Neurological complications following mRNA COVID-19 vaccination: Oral and lower limb paresthesia. A case discussion and literature review.

Vaccines used in the coronavirus pandemic have reported some minor side effects such as pain at the injection site, headache, myalgia and fever. Also major neurological side effects have been experienced by some patients. We present the clinical case of a healthy woman who two weeks after being vaccinated with the third dose of Moderna COVID-19 Vaccine, began to feel numbness in mouth, both feet, legs, interscapular space, and hands. She was diagnosed with distal sensory polyneuropathy caused by the vaccine. Progressive improvement was seen. The patient did not require corticosteroid medication. We reviewed the literature to assess the frequency of this type of complication. Key words:COVID-19, SARS-CoV-2, vaccine, vaccination, peripheral axonal neuropathy, transverse myelitis, oral manifestations.

Medication related to pigmentation of oral mucosa

Background: The diagnosis of oral melanotic lesions is, more often than not, challenging in the clinical practice due to the fact that there are several reasons which may cause an increase in pigmentation on localized or generalized areas. Among these, medication stands out. Material and Methods: In this work, we have carried out a review in the reference pharma database: Micromedex® followed by a review of the scientific published literature to analyse coincidences and possible discrepancies. Results: Our findings show that there are several prescription drugs that can cause pigmented lesions in the oral mucosa. This must be known by clinicians in order to properly diagnose pigmented lesions. We have identified a set of 21 medicaments which cause these lesions, some of which are used frequently in the clinic, such as Metronidazole, Amitriptyline, conjugated oestrogens and Chlorhexidine gluconate. We also found discrepancies with the data published in specialized literature, some of which wasn’t reflected in the Summary of Product Characteristics. Conclusions: Our work highlights the importance of the proper communication of adverse drug reactions (ADR) by health professionals in order to provide thorough and accurate information and diagnosis.(AU)

Patología sistémica múltiple en la consulta dental. A propósito de un caso ¿especial? / Multiple sistemic pathology in the dental clinic, a special case?

Introducción: La esperanza de vida en España es de las más altas del mundo. Este aumento en la esperanza de vida va unido a una mayor prevalencia de pacientes con pluripatología y polimedicación. Por lo tanto, la probabilidad de encontrar un paciente con múltiple afectación sistémica y gran carga farmacológica ha aumentado, de tal manera que lo especial se convierte en habitual. Caso clínico: Se presenta el caso clínico de una paciente con hipertensión, diabetes tipo II, hipotiroidismo, depresión, obesidad y déficit de vitamina D. Se hace una revisión de la actuación del odontólogo en la clínica cuando se presentan pacientes con dichos cuadros y las consideraciones a tener en cuenta con respecto a la prescripción y administración de medicación. El objetivo es presentar recomendaciones de tratamiento a partir de un caso clínico de una paciente con varias afecciones sistémicas en la que se realiza un tratamiento multidisciplinar. Para eso se ha realizado una revisión narrativa que se considera útil para la actividad clínica diaria. Conclusiones: Los pacientes con pluripatologías y con polimedicación no deben suponer un problema en la clínica dental. Sus patologías sistémicas suelen estar interrelacionadas y relacionadas con su patología oral por lo que mejoras esta contribuye a controlar mejor las otras. Deberíamos cuestionarnos a qué nos referimos cuando utilizamos el término “paciente especial”, ¿existe algún paciente que no sea especial? (AU)

Introduction: Life expectancy in Spain is one of the highest in the world. This increase in life expectancy is linked to a higher prevalence of patients with multiple pathologies and polypharmacy. Therefore, the probability of finding a patient with multiple systemic involvement and a high drug burden has increased, in such a way that the special becomes common. Clinical case: The clinical case of a patient with hypertension, type II diabetes, hypothyroidism, depression, obesity and vit D deficiency is presented. A review is made of the performance of the dentist in the clinic when patients with these conditions appear and the considerations to take into account with respect to the prescription and administration of medication. The objective is to present treatment recommendations based on a clinical case of a patient with several systemic conditions in which a multidisciplinary treatment is carried out. For this, a narrative review has been carried out that is considered useful for daily clinical activity. Conclusions: patients with multiple pathologies and polymedication should not pose a problem in the dental clinic. Their systemic pathologies are usually interrelated and related to their oral pathology, so improvements in this one contribute to better control the others. We should ask ourselves what we mean when we use the term “special patient”, is there a patient who is not special? (AU)

[Proposal to reorder dental health care in the National Health System. The experience of Toledo's "Unidad de Medicina y Cirugía Oral".] / Propuesta para reordenar la asistencia sanitaria odontológica en el Sistema Nacional de Salud. La experiencia de la unidad de Medicina y Cirugía Oral de Toledo.

