Medicina oral, patología oral y cirugía bucal. 2004. Vol. 9, no. 1

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    Sífilis secundaria en un paciente VIH positivo
    (2004) López Ortega, Karem; Rezende, Nathalie Pepe Madeiros; Watanuki, Fernando; Araujo, Ney; Magalhaes, Marina H.C.G.
    The incidence of oral manifestations of HIV infection is changing markedly. Oral afflictions previously uncommon in HIV condition are now emerging in this scenario and may be underestimated. Clinical characteristics of some oral diseases could change in the presence of HIV/AIDS infection and health care professionals must be made aware of such changes. Oral lesions of secondary syphilis are rare, however they can occur and the dentist should be able to diagnose them. In some cases the anamnesis and the clinical features of the lesions are not enough to diagnose this disease. Histological features and an acute knowledge on laboratory exams, as well as its applicability and limitations are necessary to diagnose it. The present report describes a case of secondary syphilis in an HIV positive patient. The patient showed red spots in the torso's skin and abdomen. The spots were also present on the hands but the color was darker. The oral mucosa had several ulcers, with variable shapes, sometimes recovered by a white and resistant membrane. They were present in the buccal mucosa, palate, gingiva, tongue and labial mucosa. Those clinical manifestations appeared 6 months earlier. Exams were performed (VDRL, FTA-abs, direct fungal exams in the skin and oral mucosa and a biopsy in the oral mucosa) but the diagnose remained unclear. Clinical and laboratory features disagreed and postponed the final diagnosis and the treatment for more than 6 months.
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    Fibroma cemento-osificante mandibular: presentación de dos casos y revisión de la literatura
    (2004) Sanchís Bielsa, José María; Peñarrocha Diago, Miguel; Balaguer Martínez, José; Camacho Alonso, Fabio
    We present two clinical cases of radioluscent mandibular lesions in young women that simulated chronic periapical infectious pathology. The detection of both cases was fortuitous since they were totally assymptomatic. Diagnosis was reached in one case (upon periapical surgery and anatomo-pathologic study) after endodontic treatment and after verifying non-resolution of affected periapical area. The other case was an extensive lesion, which involved the periapices of the four inferior incisors in which surgery was directly performed upon verifying pulp vitality of these teeth. After surgery endodontic treatment was performed on the teeth that had lost their vitality. In both cases the histopathologic tests revealed the presence of a cemento-ossifying fibroma, the initial clinical and radiographic diagnosis of which could easily be overlooked.
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    Sedación en el paciente geriátrico
    (2004) López Jiménez, Julián; Giménez Prats, Mª José
    A review is made of the utility of iatrosedation and pharmacological sedation in the dental treatment of elderly patients. The adoption of such measures is required due to the increased prevalence of oral pathology, poorer stress tolerance and frequent association of systemic disease in such patients. A description is made of the recommended psychoactive drug administration routes according to the associated pathology and of the most frequent pharmacological interactions with the background disease. Drug sedation should always be accompanied by psychological measures to minimize the required drug dose, and by correct locoregional anesthesia.
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    Efectos del consumo de alcohol etílico en la cavidad oral: relación con el cáncer oral
    (2004) Figuero-Ruiz, Elena; Carretero Peláez, Mª Angeles; Cerero Lapiedra, Rocío; Esparza Gómez, Germán Carlos; Moreno López, Luis Alberto
    In an epidemiologic point of view the consumption of alcoholic beverages is found to be associated to an increased risk for developing an upper gastrointestinal tract cancer. The relation of the studies that establish this connection is complicated due to both the confluence of various risk factors within the same person such as alcohol and tobacco, and to the lack of data that can be verifiable by the clinician. For this reason the exact pathogenic mechanism responsible for this increase of risk is not known since ethanol per se was not confirmed to be carcinogenic. Different hypotheses have been proposed, explaining how ethanol, by oral or systemic route, can act as a risk factor for the development of oral cancer. This article serves as a review of the actual situation of the potential pathogenic mechanisms, dividing them in local and systemic effects. Within the aforementioned special reference is made on the alteration of the oral mucosa permeability, the action of acetaldehyde and the role of retinoids.
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    Diagnóstico diferencial de tumefacciones y tumoraciones submandibulares
    (2004) Junquera Gutiérrez, Luis Manuel; Olay, Sonsoles; Baladrón, J.
