La leucoplasia oral. Su implicación como lesión precancerosa / Oral leukoplakia. A precancerous lesion

La leucoplasia es definida actualmente en base a un concepto esencialmente clínico. En este sentido, se propone un diagnóstico provisional de leucoplasia basado en criterios clínicos y un diagnóstico definitivo para el que se requiere la eliminación de los factores etiológicos y, ante lesiones persistentes, el examen histopatológico. La consideración de la leucoplasia como lesión precancerosa proviene esencialmente de los estudios de seguimiento en los que se constata su transformación maligna. Pese a que el diagnóstico de displasia es esencialmente subjetivo y a la existencia de algún trabajo reciente que no encuentra relación entre ésta y la evolución posterior de las leucoplasias, la presencia de displasia epitelial en el examen histológico se considera actualmente como el indicador más importante de una mayor probabilidad de transformación maligna de la leucoplasia. Entre otros factores relacionados con un peor pronóstico se consideran el que se trate de una leucoplasia idiopática, las formas clínicas no homogéneas, la localización en cara ventrolateral de la lengua y suelo de boca y un tamaño mayor de 1 centímetro (AU)

The current definition of leukoplakia is based on an essentially clinical concept. Therefore, both a provisional diagnosis of leukoplakia based on clinical criteria and a definite diagnosis for which etiological factors need to be eliminated and, should there be persistent lesions, a histological examination is required, are accepted. Follow up studies in which a malignant transformation has been observed have resulted in leukoplakia being considered as a precancerous disorder. Despite the fact that the diagnosis of dysplasia is subjective and certain recent studies have not found any association between this and the development of leukoplakia, the presence of epithelial dysplasia in the histological examination is currently considered to be the most important indicator of a higher possibility of malignant transformation of the leukoplakia. Among other factors that may indicate a worse prognosis are: if the leukoplakia is idiopathic, if clinical forms are non-homogenous, if it is located on the ventrolateral side of the tongue and the floor of the mouth, and if it is over 1 cm. (0.40 inches) in size (AU)

Radiological assessment of periapical status using the periapical index: comparison of periapical radiography and digital panoramic radiography.

AIM: To compare the use of periapical radiographs and digital panoramic images displayed on monitor and glossy paper in the assessment of the periapical status of the teeth using the periapical index (PAI). METHODOLOGY: A total of 86 subjects were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs) and a panoramic radiography. The periapical status, using the PAI score, of all appraised teeth was assessed. RESULTS: Periapical radiographs allowed the assessment of the periapical status of 87% of teeth using the PAI. On the contrary, digital radiography had a significantly reduced potential to allow assessment of the periapical status (P<0.01). Only 57.6% and 34.1% of teeth could be appraised using digital panoramic images displayed on monitor and glossy paper respectively (P<0.01). The total percentage of teeth with periapical pathosis was five fold higher when assessed with digital panoramic images displayed on glossy paper compared with periapical radiographs (P<0.01). CONCLUSIONS: Teeth were best viewed on periapical radiographs except maxillary second and third molars, which were better viewed in orthopantomograms. Orthopantomograms on screen were scorable more often than when on printed images. Apical periodontitis was scored more often on paper than on screen, and more often on screen than in periapical radiographs.

General anesthesia: as a challenge and treatment need option in pediatric dentistry

OBJECTIVE: The purpose of this study was to determine the type and characteristics of the interventions, indications of dental treatment and procedures performed to patients treated under general anesthesia (GA) by pediatric dentistry residents, during the 1997-1999 period. METHOD: A sample of 57 hospital records of patients treated as part of the Special Pediatric Course at the Puerto Rico Pediatric Hospital were reviewed. Statistical analysis was done using the chi-square test for inferences on proportions. RESULTS: MR patients made up 59.7and NMR patients made up 40.3of the sample studied. Ages ranged from 2 to 35 years with a mean age of 11 years (SD=8.54). MR patients were classified into 7 categories: mental retardation (38.2), cerebral palsy (14.7), epileptic (5.9), mental syndromes (26.9), hydrocephalic (5.9), autism (5.9) and others (2.9). The NMR were classified into 5 categories: early childhood caries (65.2), cardiac patients (8.7), maxillofacial anomalies (4.3), organic syndromes (13.1) and others (8.7). The dental procedures performed were: dental extractions 84(MR) and 68(NMR), restorative procedures 87.3(MR) and 12.7(NMR). Oral prophylaxis was performed in 76.8, fissure sealants in 10.7and topical fluoride applications in 21.8. CONCLUSION: Dental extraction was a frequently performed procedure in both groups. The prevalence of exodontia and restorative procedures indicates the need to design and implement prevention programs for special pediatric patients.

