Mandibular metastasis of pulmonary adenocarcinoma: How unexpected could it be?

Objective: Metastatic tumours of bone must be considered in all patients with unex-plained bone pain and particularly in patients who present with a known cancer, lo-calised pain at multiple sites, and radiographic findings suggestive of metastasis. The purpose of this report was to present a case of a pathological fracture of the mandible as a consequence of metastatic pulmonary adenocarcinoma.Materials and Methods: In July 2018 a 68- year- old male patient was hospitalised because of pulmonary adenocarcinoma and attended our department for an oral maxillo- facial evaluation. He complained of pain and swelling in the right temporo-mandibular region resulting in a reported functional limitation.An Orthopantomogram (OPG) demonstrated a right intracapsular condylar compound fracture associated with an osteolytic lesion at the condyle base with jagged margins. Subsequently, a CT scan with contrast of the maxillo- facial complex and a fine- needle aspiration of the lesion was performed.Results: CT images showed the presence of a right mandibular condyle fracture as-sociated with a large osteolytic lesion which confirmed the pathological nature of the fracture. Fine- needle aspiration of the lesion confirmed its metastatic nature. It was not possible to proceed with a mandibular resection due to the critical clinical condi-tion of the patient who died in September 2018.Conclusion: Lung cancer frequently produces lytic- type metastasis, sometimes even in the jaw. In patients with an established diagnosis of lung cancer, any radiolucent lesion of the jaw or an unexplained painful symptomatology to the oro- maxillo facial complex should be placed in differential diagnosis with metastasis of the primary tumour

O Atendimento odontológico do paciente renal terminal submetido a dialise: uma revisão atual da literatura médica vigente.

Chronic renal failure is a progressive disease characterized by a gradual destruction of the nephrons and a consequent reduction in renal function. End-stage kidney disease (ESRD) requires renal replacement therapy such as peritoneal dialysis, hemodialysis or transplantation. Patients affected by ESRD or on hemodialysis are at risk of developing a series of comorbidities, including hypertension, anemia, risk of bleeding, susceptibility to infection, side effects of medications and oral manifestations associated with the disease itself and treatment on hemodialysis. In this context, oral diseases represent a potential and preventable cause of poor health outcomes in people with ESRD due to their relationship with infection, inflammation and malnutrition.A insuficiência renal crônica é uma doença progressiva caracterizada por uma destruição gradual dos néfrons e uma conseqüente redução da função renal. A doença renal em estágio terminal (DRT) requer terapia de substituição renal como diálise peritoneal, hemodiálise ou transplante. Os pacientes afetados pela DRT ou em hemodiálise correm risco de desenvolver uma série de comorbidades, incluindo hipertensão, anemia, risco de sangramento, suscetibilidade à infecção, efeitos colaterais dos medicamentos e manifestações orais associadas à própria doença e ao tratamento em hemodiálise. Nesse contexto, as doenças bucais representam uma causa potencial e evitável de maus resultados de saúde em pessoas com DRT devido à sua relação com infecção, inflamação e desnutrição

Therapeutic Approach in the Treatment of Medication-Related Osteonecrosis of the Jaw: Case Series of 3 Patients and State of the Art on Surgical Strategies

Bisphosphonates and receptor activator of nuclear factor kappa-B ligand inhibitors are currently the most widely used antiresorptive therapies in bone metabolism diseases treatment. Unfortunately they can evoke medication-related osteonecrosis of the jaws. The present case series study proposes to evaluate clinical features, evolution and the surgical therapeutic approaches in three patients affected by medication-related osteonecrosis of the jaw and to review the state of art regarding the management of this complication in light of the most recent literature. Methods: Three cases of medication-related osteonecrosis of the jaws are discussed, two related to bisphosphonates therapy (ibandronic acid) and one due to denosumab. Results: All three patients were aged female and had probably a dental trigger agent. The lesions located in posterior mandible were treated in one case with the surgical approach alone and, in the other case, with surgical approach associated with Er:YAG laser. The lesion related to denosumab was treated with surgical approach and platelet rich fibrin application. A complete healing was always achieved. Conclusions: Dentists should be aware of the potential risk of developing medication-related osteonecrosis of the jaws for patients who take or had taken antiresorptive drugs. The side effects of denosumab and bisphosphonates are partly overlapping and currently there is still no consensus about the therapeutic surgical options. Prevention and early detection of the lesions should be the primary strategy

