Consensus Report of the XI Congress of the Spanish Society of Odontology for the Handicapped and Special Patients

This article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haematological disorders, the dental implications of cardiovascular disease and hospital dentistry

Drooling.

The uncontrolled and continuous release of saliva from the mouth is known as drooling. While accepted as normal in young children up to 2 years of age, drooling in older children and adolescents is secondary to altered orofacial neuromuscular control during development, and in the elderly it is a consequence of neurodegenerative disease. The underlying cause is patient inability to seal the lips, excess salivation and the inability to adequately swallow saliva. The estimated mean prevalence of drooling in such elderly patients is 37%. Drooling can give rise to irritation and excoriation of the skin around the mouth or chin, favors infections and gives rise to speech or eating disorders. Observational methods based on collection of the leaked saliva or documentation of the affected skin zones can be used to measure drooling. The management of such patients requires a multidisciplinary approach and comprises myofunctional therapy, behavioral change techniques, the administration of antisialagogues, botulinum toxin, or the use of certain surgical techniques designed to reduce salivary secretion or to deviate it towards posterior areas of the oral cavity.

Etiology of burning mouth syndrome: A review and update

Introduction: Burning mouth syndrome (BMS) is characterized by an oral burning sensation in the absence of anyorganic disorders of the oral cavity. Although the cause of BMS is not known, a complex association of biologicaland psychological factors has been identified, suggesting the existence of a multifactorial etiology.Material and Method: A PubMed/Medline search was used to identify articles describing the different hypothesesregarding the etiology of BMS, as well as the psychological and anatomical data upon which such hypotheses arefundamented.Results: A review and update was made of the different hypotheses relating to the etiology of BMS (psychogenicfactors, hormone disorders, neuropathic alterations, oral phantom pain, neuroplasticity and neuroinflammation),with a view to globally establishing possible relationships among them.Conclusions: In-depth investigation is needed to clarify the etiopathogenic mechanisms of BMS and its triggeringfactors, in order to develop effective and individualized management strategies that can be extended to patients ineach different BMS subgroup (AU)

Etiology of burning mouth syndrome: a review and update.

INTRODUCTION: Burning mouth syndrome (BMS) is characterized by an oral burning sensation in the absence of any organic disorders of the oral cavity. Although the cause of BMS is not known, a complex association of biological and psychological factors has been identified, suggesting the existence of a multifactorial etiology. MATERIAL AND METHOD: A PubMed/Medline search was used to identify articles describing the different hypotheses regarding the etiology of BMS, as well as the psychological and anatomical data upon which such hypotheses are fundamented. RESULTS: A review and update was made of the different hypotheses relating to the etiology of BMS (psychogenic factors, hormone disorders, neuropathic alterations, oral phantom pain, neuroplasticity and neuroinflammation), with a view to globally establishing possible relationships among them. CONCLUSIONS: In-depth investigation is needed to clarify the etiopathogenic mechanisms of BMS and its triggering factors, in order to develop effective and individualized management strategies that can be extended to patients in each different BMS subgroup.

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)

Clinical prevalence of drooling in infant cerebral palsy.

OBJECTIVE: To determine the prevalence and severity of drooling in infant cerebral palsy (ICP) and analyze the possible surgical, pharmacological, myofunctional and novel alternative approaches to treatment of this disorder. METHODS: A clinical study is made of a group of patients with ICP (cohort) and aged between 4 and 34 years, visiting a dental clinic for disabled patients. The classification of Thomas-Stonell and Greenberg was used to assess the presence and severity of drooling. RESULTS: Of the total of 50 patients evaluated (52% males and 48% females), 58% presented drooling (mild in 44.4% and moderate to severe in 27.7%). CONCLUSION: Over half of the patients with ICP presented drooling. Effective options are therefore needed for the treatment of this problem, which poses a series of negative effects for both patients and their care givers.

Clinical prevalence of drooling in infant cerebral palsy

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Objective: To determine the prevalence and severity of drooling in infant cerebral palsy (ICP) and analyze the possible surgical, pharmacological, myofunctional and novel alternative approaches to treatment of this disorder.Methods: A clinical study is made of a group of patients with ICP (cohort) and aged between 4 and 34 years, visiting a dental clinic for disabled patients. The classification of Thomas-Stonell and Greenberg was used to assess the presence and severity of drooling.Results: Of the total of 50 patients evaluated (52% males and 48% females), 58% presented drooling (mild in 44.4% and moderate to severe in 27.7%).Conclusion: Over half of the patients with ICP presented drooling. Effective options are therefore needed for thetreatment of this problem, which poses a series of negative effects for both patients and their care givers

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

Periodontal disease associated to systemic genetic disorders.

