose and treat these deformities, which usually begin at birth and may continue into a patient's 20s. Treatment involves various surgical and non-surgical procedures at different ages, with the overall goals of improving patient aesthetics, confidence, and quality of life.
This document discusses using fractal dimension analysis to detect dysplasia in oral leukoplakia. It begins by providing background on fractals and fractal dimension. The study aimed to determine if fractal dimension analysis could help detect malignant transformation in oral leukoplakia. 121 patients with oral leukoplakia had digital images taken before and after staining, which were analyzed using fractal dimension analysis software. Results found fractal dimension values were higher in dysplastic leukoplakia compared to nondysplastic. Values also increased with patient age and were higher in those using surti/khaini tobacco. The study concludes fractal dimension analysis may be a useful noninvasive screening tool for early detection of
A study was conducted among 1256 dental professionals to assess their knowledge and attitudes regarding conservative and endodontic practices during the COVID-19 pandemic. It was found that while the participants had good basic knowledge of COVID-19, areas for improvement were identified. For example, only 43% knew the accurate incubation period. Rubber dams were recognized as useful by 83% but techniques like low-speed handpieces were preferred by only 25%. While PPE kits were seen as important by 72%, only surgical masks were deemed sufficient by 37%. The study concluded that dental professionals need to be cautious when treating patients during the pandemic and limit disease spread.
EFFICACY IN REDUCING BACTERIAL CONTENT IN ORAL CAVITY BY CANNABINIODS IN ORAL...DrHeena tiwari
The document discusses a study that compared the efficacy of cannabinoids and popular oral care products (Oral-B and Colgate) in reducing bacterial content in dental plaque. Plaque samples were collected from 30 participants and exposed to cannabinoid toothpaste, Oral-B, and Colgate. Cannabinoids were found to significantly reduce bacterial colony counts compared to the other products. The results suggest cannabinoids may be more effective at controlling oral bacteria and could provide a personalized alternative to traditional oral care products.
This case report describes a 34-year-old male patient who presented with pain and pus discharge from a recently extracted tooth. Radiographs revealed two distinct radiolucencies - a large cyst in the left mandible and a smaller cyst in the right mandible. Histological examination found the left cyst to be a radicular cyst and the right cyst to be a dentigerous cyst. This presented a diagnostic dilemma due to the unusual presentation of multiple cysts occurring bilaterally and with atypical features for the cyst types.
Radiographic Evaluation of the MB2 Canal in Permanent Maxillary Molars- An Or...DrHeena tiwari
This study evaluated the presence and location of the MB2 canal in maxillary first molars using CBCT scans. The scans of 296 patients were analyzed, showing MB2 canals in 43.8% of teeth. No significant gender difference was found. The angle between the mesiobuccal, distobuccal and palatal canals (ƒMDP) was greater in teeth with MB2 canals. A moderate positive correlation was found between ƒMDP and the angle between mesiobuccal, distobuccal and MB2 canals (ƒMDMB2). If ƒMDP was over 90.95 degrees, there was a 78% probability of finding an
ASTHMA CORRELATES AMONG ADOLESCENCE IN COUNTRY: AN ORIGINAL RESEARCHDrHeena tiwari
The document summarizes a study on asthma correlates among adolescents in a country. The study involved a cross-sectional survey of 1200 children to examine health risks and lifestyle factors. The results found that the prevalence of self-reported asthma was 8.2%. Asthmatic adolescents were more likely to be male, overweight or obese, consume soft drinks and energy drinks more frequently, and less likely to consume milk compared to non-asthmatic adolescents. The study aims to establish how lifestyle factors are associated with increased asthma incidence among adolescents.
The document provides information on the COVID-19 pandemic as of April 2020. It discusses the epidemiology and spread of the virus globally. Key points include:
- COVID-19 originated in Wuhan, China in late 2019 and has since spread to over 210 countries. As of April 2020, there were over 29 lakh confirmed cases and 200,568 deaths worldwide, with the US becoming the new epicenter.
- The virus spreads mainly person-to-person via respiratory droplets. Common symptoms include fever, cough and shortness of breath, though many cases are asymptomatic. Chest CT scans show bilateral lung involvement like ground-glass opacities or consolidation.
- While most cases are mild, the elderly and those
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
Efficacy and safety of a diode laser in second stage implant surgeryharitha sridharan
- The study compared the efficacy and safety of using a 970nm diode laser versus a surgical blade for second-stage dental implant surgery in 30 patients.
- Patients were randomly divided into two groups - the study group underwent laser surgery while the control group used a surgical blade.
- The laser group did not require local anesthesia while the blade group did, but there were no significant differences in duration of surgery, postoperative pain, healing time, or implant success between the two techniques.
- The diode laser can effectively uncover dental implants with advantages over conventional blade techniques in reducing the need for anesthesia.
