Intravenous bisphosphonate-related osteonecrosis of the jaws: influence of coadjuvant antineoplastic treatment and study of buccodental condition

Objectives: To determine whether coadjuvant antineoplastic treatment can influence the number and size of bone exposures among patients with intravenous bisphosphonaterelated osteonecrosis of the jaws (iBRONJ), and to analyze the buccodental condition of these patients. Material and methods: The study sample comprised 67 patients with iBRONJ, 53 patients without iBRONJ receiving treatment with intravenous bisphosphonates, and 36 healthy subjects. In all three groups, measurements were made of the CAO index and of resting whole saliva and stimulated whole saliva. In the patients with iBRONJ, the size (cm) and number of bone exposures were recorded. The data obtained were subjected to analysis of variance (ANOVA), the Mann-Whitney U-test, and multivariate logistic regression analysis. Results: A total of 57.6% of the patients presented single bone exposure, 25.4% presented two, and 17% more than two exposures. The mean exposure size was 2.3±1.9 cm. Neither the bivariate analysis nor the multivariate multiple regression analysis found coadjuvant antineoplastic treatment to exert a statistically significant effect upon the number and size of bone exposures. On the other hand, there were statistically significant differences among the three study groups in relation to the CAO index (p=0.02) and the number of missing teeth (p=0.00). The resting whole saliva and stimulated whole saliva levels were similar in the three groups, though the patients with osteonecrosis of the jaws showed comparatively lower SWS levels. Conclusions: Coadjuvant antineoplastic treatment alone appears to exert no influence upon the size and number of bone exposures in iBRONJ. The patients with this disease show a higher CAO index and a larger number of missing teeth

Ewing sarcoma of the oral cavity. A review

A review is made of the clinical, diagnostic, therapeutic and survival characteristics of Ewing sarcoma (ES) of the oral cavity. A systematic literature search was carried out, with restrictions referred to time (1960-2014), language (English and Spanish) and type of study (case reports, letters, datasets, reviews). The following MeSH terms and boolean operators were used: Ewing AND Sarcoma AND [tongue, jaw, maxilla, cheek, condyle OR temporomandibular, floor AND mouth, gum OR gingiva, palate OR palatal, lip, uvula, head AND neck]. Seventy-one cases of ES of the oral cavity were documented from 53 articles. The main differences versus ES of other locations were a younger age at manifestation, a shorter time from symptoms onset to diagnosis, and swelling as the most frequent clinical manifestation versus swelling and pain in the rest of disease locations. The way in which ES manifests in the oral cavity is varied and comprises dental displacement (19.7%), dental mobility (7%), root reabsorption (5.6%), destruction of the dental follicle (4.2%), premature exfoliation (4.2%) and paresthesia of the chin (2.8%). Metastatic neck adenopathies appear in 11.3% of the cases. Significant differences in survival are observed between patients with a complete diagnosis of ES (hematoxylin-eosin staining, PAS positivity, CD99 positivity) and those with an incomplete diagnosis. Ewing sarcoma of the oral cavity presents a series of specific features that distinguish it from ES of other locations

Differences in clinical variables and risk factors between patients with osteoarthritis and osteoarthrosis of the temporomandibular joint (TMJ)

Objective: To study differences in risk factors and clinical variables between a group of patients with osteoarthritis and a group with osteoarthrosis of the temporomandibular joint. Material and methods: Thirty-five patients (32 women and 3 men) (mean age 53±18 years), 21 (60%) with a diagnosis of osteoarthrosis (mean age 54.7±20.2 years) and 14 (40%) with a diagnosis of osteoarthritis (mean age 51.7±16.9 years), were studied. The two groups were compared with each other and also with the group of 164 patients with temporomandibular joint pathology from which they were drawn. An evaluation was made of the demographic variables, risk factors (parafunctions, posterior occlusal contacts, sleep disturbances and psychoactive medication), clinical manifestations (pain, joint sounds, limitation of mandibular movements) and panoramic X-ray and magnetic resonance imaging alterations. Results: None of the studied variables showed statistically significant differences between osteoarthritis and osteoarthrosis. Age was significantly older among the patients with osteoarthritis/osteoarthrosis than in the general group of patients with temporomandibular joint pathology (36.9±17.2) (F=20.1; p=0.000). The time from appearance of the symptoms to medical consultation (35.9±41.8 months) was significantly longer in patients with osteoarthritis (F=3.95; p=0.049). The number of posterior occlusal contacts (5.2±3.0), maximum aperture (32.5±6.5 mm), and the frequency of parafunctions (42.9%) were significantly lower in the group of patient with osteoarthritis (F=6.2 p=0.01; F=4.45 p=0.04; χ2 =4.85 p=0.03) than in the group of patients with temporomandibular joint pathology from which they were drawn. Conclusions: No epidemiological or clinical differences were observed between osteoarthritis and osteoarthrosis, though both processes - particularly osteoarthritis - showed differences with respect to the group of patients with temporomandibular joint pathology from which they were drawn

