Juha Sane

Analgesic Efficacy After Single and Repeated Doses of Codeine and Acetaminophen

Abstract: A double‐blind randomized analgesic trial was carried out in patients suffering from pain after removal of a third molar tooth. In a two‐dose regimen, 108 patients received either 60 mg codeine, 500 mg acetaminophen, or 1000 mg acetaminophen. On the day of surgery, the patients assessed their pain intensity hourly on a visual analog scale. The evaluation was carried out during the 10‐hour period after first medication. The best pain reducing effects were achieved with 1000 mg acetaminophen. Both the category and position of each tooth were examined in relation to pain intensity; however, the statistical analysis did not reveal any significant correlation. In all treatment groups, the efficacy of the second dose was superior to that of the first, and the most pronounced difference was obtained in patients taking codeine, who increased their pain reduction from 20 to 60 per cent. Clinical comparisons including codeine may therefore be better carried out in a repeated‐dose regimen.

Comparison of maxillofacial and dental injuries in four contact team sports: American football, bandy, basketball, and handball

Maxillofacial and dental injuries were studied in regis tered players of American football, bandy, basketball, and handball in Finland between 1979 and 1985. In American football, where facial protection is complete and mandatory, maxillofacial and dental accidents ac counted for only 1.4% of all accidents. In bandy, where facial protection was inadequate during the time of study (only the helmet and extraoral mouth protector were mandatory), the respective figure was 10.6%. The most frequent causes of injury were a blow from an other player (in American football, basketball, and hand ball) or a blow from the stick (in bandy). In American football, the mean cost of treatment related to maxillofacial and dental injuries was only 60% of the mean total cost of all injuries. In contrast, the mean cost of treatment for maxillofacial and dental injuries in basketball and bandy was twice and three times as high, respectively, as that for all injuries. The need for adequate facial protection in contact sports is also discussed.

Osteosarcoma of the mandible: Analysis of nine cases

A total of 16 cases of mandibular osteosarcoma were diagnosed histologically in Finland and reported to the Finnish Cancer Registry between 1953 and 1983. Review of the histologic slides confirmed the diagnosis in only nine cases. The overall five-year survival rate was 44%. Three patients who were free of clinical disease at the end of the follow-up period (mean, 9.9 years) either had tumors of low-grade malignancy (two cases) or had undergone prompt radical surgery (one case). The importance of radiography in the diagnosis of mandibular osteosarcoma is stressed, because the widening of the periodontal membrane spaces, the sunray effect, and the widening of the mandibular canal are almost pathognomonic for osteosarcoma.

Sports-related maxillofacial fractures in a hospital material

Sports-related maxillofacial fractures were analysed in 80 patients, accounting for 5.6% of all patients with facial bone fractures, treated during the 5-year period 1981-1985. 55% of the patients had 1 or more mandibular fractures and 45% had midface fractures. 6% of the patients had multiple injuries. The most common causes of injury were collision and fall. Soccer and ice hockey turned out to be the most hazardous sports, although sports-related maxillofacial fractures were less severe than those related to other causes. The need for oral and facial protection among athletes involved in contact sports is discussed.

Florid cemento-osseous dysplasia (gigantiform cementoma) in a Caucasian woman.

The present study reports a case of an uncomplicated florid cemento-osseous dysplasia in a 39-year-old Caucasian woman. The extensive dysplastic lesions affected all jaw quadrants and both radio-opaque and lytic lesions were demonstrated radiographically. Histopathological studies revealed calcified, partly acellular cementum-like tissue. All clinical, radiographic, biochemical and histological features were suggestive of the diagnosis of florid cemento-osseous dysplasia.

