Parotid Gland Edema After Chlorhexidine Mouthrinse: Case Report and Literature Review

Introduction: Parotid gland swelling, caused by many pathological conditions, has also been reported to be a possible side effect of the use of chlorhexidine mouthwash. This adverse reaction to chlorhexidine mouthwash is, however, extremely rare and very few cases of parotid gland swelling due to chlorhexidine mouthwash have been reported in the literature. Case Description: This report describes the clinical management of unilateral parotid swelling caused by chlorhexidine mouthwash. Methods: A patient presented with left parotid gland swelling after using chlorhexidine mouthwash for three days following sinus augmentation on the contralateral side of the maxilla. Diagnosis of parotid gland swelling due to rinsing with chlorhexidine was formulated after anamnesis, clinical examination, radiographs and ultrasound of the gland excluded other pathological conditions. The patient was subsequently advised to stop rinsing. However, on the evening of the same day, swelling increased and the patient presented to an emergency department where a single intravenous dose of methylprednisolone was administered. Results: After seven days, parotid swelling decreased significantly and after three weeks had completely disappeared. Conclusion: Although unilateral or bilateral parotid gland swelling related to the use of chlorhexidine mouthwash is an uncommon adverse event, it must be suspected after other organic or infective conditions have been excluded. The precise pathogenic mechanism has not yet been determined and further studies should be carried out to better understand the pathophysiology of this uncommon phenomenon

The use of a xenogenic collagen matrix (Mucograft\uae) in the treatment of the implant site: a literature review

Abstract: Lack of adequate amount of keratinized gingiva around dental or implants is generally treated with coronally advanced flap in combination with connective tissue graft. The procedures of harvesting the soft tissue grafting are usually associated with a certain degree of morbidity; for this reason xenogenic collagen matrix was proposed to be used as an option to reduce morbidity. This collagen matrix quickly stabilizes the blood clot and promotes rapid vascularization. Moreover, this product promotes root coverage, reduction of recession and regeneration of keratinized gingiva both in width and thickness. Recently, xenogenic collagen matrix was also proposed as a biological material able to regenerate keratinized gingiva around implants. In this review, the role of xenogenic collagen matrix (Mucograft\uae) has been critically analyzed to evaluate its effectiveness and predictability in keratinized tissue augmentation around implants supporting prosthetic restorations. Most of the studies showed that xenogenic collagen matrix was effective in increasing the thickness of the peri-implant mucosa and in the gaining of keratinized gingiva with comparable or slightly lower results than autologous connective tissue grafts. From the aesthetics point of view, the gold standard appeared to be the autologous connective tissue graft. Histologic analysis showed a good integration of the collagen membrane that matures into a healthy tissue. Mucograft\uae seems an effective alternative to the autologous connective tissue graft with regard to the gain of keratinized tissue and the increase in thickness of peri-implant soft tissues, with less post-operative morbidity and reduced operative times

Therapeutic Approach in the Treatment of Medication-Related Osteonecrosis of the Jaw: Case Series of 3 Patients and State of the Art on Surgical Strategies

Bisphosphonates and receptor activator of nuclear factor kappa-B ligand inhibitors are currently the most widely used antiresorptive therapies in bone metabolism diseases treatment. Unfortunately they can evoke medication-related osteonecrosis of the jaws. The present case series study proposes to evaluate clinical features, evolution and the surgical therapeutic approaches in three patients affected by medication-related osteonecrosis of the jaw and to review the state of art regarding the management of this complication in light of the most recent literature. Methods: Three cases of medication-related osteonecrosis of the jaws are discussed, two related to bisphosphonates therapy (ibandronic acid) and one due to denosumab. Results: All three patients were aged female and had probably a dental trigger agent. The lesions located in posterior mandible were treated in one case with the surgical approach alone and, in the other case, with surgical approach associated with Er:YAG laser. The lesion related to denosumab was treated with surgical approach and platelet rich fibrin application. A complete healing was always achieved. Conclusions: Dentists should be aware of the potential risk of developing medication-related osteonecrosis of the jaws for patients who take or had taken antiresorptive drugs. The side effects of denosumab and bisphosphonates are partly overlapping and currently there is still no consensus about the therapeutic surgical options. Prevention and early detection of the lesions should be the primary strategy