Standing electric scooters (e-scooters) are rapidly becoming popular modes of transportation in many urban areas across the United States. However, this increase in popularity has resulted in an increase in traumatic injuries associated with these modes of expedient travel. The purpose of the present study was to determine the types of craniofacial trauma directly related to e-scooter use in a major urban center (Dallas, TX). Materials and Methods: We performed a retrospective case series and examined the medical records of the patients who had presented to the emergency department (ED) for trauma related to e-scooter use. Descriptive statistics were calculated for all variables on patient presentation, including incident notes and patient interviews, demographic information, diagnostic tests, trauma (ie, location, type, severity), treatment (ie, type, admission, outpatient referral, follow-up data), and contributing factors (ie, reported or detected alcohol use, use of protective equipment). Results: A total of 90 patients (56 males, 34 females; mean age, 31.8 years) had presented with scooterrelated trauma to the ED during the first 7 months of scooters after their introduction to the metropolitan area. A total of 52 admissions (58% of all admissions) involved injuries of the head and face. The patients had presented with a myriad of craniofacial trauma, ranging from abrasions, lacerations, and concussions to intracranial hemorrhage and Le Fort II and III fractures. Of the 52 craniofacial injuries, 30 (58%) were considered severe (ie, fracture, internal hemorrhage, concussion, loss of consciousness), and 22 (42%) were considered minor (ie, lacerations, contusion, abrasion, dental). Alcohol use had been involved in 18% of all scooter-related trauma admissions, and no rider had reported wearing a helmet. Conclusions: Injuries to the head and face were commonly found with e-scooter admissions in this sample, and the high prevalence of extremity injuries suggested that patients were breaking their fall during the crash. Craniofacial trauma related to e-scooter use could be significantly reduced by the wearing of a protective helmet.

The effectiveness of triphala in the reduction of plaque and gingivitis was comparable to chlorhexidine, and can be used for short-term purposes without potential side-effects. It is a cost-effective alternative in reducing plaque and gingivitis.

Traumatic dental injuries affect 1 to 3% of the population, and disproportionately affect children and adolescents. The management of these injuries incorporates the age of patients, as children between 6 and 13 years of age have a mixed dentition. This helps to preserve the vitality of teeth that may be salvaged after a traumatic event. The clinical examination of these cases involves a thorough examination of the maxilla and mandible for associated fractures and any lodged debris and dislodged teeth or tooth fragments. The objective is to rule out any accidental aspiration or displacement into the nose, sinuses, or soft tissue. After ruling out any complications, the focus is on determining the type of injury to the tooth or teeth involved. These include clinical examination for any color change in the teeth, mobility testing, and testing for pulp vitality. Radiographic evaluation using periapical, occlusal, panoramic radiographs, and cone beam computed tomography is performed to view the effect of trauma on the tooth, root, periodontal ligament, and adjoining bone. The most commonly used classification system for dental trauma is Andreasen's classification and is applied to both deciduous and permanent teeth. Managing dental trauma is based on the type of injury, such as hard tissue and pulp injuries, injuries to periodontal tissue, injuries of the supporting bone, and injuries of the gingiva and oral mucosa. Hard-tissue injuries without the involvement of the pulp typically require restoration only. Any pulp involvement may require endodontic treatment. Fractures involving the alveolar bone or luxation of the tooth require stabilization which is typically achieved with flexible splints. The most common procedures employed in managing dental injuries include root canal/endodontics, surgical tooth repositioning, and flexible splinting. Recognition and treatment of these injuries are necessary to facilitate proper healing and salvage of a patient's natural dentition, reducing future complications to patients.

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Macroglossia, either congenital or acquired enlargement of the tongue, is a rare condition that leads to functional deficiencies in speech, mastication/deglutition, and airway patency. Acute‐acquired cases of macroglossia are potentially life threatening and have myriad etiologies. Presented here are two cases of macroglossia in adults caused by acute angioedema resulting from reaction to angiotensin‐converting enzyme (ACE) inhibitors. The mechanism of ACE inhibitor‐induced angioedema is attributed to dysfunction in the kallikrien‐kinin system, a protease pathway converting high molecular weight kininogens to kinins such as bradykinin, which can lead to inflammation of the cardiovascular system. This condition, while rare in adults, is more easily diagnosed, monitored, and treated if detected early. However, many clinicians fail to educate patients on the warning signs of acute angioedema: swelling of the tongue, submandibular and pharyngeal spaces, and/or difficulty breathing. Furthermore, patients often do not recognize the symptoms of ACE inhibitor reactions, leading to delays in diagnosis and treatment. Management of acute angioedema and subsequent macroglossia includes hospitalization and intubation for airway maintenance, partial glossectomy, and subsequent glossal rehabilitation and speech therapy. Both cases presented here led to anoxic brain injury and necessitated intensive surgical intervention, demonstrating the need for better patient‐clinician communication for positive outcomes of ACE inhibitor use. Current research on the kinin system and its role in the cardiovascular system is limited, so baseline clinician‐patient education represents the best first‐line defense against life‐threatening cases of acute angioedema.Support or Funding InformationThis research is supported in part by funding from the Texas A&M University College of Dentistry and the Baylor University Medical Center at Dallas.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

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Presented here are two cases of acute acquired macroglossia in adults caused by angioedema resulting from a reaction to angiotensin-converting enzyme inhibitors (ACEIs). Angioedema can be caused by a variety of factors, but ACEIs are the most common precipitating factor. Symptoms such as swelling of the lips, face, tongue, and throat can lead to life-threatening airway compromise. Early management of acute angioedema and macroglossia includes antihistamines, steroids, and occasionally epinephrine, yet a small percentage of patients progress toward airway obstruction and will require intubation. Edema within the lips, face, and throat usually subsides within a week, but the tongue can remain edematous for prolonged periods if biting trauma occurs. If the patient's macroglossia does not resolve in a reasonable amount of time, a partial glossectomy may be indicated.