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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2008. Vol. 13, no. 5
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- Pediatric dental care in a tertiary public hospital. Four years of experience in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain)(2008) Poveda Roda, Rafael; Jiménez Soriano, Yolanda; Gavaldá Esteve, Carmen; Sanchís Bielsa, José María; Carbonell Pastor, Enrique; Margaix Muñoz, María; Sarrión Pérez, María GraciaA study is made of the experience gained with the Child Oral Care Program (Plan de Atención Dental Infantil, PADI) in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain) after four years in operation (July 2003 - July 2007). Study design: The sample comprised 2626 children between 5-14 years of age, pertaining to department 9 of the Valencian public health system. A clinical history was compiled in each case, a radiological study was made, and a treatment plan was elaborated including fillings, extractions, and control visits. Results: Of the 2626 designated children, 2369 visited our Service - mostly referred from the Preventive Dental Care Units. A total of 5784 fillings were carried out (93.3% with silver amalgam, 5.6% with composites and the rest as provisional fillings). The permanent first molars were the teeth with the largest number of fillings (70.2% of the total). These were followed in order of frequency by the second molars (19.1%). As regards composite resin fillings, most involved the upper central incisors, followed by the upper lateral incisors. A total of 644 extractions were performed, corresponding to 110 permanent teeth and 534 temporary teeth. In the case of the permanent dentition, the first molars were the most commonly removed teeth. In the temporary dentition, the most frequently removed teeth were the second molars. Conclusions: The response of the population to this program has been very good, and reinforces the preventive measures already in place, with the provision of restorative treatments to improve the oral and dental health of the pediatric population, and yielding good results in terms of the program quality indicators. The Service of Stomatology (Valencia University General Hospital) is able to address the demand and offers the public health network integrated and continuous patient care.
- Osteochemonecrosis of the jaws due to bisphosphonate treatments : update(2008) Gómez Font, Rafael; Martínez García, María Luisa; Olmos Martínez, José ManuelBisphosphonates (BP),were initially used in industry and later as a drug due to their great affinity to osseous tissue, because of their powerful antiresorptive effect as a treatment in various osteopathies, such as osteoporosis, Paget disease or hypercalcemia associated with some malignant tumors, as myeloma or breast cancer. They are administered orally or intravenously, and although well tolerated, the most frequent side effects are gastrointestinal, in addition to osteonecrosis when they are administered via endovenous. The aim of this work has been to evaluate the existing publications in accredited scientific literature on biphosphonates and their action mechanism and the relationship with the appearance of osteonecrosis of the jaws. Although the mechanism by which osteonecrosis of the jaws develops is not known exactly, there seems to be influence by osteoclast inhibiton, antiangiogenic action, an inhibitory effect on the cellular cycle by the keratinocytes, as well as, reinforcement of the chemiotoxic action in oncological patients treated with other drugs. Clinically, it ranges from a non-specificity of symptoms to lesions such as osteomyelitis with necrosis and osseous sequesters that may be accompanied by fetor ex oris, with the appearance of many Actinomyces contaminated lesions. As for published antecedents on osteonecrosis due to bisphosphonate treatment found until 2006: 46.5% had a previous diagnosis of multiple myeloma; 38.8% were patients with metastatic breast cancer; 6.2% patients of metastatic prostate cancer; 4.1% suffered from osteoporosis; 3.5% from other metastatic diseases and 0.8% had Paget disease. The drugs that seem to have the highest incidence of osteochemionecrosis are: zoledronate, pamidronate, alendronate, risendronate and ibandronate, from the greatest to the least. Additionally, the risk of osteonecrosis being produced is accumulative and may reach 21% in the third year of intravenous bisphosphonate use.
- Evidence concerning the medical management of caries(2008) Llena Puy, María Carmen; Forner Navarro, LeopoldoCaries is an infectious, chronic and cumulative disease. It seriously affects quality of life and creates considerable expense for individuals and communities. The disease can be managed by acting on biofilm formation and maturation, by modifying the kinetics of apatite solution or with a combination of the two processes. This can be achieved by mechanical and chemical control of plaque, appropriate use of fluorides, controlling diet and salivary flow, when possible. Many of these factors depend on the patient?s co-operation. Decisions concerning treatment are influenced by two questions: the scientific evidence for the different alternatives available and each patient?s individual caries risk. The use of different fluoride regimes, depending on the individual risk, remains the most scientifically proven method for avoiding the appearance of new lesions and curbing the speed at which existing ones progress. Chemical control of plaque using chlorhexidine is indicated for patients at high microbiological risk; it is more effective at controlling caries when used in combination with fluorides. Fissure sealing is an effective means of controlling occlusal caries of the molars when the patient?s caries risk and the eruptive age of the tooth are taken into account.
