Paget’s Disease of the Bone: a Clinical Report

Pagetova bolest kostiju (PBK) kronični je poremećaj remodeliranja kostiju s povećanom resorpcijom posredstvom osteoklasta te stvaranjem nove kosti, što rezultira neorganiziranim mozaikom „divlje“ i lamelarne kosti na pogođenim područjima kostura. Ta se bolest obično klinički ne zapaža prije dobi od 40 godina. Kliničke manifestacije mogu biti u rasponu od asimptomatičnih do bolnih deformiteta više od jedne kosti. Od PBK najčešće obolijevaju bijelci europskog podrijetla, ali i crnci, no vrlo rijetko žuta rasa. Mnogi se simptomi mogu liječiti antiosteoklastnom terapijom, poput kalcitonina i bifosfanata. Nažalost gotovo da i nema dokumentiranih dugoročnih rezultata. U ovom radu izvještavamo o kliničkom slučaju Pagetove bolesti kostiju i dajemo kratak pregled literature.Paget’s disease of bone (PDB) is a chronic bone remodeling disorder characterized by increased osteoclast-mediated bone resorption with subsequent new bone formation resulting in a disorganized mosaic of woven and lamellar bone at affected skeletal sites. The disease is usually not clinically apparent under 40 years of age. The clinical manifestations may range from asymptomatic to painful deformity of more than one bone. PDB is most common in white people of European descent, but it also occurs in black population, whereas it is rare in people of Asian descent. With anti-osteoclast therapy such as calcitonin and bisphosphonates many of the symptoms are relieved. But the risk of future complications still remains. Unfortunately, very little evidence of long-term results is available. We report a case of Paget’s disease of bone with a brief review of literature

Radiomorphometric Localization of Mental Foramen and Mandibular Canal using Cone Beam Computed Tomography as an Aid to Gender Determination- A Retrospective Study

AIM: The present study aimed at evaluating the role of mental foramen and mandibular canal in gender determination using CBCT.METHODOLOGY: A total number of 73 volumes of CBCT of the mandible was evaluated. Four measurements were used to assess the bucco-lingual and supero-inferior location of mandibular canal and the supero-inferior location of mental foramen was determined using two measurements on both right and left sides of the mandible. Inter and intra-observer variability was analyzed with help of t-test.RESULTS: Good intra-observer and inter-observer agreement was noted with regard to all the six measurements. The mean of all the measurements of mental nerve foramen and mandibular canal was found to be higher in males than females, however, significant difference was noted with regard to Superior Mental foramen (SMeF) and Superior Inferior Alveolar Canal (SMC) (p=0.037, p<0.001 respectively) on the right side and SIAC and Inferior Inferior Alveolar Canal (IIAC), (p=0.015, p=0.046 respectively) on the left side.CONCLUSION: The results of the present study suggest that SMeF, SIAC and IIAC may be used for gender determination. Further, either side of mandible can be used for this purpose. CBCT was found to be a useful modality in this study for sexual dimorphism

A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI

Background: Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist. Objective: Our objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea. Data Sources Electronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices. Limitations While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search. Conclusions: We compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications

World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction: prevalence, diagnosis, and treatment

Objectives Medication-induced salivary gland dysfunction (MISGD) causes significant morbidity resulting in decreased quality of life. This systematic review assessed the literature on the prevalence, diagnosis, treatment, and prevention of MISGD. Materials and methods Electronic databases were searched for articles related to MISGD through June 2013. Four independent reviewers extracted information regarding study design, study population, interventions, outcomes, and conclusions for each article. Only papers with acceptable degree of relevance, quality of methodology, and strength of evidence were retained for further analysis. Results There were limited data on the epidemiology of MISGD. Furthermore, various methods were used to assess salivary flow rate or xerostomia. Preventive and therapeutic strategies included substitution of medications, oral, or systemic therapy with sialogogues, use of saliva substitutes or of electro-stimulating devices. Although there are promising approaches to improve salivary gland function, most studies are characterized by small numbers and heterogeneous methods. Conclusions Physicians and dentists should identify the medications associated with xerostomia and salivary gland dysfunction through a thorough medical history. Preferably, health care providers should measure the unstimulated and stimulated whole salivary flow rates of all their patients so that these values can be used as a baseline to rate the complaints of patients who subsequently claim to experience xerostomia or salivary gland dysfunction as well as the possibilities of effectively treating this condition. Clinical relevance MISGD remains a major burden for the population. This systematic review provides a contemporary in-depth description of the diagnosis and treatment of MISGD