Mejora de las habilidades y técnicas de interconsulta para el graduado en Odontología a través del Campus Virtual. Fase I: Solicitud de pruebas diagnósticas

El desarrollo de este Proyecto, en esta primera fase, se basa en la práctica simulada del estudiante de Odontología, a través del Campus Virtual, de las técnicas de interconsulta con los diferentes especialistas médicos responsables del paciente a quien deberán solicitar las pruebas que estimen necesarias (analíticas, radiografías, resonancias magnéticas, escáneres, etc.) para planificar el tratamiento odontológico

Colutorios con alcohol y su relación con el cáncer oral: análisis crítico de la literatura

Los colutorios se han usado durante siglos con el fin de proporcionar salud oral o beneficios cosméticos. Actualmente, en la mayoría de los países, existe una gran variedad de formulaciones disponibles para el público general en forma de productos que precisan prescripción o no. El alcohol se emplea en los colutorios, en principio, como un disolvente de otros ingredientes y como un conservante de la preparación. Se han usado diferentes formulaciones de colutorios durante años, sin embargo, recientemente se ha expresado la preocupación sobre si su contenido de alcohol podría ser una amenaza para la salud. La elevada cantidad de alcohol en algunos colutorios, así como el hecho de que permanecen en contacto con la mucosa oral durante más tiempo que una bebida alcohólica, puede hacer pensar en un efecto nocivo a partir de un mecanismo local. El enjuague oral aumenta el tiempo de exposición de la mucosa al alcohol y se ha demostrado que colutorios con alto contenido en alcohol producen lesiones hiperqueratósicas tanto en hombres como en animales de estudio. Actualmente y con los datos de que disponemos, no se ha podido establecer una relación causal entre el uso de colutorios con alcohol y el desarrollo de cáncer oral. Tampoco existen evidencias de que el alcohol aumente el efecto de los agentes antiplaca en los colutorios.For centuries, mouthwashes have been used in order to provide us with oral health or cosmetic benefits. Nowadays, in most countries, there is a variety of formulas available for the general public in the form of products which may require prescription or not. Alcohol is used in mouthwashes as a solvent of other ingredients and as a preservative of the preparation. For years, different formulas of mouthwashes have been used, however, the question about its alcohol content being a threat for health or not has recently appeared. The high quantity of alcohol in some mouthwashes combined with the fact that they keep in contact with the oral mucosa for much more time than alcoholic drinks, can make us think about a harmful effect from a local mechanism. Mouthrinses increase the time of the mucosa being in contact with alcohol and it has been proved that those with a high content of alcohol do cause hyperkerastosic lesions both in human beings and laboratory animals. At the moment and with the data we have, it has not been possible to establish a causal relationship between the use of alcohol-containing mouthwashes and the development of oral cancer. There is neither an evidence of the fact that alcohol increases the effects of antiplaque agents in mouthwashes

Diagnostic criteria in proliferative verrucous leukoplakia: evaluation

Objectives: to evaluate the ability of the diagnostic criteria proposed by Cerero et al in 2010 to perform an early diagnose in patients with proliferative verrucous leukoplakia. Study Design: retrospective study with patients diagnosed with leukoplakia at Oral Medicine Service at Oral Medicine and Surgery Department at Dentistry Faculty at Universidad Complutense of Madrid. Results: the criteria were applied in 116 patients, turning positive in 40 cases. Out of these, 24 (60%) had been previously diagnosed with PVL. Most frequent criteria were major criteria A and E, concerning lesion's site and histopathology, and minor criteria b and c, concerning sex and smoking habit. Conclusions: diagnostic criteria developed by Cerero et al can be a useful tool for an early diagnose of PVL, as in 60% of the cases, the criteria would have allowed to make an early diagnose of the disease

Descriptive study of the patients treated at the clinic “Integrated Dentistry for Patients with Special Needs” at Complutense University of Madrid (2003-2012)

Objectives: To study clinical and epidemiological characteristics of the patients treated at the clinic “Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)” at Complutense University of Madrid (UCM), as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients. Study Design: Medical records review of all the patients referred to the clinic of “Integrated Dentistry for Patients with Special Needs”, performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis). Results: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%) and intellectual disability (8,85%). 70’18% of the patients were treated, with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%. Conclusions: Given the high number of patients with some kind of pathology and the amount of medicines that they use, it seems necessary for dentistry students to have a specific training regarding how to handle and treat these patients, so they will be able to provide them the best possible care

Alpha lipoic acid efficacy in burning mouth syndrome: a controlled clinical trial

Background: A double-blind placebo-controlled trial was conducted in order to evaluate the efficacy of alpha lipoic acid (ALA) and determine the statistical significance of the outcome variables. Burning mouth syndrome (BMS) is defined as an oral burning sensation in the absence of clinical signs which could justify the syndrome. Recent studies suggest the existence of neurological factors as a possible cause of the disease. Material and Methods: 60 patients with BMS, in two groups: case group with 600 mg/day and placebo as control group; with follow up of 2 months. Results: 64% of ALA patients reported some level of improvement, with a level of maintenance of 68.75% one month after treatment. 27.6% of the placebo group also demonstrated some reduction in BMS symptoms. Conclusions: Long-term evolution and the intensity of symptoms are variables that reduce the probability of improvement with ALA treatmen

