The surgeons Halsted and Hall, cocaine and the discovery of dental anaesthesia by nerve blocking.

William Stewart Halsted is considered to be one of the most influential and innovative surgeons the USA has ever produced. His contributions to surgery are abundant, ranging from sophisticated surgical techniques in the field of breast surgery, surgery of the digestive apparatus and traumatological interventions, to the introduction of gloves in the operating theatre. Here we present Dr Halsted, together with his aide Dr Hall, as the discoverers of the technique for blocking the inferior alveolar nerve and the antero-superior dental nerve using cocaine as an anaesthetic. The anaesthetic technique, described perfectly by both surgeons in 1885, has been revolutionary in the practice of odontology since its introduction, offering dentists the possibility of performing invasive interventions to the maxillary without pain.

Lipid levels in patients with lichen planus: a case-control study.

BACKGROUND: Cardiovascular risk factors have been assessed with some skin diseases such as alopecia and psoriasis. Recently, a case-control study found that lichen planus (LP) was associated with dyslipidaemia in a large series of patients. However, no data were presented about lipid values in patients and controls. OBJECTIVE: The objective of this case-control study was to evaluate lipid levels in men and women with lichen planus and in healthy controls, excluding lichenoid drug eruption and treatment for LP such as systemic corticosteroids, retinoid acid or methotrexate. PATIENTS AND METHODS: This case-control study included 160 patients, 80 with LP (40 men and 40 women) and 80 controls consecutively admitted to the outpatient clinic in Dermatology department of San Cecilio Hospital, Granada, Spain. RESULTS: Patients with LP presented higher significant triglycerides values (145.9 vs. 101.5 mg/dL P = 0.0007), total cholesterol values (197.7 vs. 178.4 mg/dL P = 0.001), LDL-C values (120.8 vs. 100.9 mg/dL P < 0.0001) and lower HDL-C values (55.3 vs. 61.9 mg/dL P = 0.004) vs. controls. Adjusted OR for dyslipidaemia in patients with LP was 3.03 (95% confidence interval: 1.49-6.17, P = 0.002). CONCLUSION: The results obtained in this study indicate an association between LP and dyslipidaemia. Lipid levels screening in men or women with LP may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.

Melatonin in diseases of the oral cavity.

BACKGROUND: Melatonin is the principal secretory product of the pineal gland. It has immunomodulatory and antioxidant activities, stimulates the proliferation of collagen and osseous tissue and acts as a protector against cellular degeneration associated with aging and toxin exposure. Arising out of its antioxidant actions, melatonin protects against inflammatory processes and cellular damage caused by the toxic derivates of oxygen. As a result of these actions, melatonin may be useful as a co-adjuvant in the treatment of certain conditions of the oral cavity. METHODS: An extensive review of the scientific literature was carried out using PubMed, Science Direct, ISI Web of Knowledge and the Cochrane base. RESULTS: Melatonin, which is released into the saliva, may have important implications for oral diseases. Melatonin may have beneficial effects in certain oral pathologies including periodontal diseases, herpes viral infections and Candida, local inflammatory rocesses, xerostomia, oral ulcers and oral cancer. CONCLUSIONS: Melatonin may play a role in protecting the oral cavity from tissue damage caused by oxidative stress. The experimental evidence suggests that melatonin may have utility in the treatment of several common diseases of the oral cavity. However, more specific studies are necessary to extend the therapeutic possibilities to other oral diseases.

Superficies bioactivas en implantología: una nueva perspectiva / Bioactive surfaces in implantology: a new perspective

Actualmente, tras años de investigación en implantología, en los cuales se han realizado muchos trabajos, en donde se han estudiado diferentes tipos de superficies de implantes, lisas y rugosas, en un intento de mejorar, tanto en el tiempo como en la calidad , la osteointegración, se ha concluido que los implantes de superficie rugosa con un intervalo de rugosidad entre 1,0-2,0 nm, son los que parecen dar una mejor respuesta ósea y mejores resultados clínicos, pero desde un punto de vista exclusivamente mecánico. Hoy en día las investigaciones se centran en el desarrollo de superficies denominadas bioactivas, las cuales son capaces de interaccionar con el hueso que rodea al implante, como ocurre cuando el implante es revestido con carbonato cálcico o bien con flúor. Pero sabemos que dentro del metabolismo óseo, juegan importantes papeles, moléculas, como son la melatonina y la hormona del crecimiento entre otras, las cuales deben de ser tenidas en cuenta a la hora de hablar de osteointegración. Se realiza una breve descripción de la fisiología de ambas moléculas y se valora su aplicación al concepto de superficie bioactiva en implantología (AU)

At present, after years of investigation in implantology, in which there have been realized a lot of works, with different types of surfaces of implants, smooth and rough, in an attempt of improving, both in the time and in the quality, the osteointegration, one has concluded that the implants of rough surface with an interval of rugosity between 1.0-2.0 nm, are those who seem to give a better bone response and better clinical results, but from an exclusively mechanical point of view. Nowadays the investigations centre on the development of named bioactive surfaces, which are capable to react with the bone around the implant, since it happens when the implant is redressed in carbonate cálcico or in fluorine. But we know that inside the bone metabolism, there are another important molecules: the melatonin and the hormone of the growth between others, which must be born in mind at the time of speaking of osteointegration. There is realized a brief description of the physiology of both molecules and his application is valued to the concept of bioactive surface in implantology (AU)