The portfolio of services in Oral Health of the National Health System (SNS in Spanish) is very broad and includes different areas of assistance. The focus of the System managers has focused on improving dental health benefits for children. The relevance that Children´s Dental Assistance Programs (PADI, Planes de Atención Dental Infantil in Spanish) have been acquiring in the oral care of the SNS has led to the resources being directed towards the prevention, diagnosis and treatment of dental pathology in the child population. The structure in Unidades de Salud Bucodental focused on strictly dental pathology does not allow the development of all health services. There is a large number of services that within the oral benefits provided by Primary Care are diverted to other hospital services or that are not even provided. Different experiences have been developed in different autonomous Health Systems to improve these benefits. Since 2012, the Toledo Unidad de Medicina y Cirugía Oral has carried out actions that have managed to improve oral care for the population, thus improving their general health. This Unit allows resources to be allocated to those activities that require training and guidance in the more medical-surgical than dental service. We recommend the implementation of services of this type within Primary Services to improve the provision of oral health services.

La cartera de servicios en Salud Bucodental del Sistema Nacional de Salud (SNS) es muy amplia y contempla distintas áreas de asistencia. El foco de los gestores del Sistema desde hace décadas se ha centrado en mejorar las prestaciones de salud dental en población infantil. La importancia que los Planes de Atención Dental Infantil (PADI) han ido adquiriendo en la asistencia Bucodental del SNS ha hecho que los recursos se orienten a la prevención, diagnóstico y tratamiento de la patología dentaria de la población infantil. La estructura en Unidades de Salud Bucodental centradas en la patología estrictamente dentaria no permite desarrollar todas las prestaciones sanitarias. Existe una gran cantidad de servicios que dentro de las prestaciones bucodentales que tiene la Atención Primaria (AP) se desvían a otros servicios hospitalarios o que incluso no se prestan. En diferentes sistemas de salud autonómicos se han desarrollado experiencias para conseguir mejorar estas prestaciones. Desde 2012, la Unidad de Medicina y Cirugía Oral de Toledo realiza acciones que han conseguido mejorar la asistencia bucodental de la población, mejorando así su salud general. Esta Unidad permite destinar los recursos a aquellas actividades que necesitan una formación y una orientación en el servicio más médico-quirúrgico que dentario. Recomendamos la implantación de servicios de este tipo dentro de la AP para mejorar la prestación de los servicios de salud bucodental.

Tumor de células granulares (tumor de Abrikossoff) en la lengua. A propósito de un caso y revisión de la literatura / Granular cell tumor (Abrikossoff´s tumor) of the tongue. A case report and literature review

Introducción: El tumor de células granulares o tumor de Abrikossoff es una neoplasia de los tejidos blandos que suele afectar a mujeres entre la cuarta y la sexta década de la vida. Puede desarrollarse en cualquier parte del organismo, pero es en la región intraoral y especialmente en la lengua donde se localiza con mayor frecuencia como un nódulo asintomático de crecimiento lento. Se analizan los hallazgos clínicos e histopatológicos, el diagnóstico diferencial y la actitud terapéutica ante esta patología junto con una revisión de la literatura. Caso clínico: una mujer de 21 años de edad acude al Departamento de Medicina y Cirugía Bucofacial de la facultad de Odontología de la universidad Complutense de Madrid por presentar una lesión asintomática en la lengua de un año de evolución. El diagnóstico definitivo tras la biopsia escisional fue de tumor de células granulares. Discusión: Descrito por primera vez en 1926 como ‘mioblastoma de células granulares’, ha recibido distintas denominaciones ‘neurofibroma de células granulares’ o ‘schwannoma de células granulares’ lo que evidencia su controvertida histogénesis. Actualmente se defiende la teoría de un origen neural de las células granulares basado principalmente en estudios inmunohistoquímicos. Su comportamiento generalmente benigno y su baja tasa de recidiva tras la exéresis quirúrgica establecen un pronóstico favorable. Conclusiones: Dadas las posibilidades diagnósticas que se pueden establecer clínicamente, la realización de una biopsia escisional y su posterior análisis histopatológico, resulta indispensable para el correcto diagnóstico y tratamiento de la lesión (AU)

