Orally dissolving buprenorphine for opioid use disorder linked to caries.

BACKGROUND: Buprenorphine is under scrutiny because of the development of xerostomia and caries. The purpose of this article was to inform dental care professionals about the oral effects of buprenorphine and to increase knowledge and awareness of medication-assisted treatment in the management of opioid use disorder (OUD). CASE DESCRIPTION: In 2022, the US Food and Drug Administration issued a warning about xerostomia and caries associated with the use of transmucosal (sublingual and buccal formulations) buprenorphine. Dental health care professionals should instruct patients taking buprenorphine on how to prevent these dental issues by means of rinsing with water and swallowing once the drug has been completely dissolved, followed by toothbrushing at least 1 hour after taking the drug. In addition, a fluoride supplement should be prescribed. PRACTICAL IMPLICATIONS: It is imperative for dentists to recognize buprenorphine as medication-assisted treatment and to recognize a patient as having an OUD. While taking buprenorphine, the patient should have more frequent oral health care appointments, including home care instructions and caries risk assessment to monitor for caries and xerostomia so that treatment, if indicated, could be initiated as soon as possible. In addition, the dentist's role in OUD is to make sure patients follow the treatment recommendations and use the buprenorphine and to not have them discontinue because of potential caries risk.

Atypical Myofibroblastic Tumor of the Oral Cavity in a Child.

A myofibroma is a relatively rare neoplasm characterized by its spindle cell proliferation. This lesion can present as a unifocal mass (myofibroma) or multifocal growths (myofibromatosis) in the skin, soft tissue, bone, or internal organs. In the oral cavity, the tumor is commonly identified on the tongue, mucosa, lips, and mandible. Myofibroma classically occurs in infants and young children. Its fast-growing nature often mimics a sarcoma; however, it is a benign tumor. The purpose of this article is to report the case of an eight-year-old boy who presented with a localized, painless, nodular mass in the palate and gingiva. Through clinical, radiological, and immunohistochemical evaluation, the diagnosis of an atypical myofibroblastic tumor was made after resection of the mass. With interprofessional team management, the patient's quality of life was improved.

A Modified Technique of Tacking Acellular Dermal Matrix to Increase Keratinized Mucosa Around Dental Implants as an Alternative to a Free Gingival Graft: A Case Report.

INTRODUCTION: Free autogenous graft was the gold standard to increase the keratinized mucosa (KM) and vestibular depth. The major downfall of this technique is the postoperative morbidity at the donor site. The purpose of this case report is to demonstrate a modified technique using acellular dermal matrix (ADM) to increase the KM around implants to achieve faster healing with less postoperative morbidity. CASE PRESENTATION: Patient presented with inadequate keratinized tissue band and shallow vestibule at submerged implant sites bilaterally. Initially, surgical procedure of vestibuloplasty in conjunction with free gingival graft (FGG) was performed at one side. However, patient opted for the allograft as a substitute for the other side due to the postoperative discomfort from palatal donor site. On the left side, the FGG procedure was performed in a conventional way stabilizing with sutures. On the right side, the ADM was stabilized with tacks only at recipient site and left exposed. The new vestibule was established and stabilized with tacks.  A significant gain of KM and vestibule depth was observed at the site of using ADM when compared with baseline. For the site of using FGG, KM was increased. However, the vestibule was rebounded compared with the site of using ADM with tacks. CONCLUSIONS: The use of ADM stabilized with tacks is a predictable procedure that can increase KM and establish stable vestibule around dental implants. It can lead to less chair time, faster healing, and reduced postoperative morbidity compared with autogenous soft tissue graft.

How to accurately measure blood pressure.

Many experienced clinicians as well as medical and dental students do not measure blood pressure accurately, because they either take shortcuts or lack knowledge regarding the appropriate technique. This article provides guidelines for proper blood pressure measurement.

Abuse potential of gabapentin in dentistry.

Gabapentin is an anticonvulsant drug widely prescribed for various ailments, including orofacial pain. It was once thought to have no potential for abuse; however, the last decade has seen a dramatic rise in the nonmedical use of gabapentin, particularly among opioid-dependent patients. Gabapentin is sedating and interacts with other sedating medications such as opioids, which can lead to impairment and accidents and may raise the risk of overdose. Dentists must be aware of the potential for abuse of gabapentin and weigh its benefits against its risks when prescribing the drug.

Periodontal Management of a Patient Undergoing Liver Transplantation.

This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients.

Epithelial and Fibrous Hyperplasia: An Oral Manifestation of Tuberous Sclerosis Complex. A Case Study.

