Dumfries and Galloway Royal Infirmary

Background The management of impacted mandibular third molars (M3Ms) has been an area of contention over the last 25 years. This study investigated the prevalence of disease processes in relation to age for a sample of patients with horizontal and mesioangular M3Ms.Method All concomitant disease processes including probing pocket depths (PPDs) and alveolar bone loss (ABL) distal to mandibular second molars (M2Ms) were recorded from a sample of 400 patients.Results From 536 M3M/M2M interfaces, 41% (n = 219) had a disease process present on the distal surface of the M2M and 11% (n = 61) had such significant disease that the M2M was removed. Presence of M3M caries was 38.2% (n = 205); localised periodontitis, 21.5% (n = 115); pericoronitis, 20.1% (n = 108); and M2M caries, 18.5% (n = 99). No simple correlation between age and number of disease processes was found (r = -0.020; p = 0.648); although, the prevalence of M2M caries and pericoronitis was related to age (2 = 9.951; p = 0.007 and χ2 = 12.834; p = 0.002), as was PPD and ABL (p <0.001).Conclusion(s) Multiple disease processes can occur concomitantly with horizontal or mesioangular M3Ms. Discussion of disease risk with regular clinical and intra-oral radiographic monitoring by general dental practitioners is recommended.

Sülek T, Dumani A, Küden C, Kussever H, Yoldas O. Anaesthetic effectiveness of mental/incisive nerve block versus inferior alveolar nerve block in mandibular first and second premolars with symptomatic irreversible pulpitis: a randomised clinical trial. J Endod 2025; https://doi.org/10.1016/j.joen.2025.01.016 . This study is a randomised, double-blinded, parallel-group clinical trial investigating the efficacy of Mental Nerve Block (MNB) and Inferior Alveolar Nerve Block (IANB) techniques for anaesthesia of mandibular Premolars with Symptomatic Irreversible Pulpitis (SIP). The aim of the clinical trial is to establish if one anaesthetic technique is superior in facilitating Endodontic treatment in Mandibular Premolar Teeth with SIP and to explore if a difference is observed when comparing anaesthesia of First and Second Premolars with use of MNB and IANB techniques. Patients were enroled as per strict inclusion and exclusion criteria, then attended for Endodontic treatment of a Mandibular Premolar Tooth with SIP. Local anaesthetic block technique was determined by random assignment to MNB or IANB. To ensure blinding of the operator with regards to the anaesthesia method, one clinician administered anaesthesia and placed dental dam, and a second clinician completed the procedure. In total, 120 patients with a diagnosis of SIP of a Mandibular Premolar Tooth were enroled in the clinical trial. Inclusion criteria required participants be aged 18 to 65 years old and ASA Class I/II. Clinical signs indicative of SIP were required, including: carious pulpal exposure, haemorrhage during cavity preparation and prolonged pain in response to and persisting after thermal stimuli. Participants were excluded from the trial if they experienced pain involving multiple teeth or if there was use of pharmacological agents, with the ability to influence pain perception, within 6 hours of treatment. Participants were excluded from the trial if there was radiographic evidence of Periapical pathology, symptoms indicative of Apical Periodontitis or lack of anaesthesia 15 minutes after IANB administration. The sample size was determined using G*Power software and 60 patients were allocated to each group: MNB and IANB respectively. The drug preparation administered in all cases was 1.8 ml Articaine 4% with 1:100,000 epinephrine hydrochloride and the aspirating technique was used. Statistical analysis was completed using SPSS Statistics. Patients were verbally questioned prior to Endodontic treatment, with responses recorded on the Numerical Rating Scale (NRS). Pain scores were recorded relating to pre-operative assessments, cold tests, cavity preparation and pulp extirpation. Success rates for the MNB and IANB anaesthesia groups were explored using chi-squared and probability ratio tests. The Man-Whitney U test allowed for comparison of tooth type and gender. In this study, success was defined as patients completing treatment with no pain (NRS = 0) or mild pain (NRS < 3), without additional anaesthesia. 120 patients were included in the clinical trial, 52 male and 68 female. The number of Premolar teeth that received Endodontic treatment was 120, this was comprised of 54 First Premolars and 66 Second Premolars. 60 patients were randomly allocated to each group: MNB and IANB, for each group data showed similar distributions of patient age, gender and tooth type. All patients reported lip numbness and both anaesthesia techniques achieved a success rate of approximately 70%. The percentage of patients that experienced pain during cavity preparation or pulp extirpation was 30% for both groups. These patients required supplementary injections and were given intraligamentary anaesthesia, 50% experienced adequate pain relief as a result. The IANB technique achieved sufficient anaesthesia for 71.4% of First Premolars and 68.8% of Second Premolars, with no statistically significant difference (P > 0.05). The MNB technique achieved sufficient anaesthesia for 76.9% of First Premolars and 64.7% of Second Premolars, with a statistically significant difference (P < 0.05) recorded comparing the Premolar tooth types. IANB and MNB techniques have comparable efficacy in achieving anaesthesia of First and Second Premolars with SIP. The anaesthesia efficacy achieved by the IANB technique was comparable for First and Second Premolars. It would be beneficial to use the MNB technique for anaesthesia of First Premolars, compared to Second Premolars, as a statistically significant difference was recorded, with higher success rates observed for anaesthesia of First Premolars by the MNB technique. Irrespective of Nerve Block technique and Premolar tooth type, it was identified that for 1 in 3 Premolars with SIP supplementary anaesthesia was required to ensure adequate anaesthesia and patient comfort.