- Study of available bone for interforaminal implant treatment using cone-beam computed tomography(2008) Madrigal Martínez-Pereda, Cristina; Ortega Aranegui, Ricardo; Meniz García, Cristina; López Quiles, JuanObjectives: To analyze the availability of bone in the interforaminal region and to demonstrate the variation in diagnosis between panoramic x-ray and cone-beam computed tomography (CBCT). Material and methods: In 50 patients and in 5 areas of each, a series of parameters concerning available bone were measured on both the panoramic and the CT images. Results: Panoramic images underestimate the vertical and horizontal measurements when compared with CBCT. Regarding implant treatment, the interforaminal region presents the same remaining bone height throughout its full extent, the correlation between one side of the midline and the other was highly significant for all the parameters studied, and 20% of the sample showed some buccal and/or lingual concavity. Conclusion: Cone-beam CT is an advantageous system for interforaminal implant treatment planning, especially since the reported radiation dose is minimal and geometric accuracy is very high.
- Lateral periodontal cysts : a retrospective study of 11 cases(2008) Formoso Senande, María Florencia; Figueiredo, Rui; Berini Aytés, Leonardo; Gay Escoda, CosmeObjective: To describe the clinical, radiological and histopathological features of lateral periodontal cysts among patients diagnosed in different centers (Vall d?Hebron General Hospital, Granollers General Hospital, the Teknon Medical Center, and the Master of Oral Surgery and Implantology of the University of Barcelona Dental School; Barcelona, Spain). Study design: A retrospective observational study was made of 11 lateral periodontal cysts, all of which were diagnosed following a thorough clinical examination, radiological study and posterior histological study. Results: The mean patient age was 37 years, and males predominated over females. The mean lesion size was 1.25 cm. A single relapse was recorded 7 years after removal of the initial lesion. All the cysts were surgically removed. Discussion and conclusions: Lateral periodontal cysts are very infrequent, and are characterized by the preserved vitality of the adjacent teeth. Identification of the lesion is initially based on the clinical findings, though histological study is required to confirm the diagnosis. The treatment of choice is the surgical removal, though occasional relapses have been documented.
- Evaluating periodontal conditions in patients with von Willebrand?s disease in Hospital Universitario de Maracaibo (University Hospital, Maracaibo) -Venezuela(2008) Benito Urdaneta, Marisol; Benito Urdaneta, Mariluz; Ferrara Mendez, Victor; Bernardoni de Socorro, Cecilia; Arteaga Vizcaino, MelvisObjective: To evaluate the periodontal conditions of patients with von Willebrand?s Disease (vWD) who went for dental examination in the ?Area of attention to patients with systemic disease? of the University Hospital in Maracaibo, Venezuela. Design of the Study: 40 patients (28 female and 12 male), with ages ranging from 10 to 72 years, who regularly attended dental control, were evaluated along with a control group of patients with no hemorrhagic alterations. Periodontal conditions were evaluated using the Löe and Silness Gingival Index (GI) and Greene and Vermillon?s Simplified Oral Hygiene Index (SOHI). The results were analyzed using averages, Standard Deviation, Student?s T-test and the Chi² test, with P<0.0005. Results: 92.5% of the patients had Type 1 vWD and 7.5% had Type 2 or 3. Periodontal Indices: GI (0.70±0.40, slight) and SOHI (1,70±0,80, acceptable). Comparison with the control group showed that there were statistically significant differences in the SOHI (P = 0.02). Conclusions: Periodontal conditions in patients with vWD regularly attending for dental control were within acceptable parameters. Education of the patient with regard to prevention and opportune treatment is of utmost importance, thereby avoiding the oral hemorrhagic complications produced by the periodontal disease. Of equal importance is multidisciplinary teamwork.
