Queilitis granulomatosa de Miescher: presentación de cinco casos

La queilitis granulomatosa de Miescher (QG), consiste en la aparición de edema labial recurrente en uno o ambos labios, el cual puede llegar a ser persistente. Ha sido considerada tradicionalmente, como una forma monosintomática del síndrome de Melkersson Rosenthal, descrito como la asociación de edema labial y/o facial recurrente, parálisis facial recidivante y lengua fisurada. El objetivo de este trabajo es presentar una serie de 5 casos diagnosticados clínica e histopatológicamente de QG, que acudieron a la consulta de la Unidad Docente de Medicina Bucal de la Universidad de Murcia. Se realizó un estudio completo de estos pacientes, valoramos la edad y el sexo, antecedentes familiares, localización y curso de los signos y síntomas. Llevamos a cabo diversos exámenes complementarios, estudiándose las características hemáticas (hemograma, velocidad de eritrosedimentación, fórmula leucocitaria y estudio inmunológico), e histopatológicas. El tratamiento consistió en corticoides intralesionales, combinado en algunos casos con fármacos antileprosos o corticoides sistémicos. En todos los casos obtuvimos una buena respuesta al tratamiento.Miescher's cheilitis granulomatosa (CG) consists of the appearance of recurrent labial edema on one or both lips, which can become persistent. It has traditionally been considered as a monosymptomatic form of the Melkersson-Rosenthal syndrome, described as the association of recurrent labial and/or recurrent facial edema, relapsing facial paralysis and fissured tongue. The aim of this study is to present a series of five clinically and histopathologically diagnosed cases of CG that came to our clinic at the Teaching Unit of Oral Medicine, Faculty of Medicine and Odontology, University of Murcia. A complete study of these patients evaluated the age, sex, family history, and location and course of the signs and symptoms. Various complementary examinations were carried out, studying the hematic characteristics (hemogram, erythrocyte sedimentation rate, leukocyte count), including immunological and histopathological studies. The treatment consisted of intralesional corticoids, combined in some cases with anti-leprous drugs or systemic corticoids. A good response to treatment was obtained in all cases

Sleep apnea and mandibular advancement device : revision of the literature

Sleep apnea and hypopnea syndrome (SAHS) is a disorder characterized by intermittent and repetitive obstruction of the upper airway provoking pharyngeal collapse. It is characterized clinically by a triad of daytime hypersomnia, snoring and pauses in breathing during sleep that are normally reported by the partner. Polysomnography is the chosen method for diagnosing this pathology. Patients with this disorder tend to have the following dental and orofacial signs: a retrognathic jaw, a narrow palate, a wide neck, deviation of the nasal septum and relative macroglossia, among others. Dentists should be ready to evaluate the risk-benefit of certain dental treatment options for this public health problem. The treatment of this problem will depend on its severity, with one of the options being the Mandibular Advancement Device (MAD) that is used especially in the treatment of slight or moderate SAHS and in the treatment of snoring, with results that are occasionally very successful. The objective of this study is to carry out an up-to-date literature review of SAHS and to evaluate the role of the dentist when faced with this pathology

Homo sapiens, Chimpanzees and the Enigma of Language

ObjectivesThe present study explores the hypothesis that the anatomical bone structures of the oral cavity have probably evolved under the influence of language function. The possible changes have been evaluated by comparing two close species essentially differentiated from each other by spoken language.Materials and MethodsTwenty dry skulls and 20 mandibles of modern Caucasians were compared with 12 dry skulls and 12 mandibles of chimpanzees, with the analysis of 37 variables and the definition of new anatomical parameters.ResultsA number of highly significant differences were found between humans and chimpanzees. The human temporomandibular joint is comparatively less flat and has a more limited excursive movement range, with structural elements that seem to be lighter. A significant difference is noted in mandibular alveolar vergency and in the internal slope of the mandibular symphysis where the oral cavity’s morphology is modified, thereby increasing the free space for tongue movements in humans. The chin, which is unique to the human species, is quantified through the external slope of the mandibular symphysis with a lesser angle in humans.DiscussionIt is obvious that there are differences between humans and chimpanzees in the bone morphology of the oral cavity structures. This has been confirmed with the analysis of new variables. Together with other factors (bipedalism, habits, and genetics) speech in humans must have played an important role in the aforementioned differences between humans and chimpanzees. The number of mandibular movements involved in speech is far greater than those used in chewing, which must have conditioned the evolution of the oral structures implicated in the development of language. On average, humans weigh 70 kg and chimpanzees 44 kg. However, the majority of the variables studied in skulls and mandibles are greater in chimpanzees, which suggests that the evolution of the oral zone in humans has suffered a reduction in size with changes in shape. The refinement of the supralaryngeal vocal tract in the human species must have co-evolved with speech fairly recently. The human skull has temporomandibular joints that are comparatively less flat with a more limited movement. There is a greater lingual space and there is also a chin that suggests a muscular stimulant. This leads to the conclusion that, at least in part, speech is behind all these changes, although it is difficult to establish a cause-effect relationship

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogénicas.The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc') confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg / 125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection

