ABSTRACT
PURPOSE: The prevention of alveolar osteitis (AO) in dental extractions remains a controversial issue. Chlorhexidine is one of the most widely studied antiseptics for the prevention of AO. The purpose of this systematic review and meta-analysis was to assess the efficacy and effectiveness of chlorhexidine in the prevention of AO after third molar extractions. MATERIALS AND METHODS: The authors searched databases and the references of each article retrieved up to December 2015. Clinical randomized controlled trials (RCTs) using only chlorhexidine were included. The predictor variable was whether chlorhexidine was used in any formulation, concentration, or regimen. The outcome measurement was the incidence of postoperative AO. The authors also recorded variables describing the characteristics of the included studies. Statistical analysis was performed using STATA 12.0. Meta-analysis of binary data was conducted using a fixed-effects model. Risk ratios and 95% confidence intervals (CIs) were estimated. Forest, l'Abbé, and funnel plots were constructed. RESULTS: Twenty-three studies published from 1979 to 2015, corresponding to 18 trials (16 parallel-group and 2 split-mouth RCTs), that reported on 2,824 third molar extractions (1,458 in experimental group and 1,366 in control group) were included. The overall relative risk (RR) was 0.53 (95% CI, 0.45-0.62; P < .0001). There was no evidence of heterogeneity (I2 = 9.3%; P = .336 by χ2 test). The number needed to treat was 8 (95% CI, 7-11). There were no relevant differences between chlorhexidine rinse (RR = 0.58; 95% CI, 0.47-0.71) and gel (RR = 0.47; 95% CI, 0.37-0.60). Chlorhexidine did not cause a larger proportion of adverse reactions than placebo. CONCLUSION: The use of chlorhexidine, in any formulation, concentration, or regimen, is efficacious and effective in preventing AO in patients who have undergone third molar extraction. Chlorhexidine gel was found to be moderately more efficacious than the rinse formulation.
Subject(s)
Anti-Infective Agents, Local/therapeutic use , Chlorhexidine/therapeutic use , Dry Socket/etiology , Dry Socket/prevention & control , Molar, Third/surgery , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Tooth Extraction/adverse effects , HumansABSTRACT
OBJECTIVES: To evaluate the efficacy of sentinel node biopsy (SNB) in oral squamous cell carcinoma (OSCC). DESIGN: A prospective study of a cohort of 25 consecutive patients with OSCC anatomopathological confirmation through biopsy, without oncological pre-treatment, in clinical stage T1-T4N0, of these 25 patients 14 were T1-T2N0. The absence of regional disease (N0) was determined by means of clinical exploration and cervical tomography (CT). To establish the overall sensitivity of the technique, a meta-analysis was carried out of 10 series published to February 2005 where SNB had been applied to head and neck cancer, adding our 14 T1-T2N0 cases, thus making a total of 260 patients. RESULTS: Identification by SNB was accurate in 96% of the 25 cases, with a sensitivity of 66.7%. Analyzing only the T1-T2N0 cases (n=14), the accuracy was 100% with a sensitivity of 1 (CI 95%, 0.29-1.00). The overall sensitivity was 93%. The accuracy in identifying the sentinel node varied between 66% and 100%. The SN was identified in 251 of 260 cases, of those, 71 were true positive, 5 false negative and 175 true negative. The overall sensitivity was 93.4% (CI 95%, 85.3-97.8), with a specificity of 100% (CI 95%, 0.98-100). The weighted negative probability quotient was 0.176 (CI 0.103-0.301) and that of positive probability 24.75 (CI 95%, 10.8-56.71). The weighted diagnostic odds ratio was 183.71 (CI 95%, 59.36-568.56). If we accept that the prevalence of hidden regional disease is 30%, a negative sentinel node has 5% possibility of having hidden disease. CONCLUSIONS: Our data provide a certain degree of evidence that, due to its high sensitivity, the SNB procedure can be applied to the initial stages of OSCC.
