Thinking Outside the Tooth: Diagnosis and Management of Patients with Neuropathic Orofacial Pain.

Nonodontogenic orofacial pain exists, and diagnosis and management of those conditions can be challenging. This article highlights and discusses how to take a complete and systematic pain history and the important red flags to recognize in patients presenting with perplexing nonodontogenic orofacial pain. Cause and epidemiology, clinical presentation, clinical evaluation and diagnosis, and management options for common neuropathic pain conditions are included. Neuralgia and neuropathic pain conditions and red flags as secondary cause of orofacial pain are more common in older-aged patients.

Dental professionals' knowledge, attitudes, and practice behaviors related to human papillomavirus vaccination.

OBJECTIVES: In Arizona, human papillomavirus (HPV)-related cancers are declining, with the exception of oropharyngeal cancer (OPC). HPV-related OPC is largely caused by persistent infection with oncogenic HPV strains, many of which the 9-valent HPV vaccine offers protection. Little is known about dental professionals' willingness to promote the HPV vaccine to prevent OPC. The current study assessed Arizona dental professionals' knowledge, attitudes, willingness, and current practice behaviors related to HPV vaccine promotion. Responses between dentists and hygienists were also compared. METHODS: A convenience sample of 711 dentists and hygienists attending a regional conference were recruited and asked to complete a 34-item survey assessing knowledge and attitudes about HPV, the HPV vaccine, HPV-related OPC, and their willingness to promote and administer the HPV vaccine. Fisher's exact tests and Mann-Whitney U tests were used for data analysis. RESULTS: Most respondents answered HPV knowledge questions correctly but did not know HPV-related OPC has a more favorable prognosis than other head and neck cancers. Dentists were more confident discussing and recommending the HPV vaccine. Both dentists and hygienists were willing to refer patients to their non-dental primary care providers for vaccination; however, they were less confident in administering the vaccine if it fell within their scope of practice. They reported willingness to receive training to recommend the vaccine. CONCLUSIONS: Given the willingness of respondents to receive training related to HPV vaccine communication, future research should develop and test talking points and communication training to aid dentists and hygienists in their promotion of the HPV vaccine.

Metoprolol-Induced Pemphigus-Like Reaction.

INTRODUCTION: Pemphigus vulgaris (PV) is a relatively rare, potentially life-threatening autoimmune disease that, in most cases, has an unknown etiology. Medications for hypertension have been linked to the onset and exacerbation of PV-like symptoms. The diagnosis of medication-related PV can be challenging because it has an identical appearance to the clinical and histologic appearance of idiopathic PV and cases may not resolve after discontinuation of the drug. CASE PRESENTATION: We present a case of an elderly patient with gingival and cutaneous erosions, who underwent several medical and dental consultations without an appropriate diagnosis. After biopsy and a thorough review of her medical history, metoprolol was suspected as the offending agent. After consulting with her cardiologist, metoprolol was discontinued, and a complete resolution of all lesions resulted. CONCLUSIONS: To our knowledge, the current case is the first reported case of metoprolol-induced PV in the English-language literature. As such, it highlights the potential of medication involvement in some immune-mediated diseases. Because the oral mucosa is often the first site of involvement in PV, knowledge of drug-related PV is crucial in the diagnosis, treatment, and management of dental patients.

Burning mouth syndrome: a review of etiology, diagnosis, and management.

Burning mouth syndrome (BMS) is a chronic condition characterized by a burning sensation of the oral cavity and is often associated with taste disturbances and xerostomia. It primarily affects menopausal or postmenopausal women. Idiopathic or primary BMS can occur spontaneously and without any identifiable precipitating factors. When BMS is associated with systemic factors, it is defined as secondary BMS. While the exact etiology of BMS is still unknown, the condition appears to be multifactorial, and numerous local, systemic, and psychological factors have been associated with it. Primary BMS is a diagnosis of exclusion and can only be reached after all potential causes of secondary burning pain have been eliminated. Management strategies include reassurance of the patient as well as pharmacologic agents such as clonazepam, supplements such as α-lipoic acid, and psychological therapy.

Mucocutaneous Diseases: Oral Lichen Planus, Mucous Membrane Pemphigoid and Pemphigus Vulgaris.

