Oral manifestations of Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome is a rare hereditary disease of the connective tissue which can present oral manifestations. A brief history of the disease is presented along with the epidemiology and characteristics of the 8 main phenotypes of the syndrome. The article also describes the case of a 12-year-old patient presenting with hypermobility of the temporo-mandibular joint and capillary fragility, and highlights the precautions to take when treating patients with this syndrome.

Upper dental prosthesis instability consecutive to the resection of a cerebral tumor.

A 57-year-old female patient was evaluated for an unstable maxillary dental prosthesis. The patient stated that approximately 2 weeks prior to this consultation the prosthesis was relined four times. Despite this, it often had a tendency to shift during meals. On the other hand, she is very satisfied with a complete fixed prosthesis on implants in the mandibular arch. She has been wearing this latter lower prosthesis for the same length of time as the upper prosthesis. She indicated that a similar problem existed with the former upper prosthesis, resulting in her consulting a prosthodontist.

Oral and maxillofacial manifestations of multiple sclerosis.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system which mostly affects young adults living in the northern hemisphere. It is a disease primarily found in temperate climates, being rare in the tropics and increasing in frequency with distance from the equator. Canada has one of the highest prevalence rates in the world. Dentists should be familiar with the clinical manifestations that affect the oral and maxillofacial areas as well as patients' general health. Three of the most frequent oro-facial symptoms include trigeminal neuralgia, trigeminal sensory neuropathy and facial palsy. Dentists should also be aware of the importance of this disease in the diagnosis, treatment and prognosis of certain oro-facial lesions or conditions. This paper reviews 2 cases of multiple sclerosis, highlights its oro-facial manifestations and discusses the dental implications of the disease.

Trigeminal sensory neuropathy: a study of 35 cases.

OBJECTIVE: Trigeminal sensory neuropathy includes a wide variety of conditions sharing a common symptom described as sensory disturbance of the face--usually numbness. STUDY DESIGN: This 10-year retrospective study included 35 patients referred for investigation of trigeminal sensory neuropathy. RESULTS: The most common causes of trigeminal sensory neuropathy were nonneoplastic cerebral disorders, mainly represented by multiple sclerosis and idiopathic trigeminal sensory neuropathy. Furthermore, when only mandibular trigeminal sensory neuropathy was considered, metastatic neoplasia was the most frequent cause, often afflicting men over the age of 60 years. CONCLUSIONS: This overview will orient clinicians in their diagnosis when they are faced with patients consulting for trigeminal sensory neuropathy.

Adenoid cystic carcinoma of the maxillary sinus.

A patient was referred by her dentist to the author for the evaluation of a left palatal mass and orofacial anesthesia. The author diagnosed a maxillary sinus malignancy and anesthesia of the maxillary branch of the left trigeminal nerve. Thoroughly examining the maxillary sinus of each patient who has anesthesia of the maxillary branch of the left trigeminal nerve is important in the early detection of adenoid cystic carcinoma.

Oral candidiasis and multiple myeloma. An unusual association.

A case of oral candidiasis possibly associated with multiple myeloma is presented. A review of the literature and a pertinent discussion relevant to this unusual association are offered.

Acoustic neuroma presenting as orofacial anesthesia.

Two cases of acoustic neuroma are reported. Orofacial anesthesia was the principal symptom in each case. This presentation is unusual for this type of tumor; therefore, the relevant literature is reviewed.

Contraindications to vasoconstrictors in dentistry: Part I. Cardiovascular diseases.

This article reviews the main contraindications of vasoconstrictors in cardiac patients, notably unstable angina, recent myocardial infarction, recent coronary artery bypass surgery, refractory arrhythmias, untreated or uncontrolled hypertension, and untreated or uncontrolled congestive heart failure. Extensive survey of the literature has been completed, giving specific guidelines for a rational use of vasoconstrictors in this category of medically compromised patients.