This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
1) The study compared the effects of dexamethasone, tranexamic acid, and a combination of both on post-rhinoplasty edema and ecchymosis in 60 patients who underwent primary open rhinoplasty.
2) Patients were divided into 4 groups: dexamethasone only, tranexamic acid only, combination, and placebo. Medications were given intravenously before and after surgery.
3) Edema and ecchymosis were evaluated on a scale of 0-4 on postoperative days 1, 3, and 7. The dexamethasone, tranexamic acid, and combination groups had significantly lower edema and ecchymosis ratings compared to the placebo
Buccal pad fat for cyst Indian Jr SCT volume 2, issue 1, April 16Avinash Gandi
A 14-year-old boy presented with a swelling on the right side of his face and upper jaw caused by a large dentigerous cyst. The cyst involved the area where his impacted right maxillary canine and other teeth were located. The patient's buccal pad of fat was harvested and processed to isolate the stromal vascular fraction (SVF) stem cells. After removing the cyst surgically, the SVF cells were administered to the bone defect area to aid bone regeneration and support orthodontic tooth movement. At 16 months post-operatively, good bone regeneration was observed and the patient was undergoing orthodontic treatment to align the impacted canine.
This study evaluated the effect of vacuum-assisted closure (VAC) therapy on wound management outcomes for patients undergoing reconstruction with split-thickness skin grafts. The study involved 100 patients randomized to either a VAC therapy group or control group treated with normal saline dressings. Results showed significantly better outcomes for the VAC therapy group, including greater graft take (>95% for 90% of patients), shorter wound healing time (2 weeks for 90% of patients), no need for re-grafting, and shorter hospital stays (<3 weeks for 90% of patients). The study concluded that VAC therapy improves wound bed preparation and is advantageous compared to traditional dressings when reconstructing wounds with skin grafts.
EVALUATION AND RECENT TECHNIQUES OF TRANSDERMAL DRUG DELIVERY SYSTEM”.pptxRahulBGole
PRESENTATION OUTLINE
1.Introduction
2.Evaluation Of Transdermal Drug Delivery System
2.1 Physicochemical Evaluation
2.2 In Vitro Release Studies
2.3 In Vivo Evaluation
2.4 Cutaneous Toxicological Evaluation
3. Recent Techniques For Enhancing TDDS
3.1 Structure Based Enhancemnet Techniques
3.2 Electrically Based Enhancement Techniques
3.3 Velocity Based Enhancement Techniques
3.4 Other Enhancement Techniques
4. Conclusion
5. References
1.Introduction :Transdermal drug delivery systems (TDDS), also known as ''patches,'' are dosage forms designed to deliver a therapeutically effective amount of drug across a patient's skin.
2.Evaluation of Transdermal Drug Delivery System:
2.1Physicochemical Evaluation:
Physicochemical Evaluation
In Vitro Release Studies
In Vivo Evaluation
Cutaneous Toxicological Evaluation
2.2. In Vitro Release Studies
●The Paddle over Disc:
The transdermal system is attached to a disc or cell resting at the bottom of the vessel which contains medium at 32 ±5°C.
●The Cylinder modified USP Basket:
The system is attached to the surface of a hollow cylinder immersed in medium at 32 ±5°C.
●Franz diffusion cell:
The cell is composed of two compartments: donor and receptor. The receptor compartment has a volume of 5-12ml and effective surface area of 1-5 cm.The diffusion buffer is continuously stirred at 600rpm by a magnetic bar.
2.3. In Vivo Evaluation
●Animal models:
The most common animal species used for evaluating transdermal drug delivery system are mouse, hairless rat, hairless dog, hairless rhesus monkey, rabbit,guinea pig etc.
●Evaporative water loss management:
Content irritation also disrupts the stratum corenum barrier and causes and excessive water loss from the damaged surface that can be measured means of evaporimetry.
3. Recent Techniques for Enhancing TDDS
3.1. Structure-Based Enhancement Techniques
●Macroflux:
This technology offers a needle-free and painless transdermal drug delivery of large-molecular-weight compounds such as insulin,several peptidic hormones, and vaccines.
●Microfabricated Microneedles:
A transdermal patch or skin adhesive patch is that device which is loaded with drug candidate and usually applied on the skin to transport a specific dose of medication across the skin and into the blood circulation.
3.2.Electrically-Based Enhancement Techniques
●Ultrasound:
In this technique, there is a mixing of drug substance with a coupling agent (usually with gel, cream or ointment) that causes ultrasonic energy transfer from the system to the skin.
●Iontophoresis:
permeation of ionized drug through electrical impulses of 0.5 mA/cm by either galvanic or voltaic cell. It contains cathode and anode which attracts positively charged ion and negatively charged ions, respectively
3.3. Velocity Based Enhancement Techniques:
●Needle-Free Injections:
The liquid or solid particles are fired at supersonic speeds through the outer layers of the skin using a reliable energy source for delivering the drug.
