Oral bisphosphonates: Adverse effects on the oral mucosa not related to the jaw bones. A scoping review.

BACKGROUND: Oral bisphosphonates are widely used in the treatment of bone resorptive diseases. There is an evidence that oral bisphosphonates can exert adverse effects on the oral mucosa independently of their effects on the jaw bones. OBJECTIVE: To systematically map the literature on adverse effects of oral bisphosphonates on the oral mucosa of adults with bone resorptive diseases. DESIGN: Scoping review of the literature, including different study designs. METHODS: Systematic searches of the PubMed, LILACS, Google Scholar and EMBASE databases were conducted. Two independent reviewers screened titles and abstracts according to predetermined criteria. RESULTS: The search retrieved 26 unique articles, comprising 22 case reports, one case series and three reviews describing a total of 56 cases of oral adverse events related to oral bisphosphonates. 88% of the reported cases were female suffering from comorbidities other than metabolic bone diseases. The improper use of the oral bisphosphonate was the most suspected cause of the adverse effect on the oral mucosa. Its management mainly involved withdrawal of the medication. CONCLUSION: Adverse effects on the oral mucosa can develop from using oral bisphosphonates. Standardised registration of these adverse effects in university clinics and private practises could provide additional information about their occurrence and severity.

Effect of needle insertion depth and root canal curvature on irrigant extrusion ex vivo.

INTRODUCTION: The aim of this study was to evaluate the effect of needle type and insertion depth, apical preparation size, and root canal curvature on irrigant extrusion by using a recently introduced method. METHODS: Sixteen human teeth with a straight root canal (group A) and 16 with a moderately curved root canal (group B) were sequentially prepared to sizes 25 or 35, .06 taper and mounted on a plastic vial filled with distilled water to simulate a periapical lesion. The vial was either closed or open to the environment. A point-conductivity probe was used to determine the volume of extruded irrigant into the vial. NaOCl was delivered by an open-ended or a closed-ended needle at 1, 3, or 5 mm short of working length. Results were analyzed by two 4-way mixed-design analyses of variance. The level of significance was set to P < .05. RESULTS: The open-ended needle extruded significantly more irrigant than the closed-ended. Irrigant extrusion decreased as needles moved away from working length or when the apical size was increased. Needle wedging increased extrusion, especially when an open-ended needle was used. Root canal curvature did not have a statistically significant effect on irrigant extrusion. CONCLUSIONS: Needle type, needle insertion depth, and apical preparation size had a significant effect on irrigant extrusion.