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Biomedical subjects

T B Dodson

Publications and source records attributed to T B Dodson.

At least 37 records · Page 2Linked to original sources
PubMed1997

Predictors of postextraction complications in HIV-positive patients.

OBJECTIVE: The purpose of this study was to identify factors associated with an increased risk for post-tooth-extraction complications in a sample of HIV-positive patients. STUDY DESIGN: A cohort of HIV-positive patients who required the extraction of one or more teeth was enrolled. The predictor variables were grouped into the following sets: demographics; medical and social history; preoperative clinical findings; preoperative laboratory measures (hematologic, immunologic, and nutritional); and treatment. The outcome variable was defined as the presence or absence of a complication following tooth extraction. Logistic regression techniques were used to identify variables associated with an increased risk for complications following tooth extraction. RESULTS: During the enrollment period, 76 HIV-positive patients were enrolled into the study cohort. Seventeen patients (22.4%) had postoperative complications. Based on the bivariate statistical analyses, variables associated with the presence of postoperative complications were red blood cell count, CD8 count, total number of positive sites tested using cell-mediated immunity skin tests, and extraction technique (p < or = 0.05). Using a stepwise logistic regression technique, the variable identified as being predictive of postoperative complications was the CD8 count (p = 0.02). The post-tooth-extraction complication rate of the HIV-positive patients in this study sample was greater than the rate reported in most other studies (22% vs. 3%-5%). The complications, however, were minor and easily treated. The variable consistently identified with an increased risk for complications was the CD8 count: the lower the CD8 count, the higher the risk for complications. The CD8 count, however, had poor predictive value. CONCLUSION: In acute clinical situations--for example, in cases of patients with significant dental pain--the results suggest that delaying treatment to obtain laboratory studies may be of little clinical value. It may be appropriate to proceed with suitable, definitive procedure(s) to alleviate symptoms.

Adult↗
PubMed1997

HIV status and the risk of post-extraction complications.

Tooth extraction is commonly performed for patients infected with the human immunodeficiency virus (HIV). We undertook a prospective study to determine if HIV-positive patients had an increased risk for complications following tooth extraction. The study sample was composed of patients who presented for tooth extraction to the outpatient oral/maxillofacial surgery clinic at Grady Memorial Hospital, Atlanta, GA. The predictor variable was HIV status (positive or negative). The outcome variable was the presence or absence of a post-extraction complication. Other study variables were grouped into the following sets: (1) demographic, (2) past medical and social history, (3) clinical, (4) laboratory values, and (5) treatment. Between 11/93 and 4/96, 166 patients were enrolled. The study sample was composed of the 151 patients who completed the study protocol and consisted of 76 HIV-positive and 75 HIV-negative patients. The post-extraction complication rates were 22.3 and 13.3% for the HIV-positive and -negative groups, respectively (relative risk = 1.68, 95% confidence interval = 0.82 to 3.42, p = 0.15). The types of complications that occurred were similar in both groups. While the data suggest an increased rate of post-extraction complications in the HIV-positive group, the difference in complication rates between the two groups was not statistically significant. In addition, the complications were minor, self-limiting, and readily treated. Based on these findings, we believe that tooth extraction is a low-risk procedure in HIV-positive patients. Treatment may be rendered routinely to patients who present on an outpatient basis without the need for an extensive pre-operative work-up, unless otherwise indicated by relevant history.

Adult↗
PubMed1996

The effect of local anesthesia with vasoconstrictor on gingival blood flow during Le Fort I osteotomy.