Mucocutaneous diseases affect the oral cavity and can present a diagnostic challenge. They can have systemic involvement, necessitating multidisciplinary management. Frequently, patients will see their general dentists initially for evaluation. A better understanding of mucocutaneous diseases can prevent delay in appropriate diagnosis and treatment. Oral lichen planus, mucous membrane pemphigoid and pemphigus vulgaris are three mucocutaneous diseases that affect the oral mucosa. This review describes the clinical features, epidemiology, etiology, pathogenesis and management for each condition.

Oral surgery in a patient with cirrhosis and thrombocytopenia: a case report.

PURPOSE: While most oral surgical procedures can be safely performed in an outpatient setting, certain medical conditions may present a higher chance of postoperative complications. In particular, those predisposing the patient to bleeding abnormalities pose a potential risk when performing such treatments. The authors report a case involving full-mouth extractions in a patient with cirrhosis and thrombocytopenia after obtaining a platelet transfusion. METHODS/CASE: A 62-year-old Caucasian female presented to a university special care dental clinic requiring extractions. Her pertinent medical history was remarkable for cirrhosis and thrombocytopenia, with a platelet count of 32,000/uL. Upon medical consultation, the patient was appointed for a prophylactic platelet transfusion. The surgery was rendered uneventfully, and the patient achieved adequate hemostasis without hospitalization. CONCLUSION/CLINICAL RELEVANCE: Patients with cirrhosis pose a potential bleeding risk with dental surgical procedures. Pre-operative medical consultation, review of pertinent laboratory values, and prophylactic platelet transfusion allow these patients to be managed safely in an outpatient setting.

Atypical odontalgia--an update.

Atypical odontalgia is a commonly misdiagnosed condition that frequently leads to unnecessary dental treatments such as extraction and endodontic therapy. These treatments often worsen the pain. Despite greater recognition and understanding of this condition, proper diagnosis and treatment remains a challenge. It is believed that atypical odontalgia is a neuropathic condition. This article updates the current understanding of the etiology and pathophysiology of atypical odontalgia, and provides appropriate diagnostic and management approaches for this condition.

A systematic review of dental recall intervals and incidence of dental caries.

BACKGROUND: Dental recall interval protocols are used to prevent dental disease through regular maintenance evaluations and preventive procedures. In this systematic review, the authors examined the evidence for the rationale behind a "one-recall-interval-fits-all" protocol, such as a six-month recall interval on caries incidence. METHODS: The authors searched the PubMed database and reviewed titles, abstracts and full reports. They also searched the references of each full report and used the "Related articles" feature. They used a checklist validated for randomized and nonrandomized studies to conduct a quality assessment for each article. RESULTS: The authors found seven articles representing six studies that met their inclusion criteria. The results of a randomized controlled trial showed no significant differences in oral health between patients recalled every 12 months and those recalled every 24 months. The investigators of one nonrandomized controlled trial reported that a two- to three-month recall interval significantly reduced the incidence and recurrence of caries. The investigators of an additional longitudinal non-randomized controlled study that compared three-, six- and 12-month recall intervals reported caries increments of 4.4, 4.0 and 4.9, respectively. The results of two retrospective studies showed that a specific recall interval did not alter caries incidence significantly. The results from a cross-sectional study suggested that a six-month recall interval was associated with more restored teeth but less active caries. CONCLUSIONS: The authors conclude that the evidence for using a one-recall-interval-fits-all protocol to reduce caries incidence was weak. Studies that addressed the impact of recall interval on caries incidence were methodologically weak. The evidence was not strong enough to support using any specific one-recall-interval-fits-all protocol for all patients. CLINICAL IMPLICATIONS: Using a one-recall-interval-fits-all protocol for caries prevention should be re-evaluated. On the basis of evidence from the randomized controlled trial, recall intervals could be extended to every two years. Evidence from the other studies revealed conflicting results for the efficacy of using any specific recall interval protocol. Because all of these studies had serious threats to validity, clinicians may wish to consider assigning recall intervals to patients on the basis of the patients' risk of developing caries. However, a discussion of a caries risk assessment is beyond the scope of this review.