Estimation of the age of majority through radiographic evaluation of the third molar maturation degree

BACKGROUND: Although the third molar is the tooth with the greatest anatomical and developmental variability, some authors consider it important to estimate whether a subject is of legal age or not. The Demirjian's technique is the most widely used tool to estimate dental age and was therefore used in our study to assess possible correlation between the age of majority and the maturational degree of the lower third molars, evaluated through radiographic images. MATERIAL AND METHODS: This observational transversal study was conducted on 180 panoramic radiographs from consecutive patients. The degree of maturation of the lower third molar was independently classified by two observers, according to the Demirjian 's maturational stage method. RESULTS: A total of 180 patients - 65 men (36.12%) and 115 women (63.88%) - were included (mean age 21.6 years; standard deviation 5.2). The age range of our subjects corresponded to maturational stages D to H in the Demirjian's classification. A logistic regression analysis showed that subjects classified into the highest maturational stage H had a significantly higher probability of being considered of legal age by both observers, as compared with subjects in the lowest stage D. Inter-observer agreement was very high. Gender predictive capacity was not observed. CONCLUSIONS: Our results showed that subjects with the lower third molars in the highest maturational stage could be estimated to be older than 18 years and therefore considered of legal age, a finding also reported by other authors. The Demirjian's tooth maturational stage method, applied to the lower third molars, can be reliably used to estimate whether an individual is of legal age (18 years or older). High concordance between different observers using this method can be expected

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Bone metabolism and clinical study of 44 patients with bisphosphonate-related osteonecrosis of the jaws

Osteonecrosis of the jaws is a clinical entity described and linked to treatment with bisphosphonates in 2003. Its real incidence is unknown and it could increase due to the large number of patients treated with these drugs, and its cumulative effect on the bone. State of the art knowledge regarding its etiopathogeny, clinical course and suitable treatments is limited. Objectives: To study the clinical characteristics of 44 patients with bisphosphonate-related osteonecrosis of the jaws and the state of their bone mineral metabolism: bone remodeling state, prevalence of fractures, bone mineral density study, and assessment of the different treatment strategies. Design of the Study: Observational. Information was gathered prospectively through interviews, clinical examinations, additional tests and review of medical records.Results: We studied 16 men and 28 women with a mean age of 64.7 years. Breast cancer was the most frequent underlying disease. Zoledronate was used in 82% of the cases and in the non-oncology group of patients; alendronate was the most frequently used bisphosphonate. The mean duration of the zoledronate and alendronate treatments was 25 months and 88 months respectively. The lower jaw was the most frequent location, and previous exodontias-among the triggering factors known-were the most closely linked to its onset. We found considerable osteoblastic activity in patients suffering from neoplasia, with artifacts present in their bone densitometry and a high percentage of vertebral fractures.Conclusions: According to our results, osteonecrosis of the jaws affects elderly patients. We found a direct relationship between the duration of exposure and the accumulated dose. Other relevant factors are: Poor oral and dental health, corticoids, diabetes and teeth extractions. In essence, it is a clinical diagnosis. Prevention is the best strategy to handle this clinical entity (AU)

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The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain-dysfunction syndrome

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Bone metabolism and clinical study of 44 patients with bisphosphonate-related osteonecrosis of the jaws.

