Association between maxillary sinus pathology and odontogenic lesions in patients evaluated by cone beam computed tomography. A systematic review and meta-analysis.

BACKGROUND: A study is made of the association between maxillary sinus pathology and odontogenic lesions in patients evaluated with cone beam computed tomography. MATERIAL AND METHODS: A literature search was made in five databases and OpenGrey. Methodological assessment was carried out using the Newcastle-Ottawa tool for observational studies. The random-effects model was used for the meta-analysis. RESULTS: Twenty-one studies were included in the qualitative review and 6 in the meta-analysis. Most presented moderate or low risk of bias. The periodontal disease showed to be associated with the thickening of the sinus membrane (TSM). Mucous retention cysts and opacities were reported in few studies. The presence of periapical lesions (PALs) was significantly associated to TSM (OR=2.43 (95%CI:1.71-3.46); I2=34.5%) and to odontogenic maxillary sinusitis (OMS) (OR=1.77 (95%CI: 1.20-2.61); I2=35.5%). CONCLUSIONS: The presence of PALs increases the probability of TSM and OMS up to 2.4-fold and 1.7-fold respectively. The risk differences suggests that about 58 and 37 of out every 100 maxillary sinuses having antral teeth with PALs are associated with an increased risk TSM and OMS respectively. The meta-evidence obtained in this study was of moderate certainty, and although the magnitude of the observed associations may vary, their direction in favor sinus disorders appearance, would not change as a result.

Effect of nonsurgical periodontal treatment in patients with periodontitis and rheumatoid arthritis: A systematic review.

BACKGROUND: Periodontitis has been regarded as a potential risk factor for rheumatoid arthrosis (RA). A systematic review is made to determine whether nonsurgical periodontal treatment in patients with RA offers benefits in terms of the clinical activity and inflammatory markers of the disease. MATERIAL AND METHODS: A search was made of the Medline-PubMed, Cochrane, Embase and Scopus databases to identify studies on the relationship between the two disease processes, and especially on the effects of nonsurgical treatment in patients of this kind. The search was based on the following keywords: rheumatoid arthritis AND periodontitis (MeSH), rheumatoid arthritis AND periodontal treatment. RESULTS: Eight articles on the nonsurgical treatment of patients with periodontitis and RA were finally included in the study. All of them evaluated clinical (DAS28) and laboratory test activity (ESR, CRP, IL-6, TNFα) before and after treatment. A clear decrease in DAS28 score and ESR was recorded, while other parameters such as CRP, IL-6 and TNFα showed a nonsignificant tendency to decrease as a result of treatment. CONCLUSIONS: Nonsurgical treatment improved the periodontal condition of patients with periodontitis and RA, with beneficial effects upon the clinical and laboratory test parameters (DAS28 and ESR), while other inflammatory markers showed a marked tendency to decrease. However, all the studies included in the review involved small samples sizes and follow-up periods of no more than 6 months. Larger and particularly longitudinal studies are therefore needed to more firmly establish possible significant relations between the two disease processes.

Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws. A review of the literature.

BACKGROUND: Bisphosphonates (BPs) and other antiresorptive agents such as denosumab are widely prescribed for the treatment of osteoporosis and are also used in patients with multiple myeloma and metastatic breast or prostate cancer for avoiding bone reabsorption and fractures that result in increased morbidity-mortality among such individuals. MATERIAL AND METHODS: We made a bibliographic search to analyze the concept, diagnosis and the different classifications for bisphosphonate-associated osteonecrosis of the jaws. RESULTS: Osteonecrosis of the jaws (ONJ) is an important complication of exposure to BPs or other antiresorptive agents, and although its prevalence is low, it can pose management problems. The definition, diagnosis and classification of osteonecrosis have evolved since Marx reported the first cases in 2003. CONCLUSIONS: The present study offers a literature review and update on the existing diagnostic methods and classification of the disorder, with a view to facilitating earlier and more effective treatment.

Post-traumatic trigeminal neuropathy. A study of 63 cases.

