Conservative Management of Chronic Suppurative Parotitis in Patients with Sjögren Syndrome: A Case Series.

BACKGROUND Parotitis is an inflammation of the parotid gland, which can be caused by factors including infection, radiation, and hyposalivation secondary to systemic conditions, such as Sjögren syndrome, rheumatoid arthritis, or medication. Bacterial parotitis is a rare complication that can be observed in patients with hyposalivation. However, it is also observed in elderly and immunocompromised patients. Lack of continuous flushing of salivary glands and their ducts due to decreased salivary flow renders the glands prone to retrograde colonization with oral microflora. Several microorganisms have been associated with bacterial infections of the parotid glands; Staphylococcus aureus is the most common, accounting for 80% of cases, followed by mixed bacterial communities, including streptococci, anaerobes, and gram-negative bacilli. Bacterial parotitis presents as tenderness, swelling, and purulent sialorrhea from the salivary gland's duct. Immediate administration of broad-spectrum antibiotics, based on the results of the patient's culture and sensitivity test, has shown success in treating these cases. CASE REPORT We report 3 cases of chronic suppurative parotitis secondary to dry mouth and due to Sjögren syndrome that did not respond to oral or intravenous antibiotics and was successfully managed using conservative methods, such as the local application of superficial moist heat and periodic pus drainage by manipulating the parotid glands at dental clinics. CONCLUSIONS We concluded that conservative approaches, such as massaging the glands, local application of superficial moist heat, and periodic pus drainage without using antibiotics, should be considered as the first-line management of bacterial infection of the parotid glands.

Dental Considerations in Patients with Oral Mucosal Diseases.

Oral mucosal diseases represent a significant health care burden, rendering a complex patient population in which interdisciplinary care among dermatologists, primary dental providers, and dental specialists is required for optimal care. Oral mucosal diseases often cause painful ulceration and blistering which can impede a patient's ability to perform dental home care and the dental professional's ability to deliver routine and complex treatment. It is crucial to consider the environment of the oral cavity. It is paramount to be aware of the potential side effects that certain medications may cause and the possible interactions with other medications the patient is using.

Prescription of potentially inappropriate medications in geriatric patients: data from a single dental institution.

OBJECTIVES: The Beers criteria and the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) are consensus-driven lists of potentially inappropriate medications (PIMs) in geriatric patients. The primary objective was to determine the frequency of PIMs prescribed to geriatric patients at Tufts University School of Dental Medicine. The secondary aim was to determine the American Society of Anesthesiologists (ASA) status of these patients and suggest that Beers/STOPP guidelines should be implied with consideration to the patient's ASA status. STUDY DESIGN: Beers/STOPP criteria were studied and PIMs thus identified. A retrospective electronic chart review of patients at TUSDM aged 65 and older was performed for calendar years 2013, 2014, and 2015. Search queries were generated for ASA status, along with PIMs prescribed. RESULTS: Out of 15,569 geriatric patients, more than half of patients between 65-74 years were classified as ASA I. Over a 3-year period, 895 (5.75%) and 840 (5.4%) received new prescriptions for opioids or nonsteroidal anti-inflammatory drugs, respectively. New prescriptions for muscle relaxants, benzodiazepines, and tricyclic antidepressants were given to 65 (0.42%), 44 (0.28%), and 38 (0.24%) patients, respectively. CONCLUSIONS: PIMs are prescribed at low percentages to geriatric patients. However, prescription of opioids, benzodiazepines, and nonsteroidal anti-inflammatory drugs across undergraduate and postgraduate clinics is not uncommon. The majority of Tufts University School of Dental Medicine geriatric patients fall within the category of ASA I-II. ASA classification must be taken into consideration when PIMs are prescribed to geriatric patients rather than relying solely on chronologic age.

How accurate is information about diagnosis and management of temporomandibular disorders on dentist websites?

OBJECTIVE: The purpose of this study was to determine the accuracy of information provided on websites of dental practices about the diagnosis and management temporomandibular disorders (TMDs) because patients often use the Internet to get information about their condition and to seek a practitioner for treatment. STUDY DESIGN: A web search was done to identify the types of dental providers who advertise themselves on the Internet as "specialists" in the management of TMDs. Issues that were analyzed included their classification of these disorders, the presumed etiology of such problems, and the types of treatment offered. RESULTS: Over two-thirds of the 255 dental providers identified who advertised management of TMDs on their websites were general dentists. TMDs were attributed to occlusal problems or malocclusion on 66.7% of the websites and were labeled as a single disorder rather than a group of disorders on 38.8% of the websites. Recommendations to treat occlusal problems or malocclusion to alleviate TMDs were made by 54.5% of the providers. CONCLUSIONS: Since these findings are not in line with current concepts about TMDs, significant inaccuracies exist with regard to the diagnosis and management of TMDs on dental practice websites. Therefore, patients need to be concerned about the dentists they may select to get their treatment, and practitioners need to be prepared to deal with the issues raised by misinformed patients.

Neuralgia associated with transcutaneous electrical nerve stimulation therapy in a patient initially diagnosed with temporomandibular disorder.