Introduction: Granular cell tumor is a soft tissue neoplasm that usually affects females in the fourth to sixth decades of life. It can affect any area of the body, with preponderance to the oral cavity, specifically in the tongue, as an asymptomatic nodule of slow growth. histological findings, differential diagnosis and therapeutic implications are discussed together with a review of the literature. Case report: A 21 year old female comes to the Oral Surgery and Medicine Department of the Complutense university of Madrid because of an asymptomatic lesion in the tongue of a year of evolution. The final diagnosis after exisional biopsy was granular cell tumor. Discussion: Firstly described as ‘granular cell myoblastoma’, different terms have been applied to this entity such as ‘granular cell neurofibroma’ or ‘granular cell schwannoma’. The theory of a neural origin of the granular cells based on inmunohistochemical studies is now accepted. Its usual benign behavior and its low recurrence rate after surgical excision set a favorable prognosis. Conclusion: A surgical excisional biopsy of the tumor and histological examination are necessary for the correct diagnosis and treatment due to differential diagnosis including benign soft tissue tumors (AU)

Alpha lipoic acid efficacy in burning mouth syndrome. A controlled clinical trial.

BACKGROUND: A double-blind placebo-controlled trial was conducted in order to evaluate the efficacy of alpha lipoic acid (ALA) and determine the statistical significance of the outcome variables. Burning mouth syndrome (BMS) is defined as an oral burning sensation in the absence of clinical signs which could justify the syndrome. Recent studies suggest the existence of neurological factors as a possible cause of the disease. MATERIAL AND METHODS: 60 patients with BMS, in two groups: case group with 600 mg/day and placebo as control group; with follow up of 2 months. RESULTS: 64% of ALA patients reported some level of improvement, with a level of maintenance of 68.75% one month after treatment. 27.6% of the placebo group also demonstrated some reduction in BMS symptoms. CONCLUSIONS: Long-term evolution and the intensity of symptoms are variables that reduce the probability of improvement with ALA treatment.

Síndrome de boca ardiente: puesta al día / Burning mouth syndrome: update

El Síndrome de Boca Ardiente (SBA) es una entidad conocida desde hace tiempo que se caracteriza por una sensación de ardor de la mucos oral en ausencia de signos clínicos y que suele aparecer en mujeres de edad media o avanzada La etiología de esta patología no es conocida, pero se han descrito factores locales, sistémicos y psicológicos relacionados con los síntomas, y las últimas investigaciones sugieren que es posible que exista una base neurológica. Debido al escaso conocimiento sobre la etiología, a día de hoy, no existe un tratamiento eficaz para todos los pacientes. El presente artículo realiza una revisión sobre la etiología, manejo y tratamiento del SBA (AU)

Burning Mouth Syndrome (BMS) is an entity which has been known for a long time. It consists on a burning sensation of the oral mucos a without anyclinical sign. It is usually found in women in the middle age or even in the elderly.The ethiology is unknown but many factors has been described to be related to the symptoms: local, systemic or psycological factors. Last researches suggests that a neurological factor could be involved in the development of the disease. Because of the lack of knowledge about the etiology, nowadays, there is not an effective treatment for most of the patients. This paper reviews the ethiology of BMS, the management of the patients and the treatment (AU)

Proliferative verrucous leukoplakia: A proposal for diagnostic criteria

Proliferative verrucous leukoplakia (PVL) is a rare form of oral leukoplakia, which was first described in 1985 byHansen et al. Since then, various published case series have presented PVL as a disease with aggressive biological behaviour due to its high probability of recurrence and a high rate of malignant transformation, usually higher than 70%. PVL is a long-term progressive condition, which is observed more frequently in women and elderly patients over 60 years at the time of diagnosis. Eventually, PVL tends to become multifocal with a progressive deterioration of the lesions, making it more and more difficult to control. Tobacco use does not seem to have a significant influence on the appearance or progression of PVL. These lesions may occur both in smokers and nonsmokers. Nevertheless, at present, the aetiology of PVL remains unclear as well as its management and diagnosis,which is still retrospective, late and poorly defined, lacking consensus criteria.Therefore, the aim of this study is to propose a set of diagnostic criteria to allow for the early and objective identification of PVL cases, and thereby conduct an adequate management. The proposal includes five major criteria and four minor criteria, as well as specific combinations among them in order to establish a correct and objective diagnosis of proliferative verrucous leukoplakia (AU)

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Proliferative verrucous leukoplakia: a proposal for diagnostic criteria.

