15 research outputs found
Treatment of osteonecrosis of the jaw related to bisphosphonates and other antiresorptive agents
The clinical management of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with bisphosphonates and other antiresorptive agents is subject to controversy. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has developed guidelines for the correct management of the disorder which are revised and updated by a panel of experts. The present systematic review analyzes the different treatments currently used to treat this clinical condition, based on the PRISMA® (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement published in 2009. An electronic Medline search was made of the PubMed database, covering the period 2006-2014. The last search date was 31 December 2014. A total of 29 articles were selected from the initial search according to the different drugs implicated in the appearance of osteonecrosis; the treatment modality used according to the stage of the disease; and the recorded success rate. It is currently still recommended that the management of MRONJ should be decided according to the stage of the disease ? conservative treatment being preferred in early stages without symptoms, while surgical management is preferred in the case of bone exposure with symptoms
Aspectos odontoestomatológicos en oncología infantil
Las neoplasias infantiles han ido adquiriendo a lo largo de
los últimos años una relevancia progresiva en el ámbito de la
pediatría. Esta importancia, se ha visto acompañada por una
espectacular mejoría en el tratamiento del cáncer infantil, alcanzando
supervivencias a largo plazo incluso del 90% en algunos
tumores, lo que hace que este tipo de población requiera una
mayor asistencia médico-sanitaria a todos los niveles pues estos
avances, crean una nueva responsabilidad que consiste en preveer
y, en lo posible, evitar las complicaciones derivadas de la propia
neoplasia y de su tratamiento.
Entre los efectos secundarios existentes, se encuentran las
manifestaciones orales, de carácter agudo o crónico, que suponen
una frecuente causa de malestar, focos potenciales de
infecciones sistémicas y secuelas a largo plazo, que estarán
en función del momento evolutivo de desarrollo en el que se
encuentre el niño.
La incidencia y severidad de una mayoría de complicaciones
orales, se asocian con factores preexistentes (caries, gingivitis
y mala higiene) que afectan notoriamente al inicio, aumento
y persistencia de las mismas. Es lamentable que el paciente
desarrolle un problema en la cavidad bucal que una medida
preventiva o un tratamiento oral e higiénico simple pudieran
prevenir o reducir.Childhood neoplasias have become increasingly important in
recent years in the ambit of paediatric medicine. This phenomenon
has been accompanied by a spectacular improvement in the
treatment of childhood cancer, long-term survival rates reaching
90% in the case of some tumours. A corollary of this success is
the obligation to provide new and improved medical assistance
both as regards the possible prevention of any alterations and,
if possible, the avoidance of complications derived from the
neoplasm itself and its treatment.
Among possible secondary effects are oral manifestations of a
chronic or acute nature, which may cause great discomfort, act
as foci of sytemic infections or have long-term after effects,
all of which will depend on the exact moment of the child s
development that treatment is undertaken.
The incidence and severity of most oral complications is associated
with pre-existent factors, such as caries, gingivitis or
generally poor hygiene, which strongly affect the beginning,
increase and persistence of the same. It is to be decried that
a problem in the buccal cavity is allowed to develop, which a
simple preventative measure, simple hygiene or dental conservation
treatment could prevent or reduce
Inherited, congenital and acquired disorders by hemostasis (vascular, platelet & plasmatic phases) with repercussions
The hemostasis alterations, either congenital or hereditary origin, and acquired, are circumstances that hinder oral
care to patients who suffer them and also generates in the professional who has to attend, high stress. Bleeding
control once established and dental treatment planning, both in the aspect of preparation, as the realization of
the odonto-stomatological therapeutic, has suffered updates that do need to remember certain aspects of the care
of these patients. But we must not forget that the hematologist or internist who controls the patient's medical
condition, is a cornerstone for the planning and implementation of treatment plans. We must also remember that,
in certain circumstances, treatment should be performed in a hospital setting. In this review, we aim to provide
the odonto-stomatologist guidance on how to address the problem and provide simple and updated guidelines to
apply in the treatment of these people
Clinical diseases with thrombotic risk and their pharmacologycal treatment: how they change the therapeutic attitude in dental treatments
The new antiplatelets and anticoagulant drugs have been recently introduced in the daily medical practices for the
control of thromboembolism associated with different diseases. The dental assistance of these patients forces us
to know these drugs, understand their action mechanisms and try to decrease the risks that entail ours actions in
these patients, making a thorough analysis of the risk of bleeding that is going to be related to our medical intervention,
as well as the use of all the control measures of the hemorrhage from our knowledge with these patients,
and to be prudent. The communication with the medical specialist that supervises these patients must be maxim,
being necessary to make clinic trials for establishing protocols or guides of the handling with these patients during
the odontological treatment
Prevalence of Apical Periodontitis in patients with Multiple Myeloma