This document compares the surgical outcomes of removing impacted mandibular third molars using either a conventional rotary handpiece or a piezoelectric device. A study was conducted on 20 patients where one impacted tooth was removed using a rotary bur and the other using piezosurgery. The piezoelectric surgery took longer on average but resulted in less post-operative pain, trismus, and higher patient satisfaction compared to the rotary technique. The document concludes that piezoelectric surgery is a precise technique that causes minimal soft tissue damage and reduced postoperative complications for removing impacted third molars.
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
42.Shilpa Sunil Khanna et al. Efficacy of Tranexamic Acid on Intraoperative Blood Loss in third molar Surgery: A Split Mouth Randomized Study. J Res Adv Dent 2020;10:3:192-196.
This document describes a study evaluating the use of dynamic dermal approximation sutures for closing wounds following fasciotomy to treat compartment syndrome. The technique was applied to 12 patients and achieved wound closure in 75% of cases without need for skin grafting. Specifically, it closed all wounds in 6 patients who developed compartment syndrome due to contrast extravasation. The technique aims to provide early wound closure following fasciotomy in order to reduce complications compared to delayed closure or skin grafting. The results suggest this technique can successfully close uncomplicated fasciotomy wounds with minimal risk and good cosmetic outcomes.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
This study compared the efficacy of the antifungal agents sertaconazole and clotrimazole in treating tinea corporis. Sixty patients were divided into two groups, with one group using sertaconazole cream and the other clotrimazole cream, applied twice daily for three weeks. Parameters like erythema, scaling, itching, lesion size and KOH mount were assessed before and after treatment. There was a significant reduction in symptoms for both groups, but sertaconazole showed significantly greater improvement in erythema, scaling, itching and lesion margins compared to clotrimazole based on statistical analysis. The mean reduction in total symptom scores was also significantly higher for
This randomized clinical trial compared the anti-inflammatory effectiveness of administering dexamethasone pre-surgery versus post-surgery for mandibular third molar extraction. Sixty patients were randomly assigned to receive 4mg of dexamethasone intramuscularly either 30 minutes before surgery (Group A) or immediately after surgery (Group B). Facial edema was lower in Group A at 60 minutes and 1-3 days post-op. Pain levels did not significantly differ between groups. Pre-surgical dexamethasone administration more effectively reduced facial edema following mandibular third molar surgery.
This study summarizes the surgical management of 30 patients with chronic fourth-degree perineal tears over an 8-year period. Key findings include:
- The average surgery time was 90 minutes and 27 of 30 patients were discharged by postoperative day 10 with no major complications.
- At follow-up 6 months and 1 year post-surgery, the success rate of repair was 93%, with 2 patients lost to follow up and 3 requiring re-surgery.
- Proper surgical technique including identification and repair of anal sphincter muscles, along with pre-op antibiotics and post-op bowel care, contributed to the high success rate with no wound or fistula complications.
This case report describes an unusual case of pseudo-ankylosis in an 8-year-old child with a history of trauma. Imaging revealed an old fractured right condyle that had been anteriorly displaced and dislocated into the sigmoid notch, where it had fused to the zygomatic arch. Computed tomography with 3D reconstruction clearly showed the displaced condylar fragment. The child underwent surgery to release the ankylotic mass and perform a coronoidectomy to improve mouth opening. Post-operatively, aggressive physiotherapy helped increase the child's maximum interincisal opening. This unique case highlights the importance of accurate imaging and diagnosis for successful treatment of complex facial injuries.
This document provides information about the editors and contributors of the book "Oral and Maxillofacial Surgery for the Clinician". It begins with an introduction by the editors explaining the motivation and scope of the book. It aims to be a comprehensive textbook on oral and maxillofacial surgery for clinicians and trainees. The book has contributions from AOMSI members in India as well as 41 international authors to represent global expertise. It contains 22 sections and 88 chapters covering all aspects of cranio-maxillofacial surgery, along with 68 video demonstrations. The editors thank the contributors and AOMSI for their support in producing this open access textbook.
Here are the key points about suction:
- The objective of suction is to maintain a clear airway by removing secretions like saliva, blood or vomit from the mouth or surgical site.
- It prevents aspiration which can lead to infections. Suction also helps surgeons see clearly during procedures.
- Safety considerations include using proper technique to avoid injury, knowing which patients are at risk of aspiration, monitoring for respiratory distress, and addressing other potential causes of distress beyond just secretions.
This document provides an introduction to mixed dentition space analysis. It discusses that during the mixed dentition period, there may be discrepancies between the space available in the dental arches and the size of the teeth. Accurate mixed dentition space analysis is important for orthodontic diagnosis and treatment planning. The document outlines that mixed dentition typically lasts from ages 6 to 12 years and is when maximum orthodontic problems can develop due to inadequate space for permanent teeth. It also categorizes different methods for mixed dentition space analysis, including those based on regression equations using measurements of erupted permanent teeth and those using radiographs.
