The aim of this systematic review was to evaluate the published literature on current educational techniques used to teach local anesthesia administration in U.S. dental schools to determine the methods by which potential complications may be minimized and efficacy maximized. A PubMed search was performed in June 2017 on the following terms: (local anesthesia, education, dental) AND (Humans[Mesh]). Out of 136 articles identified, 13 met the study criteria and were included for review. Of those, the nine with outcome measures were included in the qualitative synthesis. With a quality assessment tool designed for this study, the quality of each included article was assessed independently by three of the authors. Three main pedagogies were identified: didactic instruction based on textbooks and lectures, student‐to‐student injections, and use of anatomic models. However, the effects of these pedagogies on local anesthesia administration efficacy, patient satisfaction, and student confidence in administering local anesthesia were largely not assessed in these studies. Quality assessment of the reviewed articles yielded a mean score of 62% (range 44–83%) for the observational studies and a mean score of 56% (range 47–63%) for the interventional studies. Due to the heterogeneity of the studies assessed, no meta‐analysis could be performed. While the experimental and observational studies reviewed provided some insight into the efficacy of current educational techniques, they had numerous methodological inconsistencies. The inconsistency of the available evidence made it difficult to make fully informed curriculum recommendations based on the existing literature.
Papillary Thyroid Carcinoma (PTC) primarily metastasizes via regional lymphatics making its spread to the oral cavity exceedingly rare. Although this disease remains the most common endocrine malignancy, comprising roughly 85%-90% of all thyroid cancers, it’s occurrence within the oral cavity is seldom seen. This study identifies a case report involving a 77-year-old male with a past medical history of well-differentiated PTC that was initially treated with a total thyroidectomy and adjuvant radioactive iodine. Approximately five years after his initial treatment, surveillance imaging demonstrated a 3.0 x 1.8 x 2.0 cm expansile mass at the left mandibular body with erosion of the lingual cortex. An incisional biopsy then confirmed the diagnosis of metastatic papillary thyroid carcinoma. The patient was treated with a segmental resection of his mandible and final reconstruction utilizing a fibula free flap. Given the limited number of cases involving metastatic spread of PTC to the head and neck region, a standardized treatment algorithm does not currently exist. Thus, this case serves to provide a documented report of this rare occurrence and to review literature that may help other clinicians treat patients with this malignancy type. There remains a need for future studies to create risk stratification models for patients with metastatic PTC that consider margin analysis, genetic characteristics, and elevated risk factors for metastasis to tailor individual treatment plans.
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