INTRODUCTION: Trigeminal neuropathy is most often secondary to trauma. The present study explores the underlying causes and the factors that influence recovery. MATERIAL AND METHODS: A retrospective case study was made involving 63 patients with trigeminal neuropathy of traumatologic origin, subjected to follow-up for at least 12 months. RESULTS: Fifty-four percent of all cases were diagnosed after mandibular third molar surgery. In 37 and 19 patients the sensory defect was located in the territory innervated by the mental and lingual nerve, respectively. Pain was reported in 57% of the cases, and particularly among the older patients. Regarding patient disability, quality of life was not affected in three cases, while mild alterations were recorded in 25 subjects and severe alterations in 8. Partial or complete recovery was observed in 25 cases after 6 months, and in 32 after one year. There were few recoveries after this period of time. Recovery proved faster in the youngest patients, who moreover were the individuals with the least pain. CONCLUSION: Our patients with trigeminal neuropathy recovered particularly in the first 6 months and up to one year after injury. The older patients more often suffered pain associated to the sensory defect. On the other hand, their discomfort was more intense, and the patients with most pain and the poorest clinical scores also showed a comparatively poorer course.

Osteonecrosis de los maxilares por bisfosfonatos. Actualización y puesta al día / Bisphosphonate-related osteonecrosis of the jaws. An update

Los bisfosfonatos son unos fármacos ampliamenteutilizados principalmente para la osteoporosis y tambiénen oncología. Un efecto secundario o complicación delos mismos, desconocida hasta el año 2003, es la osteonecrosisde los maxilares. Se revisan, en este trabajo, lascaracterísticas químicas de los distintos bisfosfonatos,su posible mecanismo de acción, la potencia relativa, losproductos comerciales existentes en el mercado farmacéuticoespañol y sus indicaciones; igualmente se repasala osteonecrosis de los maxilares en sus comienzos, suconcepto, sus estadios clínicos, la razón por la que estapatología aparece en los maxilares, sus factores de riesgo,su incidencia, la actitud a tomar por los dentistas conlos pacientes que toman bisfosfonatos, el tratamiento yla posible predicción de la osteonecrosis(AU)

Bisphosphonates are widely used drugs, primarilyfor osteoporosis and also in oncology. A drug-inducedside effect or complication, which only recently cameto light in 2003, is osteonecrosis of the jaw. This studyreviews the chemical characteristics of the variousbisphosphonates, their possible mechanism of action,relative potency, the commercial products available onthe spanish pharmaceutical market and the indicationsfor bisphosphonate treatment. The study also considersosteonecrosis of the jaw with regard to its onset,concept, clinical stages, why this pathology affects thejaws, its risk factors, incidence, the attitude to be adoptedby dentists with patients taking bisphosphonates, aquick review of the treatment and the possible predictionof osteonecrosis(AU)

Oral squamous cell carcinoma: overview of current understanding of aetiopathogenesis and clinical implications.

MEDLINE contains well over 14,000 papers revealed by a search using keywords 'oral squamous cell cancer' or 'oral squamous cell carcinoma', over 27,000 using 'oral carcinoma' and over 48,000 using the keywords 'oral cancer'. It is difficult to see how clinicians could keep abreast of such a subject. This paper attempts to help by providing an overview of the aetiopathogenesis of oral squamous cell carcinoma (OSCC), discussing changes in epidemiology and increasing awareness of the wide range of risk factors, emphasising the genetic background to cancer susceptibility and the genetic changes associated with progression to OSCC and highlighting clinical implications.

Documento de consenso sobre la utilización de profilaxis antibiótica en cirugía y procedimientos dentales / Consensus document on the use of antibiotic prophylaxis in dental surgery and procedures

La profilaxis antibiótica en Odontología tiene como objetivo prevenir la aparición de infección a partir de la puerta de entrada que produce la actuación terapéutica, por lo que se encuentra indicada siempre que exista un riesgo importante de infección, ya sea por las características mismas de la operación o por las condiciones locales o generales del paciente. Sin embargo, los ensayos clínicos con antibióticos en patologías dentarias responden poco a los criterios metodológicos requeridos, y además no son lo suficientemente numerosos. Se presentan los resultados de una conferencia de expertos integrada por los Presidentes de Sociedades científicas españolas más representativas que han analizado la bibliografía existente y han aportado sus valiosas experiencias profesionales. Se describen las circunstancias técnicas, se analizan los fundamentos biológicos y farmacológicos y se aplican a las situaciones médicas más representativas. Se concluye que la profilaxis antibiótica en Odontología cuenta con indicaciones bien fundamentadas y precisas, ofreciendo a la comunidad científica internacional un protocolo práctico de actuación (AU)

The goal of antibiotic prophylaxis in Odontology is to prevent the onset of infections through the entrance way provided by the therapeutic action; therefore it is indicated provided there is a considerable risk infection, either because of the characteristics of the operation itself or the patient´s local or general condition. Nonetheless, clinical trials with antibiotics in dental pathologies scarcely adhere to the required methodological criteria and in addition, are not sufficiently numerous. This text presents the results of an expert conference comprising the Presidents of the most representative Scientific Societies in Spain who have analyzed the existing literature and have drawn on their valuable professional experience. It describes the technical circumstances, analyzes the biological and pharmacological foundations and their application to the most representative medical situations. It is concluded that antibiotic prophylaxis in Odontology has certain well-founded, precise indications and offers the international scientific community a practical protocol for action (AU)

Mucosal disease series. Number IV. Erythema multiforme.