This study compared the antifungal efficacy of various endodontic irrigants, with and without the antifungal agent clotrimazole, against Candida albicans in extracted human teeth. Teeth were inoculated with C. albicans and irrigated with sodium hypochlorite, chlorhexidine gluconate, doxycycline hydrochloride, or combinations of these with 1% clotrimazole. Colony forming units were significantly lower for sodium hypochlorite and chlorhexidine alone compared to doxycycline or the control. Adding clotrimazole increased the efficacy of all irrigants, with sodium hypochlorite with clotrimaz
This document discusses the importance of adult immunization and provides guidelines for vaccination against various diseases. It begins by noting that while childhood immunization is well-known, adult immunization is less understood but still important. It then reviews literature on vaccination protocols for adults, including for travel, communicable diseases, hepatitis B, shingles, and more. The document focuses in depth on recommended vaccination for human papillomavirus (HPV), hepatitis, and human immunodeficiency virus (HIV). It provides vaccination schedules, target groups, and notes the need to increase awareness of adult immunization among healthcare professionals and the public.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
- The document discusses animal models that are being used to test vaccines for COVID-19. It conducted a systematic review of studies published between January and August 2020.
- The review identified 20 relevant studies examining nonhuman primates, mice, hamsters, ferrets, cats and dogs. These animal models show some similar responses to SARS-CoV-2 infection as humans such as respiratory symptoms.
- However, the models do not fully mimic the severe complications seen in human COVID-19 patients such as acute respiratory distress syndrome and coagulopathy. While the models provide useful information, they have limitations in replicating the full disease severity in humans.
This study aimed to evaluate the knowledge and concerns of 124 dental health professionals in southern India regarding COVID-19. A survey was administered to assess understanding of COVID-19 transmission, oral manifestations, appropriate testing and emergency procedures. The results found good knowledge of COVID-19 and precautions, but some lack of awareness regarding appropriate testing and managing contaminated air. While most respondents understood transmission risks and emergency protocols, there was uncertainty around testing patients and using mouthwashes as prevention. This highlights gaps in knowledge that could be addressed with further education for dental professionals on COVID-19 clinical guidelines.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
A 34-year-old male presented with pain and pus discharge from a recently extracted tooth. Radiographs showed two distinct radiolucencies - a large cyst in the left mandible and a smaller cyst in the right mandible. Histological examination found the left cyst to be a radicular cyst and the right cyst to be a dentigerous cyst. This presented a diagnostic dilemma as it is uncommon to have multiple cyst types occurring bilaterally in the mandible without an associated syndrome. Careful radiographic and histological analysis was needed to arrive at the accurate diagnosis and appropriate treatment.
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Krishna, et al.: Serratiopeptidase and dexamethasone in postoperative swelling
Annals of Maxillofacial Surgery ¦ Volume 10 ¦ Issue 1 ¦ January-June 2020 109
damaged area and phagocytize invading microorganisms
and debris. As a side effect of this process, there is an escape
of fluid into interstitial spaces resulting in edema. The
inflammatory process is necessary if healing is to occur, but
often excessive inflammation causes edema leading to pain
and trismus.[3]
Several types of medications such as antihistamines, enzymes,
and steroids have been used to inhibit these postoperative
sequelae. The principal effective physical method for relieving
edema is the use of drains, while all the pharmacological
agents tried, the anti‑inflammatory steroids appear to be
most successful and remain in common usage, even though
its immunosuppressive effects are well recognized in
medicine.[4]
The use of corticosteroids to control inflammation
following the third molar surgeries has been an area of
dispute. Newer synthetic analogs of corticosteroids, with
varying doses and different routes of administration, have
been investigated over the years.[5]
Dexamethasone is potent,
highly selective long‑acting, synthetic corticosteroids, which
has anti‑inflammatory action.[6]
Previous studies on the use
of dexamethasone to control postoperative edema have been
concluded with an emphasis that there is a great need for
well‑designed clinical research to further evaluate protocols for
corticosteroid use.[7]
Serratiopeptidase, a proteolytic enzyme,
decomposes bradykinin, thus producing anti‑inflammatory
action. Serratiopeptidase is promising from the knowledge
of pharmacology of the enzymes and the pathology of the
inflammatory edema. There is no sufficient evidence from the
investigations regarding its efficacy in reducing postoperative
edema, and hence, it can be investigated.[8]
The present study is designed to investigate, evaluate, and
compare the ability of serratiopeptidase and dexamethasone
to control edema following surgical removal of the mandibular
third molar.
Materials and Methods
The study was carried out on 100 patients, requiring surgical
extraction of mandibular third molars from October 2004
to September 2006. Patients were enrolled for the study
consecutively as and when they were presented. Selected
patients were allocated to the dexamethasone group and
serratiopeptidase group by randomization procedure,
irrespective of age and sex. The following were the criteria
for the selection of patients for the study.
