Orofacial problems in musicians: a review of the literature.

OBJECTIVE: The objective of our study was to review the different pathologies of the stomatognathic system that can present in musicians as a result of playing their instruments. DESIGN: The National Library of Medicine's PubMed database was searched to identify all peer-reviewed articles in the English literature dealing with orofacial problems in musicians, using both subject headings such as MeSH terms (PubMed) and free text words in combination (oral, musician, violin, wind instruments, vocalists, orthodontic, tooth, temporomandibular disorders [TMD]). The identified studies were assessed independently by two authors. We included any instruments that involved the orofacial area: i.e., wind and brass instruments, vocalists, and violins and violas. RESULTS: Thirty-two articles were selected that were of many different types (clinical reviews, longitudinal and transverse studies of therapeutic procedures, case-control studies). Among orofacial problems, the most common disorders that affect musicians are TMDs, herpes simplex virus infections, orthodontic problems, and problems with perioral musculature. CONCLUSIONS: Musicians may suffer from pathological conditions that are worsened by their occupation due to excessive practice and stress. These conditions can cause permanent injuries that subsequently prevent the musicians from playing. Depending on the characteristics of the musical instrument and the way it is played, professional musicians generally show a propensity for buccodental problems.

A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain.

OBJECTIVES: This study describes the clinicopathological characteristics of a group of patients with oral lichen planus (OLP) in south-eastern Spain. MATERIALS AND METHODS: A retrospective descriptive study was made of 550 patients clinically and histopathologically diagnosed with OLP in the period 1991-2007. Patient gender, age, the prevalence of hepatitis C, symptoms and malignization were recorded. The clinical forms were classified as reticular-papular and atrophic-erosive. RESULTS: Of the 550 patients, 128 (23.3%) were men and 422 (76.7%) women. The mean age was 56.35 +/- 13.67 years (range 14-91). The prevalence of hepatitis C was 3.5%. The red clinical forms were the most frequent, with 359 cases (64.2%). The lesions were asymptomatic in 159 patients (28.9%). Five patients developed oral squamous cell carcinoma (0.9%); none of these subjects was smokers. CONCLUSIONS: Patients with OLP present different clinical manifestations. Women were more frequently affected by the disease, and the malignant transformation rate was under 1%.

Prevalence of temporomandibular disorder-related findings in violinists compared with control subjects.

OBJECTIVE: The aim of this study was to determine if there is an association between violin playing and the presence of signs and symptoms of temporomandibular disorder (TMD). STUDY DESIGN: We studied a group of violinists in the Murcia region of Spain, who were examined for TMD. The results were compared with those from a random control group who did not play any musical instrument. The groups were matched by age and gender. Statistical analysis was carried out using SPSS 15.0 statistical software. RESULTS: Compared with the control subjects, the violinists as a group had significantly more pain in maximum mouth opening (P < .005), parafunctional habits (P = .001), and occurrence of temporomandibular joint sounds (P < .005) as determined by chi-squared. CONCLUSIONS: Violin playing appears to be a factor associated with TMD-related findings.

Premalignant nature of oral lichen planus. A retrospective study of 550 oral lichen planus patients from south-eastern Spain.

The most important complication of oral lichen planus (OLP) is the development of squamous cell carcinoma (SCC)--this being an association that remains subject to controversy. This study aims to examine the incidence and clinical presentation of oral malignancies associated with OLP. A retrospective study was made of 550 patients diagnosed with OLP according to the criteria of the World Health Organization, in the period between 1991 and 2007, in south-eastern Spain 128 males (23.3%) and 422 females (76.7%). A clinical protocol was applied in all cases (sociodemographic data, habits and hepatitis C markers), with histological confirmation of the disease. Five of the 550 patients (0.9%) developed SCC. The mean duration of follow-up was 24+/-20.83 months. The tongue was the most common location. The exact incidence of malignant transformation of OLP is difficult to establish, due to the possible contribution of external risk factors that may be of relevance in oral malignancy.

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas / Consensus statement on antimicrobial treatment of odontogenic bacterial infections

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asimismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogénicas (AU)

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc…) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg / 125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection (AU)

Diagnóstico diferencial de los desórdenes temporomandibulares (DTM) / Diferential diagnosis of temporomandibular disorders (TMD)

No disponible

Diagnóstico diferencial de las lesiones exofíticas de los tejidos blandos orales / Differential diagnosis of exophytic lesions of soft oral tissue

No disponible

Gingival lesions as a first symptom of pemphigus vulgaris in pregnancy.

