Clinico-therapeutic management of osteoradionecrosis : a literature review and update

In the management of head and neck cancer, radiotherapy is usually a coadjuvant to surgery, or is applied on a palliative basis. The most important complication of such radiotherapy is osteoradionecrosis, which manifests as an area of exposed necrotic bone in the maxillae or mandible that fails to heal during at least three months. In most cases osteoradionecrosis gradually progresses, becoming more extensive and painful, and its late manifestations comprise infection and pathological fracture. The present study provides a literature review and update on the risk factors underlying osteoradionecrosis, its clinical and diagnostic particulars, prevention, and most widely accepted treatment options, as well as new possibilities relating to clinical management of the disorder. Lastly, a new early management protocol is proposed based on the current consensus criteria relating to maxillary osteonecrosis secondary to treatment with bisphosphonates, together with the adoption of new therapies supported by increased levels of evidence. © Medicina Oral S. L

Cemento-ossifying fibroma of the mandible: presentation of a case and review of the literature

Introduction: Cemento-ossifying fibroma is a benign fibro-osseous maxillary tumor belonging to the same category as fibrous dysplasia and cement-ossifying dysplasia. The aim of present study was report a case of cement-ossifying mandibular fibroma and offers a review of the literature on this disorder. Case report: A 41-year-old woman presented for conventional dental treatment. A control panoramic X-ray study revealed a rounded, mixed-type image in the mandible, located in the periapical zone from tooth 4.3 to 3.3. The patient presented no symptoms and had no medical history of interest. A sample of the lesion was obtained for histopathological study, which yielded a definitive diagnosis of cemento-ossifying fibroma. Discussion: The World Health Organization classifies cemento-ossifying fibroma as a fibro-osseous neoplasm included among the non-odontogenic tumors derived from the mesenchymal blast cells of the periodontal ligament, with a potential to for fibrous tissue, cement and bone, or a combination of such elements. These are slow-growing lesions, and are more frequent in women between the third and fourth decades of life. Although the underlying cause is not known, there have been reports of past trauma in the area of the lesion. Due to the good delimitation of the tumor, surgical removal and curettage is the treatment of choice

Association between obesity and periodontal disease. A systematic review of epidemiological studies and controlled clinical trials

Obesity is a very prevalent chronic disease worldwide and has been suggested to increase susceptibility of periodontitis. The aim of this paper was to provide a systematic review of the association between obesity and periodontal disease, and to determine the possible mechanisms underlying in this relationship. A literature search was carried out in the databases PubMed-Medline and Embase. Controlled clinical trials and observational studies identifying periodontal and body composition parameters were selected. Each article was subjected to data extraction and quality assessment. A total of 284 articles were identified, of which 64 were preselected and 28 were finally included in the review. All the studies described an association between obesity and periodontal disease, except two articles that reported no such association. Obesity is characterized by a chronic subclinical inflammation that could exacerbate other chronic inflammatory disorders like as periodontitis. The association between obesity and periodontitis was consistent with a compelling pattern of increased risk of periodontitis in overweight or obese individuals. Although the underlying pathophysiological mechanism remains unclear, it has been pointed out that the development of insulin resistance as a consequence of a chronic inflammatory state and oxidative stress could be implicated in the association between obesity and periodontitis. Further prospective longitudinal studies are needed to define the magnitude of this association and to elucidate the causal biological mechanisms

Hospital dental practice in special patients

Dental patients with special needs are people with different systemic diseases, multiple disorders or severe physi - cal and/or mental disabilities. A Medline search was made, yielding a total of 29 articles that served as the basis for this study, which offers a brief description of the dental intervention protocols in medically compromised patients. Dental treatment in patients with special needs, whether presenting medical problems or disabilities, is sometimes complex. For this reason the hospital should be regarded as the ideal setting for the care of these individuals. Be - fore starting any dental intervention, a correct patient evaluation is needed, based on a correct anamnesis, medical records and interconsultation reports, and with due assessment of the medical risks involved. The hospital setting offers the advantage of access to electronic medical records and to data referred to any complementary tests that may have been made, and we moreover have the possibility of performing treatments under general anesthesia. In this context, ambulatory major surgery is the best approach when considering general anesthesia in patients of this kin

Possible association between obesity and periodontitis in patients with Down syndrome

The present study was carried out to evaluate the possible association between obesity and periodontitis in patients with DS, and to explore which measure of obesity is most closely correlated to periodontitis. A prospective observational study was made to determine whether obesity is related to periodontal disease in patients with DS. The anthropometric variables were body height and weight, which were used to calculate BMI and stratify the patients into three categories: < 25(normal weight), 25-29.9 (overweight) and ? 30.0 kg/m2 (obese). Waist circumference and hip circumference in turn was recorded as the greatest circumference at the level of the buttocks, while the waist/hip ratio (WHR) was calculated. Periodontal evaluation was made of all teeth recording the plaque index (PI), pocket depth (PD), clinical attachment level (CAL) and the gingival index. We generated a multivariate linear regression model to examine the relationship between PD and the frequency of tooth brushing, gender, BMI, WHI, WHR, age and PI. Significant positive correlations were observed among the anthropometric parameters BMI, WHR, WHI and among the periodontal parameters PI, PD, CAL and GI. The only positive correlation between the anthropometric and periodontal parameters corresponded to WHR. Upon closer examination, the distribution of WHR was seen to differ according to gender. Among the women, the correlation between WHR and the periodontal variables decreased to nonsignificant levels. In contrast, among the males the correlation remained significant and even increased. In a multivariate linear regression model, the coefficients relating PD to PI, WHR and age were positive and significant in all cases. Our results suggest that there may indeed be an association between obesity and periodontitis in male patients with DS. Also, we found a clear correlation with WHR, which was considered to be the ideal adiposity indicator in this context

Application of a capsaicin rinse in the treatment of burning mouth syndrome.

