Pharmacologic considerations in the dental management of the patient with disorders of the renal system.

As reviewed in this article, the patient with ESRD presents a number of unique management challenges. A rapidly increasing number of patients are receiving renal transplants and undergoing dialysis, making it necessary for the dental practitioner to have a thorough understanding of the special treatment considerations that arise. Conservative medical management is designed to slow the progression of the disease and ameliorate the clinical consequences. Dialysis and transplantation provide renal replacement to sustain life and allow for the medical and social rehabilitation of the patient. When considering transplantation, oral examination is an essential part of the preoperative evaluation. Elimination of pathologic entities and restoring patient function are essential before the transplant and the immunosuppressive drug regimen. Any oral symptom or sign of infection must be examined immediately and treated aggressively in an immunosuppressed transplant recipient. Patients receiving hemodialysis and those with transplants should be considered for antimicrobial prophylaxis before dental treatment that induces bleeding to protect the function and patency of the vascular access site and the transplant. Drug therapy may need to be adjusted, depending on the degree of chronic renal failure, the patient's dialysis schedule, or the presence of a transplant. Therefore, the dentist must be familiar with the complexity of this interesting patient population and pay particular attention when prescribing and using various medications.

Oral manifestations of selected sexually related conditions.

The incidence of certain microbial infections occurring in the oropharynx is well documented, but infection by other pathogens, although highly probable, has not been established with certainty. Considerable recent interest in the incubation period of various infections and improved community surveillance programs combine to ascribe infection to specific incidents. It is prudent for health care personnel to acknowledge the presence of many sexually transmitted diseases in the oropharynx and consider them in the differential diagnosis of many well-established conditions.

Antibacterial prophylaxis.

Bacteremias of dental origin have been implicated as sources of infection in specific cardiac conditions, diabetes, neutropenia, kidney disease, splenectomy, and patients with prosthetic joints. This article reviews the relative risks of dental bacteremias in these patients, discusses the merits of various regimens, and presents current prophylactic antibiotic recommendations.

Actinic cheilitis.

Ultraviolet (UV) radiation of the vermilion border of the lips can precipitate recurrent herpetic infections, varying degrees of dysplasia, and squamous cell carcinoma. UV light also can aggravate certain systemic conditions, such as lupus erythematosus, and produce solar urticaria, porphyrias, and drug photosensitivity reactions.

Treating erosive lichen planus with griseofulvin: a report of four cases.

Lichen planus is one of the most common dermatologic diseases involving the skin and oral mucous membranes. It may occur anywhere in the oral cavity. Erosive lichen planus has been reported to undergo malignant transformation, making definitive diagnosis, treatment, and followup essential. The purpose of this study was to establish the effectiveness of griseofulvin therapy on erosive lichen planus and to provide an alternative to steroid therapy. The results of this study revealed that griseofulvin had little or no effect on pain, pigmentation, or disappearance of erosive lichen planus and did not protect the patient from further recurrences.

Glossodynia after radiation therapy and chemotherapy.

Radiation therapy and chemotherapy have decreased the mortality rates of cancer patients, but the morbidity associated with oral complications is high in many cases. A pretreatment oral evaluation and institution of a preventive care program reduce oral symptoms such as glossodynia considerably. When oral symptoms are minimized, the dentist can improve the patient's quality of life.

Glossodynia as an oral manifestation of sex hormone alterations.

Oral inflammation occurs during puberty, pregnancy, menses, and therapy with hormones (especially oral contraceptive agents), and other medications such as phenytoin. Alterations of the oral environment result from fluctuations of plasma and salivary sex steroids. The ratio of the sex steroids to one another, and their absolute concentration, determine the amount of prostanoid and peroxidase production and salivary flow. These relationships are complex and are not readily predictable; however, they are reproducible in both humans and animals. The sex steroids exert profound effects on the function of many nonsexual organs; particularly the skin, bone, liver, salivary glands, and oral tissues. We reviewed the currently available information concerning sex steroid action on salivary glands and oral epithelium. In light of the dramatic drop in sex steroid levels at menopause, the purely psychogenic nature of glossodynia or burning mouth (stomatopyrosis), first manifested at menopause, requires further consideration and study.

Oral lesions as a cause of glossodynia.

A number of oral lesions may be responsible for the symptoms of glossodynia. A thorough examination of the tongue and the mouth is of paramount importance to eliminate specific oral manifestations that may result in a burning or painful tongue. Ultimately, this may require consultation with an oral diagnostician for a definitive diagnosis.

Metastatic adenocarcinoma of the colon presenting as periradicular periodontal disease: a case report.

Metastases to the jaws account for only 1% of all malignant tumors of the oral cavity. Consequently the diagnosis of metastasis to the mandible requires a high degree of clinical suspicion and the use of a systematic diagnostic approach. In this case report a patient sought treatment for what appeared clinically and radiographically as periradicular periodontal disease. However, because the patient had a medical history of adenocarcinoma of the colon 5 years previously, metastasis to the jaws was included in the differential diagnosis. Metastasis to the jaws may resemble periodontal disease or many of the other benign and malignant conditions that affect the jaws, thus making the correct radiographic diagnosis difficult. Ultimately, histologic evaluation is essential to make a definitive diagnosis.

Oral complications of cancer chemotherapy: prevention and management.

Cancer chemotherapy is used to destroy rapidly proliferating cells. However, normal cells with high mitotic indexes are also affected by chemotherapy, particularly those in the oral and gastrointestinal mucosa and the hemopoietic system. Ultimately, this may lead to certain oral complications of cancer chemotherapy such as mucositis, infection, hemorrhage, xerostomia, and neurologic and nutritional disorders. The prevention and management of these oral complications that may result from the chemotherapeutic management of cancer are discussed here.

The patient with chronic renal failure who is undergoing dialysis or renal transplantation: another consideration for antimicrobial prophylaxis.

A patient with chronic renal failure who is undergoing dialysis or renal transplantation is susceptible to a number of infections. Transient, usually asymptomatic bacteremias occur in a wide variety of dental manipulations, particularly those involving the mucous membranes. Certain bacteremias may cause serious complications in these already compromised patients. Therefore, antimicrobial prophylaxis is essential when these patients undergo bacteremia-causing dental procedures.

Early aggressive cemento-ossifying fibroma: a diagnostic and treatment dilemma.

A case involving a 22-year-old male patient with early aggressive cemento-ossifying fibroma in the mandible is discussed. The historical difficulty in categorizing fibro-osseous lesions is reviewed, and the importance of clinical, radiographic, and surgical findings to the ultimate diagnosis and correct treatment of these lesions is emphasized.