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    Pautas de profilaxis antibiótica de Endocarditis Bacteriana, recomendadas por los odontólogos en España
    (2004) Tomás Carmona, Inmaculada; Diz Dios, Pedro; Limeres Posse, Jacobo; Outumuno Rial, Mercedes; Caamaño Durán, Flor
    The aim of this study was to assess the current practice of antibiotic prophylaxis of Bacterial Endocarditis (BE) among General Dental Practitioners (GDPs) in Spain. GDPs were asked over the telephone by a fictitious patient what antibiotic prophylaxis they would administer to an 'at risk' patient for BE before a tooth extraction. Four hundred randomly selected Spanish GDPs were surveyed, 200 of them were asked about BE prophylaxis in penicillin non-allergic patients and the remaining 200 in penicillin allergic patients. Of the GDPs surveyed, 182 (45.5%) did not recommend any prophylactic treatment; 74.7% of those stated that an oral examination before treatment was needed and 25.3% referred the patient to his/her physician or cardiologist for further advice. Of the 97 GDPs who recommended antibiotics to penicillin nonallergic patients, only 30 (30.9%) suggested the prophylactic guidelines proposed by the American Heart Association or the British Society for Antimicrobial Chemotherapy. For penicillin allergic patients, 68.2% of the GDPs prescribed erythromycin as the antibiotic of first choice, while 17.6% of the GDPs prescribed clindamycin. Nonetheless, fewer than 30% administered both antibiotics with the adequate dosages. These results show important gaps in the knowledge of antibiotic prophylaxis for 'at risk' patients before dental procedures among Spanish GDPs.
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    Sialosis Parotídea Alcohólica: estudio Estructural y Ultraestructural
    (2004) Carda Batalla, María del Carmen; Gómez de Ferraris, María Elsa; Arriaga, Adriana; Carranza, Miriam; Peydró Olaya, Amando
    Objectives: The purpose of this study is to demonstrate the histopathological differences between the initial and advanced stages of Alcoholic Sialosis, a pathology that generally involves parotid hypertrophy and structurally affects, to diverse degrees, the other salivary glands. Study design: An analysis and comparison was carried out of the structural and ultrastructural modifications of the parotid glands from the hepatic biopsies of chronic alcoholics with clinical diagnosis of cirrhosis and from autopsies on individuals who had died from alcoholic hepatic cirrhosis. Various samples of normal gland obtained from surgical material were used as a control. Results: The alterations found in the biopsies corresponded to the modifications discovered in the autopsies of alcoholics. Notable in both cases was the massive accumulation of secretory granules of different size, shape and electrodensity, which occupied the cytoplasm of the acinar cells. In both sample types the excretory ducts were enlarged and the epithelium of the striate ducts presented cells with nuclei and cytoplasm of irregular appearance and arrangement. A moderate adipose infiltration in the stroma and slight periacinal edema was also observed. The biopsies revealed, both at optical and electron microscopical levels, lipid inclusions in the acinar cells and the glandular parenchymal ducts. Conclusions: The structural and ultrastructural findings of the parotid biopsies and autopsies, clearly show that alterations are already present in the salivary glands of chronic alcoholics before the terminal phase of hepatic cirrhosis. The enlargement of the ductal system lumens could be the principal cause of glandular hypertrophy.
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    Perineurioma intraneural de presentación intramandibular: estudio histológico, inmunohistoquímico y citogenético
    (2004) Huguet, Pere; de la Torre, Javier; Pallarès, Judith; Carrera, Marta; Soler, Francesc
    We report a case of an intramandibular intraneural perineurioma developed in the left dentary nerve. This tumour is rare and shows a typical histological, immunohistochemical and ultrastructural appearance: concentric whorls of perineurial cells EMA+ and PS100- around nerve fibers. This tumour must be distinguished from extraneural or soft tissue perineurioma, also composed of perineurial cells, with distinct clinical presentation and histological appearance, and from localized hypertrophic neuropathy, a reactive process frequently identified with intraneural perineurioma. Cytogenetic evidence for the neoplastic nature of this tumour is also presented in this report.
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    Puesta al día sobre implantes de carga inmediata: revisión bibliográfica
    (2004) Herrera Briones, Francisco Javier; Romero Olid, María Nuria; Vallecillo Capilla, Manuel Francisco
    The treatment of totally or partially edentulous patients with osseointegrated implants is an increasing part of daily dental practice. The greater aesthetic and functional demands made by these patients have created a constant pressure to reduce the waiting time before implants are loaded. In some cases, however, a shortening of the waiting period may compromise the osseointegration of the fixtures. The present review aims to inform the clinician about the continuing controversy on this issue. Data from the reviewed studies allow comparisons to be made between the different success rates obtained after immediate implant loading, offering a more objective basis for our advice to patients on this type of treatment. According to our review, the type and quality of the bone and the surface of the implant are the factors that determine the selection of patients who can undergo the premature loading of implants.
