Sjögren’s syndrome of the oral cavity. Review and update

Sjögren´s syndrome is one of the most frequent autoimmune diseases. It is a chronic and systemic disorder predominantly found in women, and is characterized by the appearance of a lymphocytic inflammatory infiltrate, with dryness of the oral cavity and eyes, secondary to involvement of the salivary and lacrimal glands. The underlying causal mechanism involves a number of factors and has not been clearly established, though an autoimmune response is known to be triggered, with the accumulation of immune complexes in the gland acini that interfere with gland function. In the oral cavity, xerostomia or hyposialia is the most disabling manifestation for patients, and is accompanied by rapidly p…

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 sec…

Valoración clínica del estado dental y periodontal en un grupo de pacientes oncológicos, previo inicio de la quimioterapia

Objetivos: Valorar el estado bucodental en 88 pacientes con cánceres corporales, previo al inicio de su tratamiento quimioterápico. Diseño del estudio: Estudiamos 88 pacientes con cánceres de diferentes localizaciones corporales y los comparamos con un grupo control. Analizamos la placa dental (mediante el índice de Silness y Löe), el estado dental (mediante el índice CAO.D) y el estado periodontal (índice CPI modificado). Resultados: En el grupo de pacientes oncológicos, la media del índice de placa de Silnness y Löe fue de 1,28±0,11. Los pacientes presentaban múltiples ausencias dentarias, siendo la media de dientes ausentes por caries de 7,55±0,80. También se observó que la media de cari…

Esclerosis multiple como primera manifestacion en el territorio oral y facial: presentación de cuatro casos

La esclerosis múltiple (EM) es una enfermedad inflamatoria crónica del sistema nervioso central de etiología no conocida caracterizada por la aparición de sintomatologia neurológica diversa en forma de brotes o de deterioro progresivo y de lesiones en cualquier localización de la sustancia blanca cerebral que pueden dejar como secuelas la desmielinización definitiva de la zona. Esta enfermedad afecta a gente joven siendo más frecuente su aparición entre los 20 y 40 años, en climas templados y fríos y con una relación hombre-mujer de 0,46 / 0,67. La importancia de esta enfermedad radica en que es la primera causa de invalidez permanente en adultos jóvenes. Presentamos 4 casos de EM cuyo sínt…

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 endocri…

Review of temporomandibular joint pathology. Part I : classification, epidemiology and risk factors

Pathology of the temporomandibular joint (TMJ) affects an important part of the population, though it is not viewed as a public health problem. Between 3-7% of the population seeks treatment for pain and dysfunction of the ATM or related structures. The literature reports great variability in the prevalence of the clinical symptoms (6-93%) and signs (0-93%), probably as a result of the different clinical criteria used. In imaging studies it is common to observe alterations that have no clinical expression of any kind. Radiographic changes corresponding to osteoarthrosis are observed in 14- 44% of the population. Age is a risk factor, though with some particularities. In elderly patients the…

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 f…

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 …

Palatal perforations secondary to inhaled cocaine abuse: presentation of five cases

The estimated incidence of complications associated with cocaine abuse is 4.8%. Palatal perforation is a very infrequent condition within the range of complications associated with cocaine abuse. No epidemiological cha- racteristics relating to patient age or gender have been established, and the diagnosis of the disorder requires a detailed clinical history, including antecedents of cocaine abuse. The clinical and radiological studies show palatal bone erosion and perforation of the soft or hard palate. The present study describes five cases of palatal perforation secondary to inhaled cocaine abuse. As a result of the increase in cocaine use in recent years, particularly among young adults…

Lichen sclerosus of the oral mucosa : a case report

Lichen sclerosus or lichen sclerosus et atrophicus is a chronic inflammatory disease predominantly affecting the genital mucosa and skin. Clinically, it is characterized by white atrophic plaques in the anogenital region. The lesions are generally asymptomatic, but may cause discomfort with itching and pain. Extragenital mucosal involvement is very unusual, and lesions limited to the oral mucosa are even less frequent. Knowledge of such lesions is important in order to establish a differential diagnosis with other white oral lesions, and histological confirmation is required. We present the case of a 31-year-old woman with a well delimited, pearly white lesion located in the upper gingival …

Drug-induced oral lichenoid reactions: a literature review

The terms oral lichenoid reactions or oral lichenoid lesions refer to lesions histologically and clinically similar to oral lichen planus, though with the particularity that in these cases the underlying cause is identifiable. In addition, these lesions are described according to the causal factor involved, including alterations resulting from direct contact with dental restoration materials, drug-related lesions, and lesions associated to graft-versus-host disease. Drug-induced oral lichenoid reactions or oral lichenoid lesions were first cited in 1971 by Almeyda and Levantine. Since then, many drug substances have been associated with such lesions. The most common agents are nonsteroidal …