UNLABELLED: Osteonecrosis of the jaws is a clinical entity described and linked to treatment with bisphosphonates in 2003. Its real incidence is unknown and it could increase due to the large number of patients treated with these drugs, and its cumulative effect on the bone. State of the art knowledge regarding its etiopathogeny, clinical course and suitable treatments is limited. OBJECTIVES: To study the clinical characteristics of 44 patients with bisphosphonate-related osteonecrosis of the jaws and the state of their bone mineral metabolism: bone remodeling state, prevalence of fractures, bone mineral density study, and assessment of the different treatment strategies. DESIGN OF THE STUDY: Observational. Information was gathered prospectively through interviews, clinical examinations, additional tests and review of medical records. RESULTS: We studied 16 men and 28 women with a mean age of 64.7 years. Breast cancer was the most frequent underlying disease. Zoledronate was used in 82% of the cases and in the non-oncology group of patients; alendronate was the most frequently used bisphosphonate. The mean duration of the zoledronate and alendronate treatments was 25 months and 88 months respectively. The lower jaw was the most frequent location, and previous exodontias-among the triggering factors known-were the most closely linked to its onset. We found considerable osteoblastic activity in patients suffering from neoplasia, with artifacts present in their bone densitometry and a high percentage of vertebral fractures. CONCLUSIONS: According to our results, osteonecrosis of the jaws affects elderly patients. We found a direct relationship between the duration of exposure and the accumulated dose. Other relevant factors are: Poor oral and dental health, corticoids, diabetes and teeth extractions. In essence, it is a clinical diagnosis. Prevention is the best strategy to handle this clinical entity.

The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain-dysfunction syndrome.

OBJECTIVES: The goal of the present study was to evaluate the results of applying acupuncture or occlusal decompression splints in the treatment of patients diagnosed with the temporomandibular joint pain-dysfunction syndrome. DESIGN OF THE STUDY: We conducted a randomized clinical trial including 20 patients to whom the mentioned treatments were applied. Results were evaluated through an analogue pain scale, measurements of mouth opening and jaw lateral deviation in millimetres, and assessment of sensitivity to pressure on different points: preauricular, masseter muscle, temporal muscle and trapezius. Parameters were evaluated before and 30 days after the treatment. For standardized pressure, we used a pressure algometer. RESULTS: Patients treated with decompression splints showed reductions in subjective pain and pain upon pressure on temporal, masseter and trapezius muscles, as well as increased mouth opening after the treatment. Patients treated with acupuncture showed pain reduction in the short term and improvements in all of the evaluated para-meters (stronger pressure was required to produce pain; mouth opening was improved). CONCLUSION: Acupuncture was an effective complement and/or an acceptable alternative to decompression splints in the treatment of myofascial pain and temporomandibular joint pain-dysfunction syndrome.

Paragangliomas temporales. Experiencia de 12 años / Temporal paragangliomas. A 12-year experience

Objetivo: El objetivo de este trabajo es realizar un estudio retrospectivo en pacientes con diagnóstico de paraganglioma temporal, analizando los resultados según la conducta terapéutica aplicada para cada caso. Material y métodos: Se incluyó a 21 pacientes con diagnóstico de paraganglioma temporal tratados en nuestro servicio entre enero de 1999 y abril de 2011. A todos se les realizó un examen otorrinolaringológico, sistémico y de imagen. En 20 casos se realizó cirugía para su exéresis yen un caso se realizó tratamiento con cirugía estereotáxica. Resultados: Se realizó embolización preoperatoria en 12 casos. Los abordajes quirúrgicos fueron: extirpación endaural, resección transcanal tras abordaje retroauricular, mastoidectomía radical ampliada con abordaje de receso facial y abordaje infratemporal. El diagnóstico de paraganglioma fue confirmado en todos los casos. Las complicaciones postoperatorias más frecuentes fueron: paresia transitoria del VII par, hipoacusia neurosensorial, desequilibrio, parálisis del VII, parálisis del IX y el XI par y fístula salival. No se observó recidiva de enfermedad con seguimiento entre 1 y 12 años. En un caso tratado con radiocirugía persiste el tumor, estabilizado. Conclusiones: En nuestra serie la cirugía constituye la terapia con la que se logró la resección tumoral total en todos los casos. El uso de embolización preoperatoria reduce el tiempo quirúrgico y el sangrado intraoperatorio. La radiocirugía estereotáxica no permite la desaparición tumoral y persiste la enfermedad (AU)