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction characterised by a skin eruption, with or without oral or other mucous membrane lesions. Occasionally EM may involve the mouth alone. EM has been classified into a number of different variants based on the degree of mucosal involvement and the nature and distribution of the skin lesions. EM minor typically affects no more than one mucosa, is the most common form and may be associated with symmetrical target lesions on the extremities. EM major is more severe, typically involving two or more mucous membranes with more variable skin involvement - which is used to distinguish it from Stevens-Johnson syndrome (SJS), where there is extensive skin involvement and significant morbidity and a mortality rate of 5-15%. Both EM major and SJS can involve internal organs and typically are associated with systemic symptoms. Toxic epidermal necrolysis (TEN) may be a severe manifestation of EM, but some experts regard it as a discrete disease. EM can be triggered by a number of factors, but the best documented is preceding infection with herpes simplex virus (HSV), the lesions resulting from a cell mediated immune reaction triggered by HSV-DNA. SJS and TEN are usually initiated by drugs, and the tissue damage is mediated by soluble factors including Fas and FasL.

Epithelial biology.

The oral mucous membrane has features similar to skin but also differs in several ways. This paper reviews the aspects of epithelial biology necessary for an understanding of the vesiculoerosive disorders.

Adverse drug reactions in the orofacial region.

A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.

Transformación maligna del liquen plano oral en tres nuevos casos / Malignant turn of oral lichen planus in three new cases

La malignización del liquen plano es un tema controversial. En este trabajo presentamos tres nuevos casos de carcinoma oral de células escamosas (COCE) desarrollados a partir de lesiones de LPO. En cada uno de los pacientes se analizaron datos como el sexo, edad, tipo clínico, localización y extensión de las lesiones de LPO, así como también el período de seguimiento y tiempo de tratamiento, también se tomó en consideración los hábitos del paciente, la localización, estadio y tratamiento del cáncer. La edad media de los pacientes fue de 59 años y ninguno era fumador o bebedor de alcohol. El período de seguimiento fue superior a 2 años y el tiempo medio de transformación maligna fue de 9 años después del diagnóstico del LP. El cáncer apareció sobre un LP atrófico erosivo en dos de los pacientes y sobre una lesión en placa en el otro, todos estaban utilizando corticoesteroides tópicos antes del diagnóstico del cáncer. La aparición de nuevos casos de malignización de lesiones de LPO encuadrados dentro de los criterios establecidos, sugiere la realización de nuevas investigaciones a fin de determinar los factores involucrados en este proceso (AU)

The possible malignant potential of oral lichen planus (OLP) is still controversial. We present three new oral lichen planus (OLP) patients who developed oral squamous-cell carcinoma (OSCC). In all cases, were analyzed variables like sex, age, clinical type, localization, extension, follow-up study and treatment, moreover were considered the patient's habits, localization, stage and treatment of cancer. The average age was 59 years and both of them were non smoker or with no alcohol habits. The follow-up period was greater than two years and the malignant lesion developed after mean of nine years, after the diagnosis of OLP had been established. Oral squamous-cell carcinoma (OSCC) arose on lesions previously diagnosed clinically and histologically as atrophic and erosive oral lichen planus in two of our patients and on a plaque lesion LP in a patient. All of them had been using topical corticoids before the cancer was diagnosed. The appearance of new cases of OLP malignization framed inside the established approaches, suggests the realization of new researches in order to determine the factors involved in this process (AU)

Linfoma no-Hodgkin intraoral. Presentación de 4 casos clínicos / Intraoral no-Hodgkin lymphoma. Presentation of 4 clinical cases