Efectos del consumo de alcohol etílico en la cavidad oral: relación con el cáncer oral

El consumo de bebidas alcohólicas se encuentra asociado desde un punto de vista epidemiológico con un riesgo aumentado de desarrollar cáncer del tracto gastrointestinal superior. La realización de estudios que establezcan esa asociación resulta complicada, debido tanto a la confluencia de varios factores de riesgo en una misma persona, por ejemplo alcohol y tabaco, como a la falta de datos que puedan ser comprobables por el clínico. Por ello no se conoce con exactitud cual es el mecanismo patogénico responsable de este aumento de riesgo, ya que el etanol per se no ha demostrado ser carcinógeno. Se han propuesto distintas hipótesis que tratan de explicar como el etanol, ya sea por vía local o sistémica puede actuar como factor de riesgo en el desarrollo de un cáncer oral. Este trabajo supone una revisión de la situación actual de los potenciales mecanismos patogénicos, dividiéndolos en efectos locales y sistémicos. Dentro de los primeros se hace especial referencia a la alteración de la permeabilidad de la mucosa oral, a la acción del acetaldehído y al papel de los retinoidesIn an epidemiologic point of view the consumption of alcoholic beverages is found to be associated to an increased risk for developing an upper gastrointestinal tract cancer. The relation of the studies that establish this connection is complicated due to both the confluence of various risk factors within the same person such as alcohol and tobacco, and to the lack of data that can be verifiable by the clinician. For this reason the exact pathogenic mechanism responsible for this increase of risk is not known since ethanol per se was not confirmed to be carcinogenic. Different hypotheses have been proposed, explaining how ethanol, by oral or systemic route, can act as a risk factor for the development of oral cancer. This article serves as a review of the actual situation of the potential pathogenic mechanisms, dividing them in local and systemic effects. Within the aforementioned special reference is made on the alteration of the oral mucosa permeability, the action of acetaldehyde and the role of retinoids

Simulation for training in oral cancer biopsy: a surgical model and feedback from GDPs

Objectives: To describe a new bench model for oral precancer/cancer biopsy training and to assess its effectiveness in terms of trainees' perception. Study design: Cross-sectional, descriptive, performed on 424 general dental practitioners (GDP) who undertook biopsies on a pig tongue. The participants were assessed by direct observation for 2.5 hours using specific check- lists and by means of a self-applied questionnaire. Results: The workshop was perceived as "very interesting" even by those with previous surgical experience (Xi - Xj = 0.07; 95%CI= -0.20-0.09). Most GDPs considered themselves able to undertake oral biopsies on real patients after the workshop. Those who had previously received theoretical continuous education courses on oral biopsy scored higher values within the group (Xi - Xj = 0.20; 95%CI= 0.04-0.37). Conclusions: There is a need for including clinical abilities workshops when instructing on oral biopsy techniques. More studies are needed to validate the procedure and to address cognitive and communication skills

Dental implants rehabilitation in a patient with head and neck radiotherapy for osteosarcoma in the jaw. A clinical case report

A 52-year-old female patient with a diagnostic of osteosarcoma in the mandible, in which it was necessary a reconstruction with a microvascularized osteomyocutaneous fibula bone. Coadjuvant chemotherapy was scheduled. Two years later, 4 osseointegrated implants (OII) were placed in the fibula a 2 OII in the right mandible, using a splint guided surgery. The final prosthodontic consisted in a metal ceramic restoration using CAD/ CAM technology

Jaw in a day: Osseointegration of the implants in the patient’s leg before reconstructive surgery of a maxilla with ameloblastoma. A 4-year follow-up case report

Background: To describe a clinical case of a cancer patient who underwent ablative tumor surgery, including treatment planning, surgical resection and subsequent implant rehabilitation. Case Report: A 61-year-old patient with a diagnosis of multicystic follicular ameloblastoma in the maxilla, in which it was necessary a muitidisciplinary approach and two surgical steps. In the first surgical intervention osseo-integrated implants (OII) were placed in the fibula, until their osseointegration period of 8 weeks was complete. Afterwards, in the second surgery, the micro-vascularized free fibular flap bearing the implants was transplanted into the oral cavity, in order to perform simultaneous reconstruction and early rehabilitation. The final prosthetic rehabilitation consisted in a hybrid prosthesis fabricated using CAD CAM technology. Results: The latest advances in medical research have improved our understanding of the oral cavity’s regenerative capacity after oncological treatment. This, aided by the advances in digital 3D technologies, has allowed meticulous treatment planning prior surgery. Conclusions: The functional and esthetic reconstructions described in these two case reports were made possible by coordinating multidisciplinary approaches involving dentists and oral and maxillofacial surgeons. Advances in medicine have improved understanding of the regenerative capacity of the oral region following oncologic treatment, facilitating meticulous advance planning, while advances in digital 3D technologies for planning make it possible to reduce the number of surgical sessions and the time taken for the patient to recover both the esthetics and function of the stomatognathic system