Can Periodontal Disease Be Considered Linked to Obesity and Lipoinflammation? Mechanisms Involved in the Pathogenesis Occurrence

Obesity is a systemic disease, associated with an increased risk of cardiovascular disorders, type 2 diabetes, cancer, asthma, and osteoarthritis. Overweight and obesity have been suggested to be associated with periodontitis as published in studies and narrative summaries. Obesity and periodontal diseases are very prevalent in the world, and both can lead to severe chronic health conditions and impair people\u2019s life quality. Knowledge of how immune mechanisms and inflammatory responses are regulated is critical for understanding the pathogenesis of complex diseases, such as periodontitis. In conditions of overweight, it has been demonstrated that approximately 70\u201380% of individuals present an adipose tissue turnover that is both structurally and func- tionally causing of the systemic inflammatory reaction. The objective of this review is to explore the influence of lipoinflammation. The effects of lipoinflammation and obesity on development of periodontal disease are reported together with the exploration of the mechanisms of interaction between these two diseases

Factors Influencing the Onset of Intra- and Post- Operative Complications Following Tooth Exodontia: Retrospective Survey on 1701 Patients

Complications after tooth extraction may occur because of several factors correlated to the patient's medical history, surgical site or type of intervention. The aim of this retrospective cohort study was to evaluate type and frequency of complications after exodontic surgery, its correlation with antibiotic administration and between patient's related systemic factors. From June 2015 until February 2016 1701 exodontic interventions, for a total of 2322 extracted teeth, were carried out at the Unit of Oral Surgery in Trieste. Descriptive statistic, and backward multiple logistic regressions were performed to identify the variables associated with the presence of post-operative alveolitis or any other post-operative complication. The presence of coagulopathy and smoking habit were related to high risk of post-operative alveolitis (OR = 5.51, p = 0.035 and OR = 2.5, p = 0.029, respectively). Tooth fracture was found to be correlated with higher probability of post-operative alveolitis (p = 0.001) and concomitant chemotherapy put at a higher risk post-operative complications, including alveolitis (OR = 29.5, p = 0.018). According to the present results, antibiotic consumption did not seem to reduce the incidence of post-operative infective complications (alveolitis). A careful analysis of medical history, the adequate surgical technique, and the correct instructions in post-surgical behavior, prevent the insurgence of intra and post-operative complications

Comparison of orthopantomography and CT accuracy in predicting inferior alveolar nerve injury following lower third molar surgical extraction

6noBACKGROUND: The aim of this study was to compare orthopantomography (OPG) and computed tomography (CT) accuracy in predicting inferior alveolar nerve (IAN) injury after lower wisdom teeth extraction. METHODS: Twenty-three patients with completely impacted lower third molars were enrolled in this study and OPG and CT exams were obtained before surgical intervention. Finally, a total of 26 lower third molars were extracted and cases of paresthesia following a IAN lesion have been registered. Then, OPG and CT images of the same patients have been randomly submitted to four experienced oral surgeons (with a seniority of at least 5 years) who were required to predict the possibility of a IAN injury by only evaluating the radiological exams. The images were anonymous and have been submitted to the surgeons without an order avoiding to influencing the answers. The agreement between the predicted and the real outcomes was statistically evaluated using the positive predictive value (PPV), the negative predictive value (NPV), Sensitivity, Specificity and the Spearman's rank correlation coefficient. RESULTS: A perfect agreement between OPG-based prevision and the real development of paresthesia due to IAN injury has been observed. This agreement was only moderate when considering CT images. CONCLUSIONS: OPG is a first-level diagnostic exam that provides enough information for predicting IAN lesions after impacted lower third molars surgery. CT is a second-level radiological exam that provides more information on roots morphology and on the amount of the contiguity between roots and mandibular canal resulting useful in performing a minimally invasive surgery.nonenoneFusaro, Fulvio; Costantinides, Fulvia*; Maglione, Michele; Dalessandri, Domenico; Vettori, Erica; Di Lenarda, RobertoFusaro, Fulvio; Costantinides, Fulvia; Maglione, Michele; Dalessandri, Domenico; Vettori, Erica; Di Lenarda, Robert