PURPOSE: In earlier studies, it has been documented that maxillary gingival blood flow (GBF) decreased significantly during the intraoperative course of a Le Fort I osteotomy. It was not clear, however, whether the observed decrease in GBF was caused by the osteotomy or by the use of local anesthetic with vasoconstrictor (LA + V). The purpose of this study was to measure the effect of LA + V on GBF during Le Fort I osteotomy using laser Doppler flowmetry (LDF). PATIENTS AND METHODS: Using a randomized clinical trial study design, patients undergoing Le Fort I osteotomy were assigned to either a treatment (group 1, LA + V used) or a control group (group 2, LA + V not used). The predictor variable was group assignment (LV + V used or not used). The outcome variable was mean maxillary GBF. Maxillary GBF was recorded at predetermined times during the operation. Other study variables included age, sex, single- or double-jaw surgery, estimated blood loss, direction and magnitude of maxillary movements, temperature, pulse, mean blood pressure, O2 saturation, and duration of operation. RESULTS: There were 19 patients in group 1 (LA + V used) and 15 patients in group 2 (LA + V not used). In both groups, mean maxillary GBF decreased significantly during the operation (group 1, 33.3 +/- 13.1 to 16.9 +/- 16.1 mL/ min/100 g tissue, P = .015; and group 2, 48.2 +/- 17.1 to 15.5 +/- 7.6 mL/min/100 g tissue, P = .001). The decrease in GBF occurred much earlier in group 1. By an average of 2.3 hours into the operation, the mean GBF was equivalent in both study groups (group 1, 10.6 +/- 8.6, and group 2, 13.1 +/- 9.4 mL/min/100 g tissue, P = .44). CONCLUSIONS: The results of this study confirm earlier findings that mean maxillary GBF decreases significantly during the intraoperative course of a Le Fort I osteotomy. In addition, LA + V significantly affects GBF during the early phase of the operation. Its effect, however, dissipates between the time of soft tissue dissection and maxillary downfracture.

Adult↗
PubMed1996

Epidemiologic review of pediatric and adult maxillofacial infections in hospitalized patients.

OBJECTIVE: Previous studies documented that location of infection (upper face versus lower face) was a useful tool in managing pediatric facial infections. This study's two objectives were (1) to determine if location of infection was a useful parameter for managing adults with maxillofacial infections, and (2) to compare and contrast the epidemiologic patterns of maxillofacial infections in adults and children. STUDY DESIGN: We used a retrospective cohort study design to review the medical records of adults (age > or = 18) and children (age < or = 14) admitted for treatment of facial infections. Study variables were grouped into the following sets: demographic, clinical, laboratory, treatment, and outcome data. Bivariate data analyses were used to measure associations between study variables. RESULTS: The study sample was composed of 339 adults and 143 pediatric patients. For adult patients, upper and lower face infections could be differentiated on the basis of age, admission white blood cell count, cause of infection, microbiologic variability, treatment, and duration of outpatient treatment. Adults and children with facial infections differed as to duration of preadmission symptoms, presence of constitutional symptoms, admission temperature, location of infection, source of infection, culture results, treatment, duration of treatment, and complications. CONCLUSIONS: Location of infection may not be a clinically useful parameter in managing adults with facial infection. Important differences exist between adults and children with facial infection. The management of pediatric facial infections should reflect these differences.

Adolescent↗
PubMed1996

Reconstruction of alveolar bone defects after extraction of mandibular third molars: a pilot study.

INTRODUCTION: A documented complication of mandibular third molar extraction is the development of bony defects on the distal aspect of the adjacent second molar. The primary study purpose was to determine the efficacy of grafting third molar extraction sites with demineralized bone powder to prevent the formation of periodontal defects. MATERIAL/METHODS: With a randomized clinical trial study design and a third molar extraction surgical model, we enrolled a study sample composed of patients who required extraction of bilateral third molars. Demineralized bone powder was placed in one randomly selected extraction site per patient. The remaining extraction site served as a control. Patients served as their own controls. To assess periodontal healing, we measured plaque and gingival indexes and periodontal attachment loss on the distobuccal aspect of the adjacent second molar preoperatively and 6 months postoperatively. RESULTS: Of 14 patients enrolled, 7 patients with a mean age of 21.7 +/- 3.7 years completed the study protocol. No statistically significant differences were noted between patients who did and did not complete the study protocol (all p values > or = 0.42). There were noted statistically significant differences for the various anatomic, operative, or periodontal measures between the control and treatment teeth preoperatively (all p values > or = 0.46). Six months postoperatively, there were no statistically significant changes in the plaque or gingival indexes for the control or experimental sites. At the control sites, there was a nonstatistically significant decrease in mean attachment loss from 3.1 +/- 1.3 mm preoperatively to 1.4 +/- 1.6 mm 6 months postoperatively (p = 0.06). At experimental sites, there was a statistically significant decrease in mean attachment loss from 3.3 +/- 1.4 mm preoperatively to 0.6 +/- 0.8 mm 6 months postoperatively (p = 0.02) CONCLUSIONS: The study results suggest that demineralized bone powder may decrease attachment loss on the distal aspect of the second molar after extraction of the adjacent third molar. Additional studies are indicated to confirm the results of this pilot study. We recommend that future studies limit their study samples to patients at high risk for developing periodontal defects after third molar extraction.