Inclusion criteria
1. Bony impacted mandibular third molar
2. Routine blood and urine examination revealing no
abnormal values
3. The first and second molar on the side of surgery must be
present.
Exclusion criteria
1. The patients with systemic complications such as bleeding
disorders
2. Recent swelling or infection in the area of surgery
3. Patients who took proteolytic drugs or steroids 1 day
before surgery
4. Contraindication for the use of corticosteroids such as
diabetes mellitus, active tuberculosis, ocular herpes,
glaucoma, peptic ulceration, pregnancy, and hypertension.
Institutional ethical clearance was obtained for the study.
Following informed consent of the patient and preoperative
investigations, the patients were taken for surgery under
local anesthesia. Dexamethasone group was given 1 mg of
dexamethasone, one-half h before surgery and continued 1 mg,
8th
hourly for 3 days postoperatively. Serratiopeptidase group
was given 10 mg of serratiopeptidase, 8th
hourly for 3 days
postoperatively.
Preoperative measurements were taken by marking 7 points on
the face with indelible ink on the following facial landmarks:
mandibular angle, tragus, lateral canthus of the eye, alar base,
lip commissure, pogonion, and the midpoint of the hyoid bone.
With the mandibular angle as the base point and using 3‑0 silk
suture to follow the contour of the face, linear distances to the
other landmarks were noted. The sum of all measurements
was taken as the facial size. Cheek girth was measured by
measuring the maximum width of the soft tissues in the anterior
masseter region. It was measured in millimeters using calipers
by keeping one of the limbs of the calipers intraorally in the
embrasure between the first and second mandibular molars and
the other limb extraorally, so as to touch approximately 1 cm
above the anterior inferior border of the masseter [Figure 1].
Standard surgical techniques and protocols were followed for
surgical removal of the mandibular third molar. Amoxicillin,
500 mg and metronidazole, 400 mg were given orally,
8th
hourly for 5 days, for prophylactic antibiotic coverage
and diclofenac sodium 50 mg was given orally, 8th
hourly for
3 days for management of postoperative pain. Facial size and
cheek girth were measured on 1st
, 2nd
, 5th
, and 7th
postoperative
days in the same manner, as preoperative facial measurements
were recorded. The data were recorded for the statistical
analysis. Paired Student’s t‑test was applied for intragroup
comparison of facial measurement and cheek girth within the
dexamethasone group and serratiopeptidase group. Unpaired
Student’s t‑test was applied for intergroup comparison of facial
measurement and cheek girth between the dexamethasone
group and serratiopeptidase group.
Results
Theswellingwasrecordedonthe1st
,2nd
,5th
and7th
postoperative
days. The dexamethasone group consisted of 31 males and
19 females. The age range of the patients was 18–50 years with
a mean age of 25.8 ± 7.1. The serratiopeptidase group consisted
of 32 males and 18 females. The age ranges of the patients
were 17–65 years with a mean age of 27.2 ± 9.8. Table 1 shows
the changes in facial measurement in the serratiopeptidase
group. It shows the mean difference in facial measurement
on postoperative day 1, day 2, day 5, and day 7. There was
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3. Krishna, et al.: Serratiopeptidase and dexamethasone in postoperative swelling
Annals of Maxillofacial Surgery ¦ Volume 10 ¦ Issue 1 ¦ January-June 2020
110
highly significant reduction in facial measurement on the
postoperative day 5 in the serratiopeptidase group.
Table 2 shows changes in the facial measurement in the
dexamethasone group. It shows the mean difference in facial
measurement on postoperative day 1, day 2, day 5, and day 7.
There was highly significant reduction in facial measurement
on the postoperative day 2 in dexamethasone. Figure 2
shows mean comparative efficacies of serratiopeptidase and
dexamethasone in reducing facial swelling on postoperative
Figure 1: Cheek girth measurement
Figure 3: Graph showing cheek girth
day 1, day 2, day 5, and day 7. There was highly significant
difference in facial measurement between the serratiopeptidase
group and dexamethasone group on postoperative day 2
(mean difference was 62.5 with P < 0.001) and significant
difference on postoperative day 1, day 5, and day 7 (P < 0.01).
Table 3 shows changes in cheek girth in the serratiopeptidase
group. It shows the mean difference in cheek girth on
postoperative day 1, day 2, day 5, and day 7. There was
a statistically significant reduction in cheek girth on
postoperative day 5.
Table 4 shows changes in cheek girth in the dexamethasone
group. It shows the mean difference in cheek girth on
postoperative day 1, day 2, day 5, and day 7. There was
statistically significant reduction in cheek girth on postoperative
day 2 and day 5. Figure 3 shows the mean comparative
efficacies of dexamethasone and serratiopeptidase in the
reduction of cheek girth. There was statistically significant
mean difference between the serratiopeptidase group and
dexamethasone group on postoperative day 2 (mean difference
was 4.3 with P < 0.001).
