Central sensitization in burning mouth syndrome: a practical approach using questionnaires.

OBJECTIVES: Some experts have suggested that burning mouth syndrome (BMS) should be included in the family of central sensitivity syndromes, a group of similar medical disorders linked by the central sensitization (CS) mechanism. Our objective is to assess the presence of CS in patients with BMS by performing a clinical examination and administering questionnaires to measure the generalized extent of pain, the presence of associated symptoms, and the number of other concurrent chronic pain conditions. STUDY DESIGN: We conducted a case-control study in 82 subjects (40 patients with BMS and 42 controls). Patients with BMS were diagnosed using The International Classification of Headache Disorders 3rd edition, beta version (ICHD-IIIß) criteria. The Widespread Pain Index (WPI) and Symptom Severity (SS) Score questionnaires were used to determine the degree of central sensitivity. The number of other concurrent chronic pain conditions was determined with the Neblett inventory. RESULTS: Data indicative of CS show a statistically significant association with BMS. Both SS Score and Widespread Pain Index scores higher in patients with BMS. Additionally, patients with BMS reported a significantly higher number of other central sensitivity syndromes. CONCLUSIONS: Patients with BMS could present a CS component as well as other chronic pain conditions. The use of questionnaires may be useful to determine the degree of central sensitivity in patients with BMS.

Ability of Dental Students in Spain to Identify Potentially Malignant Disorders and Oral Cancer.

The aim of this study was to assess the ability of students at the School of Dentistry, Complutense University of Madrid, Spain, to diagnose oral cancer and other potentially malignant disorders, as well as to compare their ability at different stages of the learning process and evaluate their knowledge retention. Students were surveyed after they had studied oral medicine and oral pathology at two time points: midway through and near the end of their studies. The survey consisted of questions about 40 photographs of benign oral lesions, malignant oral lesions, and potentially malignant disorders. The response rate for all groups was greater than 70%. The results showed that these students' overall success rate in differentiating benign from malignant lesions averaged 73.9%. When the distinction for potentially malignant disorders was included, their average overall success rate decreased to 42.8% (p<0.001). Furthermore, the students' average success rate was at its lowest at the end of the dental program (p<0.001). Results from this study suggest that, given these students' difficulties in identifying potentially malignant disorders, an increased emphasis on cancer education in the dental curriculum may be needed for future practitioners to master this ability.

Descriptive study of the patients treated at the clinic 'Integrated Dentistry for patients with Special Needs' at Complutense University of Madrid (2003-2012)

OBJECTIVES: To study clinical and epidemiological characteristics of the patients treated at the clinic 'Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)' at Complutense University of Madrid (UCM),as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients. Study DESIGN: Medical records review of all the patients referred to the clinic of 'Integrated Dentistry for Patients with Special Needs', performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis). RESULTS: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%)and intellectual disability (8,85%). 70'18% of the patients were treated, with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%

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Descriptive study of the patients treated at the clinic "integrated dentistry for patients with special needs" at Complutense University of Madrid (2003-2012).

OBJECTIVES: To study clinical and epidemiological characteristics of the patients treated at the clinic "Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)" at Complutense University of Madrid (UCM), as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients. STUDY DESIGN: Medical records review of all the patients referred to the clinic of "Integrated dentistry for patients with special needs", performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis). RESULTS: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%) and intellectual disability (8,85%). 70'18% of the patients were treated, with with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%. CONCLUSIONS: Given the high number of patients with some kind of pathology and the amount of medicines that they use, it seems necessary for dentistry students to have a specific training regarding how to handle and treat these patients, so they will be able to provide them the best possible care.

Síndrome de Sjögren. Revisión e implicaciones en el ámbito de la salud oral / Sjögren Syndrome. Review and impact on the area of oral health

El síndrome de Sjögren (SS) es una enfermedad crónica, sistémica, inflamatoria y autoinmune que afecta a las glándulas exocrinas salivales y lagrimales, produciendo boca seca (xerostomía) y ojos secos. El SS es la principal causa no y atrogénica de laxerostomía. Esta sensación subjetiva de sequedad orales la causante de que los pacientes consideren su salud oral deficiente. Suelen presentar dificultades para hablar, masticar y tragar, alteraciones del gusto, sensación de boca ardiente así como dolor en las glándulas salivales al comer. Actualmente no hay ninguna cura para el SS, así como ningún tratamiento que minimiceo restaure el daño hecho a las glándulas. El objetivo del tratamiento será aliviar el disconfort oral y mantener la bocahidratada

The Sjögren Syndrome (SS) is a chronic, systemic, inflammatory and autoimmune disease that affects the salivary and lacrima lexocrine glands, producing dry mouth(xerostomia) and dry eyes. SS is the principal non-iatrogenic cause of xerostomia. This subjective sensation of oral dryness is the cause of patients considering their oral health deficient. Difficulties are usually presented in speaking, chewing and swallowing, taste alterations and burning mouth sensation aswell as pain in the salivary glands wheneating. Currently there is no cure for SS, nor is the retreatment that minimises or restores the damage to the glands. The objective of the treatment shall be to alleviate the oral discomfort and maintain the mouth hydrated

Implications of prion diseases for dentistry: an update.