Adult↗
PubMed1996

Are head, neck and facial injuries markers of domestic violence?

Few data exist regarding the relationship between the location of injuries and the presence of domestic violence. This study of 127 people at an inner-city hospital emergency department found that most patients had head, neck and facial injuries. Although only 23 percent of patients with such injuries were victims of domestic violence, 94.4 percent of victims of domestic violence had head, neck and facial injuries. The study results indicate that head, neck and facial injuries could be markers of domestic violence.

Adolescent↗
PubMed1995

Are mandibular third molars a risk factor for angle fractures? A retrospective cohort study.

PURPOSE: Anecodotal reports suggest that the presence of mandibular third molars predispose the mandible to angle fractures. The purpose of this study was to evaluate mandibular third molars as risk factors for angle fractures in a patient sample with fractured mandibles. MATERIALS AND METHODS: The medical records and panoramic radiographs of a patient cohort with mandible fractures was retrospectively reviewed. Data were collected for the following variables: age, sex, race, mechanism of injury, number and location of mandible fractures, and the presence and position of the mandibular third molars. RESULTS: Of the 73 patients with mandibular third molars, 30 (41.1%) had angle fractures. Of the 28 patients without mandibular third molars, 3 (10.7%) had angle fractures (P = .004). CONCLUSION: The results of this study demonstrate that patients with fractured mandibles and mandibular third molars are 3.8 times more likely to have an angle fracture than patients without mandibular third molars.

Adult↗
PubMed1995

A comparison of single-photon emission computed tomography and planar imaging for quantitative skeletal scintigraphy of the mandibular condyle.

A prospective study was designed to compare two methods of quantifying technetium-99m methylene diphosphonate uptake in the mandibular condyle. The standard technique expresses condylar activity as a ratio of condylar uptake to a reference (often the fourth lumbar vertebra) with planar scans (lateral images of the mandible). The experimental technique quantifies condylar activity as a ratio of condyle to clivus uptake with single-photon emission computed tomography (SPECT). The results of this study indicated that the uptake ratio of condyle/clivus by SPECT scintigram was positively correlated (p = 0.039) with the planar scan technique. The SPECT technique, similar to an axial computed tomography scan, was easier to perform with better reproducibility than the standard planar technique. In addition, activity in the clivus showed less variation than activity in the fourth lumbar vertebrae. With the development of normal uptake standards in the clivus, the SPECT technique may replace the planar image technique in nongrowing patients.

Adolescent↗
PubMed1995

Cost-effectiveness analysis of open reduction/nonrigid fixation and open reduction/rigid fixation to treat mandibular fractures.

