Comments on “Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus”

Adverse Reactions to Anticancer Drugs in the Oral Cavity

The development, testing, and adoption into clinical practice of anticancer medications have revolutionized cancer care over the past decades. A better understanding of the biology of cancer has translated into development of novel systemic agents, as well a more effective use of older chemotherapy agents. As a consequence, cancer mortality continues to decrease. However, greater cure and disease control rates come at a price of an increased risk of adverse effects, which often affects the mouth and related structures including the oral mucosa, salivary glands, jawbones, and cranial nerves. Oral mucositis, hyposalivation, dysgeusia, and osteonecrosis of the jaw (ONJ) are some examples of th…

Peri-Tumoral Inflammatory Cell Infiltration in OSCC: A Reliable Marker of Local Recurrence and Prognosis? An Investigation Using Artificial Neural Networks

The presence of inflammatory reaction in peri-tumoural connective tissue is generally considered as a defense mechanism against cancer, but inflammation tissue in malignant transformation and early steps of oncogenesis has been recently proven to play a supporting and aggravating role in some carcinomas. Aims of this retrospective study were to evaluate in OSCCs the independent association of peri-tumoral inflammatory infiltrate (PTI) with local recurrence (LR) or survival outcome, and to verify whether PTI can be considered a marker of prognosis. Data from 211 cases of OSCC, only surgically treated between 1990 and 2000, were collected and retrospectively analyzed for PTI and the event LR…

Oral manifestations in patients with gastro-oesophageal reflux disease: a single-center case-control study

OBJECTIVE: To assess the occurrence of oral pathological changes and symptoms in patients affected by gastro-oesophageal reflux disease (GERD). PATIENTS AND METHODS: 200 patients with GERD and 100 matched healthy controls were studied. Thorough visual examination of the dental and oral mucosal tissues was performed and medical history relevant to oral symptoms was collected. The primary outcome was defined as a statistically significant difference, between the study group and controls, in the presence of the following indicators: soft/hard palate and uvula erythema, tooth wear, xerostomia, oral acid/burning sensation, subjective halitosis and dental sensitivity. Statistical analysis include…

Biotechnological advances in neuro-electro-stimulation for the treatment of hyposalivation and xerostomia

El tratamiento de la xerostomía es un desafío clínico común en la práctica de la medicina oral. Aunque se han utilizado algunos tratamientos para mejorar los síntomas de la xerostomía, ninguno es del todo satisfactorio para los pacientes que padecen esta alteración. En los últimos años se han desarrollado tratamientos no farmacológicos basados ​​en la electroestimulación para el tratamiento de la xerostomía. Esta revisión tiene como objetivo presentar nuevos desarrollos para el tratamiento de la xerostomía, aplicando neuroestimulación mediante electroestimuladores intraorales miniaturizados. Estos dispositivos aumentan la secreción salival y mejoran los síntomas de sequedad bucal. Su efecto…

Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis

The term desquamative gingivitis (DG) refers to a clinical manifestation that can be caused by several disorders. Many of them are immunologically mediated; in addition to the oral cavity, they can affect extraoral mucocutaneous sites, e.g., larynx, conjunctiva, esophagus, nasal and genital mucosa, and the skin. The degree of oral, periodontal, and systemic involvement determines the overall morbidity and, sometimes, the mortality of these disorders. We comprehensively review disorders commonly associated with DG and highlight diagnostic pathways, guidelines for differential diagnosis, and oral, periodontal, and systemic implications. More rare conditions are reviewed as well. Mucous membra…

Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease

AbstractManagement of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate th…

Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: Not just a sporadic coincidence-a multi-centre study

Abstract Introduction Bisphosphonates (BPs) are powerful drugs that inhibit bone metabolism. Adverse side effects are rare but potentially severe such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, research has primarily focused on the development and progression of BRONJ in cancer patients with bone metastasis, who have received high dosages of BPs intravenously. However, a potential dilemma may arise from a far larger cohort, namely the millions of osteoporosis patients on long-term oral BP therapy. Patients and methods This current study assessed 470 cases of BRONJ diagnosed between 2004 and 2008 at eleven different European clinical centres and has resulted in the …

BRONJ in patients with rheumatoid arthritis: A multicenter case series

Objective: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of various medications (bisphosphonates, anti-resorptive, and anti-angiogenic drugs). ONJ pathogenesis is still unclear although some risk factors have been recognized. Of these, rheumatoid arthritis (RA) has been hypothesized as a potential risk factor for developing ONJ. This observational study will describe a multicenter case series of patients affected with RA and ONJ, and it will attempt to evaluate the association between features of ONJ and pharmacological, systemic, and site variables. Methods: Demographic, pharmacological, and clinical data from 18 RA patients with ONJ were collected and registered fr…

Nonexposed Variant of Bisphosphonate-associated Osteonecrosis of the Jaw: A Case Series

Abstract Purpose To report a case series of patients with the nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw—a form of jaw osteonecrosis that does not manifest with necrotic bone exposure/mucosal fenestration. Methods Among 332 individuals referred to 5 clinical centers in Europe because of development of jawbone abnormalities after or during exposure to bisphosphonates, we identified a total of 96 patients who presented with the nonexposed variant of osteonecrosis. Relevant data were obtained via clinical notes; radiological investigations; patients' history, and referral letters. Results The most common clinical feature of nonexposed osteonecrosis was jaw bone pa…

Electronic buccal drug delivery system to treat addiction and chronic diseases: A porcine study in the frame of “IntelliDrug” project

examination followed by the administration of a risk factor questionnaire. A cervical, buccal, occlusal/incisal, and lingual score was recorded for each tooth using a modified version of the Tooth Wear Index (Smith and Knight, 1984). Rank correlations, one-way and two-way ANOVA were used to test for associations between risk factors and percent of surfaces with wear. Results: 44 patients (31.9%) had at least one cervical lesion 1-2mm deep. 118 patients (85%) had dentin exposure on at least one incisal edge. Cervical lesions were most frequently observed on mandibular 1 premolars. Incisal/occlusal wear was most common on mandibular central incisors. Age was significantly correlated with over…

HCV infection and oral lichen planus: a weak association when HCV is endemic.

Oral lichen planus (OLP), an immune-mediated disorder, has been reported as an extra-hepatic manifestation of Hepatitis C virus (HCV) infection, especially in HCV hyperendemic areas such as southern Europe and Japan. The aim of this study was to investigate from an epidemiological standpoint whether HCV infection is an important factor affecting the relative risk of OLP in a Mediterranean population or whether this relates to the degree of HCV endemicity. Two cohorts of OLP patients resident in two different regions of southern Italy (Campania and Sicily; n = 859) were evaluated for HCV infection status and categorized into five age classes to respective region-matched controls. No signific…