Edward E. Black

The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital.

PURPOSE Psychologic distress is a common outcome among trauma survivors. This report examines both the development and predictors of acute post-traumatic stress disorder (PTSD) symptoms in a sample of US inner-city orofacial trauma survivors seeking treatment in a publicly funded hospital. PATIENTS AND METHODS Baseline data were collected from 336 patients seeking urgent care for an oral injury (mandibular or midfacial fracture). Participants were predominantly unemployed, unmarried, African American or Hispanic men in their 30s. One-month follow-up assessments of PTSD symptoms were conducted on the available 84% of the sample. RESULTS Absolute levels of PTSD symptoms were high at 1 month; 25% of the sample appeared to meet diagnostic criteria for acute PTSD, based on a self-report of symptoms. Variables associated with self-reports of higher rates of PTSD symptoms included older age, being female, prior psychologic disturbance as reflected in lifetime and current mental health and social service need and use, exposure to and distress at a prior trauma as well as overall high rates of stressful life events in the past year, injury pain, psychologic distress at hospital discharge, and unmet social support needs during the recovery phase. CONCLUSIONS A substantial subsample of these traumatized medical patients had negative psychologic outcomes at 1 month. Results underscore the potential use of screening survivors of orofacial injury at urban trauma centers for PTSD and developing systems of care that facilitate referral to appropriate psychologic treatment.

Predictors of Depressive Symptoms Following Mandibular Fracture Repair

PURPOSE This study sought to identify sociodemographic, psychosocial, and clinical factors associated with increased postsurgery depressive symptoms among inner-city minority patients recovering from a mandibular fracture. PATIENTS AND METHODS Surveys of African American and Hispanic adults receiving treatment at King/Drew Medical Center for a mandible fracture (n=98) are used to identify factors associated with increased postsurgery depressive symptoms. Using correlation coefficients and t tests, bivariate relationships between patient characteristics and depressive symptoms at first follow-up were examined. Multiple regression analysis was used, predicting depressive symptoms at 1 month postadmission by entering covariates that were found to be significant at the bivariate level. RESULTS Consistent with the etiology of maxillofacial trauma, the majority of study participants were male (88%), unmarried (92%), unemployed (57%), and experienced some type of interpersonal violence resulting in their broken jaw (77%). Patient characteristics significantly associated with depressive symptoms at first follow-up included age (r=0.26, P= .011), symptoms of post-traumatic stress (r=0.31, P= .003), prior dental problems (r=0.24, P= .022), current pain (r=0.38, P<0.001), and oral health problems during healing (GOHAI) (r= 0.34, P= .001). Two of the 5 significant covariates (pain and GOHAI) remained significant at the multivariate level (adjusted R(2)=0.33). CONCLUSION Findings from this study show that depressive symptoms increase immediately after oral surgery for jaw fracture. This increase is associated with pain and quality of life during recovery.

A qualitative study of hardiness and social support among underserved, inner-city minority adults recovering from oral surgery.

Abstract Using qualitative data, this study examines hardiness and social support among twenty-two African American and Hispanic subjects, at least 18 years of age, who received treatment for a jaw fracture and participated in an hour-long focus group to discuss the treatment they received at King/Drew Medical Center, an inner-city hospital in Los Angeles, California. Treatment was either a non-surgical wiring of the teeth closed for six to eight weeks or surgical placement of a metal bone plate in the lower jaw with a short period of jaw fixation following surgery. A mandibular fracture is one of the most common orofacial traumas for minority individuals, and the majority of these fractures among patients at urban trauma centers are a result of interpersonal violence. Thus the link between psychosocial stress and oral health is evident, yet exposure to daily stress does not automatically place one at risk for distress. Some people under daily stress have hardiness, conceptualized as an internal personal resource consisting of control, commitment, and challenge. This study examines hardiness and social support relevant to an underserved, minority population. Hardiness and social support were identified and noted in order of frequency according to participant characteristics of treatment type, gender, and ethnicity. Main themes related to hardiness and social support are highlighted with verbatim quotes providing additional context to the theme presented.

Orofacial injury in underserved minority populations

The translation of clinical and epidemiological research findings into cliniical practice in the management of orofacial injuries at an inner-city community promises a reduction in the incidence and severity of orofacial injuries. This article reports on the sociodemographic characteristics, economical impact, nature of injuries, and associated risk factors of mandible fractures sustained in the inner-city community treated at KDMC. An overwhelmingly high incidence of intentional/assaultive injuries were treated at KDMC that contribute to the escalating cost of medical care provided at the public county hospital. Knowledge of associated risk factors and nature of injuries is fundamental to the development of a sound screening and interventional program tailored to the high-risk minority groups, to reduce the high burden of preventable orofacial injuries in this community. Multidisciplinary health professionals should recognize the relationship between alcohol and substance abuse and orofacial injuries and the subtle signs of domestic abuse. and should provide social support and counseling intervention to reduce risk of recurrent injuries in abused victims.

Dermoid cyst of the floor of the mouth

Sublingual dermoid cysts are uncommon in the head and neck region. They are most often seen in young adults and can become unusually large with few symptoms. A case is presented to demonstrate the slow, expansive growth pattern and relatively painless swelling in the floor of the mouth that occurred over a 9-year period.

Predictors of risk tolerance among oral surgery patients.

PURPOSE This study attempts to provide insight on how the treatment preference for a mandible fracture and treatment received and its consequences are related to the patients risk tolerance, as measured by the Standard Gamble (SG). PATIENTS AND METHODS Data from a prospective cohort study of 203 subjects receiving treatment at the former King/Drew Medical Center in Los Angeles, CA, for either a mandible fracture (n = 98) or third molar removal (n = 105) were examined. Subjects were interviewed at 4 time points: on admission to the medical center and at 3 monthly follow-up visits. Risk tolerance for hypothetical treatment scenarios is measured by use of the SG, a health-value utility measure assessing the tradeoff between good outcomes and serious complications associated with treatment. Separate regression analyses with subsets of predictors (sociodemographic, psychosocial health, and clinical characteristics) were conducted and then synthesized by use of the significant predictors in separate analyses. RESULTS For fracture subjects, there was a noticeable rise in the SG reports from admission to the 1-month follow-up. Their greater risk tolerance was associated with being older, receiving surgery, having a lower post-traumatic stress disorder score, and having a swollen jaw or face. For third molar subjects, SG did not change substantively over the course of the study. Predictors of greater risk tolerance for third molar subjects included the jaw or face being swollen and having to use less pain medication. CONCLUSIONS Findings from this study show a preference for less invasive treatment, with the majority of both groups preferring wiring, and support the theory that treatment choices differ between subjects with different health states. Factors associated with risk tolerance include the patients age, treatment received, psychosocial health state, experience with previous treatment, and value for oral health quality of life.