The authors present a case study of a 13-year-old female with a past medical history of tuberous sclerosis complex (TSC), an autosomal dominant disorder. It usually presents with a triad of epilepsy, mental deficiency and facial angiofibromas that are often distributed around the nose, cheek and chin, and are frequently shaped like butterfly wings. In addition, oral manifestations include gingival enlargement and developmental enamel pitting on the facial aspect of the anterior permanent dentition in 50% to 100% of patients. The patient's chief complaint was gingival enlargement and gingival bleeding. The histology of the excised gingival tissue revealed epithelial and fibrous hyperplasia, consistent with TSC.

Septic arthritis of the shoulder in a dental patient: a case report and review.

Septic arthritis of the glenohumoral joint is rare following dental procedures, comprising approximately 3% of all joint infections. Septic arthritis following bacteremia from dental procedures is uncommon and generally occurs in prosthetic joints. Predisposing causes may include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. We report a rare case of unilateral glenohumoral joint septic arthritis in a 60-year-old male patient (without a prosthetic joint) secondary to a dental procedure. The insidious nature of the presentation is highlighted. Septic arthritis infections, though rare, require a high level of clinical suspicion. Vague symptoms of shoulder pain may mask the initial diagnosis, as was the case in our patient. Incision and drainage via surgical intervention are often required, followed by parenteral antibiotics.

Septic arthritis of the shoulder in a dental patient.

Septic arthritis of the glenohumoral joint is rare following dental procedures, comprising approximately 3% of all joint infections. Septic arthritis following bacteremia from dental procedures is uncommon and generally occurs in prosthetic joints. Predisposing causes may include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. We report a rare case of unilateral glenohumoral joint septic arthritis in a 60-year-old male patient (without a prosthetic joint) secondary to a dental procedure. The insidious nature of the presentation is highlighted. Septic arthritis infections, though rare, require a high level of clinical suspicion. Vague symptoms of shoulder pain may mask the initial diagnosis, as was the case in our patient. Incision and drainage via surgical intervention are often required, followed by parenteral antibiotics.

Medical and dental standardization for solid organ transplant recipients.

Communication between the organ transplant team and dentist is important in formulating individualized care plans to reduce the incidence of pre- and post-transplant complications. Periodontal diseases and other oral infections may present serious risks that could compromise the success of a solid organ transplant. This article reviews why dentistry is an important component of total transplant care while the patient is on the waiting list for a transplant and after the transplantation. Recommendations regarding the care of the organ transplant patient are given.

Doxycycline-induced dizziness in a dental patient.

Many dentists are unaware of the documented adverse drug reaction of doxycycline-induced dizziness. Because doxycycline is frequently prescribed in dentistry, it is important for dentists and patients to be aware of this significant adverse reaction to prevent medical complications. A clinical case is reported in which a patient developed dizziness after taking doxycycline that was prescribed following periodontal surgery. The dizziness resolved when the doxycycline was stopped. Patients and dentists should be educated to recognize the signs and symptoms of doxycycline's adverse reactions.

New York state ear, nose, and throat specialists' views on pre-sinus lift referral.

BACKGROUND: Dental implant surgery in the posterior maxilla often involves the maxillary sinuses. Sinus surgery for dental implants is highly successful, but the preoperative risk is difficult to assess because a routine preoperative evaluation does not include an intranasal examination by an otolaryngologist. The purpose of the present study is to obtain the opinions of ear, nose, and throat (ENT) specialists located within New York state in an effort to establish a referral protocol before performing a maxillary sinus elevation. This study assesses the need to consult an ENT specialist for evaluation and treatment recommendations in the pretreatment workup. METHODS: A questionnaire and a stamped, return envelope with an identification number was mailed to 302 physicians who maintained a current ENT-specialty practice or practiced that specialty in a hospital or clinic setting in New York state. The requirement criteria included a valid address and specialty designation. Up to two follow-up phone calls were made, and another questionnaire was mailed 30 days after the initial mailing. The questionnaire included eight computerized tomography (CT)?scan images that represented different sinus configurations. Answers to the five questions were statistically evaluated and analyzed. A total of 63 recipients returned the questionnaire and were included in the study. RESULTS: A majority of 58.7% (95% confidence interval: 46.9% to 71.1%) of respondents recommended that a maxillary sinus CT scan should be routinely prescribed before a sinus-lift surgery. Patient symptoms that ENT specialists suggested indicated referral included nose complications/problems (40.1%) and sinus issues (23.6%). Of the eight CT-scan images, referral suggestions were >50% for the following: an occluded sinus with septum, inflammation at the base of the sinus only, a sinus with a generalized thickened membrane, an oroantral fistula, a thickened sinus membrane in association with teeth that had endodontic and/or periodontic involvement, and a nearly completely occluded sinus that was missing palatal bone. For patients with seasonal allergies, ENT specialists suggested delaying surgery (20.6%) or controlling symptoms before surgery (41.3%). Concerns included a past history of a sinus surgery (87.3%), chronic sinusitis (85.7%), presence of ostium stenosis (68.3%), nasal or sinus obstruction (82.5%), and oroantral fistulation (74.6%). CONCLUSIONS: Within the limits of the study, an attempt is made to develop a preoperative protocol, and 63 responses from ENT specialists suggested that the majority (58.7%) would recommend a maxillary CT scan before a sinus-lift surgery. Their greatest concerns were a prior sinus surgery, severe sinus inflammation, nasal/sinus obstruction, and oroantral fistulation.