Aim Previous reports have been analyzed the prevalence/association of apical periodontitis (AP) with systemic diseases. The present study aims to analyze the prevalence of healthy/diseased periapex and endodontic treatments in patients with Multiple Myeloma (MM) and compare the results with those of control subjects. Methodology Panoramic radiographs of 50 individuals with MM were evaluated and compared with 50 controls that were sex and age matched exactly with the diseased group. Radiographic analysis was performed by 2 two experienced endodontists under standardized conditions. The periapical status (presence or not of AP) was assessed using the periapical index (PAI). Data included systemic health, technical quality of root fillings, total number of teeth, quality of restoration, and periapical status. Statistical evaluation of differences between groups included used chi-squared tests and Fisher?s exact tests. The prevalence of root canal-treated teeth was 10.11% in the MM group and 12.05% in the control group (p=0.90). The average root canal-treated teeth in the test group was 2,34 and 2.48 in the control group, where the difference was statistically significant (p=0.05). AP in 1 or more teeth was found in 86 % and in 78% of the patients in the MM and the control groups, respectively. When analyzed by subject, there was no statistically significant difference in the prevalence of AP (p>0.72). Similarly there was also no statistically significant difference in the prevalence of PA (p=0.85), when analyzed by tooth, AP was found in 63.2% and 62.9% in MM and control groups. The presence of AP and endodontic treatment was not significantly different in individuals with MM compared with control subjects. Future studies are needed to elucidate and confirm the association between MM and AP
Valoración de la mucositis secundaria a tratamiento oncohematológico mediante distintas escalas: revisión
La mucositis oral es la inflamación que tiene lugar en el epitelio
oral, a consecuencia de los tratamientos antineoplásicos
tales como la radioterapia, la quimioterapia o el transplante de
médula ósea, siendo muy frecuente en los tratamientos de los
procesos oncohematológicos. Las consecuencias de esta inflamación,
no sólo afectan a la calidad de vida del paciente, sino
que además puede suponer una limitación en la aplicación del
tratamiento, así como un aumento de la estancia hospitalaria y
de los gastos terapéuticos. Un obstáculo principal a la hora de
estudiar la mucositis, ha sido la falta de un sistema adecuado
para su valoración mediante el examen oral. Los métodos desarrollados
para medir y cuantificar los cambios producidos en
el epitelio oral, como consecuencia del tratamiento del cáncer,
van desde los más sencillos, tales como escalas generales con
cuatro o cinco grados de severidad que permiten relacionar la
mucositis con el estado de salud oral, hasta llegar a las escalas
específicas de tratamiento, en las que se distingue el tipo de
tratamiento antineoplásico que dio lugar a la mucositis, pasando
por las escalas de múltiples variables, en las que se valoran
distintos aspectos y se estudia su correspondencia con el estado
de salud oral y su función, obteniendo una puntuación global
de severidad de la mucositis; es importante el establecimiento
de una escala común para la valoración de la mucositis, no sólo
con fines clínicos sino también para la investigación del grado
de toxicidad de los distintos regímenes terapéuticos que dan
lugar a mucositis.Oral mucositis is the inflammation that takes place in the oral
epithelium, as a result of antineoplastic treatments such as radiotherapy,
chemotherapy or bone marrow transplant, being very
frequent in these treatments for oncohematologic disease. The
consequences of this inflammation, not only affect the quality
of life of the patient, but can also suppose a limitation in the application
of the treatment, as well as an increase in the hospital
stay and therapeutic costs. A main obstacle for the study of the
mucositis, has been the lack of a system adapted for its valuation
by means of the oral examination. Methods developed to
measure and quantify the changes produced in oral epithelium
as a result of treatment of cancer can be very varied from more
simple methods, such as general scales with four or five degrees
of severity that link the mucositis to the state of oral health, to
specific scales of treatment. In this last type of scale the type of
antineoplastic treatment that gave rise to the mucositis is identified
giving a global severity score for the mucositis.
The establishment of a common scale for the evaluation of
mucositis is important, not only for clinical purposes but also
for the investigation of the degree of toxicity of the different
therapeutic regimes that give rise to the mucositis
La Ortopantomografía como método para la detección de las placas de ateroma calcificadas: revisión de la literatura
Los accidentes cerebrovasculares (ACV) constituyen la tercera causa de muerte en los países industrializados, tras la cardiopatía isquémica y el cáncer. Se trata pues de un importante problema de Salud pública, no sólo por su elevada incidencia, sino también por el alto costo que genera la rehabilitación física y psicológica de estos pacientes.
El Odontoestomatólogo, como profesional de la salud, debe implicarse ante esta situación y contribuir, dentro de sus posibilidades, a la detección precoz de los pacientes con riesgo de sufrir un ACV.
Desde la década de los ochenta, distintos autores han descrito la posibilidad de detectar las placas de ateroma calcificadas localizadas en la bifurcación de la arteria carótida a través de la ortopantomografía (OPG). De este modo, las posibilidades del Odontoestomatólogo en este campo han sido ampliadas. Esta nueva aplicación de la OPG, sin embargo, debe superar ciertos obstáculos antes de poder afianzarse como una nueva medida de cribaje de pacientes con riesgo de sufrir un ACV. Entre éstos estaría, por una parte, la valoración del auténtico significado clínico, a nivel pronóstico, de la calcificación de las placas de ateroma al igual que su utilidad como factor predictor de aparición de cuadros de ACV y por otra, el realizar un correcto diagnóstico diferencial con otras estructuras calcificadas que pueden aparecer en la ortopantomografía.Cerebrovascular accident (CVA) is the third cause of death in industrialized countries, following cardiovascular disease and cancer. It is therefore a significant public health issue, not only due to its high incidence, but also to the high costs involved in the physical and psychological rehabilitation of these patients.
