19 research outputs found
Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws: a review of the literature
Background: Bisphosphonates (BPs) and other antiresorptive agents such as denosumab are widely prescribed
for the treatment of osteoporosis and are also used in patients with multiple myeloma and metastatic breast or
prostate cancer for avoiding bone reabsorption and fractures that result in increased morbidity-mortality among
such individuals.
Material and Methods: We made a bibliographic search to analyze the concept, diagnosis and the different classifications for bisphosphonate-associated osteonecrosis of the jaws.
Results: Osteonecrosis of the jaws (ONJ) is an important complication of exposure to BPs or other antiresorptive
agents, and although its prevalence is low, it can pose management problems. The definition, diagnosis and classification of osteonecrosis have evolved since Marx reported the first cases in 2003.
Conclusions: The present study offers a literature review and update on the existing diagnostic methods and classification of the disorder, with a view to facilitating earlier and more effective treatment
Dental management of patients receiving anticoagulant and/or antiplatelet treatment
Introduction: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems
can give rise to complications associated with important morbidity-mortality. The dental treatment of patients who
tend to an increased risk of bleeding due to the use of anticoagulant and/or antiplatelet drugs raises a challenge in
the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis, and the
optimized management of such patients, are therefore very important issues.
Objectives: A study is made of the anticoagulant / antiplatelet drugs currently available on the market, with evaluation
of the risks and benefits of suspending such drugs prior to invasive dental treatment. In addition, a review is
made of the current management protocols used in these patients.
Material and Methods: A literature search was made in the PubMed, Cochrane Library and Scopus databases, covering
all studies published in the last 5 years in English and Spanish. Studies conducted in humans and with scientific
evidence levels 1 and 2 (metaanalyses, systematic reviews, randomized phase 1 and 2 trials, cohort studies
and case-control studies) were considered. The keywords used for the search were: tooth extraction, oral surgery,
hemostasis, platelet aggregation inhibitors, antiplatelet drugs, anticoagulants, warfarin, acenocoumarol.
Results and Conclusions: Many management protocols have been developed, though in all cases a full clinical history
is required, together with complementary hemostatic tests to minimize any risks derived from dental treatment.
Many authors consider that patient medication indicated for the treatment of background disease should not be
altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown
to suffice for controlling possible bleeding problems resulting from dental treatment
Oral manifestations and dental management of patient with leukocyte alterations
Leukocytes are the main cellular elements of inflammatory and immune reactions of the organism. Leukocyte alterations
are the consequence of an imbalance between the formation of leukocytes in the bone marrow and its elimination
by the mononuclear phagocytic system. Factors that can modify leukopoyesis are varied and can lead to an
alteration in the number of leukocytes or tumoral alterations of white cells (leukemias, lymphomas and plasma cell
tumors). There is also a wide range of clinical manifestations that can derive from them: from very slight symptoms
to life-threatening conditions. In some cases oral manifestations will be the first signs and it will be the dentist’s responsibility
to identify the underlying disorder and guide the diagnosis of the patient. It is important to be familiar
with the special management required for these patients, in which the dental treatment can affect the course of the
underlying disease. The objective of this article is to review the literature concerning the oral manifestations and
the considerations that must factor in the dental treatment of patients with leukocyte alterations
Dental considerations in patients with respiratory problems.