Proliferative verrucous leukoplakia (PVL) is a rare form of oral leukoplakia, which was first described in 1985 by Hansen et al. Since then, various published case series have presented PVL as a disease with aggressive biological behaviour due to its high probability of recurrence and a high rate of malignant transformation, usually higher than 70%. PVL is a long-term progressive condition, which is observed more frequently in women and elderly patients over 60 years at the time of diagnosis. Eventually, PVL tends to become multifocal with a progressive deterioration of the lesions, making it more and more difficult to control. Tobacco use does not seem to have a significant influence on the appearance or progression of PVL. These lesions may occur both in smokers and non-smokers. Nevertheless, at present, the aetiology of PVL remains unclear as well as its management and diagnosis, which is still retrospective, late and poorly defined, lacking consensus criteria. Therefore, the aim of this study is to propose a set of diagnostic criteria to allow for the early and objective identification of PVL cases, and thereby conduct an adequate management. The proposal includes five major criteria and four minor criteria, as well as specific combinations among them in order to establish a correct and objective diagnosis of proliferative verrucous leukoplakia.

Genotypic determination by PCR-RFLP of human papillomavirus in normal oral mucosa, oral leukoplakia and oral squamous cell carcinoma samples in Madrid (Spain).

BACKGROUND: Human papillomaviruses (HPVs), especially genotypes 16 and 18, are considered to be human carcinogens by the International Agency for Research on Cancer (IARC). They are the most important etiological agents of uterine cervix cancer but their true role in oral carcinogenesis is controversial. OBJECTIVES: To detect the presence of HPV genome genotypes in oral leukoplakia and oral squamous cell carcinoma (OSCC) and analyze their relationship with clinicopathological variables. MATERIALS AND METHODS: Presence of genome ofHPV types 6, 11, 16, 18, 31, 33, 39, 42, 45, and 52 was studied by polymerase chain reaction in samples of normal mucosa (30 controls), oral leukoplakia (35 cases) and OSCC (33 cases). Results were compared between groups and differences were examined in relation to clinical and histological variables. RESULTS: HPV genome was detected in 23.3% of controls, 45.7% of oral leukoplakias, and 39.4% of OSCCs. Only HPV-16 was significantly (p=0.0005) more frequently detected in leukoplakias (40%) and OSCCs (33.3%) versus controls (0%). No significant relationship was found between the presence of viral genome and the main clinicopathological variables. CONCLUSION: According to these findings, the presence of HPV-16 is significantly associated with oral leukoplakia and OSCC lesions, therefore in our setting this virus may be a carcinogenic element in this disease.

Undecalcified bone samples: a description of the technique and its utility based on the literature.

The evaluation of bone regeneration and peri-implantary bone apposition requires laboratory techniques that allow the evaluation of hard tissues without needing to decalcify them. In this study, we describe the cutting-grinding procedure (EXAKT system) for obtaining samples of undecalcified bone and aim to establish the procedures for their histological and histomorphometric evaluation. A review is made of the literature on histological and histomorphometric evaluation using undecalcified samples in surgical and oral implantology procedures in which bone regeneration or bone apposition is produced on the dental implants. The technique is a lengthy process, and is principally indicated in the investigation of bone biology. The use of undecalcified samples allows the differentiation of immature from mature bone, and the quantification of variables such as the bone-implant interface, the density of the bone area and the speed of bone apposition.

Effects of the consumption of alcohol in the oral cavity: relationship with oral cancer.

In an epidemiologic point of view the consumption of alcoholic beverages is found to be associated to an increased risk for developing an upper gastrointestinal tract cancer. The relation of the studies that establish this connection is complicated due to both the confluence of various risk factors within the same person such as alcohol and tobacco, and to the lack of data that can be verifiable by the clinician. For this reason the exact pathogenic mechanism responsible for this increase of risk is not known since ethanol per se was not confirmed to be carcinogenic. Different hypotheses have been proposed, explaining how ethanol, by oral or systemic route, can act as a risk factor for the development of oral cancer. This article serves as a review of the actual situation of the potential pathogenic mechanisms, dividing them in local and systemic effects. Within the aforementioned special reference is made on the alteration of the oral mucosa permeability, the action of acetaldehyde and the role of retinoids.