Discussion
Most surgical procedures result in a certain amount of
postoperative edema. The swelling usually reaches its
maximum within 48–72 h, after the surgical procedure. It
begins to subside in the late postoperative phase. The operator
can control the amount of postsurgical edema by performing
surgery in a manner that minimizes the tissue damage. Some
believe that ice applied to freshly wounded areas decreases
the vascularity and thereby decreases transudation. However,
no controlled study has verified this practice.[9]
Glucocorticoids are a group of steroids that possess
anti‑inflammatory properties. Perhaps, one of the most
important actions of corticosteroids is the suppression or
prevention of inflammation by interfering with capillary
dilatation, edema formation, fibrin deposition, leucocyte
migration, and phagocytosis.[10]
Mechanism of the action of
glucocorticoids are due to its effect on movement suppression
and function of leukocytes, accumulation of macrophage at
inflammatory site, and prevention of prostaglandin synthesis
by inhibiting the arachidonic acid cascade. Lipocortin is an
endogenous protein produced by steroids. It blocks the activity
of phospholipaseA2, thus inhibiting the release of arachidonic
acid from cell membranes and the synthesis of prostaglandins,
leukotrienes, and thromboxanes.[11]
During the selection of therapeutic regimen for
glucocorticosteroid administration, a number of decisions must
be made, including the type of steroid, the dosage, the route of
administration, and, finally, the timing of the administration,
related to the surgical procedure. In selecting the steroid, the
major advantage is offered by the synthetic agents in use today
and is the ones with longer duration of action and little or no
mineralocorticoid activity.[12]
Figure 2: Graph showing the facial measurements
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Annals of Maxillofacial Surgery ¦ Volume 10 ¦ Issue 1 ¦ January-June 2020 111
In a study on dexamethasone for reduction of swelling
following extraction of the third molar teeth was conducted,
and it was concluded that dexamethasone group had more
patients with mild swelling and fewer patients with severe
swelling.[13]
Another study was conducted for establishing the
anti‑inflammatory effects of dexamethasone. It was concluded
that the dexamethasone group had mean swelling volumes
significantly lesser than the controls.[3]
AstudyconductedbyWareet al.used1 mgdexamethasonebythe
oralrouteofadministration,8th
hourlyfor3 daysbeginningonthe
morningofthesurgery.Lindbergused1 mgoraldexamethasone,
8th
hourly on the day of surgery and on 1st
postoperative day,
1st
dose taken, ½ h before the surgery.They reported a significant
clinical improvement in postoperative swelling.[14]
Quantitative assessment of swelling represents a major
difficulty. Evaluation of facial swelling resulting from surgical
Table 1: Facial measurement (mm) of the serratiopeptidase group
Time of assessment Serratiopeptidase group P*
Mean±SD Difference from preoperative measurement
(baseline)
Percentage increase from preoperative
measurement (baseline)
Preoperative (baseline) 475.6±73.4 ‑ ‑ ‑
Postoperative (day 1) 506.2±71.0 30.6±14.8 6.4 <0.001
Postoperative (day 2) 508.8±70.9 33.2±12.6 7.0 <0.001
Postoperative (day 5) 488.8±71.1 13.2±8.1 2.8 <0.001
Postoperative (day 7) 476.3±72.9 0.7±3.1 0.1 0.11 (NS)
*Paired Student’s t‑test for intragroup comparison. SD: Standard deviation, NS: Not significant
Table 2: Facial measurement (mm) of the dexamethasone group
Time of assessment Dexamethasone group P*
Mean±SD Difference from preoperative measurement
(baseline)
Percentage increase from preoperative
measurement (baseline)
Preoperative (baseline) 431.6±83.7 ‑ ‑ ‑
Postoperative (day 1) 451.3±86.5 19.7±18.8 4.6 <0.001
Postoperative (day 2) 446.3±87.4 14.7±20.5 3.4 <0.001
Postoperative (day 5) 437.2±84.7 5.6±16.6 1.3 <0.05
Postoperative (day 7) 430.1±84.4 1.5±14.3 0.3 0.45 (NS)
*Paired Student’s t‑test for intragroup comparison. SD: Standard deviation, NS: Not significant
Table 3: Cheek girth measurement (mm) of the serratiopeptidase group
Time of assessment Serratiopeptidase group P*
Mean±SD Difference from preoperative cheek
girth (baseline)
Percentage increase from preoperative cheek
girth (baseline)
Preoperative (baseline) 29.8±4.3 ‑ ‑ ‑
Postoperative (day 1) 36.2±3.4 6.5±3.6 21.8 <0.001
Postoperative (day 2) 37.4±4.9 7.6±3.7 25.5 <0.001
Postoperative (day 5) 33.2±2.5 3.4±3.0 11.4 <0.001
Postoperative (day 7) 29.7±4.3 0.01±0.05 0.03 0.29 (NS)
*Paired Student’s t‑test. SD: Standard deviation, NS: Not significant
Table 4: Cheek girth measurement (mm) of the dexamethasone group
Time of assessment Dexamethasone group P*
Mean±SD Difference from preoperative cheek
girth (baseline)
Percentage increase from preoperative cheek
girth (baseline)
Preoperative (baseline) 29.6±4.9 ‑ ‑ ‑
Postoperative (day 1) 35.1±5.3 5.4±1.5 18.2 <0.001
Postoperative (day 2) 33.1±4.9 3.4±1.8 11.5 <0.001
Postoperative (day 5) 31.6±4.8 2.0±1.8 6.8 <0.001
