Prevention of medication-related osteonecrosis of the jaws secondary to tooth extractions: a systematic review

Background: A study was made to identify the most effective protocol for reducing the risk of osteonecrosis of the jaws (ONJ) following tooth extraction in patients subjected to treatment with antiresorptive or antiangiogenic drugs. Material and Methods: A MEDLINE and SCOPUS search (January 2003 - March 2015) was made with the purpose of conducting a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All articles contributing information on tooth extractions in patients treated with oral or intravenous antiresorptive or antiangiogenic drugs were included. Results: Only 13 of the 380 selected articles were finally included in the review: 11 and 5 of them offered data on patients treated with intravenous and oral bisphosphonates, respectively. No randomized controlled trials were found – all publications corresponding to case series or cohort studies. The prevalence of ONJ in the patients treated with intravenous and oral bisphosphonates was 6,9% (range 0-34.7%) and 0.47% (range 0-2.5%), respectively. The main preventive measures comprised local and systemic infection control. Conclusions: No conclusive scientific evidence is available to date on the efficacy of ONJ prevention protocols in patients treated with antiresorptive or antiangiogenic drugs subjected to tooth extraction

Pautas de profilaxis antibiótica de Endocarditis Bacteriana, recomendadas por los odontólogos en España

El propósito del presente estudio fue conocer las pautas de profilaxis antibiótica de Endocarditis Bacteriana (EB) recomendadas por los odontólogos en España. Se preguntó a través de una llamada telefónica, cuál era el régimen profiláctico que se debía administrar a un paciente de riesgo de EB antes de someterse a una exodoncia. La información se obtuvo de 400 odontólogos seleccionados aleatoriamente y distribuidos por todo el territorio español. A 200 se les preguntó sobre la pauta recomendada en pacientes no alérgicos a la penicilina y, a los 200 restantes, sobre la aplicada en los alérgicos a la penicilina.Del total de encuestados, 182 (45,5%) no sugirieron ningún régimen profiláctico, de éstos el 74,7% señalaron la necesidad de una cita para una exploración previa y el 25,3% refirieron al paciente a su médico general o cardiólogo. De los 97 odontólogos que recomendaron antibióticos para pacientes no alérgicos a la penicilina, solamente 30 (30,9%) contestaron correctamente algún régimen profiláctico de los publicados por la Asociación Americana de Cardiología o la Sociedad Británica de Quimioterapia Antimicrobiana. Para pacientes alérgicos a la penicilina, el 68,2% de los odontólogos recomendaron eritromicina como antibiótico de elección, y el 17,6% clindamicina. Sin embargo, menos del 30% prescribieron estos antibióticos en las posologías correctas. Estos resultados demuestran una importante carencia de conocimientos entre los odontólogos españoles sobre las pautas de profilaxis de EB para pacientes de riesgo que van a someterse a una manipulación dental.The aim of this study was to assess the current practice of antibiotic prophylaxis of Bacterial Endocarditis (BE) among General Dental Practitioners (GDPs) in Spain. GDPs were asked over the telephone by a fictitious patient what antibiotic prophylaxis they would administer to an 'at risk' patient for BE before a tooth extraction. Four hundred randomly selected Spanish GDPs were surveyed, 200 of them were asked about BE prophylaxis in penicillin non-allergic patients and the remaining 200 in penicillin allergic patients. Of the GDPs surveyed, 182 (45.5%) did not recommend any prophylactic treatment; 74.7% of those stated that an oral examination before treatment was needed and 25.3% referred the patient to his/her physician or cardiologist for further advice. Of the 97 GDPs who recommended antibiotics to penicillin nonallergic patients, only 30 (30.9%) suggested the prophylactic guidelines proposed by the American Heart Association or the British Society for Antimicrobial Chemotherapy. For penicillin allergic patients, 68.2% of the GDPs prescribed erythromycin as the antibiotic of first choice, while 17.6% of the GDPs prescribed clindamycin. Nonetheless, fewer than 30% administered both antibiotics with the adequate dosages. These results show important gaps in the knowledge of antibiotic prophylaxis for 'at risk' patients before dental procedures among Spanish GDPs

Evaluation of an oral health scale of infectious potential using a telematic survey of visual diagnosis