A number of systemic disorders increase patient susceptibility to periodontal disease, which moreover evolves more rapidly and more aggressively. The underlying factors are mainly related to alterations in immune, endocrine and connective tissue status. These alterations are associated with different pathologies and syndromes that generate periodontal disease either as a primary manifestation or by aggravating a pre-existing condition attributable to local factors. This is where the role of bacterial plaque is subject to debate. In the presence of qualitative or quantitative cellular immune alterations, periodontal disease may manifest early on a severe localized or generalized basis--in some cases related to the presence of plaque and/or specific bacteria (severe congenital neutropenia or infantile genetic agranulocytosis, Chediak-Higiashi syndrome, Down syndrome and Papillon-Lefévre syndrome). In the presence of humoral immune alterations, periodontal damage may result indirectly as a consequence of alterations in other systems. In connective tissue disorders, bacterial plaque and alterations of the periodontal tissues increase patient susceptibility to gingival inflammation and alveolar resorption (Marfan syndrome and Ehler-Danlos syndrome). The management of periodontal disease focuses on the control of infection and bacterial plaque by means of mechanical and chemical methods. Periodontal surgery and even extraction of the most seriously affected teeth have also been suggested. There are variable degrees of consensus regarding the background systemic disorder, as in the case of Chediak-Higiashi syndrome, where antibiotic treatment proves ineffective; in severe congenital neutropenia or infantile genetic agranulocytosis, where antibiotic prophylaxis is suggested; and in Papillon-Lefévre syndrome, where an established treatment protocol is available.

Enfermedad periodontal asociada a desórdenes genéticos sistemáticos / Periodontal disease associated to systemic genetic disorders

Existen condiciones sistémicas que generan una mayor susceptibilidad a la enfermedad periodontal, la cual evoluciona de forma más rápida y agresiva. Los factores involucrados tienen relación, principalmente con alteraciones a nivel inmunológico, a nivel hormonal y del tejido conectivo. Estas alteraciones se asocian a diversas patologías y síndromes, generando la enfer-medad periodontal como una manifestación primaria o agravando una condición ya establecida por factores locales. Aquí es donde el papel de la placa bacteriana es discutido. Cuando existe alteración inmunológica celular cualitativa o cuantitativa, la enfermedad periodontal se puede presentar tempranamente de forma severa localizada o generalizada, existiendo en algunos casos relación a la presencia de placa y/o a bacterias específicas (neutropenia severa congénita o agranulocitosis infantil genética, síndrome de Chediak-Higashi, síndrome de Down y síndrome Papillon-Lefévre). En la alteración inmune humoral el daño periodontal, puede ser generado de forma indirecta por alteración de otros sistemas.En los desordenes del tejido conectivo, la placa bacteriana y las alteraciones en los tejidos periodontales, aumentan la susceptibilidad a la inflamación gingival y resorción alveolar (síndrome de Marfan y síndrome de Ehler-Danlos)El manejo y tratamiento de la enfermedad periodontal esta enfocado al control de la infección y de la placa bacteriana, mediante métodos mecánicos y a métodos químicos. También se sugiere la cirugía periodontal e inclusive la exodoncia de los dientes mas afectados. Existen variantes de acuerdo a la alteración sistémica de base, como el caso del síndrome de Chediak-Higashi donde no responde a tratamientos antibióticos, en la neutropenia severa congénita o agranulocitosis infantil genética que sugiere profilaxis antibiótica y en el caso del síndrome de Papillon-Lefévre con un protocolo establecidopara el tratamiento

A number of systemic disorders increase patient susceptibility to periodontal disease, which moreover evolves morerapidly and more aggressively. The underlying factors are mainly related to alterations in immune, endocrine and con-nective tissue status. These alterations are associated with different pathologies and syndromes that generate periodontaldisease either as a primary manifestation or by aggravating a pre-existing condition attributable to local factors. Thisis where the role of bacterial plaque is subject to debate. In the presence of qualitative or quantitative cellular immunealterations, periodontal disease may manifest early on a severe localized or generalized basis – in some cases relatedto the presence of plaque and/or specific bacteria (severe congenital neutropenia or infantile genetic agranulocytosis,Chediak-Higiashi syndrome, Down syndrome and Papillon-Lefèvre syndrome). In the presence of humoral immunealterations, periodontal damage may result indirectly as a consequence of alterations in other systems.In connective tissue disorders, bacterial plaque and alterations of the periodontal tissues increase patient susceptibilityto gingival inflammation and alveolar resorption (Marfan syndrome and Ehler-Danlos syndrome).The management of periodontal disease focuses on the control of infection and bacterial plaque by means of mecha-nical and chemical methods. Periodontal surgery and even extraction of the most seriously affected teeth have alsobeen suggested. There are variable degrees of consensus regarding the background systemic disorder, as in the case of Chediak-Higiashi syndrome, where antibiotic treatment proves ineffective; in severe congenital neutropenia or infantilegenetic agranulocytosis, where antibiotic prophylaxis is suggested; and in Papillon-Lefèvre syndrome, where an establis-hed treatment protocol is available