OBJECTIVES: When open reduction and internal fixation is indicated for the management of mandibular fractures, it is generally agreed that nonrigid fixation and rigid fixation represent acceptable treatment alternative. Opinions vary, however, regarding the cost-effectiveness of the two alternative. The purpose of this study was to compare the costs of these treatments of mandibular fractures that required open reduction and internal fixation. STUDY DESIGN: Cost-effectiveness analysis was used to determine the most efficient resource used to treat mandibular fractures requiring open reduction and internal fixation. Cost-effectiveness was defined as the treatment charges per successfully treated patient. Data were collected retrospectively from patients with mandibular fractures treated between 1991 and 1994. The patient's medical record and hospital billing record were used as data sources. To estimate treatment charges, the sample was divided into three groups: (1) group 1, patients treated with nonrigid fixation without postoperative complications, (2) group 2, patients treated with rigid fixation without postoperative complications, and (3) group 3, patients treated with either procedure who had postoperative complications. The study variables were grouped into two categories: clinical information and charges. Treatment charges for both treatments were estimated and compared. RESULTS: Data were collected for 12 patients in group 1 and 11 patients in group 2. Costs for rigid fixation averaged $1,468 more per patient than for nonrigid fixation in uncomplicated cases. There were 11 patients in group 3. The average cost to treat a postoperative complication was $11,637. Given the institution-specific treatment cost and the probability of complications, rigid fixation was a more cost-effective treatment than nonrigid fixation. CONCLUSION: Cost estimates for treating mandibular fractures may vary widely depending on practice patterns and complication rates. Despite these cost variations, one may determine the most cost-effective treatment alternative by estimating treatment costs of both uncomplicated and complicated cases and the postoperative complication rate.

Adult↗
PubMed1994

Epidemiologic review of facial infections in hospitalized pediatric patients.

PURPOSE: Pediatric facial infections are quite variable in clinical behavior, making early diagnosis and treatment challenging. To better understand and manage these infections, we conducted a retrospective study. PATIENTS AND METHODS: The cohort consisted of 143 pediatric patients (age < 15 years) admitted to Grady Memorial Hospital (Atlanta, GA) with facial infections. Data concerning patient demographics, source and location of infection, culture results, and treatment modalities were evaluated. RESULTS: Eighty-one percent (n = 116) had lower face infections (LFI). Children with UFI were younger, had more acute symptoms, and an elevated white blood cell count. The source of infection was commonly unknown and there was a wide variability of cultured organisms. Children with LFI were generally older, with symptoms of a more chronic nature. The source of infection could frequently be identified and the types of organisms cultured were less variable. Children with UFI were usually treated with antibiotics alone while children with LFI were more likely to require an operation to resolve the infection. CONCLUSION: Study results lend support to our clinical hypothesis developed in earlier studies that location of infection may be a useful variable that aids in the early diagnosis and management of pediatric facial infections.

Adolescent↗
PubMed1994

Intraoperative assessment of maxillary perfusion during Le Fort I osteotomy.

Intraoperative maxillary blood flow was measured using laser Doppler flowmetry (LDF) in two groups of patients undergoing orthognathic surgery. Group 1 (n = 14) consisted of patients undergoing Le Fort I osteotomy and group 2 (n = 8) consisted of patients undergoing isolated mandibular osteotomies. In group 1, the mean gingival blood flow (GBF) decreased significantly over time during the course of the operation from 29.5 mL/min/100 g of tissue to 13.2 mL/min/100 g of tissue (P = .0001). The mean GBF did not change significantly over time in group 2 (P = .39). The results of this study demonstrate that 1) LDF may be used to measure intraoperative GBF during Le Fort I osteotomy with an acceptable level of variability, and 2) maxillary GBF decreased significantly over time during Le Fort I osteotomy procedures.

Adult↗
PubMed1994

Human immunodeficiency virus serostatus and the risk of postextraction complications.

Despite the increasing prevalence of human immunodeficiency virus (HIV) disease in the population and the increasing likelihood that HIV-positive (HIV+) patients may have an extraction, little is known about the risk of postoperative complications in this group. The goal of this investigation was to assess the risk of postoperative complications in HIV+ patients after tooth extraction. The study was designed as a retrospective cohort study with a sample consisting of 145 males who underwent tooth extraction. The patients' medical and dental records were reviewed to identify HIV serostatus, to document the frequency and type of postoperative complications, and to collect data on potential confounding variables. Forty-four patients were identified as HIV+. The postoperative complication rate in HIV+ patients was 20.9% and for HIV-negative (HIV-) patients 2.9% (relative risk = 7.0, 95% confidence interval = 2.0-25.0, P = 0.001). Furthermore, as the manifestations of the symptoms of HIV infection became more severe, the postextraction complication rate also increased (P = 0.008). The results of this study suggest that HIV+ patients have an increased risk of postextraction complications and as the level of HIV disease increases, the risk of complications also increases. While the findings of this study are consistent with studies based on case series, prospective cohort studies are required to confirm the findings.

