Prevention and treatment of oral mucositis in patients receiving chemotherapy

Oral mucositis is one of the most common side effects of cancer treatment (chemotherapy and/or radiotherapy). It is an inflammatory process that affects the mucosa of the oral cavity, giving rise to erythematous areas in combination with ulcers that can reach a large size. The true importance of oral mucositis is the complications it causes ' fundamentally intense pain associated to the oral ulcers, and the risk of overinfection. This in turn may require reduction or even suspension of the antineoplastic treatment, with the risk of seriously worsening the patient prognosis. This points to the importance of establishing therapeutic tools of use in the prevention and/or treatment of mucositis. The present study offers a literature review of all the articles published over the last 10 years referred to the prevention and/or treatment of oral mucositis associated to chemotherapy

Dental considerations in pregnancy and menopause

The present study offers a literature review of the main oral complications observed in women during pregnancy and menopause, and describes the different dental management protocols used during these periods and during lactation, according to the scientific literature. To this effect, a PubMed-Medline search was made, using the following key word combinations: “pregnant and dentistry”, “lactation and dentistry”, “postmenopausal and dentistry”, “menopausal and dentistry” and “oral bisphosphonates and dentistry”. The search was limited to reviews, metaanalyses and clinical guides in dental journals published over the last 10 years in English and Spanish. A total of 38 publications were evaluated. Pregnancy can be characterized by an increased prevalence of caries and dental erosions, worsening of pre-existing gingivitis, or the appearance of pyogenic granulomas, among other problems. Although routine dental treatment is generally safe in pregnant patients and posteriorly during the lactation period, certain dental procedures can have potentially damaging effects, such as the use of ionizing radiations, the administration of drugs, or the generation of pain and stress. In postmenopausal women, alterations of the oral cavity are related to the hormone alterations that characterize these patients and to physiological aging of the oral tissues, potentially giving rise to periodontitis, burning mouth syndrome and xerostomia. As a result of the development of osteoporosis, these patients may be receiving treatment with oral bisphosphonates, which in turn may require changes in the dental management plan

Dental management in patients with hemostasis alteration

Haemostasis is a mechanism that, through different interdependent biologic processes, has the purpose of ensuring the integrity and permeability of the circulatory system. Hemostasis term means prevention the loss of blood. Interventions or treatments in the oral cavity, in particular those with a possibility of bleeding, represent a risk for patients with disorders of hemostasis. Prevention is the key to avoid bleeding complications after oral surgical procedures and therefore it is essential a detailed medical history of the patient. The appropriate diagnosis and treatment in patients with disorders of hemostasis, depends directly in the understanding of hemostasis standard mechanisms. Emphasising not only the importance of a thoughtful insight into these mechanisms, but also of the existing analysis that study them. This paper makes a synthesis of the general aspects of inherited coagulation disorders (Von Willebrand disease and Hemophilia A and B) as well as of the alterations on platelets consequence of the use of certain medication (antiplatelet and anticoagulant drugs), and their dental management

Oral manifestations and dental management of patient with leukocyte alterations

Leukocytes are the main cellular elements of inflammatory and immune reactions of the organism. Leukocyte alterations are the consequence of an imbalance between the formation of leukocytes in the bone marrow and its elimination by the mononuclear phagocytic system. Factors that can modify leukopoyesis are varied and can lead to an alteration in the number of leukocytes or tumoral alterations of white cells (leukemias, lymphomas and plasma cell tumors). There is also a wide range of clinical manifestations that can derive from them: from very slight symptoms to life-threatening conditions. In some cases oral manifestations will be the first signs and it will be the dentist’s responsibility to identify the underlying disorder and guide the diagnosis of the patient. It is important to be familiar with the special management required for these patients, in which the dental treatment can affect the course of the underlying disease. The objective of this article is to review the literature concerning the oral manifestations and the considerations that must factor in the dental treatment of patients with leukocyte alterations

Dental management of patients with inflammatory bowel disease

Ulcerative colitis and Crohn’s disease are the most common forms of inflammatory bowel disease (IBD), both of unknown aetiology. These conditions are characterised by the chronic and recurrent inflammation of different parts of the gastrointestinal tract, but while in CD, chronic inflammation may affect any part of the gastrointestinal tract, in UC, mucosal inflammatory changes are confined to the colon. IBD is currently on the increase, and it is important for the dental professional to be familiar with the condition as patients with IBD may present oral manifestations of the underlying disease. Such manifestations of IBD may precede the onset of intestinal radiographic lesions by as much as a year, or even more. Treatments used to manage IBD can affect the delivery of routine dental care

Dental considerations in patients with heart disease

Summary: Cardiovascular diseases are one of the main causes of death in the developed world, and represent the first cause of mortality in Spain. In addition to their associated morbidity, such disorders are important due to the number of affected individuals and the many patients subjected to treatment because of them. Objective: An update is provided on the oral manifestations seen in patients with arterial hypertension, ischemic heart disease, arrhythmias and heart failure, and on the dental management of such patients. Material and methods: A Medline-PubMed search was conducted of the literature over the last 10 years using the keywords: “cardiopathy”, “dental management”, “endocarditis”, “hypertension” and “arrhythmia”. A total of 31 articles were reviewed, of which 22 were literature reviews, three were expert committee guides, four clinical trials and two case series. Results: The drug treatments used by these patients can give rise to oral manifestations in the form of xerostomia, lichenoid reactions, burning mouth sensation, loss of taste sensation, gingival hyperplasia and bleeding, as well as extraoral manifestations such as sialadenosis. An inadequately controlled cardiological patient constitutes a risk case in dental practice; dental surgeons therefore must take a series of aspects into account before treating such patients, in order to avoid complications