Background Mesio-angular and horizontal mandibular third molars (M3Ms) are a risk factor for the development of dental disease, particularly affecting mandibular second molars (M2Ms). The aim of this study was to gain an insight into patient knowledge, views and opinions on management of disease-free horizontal and mesio-angular M3Ms.Methods Adult patients with at least one horizontal or mesio-angular M3M with an adjacent M2M attending an oral and maxillofacial surgery clinic were invited to participate in a structured survey.Results From 400 responses, 64% (n = 257) of respondents stated they would choose to have their impacted M3M prophylactically removed given the hypothetical scenario that they have never experienced any symptoms from their wisdom tooth. Of patients that never experienced symptoms from their wisdom teeth, 39.1% (n = 43) selected prophylactic removal, compared with 73.8% (n = 214) of patients that had previously experienced symptoms (χ2 = 40.3; p <0.001). The extent of disease progression significantly influenced patient preference for surgery (χ2 = 55.173; p <0.001), as did age (χ2 = 28.28; p <0.001).Conclusion In most cases, symptoms, age and disease experience influenced patients' treatment preferences. These findings support the importance of discussion and shared decision-making in the consent process.

The British Thoracic Society recommend that pulmonary embolism (PE) patients with low-risk Pulmonary Embolism Severity Index (PESI) scores are considered for outpatient (OP) management, in settings where robust pathways for follow-up and monitoring exist. Retrospective cohort study. We reviewed the electronic records of 109 consecutive PE patients considered appropriate for OP management. Primary outcomes were the incidence of recurrent venous thromboembolism, major bleeding, mortality at 1 year and evidence of chronic thromboembolic pulmonary hypertension (CTEPH). Low-risk PESI scores (I-II) were recorded in 78 (72%) patients, with higher scores a consequence of age and comorbidity rather than haemodynamic instability. There was a low rate of adverse outcomes despite a lack of formal follow up for most patients. There was no evidence of CTEPH in 34 patients who underwent echocardiography. Our analysis challenges the need for robust follow-up pathways for all patients with pulmonary embolism.

A 74-year-old man who presented with upper abdominal pain was found to have an incidental appendiceal mass on cross-sectional imaging. He underwent a laparoscopic appendicectomy with histopathological examination confirming a completely resected appendiceal gastrointestinal stromal tumour (GIST). Appendiceal GISTs are rare. Therefore, there is limited evidence to guide risk stratification and management with extrapolation of prognosis from data on GISTs at other sites. This paper highlights the rarity of these tumours and presents another case which correlates well with the existing but limited literature. There is a need to maintain a registry of this rare disease entity with the maintenance of longer-term follow-up data.