Cocaine-related oronasal communication and hard palate destruction.

Four cases of midpalatal perforation in cocaine abusers are presented. Other potential etiological processes are discussed to establish an adequate differential diagnosis. These patients were treated at our department, due to the drawback promoted by the establishment of oronasal communication that was provided after an accurate diagnosis. Histopathological evaluation of the lesion margins were conducted in two of the four cases, and yielded no evidence of vasculitis or active cocaine abuse. Therapeutic approach consisted of reconstructive surgeries and/or sealing prostheses. Histological assessment of oronasal communication margins could be useful in establishing the persistence of active addiction, and also as a complementary tool for planning possible treatment.

Chlorhexidine in the prevention of dry socket: effectiveness of different dosage forms and regimens.

UNLABELLED: Dry socket (DS) is a potential postoperative complication of dental extractions. It is clinically diagnosed by the presence of a denuded socket secondary to premature loss of the blood clot, and manifests as slight discomfort for the patient, followed by sudden worsening with intense or lancing pain. Since the underlying etiology is not clear, the best treatment is prevention. Chlorhexidine (CHX) is an antiseptic that acts upon the bacteria of the oral cavity, and is widely used in dental practice. OBJECTIVES: A metaanalysis is made of the different CHX treatment regimens used for the prevention of DS, with the proposal of a management protocol designed to maximize the efficacy of such treatment. MATERIAL AND METHODS: Literature searches were made in the PubMed Medline, Cochrane and ISI Web of Knowledge databases, crossing the terms: alveolar osteitis, dry socket and chlorhexidine. The search was limited to randomized or nonrandomized clinical trials. RESULTS: Twelve clinical trials using CHX in rinse or gel form at doses of 0.12% or 0.2% with different administration regimens for the prevention of DS were identified. CONCLUSION: After reviewing the existing medical literature, it can be concluded that 0.2% CHX gel, applied every 12 hours for 7 days after extraction is the best available option for the prevention of DS. However, this is also the most expensive option, and since CHX is not subsidized by the Spanish public healthcare system, it occasionally may be more advisable to use the 0.12% rinse with the same dosing regimen.

Chlorhexidine in the prevention of dry socket: Effectivenessof different dosage forms and regimens

Dry socket (DS) is a potential postoperative complication of dental extractions. It is clinically diagnosed by thepresence of a denuded socket secondary to premature loss of the blood clot, and manifests as slight discomfort forthe patient, followed by sudden worsening with intense or lancing pain.Since the underlying etiology is not clear, the best treatment is prevention. Chlorhexidine (CHX) is an antisepticthat acts upon the bacteria of the oral cavity, and is widely used in dental practice.Objectives: A metaanalysis is made of the different CHX treatment regimens used for the prevention of DS, withthe proposal of a management protocol designed to maximize the efficacy of such treatment.Material and Methods: Literature searches were made in the PubMed Medline, Cochrane and ISI Web of Knowledgedatabases, crossing the terms: alveolar osteitis, dry socket and chlorhexidine. The search was limited torandomized or nonrandomized clinical trials.Results: Twelve clinical trials using CHX in rinse or gel form at doses of 0.12% or 0.2% with different administrationregimens for the prevention of DS were identified.Conclusion: After reviewing the existing medical literature, it can be concluded that 0.2% CHX gel, applied every12 hours for 7 days after extraction is the best available option for the prevention of DS. However, this is also themost expensive option, and since CHX is not subsidized by the Spanish public healthcare system, it occasionallymay be more advisable to use the 0.12% rinse with the same dosing regimen (AU)

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Oral implants in patients receiving bisphosphonates: A review and update

This rewiew was mad to establish the convenience of dental implant treatment in patients receiving bisphosphonatesor programmed to receive such drugs, with a description of their mechanisms of action and the way in which theycan affect the mandibular or maxillary bone of dental implant candidates. In turn, a description is provided of thekey elements for evaluating the benefit-risk ratio in patients treated with bisphosphonates who require oral surgery.Clinicians must be aware of the potential risk of osteonecrosis in patients treated with bisphosphonates via the oralor intravenous route.When bisphosphonates are administered via the intravenous route, all invasive oral procedures (including implantsurgery) are contraindicated, and should be avoided unless absolutely necessary. The indications are more controversialin the case of bisphosphonates administered via the oral route. There is little literature on the influence of oralbisphosphonates upon bone repair, and there are not many published cases of mandibular or maxillary osteonecrosisamong patients that receive such medication.The use of bisphosphonates is becoming increasingly widespread, and the duration of such treatment is increasing.It would be of interest to design studies to evaluate the risk factors of maxillary osteonecrosis among dental implantpatients receiving treatment with oral bisphosphonates, and to define biomarkers capable of indicating the level ofrisk in the event of oral surgery in patients receiving such drugs (AU)

