Halifax Health Medical Center

Chronic cannabis use has become increasingly prevalent due to its medicinal and recreational applications, necessitating a comprehensive understanding of its impact on oral and periodontal health. This review explores the multifaceted effects of cannabis consumption, focusing on periodontal health, salivary gland function, oral microbiome alterations, wound healing, and associated risks of oral cancer. Chronic cannabis use is linked to higher prevalence and severity of periodontitis, driven by its influence on inflammatory pathways and immune modulation. Salivary gland dysfunction resulting in xerostomia compromises oral health, increasing the risk of dental caries and mucosal infections. Changes in the oral microbiome, characterized by dysbiosis, contribute to periodontal disease progression and peri-implant complications. Furthermore, while cannabinoids offer therapeutic potential due to their anti-inflammatory and analgesic properties, chronic use poses significant risks, including delayed wound healing and increased oral cancer susceptibility. This review underscores the dual role of cannabis as both a therapeutic agent and a risk factor, emphasizing the need for further research to optimize clinical management strategies for cannabis users and improve oral health outcomes.

A patient with a peritonsillar abscess (PTA) may initially appear clinically stable, but certain risk factors can predispose to a sudden airway obstruction. Those risk factors include being a young-to-middle-aged male, obesity (defined as a BMI ≥30.0 kg/m²), or diabetes. An obese 52-year-old diabetic male presented to the emergency department with throat pain, trismus, and a muffled voice. CT imaging of the neck without contrast showed a large abscess extending into the parapharyngeal space and compressing the airway anteriorly. Although he initially had normal oxygenation, he suddenly lost consciousness and experienced cardiac arrest during a positional change during the gurney-to-bed transfer. Intubation was not possible due to mechanical obstruction, and a percutaneous tracheostomy was performed during chest compressions. Return of spontaneous circulation was achieved, and the patient recovered without neurological deficits. This case demonstrates that patients with PTA and certain comorbidities may suddenly deteriorate, even when they initially appear clinically stable. Early airway management is essential when the risk factors are present.

Craniofacial anomalies represent a diverse group of developmental disorders with profound implications for a child’s functional, aesthetic, and psychological well-being. Effective management of these conditions requires a multidisciplinary approach, with orthodontists playing a pivotal role in guiding craniofacial growth and development. This literature review explores current diagnostic techniques, orthodontic management strategies, and interdisciplinary care frameworks for addressing common craniofacial anomalies, such as cleft lip and palate, craniosynostosis syndromes, and hemifacial microsomia. Advances in 3D imaging, virtual surgical planning, and custom appliance fabrication are highlighted as transformative tools that enhance diagnostic accuracy and treatment precision. The review also underscores the importance of long-term monitoring and adaptive care to maintain favorable outcomes as patients grow and develop. Key research gaps and future directions are identified, emphasizing the need for further exploration into genetic mechanisms, advanced technologies, and evidence-based treatment protocols to optimize outcomes for pediatric patients with craniofacial anomalies.

The growing importance of facial aesthetics in modern orthodontic practice has led to a renewed focus on the multifaceted impact of various treatment approaches on a patient’s overall appearance and well-being. This comprehensive review aims to explore the complex relationship between orthodontic interventions and their profound influence on facial aesthetics. It examines different types of malocclusions, from skeletal discrepancies to dental misalignments, and evaluates the effectiveness of diverse treatment modalities, such as traditional braces, clear aligners, and orthognathic surgery, in improving facial balance, symmetry, and harmony. To conduct this review, we performed an extensive and systematic search across multiple reputable databases, including PubMed, Scopus, Web of Science, Cochrane Library, Embase, and Google Scholar, covering literature published from 2000 to 2024. Studies included were peer-reviewed clinical trials, systematic reviews, and meta-analyses involving adolescents and adults undergoing orthodontic treatment. Emphasis was placed on both objective outcomes, such as cephalometric analysis and 3D imaging, and subjective outcomes, including patient satisfaction and psychological impact on facial aesthetics. Studies focusing exclusively on functional outcomes, non-peer-reviewed articles, or those involving pediatric populations without long-term aesthetic data were excluded. The key findings of this review indicate that orthodontic treatments can significantly influence a patient's facial aesthetics, with outcomes varying widely based on the specific type of malocclusion and the chosen treatment approach. While some interventions successfully enhance facial symmetry, proportion, and overall aesthetic appeal, others may lead to less desirable or unintended aesthetic outcomes. This underscores the need for a holistic, patient-centered approach that incorporates both functional and aesthetic considerations into treatment planning. Ultimately, this review emphasizes the importance of prioritizing patient satisfaction and incorporating comprehensive aesthetic evaluations to ensure optimal results. By addressing the complex interplay between malocclusion, treatment modalities, and their impact on facial aesthetics, clinicians can optimize orthodontic outcomes, enhancing both facial harmony and patient self-confidence.

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Pancreatic schwannoma is a neuroendocrine cell tumor that arises in the pancreas. It is very rare, and, to date, only fewer than 70 similar cases have been reported in the literature. Here, we present another case of this type of tumor in a 68-year-old female.In addition to describing the pancreatic schwannoma, we discuss the major challenges associated with its diagnosis and management. As such, clinically and on imaging, pancreatic schwannomas are almost indistinguishable from other cancerous or benign pancreatic tumors. Therefore, only a biopsy can definitively diagnose pancreatic schwannomas by demonstrating spindle-shaped cells with immunohistochemistry positive for S-100.Because pancreatic schwannomas are very rare, it is important to increase awareness among clinicians about this condition and inform them regarding the challenges associated with its diagnosis and management.

Comorbidity burden is commonly measured among hospitalized adults, yet the U.S. national norms for 2 commonly used comorbidity indexes have not yet been reported. Thus, this study reports U.S. national norms for both Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) among hospitalized adults based on age, biological sex, and race. A retrospective observational cohort study using data from the Agency of Healthcare Research and Quality U.S. National Inpatient Sample database for 2017. Patient data were extracted from 7 159 694 inpatient adults, and analyses were focused on individuals older than 45 years, yielding 4 370 225 patients. International Classification of Diseases, 10th Edition, diagnostic codes were used to calculate CCI and ECI scores. These scores were then weighted for the U.S. national population. The weighted mean CCI was 1.22 (95% confidence interval [CI]: 1.22, 1.22), and the weighted mean ECI was 2.76 (95% CI: 2.76, 2.76). Both indexes had increasing average scores with increasing age, independent of sex and race (all p values < .001). For the first time, U.S. national norms for the CCI and ECI are reported for adult inpatients. The norms can serve as a reference tool for determining if clinical and research populations have greater or lesser comorbidity burden than typical hospitalized adults in the United States for their age, sex, and race.