Dental management of patients receiving anticoagulant and/or antiplatelet treatment.

INTRODUCTION: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can give rise to complications associated with important morbidity-mortality. The dental treatment of patients who tend to an increased risk of bleeding due to the use of anticoagulant and/or antiplatelet drugs raises a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis, and the optimized management of such patients, are therefore very important issues. OBJECTIVES: A study is made of the anticoagulant / antiplatelet drugs currently available on the market, with evaluation of the risks and benefits of suspending such drugs prior to invasive dental treatment. In addition, a review is made of the current management protocols used in these patients. MATERIAL AND METHODS: A literature search was made in the PubMed, Cochrane Library and Scopus databases, covering all studies published in the last 5 years in English and Spanish. Studies conducted in humans and with scientific evidence levels 1 and 2 (metaanalyses, systematic reviews, randomized phase 1 and 2 trials, cohort studies and case-control studies) were considered. The keywords used for the search were: tooth extraction, oral surgery, hemostasis, platelet aggregation inhibitors, antiplatelet drugs, anticoagulants, warfarin, acenocoumarol. RESULTS AND CONCLUSIONS: Many management protocols have been developed, though in all cases a full clinical history is required, together with complementary hemostatic tests to minimize any risks derived from dental treatment. Many authors consider that patient medication indicated for the treatment of background disease should not be altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown to suffice for controlling possible bleeding problems resulting from dental treatment. Key words:Tooth extraction, oral surgery, hemostasis, platelet aggregation inhibitors, antiplatelet drugs, anticoagulants, warfarin, acenocoumarol.

Oxidative stress in bisphosphonate-related osteonecrosis of the jaws.

OBJECTIVES: To analyze whether oxidative stress (OS) changes are present in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) versus controls. MATERIALS AND METHODS: Oxidative stress was analyzed in serum and unstimulated saliva of three groups: Group 1 consisted of 24 patients who had been treated with intravenous bisphosphonates (ivBPs) and developed BRONJ, group 2 consisted of 20 patients who had received ivBPs and did not develop BRONJ, and group 3 comprised 17 control subjects. Reduced glutathione (GSH), malondialdehyde (MDA), oxidized glutathione (GSSG), and 8-oxo-7,8-dihydro-2-deoxyguanosine (8-oxo-dG) levels, as well as the GSSG/GSH ratio, were measured. RESULTS: Mean serum and saliva levels of MDA, GSSG, and 8-oxo-dG and the GSSG/GSH ratio were significantly higher in patients with BRONJ than in controls. We found no significant difference in OS according to BRONJ stage, sex, or location in the jaws. Logistic regression analysis revealed that the GSSG/GSH ratio was a significant factor predicting the development of BRONJ (P = 0.01). CONCLUSIONS: Oxidative stress was detected in patients with BRONJ, and the GSSG/GSH ratio was the most significant OS variable found; it was a significant factor predicting the development of BRONJ.

Retinoids and proliferative verrucous leukoplakia (PVL). A preliminary study

Objective. A study is made of the efficacy and adverse effects of retinoid therapy applied to the white lesions ofproliferative verrucous leukoplakia (PVL). Material and methods. The results of retinoid therapy were evaluatedin 17 patients diagnosed with PVL. Topical retinoids were used in 5 patients, in the form of two daily applicationsof 0.1% 13-cis-retinoic acid in orabase for an average of 6.17+/-3.13 months. Systemic retinoids were used in 11patients, with the administration of 25 mg/day of acitretin in tablet form for an average of 5.41+/-2.02 months.One patient successively received the topical and systemic retinoid formulations. The course and results wereevaluated on a blind basis by two investigators. The adverse effects of the medication were also assessed. Results.Clinical improvement was recorded for 7 lesions (38.8%) (six involving systemic treatment and one as a resultof topical application). Clinical worsening was recorded in the same proportion (5 lesions with systemic therapyand two with topical treatment), while four lesions (22.4%) showed no changes (one lesion with systemic therapyand three with topical treatment). Adverse effects were documented in all the patients administered the systemicformulation, versus in only one patient administered topical retinoids. The most frequent problems were desquamationand pruritus. Conclusion. Although topical or systemic retinoic acid produces some improvement in aboutone-third of all patients with PVL, further studies are needed to assess the efficacy and safety of these products,in view of the important percentage of individuals who worsen despite therapy, and the frequent appearance of adverse effects (AU)

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Retinoids and proliferative verrucous leukoplakia (PVL). A preliminary study.

OBJECTIVE: A study is made of the efficacy and adverse effects of retinoid therapy applied to the white lesions of proliferative verrucous leukoplakia (PVL). MATERIAL AND METHODS: The results of retinoid therapy were evaluated in 17 patients diagnosed with PVL. Topical retinoids were used in 5 patients, in the form of two daily applications of 0.1% 13-cis-retinoic acid in orabase for an average of 6.17+/-3.13 months. Systemic retinoids were used in 11 patients, with the administration of 25 mg/day of acitretin in tablet form for an average of 5.41+/-2.02 months. One patient successively received the topical and systemic retinoid formulations. The course and results were evaluated on a blind basis by two investigators. The adverse effects of the medication were also assessed. RESULTS: Clinical improvement was recorded for 7 lesions (38.8%) (six involving systemic treatment and one as a result of topical application). Clinical worsening was recorded in the same proportion (5 lesions with systemic therapy and two with topical treatment), while four lesions (22.4%) showed no changes (one lesion with systemic therapy and three with topical treatment). Adverse effects were documented in all the patients administered the systemic formulation, versus in only one patient administered topical retinoids. The most frequent problems were desquamation and pruritus. CONCLUSION: Although topical or systemic retinoic acid produces some improvement in about one-third of all patients with PVL, further studies are needed to assess the efficacy and safety of these products, in view of the important percentage of individuals who worsen despite therapy, and the frequent appearance of adverse effects.

Eritema multiforme. Revisión y puesta al día / Erythema multiforme. Revision and update

El eritema multiforme es una enfermedad de la piel y las mucosas que se manifiesta con lesiones eritematosas y de tipo vesículo-ampollar. Las lesiones vesiculo-ampollares y erosivas a nivel de la cavidad oral y la piel pueden ser causadas por un amplio grupo de patologías. La etiología de las mismas también puede ser muy variable, desde una causa traumática o química por contacto, hasta una causa autoinmune. Dado que en ocasiones es difícil hacer un diagnóstico diferencial para discernir la etiología de las lesiones, es importante conocer los detalles clínicos y los aspectos epidemiológicos e histopatológicos de cada una de ellas. En este artículo se hace una revisión de los aspectos epidemiológicos, etiopatogénicos, clínicos, histopatológicos, de tratamiento y pronóstico del eritema multiforme (AU)