Objective: To compare the results of a subjective estimation of oral health through review of a set of intraoral photographs with those of an objective oral health scale of infectious potential. Method : The pool of patients was made up of 100 adults. Using an infectious-potential scale based on dental and periodontal variables, we assigned 1 of the 4 grades of the scale (range, 0 to 3; 0 corresponds to an excellent oral health status and 3 to the poorest oral health status) to each subject. A total of 20 representative subjects were selected from the pool of patients, 5 subjects for each one of the grades of the scale, and a standardized photographic record was made. One thousand dentists practicing in Spain were sent the survey by e-mail and 174 completed forms were received. We then calculated the concordance of the oral health status indicated by the respondents after visualising the photographs on comparison with the results of the oral health scale of infectious potential; concordance was termed correct grade allocation (CGA). Results : The majority of respondents (69.1%) achieved a CGA in 8 to 12 cases and none achieved more than 15 CGAs. The poorest CGA rates were found with grades 1 and 2, with a mean of 1.74 ± 1.09 and 1.87 ± 1.18, respectively, out of a maximum of 5. The concordance in terms of CGA was high for grade 0 (70.5%), very low for grade 1 (10.8%), low for grade 2 (37.3%), and moderate for grade 3 (42.6%). Conclusion : In comparison with visual examination of the oral cavity, the use of objective scale that establishes a reliable diagnosis of oral health in terms of infectious potential was found to be advantageous

Control of drooling using transdermal scopolamine skin patches : a case report

Transdermal scopolamine has been shown to be very useful in the management of drooling, particularly in patients with neurological or neuropsychiatric disturbances or severe developmental disorders. In this paper, we present the case of a 24-year-old patient with a diagnosis of cerebral palsy and a severe problem of drooling, exacerbated by marked mandibular prognathism. After exclusion of other therapeutic alternatives, it was decided to use sustainedrelease transdermal scopolamine patches (Scopoderm TTS). This technique consists of the application every three days of a patch with 1.5 mg of scopolamine in the area of the mastoid apophysis; the patch releases a dose of 0.5 mg of the active substance over each 24 hour period. The patient underwent periodic clinical and laboratory follow-up over a period of three years, achieving satisfactory results with no significant undesirable effects

In Vivo Antiplaque Effect of Three Edible Toothpastes

Objectives: The objective of this study was to analyse the antibacterial and antiplaque activity of three edible toothpastes with the widest worldwide distribution: KidScents™, which contains essential oils; Browning B&B™,, with medicinal plants; and Wysong Probiodent™, which contains probiotics. Study Design: The study group was formed of twenty healthy volunteers (dental students) with a good oral health status. Using a balanced randomisation system, all volunteers performed toothbrushing with four products (the three edible toothpastes and water) at intervals of one week. Bacterial vitality in the saliva was analysed by epifluorescence microscopy and plaque regrowth was evaluated using the Turesky-Quigley-Hein plaque index. Results: Bacterial vitality in the saliva was significantly higher after toothbrushing with water (positive control) than with the three toothpastes (P=0.002, P=0.003 and P<0.001, respectively). The plaque index was significantly higher after using these three toothpastes than after toothbrushing with water (P=0.047, P=0.032 and P<0.001, respectively). Conclusions: The three edible toothpastes analysed have some antimicrobial activity but favour plaque regrowth

Modelos de enseñanza-aprendizaje. Un modelo de aplicación del Aprendizaje Basado en Problemas (ABP) en odontología infantil