Contraindications to vasoconstrictors in dentistry: Part II. Hyperthyroidism, diabetes, sulfite sensitivity, cortico-dependent asthma, and pheochromocytoma.

Dentists are aware of contraindications to the use of vasoconstrictors in patients with cardiovascular diseases. However, there are some other noncardiac conditions we should know. This article discusses the absolute contraindications to the use of vasoconstrictors in patients with a history of hyperthyroidism, diabetes, allergy to sulfites, asthma, and pheochromocytoma.

Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions.

This article discusses the relative contraindications to the use of vasoconstrictor in patients currently medicated with tricyclic antidepressants, monoamine oxidase inhibitors, phenothiazines and beta-blockers. It reviews drug interactions and emphasizes potential detrimental systemic effects that epinephrine contained in local anesthetics can have when administered concomitantly with these drugs. Finally, special considerations are expressed concerning patients who abuse illicit drugs such as cocaine.

[The influence of medical and nutritional factors in gerodontology]. / Influence des facteurs médicaux et alimentaires sur l'approche gérodontologique.

Nutritional and medical factors may influence dental treatment for the elderly. The aim of this paper is to review these factors for the practitioner who provides treatment for the aged. Better knowledge should lead to a greater facility in providing treatment for this group of people.

Oral pigmentation induced by Premarin.

Pigmented lesions of the oral cavity are important entities. The wide range of their clinical differential diagnosis includes such diverse systemic conditions as Addison's disease, Peutz-Jeghers syndrome, malignant melanoma, Kaposi's sarcoma, as well as specific oral lesions, such as amalgam tattoo or gingival melanosis. This paper reports a very rare cause of oral pigmentation, a melanic type, related to the use of Premarin.

[Sjögren's syndrome and differential diagnosis of parotid gland hypertrophy]. / Syndrome de Sjögren et diagnostic différentiel des parotidomégalies.

Some auto-immune systemic pathologies can first be detected through a very characteristic symptomatology which must be known for an early diagnosis. This is particularly the case with primary Sjögren syndrome (sicca syndrome). Based on a well documented case, this article is a review of the etiopathogenesis, symptomatology and investigation of the Sjögren syndrome. The differential diagnosis of the parotid gland hypertrophies is also discussed, based on a systematic approach.

[Differential diagnosis of neck masses]. / Diagnostic différentiel des masses cervicales.

This is the second part of an article on the differential diagnosis of cervical masses. It deals more specifically with non ganglionic masses and emphasizes the differential diagnosis as well as the clinical characteristics of these different masses.

[The differential diagnosis of neck masses]. / Diagnostic différentiel des masses cervicales.

This article on the differential diagnosis of cervical masses is a review of the main causes of the masses that an extra-oral exam can detect. Some of these masses are of particular interest to the dentist; they are notably cellulitis of dental origin, salivary pathologies and cervical adenopathies. There is no need to stress the major importance of the role played by the cervical adenopathies in the diagnosis of leukaemias, lymphomas and disorders linked to the HIV virus. The first part of this article focuses mainly on the differential diagnosis of cervical adenopathies, while the non-ganglionic masses will be discussed in another article.

[Oral manifestations of infectious diseases]. / Manifestations buccales des désordres infectieux.

Numerous bacterial diseases, both viral and fungal in nature, can affect the oral cavity, either directly or secondarily as a result of a systemic problem. Their oral manifestations can vary, but are sometimes very typical, and early detection significantly reduces the risk of transmitting pathogenic agents to the dental team and to patients. The principal oral manifestations are reviewed and special emphasis is placed on sexually transmitted diseases and HIV infection.

Sulfite, asthma and vasoconstrictors.

The use of vasoconstrictors in dentistry has always been a topic of controversy for the medically compromised patient. Over the past few years, dentists have been warned not to use local anesthetics with vasoconstrictors in asthmatic patients. In this article, the authors question the rationale behind these recommendations and explain why the warning should be restricted to steroid-dependent asthmatic patients.