Efectos del consumo de alcohol etílico en la cavidad oral: relación con el cáncer oral / Effects of the consumption of alcohol in the oral cavity: relationship with oral cancer

El consuno de bebidas alcohólicas se encuentra asociado desde un punto de vista epidemiológico con un riesgo aumentado de desarrollar cáncer del tracto gastrointestinal superior. La realización de estudios que establezcan esa asociación resulta complicada, debido tanto a la confluencia de varios factores de riesgo en una misma persona, por ejemplo alcohol y tabaco, como a la falta de datos que puedan ser comprobables por el clínico. Por ello no se conoce con exactitud cual es el mecanismo patogénico responsable de este aumento de riesgo, ya que el etanol per sé no ha demostrado ser carcinógeno. Se han propuesto distintas hipótesis que tratan de explicar como el etanol, ya sea por vía local o sistémica puede actuar como factor de riesgo en el desarrollo de un cáncer oral. Este trabajo supone una revisión de la situación actual de los potenciales mecanismos patogénicos, dividiéndolos en efectos locales y sistémicos. Dentro de los primeros se hace especial referencia a la alteración de la permeabilidad de la mucosa oral, a la acción del acetaldehído y al papel de los retinoides (AU)

Corticoids: their use in the pathology of the oral mucosa.

The etiology of a great number of processes that affect the oral mucosa is yet quite unclear. It is generally known that many of them develop into a chronic and unspecific inflammatory process, occasionally of possible immunologic cause. Treatment therefore is not aimed on their cause but on their symptoms. Due to their anti-inflammatory and immunosuppressive properties, corticoids continue to be the first drug of choice. However, the chronicity of these types of processes together with the wide variety of adverse effects that corticoids can cause on a long-term basis, make their use complex and empirical. Guidelines of variable application are used depending on the clinical manifestations, the individual susceptibility and the evolution of the disease. The most commonly used corticoids in oral pathology, the different routes of administration and the possible guidelines and precautions proposed by diverse authors to control the disease and to decrease the possible adverse effects derived from corticotherapy are described.

Utilidad del screening en el cáncer oral / Utility of screening in oral cancer

Detectar un cáncer oral de forma precoz tiene gran importancia, ya que aumenta considerablemente la probabilidad de supervivencia del paciente. Para ello, se han propuesto distintos métodos a lo largo del tiempo, con resultados más o menos efectivos. El objetivo de este trabajo es realizar una revisión bibliográfica sobre su utilidad de realizar un programa de screening en le población general para la detección precoz del cáncer oral un screening es un medio que nos ayuda a detectar une enfermedad: no realiza diagnósticos, sino que discrimine e une población susceptible de padecer o no ese enfermedad. Para ello, se he revisado le literatura sobre diferentes aspectos de diagnóstico del cáncer, los distintos métodos de detección precoz, así como de los intentos de screening llevados a cabo en amplios sectores de le población. Como conclusión, no se recomienda realizar programas de screening masivos pare el cáncer oral, y que aunque en principio si representa un problema de salud pública debido e su elevada mortalidad y e que existe un estadio precoz identificable del cáncer oral, la historia natural del mismo se desconoce y los métodos actuales de detección precoz no son realmente sensibles. Sin embargo, es imprescindible señalar la Importancia de realizar exámenes de manera rutinaria en las consultas dentales con el fin de descubrir el mayor número posible de lesiones precoces de cáncer oral (AU)

Diagnóstico diferencial de las lesiones blancas orales / Differential diagnosis of oral white lesions

Dentro de la patología de la mucosa oral, las alteraciones del color tienen gran importancia, fundamentalmente debido a su frecuencia. Entre ellas, las lesiones blancas son de obligado conocimiento para el odontólogo/estomatólogo ya que la leucoplasia, que es la lesión blanca por antonomasia, está catalogada por la Organización Mundial de la Salud como lesión precancerosa. Es por tanto imprescindible que el profesional sepa identificar fas patologías, distinguir las que son banales de las que no y, sobre todo, diagnosticar las que se puedan malignizar. El objetivo de este trabajo es la sistematización y clasificación de las lesiones blancas que se observan con más frecuencia en la mucosa oral, con el fin de elaborar unos criterios claros de diagnóstico diferencial, que le sean útiles al profesional en su práctica diaria (AU)