Objective: To examine the efficacy of a new topical capsaicin presentation as an oral rinse in improving the symptoms of burning mouth syndrome (BMS). Study design: A prospective, double-blind, cross-over study was made of 30 patients with BMS. There were 7 dropouts; the final study series thus comprised 23 individuals. The patients were randomized to two groups: (A) capsaicin rinse (0.02%) or (B) placebo rinse, administered during one week. After a one-week washout period,the patients were then assigned to the opposite group. Burning discomfort was scored using a visual analog scale(VAS): in the morning before starting the treatment, in the afternoon on the first day of treatment, and at the end of the week of treatment in the morning and in the afternoon. The same scoring sequence was again applied one week later with the opposite rinse. Results: The mean patient age was 72.65 ± 12.10 years, and the duration of BMS was 5.43 ± 3.23 years on average. Significant differences in VAS score were recorded in the capsaicin group between baseline in the morning (AM1)or afternoon (AA1) and the end of the week of treatment (AA7)(p=0.003 and p=0.002, respectively). Conclusion: The topical application of capsaicin may be useful in treating the discomfort of BMS, but has some limitations

Burning mouth syndrome : correlation of treatment to clinical variables of the disease

Objective: Burning mouth syndrome (BMS) is a complex disorder with a still uncertain etiopathogenesis. A number of treatments have been used in application to BMS, though without clearly successful results. The present study compares the improvement in BMS obtained as a result of different treatment modalities in relation to the clinical characteristics of the patients. Study Design: A retrospective cohort study was made of 115 patients with BMS (109 females and 6 males) subjected to different treatments with a view to improving the symptoms. The clinical variables examined included the duration of the disorder, the location of the burning sensation, its daily variations and relationship with meals. The parameters were measured using a visual analog scale (VAS) applied at baseline and again after two weeks of treatment. Results: The mean patient age was 70±11.41 years, and the mean duration of the syndrome was 7.16±2.63 years. The tongue was the most frequently affected location. Anxiolytic treatment afforded the best results (p<0.001), and the patients with the shortest duration of disease showed the best improvement with treatment (p=0.005). Conclusion: The greatest treatment efficacy corresponded to anxiolytic drugs, and treatment was more effective when introduced early after the diagnosis of BMS. © Medicina Oral S. L

Treatment of xerostomia and hyposalivation in the elderly: a systematic review

Background: Therapeutic strategies for xerostomia, regardless of etiology, have so far not had definitive or clearly effective results. Objectives. To systematically revise the latest scientific evidence available regarding the treatment of dry mouth, regardless of the cause of the problem. Material and Methods: The literature search was conducted in March 2015, using the Medline and Embase databases. The “Clinical Trial”, from 2006 to March 2015, was carried out in English and only on human cases. The draft of the systematic review and assessment of the methodological quality of the trials was carried out following the criteria of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the “Oxford Quality Scale”. Results: Finally, a total of 26 trials were identified that met the previously defined selection and quality criteria; 14 related to drug treatments for dry mouth, 10 with non-pharmacological treatment and 2 with alternative treatments. Conclusions: Pilocarpine continues to be the best performing sialogogue drug for subjects with xerostomia due to radiation on head and neck cancer or diseases such as Sjogren’s Syndrome. For patients with dry mouth caused solely by medication, there are some positive indications from the use of malic acid, along with other elements that counteract the harmful effect on dental enamel. In general, lubrication of oral mucous membrane reduces the symptoms, although the effects are short-live

Cardiovascular disease versus periodontal disease: chronic systemic infection as a link

Objective : Analysis of the alleged connection between the periodontal and cardiovascular disease, with reference to periodontal pathogens as a risk factor for heart disease. Researching method : A research was carried out at Medline/Pubmed. Included criteria and researching strategy. The articles selection has been made taking into account key-terms appearing either in the title or in the summary. Experimental studies in animals, clinical prospective studies performed with a minimum sample size (>30) and studies written in English have been included. The rejected criteria were the following: clinical retrospective studies and/or studies carried out with a low sample size (n<30). Results : Within systemic diseases related to periodontal ones, the alleged link between periodontal and heart and circulatory disease has been one of the most investigated in recent times. Different authors consider the existence of a link between the diseases as such, inappropriate and implausible since both the diseases have risk factors in common (age, gender, smoking, diet, oral hygiene and diabetes). However, speculations about the origin of the diseases were raised when it was demonstrated that some bacteria species, bacteria proteins and lipopolysaccharide are present at the plaques of atherosclerosis that obstruct the coronary arteries. The mechanisms of this connection have been analyzed following an actualized review. Conclusion : Most of the experimental and clinical studies ensure that a positive association between periodontal disease and heart disease has been found, once the con-founder factors have been eliminate