The erosive gingival lesions associated with vesiculobullous diseases can be an important early clinical manifestation of serious diseases such as pemphigus vulgaris (PV). PV is a vesiculobullous disease of the skin and mucosa which tends to be chronic and which normally affects people of 40-60 years of age. Its incidence varies from 0.5 to 3.2 cases per 100,000 per year. Mucosal lesions are located mainly in the oral and pharyngeal mucosa, although conjunctiva, larynx, nasal mucosa, vulva, vagina, cervix, and ano-rectal mucosa may also be involved. It is a serious mucocutaneous disease of an autoimmune nature, whose appearance during pregnancy is extremely rare.

The clinicopathological characteristics of oral lichen planus and its relationship with dental materials.

The objective of this work was to carry out a clinicopathological study to ascertain whether clinical and histopathologic differences existed between oral lichen planus OLP patients with and without metal restorations. The predominant clinical form in both groups was reticular white, with no statistically significant differences between the forms associated or not with metal. The histological variables showed no statistically significant differences between the groups.

Tratamiento quirúrgico dé una hiperplasia fibrosa localizada en la desembocadura del conducto de Estenon. Descripción de la técnica / Surgical treatmen of a fibrous hyperplasia located in the cauncula of opening of Estenon´duct

La hiperplasia fibrosa es una lesión exofítica circunscrita y formada por tejido conectivo fibroso denso, cubierto por un epitelio escamoso estratificado. Se localiza con más frecuencia en la mucosa yugal, encía, lengua y paladar blando, generalmente zonas donde se produce mayor roce, ya que su etiopatogenia parece estar relacionada con factores irritativos crónicos o traumáticos repetidos. El tratamiento consiste en la extirpación quirúrgica y la eliminación de los factores irritantes locales. Presentamos un caso de tumoración unilateral de aspecto fibroso de diez años de evolución localizada en mucosa yugal izquierda, que incluía la carúncula de desembocadura del conducto de Estenon. El tratamiento consistió en la canalización del conducto para preservar su integridad, extirpación quirúrgica de la lesión con bisturí frío y colocación de un drenaje activo intraoral. El estudio histopatológico de la muestra confirmó el diagnóstico de hiperplasia fibrosa. Tras un año de seguimiento, el paciente no ha presentado ninguna recidiva, y el drenaje de la glándula parótida izquierda se mantiene normal (AU)

The fibrous hyperplasia is an exofitic injury circumscribed and formed by dense fibrous conective weave, covered by epithelio squamous stratified. lt is located with more frequency in the buccal mucosa, gingiva, tongue and soft palate, generally zones where greater rubbing takes place, since his etiopathogenia seems to be related to chronic irritatives or traumatic repeated factors. The treatment is based in the surgical extirpation and the elimination of the local irritating factors. We present a case of unilateral tumor of fibrous aspect of ten years of evolution located in left buccal mucosa, that included caruncula of opening of Estenon's duct. The treatment consisted of the canalization of the duct to preserve its integrity, surgical extirpation of the injury with cold scalpel and positioning of an active intraoral drainage. The histopathologic study of the sample confirmed the diagnosis of fibrous hyperplasia. After one year follow-up, the patient has not presented any recurrence, and the drainage of the left parotid gland is functioning normally (AU)

Variabilidad anatómica del ángulo mandibular en pacientes con desórdenes temporomandibulares (DTM) / Gonial angle anatomic variability in patients with temporomandibular disorders (TMD)

Analizamos una muestra de 102 pacientes procedentes de la Unidad de DTM de la clínica odontológica universitaria de la Universidad de Murcia y revisamos 110 historias clínicas de pacientes que asisten a la clínica odontológica universitaria y no presentan DTM: Las mediciones del ángulo mandibular se han realizado en las ortopantomografías trazando la línea que une los puntos más periféricos de la rama mandibular y del cuerpo mandibular. Hemos encontrado que el ángulo es mayor en los pacientes sanos que en los pacientes con DTM (p-valor= 0,00149). El ángulo mandibular es mayor en los pacientes de edad más avanzada y en los varones. Los pacientes con ausencia de molares posteriores presentan aumento en la angulación, al igual que los pacientes con clase 111 de Angle molar. En cuanto al grupo que presenta patologías de la DTM, se observaron ángulos mayores en los pacientes con alteraciones articulares y mixtas (AU)

This study analyses a sample of 102 patients from the Dental Clinic TMD Unit of the University of Murcia (Spain), and revise 110 clinic reports of patients attending the University dental clinic with no sign of TMD. The mea surements of the gonial angle have been determined from the orthopantomogram by drawing the line joining the furthest points of the mandibular ramus and condyle (rama y cuerpo). lt has been found that that the angle is greater in healthy patients than in those with TMD (p-value = 0.00149). The gonial angle is also greater in older patients and maleo Patients with no back teeth show again greater angle, as well as patients with type III teeth Angle. As regards the group with pathologies of the TMD, greater angles were observed in patients with articular and mixed disorders (AU)

