Alastair N. Goss

Tranexamic acid mouthwash A prospective randomized study of a 2-day regimen vs 5-day regimen to prevent postoperative bleeding in anticoagulated patients requiring dental extractions

This prospective randomized study analyses the use of a prescribed 4.8% tranexamic acid post-operative mouthwash over 2 days vs 5 days to prevent bleeding in patients taking warfarin who require dental extractions. Eighty-five patients therapeutically anticoagulated with warfarin for various conditions, ranging in age from 21 to 86 years and requiring dental extractions, were randomly divided into two groups. Group A postoperatively received a 4.8% tranexamic acid mouthwash to be used over a 2-day period. Group B received the same mouthwash and instructions postoperatively, to be taken over 5 days. All procedures were performed on an ambulatory basis under local anaesthetic by the same surgeon. Patients were reviewed 1, 3, and 7 days postoperatively to assess bleeding. Eighty-two of the 85 patients encountered no postoperative problems. Two patients in group A and one in group B had minor postoperative bleeds that required minor ambulatory intervention to control. This study shows that a 2-day postoperative course of a 4.8% tranexamic acid mouthwash is as equally effective as a 5-day course in controlling haemostasis post-dental extractions in patients anticoagulated with warfarin.

A model for osteoarthritis of the temporomandibular joint

There is a need for a simple, reproducible animal model of advanced osteoarthritis of the temporomandibular joint (TMJ). In this study, gentle removal of the condylar articular layer in the sheep TMJ resulted in an eburnated condyle with peripheral osteophytes, thin or perforated discs, and temporal surface proliferation. This model can be used for both the study of osteoarthritis and the evaluation of therapeutic methods.

The sheep as a model for temporomandibular joint surgery

The anatomical, histological and surgical details of sheep as a model for temporomandibular surgery are presented. The advantages are the similarities in size, shape and structure of the joint to humans, coupled with low cost and high ethical acceptability.

The arthroscopic appearance of acute temporomandibular joint trauma.

The arthroscopic appearance of the temporomandibular joint following acute trauma sufficient to result in mandibular fracture was described in 40 joints in 20 patients. It was found that 38 of 40 joints showed evidence of intra-articular damage. Hemarthrosis with shredding of the disc and joint surfaces was the most common finding. The hemarthrosis rapidly resolved but the shredding remained. The degree of damage was related to the site of mandibular fracture with the most damage being seen when the condylar neck was not fractured.

Temporomandibular joint arthroscopy

The surgical technique for arthroscopic examination of the superior space of the temporomandibular joint and the morbidity encountered with the procedure in 50 cases are presented. Eighty-eight per cent of the examinations provided diagnostic information. There were no serious complications, and minor short-term complaints were encountered in only 12% of the examinations.

The role of the disk in sheep temporomandibular joint ankylosis

OBJECTIVE The purpose of this study was to determine the role of the disk in intraarticular ankylosis of the temporomandibular joint. STUDY DESIGN Twelve adult sheep were divided into 2 groups. In group 1, removal of the temporal and condylar articular surfaces was performed on the right temporomandibular joint and the disk was maintained; in group 2, removal of the articular surfaces and diskectomy were performed on the right temporomandibular joint. One sheep from each group was killed just after surgery and 5 sheep from each group were killed at 3 months. The joints were examined radiologically, macroscopically, and histologically. The range of jaw movements was recorded preoperatively and at sacrifice. RESULTS Each of 2 sheep in group 2 had lost 4% of their body weight by 3 months; all of the other sheep maintained or increased their weight. The range of jaw motion to the right was significantly lower in group 2 than in group 1 (P<.01). In group 1, fibrous repair of the articular surface and regeneration of the condylar head was seen. In group 2, each of the joints showed a total fibrous ankylosis with some calcification. There was a statistically significant difference in radiologic score between the groups (P<.0001). Histologic scores for group 1 demonstrated significantly lower scores on the degree of ankylosis scale and degree of calcification scale (P<.0001). CONCLUSIONS This study showed that the presence of the disk prevented the development of fibrous intraarticular ankylosis of the temporomandibular joint.