Many respiratory disorders can compromise routine dental care and require special treatment for the affected patients. Patients often visit the dental clinic with respiratory problems already diagnosed by other specialists. The
dental professional therefore must provide correct dental care in the context of such a diagnosis. The present study
offers a literature review of those respiratory disorders which can have implications for dental care. Chronic obstructive pulmonary disease (COPD) and asthma require special measures, such as working with the patient in the
vertical position, since some of these subjects do not tolerate decubitus. On the other hand, patients with COPD can
suffer infectious lung diseases secondary to the aspiration of microorganisms in the presence of deficient periodontal conditions. The treatments received by patients with respiratory diseases can also influence their oral health. In
this sense, it has been shown that inhalatory medication used for asthma can cause oral disorders such as xerostomia, oropharyngeal candidiasis and an increased presence of caries (due to the action of β-agonists), as well as gingivitis. In contrast, oral manifestations of tuberculosis are infrequent. The clinical appearance of the lesions is very
similar to that of squamous cell carcinoma; it is therefore important to establish a correct differential diagnosis in
such cases. Mention also will be made of patients with obstructive sleep apnea syndrome (OSAS), characterized by
critical narrowing and occlusion of the upper airways during sleep. In this context, the dental professional is often
directly implicated in the management of such patients by preparing and fitting oral devices designed to advance the
mandible. Lastly, mention will be made of dental management in the event of foreign body aspiration, where rapid
intervention by the dental professional is critical. The basic approach in such cases is adequate prevention
Dental management in transplant patients
Introduction: Transplant is the replacement with therapeutic purposes, of organs, tissues or cellular material for
others, from a donor who is usually a human, alive or dead. In recent years, transplant organs have been developed
by the advances that have occurred with immunosuppressive drugs and medical-surgical technology. Due to the
frequency of transplants that are performed today, it is common to find these patients in dental clinics.
Objectives: To review the literature on oral manifestations in transplant patients and general dental management
and according to transplant organs (heart, lung, liver, kidney, pancreas and bone marrow).
Material and Methods: For the literature review, we carried out a search in Pubmed / Medline database using limits
and keywords according to the controlled vocabulary “Medical Subject Headings” (MeSH). We obtained a total of
30 articles (eight literature reviews, three randomized clinical trials, one cohort study, three case-control studies,
eight clinical case series and seven cross-sectional studies).
Results and discussion: We describe the most common oral manifestations in transplant patients (viral, bacterial
and fungal infections, gingival enlargement secondary to drug therapy and higher risk in the development of oral
malignancy) and the special dental management that should be carried out on these patients, generally and specifically
according to the type of transplant.Introduction: Transplant is the replacement with therapeutic purposes, of organs, tissues or cellular material for
others, from a donor who is usually a human, alive or dead. In recent years, transplant organs have been developed
by the advances that have occurred with immunosuppressive drugs and medical-surgical technology. Due to the
frequency of transplants that are performed today, it is common to find these patients in dental clinics.
Objectives: To review the literature on oral manifestations in transplant patients and general dental management
and according to transplant organs (heart, lung, liver, kidney, pancreas and bone marrow).
Material and Methods: For the literature review, we carried out a search in Pubmed / Medline database using limits
and keywords according to the controlled vocabulary “Medical Subject Headings” (MeSH). We obtained a total of
30 articles (eight literature reviews, three randomized clinical trials, one cohort study, three case-control studies,
eight clinical case series and seven cross-sectional studies).
Results and discussion: We describe the most common oral manifestations in transplant patients (viral, bacterial
and fungal infections, gingival enlargement secondary to drug therapy and higher risk in the development of oral
malignancy) and the special dental management that should be carried out on these patients, generally and specifically
according to the type of transplant
Dental management in patients with hemostasis alteration
Haemostasis is a mechanism that, through different interdependent biologic processes, has the purpose of ensuring
the integrity and permeability of the circulatory system. Hemostasis term means prevention the loss of blood.
Interventions or treatments in the oral cavity, in particular those with a possibility of bleeding, represent a risk for
patients with disorders of hemostasis. Prevention is the key to avoid bleeding complications after oral surgical
procedures and therefore it is essential a detailed medical history of the patient.
The appropriate diagnosis and treatment in patients with disorders of hemostasis, depends directly in the understanding
of hemostasis standard mechanisms. Emphasising not only the importance of a thoughtful insight into these
mechanisms, but also of the existing analysis that study them.
This paper makes a synthesis of the general aspects of inherited coagulation disorders (Von Willebrand disease and
Hemophilia A and B) as well as of the alterations on platelets consequence of the use of certain medication (antiplatelet
and anticoagulant drugs), and their dental management
Dental treatment considerations in the chemotherapy patient
Cancer patients can suffer oral toxic effects secondary to antineoplastic therapy in the form of radiotherapy and/
or chemotherapy. This risk is conditioned by a range of factors, including the high cell turnover rate of the oral
mucosa, the diversity and complexity of the oral microflora, and soft tissue trauma during normal oral function. The
present study offers a literature review of the main oral complications secondary to chemotherapy, and describes
the different options for dental treatment before, during and after oncological treatment, published in the scientific
literature. To this effect a PubMed-Medline® search was made using the following keywords: chemotherapy, cancer
therapy, dental management, oral mucositis, neurotoxicity, intravenous bisphosphonates and jaw osteonecrosis.