Dolor mandibular de origen cardíaco

En las complejas estructuras anatómicas orofaciales, asientan muchos procesos dolorosos. Las algias orofaciales más comunes tienen su origen a nivel dental, periodontal o en estructuras musculoesqueleticas. Sin embargo, el paciente puede manifestar dolor en esta región, bien en dientes o estructuras musculoesqueleticas, y la fuente originaria localizarse a distancia. A este tipo de dolor se le llama dolor heterotópico. Una posible fuente de dolor heterotópico es el dolor de origen cardíaco. Este articulo presenta un caso clínico en el que el dolor mandibular bilateral fue el síntoma inicial de una cardiopatía isquémica que fue erróneamente etiquetada de artrosis de la articulación temporomandibular (AU)

In the complex orofacial anatomic structures, many painful processes are felt. The most common orofacial pains have their origin at dental or periodontal level, or in muscle -skeletical structures. However, the patient can have pain in this area- either in teeth or muscle-eskeletical structures- and the originating source can be located at a distance. This type of pain is called heterotopic pain. A possible source of heterotopic pain is the pain of cardiac origin. This paper presents a clinical case in which the bilateral mandibular pain is the initial symptom of an ischemic cardiopathy that was erroneously labeled as temporomandibular arthrosis (AU)

Cambios de presión arterial y frecuencia cardiaca en pacientes sometidos a un tratamiento odontológico bajo anestesia local / Changes of arterial pressure and Herat frequency in patients undergoing dental treatment with local anesthetic

Introducción: Varios estudios publicados ponen de manifiesto que la respuesta cardiovascular del paciente en la clínica odontológica puede estar influenciada por diversos factores como: el estrés psicológico y físico, los estímulos dolorosos y los vasoconstrictores de la anestesia. Objetivos: Analizar si existen cambios de presión arterial sistólica (P.A.S.) y diastólica (P.A.D.), así como de la frecuencia cardiaca (F.C.) en los pacientes que acuden a la Clínica Odontológica Universitaria del Hospital Morales Meseguer, Murcia. Observar, en caso de que existan cambios, si se deben al uso de vasoconstrictor en la anestesia o a otros factores como la edad, el sexo, el estrés, la ansiedad o la presencia de enfermedades sistémicas. Material y método: Se estudiaron un total de 50 pacientes, 33 mujeres y 17 hombres, con una edad media de 48 años. Todos fueron sometidos a un tratamiento dental bajo tres tipos de anestesia local: una sin vasoconstrictor y dos con vasoconstrictor a distinta concentración. Se les midió la presión arterial sistólica y diastólica, así como la frecuencia cardiaca en 5 ocasiones, antes, durante y después del tratamiento. Resultados: Se observaron diferencias estadísticamente significativas, registrándose la mayor P.A.S. y P.A.D. después de dicha inyección. No hubo diferencias estadísticamente significativas entre los 3 grupos de pacientes a los que administramos 3 tipos distintos de anestesia, pero sí ente los distintos grupos de edad; entre los que presentaban enfermedades sistémicas y los que no. Conclusión: Podemos decir que el tipo de anestésico local administrado al paciente no parece modificar la presión arterial ni la frecuencia cardiaca. EN general, se observa en los pacientes un aumento de la P.A.S. y F.C. media atribuible al miedo al momento de la inyección del A.L. Otros factores que influyeron en los cambios cardiovasculares registrados fueron la presencia de enfermedades sistémicas, la edad y malas experiencias previas con el dentista (AU)

Estudio seccional de la prevalencia de desódenes temporomandibulares (DYTM) en un grupo de 131 sujetos / Sectional study of prevalence of the temporomandibular joints disorders (DYTM) in a group of 131 subjects

Existen muchas hipótesis sobre posibles factores etiológicos de los Desórdenes Temporomandibulares (DTM). Uno de los factores más estudiados es la oclusión, ya sea ausencias dentarias, contactos prematuros, interferencias, restauraciones dentarias o existencia de prótesis. En este trabajo estudiamos la prevalencia de signos y síntomas de DTM en un grupo de pacientes que estaba siendo tratados en la Clínica Odontológica Universitaria de Murcia, y establecer si existía algún tipo de dependencia estadísticamente significativa entre los signos y síntomas tanto de los pacientes afectados por DTM, como del grupo control. Estudiamos 131 sujetos pertenecientes a dos grupos: uno de pacientes en tratamiento y un grupo control. Comprobamos que existía dependencia estadísticamente significativa, entre el pertenecer al grupo de pacientes y la presencia de ausencias dentarias, ruidos articulares y dolor. No hemos encontrado dependencia en relación con factores oclusales tales como prematuridades, interferencias o mal oclusiones (AU)