Restorative Dental Treatment and Endodontic Surgery in a Pregnant Patient Receiving Corticosteroids.

Corticosteroid therapy (CST) can be used to treat complicated pregnancy. Second trimester of pregnancy is the preferred period to perform dental treatments. The long-term use of CST may result in hyperglycemia, hypertension, immunosuppression, and adrenal suppression, which, theoretically, may cause adrenal crisis during surgical procedures. The risk of adrenal crisis at the dental clinic caused by exogenous CST depends on the dosage, duration of treatment, route of administration, frequency, time lapse since the last dose, and type of procedure performed. Current evidence found that patients on CST undergoing general dental procedures or minor surgical procedures under local anesthesia do not require supplementary corticosteroids.

Delusional Parasitosis or Morgellons Disease: A Case of an Overlap Syndrome.

Background. Delusional parasitosis (DP) is a monosymptomatic hypochondriacal psychosis where the patient has the delusion of being infested with parasites, whereas Morgellons disease (MD) is described when the patient has fixed ideation of fibers or other materials emerging from skin. Both psychological and organic causes can result into the delusion of infestation, and careful examination is required to exclude secondary causes. Oral DP can result in self-inflected mutilations of the oral mucosa. To our knowledge, oral DP is only rarely reported in the literature. Here, we describe and discuss the management of a case of overlap between oral DP and oral MD at the oral medicine (OM) clinic. Case Report. A 50-year-old male presented to the OM clinic with ulcerations of oral and perioral tissues. Patient reported inflicting wounds to himself using a shaving blade to extirpate worms and pieces of glass from underneath his oral and perioral mucosa. Clinical and laboratory investigations ruled out parasitic infestations. Self-inflected ulcers were treated with topical steroids and prophylactic antifungals, and the patient was referred for psychiatric evaluation. A diagnosis of primary DP was reached, and the patient was managed with antipsychotics. Practical Implications. Oral health care providers should be familiar with oral manifestations of psychiatric disorders and should be able to manage such patients in a multidisciplinary team of internist, dermatologist, and psychiatrist.

A Patient with Active Hepatitis B Presents for Dental Extraction.

Goals of the dental management of patients with active hepatitis B is to stabilize the patient until the active liver infection subsides and to defer all dental treatments until recovery. If treatment cannot be deferred during the active stage of the disease, consultation with the patient's physician is necessary to obtain information to avoid excessive bleeding, infection, or adverse drug reactions. Dental treatments of such patients should be carried out in an isolated operation room with adherence to the standard precautions to prevent cross-infection. An effective vaccine against hepatitis B is available; all health care workers should be fully vaccinated.

A Patient with Alcoholic Liver Disease Reports for Treatment of Dentoalveolar Abscess in Relation to Maxillary Left Molar.

Dental management of patients with alcoholic liver disease (ALD) depends on the understanding of the systemic effects of liver disease on the body's various systems. ALD can affect normal hemostatic functions by affecting platelets and coagulation factors resulting in prolonged postoperative bleeding. Given these facts, a complete blood count, liver function test, and coagulation profile should be requested before oral surgical procedures. Because the liver is an organ for drug metabolism and detoxification, liver disease may cause increased or decreased drug metabolism and hence alteration of drugs effectiveness and/or increase toxicity. Prophylactic antibiotics may be required to prevent serious infections.

The association of sleep disturbances with burning mouth syndrome: An overlooked relationship-A qualitative systematic review.

OBJECTIVES: To review the relevant literature to assess whether patients with burning mouth syndrome (BMS) are more prone to have sleep disturbances than general population. METHODS: The literature search for relevant articles was from July 2020 to March 2021. A systematic search of PubMed, Embase, Google Scholar, Cochrane library, Dentistry & Oral Sciences Source, and Scopus was conducted to search for relevant studies. The quality of studies was assessed in accordance with the Joanna Briggs Institute's guidelines and using the software SUMARI-The System for the Unified Management, Assessment and Review of Information. Confidence in the findings was assessed using the GRADE-CERQual approach. RESULTS: A total of 1064 studies were initially identified from the search; six studies, two cross-sectional and four case-control, met the inclusion criteria and were selected for this systematic review. Sleep disturbances were a required outcome measured in selected studies evaluating symptoms of BMS. For studies that were included in the final analyses, BMS was found to relate to several dimensions of sleep including sleep disturbance and duration (n = 6), sleep affecting daytime function (n = 4), sleep quality (n = 6), sleep efficiency (n = 4), and ability to fall asleep (n = 4). Consistent evidence of moderate confidence found that BMS was associated with greater sleep disturbance, reduced sleep quality, increased time taken to fall asleep, reduced sleep efficiency, and poor daytime function, whereas evidence of low confidence was found regarding the association of BMS with reduced sleep duration. CONCLUSIONS: Although the presented studies could not establish a direct causal relationship between BMS and sleep disturbances, it supports the evidence that sleep disturbance is associated with symptoms of BMS. Management strategies to improve sleep may be considered in future research for managing BMS patients.

Systemic sclerosis: Update for oral health care providers.

Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune disease of unknown origin characterized by an uncontrolled inflammatory process resulting in fibrosis of the skin, internal organs and vasculopathy. Manifestations of SSc are heterogenous and can include pulmonary, cardiac, neural, renal, muscular, cutaneous and orofacial complications. Recent scientific advances have led to a better understanding of disease etiopathogenesis and the development of a new classification system. Therapeutic management is often multidisciplinary and targeted toward the affected organs. Oral health care providers (OHCPs) should be familiar with SSc, particularly as it relates to its impact on the orofacial region and modifications to delivery of oral health care for patients with this condition.