The Nature and Frequency of Bisphosphonate-Associated Osteonecrosis of the Jaws in Dental Implant Patients: A South Australian Case Series

PURPOSE To determine the number of bisphosphonate-associated cases of dental implant failure in South Australia. MATERIALS AND METHODS All general and specialist dentists who place dental implants in South Australia were contacted and asked to provide information on the total number of implants placed over the decade to December 2007. Cases of bisphosphonate-associated implant failure were identified. RESULTS All 46 practitioners involved in implant placement and the management of bisphosphonate-associated osteonecrosis of the jaws in South Australia were identified. Approximately 28,000 implants had been placed in 16,000 patients. We identified 7 cases of oral bisphosphonate-associated implant failure, with 3 cases of failure of osseointegration and 4 cases of successful implants losing integration after being placed on oral bisphosphonates. There were 5 women and 2 men, and the mean age was 65.7 years (range, 49-75 years). Only 1 was medically compromised, with steroids and diabetes. No cases of implant failure in intravenous bisphosphonate cases were identified. On the basis of the assumption that 5% of the patients were taking an oral bisphosphonate, 1 in 114 (0.89%) had implant failure. CONCLUSION In patients taking oral bisphosphonates, a failure to integrate or subsequent loss of integration may occur when oral bisphosphonates are started after successful implant placement. The rate of failure is low, at less than 1%.

The effect of an intra-articular bone fragment in the genesis of temporomandibular joint ankylosis

The aim of this study was to examine the effect of an intra-articular bone fragment on the genesis of temporomandibular joint (TMJ) ankylosis. Twenty-two adult sheep had a unilateral operation of removal of the temporal and condylar articular surfaces, plus discectomy with or without insertion of an intra-articular bone fragment. Functionally, radiologically, macroscopically and histologically, in the group with the intra-articular bone fragment, the joints showed more advanced ankylosis both at one and three months after the operation, as compared to the group with no intra-articular bone. This study shows that the bone fragment increases the extent of ankylosis in the sheep model. The clinical significance of the various experimental findings of this study and others in the same series is presented.

Temporo-mandibular joint dysfunction : Pain and illness behaviour

Abstract This study investigated prospectively the illness behaviour of 100 patients with temporo‐mandibular (TMJ) dysfunction and 100 asymptomatic patients. It has previously been shown that a simple illness behaviour questionnaire (IBQ) can discriminate between patients with intractable facial pain and minor odontogenic pain [28]. The purpose of this study was to determine whether it was possible to prospectively identify those patients who may be resistant to conservative therapy. The results showed that the TMJ dysfunction patients had significantly increased levels of disease conviction (P < 0.001), anxiety or depression (P < 0.005), and were less likely to deny the existence of problems in their life (P < 0.05) compared to control patients. However, the TMJ population was much closer to the control population than to a pain clinic population. In the small percentage (13%) of patients who failed to respond to conservative therapy, over half showed abnormal illness behaviour. Seventy‐five percent of all the TMJ patients could be excluded from further assessment of abnormal illness behaviour at little risk of incorrect classification. Thus the illness behaviour questionnaire can be used as a screening device to identify those patients who require psychologic treatment rather than more aggressive surgical treatment.

Toward an international consensus on temporomandibular joint surgery

This consensus statement reflects the current status of temporomandibular joint surgery in the international community of oral and maxillofacial surgeons in the early 1990s. It is not the end, and it is not the beginning; it is a step forward in the treatment of patients with temporomandibular disorders. It is hoped that this statement will encourage member organizations, and individual members to pursue the issues raised by the proposed criteria. Also there should be continuing debate on the findings presented and on future developments, as well as efforts to teach others the skills the specialty has acquired.