Dental Practitioners, as health care providers, ought to play their part in this issue and contribute, within their means, to the early detection of patients at risk of having a CVA.
Since the eighties, different authors have described the possibility of detecting calcified atheroma plaques located at carotid artery bifurcation through panoramic radiograph. In this way, the Dental Practitioner's possibilities in this field have been extended. However, this new use of panoramic radiograph must overcome certain obstacles before it is implemented as a new screening method for patients at risk of having a CVA. Amongst these, we would have, on the one hand, the assessment of the real clinical significance, as regards prognosis, of atheroma plaque calcification as well as its usefulness as a factor for predicting the appearance of CVA symptoms and, on the other hand, the possibility of making a correct differential diagnosis regarding other calcified structures that may appear on panoramic radiograph
Panoramic radiograph as a method for detecting calcified atheroma plaques : Review of literature
Los accidentes cerebrovasculares (ACV) constituyen la tercera causa de muerte en los países industrializados, tras la cardiopatía isquémica y el cáncer. Se trata pues de un importante problema de Salud pública, no sólo por su elevada incidencia, sino también por el alto costo que genera la rehabilitación física y psicológica de estos pacientes. El Odontoestomatólogo, como profesional de la salud, debe implicarse ante esta situación y contribuir, dentro de sus posibilidades, a la detección precoz de los pacientes con riesgo de sufrir un ACV. Desde la década de los ochenta, distintos autores han descrito la posibilidad de detectar las placas de ateroma calcificadas localizadas en la bifurcación de la arteria carótida a través de la ortopantomografía (OPG). De este modo, las posibilidades del Odontoestomatólogo en este campo han sido ampliadas. Esta nueva aplicación de la OPG, sin embargo, debe superar ciertos obstáculos antes de poder afianzarse como una nueva medida de cribaje de pacientes con riesgo de sufrir un ACV. Entre éstos estaría, por una parte, la valoración del auténtico significado clínico, a nivel pronóstico, de la calcificación de las placas de ateroma al igual que su utilidad como factor predictor de aparición de cuadros de ACV y por otra, el realizar un correcto diagnóstico diferencial con otras estructuras calcificadas que pueden aparecer en la ortopantomografía
Cambra system in patients awaiting hematopoietic progenitor cell transplant and high caries risk
Recent times have witnessed a significant increase in the number of patients affected by problems related to oncological treatment Aims of this study is to evaluate dental affectation among patients awaiting hematopoietic progenitor cell transplant (HPCT), and they showed high caries risk, so it should establish a protocol prior to transplantation. The study included 72 patients due for HPCT. Clinical and radiological explorations were performed and oral photos taken. The amount of caries, missing teeth and fillings were registered for each patient. CAO, DMFS and Restoration Indices were calculated. 83% of patients presented caries. 48 patients (67%) had lost at least one tooth. Only 32 patients (44%) had received some sort of conservative treatment. The average CAO index value obtained was 10.37. The DMFS index showed an average of 27.06 affected surfaces. Of the 72 patients studied, 40 (56%) showed a restoration index value of zero. These patients presented a high number of carious teeth and a low restoration index. The presence of so many possible septic foci in an individual, who will later become susceptible to infection, highlights the importance of preventative treatment and bucco-dental restoration within this patient population. These patients with a high caries risk can be treated with CAMBRA system
Influence of oral health on mucositis in patients undergoing hematopoietic progenitor cell transplantation (HPCT)
Aims: To establish whether or not the state of patient oral health can influence the occurrence and/or severity of oral mucositis during hematopoietic progenitor cell transplantation (HPCT). Materials and Methods: The study included 72 patients awaiting HPCT. Prior to transplantation, clinical explora-exxploration and radiology were carried out and oral photographs were taken. This evaluated the exxtent of caries present, the number of missing teeth and the number of dental fillings in each patient; CAO (Caries and Obturations Index) DMFS (Decayed, Missing, and Filled Surfaces) and Restoration Indices were calculated. Gingival pathology was also examined by means of the Ainamo and Bay Gingival Bleeding Index. O'Leary's Plaque Index was used to evaluate the level of patient oral hygiene. This data was analyzed to see if it exercised any influence on the mucositis grade suffered during HPCT. Results: 96,87% of patients suffered some degree of mucositis during their treatment by the Transplant Unit. The grade of mucositis was seen to be influenced by the number of missing teeth (ANOVA p<0.016) and by the DMFS Index (ANOVA p< 0.038). Although this was not one of the aims of this study, patient age and the administration of colony-stimulating factors were also seen to influence these clinical manifestations. Conclusions: The state of prior oral health can influence decisively the mucositis suffered during transplantation. © Medicina Oral S. L