Retrospective study of a series of 850 patients with temporomandibular dysfunction (TMD). Clinical and radiological findings

Objective: To define the clinical and radiological characteristics of the four most common presentations of temporomandibular dysfunction-myofascial pain (MFP), disc displacement with reduction (DDWR), disc displacement without reduction (DDWoR), and osteoarthrosis (OR)-and to identify the differences among them. Material and methods: The study comprised a series of 850 patients (121 males and 729 females) seen between May 2003 and December 2006 in Valencia University General Hospital (Spain) for temporomandibular joint disease (TMJD). An analysis was made of the possible etiological factors (stress, traumatisms, sleep disturbances, parafunctional habits, reason for consultation), possible pain sensations in response to palpation of the masticatory muscles, joint sounds, etc. A panoramic X-ray study was made on a routine basis, and in some patients (n = 54) the study was completed with a magnetic resonance imaging scan of the temporomandibular joints and related tissues. The differences between qualitative variables were examined by means of the chi-square test with R x C contingency tables and the Z-test, while quantitative variables were contrasted by analysis of variance (ANOVA) and post hoc testing (Scheffe). Results: The variables showing statistically significant differences among the four diagnostic categories were: patient age, sleep disturbances, stress, parafunctional habits, nibbling on hard objects and ?parafunctions?, reason for consultation, mandibular movements, ?non-evaluable? molar and canine relationship, ligament hyperlaxity, and panoramic X-ray alterations

Osteoartrosis de la articulación temporomandibular: estudio clínico y radiológico de 16 pacientes

Objetivo: El objetivo del presente estudio fue describir las características clínicas y radiológicas de 16 pacientes con osteoartrosis (OA) de la articulación temporomandibular (ATM). Material y métodos: En el estudio participaron aquellos pacientes que reunieran los criterios diagnósticos para la OA propuestos por Stegenga y cols en 1989. Los pacientes fueron sometidos a un protocolo de diagnóstico tanto clínico como por técnicas de imagen (obteniéndose los datos de una resonancia nuclear magnética). Resultados: Los signos clínicos más destacados fueron la presencia de crepitación a la auscultación en un 93,8% de los casos, y una disminución en el rango de los movimientos mandibulares. Los hallazgos radiológicos mostraron una alteración en la morfología de las superficies articulares en un 62% de los casos en el lado derecho y en un 68,8% de los pacientes en el lado izquierdo. En el estudio de la posición dinámica del disco articular se observó un desplazamiento anterior sin reducción en el 50% de los casos en la ATM derecha y en un 43,8% en la izquierda. Conclusiones: Los pacientes con OA de la ATM presentan crepitación y disminución en el rango de los movimientos mandibulares, siendo la alteración de la morfología articular el rasgo radiológico más destacable.A study is made of the clinical and radiological characteristics of 16 patients with osteoarthrosis (OA) of the temporomandibular joint (TMJ). The study comprised those patients satisfying the diagnostic criteria for OA proposed by Stegenga et al. in 1989. The patients were subjected to a clinical and radiological diagnostic protocol (including the obtainment of magnetic resonance imaging data). The most relevant clinical findings were the detection of crepitants in 93.8% of cases, with a reduction in mandibular movement range. Radiology in turn identified joint surface alterations in 62% of cases on the right side, and in 68.8% of the patients on the left side. The joint disc dynamic position study showed anterior displacement without reduction in 50% of cases in the right joint and in 43.8% of patients in the left joint. In conclusion, patients with OA of the TMJ present joint sounds and a reduced mandibular movement range ' the salient radiological characteristic being altered joint morphology

Reacción granulomatosa facial por rellenos cosméticos inyectados: presentación de cinco casos

El uso de sustancias para el aumento de tejidos blandos por motivos estéticos puede ocasionar la aparición de granulomas a cuerpo extraño, entre otros efectos indeseables. Las mejoras introducidas en dichas sustancias han conseguido la disminución de la incidencia de reacciones adversas pero no su desaparición. Presentamos cinco casos de reacción a cuerpo extraño por tres productos diferentes, dimetilpolisiloxano (silicona), colágeno bovino, y ácido poliláctico, que habían sido infiltrados en el tejido celular subcutáneo de las pacientes (las cinco eran mujeres) entre dos y dieciséis años antes de la aparición de la reacción a cuerpo extraño. Las cinco presentaron un cuadro de tumefacción facial difusa, no dolorosa y de consistencia duroelástica. Los estudios de imagen con resonancia magnética mostraron signos de reacción inflamatoria intensa de la zona afectada. La histología mostró la presencia de granulomas a cuerpo extraño con células gigantes multinucleadas. Las pacientes fueron tratadas con corticoides administrados por vía sistémica, excepto una de ellas que no precisó tratamiento farmacológico.The use of substances to augment soft tissues as aesthetic purpose is associated with, among other undesirable effects, the appearance of foreign body granulomas. The improvements made to these substances have reduced the incidence of adverse reactions, but not eliminated them. We present five cases of foreign body reactions to three different products, dimethylpolysiloxane (silicone), bovine collagen, and polylactic acid, which were injected into the subcutaneous cellular tissue of the patients (all five were women), between two and sixteen years before the appearance of the foreign body reaction. All five presented painless, diffuse facial tumefaction, of firm, elastic consistency. The magnetic resonance image (MRI) studies showed signs of intense inflammatory reaction in the affected areas. The histology revealed the presence of foreign body granulomas with giant multi-nucleated cells. The patients were treated with systemically administered corticoids, except in one case which did not require pharmacological treatment