Los linfomas no-Hodgkin (LNH) incluyen un grupo heterogéneo de malignidades de histogénesis linforreticular. La mayoría de casos inician en los nódulos linfáticos, aunque existe también la forma extraganglionar. En la cavidad oral el LNH tiene baja incidencia. Puede afectar a los maxilares y/o tejidos blandos como manifestación primaria o secundaria de la enfermedad. Presentamos una revisión de la literatura y cuatro casos clínicos de LNH intraoral, con el propósito de describir sus características clínicas e histológicas. Los dos primeros casos son linfomas intraorales primarios, un tercero asociado a infección VIH y por último una manifestación oral como parte de la diseminación de la enfermedad (AU)

The non-Hodgkin lymphomas (NHL) represent an heterogeneous group of malignancies of lymphoreticular histogenesis. In most cases, they initially arise within lymph nodes but so-called extranodal lymphomas are also found. The NHL has low incidence in the oral cavity. It may involve bone and/or soft tissues as a primary or secondary manifestation. We present a review of the literature and four clinical cases of intraoral NHL. The first couple of cases are primary forms, the third one is associated to HIV infection and the last one is an oral presentation as a component of more widely disseminated disease (AU)

Linfoma angiocéntrico localizado en paladar / Angiocentric lymphoma of the palate

Los linfomas angiocéntricos son neoplasias muy poco frecuentes en nuestra área geográfica. Suelen presentarse en la región oronasal como lesiones de tipo necrótico, en concreto en la zona mediofacial, con una evolución rápida y un pronóstico sombrío. Inmunohistoquímicamente se ha detectado que en estas neoplasias las células malignas corresponden a linfocitos T. Además estudios recientes apoyan la hipótesis del posible papel del virus de Epstein-Barr como posible factor etiológico. Presentamos en este artículo el caso clínico de un hombre de 67 años con una lesión ulcerada en el paladar, de corto tiempo de evolución y que tras estudio histopatológico e inmunohistoquímico se confirmó se trataba de un linfoma angiocéntrico. Tras su diagnóstico el paciente fue tratado con 3 ciclos de quimioterapia tipo CHOP y radioterapia (AU)

Angiocentric lymphomas are very infrequent neoplasms in our geographical setting. They tend to develop in the oronasal region in the form of necrotic lesions--specifically in the midfacial zone--with a rapid course and poor prognosis. Immunohistochemically, the malignant cells have been shown to correspond to T lymphocytes. In addition, recent research supports the possible role of Epstein-Barr virus as a possible etiological factor. We present the case of a 67 year old man with an ulcerated palatinal lesion of recent appearance that was diagnosed as angiocentric lymphoma by histopathological and immunohistochemical study. Following diagnosis, treatment was provided in the form of 3 cycles of CHOP type chemotherapy and radiotherapy (AU)

Neuralgia trigeminal secundaria a dolicoectasia de la arteria basilar / Trigeminal neuralgia associated to basilar artery dolichoectasia

Presentamos un paciente con una neuralgia trigeminal secundaria a dolicoectasia de la arteria basilar. En los pacientes con neuralgias trigeminales las malformaciones vasculares y los tumores del ángulo pontocerebeloso pueden ser detectados con técnicas no invasoras, como la tomografía computarizada o la resonancia magnética, por lo que su uso está indicado en los pacientes con neuralgias del trigémino para descartar alteraciones del sistema nervioso central (AU)

Estudio del postoperatorio tras la extracción quirurgica de 100 terceros molares inferiores impactados en relación a la dificultad del acto quirúrgico / An evaluation of the prospective course following surgical extraction of 100 impacted mandibular third molars in relation to surgical difficulty

El propósito de este estudio es valorar el dolor, la inflamación, el trismo y el consumo de analgésicos durante los 7 día, del postoperatorio, tras la extracción quirúrgica de terceros molares inferiores impactados, en relación con la dificultad de la intervención. Incluimos 100 pacientes sanos que fueron sometidos a la extracción quirúrgica de terceros molares inferiores impactados. Valoramos el dolor postquirúrgica usando una escala analógica-visual, la inflamación mediante una escala subjetiva, el trismo como disminución de la apertura interincisiva y el consumo de analgésicos. El tiempo de ostectomía, la práctica de odontosección y la duración de la intervención, influyeron en el postoperatorio aumentado el dolor, la inflamación y el trismo. El tiempo de ostectomia y la duración de la intervención presentaron una relación estadísticamente significativa con el trismo, y la odontosección con el dolor el trismo. El estudio trata de ser una herramienta para ayudar a preveer los efectos secundarios del postoperatorio, en función de la dificultad del acto quirúrgico (AU)

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