Osteoporosis y enfermedad periodontal, ¿existe relación? / Osteoporosis and peridontal disease. Is there a relationship?

No disponible

La Odontología en España: Hacia la Integración en el Espacio Europeo de Educación Superior / Odontology in Spain: towards the integration to the European high education space

The European Higher Education Space (EHES) is a project to harmonize all the European University systems in order that all of them will posses a homogeneous structure of undergraduate, graduate and post graduate studies. The time period established to implement this project is year 2010. The present paper describes the establishment of a new career degree model in Spain, the degree in Dentistry that started twenty years ago. Also it has been stated the number of the present Departments and Schools, the access system to Public University Schools of Spain, the evaluation system, and which are the new mechanisms incorporated in the Spanish University system to implement this integration to the EHEE. This is the moment to design the new master guidelines to obtain homogeneous career degrees that may imply more accessibility and mobility of students and professionals.

Diagnóstico por el laboratorio de las enfermedades periodontales y periimplantarias. Diagnóstico de la periodontitis / Diagnostic by laboratory in the periodontal and periimplantar disease. Diagnostic of the periodontitis

Desde el punto de vista epidemiológico la enfermedad periodontal tiene una enorme trascendencia. El diagnóstico del proceso es una necesidad para, con arreglo a él, realizar el tratamiento y la prevención mas apropiada. El enfoque del diagnóstico depende del concepto que sobre la patogenia se tiene en un momento dado. Desde esa perspectiva se hace un análisis de los distintos métodos de diagnóstico que existen. Se llega a la conclusión de que actualmente el método clínico, mediante el sondaje periodontal, es el mas apropiado para conocer el estado de gravedad del proceso y enfocar el tratamiento. Tras la revisión de los distintos procesos que estudian: los patógenos responsables, los mediadores de la inflamación, los parámetros de destrucción ósea y del conectivo, los factores genéticos y de riesgo ambiental y adquirido, se llega a la conclusión de que actualmente no existe ningún método capaz de identificar a la población de riesgo de padecer la enfermedad periodontal ni los períodos de actividad. Ello en gran medida se debe a que existen muchas incógnitas en la patogenia del proceso y que es preciso seguir la búsqueda de un parámetro eficaz que me ayude en la toma de decisiones a la hora de enfocar el tratamiento y la prevención del proceso (AU)

The periodontal disease is very important in the general health status of our patients. We need an adequate diagnosis of the process to treat and prevent successfully. The diagnosis depends on the concept about the illness is generally accepted nowadays. We revise all the diagnostic procedures we can use in the clinic. We conclude that the clinic diagnostic method with the periodontal probe is the best way to know the destructive bone process and treat it. The others methods that study the bacteria, inflammatory mediators, parameters of bone and collagen resorption, genetic tests cannot identify the high-risk patients and the period of activity. The reason could be the lack of a completely knowledge of the pathogenic process involved in the periodontal disease. We have to work in this field in the future to improve the treatment and prevention of the periodontitis (AU)

Comparison of modified Bass technique with normal toothbrushing practices for efficacy in supragingival plaque removal.

OBJECTIVES: This study was designed to compare the efficacy in supragingival plaque removal of normal toothbrushing practices and a particular toothbrushing technique, the modified Bass method. SUBJECTS AND METHODS: The research consisted of two identical experiments with two toothbrushing methods: the normal toothbrushing practices and the modified Bass technique. Forty-six secondary, non-dental students (10 males and 36 females) with ages ranging from 18 to 30 years were selected. Dental plaque was assessed according to the Turesky modification of Quigley-Hein Index. Subjects were requested not to brush their teeth 48 h prior to the baseline record of plaque index. Participants were instructed to brush twice daily during 3 min for the duration of the 3-week trial using their usual toothpaste. Plaque index was recorded at 2, 7 and 21 days. RESULTS: The modified Bass (Mod-Bass) technique was significantly (P < 0.05) more effective in removing supragingival plaque than normal toothbrushing practices both in all, buccal and lingual sites. After 21 days, the normal practices did not significantly decrease mean plaque indices compared to the scores calculated after 7 days (P > 0.05), but did so with the modified Bass technique (P < 0.05). The modified Bass technique was specially efficient at the lingual sites where it was 2.9-fold more effective than normal practices in reducing plaque scores (P < 0.01). CONCLUSION: The results show that a particular toothbrushing technique as modified Bass method is significantly superior to normal toothbrushing practices in supragingival plaque removal. The introduction of a specific toothbrushing technique, such as modified Bass technique represents an important improvement in the oral hygiene of the patients.