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Interactions between ibuprofen and antihypertensive drugs: incidence and clinical relevance in dental practice.

It has been well documented in the literature that ibuprofen interacts with different groups of antihypertensive drugs (beta-adrenergic blockers, alpha-adrenergic blockers, diuretics and angiotensin-converting enzyme inhibitors), reducing their antihypertensive activity. The mechanism of action of ibuprofen involves inhibition of the enzyme cyclooxygenase, thereby inhibiting the synthesis of inflammatory prostaglandins and vasodilatory prostaglandins that increase renal blood flow and thus favor the excretion of water and sodium. More than five days of treatment with both drugs are normally required for the interaction to manifest. Although the changes in blood pressure resulting from this interaction are typically small, some patients can experience substantial elevations in both systolic and diastolic blood pressure. It has been estimated that the avoidance of minor changes in systolic pressure in patients with osteoarthritis subjected to treatment with nonsteroidal antiinflammatory drugs would avoid over 30,000 deaths due to myocardial infarction, and over 2000 deaths due to coronary disease, in the United States alone.

Interactions between ibuprofen and antihypertensive drugs: Incidence and clinical relevance in dental practice

It has been well documented in the literature that ibuprofen interacts with different groups of antihypertensivedrugs (beta-adrenergic blockers, alpha-adrenergic blockers, diuretics and angiotensin-converting enzyme inhibitors),reducing their antihypertensive activity. The mechanism of action of ibuprofen involves inhibition of the enzymecyclooxygenase, thereby inhibiting the synthesis of inflammatory prostaglandins and vasodilatory prostaglandins thatincrease renal blood flow and thus favor the excretion of water and sodium. More than five days of treatment withboth drugs are normally required for the interaction to manifest. Although the changes in blood pressure resultingfrom this interaction are typically small, some patients can experience substantial elevations in both systolic anddiastolic blood pressure. It has been estimated that the avoidance of minor changes in systolic pressure in patientswith osteoarthritis subjected to treatment with nonsteroidal antiinflammatory drugs would avoid over 30,000 deathsdue to myocardial infarction, and over 2000 deaths due to coronary disease, in the United States alone (AU)

Drug-induced burning mouth syndrome: a new etiological diagnosis

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Burning mouth syndrome (BMS) is defined as a burning sensation of the oral mucosa, in the absence of specificoral lesions. The underlying etiology remains unclear. Peripheral alterations may be related to the density or reactive capacity of the oral mucosal membrane receptors - these being largely influenced by BMS-related risk factors such as stress, anxiety, the female gender, climacterium and advanced age. The present study compiles the cases of BMS induced by drugs reported in the literature, and attempts to draw a series of conclusions. A search was conducted in the PubMed® database using the following key words: burning mouth syndrome, drug-induced, antihypertensiveand chemically-induced. The search was carried out in April 2007. The literature yielded clinical cases in which oral burning sensation is described after the administration of drugs belonging to different therapeutic groups: antiretrovirals, antiseizure drugs, hormones and particularly antihypertensive medication. Curiously, among the different types of antihypertensive drugs, BMS was only associated with those compounds that act upon the angiotensin-renin system

Drug-induced burning mouth syndrome: a new etiological diagnosis.

