Saliva as a diagnostic fluid: literature review

There is a growing interest in diagnosis based on the analysis of saliva. This is a simple, non-invasive method of obtaining oral samples which is safe for both the health worker and the patient, not to mention allowing for simple and cost-efficient storage. The majority of studies use general saliva samples in their entirety, complex fluids containing both local and systemic sources and whose composition corresponds to that of the blood. General saliva contains a considerable amount of desquamated epithelial cells, microorganisms and remnants of food and drink; it is essential to cleanse and refine the saliva samples to remove any external elements. Immediate processing of the sample is recommended in order to avoid decomposition, where this is not possible, the sample may be stored at -80oC. Salivary analysis . much the same as blood analysis . aims to identify diverse medication or indications of certain diseases while providing a relatively simple tool for both early diagnosis and monitoring various irregularities. The practicalities of salivary analysis have been studied in fields such as: viral and bacterial infections, autoimmune diseases (like Sjogren'fs syndrome and c.liac disease), endocrinopathies (such as Cushing'fs syndrome), oncology (early diagnosis of breast, lung and stomach carcinoma and oral squamous cell carcinoma), stress assessment, medication detection and forensic science among others. It is hoped that salivary analysis, with the help of current technological advances, will be valued much more highly in the near future. There still remain contradictory results with respect to analytic markers, which is why further studies into wider-ranging samples are fundamental to prove its viability

Dental considerations for the patient with diabetes

Diabetes mellitus (DM) is one of the most frequent pathologies that dentists encounter, due to its high prevalence worldwide. It is diagnosed by the repeated obtaining of fasting plasma glucose levels of 126 mg/ dl or higher, or glycosylated hemoglobin of 6’5% or higher. Diabetes (especially if it is not well controlled) brings with it a greater risk of periodontal disease, which is the most frequent complication. On the other hand, the possible influence of periodontal disease on glycemic control is still not well established. Other reported manifestations are xerostomia, sialadenosis and burning mouth syndrome. With regard to dental caries, oral lichen planus and candidosis, recent studies have not revealed a significantly higher incidence in these patients. For dental treatment, the type of diabetes suffered, the treatment given for the disease, and the glycemic control status (using the glycosylated hemoglobin test) should be known. Patients should receive short morning appointments to reduce stress. The dentist has to be aware of the possible occurrence of an acute complication (hypoglycemia or hyperglycemia). Furthermore, these patients suffer from delayed wound healing and major susceptibility to infections

Foreign body granulomatous reactions to cosmetic fillers

Introduction: The use of different facial cosmetic fillers has increased in recent years. The introduction of apparently inert substances in the epidermis can give rise to foreign body granulomatous reactions. Objetives: A literature review is made of the foreign body granulomatous reactions to cosmetic fillers. Material and methods: A PubMed-Medline search was made using the following keywords: 'granulomatous reactions', 'foreign body reactions', 'esthetic fillers', 'cosmetic fillers'. The search was limited to articles published in English and Spanish during the last 10 years. A total of 22 articles were reviewed. Results: A great variety of substances have been found to give rise to foreign body granulomatous reactions. The most common locations are the upper and lower lip and the nasogenian sulcus. The clinical presentation is variable and can range from single or multiple nodules to diffuse facial swelling of hard-elastic consistency, accompanied by reddening. Most lesions are asymptomatic or cause only mild discomfort. The literature describes different treatments, including systemic corticosteroids, local tacrolimus infiltrations, minocycline, retinoids, allopurinol, 5% imiquimod, and surgical removal. Conclusions: In view of the current demand for esthetic treatments, the use of cosmetic fillers can be expected to increase in future, together with the incidence of complications

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

Dental considerations for the patient with renal disease

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

Osteoquimionecrosis de los maxilares por bisfosfanatos

Osteonecrosis of the jaw (ONJ) is a known complication of Biphosphonate treatment. ONJ is defined as the exhibition of necrotic bone in the maxillofacial region during more than eight weeks in a patient receiving Biphosphonate treatment. This complication has been recently described and the first reports are dated on 2003, but its interest is big due to its repercussion. Maxillaries are the only affected bones, being the jaw, specially the molar area, the most frequently affected. Biphosphonates are widely used in cancer and osteoporosis. The real incidence of ONJ in currently unknown, ranging from 1,8% to 12% in the case of intravenous treatment and differing hugely depending on the report. Oral treatment leads to a lower rate of ONJ (between 1/10.000 and < 1/100.000 patients per year of treatment). The main risk factor for the development of ONJ is a previous tooth extraction, although in many cases this complication occurs spontaneously. Treatment of this complication is still controversial and not easy. Therefore, prevention is crucial.La osteoquimionecrosis de los maxilares por bisfosfonatos (ONM) es una complicación por el tratamiento con estos fármacos. Se define como la exposición de hueso necrótico en la región maxilofacial, que persiste durante más de ocho semanas, en un paciente sometido a terapia con bisfosfonatos. Se trata de una complicación descrita hace relativamente pocos años, ya que las primeras series de casos fueron publicadas en el 2003, pero de gran interés porque supone un problema global. Los maxilares son los únicos huesos afectados, y se ha observado una predilección por la mandíbula, concretamente la zona de los molares. Los bisfosfonatos son unos fármacos ampliamente utilizados para el tratamiento de enfermedades malignas y osteoporosis. La incidencia exacta de la ONM es desconocida actualmente; las cifras varían mucho en función del estudio analizado, y oscilan entre el 1,8 y el 12% en el caso de los bisfosfonatos intravenosos. El tratamiento con bisfosfonatos por vía oral implica un riesgo mucho menor de desarrollo de ONM (entre 1/10.000 y <1/100.000 pacientes por año de tratamiento). El factor de riesgo más frecuente de desarrollo de una ONM es el antecedente de extracciones dentales, aunque en muchos casos esta complicación aparece de forma espontánea. El tratamiento de esta complicación es complicado y en ocasiones controvertido, por lo que cobra importancia la prevención

Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study).

Coagulopathy is a key feature of COVID-19 and D-dimer has been reported as a predictor of severity. However, because D-dimer test results vary considerably among assays, resolving harmonization issues is fundamental to translate findings into clinical practice. In this retrospective multicenter study (BIOCOVID study), we aimed to analyze the value of harmonized D-dimer levels upon admission for the prediction of in-hospital mortality in COVID-19 patients. All-cause in-hospital mortality was defined as endpoint. For harmonization of D-dimer levels, we designed a model based on the transformation of method-specific regression lines to a reference regression line. The ability of D-dimer for prediction of death was explored by receiver operating characteristic curves analysis and the association with the endpoint by Cox regression analysis. Study population included 2663 patients. In-hospital mortality rate was 14.3%. Harmonized D-dimer upon admission yielded an area under the curve of 0.66, with an optimal cut-off value of 0.945 mg/L FEU. Patients with harmonized D-dimer ≥ 0.945 mg/L FEU had a higher mortality rate (22.4% vs. 9.2%; p

Cardiac troponin and COVID-19 severity: Results from BIOCOVID study.

Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I. This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint. A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P  In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day mortality, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID-19