Postoperative (day 7) 29.7±4.9 0.1±0.3 0.3 0.18 (NS)
*Paired Student’s t‑test. SD: Standard deviation, NS: Not significant
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5. Krishna, et al.: Serratiopeptidase and dexamethasone in postoperative swelling
Annals of Maxillofacial Surgery ¦ Volume 10 ¦ Issue 1 ¦ January-June 2020
112
procedures has proven to be most problematic. Swelling
involves a three‑dimensional volumetric change at the
tissue and cellular level. Methods used to evaluate swelling
include photographic analysis, modified face bow, linear
measurement, subjective assessment, and others.[4,15‑18]
No
technique has been proved to be superior or more accurate in
analyzing swelling. The desire to include a large number of
patients and the practicality of a low‑cost reliable technique
made linear measurement a feasible choice. The swelling was
also measured in terms of cheek girth, using calibrated slide
calipers.
In the present study, the administration of dexamethasone
resulted in significantly less degree of swelling on the
2nd
postoperative day. There was further reduction of
swelling by 7th
postoperative day. The facial size reached
the preoperative. In the present study, the oral route of drug
administration was done. With respect to measurement by
7th
‑day routes of administration, virtually, all avenues of
administration have been used with corticosteroids. However,
onset, peak, and duration of action are dependent on the route
of administration, the dosage, and the solubility of the agent.
With the oral route, corticosteroids are rapidly and almost
completely absorbed; hence, this route of administration is as
effective as parenteral route. All studies using the oral route
of administration reported a clinical reduction in swelling.[12]
In the present study, 1 mg of dexamethasone was given ½ h
before the surgery and continued thrice daily for 3 postoperative
days. The administration of the preoperative dose of
dexamethasone maintains an adequate amount of drug in the
blood before, during, and after the surgery, as dexamethasone
is a long‑acting corticosteroid. Since the appearance of
swelling has been around 4–5 h after surgery, preoperative
administration of the drug would be very effective in preventing
swelling.
Dexamethasone has minimal or zero mineralocorticoid
activity and is a long‑acting corticosteroid with potent
anti‑inflammatory action.[12]
In this study, dexamethasone was
selected as prototype corticosteroid because it is desirable to
use a steroid with minimal mineralocorticoid activity and a
longer duration of action.
Enzymes are extremely potent substances. The possibility
of their therapeutic application is attractive. Enzymes are
derived from bacteria (streptokinase and streptodornase),
plants (papase and bromelain), and animals (trypsin and
chymotrypsin). The enzymes used therapeutically for
reduction of edema are hyaluronidase, streptodornase, trypsin,
chymotrypsin, alpha‑chymotrypsin, and serratiopeptidase.
Various studies have been carried out to determine the
efficacy of serratiopeptidase as an anti‑inflammatory agent.
A prospective study on serratiopeptidase for reduction of
postoperative swelling after upper ankle joint surgery was
conducted, and it was concluded that significant reduction in
swelling was achieved with the use of serratiopeptidase.[19]
Another trial was conducted to investigate the clinical efficacy
of the anti‑inflammatory enzyme preparation, serratiopeptidase
in patients who underwent Caldwell‑Luc‑antrostomy for
chronic empyema and concluded that swelling was smaller
in size in the serratiopeptidase treated group than in the
placebo‑treated group.[20]
Serratiopeptidase was the other drug, which was compared
with dexamethasone for its efficacy to control postoperative
edema. In the present study, administration of 10 mg of
serratiopeptidase, thrice daily for 3 postoperative days resulted
in the reduction of swelling on 5th
postoperative day. The
facial size reached the preoperative facial measurement by
7th
postoperative day.
A study was conducted on prednisolone, a corticosteroid and
papase, an enzyme as inhibitors of complications after the
oral surgery. The conclusion of this study indicated that in
comparing prednisolone and papase, prednisolone was more
effective in reducing postsurgical sequel of trismus and pain,
but no difference was found with regard to edema. This was
probably because few moderate‑to‑severe cases of edema were
observed in the first few postoperative days.[15]
In our study, on comparison between serratiopeptidase and
dexamethasone, it was found that the swelling was less in the
dexamethasone group on postoperative day 1, day 2, and day 5
compared to the serratiopeptidase group on day 1, day 2, and day
5. There was no difference in postoperative swelling on 7th
day
between dexamethasone and serratiopeptidase group. However,
more studies need to be conducted prospectively with a large
samplesizewithmorevariablescomparingitwithacontrolgroup.
