Objectives: To evaluate hemodynamic changes of blood pressure and heart rate on hypertensive patients undergoing tooth extraction using various types of local anesthesia (LA). Study Design: A prospective randomized clinical trial was conducted on 45 hypertensive patients who were divided equally into 3 parallel groups according to LA received. Group 1: Lidociane 2% with epinephrine 1: 80,000. Group 2: Prilocaine 3% with Felypressin 0.03 IU/ml. Group 3: Mepivacaine 3% plain. Inclusion criteria: hypertensive patients, under medical management with blood pressure ≤ 159/99. Exclusion criteria: Blood pressure ≥160 /100 and patients receiving β blockers. Negative aspiration was mandatory before the injection of 2 cartridges of LA. Blood pressure and heart rate were evaluated by Electronic Sphygmomanometer and Pulse Oximeters in 3 different time-points; 3 minutes before LA, three minutes after LA and three minutes after extraction. Results: The mean of systolic blood pressure (SBP) had increased after LA injection, and then decreased after extraction in the 3 groups of patients. Increase of SBP after extraction with (Mepivacaine plain) was higher than (Lidociane with Epinephrine) and the difference was statistically significant using ANOVA (p=0.037). The differences in the mean heart rates and mean diastolic blood pressures in the 3 groups were not significant. Conclusions: The increase of blood pressure with Epinephrine and Felypressin is negligible. Therefore, it is safe to use 2 cartridges of Lidociane 2% with Epinephrine 1:80,000 or Prilocaine 3% with Felypressin 0.03 IU/ml for hypertensive patients whose blood pressure ≤ 159/99 provided negative aspiration is verified before injection. Key words:Local anesthesia, tooth extraction, hypertensive patients, vasoconstrictors, epinephrine, Felypressin.

The dentigerous cyst (DC) is the most common type of developmental odontogenic cyst. It is usually asymptomatic and associated with the crown of an unerupted or impacted tooth. However, after a long duration, it is likely to cause significant bone resorption, cortical expansion, and tooth displacement. This report presents a large infected DC in the mandible of a 12-year-old female patient. The DC was located inferior to badly decayed primary molars and surrounded three impacted permanent teeth: canine, first premolar, which had a dilacerated root, and second premolar. The DC was treated successfully by marsupialization and extrusion of the impacted teeth. In conclusion, the combination of marsupialization with orthodontic extrusion is a conservative, efficient protocol that stimulates bone healing and promotes the eruption of cyst-associated teeth even if they are deeply impacted, crowded, or have a dilacerated root. Key words:Dentigerous cyst, marsupialization, impacted teeth, orthodontic extrusion, dilacerated root.

Background Presence of epinephrine in local anesthetic cartridge increases the duration of local anesthesia (LA), decreases the risk of toxicity, and provides hemostasis. However, the unfavorable effects are increasing heart rate (HR) and raising blood pressure (BP). The aim was to evaluate hemodynamic changes in the BP, HR, and oxygen saturation (SpO2) of normal patients undergoing tooth extraction using LA with various epinephrine concentrations. Material and Methods A prospective randomized clinical trial was conducted on 120 patients who were divided randomly into 3 parallel groups according to the LA received. Group 1: lidocaine 2% with epinephrine 1:80,000 (L80). Group 2: articaine 4% with epinephrine 1:100,000 (A100). Group 3: articaine 4% with epinephrine 1:200,000 (A200). Inclusion criteria: normal patients whose BP < 140/90. Exclusion criteria: hypertension, cardiovascular disease, hyperthyroidism, pregnancy, and allergy to LA. BP, HR, and (SpO2) were evaluated in 3 different time points: 3 minutes before LA, 3 minutes after LA, and 3 minutes after extraction. Results Systolic blood pressure (SBP) significantly increased after injection of L80 and continued after extraction to be significant than pre-injection. SBP significantly increased after injection of A100 then decreased after extraction. In the group of A200, SBP insignificantly decreased after injection then increased after extraction. The increasing of SBP between time point 1and 2 was significantly higher in G1 than G3 (p=0.014). Diastolic blood pressure decreased after LA in the 3 groups; however it was significant only with L80, then increased after extraction for all. Conclusions The changings of DBP, HR and SpO2 after anesthesia and extraction showed no significant difference among the three groups. However, A200 had significant lesser effect on SBP than L80 and the least effect on other parameters. Therefore, A200 is considered safer than L80 and A100 and is recommended for LA before teeth extraction in normal patient. Key words:Local anesthesia, lidocaine, epinephrine 1:80,000, articaine, epinephrine 1:100,000, epinephrine 1:200,000, tooth extraction.