Bacteremia originating in the oral cavity. A review

In patients at risk because of heart disease, bacteremias induced by invasive dental treatments have been reported as a cause of bacterial endocarditis (BE) - a serious disorder that continues to involve a high mortality. As a result, different scientific societies have supported recommendations for the administration of antibiotics prior to invasive dental treatments, in order to neutralize bacteremia. In this context, the recommendations of the American Heart Association (AHA) are the most widely used in our setting. Advances in our knowledge of the etiopathogenesis of bacterial endocarditis have placed increasingly less importance on invasive dental treatments as a causal factor (the AHA…

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…

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 ma…

A review of temporomandibular joint disease (TMJD). Part II : clinical and radiological semiology. Morbidity processes

The clinical signs and symptoms of greatest semiologic value in temporomandibular joint disease (TMJD) are muscle pain, joint pain, limitations in mandibular movement, and joint sounds. Imaging studies of the joint are very useful for establishing the diagnosis and for discarding other disease processes, though in many cases diagnostic error results from the detection of a large proportion of patients with alterations in the imaging studies but with no associated clinical manifestations. Panoramic X-rays and magnetic resonance imaging are the most commonly used complementary techniques for diagnosing TMJD. MRI may be regarded as the imaging technique of choice, particularly when studying th…

Dental treatment of patients with coagulation factor alterations: An update

Hemostasia is a defense mechanism that protects vascular integrity, avoids blood loss, and maintains blood fluidity throughout the circulatory system. The biochemical processes leading to blood clot formation are complex, and alterations can appear at any point within the chain of events. While a range of alterations can affect the coagulation factors, some are more common than others in the general population, including congenital (hemophilia A and B, Von Willebrand’s disease) and acquired disorders (anticoagulant drugs). Such diseases require special consideration in the context of dental treatment, and therefore must be known to dental professionals. Interconsultation with the hematologi…

Pediatric dental care in a tertiary public hospital. Four years of experience in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain)

A study is made of the experience gained with the Child Oral Care Program (Plan de Atención Dental Infantil, PADI) in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain) after four years in operation (July 2003 - July 2007). Study design: The sample comprised 2626 children between 5-14 years of age, pertaining to department 9 of the Valencian public health system. A clinical history was compiled in each case, a radiological study was made, and a treatment plan was elaborated including fillings, extractions, and control visits. Results: Of the 2626 designated children, 2369 visited our Service - mostly referred from the Preventive Dental Care Units. A total o…

Graft-versus-host disease affecting oral cavity: a review

Graft versus host disease (GVHD) is one of the most frequent and serious complications of hematopoietic stem cell transplantation, and is regarded as the leading cause of late mortality unrelated to the underlying malignant disease. GVHD is an autoimmune and alloimmune disorder that usually affects multiple organs and tissues, and exhibits a variable clinical course. It can manifest in either acute or chronic form. The acute presentation of GVHD is potentially fatal and typically affects the skin, gastrointestinal tract and liver. The chronic form is characterized by the involvement of a number of organs, including the oral cavity. Indeed, the oral cavity may be the only affected location i…

An update on the management of anticoagulated patients programmed for dental extractions and surgery

Oral anticoagulants (OACs) antagonizing vitamin K - fundamentally sodium warfarin and acenocoumarol - are widely used for preventing arterial thromboembolism in patients with atrial fibrillation and/or heart valve prostheses, and for the treatment and prevention of deep venous thrombosis and pulmonary embolism. The handling of these drugs requires correct monitorization and dose adjustment to obtain the desired therapeutic effect while minimizing the adverse effects associated both with excessive anticoagulation (which leads to bleeding) and with insufficient antithrombotic action (which can produce thrombosis). This is particularly important when patients must be subjected to surgical proc…

Dental considerations in patients with liver disease

Introduction: Liver diseases are very common, and the main underlying causes are viral infections, alcohol abuse and lipid and carbohydrate metabolic disorders. The liver has a broad range of functions in maintaining homeostasis and health, and moreover metabolizes many drug substances. Objective: An update is provided on the oral manifestations seen in patients with viral hepatitis, alcoholic and non-alcoholic liver disease, cirrhosis and hepatocellular carcinoma, and on the dental management of such patients. Material and methods: A Medline-PubMed search was conducted of the literature over the last 15 years using the keywords: “hepatitis”, “alcoholic hepatitis”, “fatty liver”, “cirrhosis…

Relationship between the oral cavity and cardiovascular diseases and metabolic syndrome

The components of the human body are closely interdependent; as a result, disease conditions in some organs or components can influence the development of disease in other body locations. The effect of oral health upon health in general has been investigated for decades by many epidemiological studies. In this context, there appears to be a clear relationship between deficient oral hygiene and different systemic disorders such as cardiovascular disease and metabolic syndrome. The precise relationship between them is the subject of ongoing research, and a variety of theories have been proposed, though most of them postulate the mediation of an inflammatory response. This association between …

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 evalua…

Estudio clínico y hematológico de la estomatitis aftosa recidivante. Análisis de 71 casos