Candidiasis: Red and White Manifestations in the Oral Cavity.

Candidiasis is a very common malady in the head neck region. This review will concentrate on intraoral, pharyngeal and perioral manifestations and treatment. A history of the origins associated with candidiasis will be introduced. In addition, oral conditions associated with candidiasis will be mentioned and considered. The various forms of oral and maxillofacial candidiasis will be reviewed to include pseudomembranous, acute, chronic, median rhomboid glossitis, perioral dermatitis, and angular cheilitis. At the end of this review the clinician will be better able to diagnose and especially treat candidal overgrowth of the oral facial region. Of particular interest to the clinician are the various treatment modalities with appropriate considerations for side effects.

Managing xerostomia and salivary gland hypofunction: executive summary of a report from the American Dental Association Council on Scientific Affairs.

BACKGROUND AND OVERVIEW: Xerostomia, also known as "dry mouth," is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction, which is the objective measurement of reduced salivary flow. Patients with dry mouth exhibit symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, demineralization, tooth sensitivity, candidiasis and other oral diseases that may affect quality of life negatively. This article presents a multidisciplinary approach to the clinical management of xerostomia, consistent with the findings of published systematic reviews on this key clinical issue. CONCLUSIONS AND PRACTICE IMPLICATIONS: Initial evaluation of patients with dry mouth should include a detailed health history to facilitate early detection and identify underlying causes. Comprehensive evaluation, diagnostic testing and periodic assessment of salivary flow, followed by corrective actions, may help prevent significant oral disease. A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use. Comprehensive management of xerostomia and hyposalivation should emphasize patient education and lifestyle modifications. It also should focus on various palliative and preventive measures, including pharmacological treatment with salivary stimulants, topical fluoride interventions and the use of sugar-free chewing gum to relieve dry-mouth symptoms and improve the patient's quality of life.

Caries prevention for patients with dry mouth.

Patients with xerostomia, or dry mouth, resulting from various causes, are at higher risk for developing caries because of a loss of saliva and its benefits. A loss of saliva increases the acidity of the mouth, which affects many factors that contribute to the development of caries, such as proliferation of acid-producing bacteria, inability to buffer the acid produced by bacteria or from ingested foods, loss of minerals from tooth surfaces and inability to replenish the lost minerals, and loss of lubrication. Currently, a number of new products that can substitute for these functions of saliva or induce production of saliva are available in Canada. Some of these products are reviewed and a protocol for caries prevention in this high-risk population is proposed.

Bisphosphonate induced osteochemonecrosis of the jaws: an ounce of prevention may be worth a pound of cure.

Patient exposure to bisphosphonate drugs for the management of hypercalcemia of malignancy, osteolytic lesions of metastatic cancer and osteoporosis has led to increasing reports of osteochemonecrosis of the jaws (bis-phossy jaw). This serious and debilitating condition requires dental practitioners to be alert for signs and symptoms of this syndrome. Thus far, nitrogen containing bisphosphonates have been implicated as a causative agent. While only a small fraction of patients who have taken these agents will develop osteochemonecrosis, it seems that patients who have received intravenous bisphosphonates are at greater risk than those who have taken oral agents. Tooth extractions are the most frequently reported predisposing dental procedure. While appropriate management strategies for patients with osteochemonecrosis of the jaws are evolving, we are suggesting rational preventive protocols and therapies based upon current experience and knowledge. These recommendations may change over time as the profession gains more experience in managing these patients.

Bisphosphonate osteochemonecrosis (bis-phossy jaw): is this phossy jaw of the 21st century?

PURPOSE: Bisphosphonates are being implicated in a growing number of complications of the jaws. A number of terms are being applied to this phenomenon and perhaps the descriptive term bisphosphonate osteochemonecrosis has the most merit. But the eerie similarity of this 21st century disease process with the 19th century disease known as phossy jaw is striking. As the nomenclature continues to evolve, the term used in this article will be bis-phossy jaw. This article will explore historical and current aspects of these diseases. Although there may be other mitigating factors, such as oral health, chemotherapy history, immune status, Karnofsky performance status, or Kaplan-Feinstein index, bisphosphonates appear to be the necessary component in cases of bis-phossy jaw. MATERIALS: This is primarily a review article on reported cases of bis-phossy jaw, with historical looks at phossy jaw and osteoradionecrosis. Our laboratory has reviewed 20 suspected cases of bis-phossy jaw and the typical histopathologic features of bis-phossy jaw are presented. RESULTS: Descriptions of phossy jaw and current bis-phossy jaw cases are remarkably similar. Histopathologic features of bis-phossy jaw showed intact vascular channels, even in areas with acute inflammatory infiltrates and bacterial overgrowth. Non-vital bone fragments with reduced evidence of osteoclastic action were also noted. CONCLUSION: Bis-phossy jaw may have more of a bacterial cofactor risk than osteoradionecrosis, and though altered angiogenesis may yet prove to be a factor, avascularity does not appear to be a major cofactor. The historical disease phossy jaw appears to serve as a possible analogous disease for current research and treatment of bis-phossy jaw. Prevention and early identification of patients at risk should be of prime concern.