Inappropriate use of antibiotics may lead to adverse side effects. This cross-sectional survey aimed to investigate the knowledge and attitude of female non-medical students regarding the medical and dental use of antibiotics. Four hundred validated self-administered questionnaires were distributed in Princess Norah Bint-Abdurrahman University, Riyadh, Saudi Arabia. The questionnaire included questions about accessibility, attitude toward usage, efficacy, side effects, resistance, and usage for dental issues. Knowledge was estimated for every respondent by counting the correct answers, which were considered as points. The scores were categorized as poor, moderate, and high. Of the respondents, 77.8% answered they get antibiotics according to a doctor's prescription; however, 31% stops taking antibiotics when they feel well. Only 38.8% of respondents knew that antibiotics may cause allergic reactions while 59.8% believed the human body can be resistant to antibiotics. The percentages of answers related to dental issues were: antibiotics relieve dental pain (68.8%), antibiotics can be harmful for children's teeth (27.3%), antibiotics are best avoided in pregnancy (56.7%) and no need for antibiotics after scaling (33.8%), root canal treatment (16%), or simple extraction (40.3%). Of respondents, 68% had poor scores about antibiotics efficacy, side effects, and resistance while 86.8% had poor scores related to dental problems. This study noticed a bad attitude related to antibiotics usage, with many misconceptions and poor knowledge. Moreover, the necessity of antibiotics for treatment of dental disease or after dental procedures was totally unclear for the respondents. Community campaigns are recommended every university semester to educate students about the indications, efficacy, and side effects of antibiotics.

Background and Objectives. Surgical extraction of mandibular third molars (3rd M) may cause inferior alveolar nerve injury (IANI), whereas in coronectomy the crowns of 3rd M are removed, keeping the roots intact to avoid IANI. This study aims to review the literature which evaluated coronectomy effectiveness as an alternative for surgical extraction of 3rd M that have a high risk of trauma to the inferior alveolar canal. A computerized literature search was conducted on the databases PubMed, SCOPUS, and ScienceDirect to gather information regarding the coronectomy procedure from inception till June 5, 2020. A total of 97 articles were identified, and seven studies were finally included for conducting qualitative analysis: 3 randomized clinical trials and 4 clinical controlled trials. Cochrane Collaboration’s tool was used for assessing risk of bias. Coronectomy procedures were performed on 15–171 teeth. In the control group, extraction procedures were done on 15–178 teeth. Results. No study reported permanent inferior alveolar nerve injury (p-IANI) regarding coronectomy; however, transient inferior alveolar nerve injury (t-IANI) was reported in 0–2.20% of successful coronectomy and 0–8% of failed coronectomy. Postextraction t-IANI ranged from 0% to 16.66% while p-IANI from 0% to 3.63%. In 5 studies, root migration occurred in 2% to 85.3% of cases and the distance rate was 2.33–3.43 mm at 6 months postoperatively; then the migration gradually decreased and stopped at 12 months. Conclusion. This systematic review revealed that coronectomy is an efficient alternative for the management of impacted 3rd M with a high risk of IANI. Patients who got antibiotics postcoronectomy procedures had lower infection rates than those who did not receive antibiotic therapy. We recommend further research on coronectomy with longer follow-up periods to assess the retained roots’ long-term outcomes and to assess the effect of antibiotics administration on postcoronectomy infection rate. This systematic review is registered under number CRD42020198394.