0000000000458898
AUTHOR
Rafael Poveda Roda
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…
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…
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…
Osteoartrosis de la articulación temporomandibular: estudio clínico y radiológico de 16 pacientes
Objetivo: El objetivo del presente estudio fue describir las características clínicas y radiológicas de 16 pacientes con osteoartrosis (OA) de la articulación temporomandibular (ATM). Material y métodos: En el estudio participaron aquellos pacientes que reunieran los criterios diagnósticos para la OA propuestos por Stegenga y cols en 1989. Los pacientes fueron sometidos a un protocolo de diagnóstico tanto clínico como por técnicas de imagen (obteniéndose los datos de una resonancia nuclear magnética). Resultados: Los signos clínicos más destacados fueron la presencia de crepitación a la auscultación en un 93,8% de los casos, y una disminución en el rango de los movimientos mandibulares. Los…
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 …
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…
Pseudotumors and tumors of the temporomandibular joint: a review
Objective: To review the pseudotumors and tumors of the temporomandibular joint (TMJ) published in journals included in Journal Citation Reports (JCR), and to evaluate whether there are clinical and radiological signs capable of differentiating between pseudotumors and tumors and between malignant and benign tumors. Material and Methods: A systematic Medline search was made of clinical cases of tumors and pseudotumors of the TMJ covering a 20-year period and published in journals included in JCR. Only cases with histological confirmation were included. A description is provided of the general characteristics of TMJ tumors, with comparison of the clinical, diagnostic, therapeutic and evoluti…
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…
Differences in clinical variables and risk factors between patients with osteoarthritis and osteoarthrosis of the temporomandibular joint (TMJ)
Objective: To study differences in risk factors and clinical variables between a group of patients with osteoarthritis and a group with osteoarthrosis of the temporomandibular joint. Material and methods: Thirty-five patients (32 women and 3 men) (mean age 53±18 years), 21 (60%) with a diagnosis of osteoarthrosis (mean age 54.7±20.2 years) and 14 (40%) with a diagnosis of osteoarthritis (mean age 51.7±16.9 years), were studied. The two groups were compared with each other and also with the group of 164 patients with temporomandibular joint pathology from which they were drawn. An evaluation was made of the demographic variables, risk factors (parafunctions, posterior occlusal contacts, slee…
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…
Antibiotic use in dental practice: A review
Antibiotics are commonly used in dental practice. It has been estimated that 10% of all antibiotic prescriptions are related with dental infections. The association amoxicillin-clavulanate was the drug most frequently prescribed by dentists during 2005, at least in the Valencian Community (Spain). The use of antibiotics in dental practice is characterized by empirical prescription based on clinical and bacteriological epidemiological factors, with the use of broad spectrum antibiotics for short periods of time, and the application of a very narrow range of antibiotics. The simultaneous prescription of nonsteroidal antiinflammatory drugs (NSAIDs) can modify the bioavailability of the antibio…