Los trastornos temporomandibulares en la práctica odontologica I. Clasificación y Etiopatogenia / Temporal disorders in dental practice. Classification and etiopathogenesis

Los trastornos Témporomandibulares (TTM) son relativamente frecuentes en la práctica odontológica. Los TTM constituyen un conjunto heterogéneo de signos y síntomas que afectan a la articulación témporomandibular y/o los músculos masticatorios. La naturaleza de los TTM representa una permanente controversia según la experiencia clínica e investigadora acumuladas. La prevalencia de los TTM es muy diferente, probablemente debida a los diversos métodos de valoración utilizados. Aunque se han realizado muchas clasificaciones de los TTM, coinciden en diferenciar dos grandes grupos, las afecciones intra y extraarticulares. La etiopatogenia de los TTM es multifactorial, sin embargo, las condiciones físicas (ej. interferencias oclusales, la pérdida de dientes posteriores, los hábitos parafuncionales) y psicológicas (ej. estrés , ansiedad, depresión) pueden ser responsables (AU)

Los implantes dentales no sumergidos en el paciente anciano / Non-submerged dental implants in the aged patient

En los últimos 15 años, la implantología oral ha representado una técnica creciente en la gerodontología. En este sentido, la edad avanzada no es una contraindicación para la implantología oral. Desde un punto de vista integral, es necesario la valoración de la salud general del paciente anciano, un diagnóstico oral y una correcta planificación de tratamiento, con un estricto protocolo quirúrgico. El éxito a largo plazo de los implantes dentales exige una buena reacción de los tejidos blandos y duros peri-implantarios. Varios tipos de prótesis fijas y removibles pueden estar indicadas en los pacientes ancianos edéntulos. El mantenimiento por el paciente (ej. higiene oral) y las revisiones periódicas por el dentista son muy importantes. Las prótesis implantosoportadas mejoran la calidad de vida oral y el bienestar psicosocial de los pacientes ancianos edéntulos (AU)

[Dental treatment under general anesthesia offered at the Hospital Pediátrico Universitario de Puerto Rico during the years 1989-1994]. / Tratamiento odontológico bajo anestesia general ofrecido por el Hospital Pediátrico Universitario de Puerto Rico durante los años 1989-1994.

One hundred and fourteen mentally retarded (MR) and non-mentally retarded (NMR) patients were divided into two groups and categorized according to the condition presented. Age, sex, and type of procedure performed were recorded for each patient. On the MR group 32% were over 17 years of age. On the NMR group 51% were under 6 years of age. The sex distribution was similar in both groups. Exodontia was the most frequently performed dental procedure. The MR group was composed of those who presented only mental retardation (42%), cerebral palsy (17%), epilepsy (15%), syndromes (7%), endocrinopathies (7%), hydrocephalus (5%) and other conditions (7%). The NMR group was composed of those who presented cardiopathy (7%), bottle syndrome (42%), hemotopathy (11%), maxillofacial disorders (24%) and other conditions (16%).

[Effectiveness of chemical products as antiplaque agents]. / Eficacia de los productos quimicos como agentes antiplaca.

We review the antiplaque effectiveness of distinct chemical products. We considered two types, depends on the "in vitro" or "in vivo" demonstrable effect.

[Oral lesions in toxic epidermal necrolysis]. / Lesiones orales en la necrólisis epidérmica tóxica.

In the oral mucosa it can be observed lesion produced by general disease. These, in some occasions help to obtained diagnosis, but in other it makes a lot of difficulties. We observed a patient with a toxic epidermal necrosis. His first signs were herpes oral lesions. We made a differential diagnosis with other dermatological process, and examined the possibilities in obtaining a diagnosis and the validity of the analytical data.

[Nonsurgical endodontic treatment of an invaginated canine]. / Tratamiento endodóncico no quirúrgico de un canino con invaginación.

We present a case of a maxillary canine with a dens invaginatus treated successfully. The patient had pain, swelling and a sinus tract coming from the inmature apex of the canine. The canals were enlarged and cleaned and the main canal was filled with Calcium Hydroxide to allow the root development. Seven months later, the patient was asymptomatic and the tooth was obturated with guttapercha. One year later it was confirm the success in the treatment.