MuGard, an oral mucoadhesive hydrogel, reduces the signs and symptoms of oral mucositis in patients with lichen planus: a double-blind, randomized, placebo-controlled pilot study.

OBJECTIVE: To determine if MuGard, a mouthwash shown to reduce the severity of oral mucositis when started before initiating antineoplastic therapy for head and neck cancers, is effective when painful, oral lesions are present in patients with biopsy-proven erosive oral lichen planus. STUDY DESIGN: This was a double-blind, randomized, placebo-controlled pilot study at a college of dental medicine. Twenty patients with oral lichen planus were randomly assigned to receive either MuGard (n = 10) or saline-bicarbonate control (n = 10). One teaspoonful of the assigned mouthwash was swished for 1 minute, 5 times a day, for 14 days. Outcome measures (Oral Mucositis Assessment Scale scores and visual analog scale pain scores) were obtained before the start of treatment and repeated on days 2, 7, and 14. RESULTS: Significant reductions in all outcome measures occurred in the MuGard-treated group. Number-needed-to-treat (NNT) to achieve a >50% reduction in averaged pain from baseline was 1.25, and to obtain complete relief, the NNT was 2.5. CONCLUSIONS: MuGard significantly reduces pain and ulceration associated with oral mucositis in patients with lichen planus.

Management of the anxious dental patient.

The anxious patient in the dental office reacts with panic and inability to cooperate with necessary treatment. It is the dentist's responsibility to recognize and assuage the patient's anxiety on both psychological and medical levels. The diagnosis, etiology and treatment of anxiety will be investigated and presented as any other disease entity. It is an illness that contributes to dental neglect and subsequent pain, disease and dysfunction. The purpose of this paper is to discuss the recognition and etiology of patient anxiety and to offer treatment solutions and behavior modification techniques. The discussion will include psychological insight as well as the use of anxiolytics and nitrous oxide-oxygen (N2O-O2) sedation to ameliorate the symptoms. Finally, a presentation will be made of the modern application of philosophic dicta of Plato and Aristotle in which the doctor is considered a philosopher who values the concept of self-healing based on the doctor-patient relationship. These techniques and concepts of totality in diagnosis and treatment are applicable today just as they were 17 centuries ago.

Clinical identification of head and neck lymphadenopathy: a diagnostic obligation.

The purpose of this article is to reinforce the need for all dental clinicians to perform a complete lymph node examination on every patient, regardless of age, gender, or chief complaint. As early diagnosis provides for the best prognosis, head and neck lymph node palpation may be the earliest indicator of infection or neoplasia. This article provides the rationale for lymph node examination, the palpation techniques for the clinician to utilize, and the anatomic locations and descriptions of lymph nodes.

A holistic approach to a rare pathology.

A case of cystic hygroma (CH), a congenital lymph-filled multicystic hamartoma of the neck, with a holistic approach to patient management is presented. The stigma of the CH imposed by attending physicians, dentists, parents, teachers and peers affected the psychological development of this patient since her diagnosis in childhood. Although surgery relieves the threat of airway obstruction and may improve the esthetic appearance of the CH, the patient may be isolated and traumatized by the ignorance and superstitions of the individuals she encounters on a daily basis.

Cryopreserved amniotic membrane for modulation of periodontal soft tissue healing: a pilot study.

BACKGROUND: The purpose of this randomized study is to evaluate cryopreserved amniotic membrane (CAM) for helping cicatrization and wound healing after dental implant surgery. Epithelialization, pain, infection, inflammation, and scarring were studied. METHODS: CAM was placed in surgical wounds related to implant surgery. The extent of healing was evaluated by a masked investigator for lesion size, epithelialization, pain, infection, inflammation, and scarring. A clinical evaluation occurred at baseline, 72 and 144 hours, 2 weeks, and 1, 1.5, and 3 months. The results were compared to conventionally managed, similar lesions that were treated the same day in the same patient allowing each patient to serve as their own control. RESULTS: This prospective randomized study showed statistically significant differences between experimental and control groups regarding cicatrization, wound healing, and pain. The effects of the membrane were statistically significant during the first 3 weeks of the study, and thereafter, the effects of the membrane for the two groups were equivalent. CONCLUSIONS: CAM was effective in helping cicatrization and wound healing. CAM supported the growth of the epithelium and, thus, facilitated migration and reinforced adhesion. It also decreased the pain of subjects. Regarding dental implants, the use of CAM is not cost effective. New studies evaluating other oral conditions are encouraged.

Oral cancer: a prosthodontic diagnosis.

The prosthodontic literature is replete with articles addressing the reconstruction, psychological adaptation, prosthesis success, quality of life, need for careful follow-up, and many other issues related to the patient who has undergone surgery, radiation, and/or chemotherapy for oral malignant neoplasms. However, in the prosthodontic professional literature, there is a paucity of information related to the early diagnosis and referral of lesions that may represent premalignant or malignant neoplasia. This article will describe the rationale, epidemiology, and appearance of oral premalignant and malignant mucosal lesions as well as the state-of-the-art diagnostic tools currently available to prosthodontists to ensure that their patients are diagnosed at the earliest possible time.

Management of burning mouth syndrome: systematic review and management recommendations.