Objective: Our objective was to perform a retrospective analysis of patients with jugulotympanic paragangliomas. We present the results according to the surgical approach applied in each case. Materials and methods: This retrospective study presents the findings in 21 patients with jugulotympanic paragangliomas who were observed and treated in our department over a 12-year period (1999 to 2011). We performed a general otolaryngology exam, systemic evaluation and radiological exam. Surgical treatment was performed in 20 cases out of 21. In 1 case, treatment with stereotactic radiosurgery was carried out. Results: The surgical approaches were: endaural, retroauricular transcanal, radical or modified mastoidectomy through facial recess and infratemporal fossa approach. Preoperative embolization was used in 12 cases. In all cases the diagnosis of paraganglioma was confirmed. The most frequent postoperative complications found were transitory palsy of the facial nerve, sensorineural hearing loss, imbalance, paralysis of the cranial nerves IX and XI and salivary fistula. No recurrences were found after 12 years of follow-up. One case of persistence was found in the case treated with radiosurgery. Conclusions: In our series surgery was found to be the elective therapy for patients with paraganglioma, with no recurrences after 12 years of follow-up. Preoperative embolization decreases surgery time and intraoperative bleeding. Stereotactic Radiotherapy cannot eliminate the tumour (AU)

[Temporal paragangliomas. A 12-year experience]. / Paragangliomas temporales. Experiencia de 12 años.

OBJECTIVE: Our objective was to perform a retrospective analysis of patients with jugulotympanic paragangliomas. We present the results according to the surgical approach applied in each case. MATERIALS AND METHODS: This retrospective study presents the findings in 21 patients with jugulotympanic paragangliomas who were observed and treated in our department over a 12-year period (1999 to 2011). We performed a general otolaryngology exam, systemic evaluation and radiological exam. Surgical treatment was performed in 20 cases out of 21. In 1 case, treatment with stereotactic radiosurgery was carried out. RESULTS: The surgical approaches were: endaural, retroauricular transcanal, radical or modified mastoidectomy through facial recess and infratemporal fossa approach. Preoperative embolization was used in 12 cases. In all cases the diagnosis of paraganglioma was confirmed. The most frequent postoperative complications found were transitory palsy of the facial nerve, sensorineural hearing loss, imbalance, paralysis of the cranial nerves IX and XI and salivary fistula. No recurrences were found after 12 years of follow-up. One case of persistence was found in the case treated with radiosurgery. CONCLUSIONS: In our series surgery was found to be the elective therapy for patients with paraganglioma, with no recurrences after 12 years of follow-up. Preoperative embolization decreases surgery time and intraoperative bleeding. Stereotactic Radiotherapy cannot eliminate the tumour..

[Osteonecrosis of the jaw secondary to oral alendronate: Report of three cases]. / Osteonecrosis maxilar secundaria al uso de bisfosfonatos por vía oral: Exposición de tres casos clínicos relacionados con alendronato.

Osteonecrosis of the jaw associated to biphosphonate use is more common in cancer patients with bone metastases, that are using intravenous diphosphonates. When these drugs are used orally the risk of the complication is lower. We report 3 diabetic women aged 69, 76 and 82 years, receiving alendronate 70 mg every one week. The unveiling event was the extraction of several teeth without the use of antibiotics. All had bone pain, purulent discharge, loss of bone and halitosis. All improved five months after discontinuing alendronate.

Osteonecrosis maxilar secundaria al uso de bisfosfonatos por vía oral: Exposición de tres casos clínicos relacionados con alendronato / Osteonecrosis of the jaw secondary to oral alendronate: Report of three cases

Osteonecrosis of the jaw associated to biphosphonate use is more common in cancer patients with bone metastases, that are using intravenous diphosphonates. When these drugs are used orally the risk of the complication is lower. We report 3 diabetic women aged 69, 76 and 82 years, receiving alendronate 70 mg every one week. The unveiling event was the extraction of several teeth without the use of antibiotics. All had bone pain, purulent discharge, loss of bone and halitosis. All improved five months after discontinuing alendronate.