- Salivary concentration of TNF?, IL1?, IL6, and IL8 in oral squamous cell carcinoma(2008) SahebJamee, Mahnaz; Eslami, Mohammad; AtarbashiMoghadam, Fazele; Sarafnejad, AbdolfattahObjectives: The aim of this study was to compare the concentration of tumor necrosis factor ?, interleukin 1?, 6, and 8 in the saliva of oral squamous cell carcinoma patients with control group. Study design: In this study 18 subjects were involved, nine patients with oral squamous cell carcinomas and nine age-sex-matched healthy individuals that were matched for gingival conditions too. Active dental abcesses, collagen vascular diseases, and infectious diseases during one month before saliva sampling were considered as exclusion criteria. Unstimulated whole saliva was collected and after processing the samples were analyzed by Enzyme Linked Immune Assay. Results: The concentration of salivary interleukin 6 in oral squamous cell carcinoma patients was higher than control group and it was statistically significant (p < 0.05). The concentration of salivary tumor necrosis factor ?, interleukin 1? and 8 in case group was higher than control group but it was not statistically significant (p > 0.05). Conclusions: These results shows that more studies are needed to accept the utility of these cytokines in predicting or diagnosis of oral squamous cell carcinoma or evaluation of treatment.
- Cardiovascular diseases in dental practice : Practical considerations(2008) Margaix Muñoz, María; Jiménez Soriano, Yolanda; Poveda Roda, Rafael; Sarrión Pérez, María GraciaCoronary heart disease is the principal cause of death in the industrialized world. Its most serious expression, acute myocardial infarction, causes 7.2 million deaths each year worldwide, and it is estimated that 20% of all people will suffer heart failure in the course of their lifetime. The control of risk cardiovascular factors, including arterial hypertension, obesity and diabetes mellitus is the best way to prevent such diseases. The most frequent and serious cardiovascular emergencies that can manifest during dental treatment are chest pain (as a symptom of underlying disease) and acute lung edema. Due to the high prevalence and seriousness of these problems, the dental surgeon must be aware of them and should be able to act quickly and effectively in the case of an acute cardiovascular event. In patients with a history of cardiovascular disease, attention must center on the control of pain, the reduction of stress, and the use or avoidance of a vasoconstrictor in dental anesthesia. In turn, caution is required in relation to the antiplatelet, anticoagulant and antihypertensive medication typically used by such patients.
- Sensitivity of direct immunofluorescence in oral diseases : study of 125 cases(2008) Sano, Susana Mariela; Quarracino, María Cecilia; Aguas, Silvia Cristina; González, Ernestina Jesús; Harada, L.; Krupitzki, Hugo; Mordoh, AnaDirect immunofluorescence (DIF) is widely used for the diagnosis of bullous diseases and other autoimmune pathologies such as oral lichen planus. There is no evidence in the literature on how the following variants influence the detection rate of DIF: intraoral site chosen for the biopsy, perilesional locus or distant site from the clinical lesion, number of biopsies and instrument used. Objectives: to determine if the following variants influenced the sensitivity (detection rate): intraoral site chosen for the biopsy, perilesional or distant site from the clinical lesion, number of biopsies and instrument used (punch or scalpel). Material and methods: A retrospective study was done at the Cátedra de Patología y Clínica Bucodental II at the Facultad de Odontología, Universidad de Buenos Aires; 136 clinical medical histories were revised for the period March 2000 ? March 2005 corresponding to patients with clinical diagnosis of OLP and bullous diseases (vulgar pemphigus, bullous pemphigoid and cicatricial pemphigoid). Results: DIF detection rate was 65.8% in patients with OLP, 66.7% in cicatricial pemphigoid patients, in bullous pemphigoid 55.6%, in pemphigus vulgaris 100%, and in those cases in which certain diagnosis could not be obtained, the DIF positivity rate was 45.5% (Pearson chi2 (4)= 21.5398 Pr= 0.000). There was no statistically significant difference between the different sites of biopsy (Fisher exact test: 0.825). DIF detection rate in perilesional biopsies was 66.1% and in those distant from the site of clinical lesion was 64.7% (Pearson chi2 (1)= 0.0073 Pr= 0.932). When the number of biopsies were incremented, DIF detection rate also incremented (Pearson chi2 = 8.7247 Pr= 0.003). The biopsies taken with punch had a higher detection rate than those taken with scalpel (39.1% versus 71.7%) (Pearson chi2 = 49.0522 Pr= 0.000). Conclusion: While not statistically significant, the tendency outlined in this study indicates there are intraoral regions in which the detection rate of the DIF technique is higher than others: mouth floor, hard palate, superior labial mucosa, ventral face of tongue. This finding could allow a choice of accessible locations and easy operator manipulation, even in distant places from the clinical lesion. Perilesional biopsies have a detection rate similar to those taken distant from the clinical lesion, and those taken with punch have a higher sensitivity rate than those taken with scalpel (both differences were statistically significant).