Maxillofacial and dental soccer injuries in Finland

Between 1979 and 1982 there were 8640 accidents to registered soccer players in Finland. Of these, 552 (6.4%) affected the maxillofacial and dental regions. Medical records were located relating to 537 of these cases (97%). There were a total of 843 injuries, of which 681 (80.8%) affected the teeth or alveolar processes, and 95 (11.2%) were fractures of the lower or middle third of the facial skeleton. The most common cause of the accidents (in 86.4% of cases) was contact with another player. The mean cost of maxillofacial and dental injuries was over twice as high as the mean cost relating to all soccer injuries. The need for the use of mouthguards by soccer players to protect against such injuries is discussed.

Dental injuries in ice hockey games and training.

PURPOSE The purpose of this study was to determine the incidence, cause, and nature of maxillofacial and dental injuries in ice hockey games and training and also evaluate the use and the effect of dental or facial guards. METHODS Maxillofacial and dental ice hockey injuries in Finland were studied during years 1991 and 1992. Material was gathered from the insurance company that had practically all the ice hockey licenses in those years. The material consisted of 479 injured ice hockey players who suffered from 650 separate injuries. The most common dental injury was a noncomplicated crown fracture, which accounted for 43.5% of all maxillofacial or dental injuries. Of these noncomplicated crown fractures, almost 70% occurred in the games. RESULTS The most common cause of accidents was a blow from the ice hockey stick. The stick as a cause of injury was approximately 3 times as common in the games than in training. Only 10% of injured players wore some kind of protective guard. CONCLUSION A mandatory use of mouthguards and face masks or tightened rules for protection to decrease the high number of maxillofacial and dental injuries in the ice hockey games should be considered.

Maxillofacial and dental ice hockey injuries

Maxillofacial and dental ice hockey injuries in Finland were studied during 1979 to 1985. A total of 6,885 accidents occurred to registered players between 1979 and 1982, and 791 (11.5%) of them affected the maxillofacial and dental regions. There were 1,401 separate injuries during the same period, 1,184 of which (84.5%) affected the teeth. The most common cause of accidents (in 54.1% of cases) was a blow received from a stick. Maxillofacial and dental injuries accounted for 38.0% of the total cost of all ice hockey injuries. The mean cost of maxillofacial and dental injuries was over 3 times as high as that for ice hockey injuries as a whole. The use of a mandatory full-cage face mask greatly reduced the number of maxillofacial and dental injuries and hence the cost of treatment.

Bone resection in patients with mandibular sarcoma

Thirty-nine cases of mandibular sarcoma were reported to the Finnish Cancer Registry during the period 1953-1985. In 11 of these (nine osteosarcomas, one chondrosarcoma, one leiomyosarcoma), the pre- and postoperative radiographs were still available, and they were analyzed in order to evaluate the radicality of the primary surgical procedure in relation to recurrences during the follow-up. On the basis of several radiological details, the resection was considered inadequate in seven cases. One operation was probably inadequate because of rather scanty margins. In only three cases had an adequate primary resection with proper safety margins been performed. All of the seven patients with inadequate primary surgery had recurrence and five of them died of local disease or metastases, whereas only one of the three patients with adequate resection had recurrence in adjacent soft tissues. It is concluded, that radiological findings of mandibular sarcoma that often are missed include widening of the mandibular canal and disappearance of the lamina dura. Proper preoperative radiological examination resulting in more radical primary surgery would certainly decrease the recurrence and mortality rates in patients with mandibular sarcoma.

Topical treatment of oral leukoplakia with bleomycin

Ten patients with oral leukoplakia were treated topically with bleomycin. We found the method convenient but only successful where sufficient attention was paid to the activity of the bleomycin-dimethylsulphoxide solution. The initial epithelial dysplasia disappeared completely in five of the 10 patients, while in the remainder the dysplastic grade remained the same. Following treatment the thickness of the keratotic layer increased in four patients, became thinner in five and remained unchanged in one. Although clinically the results of treatment only appear some 3 months after bleomycin application, once the lesions are cured their recurrence seems to be slower than after surgery. Nevertheless we strongly emphasise that 3-monthly follow-ups are mandatory for patients with oral leukoplakias whether or not they have been treated successfully.