AIDS-Related Complex↗
PubMed1993

Prevalence of HIV infection in oral and maxillofacial surgery patients.

To date there have been no systematic reports of the prevalence of HIV infection in dental surgery patients. The purpose of this study was to estimate the prevalence of (1) HIV infection and (2) the risk factors for HIV infection in a sample of patients who went an oral and maxillofacial surgery outpatient clinic in an urban hospital setting. Using a cross-sectional study design and anonymous self-administered patient questionnaires, we estimated the prevalence of HIV infection to be 4.8% (95% confidence interval = 2.3% to 9.7%) in our sample of 165 patients. Prevalence estimates for HIV risk factors were: (1) homosexual/bisexual preference (17.3%), (2) history of sexually transmitted disease (20.0%), (3) history of intravenous drug abuse (10.0%), and (4) history of blood transfusion (3.8%). In general, one might anticipate the prevalence of HIV infection in the patient sample to reflect the community prevalence of HIV infection. Consequently, the prevalence estimates of HIV infection in a sample of patients who live in San Francisco may not be applicable to the reader's local community. Given the known risk factors of HIV infection, however, a well-directed, frank patient history may be useful in identifying patients at risk for HIV infection.

Bisexuality↗
PubMed1993

Fetal cleft lip repair in lambs: histologic characteristics of the healing wound.

Sequential surgical procedures in cleft lip/palate (CL/P) patients result in scar formation that is believed to be associated with midface growth retardation. By use of a previously developed fetal lamb model, wound healing characteristics were investigated after in utero CL repair. It is hypothesized that scarless healing after fetal CL repair occurs without inflammation and scar formation. CL wounds were created in mid-second-trimester fetal lambs and either repaired in three layers (mucosa, muscle, and skin) or left unrepaired. Fetuses were then harvested at 7, 14, and 21 days postoperatively, and the wound site was examined microscopically. When created at 75 days' gestation (term = 145 days), fetal lamb CL wounds heal rapidly without inflammation and scar formation. By day 21 postoperatively, there was complete regeneration of skin, muscle, and mucosa, as well as epidermal appendages. With this model, it will be possible to compare the effects of scarless fetal CL repair with those of postnatal repair on midface growth.

Animals↗
PubMed1993

Risk factors for infection following operative treatment of mandibular fractures: a multivariate analysis.

Utilizing a retrospective study design and a study sample of 284 consecutive patients, we measured the association between five different risk factors and the development of infection following the operative management of mandibular fractures. The five risk factors analyzed were age, sex, number of fractures per patient, time from admission to treatment, and treatment modality. The overall infection rate was 5.3 percent. The infection rate for each treatment modality was (1) 0 percent for closed reduction, (2) 20.0 percent for open reduction and internal fixation with wire osteosynthesis, and (3) 6.3 percent for open reduction and rigid internal fixation. To measure the association between the various risk factors and postoperative infection, we used multivariate logistic regression. After controlling for potential confounding variables, the only risk factor statistically associated with postoperative infection was treatment modality.

Adult↗
PubMed1993

Fetal cleft lip repair in rabbits: long-term clinical and cephalometric results.

We have developed a model for fetal cleft lip (CL) repair in rabbits. To date, the in utero CL procedure has been performed on 174 fetuses in 98 pregnant does. Details of the model, wound healing characteristics, and early growth results have been published previously. In this study, we report long-term clinical and cephalometric findings in 23 fetuses who underwent the fetal CL procedure, were born alive, and survived until completion of growth. The surgically created and repaired CL in fetal rabbits described here resulted in healing without scar formation. The deformity varies from an incomplete to a severe complete cleft, resembling the clinical spectrum of spontaneous clefts in humans. Cephalometric studies indicate that there were no statistically significant differences in premaxillary width, anterior maxillary length, or anterior and posterior maxillary width among control, unrepaired, and repaired animals. Documentation of this phenomenon in higher animals is necessary before the technique can be applied to humans with cleft lip.

Animals↗