Salivary enzymes and periodontal disease.

BACKGROUND: Host responses to periodontal disease include the production of different enzymes that are released by stromal, epithelial or inflammatory cells. There are important enzymes associated with cell injury and cell death like: aspartate and alanine aminotransferase (AST, ALT), lactate dehydrogenase (LDH), creatine kinase (CK), alkaline and acidic phosphatase (ALP, ACP), gama glutamyl transferase (GGT). Changes in enzymatic activity reflect metabolic changes in the gingiva and periodontium in inflammation. DESIGN OF STUDY: In this paper we have examined the activity of CK, LDH, AST, ALT, GGT, ALP and ACP in saliva from patients with periodontal disease before and after periodontal treatment (experimental group, 30 samples) and in saliva from healthy patients (control group--20 samples). Periodontal disease was determined based on clinical parameters (gingival index (GI), bleeding on probing (BOP), probing depth (PD)). Patients with periodontal disease were under conventional periodontal treatment. RESULTS: Obtained results were shown statistically significant increases of activity of CK, LDH, AST, ALT, GGT, ALP, ACP in saliva from patients with periodontal disease in relation to control group. There is positive correlation between the activity of examined salivary enzymes and value of the gingival index. After conventional periodontal therapy the activity of all salivary enzymes was significantly decreased. CONCLUSIONS: Based on these results, it can be assume that activity of these enzymes in saliva, as biochemical markers for periodontal tissue damage, may be useful in diagnosis, prognosis and evaluation of therapy effects in periodontal disease.

Queratoquiste odontogénico con cartílago en la pared. Presentación de un caso / Cartilage in the walls of odontogenic keratocyst

Existen siete casos publicados en la literatura médica referentes a la presencia de cartílago en la pared de un queratoquiste. Presentamos un nuevo caso con inclusiones de queratina y cartílago en la pared quística. Incluimos imágenes clínicas, radiográficas e histopatológicas, así como sus posibilidades etiopatogénicas (AU)

There are seven published cases in world literature on cartilage in the walls of odontogenic keratocysts. Herein is presented one further case with keratin inclusions in the cystic wall, which also bears a cartilaginous component. X-rays, clinical images and pathohistological images are included (AU)

Cartilage in the walls of odontogenic keratocyst.

There are seven published cases in world literature on cartilage in the walls of odontogenic keratocysts. Herein is presented one further case with keratin inclusions in the cystic wall, which also bears a cartilaginous component. X-rays, clinical images and pathohistological images are included.

Oral surgery in patients undergoing oral anticoagulant therapy.

UNLABELLED: There is an evident need for procedural protocol for oral surgery patients who undergo oral anticoagulant treatment (OAT) because of: 1) the possible severity of complications and 2) the growing demand for OAT, which in some cases may be as much as 8% of the oral surgery patients that are referred to the hospital from primary care centers. In this study, the authors define the parameters for creating a proto- col applicable to this group of patients. The conclusion is that it is not necessary to suspend OAT before surgery; rather, these procedures should be performed under multidisciplinary medical control. OBJECTIVE: The authors demonstrate that it is possible to perform oral surgery on OAT patients, without having to sus- pend treatment beforehand. STUDY DESIGN: A longitudinal study was performed in OAT patients that required some type of oral surgical procedures. After an INR control, the patient underwent surgery and afterwards the patient was given tranexamic acid as a mouth rinse. Postoperative hemorrhage was classified as slight when it lasted less than 5 minutes, moderate when it lasted longer than five minutes, and severe when it required blood transfusion. RESULTS: The study was performed over a 5-year period (1996-2000), by the maxillofacial surgery department. In that time period, 125 patients with OAT were treated; 90 of them were males and 35 were females. Tooth extraction was per- formed in 229 sessions and a total of 367 teeth were extracted, with an average of 1.6% per session. With regards to postoperative hemorrahage, it was slight in 210 cases (91.7%), moderate in 18 (7.9%) and severe only in one case (0.4%). All the variables were compared and no statistically significant differences were found. CONCLUSIONS: We believe that OAT should not be suspended before oral surgery, but it surgery should be performed under multidisciplinary control-especially in the case of the elderly (over 65) or with those patients that have other concomitant illnesses such as renal insufficiency or anemia or other medical treatments.