- Oral lesions in HIV infected individuals from Ribeirão Preto, Brazil(2008) Lourenço, Alan Grupioni; Figueiredo, Luiz Tadeu MoraesObjectives: The aim of this study was to diagnosis oral lesions related to HIV infection in individuals followed in the General Hospital of the School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. The presence of oral lesions was correlated with gender, age, smoking habit, levels of CD4 lymphocytes, HIV load, time of HIV seropositivity, AIDS condition, use of removable dental prosthesis, and use of HAART. Materials and Methods: 340 HIV infected individuals were selected for this study, all participants of the study were examined by only one practiced dentist which performed anamnesis, peribuccal and oral examination. Results: Oral lesions were observed in 113 of 340 (33.2%) HIV infected individuals. These oral lesions included: oral candidiasis (17.7%) of pseudomembranous (10.8%) and of erythematous types (6.9%), angular cheilitis (13.9%), hairy leukoplakia (11.8%), and oral ulcers (2.1%). Oral candidiasis lesions were more frequently observed in women (p.033). Smoking addict participants presented a high frequency of tongue hairy leukoplakia (p.038) and a reduced frequency of oral ulcers (p.018). Hairy leukoplakia and pseudomembranous candidiasis were inversely correlated to CD4+L levels and directly correlated with HIV load, behaving as immune depression markers. Hairy leukoplakia and pseudomembranous candidiasis also showed an inverse correlation with HAART use (p<.0001). Patients using mobile dental prosthesis presented a high frequency of erythematous candidiasis (p.003). Conclusion: The inverse correlation with CD4+L level and the direct correlation with HIV load suggest that oral lesions could be used as alternative clinical markers for poor immune condition in HIV infected individuals.
- Immunohistochemical analysis of the patterns of p53 and PCNA expression in odontogenic cystic lesions(2008) Oliveira, Márcia Gaiger de; Lauxen, Isabel da Silva; Chaves, Anna Cecília Moraes; Rados, Pantelis Varvaki; Sant Ana Filho, ManoelObjective: the role of p53 expression in odontogenic lesions has not been fully determined, but has been associated with cell proliferation. The purpose of this study was to analyze p53 and proliferating cell nuclear antigen (PCNA) expression in 4 different odontogenic lesions. Design: expression of p53 and PCNA was analyzed in radicular and dentigerous cysts, odontogenic keratocysts, and calcifying odontogenic cysts (Gorlin cysts) using monoclonal antibodies for detection of p53 and PCNA. Results: PCNA expression was significantly greater in the basal layer of radicular cysts and in the suprabasal layer of odontogenic keratocysts; the percentage of p53 positive cells was significantly greater in the suprabasal layer of odontogenic keratocysts. Conclusions: The patterns of p53 and PCNA expression in dentigerous and radicular cysts were similar although the two lesions are of different origin. In odontogenic keratocysts and Gorlin cysts, results indicate a different pattern of tumor growth.
- Prevalence of oral soft tissue lesions in an elderly venezuelan population(2008) Mújica, Valentina; Rivera, Helen; Carrero, MaríaAim: The purpose of the present study was to determine the prevalence of the oral soft tissue lesions in patients referred to the geriatric unit ?Dr. Joaquin Quintero?, National Institute of Gerontology. Study Design: 340 patients were clinically evaluated, of these 266 were institutionalized and 74 were seen at the outpatient clinic, age ranging 60 to 104 years. 212 were females and 128 males. The statistical analysis was done using the SPSS software (11.0) to a significant level of 5% (p<0.05). Results: Fifty seven percent of the studied population presented one or more oral lesions, associated to prosthetic use, trauma and tobacco consumption. Females were more affected than males. The lesions were more frequently observed between 60 to 74 years of the institutionalized group of patients of these, 34% exhibited only one oral lesion. Few cases presented up to 4 oral lesions. The most common alterations observed were: denture stomatitis, oral leukoplakia, hemangioma, oral melanotic macule, traumatic fibroma, inflammatory fibrous hyperplasia and angular cheilitis. Conclusions: The findings observed in this population are important to be considered when clinically evaluating oral soft tissue in elderly. Close follow up and systematic evaluation is required in this population.