Primary burning mouth syndrome (BMS) is a chronic, idiopathic intraoral mucosal pain condition that is not accompanied by clinical lesions or systemic disease. There is some uncertainty whether this condition should be referred to as a disease, a disorder, or a syndrome but there are insufficient data to justify any change in taxonomy at present. BMS occurs most often among women and is often accompanied by xerostomia and taste disturbances. More recently a neuropathological basis has been proposed so that BMS may be regarded as an oral dysesthesia or painful neuropathy. However, our incomplete understanding of the epidemiology, etiology, pathophysiology, and lack of diagnostic criteria are barriers to critical investigation and selection of effective treatments. There is only limited evidence to guide clinicians in the management of patients with BMS. Treatable secondary causes should be investigated before diagnosing primary BMS. Topical clonazepam and cognitive therapy have been proven efficacious in some patients. Emerging evidence supports the effectiveness of the antioxidant, alpha lipoic acid, with further studies of this agent being warranted. Additional research into mechanisms, diagnostic criteria, and randomized controlled interventional studies are needed.

Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment.

We present current knowledge of bisphosphonate-associated osteonecrosis, a new oral complication in oncology. It was first described in 2003, and hundreds of cases have been reported worldwide. The disorder affects patients with cancer on bisphosphonate treatment for multiple myeloma or bone metastasis from breast, prostate, or lung cancer. Bisphosphonate-associated osteonecrosis is characterised by the unexpected appearance of necrotic bone in the oral cavity. Osteonecrosis can develop spontaneously or after an invasive surgical procedure such as dental extraction. Patients might have severe pain or be asymptomatic. Symptoms can mimic routine dental problems such as decay or periodontal disease. Intravenous use of pamidronate and zoledronic acid is associated with most cases. Other risk factors include duration of bisphosphonate treatment (ie, 36 months and longer), old age in patients with multiple myeloma, and a history of recent dental extraction. We also discuss pathobiology, clinical features, management, and future directions for the disorder.

Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper.

BACKGROUND: This position paper addresses the prevention of bisphosphonate-associated osteonecrosis (BON) and the management of care of patients with cancer and/or osteoporosis who are receiving bisphosphonates and who have BON or are at risk of developing it. METHODS: The authors reviewed the literature available on this newly described oral complication. Information of interest included bisphosphonates, the medications associated with this oral complication; the patient population at risk of developing BON and the diseases being treated with this class of medications; the clinical presentation of the oral lesions; guidelines for managing the care of patients who develop BON; the prevention of this complication based on current knowledge; and recommendations for routine dental treatment of patients receiving bisphosphonates. RESULTS: There is strong evidence that bisphosphonate therapy is the common link in patients with BON. The pathobiological mechanism leading to BON may have to do with the inhibition of bone remodeling and decreased intraosseous blood flow caused by bisphosphonates. People at risk include patients with multiple myeloma and patients with cancer metastatic to bone who are receiving intravenous bisphosphonates, as well as patients taking bisphosphonates for osteoporosis. The risk of developing complications appears to increase with time of use of the medication. There are no guidelines based on evidence, and the clinical management of the oral complication is based on expert opinion. CONCLUSION: Prevention of BON is the best approach to management of this complication. Existing protocols to manage the care of patients who will receive radiation therapy or chemotherapy may be used until specific guidelines for BON are developed.

An overview of oral frena and their association with multiple syndromic and nonsyndromic conditions.

The development of abnormal oral frena is an important diagnostic feature of several syndromic states. Five such syndromes are reviewed which include Ehlers-Danlos syndrome, infantile hypertrophic pyloric stenosis, holoprosencephaly, Ellis-van Creveld syndrome, and oral-facial-digital syndrome. Each syndrome exhibits relatively specific frena abnormalities, ranging from multiple, hyperplastic, hypoplastic, or absent. 1-8 In addition to abnormal oral frena observed in syndromic conditions, anomalous frena are encountered without other associated phenotypic features of genetic or chromosomal states. 9 This paper is a review of the above stated frena deformities and their management.

Head and neck diagnostic challenge.

An interesting and unusual clinical case is presented to challenge the dentist's diagnostic acumen. Diagnostic and management consideration will be discussed, and a list of suggested readings is provided.

Advances in the diagnosis and management of human viral hepatitis.

This article presents a comprehensive review of viral hepatitis types A through G and TTV. The information that is provided includes the definition, causes, signs and symptoms, diagnosis, pathogenesis, and acute and chronic forms of hepatitis. The modes of transmission, risk groups, morbidity and mortality, epidemiology, and treatment modalities are also presented. The primary objective for this extensive review is to provide dental health care workers with the most current information on the subject, which will allow them to identify the patients who will potentially have complications as the result of invasive dental treatment. By using this information, dental health care workers can be assured that they are practicing "state-of-the-art dentistry" while ensuring the health of their patients, staff, and families.

Diagnosis and management of recurrent herpes simplex infections.

BACKGROUND: Dentists are frequently asked by patients to diagnose and treat recurrent herpetic infections, which are painful and disfiguring. The author explores the diagnosis and treatment of these commonly encountered viral conditions. OVERVIEW: Herpetic infections represent a reactivation of the herpes simplex virus, which is highly infectious to patients, their families, dentists and staff members. The diagnosis of these conditions usually is based on case-specific historical findings, the characteristic clinical appearance and the location of the lesions. CONCLUSIONS: Dentists often treat patients with a history of recurrent herpetic infections. Currently used topical antiviral agents, when used in a timely manner, are well-absorbed and quite effective in decreasing the severity and duration of herpetic episodes. CLINICAL IMPLICATIONS: Until the herpetic lesions are completely healed, the dental team and patient should use management strategies to prevent spread of the virus, ensure adequate nutrition and maintain appropriate oral hygiene practices.