Prions are normal proteins present in all mammals, especially in the central nervous system (CNS) and lymphoreticular tissue. Their transformation into a highly infectious molecule gives rise to a group of diseases known as transmissible spongiform encephalopathies (TSEs), which cause vacuolar degeneration of gray matter and produce a fatal neurodegenerative disorder. Prion diseases have attracted considerable attention in recent years, and this review of the literature was designed to determine their implications for dentistry, studying the possibility of cross-transmission in the dental office and describing their oral manifestations. The main oral manifestations are dysphagia, dysarthria, paresthesias, dysesthesias, and dysgeusia. The most frequently involved oral tissues are the trigeminal ganglion, posterior third of the tongue, tonsils, and, much less commonly, alveolar nerves, gingiva, and salivary glands. Although no contagion has been reported in the dental setting to date, prions resist the usual dental sterilization systems and transmission of this type of disease remains a potential risk. It is therefore important for dentists to be aware of these diseases, to identify high-risk patients by obtaining an adequate clinical history, and to know the appropriate procedures to be followed.

Alteraciones gingivales no relacionadas con placa / Non-plaque related gingival conditions

El depósito de placa bacteriana constituye el principal factor etiológico de las alteraciones gingivales; sin embargo se debe tener en cuenta que las lesiones gingivales pueden ser la manifestación de múltiples procesos en los cuales la placa no constituye el factor principal. Debido a la importancia que pueden tener algunos de estos procesos y a que las lesiones gingivales pueden ser un signo temprano que pueden ayudar a establecer un diagnóstico precoz, se ha propuesto hacer una revisión de los mismos destacando las alteraciones gingivales que aparecen relacionadas con enfermedades mucocutáneas, con niveles hormonales, con los tratamientos farmacológicos, con las infecciones víricas, con las discrasias sanguíneas y, por último, las alteraciones gingivales de origen genético o fibromatosis gingival hereditaria (AU)

Dental plaque remains the main aetiological factor of gingival diseases; nevertheless, a number of gingival lesions could be the expression of other, non-plaque related entities. The aim of this paper is to perform a review and underscore the importance of some of these diseases, since they can be an early and useful sign in order to establish an accurate diagnosis. The main entities are: gingival lesions related to mucocutaneous diseases, gingival lesions related to hormonal levels, gingival alterations produced by pharmacological treatments, gingival lesions produced by viral infections, gingival alterations related to haematological disorders and, finally, gingival alterations of genetic origin such as gingival fibromatosis (AU)

Síndrome de boca ardiente: puesta al día / Burning Mouth Syndrome

Se ha realizado una revisión bibliográfica del Síndrome de Boca Ardiente (SBA) con el fin de conocer los aspectos más relevantes en cuanto a los factores etiológicos implicados y las alternativas terapéuticas disponibles hasta la actualidad. Entre los factores etiológicos se pueden encontrar factores locales como infecciones, alergias o alteraciones en la cantidad y la calidad de la saliva; factores sistémicos como la menopausia, la diabetes mellitus o las carencias nutricionales, y factores psicológicos entre los que destacan la depresión, la ansiedad y la cancerofobia. Además, las últimas investigaciones sugieren un cuarto factor: las alteraciones neurosensoriales que apuntan hacia la posibilidad de que exista un trasfondo neuropático en la etiología de esta enfermedad. Entre los tratamientos empleados hasta la fecha, aparte del control de los factores implicados, destacan la capsaicina (el principio activo de especies vegetales del género Capsaicum, como por ejemplo el pimiento),cuya aplicación repetida provoca la depleción de la sustancia P y el ácido alfa-lipoico (ALA), un potente antioxidante que también actúa como coenzima en el ciclo de Krebs. De estos dos tratamientos parece que el ALA es el que mejores resultados ha obtenido hasta la actualidad, además de ser el que menos reacciones adversas ha provocado (AU)

A literature review on Burning Mouth Syndrome(BMS) has been performed in order to know the most relevant aspects regarding etiological factors and the treatments avalaible nowadays. Among etiological factors can be considered local factors as infections, allergy or qualitative and cuantitative salivary alterations; sistemic factors as menopause, diabetes mellitus or nutritional deficits; and psychological factors as depression, anxiety or cancerophobia. Moreover recent investigations hint a fourth factor, neurosensorial alterations that suggest a neuropathic background in the etiology of this syndrome. Among treatments employed to date, besides the control of involved factors , new drugs are being used, as capsaicin (an extract of peppers of Capsaicum gender) that can cause a deplection of P substance, and alpha-lipoic acid (ALA) a potent antioxidant agent that participates in Krebs´ cycle as a coenzyme. Of these therapies, ALA seems to obtain better results, and also less adverse reactions (AU)