The search was limited to human studies published in the last 10 years in English or Spanish. A total of 50 articles
were identified: 17 research papers, 25 reviews, 6 letters to the Editor, and two clinical guides developed by expert
committees. The data obtained showed the main oral complications of chemotherapy to be mucositis, neurotoxicity,
susceptibility to infections, dental, salivary and taste alterations, and the development of osteonecrosis. Based
on the reviewed literature, elective dental treatment can be provided before chemotherapy, with emphasis on the
elimination of infectious foci. During chemotherapy, dental treatment should be limited to emergency procedures,
while dental treatment of any kind can be prescribed after chemotherapy – with special considerations in the case
of patients who have received treatment with intravenous bisphosphonate
Patient with renal disease. Journal section: Oral Medicine and Pathology
Abstract Chronic renal disease (CRD) is the renal disease that manifests oral consequences most frequently, and it is defined as a progressive and irreversible decline in renal function associated with a reduced glomerular filtration rate (GFR). The most frequent causes of CRD are diabetes mellitus, arterial hypertension and glomerulonephritis. CRD is classified in 5 stages -from kidney damage with normal or increased GFR to renal failure. In order to quantify the CRD, renal function is measured using the GFR, which is estimated using creatinine clearance (CC). This CC is used for dose adjustment of drugs. In dental practice, the function of the kidneys can be measured indirectly through plasmatic creatinine (Cr), that can be related to the CC using several formulas. The treatment of CRD includes dietary changes, correction of systemic complications, and dialysis or the receipt of a renal graft in severe cases. The importance of CRD for the dental practitioner lies in the fact that an increasing number of patients with this disease will probably demand dental treatment, and that up to 90% of them will show oral signs and symptoms related to this systemic disease. Dental management must be adapted to these patients' special conditions, as a greater bleeding tendency, hypertension, anemia, drug intolerance, increased susceptibility to infections and the presence of several oral manifestations associated with either the disease or its treatment
Lichen sclerosus of the oral mucosa : a case report
Lichen sclerosus or lichen sclerosus et atrophicus is a chronic inflammatory disease predominantly affecting the genital mucosa and skin. Clinically, it is characterized by white atrophic plaques in the anogenital region. The lesions are generally asymptomatic, but may cause discomfort with itching and pain. Extragenital mucosal involvement is very unusual, and lesions limited to the oral mucosa are even less frequent. Knowledge of such lesions is important in order to establish a differential diagnosis with other white oral lesions, and histological confirmation is required. We present the case of a 31-year-old woman with a well delimited, pearly white lesion located in the upper gingival mucosa, lip mucosa and adjacent skin. The lesion had led to loss of periodontal attachment of the affected tooth (2.3), causing pain in response to tooth brushing. The biopsy confirmed lichen sclerosus, and treatment was provided in the form of intralesional corticoid injections, followed by improvement of the mucosal lesion, though without recovery of the periodontal loss
An update on the management of anticoagulated patients programmed for dental extractions and surgery
Oral anticoagulants (OACs) antagonizing vitamin K - fundamentally sodium warfarin and acenocoumarol - are widely used for preventing arterial thromboembolism in patients with atrial fibrillation and/or heart valve prostheses, and for the treatment and prevention of deep venous thrombosis and pulmonary embolism. The handling of these drugs requires correct monitorization and dose adjustment to obtain the desired therapeutic effect while minimizing the adverse effects associated both with excessive anticoagulation (which leads to bleeding) and with insufficient antithrombotic action (which can produce thrombosis). This is particularly important when patients must be subjected to surgical procedures such as tooth extractions. In this context, a number of management recommendations are available. The present study offers an update on the recommendations for the management of anticoagulated patients programmed for tooth extractions. In recent years, most studies do not recommend reducing or interrupting anticoagulation, or replacing it with heparin, prior to tooth extraction - provided therapeutic international normalized ration (INR) levels are maintained, with emphasis on the application of local measures such as antifibrinolytic agents, for the control of hemostasia