Cirugía oral en pacientes en tratamiento con anticoagulantes orales. Pauta de actuación / Oral surgery in the patients undergoing oral anticoagulant therapy

Hay una necesidad evidente de protocolizar los procedimientos de cirugía oral en pacientes sometidos a tratamiento anticoagulante por vía oral (TAO), tanto por la gravedad de las complicaciones como por la frecuencia creciente de la demanda, que puede cuantificarse en algunos casos en el 8 por ciento de los pacientes referidos desde atención primaria al hospital para tratamiento quirúrgico oral. En este estudio se definen los parámetros para crear un protocolo aplicable a este grupo de pacientes. Se concluye que los pacientes en TAO no deben suspenderlo previamente a la cirugía oral si bien debería realizarse con control multidisciplinario. especialmente si se trata de mayores de 65 años o con patología concomitante como insuficiencia renal o anemia o con otros tratamientos médicos, Objetivo: Pretendemos demostrar que es posible la realización de cirugía oral en pacientes anticoagulados, sin necesidad de retirar el tratamiento previamente. Diseño del estudio: Se realizó un estudio longitudinal en aquellos pacientes que precisaron algún procedimiento quirúrgico a nivel oral de los que estaban en TAO. Tras un con trol de INR se procedía a la intervención quirúrgica y posteriormente se suministraba al paciente ácido tranexámico para enjuagues bucales. La hemorragia postoperatoria se catalogó leve cuando el sangrado fue inferior a 5 minutos, moderado mavor de 5 minutos e intenso cuando se precisó transfusión. Resultados: Durante 5 años (1996-2000) se atendieron en nuestro Servicio 125 pacientes con TAO, 90 hombres y 35 mujeres, a los que se les exodonciaron 367 piezas dentarias, en 229 sesiones, con una media de 1,6 exodoncias por sesión. Con respecto a la hemorragia postoperatoria, fue leve en 210 casos (91,7 por ciento), moderada en 18 (7,9 por ciento) y grave en un solo caso (0,4 por ciento).Se compararon todas las variables observándose que no existieron diferencias estadísticamente significativas. Conclusiones: Consideramos que el TAO no debe suspenderse previamente' a la cirugía oral si bien debería realizarse bajo control multidisciplinario, especialmente si se trata de mayores de 65 años o con patología concomitante como insuficiencia renal o anemia o con otros tratamientos médicos (AU)

Non-Hodgkin lymphomas of oral cavity.

Non-Hodgkin lymphomas (NHL) often show up in an extranodal pattern, especially in the head and neck. Intraoral locations are much less frequent, particularly when they are single. This, in turn, can lead to a prolonged diagnosis and even to inadequate treatment. Different patients with initial extranodal location of NHL which were not previously diagnosed and in which it was manifested only intraorally are presented in this paper. These cases are presented together with the additional examinations used for the early diagnosis and with the corresponding clinical pictures, as well as with the overview of other cases from the available literature.

Enfermedad de Kikuchi-Fujimoto. A propósito de un caso / Kikuchi-Fujimoto disease. A case report

La enfermedad de Kikuchi Fujimoto (EKF) es, desde el punto de vista histológico una linfadenitis necrotizante de evolución clínica autolimitada. Afecta típicamente a los ganglios linfáticos, cursando a menudo con fiebre alta. En el presente trabajo se documenta el caso de un varón de 28 años portador de una EKF, compatible clínicamente con un tumor de glándula salival. Ecográficamente llegaba a plantearse el diagnóstico diferencial con un quiste branquial. En general, debe plantearse este diagnóstico también con el linfoma (AU)