Entre las diferentes técnicas de Enseñanza-Aprendizaje utilizadas en las ciencias biomédicas, una de las que mayor popularidad ha adquirido en las últimas décadas es el “Aprendizaje Basado en Problemas” (ABP), considerado un hito en la educación médica. Como ocurre en otros sistemas, el ABP está centrado en el alumno y pretende fomentar un tipo de aprendizaje auto-dirigido. De sus principales virtudes se destaca que favorece el desarrollo de cierto tipo de competencias como la toma de decisiones, el razonamiento crítico, o el trabajo en equipo. Buena parte del el éxito de una actividad basada en el ABP radica en la planificación de la misma. Los principales factores que deben tenerse en cuenta y detallar son: - la delimitación de los objetivos a alcanzar - la selección del/los problemas sobre los que se trabajará - la definición de las reglas de la actividad - determinar el tiempo en el que deberá darse solución al problema A lo largo del siguiente capítulo se detallan cada uno de estos aspectos y se relata una modelo de experiencia educativa inspirada en el ABP. El objetivo de la actividad es poner al alumno frente a situaciones clínicas infrecuentes en la consulta de Odontología Infantil en la Licenciatura/Grado de Odontología pero que son situaciones relativamente cotidianas para un odontólogo general/odontopediatra. Se pretende fomentar la integración de conocimientos de odontología infantil, la responsabilidad colectiva y la toma de decisiones clínicas simulando las condiciones a las que los alumnos se van a enfrentar una vez graduados. Para ello se diseñaron una serie de situaciones clínicas en un paciente virtual. A lo largo de todo el curso académico se realizaron distintas sesiones en las que se facilitaba a los alumnos una serie de datos clínicos (historia clínica, fotos, radiografías) y se les planteaban una serie de preguntas: diagnóstico, plan de tratamiento justificado, etc. que deberían responder en 15 minutos. Los alumnos participaron por equipos en base a los boxes en los que realizaban sus prácticas clínicas pero sólo uno del equipo respondía a las preguntas en cada jornada. A medida que transcurrían las diferentes sesiones clínicas se fue haciendo pública las respectivas calificaciones y el acumulado hasta ese momento de forma que los alumnos podían ir viendo sus progresos en relación al resto de la clase. Para fomentar la implicación en la actividad se estableció un “pódium” con los boxes que obtuvieron una mejor puntuación al acabar el curso académico, que además vieron recompensado su buen hacer con un incremento en su calificación final en la asignatura. La opinión de los alumnos respecto a la actividad fue muy positiva, y un buen complemento para la formación teórico-práctica recibida respecto a Odontología Infantil

Antibiotic Prophylactic Regimens for Infective Endocarditis in Patients Undergoing Dental Procedures

Up to date causal relationship has been demonstrated between dental manipulations and the onset of infective endocarditis (IE). However, since 1955, numerous expert committees have proposed antibiotic prophylaxis (AP) to prevent bacteraemia of oral origin. Controversy regarding the efficacy of AP prior to the dental procedures has intensified in recent years because of the lack of conclusive evidence on its efficacy for the prevention of IE and on its cost-effectiveness, as well as the possibility of allergic reactions and the emergence of antibiotic resistance. Accordingly, AP is now maintained exclusively for patients at highest risk and who require the manipulation of the gingival or periapical regions of the teeth or perforation of the oral mucosa. In the context of a restrictive policy, the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom published a new guideline in 2008 stating that “AP against IE is not recommended for persons undergoing dental procedures”, regardless of risk status and of the nature of the procedure to be performed. The NICE guideline has generated further controversy, and expert committees in other countries continue to publish prophylactic regimens for the prevention of IE secondary to dental procedures. In this chapter, we discuss the principal guidelines currently applicable in Europe, the USA and Australia, and we draw particular attention to the need for randomised clinical trials

Non-surgical treatment of periodontal disease in a pregnant caucasian women population: adverse pregnancy outcomes of a randomized clinical trial

Aim: To analyze if non-surgical treatment of periodontitis in a pregnant Caucasian women population can reduce adverse pregnancy outcomes. Methods and results: A parallel randomized clinical trial was designed and approved by the Ethical Committee of Sanitary Area Santiago-Lugo, Spain (registration number: 2016/451). Forty patients with periodontitis stage II grade B were randomly allocated to receive either comprehensive non-surgical periodontal therapy (test group; n = 20) or professional tooth cleaning (control group; n = 20) before 24 gestational weeks. Randomization was computer-generated by the statistic program Epidat v.4.1 and allocation was performed using sealed opaque envelopes. Clinical measurements and peripheral blood samples for biochemical variables were collected at baseline, in the middle of second trimester before non-surgical treatment, and in the third trimester. Microbiological samples were collected in the second and third trimester. A statistically significant reduction was verified in all clinical and microbiological parameters after periodontal treatment in the test group. No significant differences were observed for the rest of the variables, including preterm birth and/or low birth weight. No adverse events related to periodontal treatment were reported. Conclusions: Non-surgical periodontal treatment in Caucasian patients with periodontitis stage II grade B did not significantly reduce the risk of adverse pregnancy outcomes.S