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    Asociación entre alteraciones psicológicas y la presencia de Liquen plano oral, Síndrome boca urente y Estomatitis aftosa recividante
    (2004) Soto Araya, Milena; Rojas Alcayaga, Gonzalo; Esguep, Alfredo
    OBJECTIVE: The aim of this study was to determine the existing relation between the Oral Lichen Planus (OLP), Recurrent Aphthous Stomatitis (RAS), Burning Mouth Syndrome (BMS) and psychological alterations of the patient, such as stress, anxiety and depression. DESIGN OF THE STUDY: 18 patients with RAS, 9 patients with OLP and 7 patients with BMS, that presented the condition at the moment of the examination, were studied, as well as a control group of 20 healthy patients. Both groups were extracted of hospitals and universitary centers, where the clinical diagnosis was made by a team of oral pathologists. Two measuring instruments were applied to them about their psychological condition: the Test of Recent Experience, to measure the stress level and scale H.A.D., to determine the level of anxiety and depression; the score given by them were statistically analyzed through T-test and the Anova Tukey test. RESULTS: Our results suggested a statistically significant association between these psychological disorders and the diseases of the oral mucosa in study. It was observed that the stress level is greater in patients with RAS and OLP, depression is particularly high in patients with BMS, and levels of anxiety are rised in the three groups, in comparison with the group control. CONCLUSIONS: A positive relationship can be established between psychological alterations and RAS, OLP and BMS. The RAS and the OLP stress and anxiety levels were considered as high, whereas the BMS was more related to important levels of anxiety and depression. According to these findings it is possible to assume that psychological factors should be taking into account when oral health wants to be maintain as normal.
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    Síndrome de boca ardiente: estudio de la psicoterapia, medicación con ácido alfa- lipoico y combinación de terapias
    (2004) Femiano, Felice; Gombos, Fernando; Scully, Crispian
    En este estudio de 192 personas sanas con Síndrome de boca ardiente, se analizó la eficacia del control de los síntomas de la psicoterapia sola durante dos sesiones semanales de 1 hora durante dos meses, del ácido alfa lipoico (ALA, ácido tioctico, Tiobec) 600 mg al día durante dos meses, y de la combinación de la psicoterapia y los 600 mg / día de ALA durante 2 meses. Los controles solo recibieron placebo. RESULTADOS. Se obtuvo el mayor beneficio con la terapia combinada. La combinación de los tratamientos con psicoanálisis y ácido alfa lipoico (ALA, acido tioctico, Tiobec 600 mgr al día), durante 2 meses fue significativamente más beneficiosa que el psicoanálisis solo durante dos sesiones semanales de una hora durante dos meses ( p< 0.0005) o el ALA 600 mgr al día solo, durante dos meses (p< 0,0005). CONCLUSIÓN. Los resultados sugieren que el ácido alfa lipoico podría complementar la psicoterapia y ser una alternativa aceptable a los fármacos psicoactivos, por lo que estudios de comparación de ambas alternativas están actualmente justificados.
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    Tumor fibroso solitario de la region parotidea: Reporte de un caso y revisión de la literatura
    (2004) Suárez Roa, María de Lourdes; Ruíz Godoy Rivera, Luz María; Meneses García, Abelardo; Granados García, Martín
    Solitary fibrous tumor is a well-recognized entity that most commonly involves the pleura; however, it has been recently described in other locations including the head and neck region, where it occurs as a slowly growing and well-circumscribed lesion. Due to its low frequency it may be confused with other neoplasms, and for this reason microscopic, ultrastructural and immunohistochemical features are necessary to establish its diagnosis. Prognosis of this tumor depends on its location and size. We present a 20-year-old woman with a well circumscribed, rapidly enlarging solitary fibrous tumor located in the parotid region, which protruded into the oral cavity, measured 10 x 8.5 x 5.5 cm and exhibited benign histological features and positive immunoreactivity to CD34.
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    Manifestaciones orales de la enfermedad por depósito lineal de IgA
    (2004) Eguía Del Valle, Asier; Aguirre Urízar, José Manuel; Martínez-Sahuquillo Márquez, Ángel
    The Linear IgA deposit related disease or Linear IgA disease (LAD) is a chronic, uncommon and autoimmunological mucocutaneous disease, characterised by linear IgA deposits along the basement membrane zone. In mainly cases, moreover cutaneous lesions, there are oral mucosal and other mucosal lesions. There are also, some cases published of Linear IgA disease limited to oral mucosa. The known of this disease is important for the establishment of a correct differential diagnosis in cases of blistering mucocutaneous diseases. In this paper, we analyze the most important features of this disease, attending specially to the oral manifestations.