Salud bucodental en la valoración geriátrica integral / Oral health in the comprenhensive geriatric assesment

La Valoración Geriátrica Integral intenta evaluar al mayor desde distintas perspectivas, no centrándose en problemas exclusivamente clínico-médicos. La salud bucodental debe ser parte de dicha Valoración Geriátrica Integral y no considerarla como un problema de salud independiente. Al mismo tiempo, es muy importante conocer y prevenir el impacto que pueda tener la salud oral de los mayores en la salud general y calidad de vida de estos. Son algunos los problemas que se plantean en la actual concepción de la Valoración Geriátrica Integral, en relación a los problemas bucodentales, y en sus cuatro dimensiones: valoración de la habilidad funcional, valoración de la salud física, valoración de la salud mental y deterioro cognitivo y valoración de la situación socio-económica. En cada una de ellas los dentistas tenemos algo que aportar (AU)

Oral health management implications in patients with tuberous sclerosis.

We report 6 cases of patients with tuberous sclerosis and concomitant dental pathosis. The multiple manifestations in tuberous sclerosis determine its impact on dental therapy. A lack of awareness of this condition may compound the possible side effects of dental treatment. Possible preventive measures by dentists are highlighted in this presentation. Medical evaluation and the control of risk factors in relation to general anesthesia and sedation are key considerations for the management of patients with tuberous sclerosis.

Denture stomatitis: quantification of interleukin-2 production by mononuclear blood cells cultured with Candida albicans.

Denture stomatitis is usually associated with the presence of yeast, particularly Candida albicans, and several bacteria. In this study mononuclear blood cells were grown in the presence of Candida albicans from a single colony, and interleukin-2 production induced in T lymphocytes was measured. Blood cells were from a population of patients with denture stomatitis and a control group of denture wearers without stomatitis. Induction of interleukin-2 production was correlated with factors that condition denture stomatitis, namely, isolation of Candida albicans in selective medium, age of the denture, and diabetes. Concentrations of interleukin-2 in supernatant and serum were also compared. Significant differences in interleukin-2 production were found between patients with denture stomatitis and controls. Statistical analysis demonstrated a significant association between isolation of Candida albicans and elevated interleukin-2 production in cultures from patients with and without denture stomatitis.

Melatonin: implications at the oral level.

The strong relationship between the pineal gland and the immune system continues to establish itself more and more. In situations of a pinealectomy or in those of inhibition of the production of melatonin, a state of immunosuppression is produced which disappears when the patient receives this hormone. Likewise, melatonin counteracts the negative effects that immunosuppressive drug treatment produce over the immunity. It is due to these facts that one postulates the possibility of utilizing melatonin in primary and secondary immunodeficiency states as well as in cancerous immunotherapy. The action of this hormone over the immune system is carried out through the T-helper lymphocytes, lymphokines and also it seems through certain pituitary hormones. On the other hand, lymphokines such as gamma-interferon and interleukin-2, as well as the thymus, can modulate the synthesis of melatonin at the level of the pineal gland. Without doubt, all these actions have important consequences at the time of treatment of our high-risk dental patients who have, in one way or another, an altered immunologic system. The altered immune system has direct implications in primary oral pathologies, or in others derived directly from our dental treatment.

Phagocytosis and adhesiveness of peripheral blood polymorphonuclear leukocytes in patients with rapidly progressive periodontitis.

Phagocytosis and adhesiveness of peripheral blood polymorphonuclear leukocytes were studied in patients diagnosed with generalized rapidly progressive (form A) periodontitis. All patients belonged to a single family and were first degree relatives. In the patients' leukocytes there was a statistically significant reduction in phagocytic index and adhesiveness, in comparison with leukocytes from controls. However, adhesiveness approached control values in the presence of autologous serum, thus implying that serologic factors may enhance this function in patients with this type of periodontitis.

Determination of cell membrane bound IgE in allergic patients and healthy controls. A new technology.

Cell membrane bound IgE was determined in 44 allergic patients and 34 healthy controls with a radiobinding technique using I-125 labeled anti-IgE as a marker. The technique possesses an intraassay variability of 10% and an interassay variability of 20%. Owing to the possibility that anti-IgE may bind to the cell membrane via the Fc receptor, IgE was detached from the membrane by gradually reducing pH to 4 and quantitating bound anti-IgE. This procedure led to an 83 +/- 14.23% drop in I-125 anti-IgE uptake. However, other cell markers tested (OKT-3, OKT-4, IgG) as well as cell viability remained unchanged, thus demonstrating the high degree of specific labeled anti-IgE uptake by IgE molecules on the cell membrane. The results presented to date support the usefulness of the technique described. Hence, bound IgE was determined in allergic subjects and controls, and correlated to the free serum levels of IgE. The results show that greater quantities of IgE are found on the cell membranes of allergic patients in comparison to the control population. In 81% of the former, uptake surpassed 3% of the total amount of isotope added, whereas 85% of the control subjects showed less than 3% uptake. No statistically significant correlation was obtained between serum IgE (UI/ml) and bound IgE levels in allergic subjects. Double immunofluorescence assays demonstrated the presence of cells with surface-bound IgE (s IgE +) which also expressed HLA class II (DR) molecules. Protein synthesis blocking studies showed IgE on the cell membrane to have a predominantly carrier role.