Burning mouth syndrome (BMS) is defined as a burning sensation of the oral mucosa, in the absence of specific oral lesions. The underlying etiology remains unclear. Peripheral alterations may be related to the density or reactive capacity of the oral mucosal membrane receptors - these being largely influenced by BMS-related risk factors such as stress, anxiety, the female gender, climacterium and advanced age. The present study compiles the cases of BMS induced by drugs reported in the literature, and attempts to draw a series of conclusions. A search was conducted in the PubMed database using the following key words: burning mouth syndrome, drug-induced, antihypertensive and chemically-induced. The search was carried out in April 2007. The literature yielded clinical cases in which oral burning sensation is described after the administration of drugs belonging to different therapeutic groups: antiretrovirals, antiseizure drugs, hormones and particularly antihypertensive medication. Curiously, among the different types of antihypertensive drugs, BMS was only associated with those compounds that act upon the angiotensin-renin system.

Pharmacological treatment of burning mouth syndrome: A review and update.

Burning mouth syndrome (BMS) is defined as a burning sensation in the tongue or in any other region of the oral mucosa, in the absence of specific oral lesions. The present study reviews the pharmacological treatments used in the last 10 years to reduce the symptoms of BMS, and assesses the efficacy and safety of pharmacological interventions destined to alleviate the symptoms of BMS. To this effect, searches were made in the following databases: Micromedex, Cochrane Database and PubMed, crossing the following key words: drug, treatment, clinical trial, pain management, and burning mouth syndrome. The searches were limited to articles published in the last 10 years in English or Spanish, and involving human subjects. The searches were conducted in November 2006. The literature contains clinical studies in which BMS has been treated with drugs belonging to different pharmacological groups: antidepressants, antipsychotics, antiepileptic drugs, analgesics and mucosal protectors, among others. Although effective therapies have been identified in concrete cases, a treatment modality offering efficacy in most cases of BMS remains to be established. It is essential to gain further insight to the physiopathological mechanisms of BMS, and to establish differential diagnostic criteria to develop drugs with improved efficacy and safety profiles in the treatment of BMS.

Pharmacological treatment of burning mouth syndrome: a review and update

El Síndrome de Boca Ardiente (SBA) se define como una sensación de ardor o quemazón en la lengua o en cualquier otra localización de la mucosa oral en ausencia de lesiones bucales específicas. El presente artículo revisa los tratamientos farmacológicos utilizados en los últimos diez años para reducir la sintomatología del SBA y trata de objetivar la eficacia y seguridad de cualquier intervención farmacológica encaminada a aliviar los síntomas del SBA. Para ello se realizaron búsquedas en las bases de datos: Micromedex®, Cochrane Database® y Pubmed® cruzando las palabras: drug, treatment, clinical assay, pain management y burning mouth syndrome. Se establecieron como límites en la búsqueda los artículos publicados en los últimos 10 años, en inglés o español y los estudios realizados en humanos. Las búsquedas fueron realizadas en noviembre 2006. En la literatura encontramos estudios clínicos en los que el SBA se ha tratado con fármacos enmarcados en diferentes grupos farmacológicos: antidepresivos, antipsicóticos, antiepilépticos, analgésicos y protectores de la mucosa entre otros. Aunque se han encontrado tratamientos eficaces en casos particulares, se sigue buscando un tratamiento que resulte eficaz en la mayoría de los casos. Es indispensable profundizar en los mecanismos fisiopatológicos del SBA y establecer criterios diagnósticos diferenciales para poder desarrollar fármacos con mejor perfil de eficacia y seguridad en el tratamiento del SBA

Burning mouth syndrome (BMS) is defined as a burning sensation in the tongue or in any other region of the oral mucosa, in the absence of specific oral lesions. The present study reviews the pharmacological treatments used in the last 10 years to reduce the symptoms of BMS, and assesses the efficacy and safety of pharmacological interventions destined to alleviate the symptoms of BMS. To this effect, searches were made in the following databases: Micromedex®, Cochrane Database® and PubMed®, crossing the following key words: drug, treatment, clinical trial, pain management, and burning mouth syndrome. The searches were limited to articles published in the last 10 years in English or Spanish, and involving human subjects. The searches were conducted in November 2006. The literature contains clinical studies in which BMS has been treated with drugs belonging to different pharmacological groups: antidepressants, antipsychotics, antiepileptic drugs, analgesics and mucosal protectors, among others. Although effective therapies have been identified in concrete cases, a treatment modality offering efficacy in most cases of BMS remains to be established. It is essential to gain further insight to the physiopathological mechanisms of BMS, and to establish differential diagnostic criteria to develop drugs with improved efficacy and safety profiles in the treatment of BMS