Líquen plano oral, reacciones liquenoides y tratamientos odontológicos / Oral lichen planus, lichenoid reactions and general dentistry

El liquen plano oral es una enfermedad mucocutánea inflamatoria crónica, de etiología desconocida aunque se reconoce una base autoinmune. Actualmente la mayoría de los autores describen dos formas clínicas principales: reticular y atrófico-erosivo. Es preciso conocer la diferencia entre el liquen plano oral y las reacciones liquenoides. El liquen plano oral es un desorden idiopático que puede progresar hacia formas malignas, mientras que las reacciones liquenoides son lesiones clínicas e histiológicamente similares al liquen plano, pero con una causa identificable. En el presente trabajo se ha realizado una búsqueda bibliográfica estudiando la posible relación existente entre el liquen plano oral y las reacciones liquenoides; y los tratamientos más habituales que se realizan en la clínica odontológica general, así como la actuación ante la sospecha de asociación positiva. No se han encontrado datos bibliográficos sobre las relaciones entre tratamientos ortodoncicos y liquen plano oral. A la vista de los resultados, para descartar la relación entre la lesión y una restauración se realizarán las pruebas de sensibilidad de contacto. Si estos resultaran positivos a alguno de los componentes de la restauración, esta deberá ser eliminada y sustituida por otra. Además, siempre que se pueda y el paciente lo necesite, se realizarán prótesis fijas. En cuanto a colocar implantes en un paciente con liquen plano oral es un tema de controvertido. Sin embargo un punto importante es el tratamiento periodontal en los pacientes con liquen, ya que se ha observado que la eliminación de la placa provoca mejoría en estos pacientes (AU)

Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology although an autoimmune basis has been recognized. At present two clinical forms are considered by most of the autors: reticular and atrophic-erosive forms. It is essential differenciate oral lichen planus from lichenoid reactions. Oral lichen planus is an idiopathic disease that can progress into malignancy, whereas lichenoid reactions are clinically and histologically similar to lichen planus but related with known factors. In the present study a bibliographical review has been made in order to achieve relationships between lichen planus and lichenoid reactions; and the the most common treatments that are performed in general dentistry. No avaylable data have been found about the relationship between lichen planus and orthodontic treatments. The results indicates that in order to rule out the relationship between a lession and an specific material patch tests should be performed. If a positive test is obtained, the material should be removed and replaced by a different one. If it is possible fixed prosthodontics are recomended. At present the use of osteointegrated implants in patients with oral lichen planus is controversial. However periodontal treatment in these patients has demonstrated improvement after plaque removal (AU)

Alcohol-containing mouthwashes and oral cancer. Critical analysis of literature.

For centuries, mouthwashes have been used in order to provide us with oral health or cosmetic benefits. Nowadays, in most countries, there is a variety of formulas available for the general public in the form of products which may require prescription or not. Alcohol is used in mouthwashes as a solvent of other ingredients and as a preservative of the preparation. For years, different formulas of mouthwashes have been used, however, the question about its alcohol content being a threat for health or not has recently appeared. The high quantity of alcohol in some mouthwashes combined with the fact that they keep in contact with the oral mucosa for much more time than alcoholic drinks, can make us think about a harmful effect from a local mechanism. Mouthrinses increase the time of the mucosa being in contact with alcohol and it has been proved that those with a high content of alcohol do cause hyperkerastosic lesions both in human beings and laboratory animals. At the moment and with the data we have, it has not been possible to establish a causal relationship between the use of alcohol-containing mouthwashes and the development of oral cancer. There is neither an evidence of the fact that alcohol increases the effects of antiplaque agents in mouthwashes.

Isolated gingival metastasis from hepatocellular carcinoma mimicking a pyogenic granuloma.

BACKGROUND: Oral metastatic tumours are uncommon and account for approximately 1% of malignant oral neoplasms. RESULTS: If the cases where the oral location is in the jawbone, with secondary invasion to the oral soft tissue, are excluded, only 10 cases of gingival metastasis from hepatocellular carcinoma (HCC) have been previously reported in the literature. The clinicopathologic features of an HCC with gingival metastasis are reported. Six months after the multicentric HCC and alcoholic cirrhosis was diagnosed, a 65-year-old male patient presented a rapidly growing, lobulated and reddish exophytic lesion that was located in the gum in the incisal region of the upper jaw. The lesion was excised, and the final diagnosis of gingival metastasis of the HCC was established. Diagnostic investigations did not show any evidence of other metastatic lesions. This article describes a case with solitary metastasis from HCC in the gingiva, an event that, to our knowledge, has not been previously published. CONCLUSIONS: The clinical appearance of isolated gingival metastasis from HCC in the present case mimicked a pyogenic granuloma.