Dental management of patients with endocrine disorders

Introduction: The endocrine system is responsible for hormonal secretion and is closely related to the central nervous system, as it diversifies its functions through the hypothalamus and pituitary glands. It controls physiological processes and maintains homeostasis. The neuroendocrine system is responsible for adaptation to environmental changes. Therefore, in dentistry, it is important to be aware of the risks and difficulties that may arise during the dental management of patients with endocrine disorders, and that visits to the dental clinics often represent a stressful situation. Objectives: To review the literature on oral manifestations and dental management in patients with endocrine disorders (disorders of the thyroid, parathyroid and adrenal glands). Material and Methods: For the literature review, we carried out a search in Pubmed / Medline database using limits and keywords according to the controlled vocabulary “Medical Subject Headings” (MeSH). We obtained a total of 19 articles (ten literature reviews, one case-control study, and eight clinical case series). Results and discussion: We describe the most common oral manifestations in patients with endocrine disorders and the special dental management that should be carried out on these patient

Dental management in transplant patients

Introduction: Transplant is the replacement with therapeutic purposes, of organs, tissues or cellular material for others, from a donor who is usually a human, alive or dead. In recent years, transplant organs have been developed by the advances that have occurred with immunosuppressive drugs and medical-surgical technology. Due to the frequency of transplants that are performed today, it is common to find these patients in dental clinics. Objectives: To review the literature on oral manifestations in transplant patients and general dental management and according to transplant organs (heart, lung, liver, kidney, pancreas and bone marrow). Material and Methods: For the literature review, we carried out a search in Pubmed / Medline database using limits and keywords according to the controlled vocabulary “Medical Subject Headings” (MeSH). We obtained a total of 30 articles (eight literature reviews, three randomized clinical trials, one cohort study, three case-control studies, eight clinical case series and seven cross-sectional studies). Results and discussion: We describe the most common oral manifestations in transplant patients (viral, bacterial and fungal infections, gingival enlargement secondary to drug therapy and higher risk in the development of oral malignancy) and the special dental management that should be carried out on these patients, generally and specifically according to the type of transplant.Introduction: Transplant is the replacement with therapeutic purposes, of organs, tissues or cellular material for others, from a donor who is usually a human, alive or dead. In recent years, transplant organs have been developed by the advances that have occurred with immunosuppressive drugs and medical-surgical technology. Due to the frequency of transplants that are performed today, it is common to find these patients in dental clinics. Objectives: To review the literature on oral manifestations in transplant patients and general dental management and according to transplant organs (heart, lung, liver, kidney, pancreas and bone marrow). Material and Methods: For the literature review, we carried out a search in Pubmed / Medline database using limits and keywords according to the controlled vocabulary “Medical Subject Headings” (MeSH). We obtained a total of 30 articles (eight literature reviews, three randomized clinical trials, one cohort study, three case-control studies, eight clinical case series and seven cross-sectional studies). Results and discussion: We describe the most common oral manifestations in transplant patients (viral, bacterial and fungal infections, gingival enlargement secondary to drug therapy and higher risk in the development of oral malignancy) and the special dental management that should be carried out on these patients, generally and specifically according to the type of transplant

Dental considerations in patients with respiratory problems.

Many respiratory disorders can compromise routine dental care and require special treatment for the affected patients. Patients often visit the dental clinic with respiratory problems already diagnosed by other specialists. The dental professional therefore must provide correct dental care in the context of such a diagnosis. The present study offers a literature review of those respiratory disorders which can have implications for dental care. Chronic obstructive pulmonary disease (COPD) and asthma require special measures, such as working with the patient in the vertical position, since some of these subjects do not tolerate decubitus. On the other hand, patients with COPD can suffer infectious lung diseases secondary to the aspiration of microorganisms in the presence of deficient periodontal conditions. The treatments received by patients with respiratory diseases can also influence their oral health. In this sense, it has been shown that inhalatory medication used for asthma can cause oral disorders such as xerostomia, oropharyngeal candidiasis and an increased presence of caries (due to the action of β-agonists), as well as gingivitis. In contrast, oral manifestations of tuberculosis are infrequent. The clinical appearance of the lesions is very similar to that of squamous cell carcinoma; it is therefore important to establish a correct differential diagnosis in such cases. Mention also will be made of patients with obstructive sleep apnea syndrome (OSAS), characterized by critical narrowing and occlusion of the upper airways during sleep. In this context, the dental professional is often directly implicated in the management of such patients by preparing and fitting oral devices designed to advance the mandible. Lastly, mention will be made of dental management in the event of foreign body aspiration, where rapid intervention by the dental professional is critical. The basic approach in such cases is adequate prevention