Conclusion
Two different classes of drugs, serratiopeptidase, a proteolytic
enzyme having anti‑inflammatory action, and dexamethasone,
a long‑acting corticosteroid with minimum or zero
mineralocorticoid activity having maximum anti‑inflammatory
action, were evaluated for its efficacy and compared with each
other for its ability to reduce the postoperative swelling.
It appeared in this study that both serratiopeptidase and
dexamethasone were effective in the reduction of swelling
but in comparison with serratiopeptidase, dexamethasone was
more effective in the reduction of swelling.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patients have given their
consent for their images and other clinical information to be
reported in the journal.The patients understand that their names
and initials will not be published and due efforts will be made
to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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6. Krishna, et al.: Serratiopeptidase and dexamethasone in postoperative swelling
Annals of Maxillofacial Surgery ¦ Volume 10 ¦ Issue 1 ¦ January-June 2020 113
References
1. Alexander RE, Throndson RR. A review of perioperative corticosteroid
use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2000;90:406‑15.
2. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain
and swelling following extraction of third molar teeth. Anaesthesia
1993;48:961‑4.
3. Esch PM, Gerngross H, Fabian A. Reduction of postoperative
swelling. Objective measurement of swelling of the upper ankle
joint in treatment with serrapeptase – A prospective study. Fortschr
Med 1989;107:67‑8, 71‑2.
4. Beirne OR, Hollander B. The effect of methylprednisolone on pain,
trismus, and swelling after removal of third molars. Oral Surg Oral Med
Oral Pathol 1986;61:134‑8.
5. Breytenvach HS. Objective measurement of postoperative swelling. Int
J Oral Surg 1979;7:386.
6. Cameron IW. An investigation into some of the factors concerned in
the surgical removal of the impacted lower wisdom tooth, including a
double blind trial of chymoral. Br J Oral Surg 1980;18:112‑24.
7. Edilby GI, Gennit SP. A double blind placebo controlled trial on the
effect of dexamethasone on post operative swelling. J Dent Res
1982;62:556.
8. Caci F, Gluck GM. Double‑blind study of prednisolone and papase
as inhibitors of complications after oral surgery. J Am Dent Assoc
1976;93:325‑7.
9. ElHag M, Coghlan K, Christmas P, Harvey W, Harris M. The
anti‑inflammatory effects of dexamethasone and therapeutic ultrasound
in oral surgery. Br J Oral Maxillofac Surg 1985;23:17‑23.
10. Flower RJ, Blackwell GJ. Anti‑inflammatory steroids induce
biosynthesis of a phospholipase A2 inhibitor which prevents
prostaglandin generation. Nature 1979;278:456‑9.
11. Gilman AG, Rall TW, Nies AS. The Pharmacological Basis of
Therapeutics. New York: Macmillan; 1990. p. 1436.
12. Holland CS. The development of a method of assessing swelling
following third molar surgery. Br J Oral Surg 1979;17:104‑14.
13. Linenberg W. The clinical evaluation of dexamethasone in oral surgery.
Oral Surg Oral Med Oral Pathol 1965;20:6.
14. Milles M, Desjardins PJ, Pawel HE. The facial plethysmograph: A new
instrument to measure facial swelling volumetrically. J Oral Maxillofac
Surg 1985;43:346‑52.
15. Montgomery MT, Hogg JP, Roberts DL, Redding SW. The use of
glucocorticosteroids to lessen the inflammatory sequelae following third
molar surgery. J Oral Maxillofac Surg 1990;48:179‑87.
16. Neupert EA 3rd
, Lee JW, Philput CB, Gordon JR. Evaluation of
dexamethasone for reduction of postsurgical sequelae of third molar
removal. J Oral Maxillofac Surg 1992;50:1177‑82.
17. Peterson LJ, Ellis E 3rd
, Hupp JR, Tucker MR. Contemporary Oral and
Maxillofacial Surgery. St. Louis: Mosby; 2003. p. 47.
18. Satoskar RS, Bhandarkar SD, Ainapure SS. Pharmacology and
Pharmacotherapeutics. Mumbai: Popular Prakashan Private Limited;
2003. p. 1048‑50.
19. Tachibana M, Mizukoshi O, Harada Y, Kawamoto K, Nakai Y.
A multi‑centre, double‑blind study of serrapeptase versus
placebo in post‑antrotomy buccal swelling. Pharmatherapeutica
1984;3:526‑30.
20. Tripathi KD. Essentials of Medical Pharmacology. New Delhi: Jaypee
Brothers Medical Publishers (p) Ltd; 2003. p. 261.
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