MRONJ risk of adjuvant bisphosphonates in early stage breast cancer.

Medication-related osteonecrosis of the jaw (MRONJ) has most commonly been associated with bisphosphonates. The routine uses of these drugs are now well established predominantly in metastatic cancer with bone involvement, multiple myeloma, hypercalcaemia, osteoporosis and Paget's disease. Recently, however, the use of bisphosphonates in early breast cancer has shown a reduction in breast cancer recurrence and breast cancer deaths. This new indication for their use approximates to a further 20,000 women per year in the UK being prescribed bisphosphonates. In this article, we consider the dental impact of this new use of bisphosphonates, report on the rates of MRONJ seen in early breast cancer bisphosphonate trials and discuss strategies aimed at minimising the risk of bisphosphonate-exposed patients developing MRONJ.

Interactive group therapy for the management of myofascial temporomandibular pain.

Background and aim To evaluate the outcome of a group therapy approach in the management of myofascial temporomandibular pain (TMD) through promotion of self-care.Methods A group based interactive session was introduced for those patients who, at initial consultation, were diagnosed with myalgic TMD. Feedback forms and telephone interviews were used to record patient reported outcome measures to assess patient satisfaction with the service.Results Fifty-five patients attended 17 group sessions over ten months. Feedback revealed a high level of satisfaction immediately after the session with 71% (n = 39) of patients opting for discharge, reporting confidence to self-manage in primary care. This effect appears to be sustainable up to 11 months.Conclusions This approach benefits patients with myofascial TMD through promotion of self-management while utilising health care resources efficiently.

Beyond ONJ - A review of the potential uses of bisphosphonates in dentistry.

There is evidence, although limited, for beneficial effects of bisphophonates (BPs) across multiple dental specialties. Within implant dentistry BP coatings have been shown to significantly increase pull out forces and bone density in animal models, and significantly increase implant stability whilst reducing marginal bone loss in humans. Adjunctive topical and systemic application of BPs during conventional periodontal treatment have shown significant improvements in probing depth and clinical attachment level in various forms of periodontal disease. Within orthodontics, BPs have been shown to significantly reduce root resorption and have benefits with respect to anchorage maintenance. Case reports have suggested the use of BPs in the management of diffuse sclerosing osteomylitis. Whilst this review highlights these potential benefits and acknowledges there are no reported cases of osteonecrosis of the jaw associated with locally applied BP, there remains a paucity of human and long-term studies exploring BPs in the context of significant clinical benefit. Further human studies are required to understand the long-term clinical outcomes of these drugs when used as primary therapeutic agents, or adjuncts to conventional treatment.

New cancer therapies and jaw necrosis.

Osteonecrosis of the jaw (ONJ) has a number of causes, the most familiar being radiation or bisphosphonate induced. Various other novel anti-neoplastic and bone-targeting therapies that can also cause jaw necrosis have recently become available. This has led to the suggested acronym MRONJ for medication-related osteonecrosis of the jaw. This article summarises the available information on these drugs and their implications for the dental surgeon.

Brief advice on alcohol: as easy as A...B...I?

Alcohol is widely consumed by the majority of the UK population and alcohol-related harm is estimated to cost society £21 billion per year in healthcare, lost productivity costs, crime and antisocial behaviour. The dental setting offers an ideal opportunity to screen for harmful alcohol consumption; however, current emphasis is on the management of acute complications and risk associated in treating patients with excessive alcohol intake rather than screening and patient education. This article outlines ways in which dentists could improve their recognition of 'at risk' patients and then offer practical advice to help reduce the harmful effects of alcohol.

Coronectomy - oral surgery's answer to modern day conservative dentistry.

Removal of mandibular third molars is a common oral surgery procedure which is associated with a significant risk of injury to the inferior dental nerve (IDN). In an era of conservative dentistry the technique of coronectomy, which is conservative in terms of surgery and successful in minimising the incidence of IDN injury, has been met with some resistance and has been deemed non-ideal and controversial by many oral surgeons. This article outlines the benefits of coronectomy and highlights some examples from other dental specialities that have embraced conservative principles, despite their detractors.

Should we screen for hypertension in general dental practice?

Hypertension is reported by the World Health Organisation as one of the most important causes of premature morbidity and mortality, although it is often asymptomatic. Approximately 40% of the UK population are thought to be affected, however, only one third of these are currently detected. Dental practice offers an ideal opportunity to screen for hypertension, due to the large cohort of the general population who regularly attend. A pilot study was carried out to screen for hypertension and associated risk factors in 114 consecutive patients who attended a city general dental practice. Results revealed that 39% (44) of the population screened had a high blood pressure reading but only 18% (8) of these were previously diagnosed as hypertensive, and 16% (7) had systolic readings greater than 160 mmHg. Of those currently receiving treatment for hypertension, the blood pressure was still elevated in 63% (5). This suggests that screening for hypertension in general dental practice may be of benefit to the population at large.

Endoscopically assisted operative retrieval of parotid stones.

The treatment of large parotid stones remains a problem. We describe a technique in which microendoscopy is used to locate the stone and facilitate its removal. Over a 12-month period, eight patients were treated and seven stones removed successfully. The remaining duct was obstructed by a stricture. In six instances, the parotid duct was repaired and in two ligated. The mean follow up was 10 months (range 6-18) and there have been no complications. Our initial experience suggests that microendoscopy to locate the stone and facilitate its removal is an option in the management of persistent parotid stones.

Conservative management of salivary stones and benign parotid tumours: a description of the surgical techniques involved.

Recent advances in salivary gland surgery have made it possible to apply minimally invasive techniques to the management of salivary stones and benign parotid tumours. The techniques of extra-capsular dissection, intraoral removal of stones and endoscope-assisted removal of parotid calculi are described together with the context in which they are applied in clinical practice.

Oral metastasis in malignant pleural mesothelioma.

A case is reported of a 48-year-old man with malignant sarcomatous pleural mesothelioma, who presented with a secondary deposit in the mandibular alveolus. We believe that this is the first reported case of this nature.