Tonsilolito gigante: A propósito de un caso / Giant tonsillolith: Report of a case

Los tonsilolitos son pequeñas concreciones calcificadas que seforman en las criptas de las amígdalas palatinas formados porsales cálcicas o en combinación con otras sales minerales yque suelen tener pequeño tamaño. En pocas ocasiones han sidodescritos tonsilolitos de grandes dimensiones o en localizacionesperiamigdalinas.Nosotros presentamos el caso de una mujer de 55 años de edadque tenía sintomatología de disfagia y molestias en la faringecon sensación de cuerpo extraño desde había un año aproximadamenteaunque últimamente se habían agudizado las molestias.A la exploración se palpaba una tumoración dura a nivelsubmucoso en el paladar blando a nivel del pilar amigdalinoanterior derecho. El pilar parecía algo abombado, palpándosedicha tumoración como una lesión de consistencia dura y que ensuperficie presentaba la mucosa algo eritematosa. La tomografíacomputadorizada mostraba una imagen ovalada delimitada ymuy calcificada de gran tamaño (2,5x1,5 cm). Se procedió a laexéresis quirúrgica de dicha estructura

Tonsilloliths or tonsil stones are calcifications that form in thecrypts of the palatal tonsils. These calculi are composed ofcalcium salts either alone or in combination with other mineralsalts, and are usually of small size though there ha ve beenoccasional reports of large tonsilloliths or calculi in peritonsillarlocations.We present the case of a 55-year-old woman with a one-year historyof dysphagia and pharyngeal discomfort with a foreign bodysensation, though the manifestations had recently intensified.Exploration of the oral cavity revealed a hard bulging submucosalmass in the region of the soft palate, at right anteriortonsillar pillar level. The mucosa overlying the lesion appearederythematous. Computed tomography revealed a large, delimitedand highly calcified oval image measuring 2.5 x 1.5 cm, whichwas subsequently surgically removed

Giant tonsillolith: report of a case.

Tonsilloliths or tonsil stones are calcifications that form in the crypts of the palatal tonsils. These calculi are composed of calcium salts either alone or in combination with other mineral salts, and are usually of small size - though there have been occasional reports of large tonsilloliths or calculi in peritonsillar locations. We present the case of a 55-year-old woman with a one-year history of dysphagia and pharyngeal discomfort with a foreign body sensation, though the manifestations had recently intensified. Exploration of the oral cavity revealed a hard bulging submucosal mass in the region of the soft palate, at right anterior tonsillar pillar level. The mucosa overlying the lesion appeared erythematous. Computed tomography revealed a large, delimited and highly calcified oval image measuring 2.5 x 1.5 cm, which was subsequently surgically removed.

Tratamiento de la boca seca: puesta al día / Protocol for the clinical management of dry mouth

La boca seca es una situación muy común en la clínica odontológica y las causas que producen esta alteración de la secreción de saliva pueden ser múltiples. Es especialmente frecuente en personas de edad avanzada y en pacientes que están tomando gran cantidad de fármacos. El tratamiento de esta situación deberá estar relacionado con la eliminación de la causa que la produce y cuando esto no es posible se basará en el estímulo de la secreción salival con determinados fármacos o en la sustitución de la misma con las llamadas salivas artificiales. En este artículo queremos sistematizar de forma sucesiva las actuaciones terapéuticas a seguir en este tipo de pacientes (AU)

Dry mouth is a very common condition in dental practice, and the causes underlying this alteration in salivary secretion are diverse. The problem is particularly common in polymedicated elderly people. Treatment should aim to eliminate the background cause; however, when this is not possible, management should focus on the stimulation of salivation or the provision of a saliva substitute. The present study provides a systematic account of the management protocol for patients with dry mouth (AU)