Head and neck neoplasms may be difficult to detect because of wide-ranging symptoms and the presence of overlapping anatomic structures in the region. This case report describes a patient with chronic otalgia and temporomandibular disorder, who developed sudden-onset neuralgia while receiving transcutaneous electrical nerve stimulation (TENS) therapy. Further diagnostic evaluation revealed a skull base tumor consistent with adenoid cystic carcinoma. To our knowledge, this is the first report of TENS-associated neuralgia leading to a diagnosis of primary intracranial adenoid cystic carcinoma.

Metastatic melanoma misdiagnosed as a temporomandibular disorder: a case report and review of the literature.

BACKGROUND: Malignancies in the head and neck region are difficult to diagnose because of their deep location and presence of symptoms mimicking those of temporomandibular disorders or other orofacial pain disorders. CASE DESCRIPTION: A 75-year-old woman reported experiencing right-sided jaw pain, temporal discomfort and paresthesia. She had undergone conservative therapy for temporomandibular joint disorder, which was unsuccessful. A magnetic resonance image of the midface revealed a mass on the base of the tongue along with possible metastatic lesions to the brain. Further investigation of the lesions revealed them to be metastatic melanoma. PRACTICAL IMPLICATIONS: Patients with atypical symptoms of facial pain, including neurological signs, should undergo further investigation with advanced imaging to determine the source of the symptoms, which could include neoplasms.

An oral ulceration associated with Morgellons disease: a case report.

Morgellons disease is a psycho-dermatologic condition in which patients report fibers or filaments "growing" out of their skin. This case report highlights an oral ulceration in a young woman associated with Morgellons disease, a condition that has not been previously described in the dental literature. An increasing number of individuals are self-reporting this condition and oral health care providers must be familiar with this disorder.

Invadopodia and matrix degradation, a new property of prostate cancer cells during migration and invasion.

The present study demonstrated that invadopodia are associated with invasion by degradation of matrix in prostate cancer cells PC3. To find out the presence of invadopodia in PC3 cells, we performed a few comparative analyses with osteoclasts, which utilize podosomes for migration. Our investigations indeed demonstrated that invadopodia are comparable to podosomes in the localization of Wiskott-Aldrich syndrome protein (WASP)/matrix metalloproteinase-9 and the degradation of matrix. Invadopodia are different from podosomes in the localization of actin/vinculin, distribution during migration, and the mode of degradation of extracellular matrix. Invadopodia enable polarized invasion of PC3 cells into the gelatin matrix in a time-dependent manner. Gelatin degradation was confined within the periphery of the cell. Osteoclasts demonstrated directional migration with extensive degradation of matrix underneath and around the osteoclasts. A pathway of degradation of matrix representing a migratory track was observed due to the rearrangement of podosomes as rosettes or clusters at the leading edge. Reducing the matrix metalloproteinase-9 levels by RNA interference inhibited the degradation of matrix but not the formation of podosomes or invadopodia. Competition experiments with TAT-fused WASP peptides suggest that actin polymerization and formation of invadopodia involve the WASP-Arp2/3 complex pathway. Moreover, PC3 cells overexpressing osteopontin (OPN) displayed an increase in the number of invadopodia and gelatinolytic activity as compared with PC3 cells and PC3 cells expressing mutant OPN in integrin-binding domain and null for OPN. Thus, we conclude that OPN/integrin alphavbeta3 signaling participates in the process of migration and invasion of PC3 cells through regulating processes essential for the formation and function of invadopodia.

Mechanisms of osteopontin and CD44 as metastatic principles in prostate cancer cells.

BACKGROUND: The expression level of osteopontin correlates with the metastatic potential of several tumors. Osteopontin is a well-characterized ligand for the alphavbeta3 integrin. The present study was undertaken to elucidate the possible role of osteopontin/alphavbeta3 signaling in prostate cancer cell migration. RESULTS: We generated stable prostate cancer cell (PC3) lines that over-express osteopontin (PC3/OPN), mutant OPN in the integrin binding-site (PC3/RGDDeltaRGA), and null for OPN (PC3/SiRNA). The following observations were made in PC3/OPN cells as compared with PC3 cells: 1) an increase in multinucleated giant cells and RANKL expression; 2) an increase in CD44 surface expression, interaction of CD44/MMP-9 on the cell surface, MMP-9 activity in the conditioned medium, and cell migration; 3) western blot analysis of concentrated conditioned medium exhibited equal levels of MMP-9 protein in all PC3 cells. However, zymography analysis demonstrated that the levels of MMP-9 activity in the conditioned media reflect the CD44 surface expression pattern of the PC3 cell lines; 4) although MMP-9 and MMP-2 are secreted by PC3 cells, only the secretion of MMP-9 is regulated by OPN expression. A strong down regulation of the above-mentioned processes was observed in PC3/OPN (RGA) and PC3/SiRNA cells. PC3/OPN cells treated with bisphosphonate (BP) reproduce the down-regulation observed in PC3/OPN (RGA) and PC3/SiRNA cells. CONCLUSION: Rho signaling plays a crucial role in CD44 surface expression. BPs inhibits the mevalonate pathway, which in turn, prevents the prenylation of a number of small GTPases. Attenuation of Rho GTPase activation by BPs may have contributed to the down regulation of cell surface CD44/MMP-9 interaction, MMP-9 activation/secretion, and cell migration. Taken together, these observations suggest that CD44 surface expression is an important event in the activation of MMP-9 and migration of prostate cancer cells. The various steps involved in the above mentioned signaling pathway and/or the molecules regulating the activation of MMP-9 are potential therapeutic target.