Subject(s)
Carcinoma, Squamous Cell/secondary , Mouth Neoplasms/pathology , Sentinel Lymph Node Biopsy , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Neoplasm Staging/methods , Prospective StudiesABSTRACT
Objetivos: Evaluar la efectividad de la biopsia del ganglio centinela (BGC) en el carcinoma oral de células escamosas (COCE). Diseño: Estudio prospectivo, de una cohorte consecutiva de 25 pacientes con COCE confirmado anatomopatológicamentemediante biopsia, sin tratamiento oncológico previo, en estadiaje clínico T1-T4N0, de estos 25 pacientes 14 fueron T1-T2N0. La ausencia de enfermedad regional (N0) se determinó mediante exploración clínica y TC cervical. Para establecer globalmente la sensibilidad de la técnica se ha realizado un estudio con técnicas de metaanálisis de 10 series publicadas hasta febrero de 2005, que han aplicado BGC en el cáncer de cabeza y cuello, a la que hemos sumado nuestros 14 casos T1-T2N0 lo que hace un total de 260 pacientes. Resultados: En los 25 casos la exactitud en la identificacióndel BCG fue del 96% con una sensibilidad del 66.7%. Si únicamente analizamos los casos T1-T2N0 (n=14), nuestra exactitud en la identificación fue del 100% siendo la sensibilidad de 1 (IC 95%, 0.29-1.00). La sensibilidad global fue del 93%. La exactitud en la identificación del ganglio centinela varió entre el 66% y 100%. Se identifico el GC en 251 de 260 casos, de los que 71 fueron verdaderos positivos, 5 falsos negativos y 175 verdaderos negativos. La sensibilidad global fue del 93,4% (IC 95%, 85,3-97,8) con una especificidad de 100% (IC 95%, 0,98 -100). El cociente de probabilidad negativo ponderado fue de 0,176 (IC 0,103-0,301) y el de probabilidad positivo fue de 24,75 (IC 95%, 10,8- 56,71). La odds ratio diagnóstica ponderada fue de 183,71 (IC 95%, 59,36-568,56). Si aceptamos que la prevalencia de enfermedad regional oculta es del 30%, un ganglio centinela informado como negativo tiene un 5% de posibilidades de tener enfermedad oculta. Conclusiones: Nuestros datos aportan un cierto nivel de evidencia que el BGC es un procedimiento que por su elevada sensibilidad, puede ser aplicada en los estadios iniciales del COCE
Objectives: To evaluate the efficacy of sentinel node biopsy (SNB) in oral squamous cell carcinoma (OSCC).Design: A prospective study of a cohort of 25 consecutive patients with OSCC anatomopathological confirmation throughbiopsy, without oncological pre-treatment, in clinical stage T1-T4N0, of these 25 patients 14 were T1-T2N0. The absenceof regional disease (N0) was determined by means of clinical exploration and cervical tomography (CT). To establishthe overall sensitivity of the technique, a meta-analysis was carried out of 10 series published to February 2005 whereSNB had been applied to head and neck cancer, adding our 14 T1-T2N0 cases, thus making a total of 260 patients.Results: Identification by SNB was accurate in 96% of the 25 cases, with a sensitivity of 66.7%. Analyzing only theT1-T2N0 cases (n=14), the accuracy was 100% with a sensitivity of 1 (CI 95%, 0.29-1.00). The overall sensitivity was93%. The accuracy in identifying the sentinel node varied between 66% and 100%. The SN was identified in 251 of 260cases, of those, 71 were true positive, 5 false negative and 175 true negative. The overall sensitivity was 93.4% (CI 95%,85.3-97.8), with a specificity of 100% (CI 95%, 0.98-100). The weighted negative probability quotient was 0.176 (CI0.103-0.301) and that of positive probability 24.75 (CI 95%, 10.8-56.71). The weighted diagnostic odds ratio was 183.71(CI 95%, 59.36-568.56). If we accept that the prevalence of hidden regional disease is 30%, a negative sentinel node has5% possibility of having hidden disease.Conclusions: Our data provide a certain degree of evidence that, due to its high sensitivity, the SNB procedure can beapplied to the initial stages of OSCC