Doxycycline-induced dizziness in dental patient. Case report.

Many dentists are unaware of the documented adverse drug reaction of doxycycline: induced dizziness. Because doxycycline is frequently prescribed in dentistry, it is important for dentists and patients to be aware of this significant adverse reaction to prevent medical complications. A clinical case is reported in which a patient developed dizziness after taking doxycycline that was prescribed following periodontal surgery. The dizziness resolved when the doxycycline was stopped. Patients and dentists should be educated to recognize the signs and symptoms of doxycycline's adverse reactions.

Recognizing doxycycline-induced esophageal ulcers in dental practice: a case report and review.

BACKGROUND: Doxycycline-induced esophageal ulcer is a documented adverse drug reaction. Unfortunately, many health care professionals are not familiar with this particular drug reaction. Because doxycycline frequently is prescribed in the clinical practice of periodontics, it is important for dentists to be aware of this potential drug reaction. METHODS: The authors describe the case of a patient who was taking doxycycline after undergoing periodontal surgery and experienced a complication. The diagnosis revealed that the patient had developed an esophageal ulcer as a result of taking the doxycycline. RESULTS: The patient's esophageal ulcer resolved with the aid of dietary changes and a prescription of rabeprazole, a proton pump inhibitor. CONCLUSIONS: and CLINICAL IMPLICATIONS: The etiology of doxycycline-induced esophageal ulceration is complex, and proper diagnosis is essential for its resolution. Dentists should be aware of the potential for this adverse drug reaction.

Congenital diseases and a New York State regulation. Help is here.

Knowledge of a little known New York State regulation and its insurance implications can be used to provide dental benefits to people who have congenital diseases or anomalies. An explanation of the regulation is provided, and some of the more common congenital diseases that may affect the dentition, such as amelogenesis imperfecta, dentinogenesis imperfecta, ectodermal dysplasia, cleft lip/palate and trisomy 21, are reviewed.

Reevaluation of initial therapy. When is the appropriate time?

The concept of periodontal reevaluation of initial therapy needs to be revisited. From interviewing selective periodontists and reviewing the literature, it is apparent that the time period to perform a reevaluation is an ambiguous topic. This seems to be a dichotomy because today everything in dental medicine and medicine is evidence based. When reviewing selective literature sources, it was found that either a time period for reevaluation was given that was different in almost every publication, or a time period was not given but the subject of reevaluation was addressed. The objective of this commentary is to define reevaluation and to determine the best time interval after initial therapy to perform a reevaluation based on classic and current literature. Some questions that need to be addressed are the following: 1. Does too short of a time frame for reevaluation lead to the over treatment of patients? 2. Is there a danger in reevaluating over too long of a time frame that will lead to disease progression and the return of pathogenic microbial flora? This would mean unnecessary periodontal break-down could be occurring without appropriate further treatment. Many concerns need to be addressed, including when the appropriate time period is to measure the effects of initial therapy. After this time period, the stability of the periodontium should be evaluated rather than the effects of therapy.

Hematoma following periodontal surgery with a torus reduction: a case report.

BACKGROUND: There are no published case reports that hematomas occur on the floor of the mouth as a result of periodontal surgery. REPORT: These three case reports document post surgical hematoma formation on the floor of the mouth that pose problems with the diagnosis, prognosis, and patient management. All cases involved periodontal surgery where extensive reduction of tori and bony exostoses were required. Two cases resulted in hematomas in the floor of the mouth. However, a change in the post surgical management for a third case demonstrated possible prevention of hematoma formation. SUMMARY: Hematomas in the floor of the mouth can be a resolving post surgical phenomenon or a serious vascular insult to this region of the oral cavity. This report clarifies the diagnosis, prognosis, and the best management protocol through the presentation of three cases.