Granulomatous facial reaction to injected cosmetic fillers : a presentation of five cases

The use of substances to augment soft tissues as aesthetic purpose is associated with, among other undesirable effects, the appearance of foreign body granulomas. The improvements made to these substances have reduced the incidence of adverse reactions, but not eliminated them. We present five cases of foreign body reactions to three different products, dimethylpolysiloxane (silicone), bovine collagen, and polylactic acid, which were injected into the subcutaneous cellular tissue of the patients (all five were women), between two and sixteen years before the appearance of the foreign body reaction. All five presented painless, diffuse facial tumefaction, of firm, elastic consistency. The magnetic resonance image (MRI) studies showed signs of intense inflammatory reaction in the affected areas. The histology revealed the presence of foreign body granulomas with giant multi-nucleated cells. The patients were treated with systemically administered corticoids, except in one case which did not require pharmacological treatment

Cardiovascular diseases in dental practice : Practical considerations

Coronary heart disease is the principal cause of death in the industrialized world. Its most serious expression, acute myocardial infarction, causes 7.2 million deaths each year worldwide, and it is estimated that 20% of all people will suffer heart failure in the course of their lifetime. The control of risk cardiovascular factors, including arterial hypertension, obesity and diabetes mellitus is the best way to prevent such diseases. The most frequent and serious cardiovascular emergencies that can manifest during dental treatment are chest pain (as a symptom of underlying disease) and acute lung edema. Due to the high prevalence and seriousness of these problems, the dental surgeon must be aware of them and should be able to act quickly and effectively in the case of an acute cardiovascular event. In patients with a history of cardiovascular disease, attention must center on the control of pain, the reduction of stress, and the use or avoidance of a vasoconstrictor in dental anesthesia. In turn, caution is required in relation to the antiplatelet, anticoagulant and antihypertensive medication typically used by such patients

Dental management in renal failure : patients on dialysis

Chronic renal failure is an important health care problem throughout the world, with an incidence of 337, 90, 107 and 95 new cases per million inhabitants/year in the United States, Australia, New Zealand and the United Kingdom, respectively. These figures moreover invariably tend to increase. During the progression of renal damage, clinical manifestations are noted in practically all body organs and systems, and 90% of all affected patients experience oral symptoms. The existing management options range from simple measures based on changes in diet and life style, to different forms of dialysis (hemodialysis and peritoneal dialysis), and also kidney transplantation. Given the multiple oral manifestations of chronic renal failure, and the different repercussions of its treatment upon the oral cavity, these patients require special considerations and precautions in the face of dental treatment. Consultation with the nephrologist is essential before any dental treatment is carried out, in order to determine the condition of the patient, define the best moment for dental treatment, introduce the necessary pharmacological adjustments, or to establish other important aspects for preventing complications in the dental clinic. The present study reviews the characteristics of the disease, the existing therapeutic options, and the considerations of relevance for the dental professional

Use of nonsteroidal antiinflammatory drugs in dental practice : a review

Nonsteroidal antiinflammatory drugs (NSAIDs) are drugs commonly prescribed in dental practice for the management of pain and swelling. Of these substances, paracetamol and ibuprofen are the most widely used. Their mechanism of action is based on the inhibition of cyclooxygenase, and therefore of prostaglandin synthesis. All of these drugs present a similar mechanism of action, as a result of which their side effects are also similar. The most frequent range from mild (e.g., nausea or vomiting) to serious gastric problems (such as gastric bleeding or perforation). Other side effects include an increased risk of vascular accidents (particularly acute myocardial infarction), renal toxicity secondary to a decrease in perfusion, and the risk of abnormal bleeding tendency due to the antiplatelet effect of these drugs. Their use is contraindicated in the third trimester of pregnancy, due to the induction of premature ductus arteriosus closure. The present study reviews the information currently available on NSAIDs, with special emphasis on those aspects related to dental practice