Morphometric analysis of the dorsum linguae in patients with Oral Lichen Planus

Objective: Morphometric study of the dorsum linguae in patients with Oral Lichen Planus (OLP).Material and Method: In 236 patients with a clinicopathologic diagnosis of OLP, 111 were found to have involvement of the dorsum linguae. For the purposes of the study, 41 of these cases were used, due to the availability of photographic records fulfilling quality conditions according to objective criteria. The experimental variable was defined as the proportion of affected dorsum linguae measured and calculated using the MIP4(R) computer software.Results: In 236 patients with OLP, the mucosa of the dorsum linguae was affected in 47.6% of the cases (total 111). The proportion of affected area was studied in 41 of these cases, 8 men (19.5%) and 33 women (80.5%). In 73% of these cases, the affected area was less than 50% of the total surface of the dorsum linguae. There were no statistically significant differences (p=0.495) in relation to age and proportion of lingual surface affected. On the other hand, significant statistical differences were found between the period of disease evolution and area of lingual involvement (p=0.044).Conclusion: Lingual involvement is frequent in patients with OLP, and manifests as de-papillate areas to the left and right of the median sulcus of tongue (occasionally linked by an isthmus) and having a certain “ butterfly wing” symmetr

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogé[email protected]

Pénfigo vulgar: presentación de catorce casos y revisión de la literatura

El pénfigo vulgar (PV) es una enfermedad mucocutánea crónica de tipo vesículo-ampollares que casi siempre produce manifestaciones orales. El hecho de que en ocasiones sean las ampollas en la mucosa oral la primera manifestación de este desorden implica que los odontólogos deben conocer suficientemente las claves clínicas con el fin de realizar un diagnóstico y tratamiento precoces. El objetivo de este trabajo es presentar una serie de 14 casos diagnosticados clínica e histopatológicamente de PV, que acudieron a la consulta de la Unidad Docente de Medicina Bucal de la Universidad de Murcia entre 1981 y 2001. Se realizó un estudio completo de estos pacientes, valorando la edad y el sexo, localización y extensión de las lesiones, así como el curso de los signos y síntomas. Se llevaron a cabo diversos exámenes complementarios, estudiándose las características hemáticas (biometría hemática y química sanguínea), histopatológicas, e inmunohistoquímicas (inmunofluorescencia directa en dos de los pacientes). El tratamiento consistió en corticoides tópicos, combinado en doce casos con corticoides sistémicos, y en uno con corticoides intralesionales. En todos los pacientes se obtuvo una buena respuesta al tratamiento.Pemphigus vulgaris (PV) is a chronic vesicular-ampullar mucocutaneous disease that almost always produces oral manifestations. The fact that blisters on the oral mucosa are sometimes the first manifestation of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of PV to ensure early diagnosis and treatment. We present a series of 14 patients with clinically and histologically diagnosed PV seen in the Teaching Unit of Oral Medicine of the University of Murcia (Spain) between 1981 and 2001. A thorough evaluation was made, recording patient age and sex, the location and extent of the lesions, and the signs and symptoms of the disease. Complementary studies were also carried out, with the evaluation of hematological parameters (including blood chemistry), the histology and immunohistochemical characteristics (direct immunofluorescence in 2 cases). Treatment comprised topical corticoids, in 12 cases combined with systemic corticoids, and associated to intralesional corticotherapy in one patient. A good response to treatment was observed in all cases

Influencia de la caries y la enfermedad periodontal en la halitosis / Manuel Saura Pérez ; directores Pía López Jornet, Ambrosio Bermejo Fenoll.

Tesis-Universidad de Murcia.MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 631.Consulte la tesis en: BCA. GENERAL. DEPOSITO. T.M-1958

Hypothesis about the appearance of the vermillion border of the lips in Homo sapiens

The vermillion border of the lips is an exclusive aspect of Homo sapiens, and is one of the few morphological elements that mark the facial difference with the rest of hominids. On the other hand, modern spoken language is also a characteristic of the human species. Spoken language and the vermillion border could have a relationship. Hypothesis: About 200,000 years ago, spoken language appeared in Africa. The friction between the lips when pronouncing bilabial syllables could have been the origin of the disappearance of hair follicles, resulting in the emergence of the vermillion border of the lips. This study tries to evaluate the influence of persistent, non-aggressive friction on the density of the hair follicles in a given area of human skin. Material and methods: Twenty-five men between the ages of 25 and 95 years old, who had worn a gold ring on the finger of one hand for more than 5 years, were selected. A trichogram of the skin of the finger with the ring was made and compared with the skin of the finger without a ring on the opposite hand. The data analysis was carried out with the SPSS version 18 statistical package and the Kolmogorov-Smirnov, Student T, Mann Witney's U and Spearman tests were used. Results: The area of the collective study of fingers with a ring gave an average number of hair follicles of 7.0 with a standard deviation of 2.80. The area of the collective control fingers without a ring gave an average number of hair follicles of 9.76 with a standard deviation of 4.53. The differences between both groups are statistically very significant with p-value of 0.002. Discussion: The results obtained prove that there is a direct influence of persistent, non-aggressive friction on the hair density of human skin on the finger. It was verified that there is a 28.3% decrease in the average values of the follicles, which can be considered to be an important effect. Conclusions: It can be concluded that the hypothesis initially proposed to explain the appearance of the vermillion border in Homo sapiens is plausible. Also that the friction between lips, caused by the spoken language, especially its bilabial syllables, can be the origin, as in the case of a ring rubbing against the skin of a finger over several years