Factors Influencing the Onset of Intra- and Post- Operative Complications Following Tooth Exodontia: Retrospective Survey on 1701 Patients

Complications after tooth extraction may occur because of several factors correlated to the patient’s medical history, surgical site or type of intervention. The aim of this retrospective cohort study was to evaluate type and frequency of complications after exodontic surgery, its correlation with antibiotic administration and between patient’s related systemic factors. From June 2015 until February 2016 1701 exodontic interventions, for a total of 2322 extracted teeth, were carried out at the Unit of Oral Surgery in Trieste. Descriptive statistic, and backward multiple logistic regressions were performed to identify the variables associated with the presence of post-operative alveolitis or any other post-operative complication. The presence of coagulopathy and smoking habit were related to high risk of post-operative alveolitis (OR = 5.51, p = 0.035 and OR = 2.5, p = 0.029, respectively). Tooth fracture was found to be correlated with higher probability of post-operative alveolitis (p = 0.001) and concomitant chemotherapy put at a higher risk post-operative complications, including alveolitis (OR = 29.5, p = 0.018). According to the present results, antibiotic consumption did not seem to reduce the incidence of post-operative infective complications (alveolitis). A careful analysis of medical history, the adequate surgical technique, and the correct instructions in post-surgical behavior, prevent the insurgence of intra and post-operative complications

Reliability of kinesiography vs magnetic resonance in internal derangement of TMJ diagnosis: A systematic review of the literature

The aim of this systematic review was to evaluate the accuracy and the diagnostic reliability of kinesiography and magnetic resonance imaging (MRI) in diagnosis of patients presenting temporomandibular disorders. METHODS: A literature survey carried out through PubMed, SCOPUS, LILIACS, and the Cochrane Library from the inceptions to the last access on August 18 2016 was performed to locate randomized clinical trials, controlled trials, prospective cohort studies, or retrospective studies (with or without a control group), that examined the diagnostic reliability of recording devices of mandibular movements in comparison to MRI. RESULTS: From the results, it was found that a significant correlation between these electronic devices and MR images could not be detected in case of disc displacement. DISCUSSION: The scientific evidence does not support the usefulness in clinical practice of the jaw-tracking devices to diagnose temporomandibular disorders because their diagnostic reliability is poor

Communities, Sport, Inclusion. Strategies for Parish Complexes Social Reactivation Through Sport Practice Promotion

The following contribution presents some findings deriving from the research project "Sport is Society" by Politecnico di Milano. The research reflects on the built heritage and its ability to be accessible and usable for different users with different needs in its structures and offer of services, focusing on sports activities and spaces. The study refers to collective ecclesiastical structures in the contemporary city. The research in this area demonstrates the possible degrees of innovation regarding the increase in the inclusiveness of private facilities with a public vocation, where sport represents a driver of social inclusion for the community. The research proposes advice to guarantee inclusive sports facilities for the community, highlighting the strict relationship between the inclusive city and the ecclesiastical heritage, as an emerging issue to be investigated and solved. Starting from its relevance and the potential of the structures to become a truly "accessible patrimony”, the tool suggests strategies for policymakers and ecclesiastical administrations to make them become "open services" - usable and accessible by all - for and inside the urban community

Dental Care for Patients with End-Stage Renal Disease and Undergoing Hemodialysis

Chronic renal failure is a progressive disease characterized by a gradual destruction of nephrons and a consequent reduction of kidney function. End-stage renal disease (ESRD) necessitates renal replacement therapy as peritoneal dialysis, hemodialysis, or transplantation. Patients affected by ESRD or in hemodialysis are at risk for developing a number of comorbidities including hypertension, anemia, risk of bleeding, susceptibility to infection, medication side effects, and oral manifestations associated with the disease itself and with hemodialysis treatment. In this context, oral diseases represent a potential and preventable cause of poor health outcomes in people with ESRD due to their relation to infection, inflammation, and malnutrition. The aim of this article was to review ESRD and hemodialysis-associated manifestations and to describe the dental operative protocols for patients awaiting kidney transplantation in light of the most recent literature