Manifestaciones orales de la viruela símica y recomendaciones para su prevención en la práctica odontológica / Oral manifestations of monkeypox and recommendations for its prevention in dental practice

El brote reciente de viruela símica ha despertado el interés de la comunidad internacional por su creciente número de contagiados en países no endémicos. Entre sus síntomas se encuentran la fiebre, dolor de cabeza, fatiga, dolor muscular, exantema y linfadenoma. La cavidad bucal es el lugar en el que suelen aparecer los primeros signos de la enfermedad. Por tanto, el objetivo de este trabajo fue establecer las principales manifestaciones orales de la viruela del mono y enumerar algunas recomendaciones de prevención. Para ello, se hizo una revisión bibliográfica entre 2012 y 2022 en la base de datos PubMed, usando las palabras clave, en inglés, monkeypox, oral manifestation y transmission. Se garantizó que, de los 14 documentos seleccionados, al menos el 80%, fueran publicaron en 2022. Las manifestaciones orales más frecuentes fueron: úlcera eritematosa, vesículas-ulcerosas y las asociadas a linfadenopatía (disfagia, odinofagia y faringitis). Entre las recomendaciones se encuentran: uso de mascarilla N95 y visores faciales, lavado constante de manos y espacios y atención de contagiados solo por eventos agudos (urgencias). Aunque no se ha confirmado, es posible que el Tecovirimat sea de ayuda en pacientes con sintomatología grave. Se concluye que es necesario que los odontólogos sepan distinguir los signos orales de la enfermedad para que contribuyan a cortar la cadena de contagio y deriven prontamente a los sospechosos para que se hagan las pruebas diagnósticas y las terapias medicamentosas de manera oportuna(AU)

The recent outbreak of monkeypox has aroused the interest of the international community due to its growing number of infections in non-endemic countries. Its symptoms include fever, headache, fatigue, muscle pain, rash, and lymphadenoma. The oral cavity is the place where the first signs of the disease usually appear. Therefore, the objective of this work was to establish the main oral manifestations of monkeypox and list some prevention recommendations. For this, a bibliographic review was carried out between 2012 and 2022 in the PubMed database, using the keywords, in English, monkeypox, oral manifestation and transmission. It was guaranteed that, of the 14 selected documents, at least 80% would be published in 2022. The most frequent oral manifestations were: erythematous ulcer, ulcer-vesicles and those associated with lymphadenopathy (dysphagia, odynophagia and pharyngitis). Among the recommendations are: use of N95 mask and face visors, constant washing of hands and spaces, and attention to those infected only due to acute events (emergencies). Although it has not been confirmed, it is possible that Tecovirimat is helpful in patients with severe symptoms. It is concluded that it is necessary for dentists to know how to distinguish the oral signs of the disease so that they contribute to breaking the chain of contagion and promptly refer suspects to diagnostic tests and drug therapies in a timely manner(AU)

Community pharmacy staff oral health training, training needs and professional self-efficacy related to managing children's dental problems.

OBJECTIVES: Few studies have explored the oral health training needs and professional self-efficacy (PSE) in both pharmacy support staff and pharmacists related to managing children's dental problems. This study assessed community pharmacy staff perceptions of their (i) training experiences and interests; (ii) PSE; and (iii) whether this was influenced by the pharmacy being part of a minor ailment scheme (MAS), where staff could directly offer advice and issue prescription medications without patients seeing a doctor. METHODS: All of the 1851 community pharmacies across London, UK, were invited to participate in an online questionnaire. Staff rated their prior training, perceived need for further training and confidence in giving parents advice related to three dental problems in children (dental pain, mouth ulcers and dental trauma). Information was collected about staff roles and whether the pharmacy was a MAS. KEY FINDINGS: From 752 community pharmacies, 846 community pharmacy staff participated. Positive experiences of training were variable but interest in further training for all three dental problems was high. Pharmacy support staff had significantly lower PSE scores than pharmacy professionals (P = 0.009). A significant interaction showed that pharmacy staff who had poorly rated prior training on advising parents about managing their child's dental pain and who did not work in a MAS had lower PSE scores than staff who had highly rated training and who worked in a MAS (P = 0.02). CONCLUSIONS: Minor ailment scheme pharmacies may be an optimal environment for frontline pharmacy support staff to develop higher PSE when combined with good quality oral health training.

Biological agent in prevention of ocular recurrence in Behçets disease: a case report.

INTRODUCTION: Ocular involvement in Behçets disease (BD) is characterized by recurrent inflammatory attacks leading to poor long-term visual prognosis. The development of biologic agents has heralded a new era in the management of BD uveitis enabling more targeted immune modulation with greater efficacy and has now become the first line agents. OBJECTIVE: To report a case of young gentleman with Behçets disease whose ocular recurrence was controlled with injection Adalimumab. CASE: A 31-year-old male with recurrent oral and genital ulcers with bilateral recurrent uveitis was diagnosed as bilateral ocular Behçet's disease based on positive HLA B51typing and ferning pattern in FFA. He was on oral Prednisolone and Cyclosporine and was advised for biological agents. On presentation to us, he had anterior uveitis with pseudophakia and secondary open angle glaucoma in right eye and posterior sub capsular cataract in left eye. After starting Inj Adalimumab with oral Methotrexate, he ocular inflammation was under control and patient underwent uneventful cataract surgery in left eye. Over 1-year follow-up, the patient is on remission, on injection Adalimumab with the steroid tapered off. CONCLUSION: Biological agents like Adalimumab is effective in controlling recurrences in Behçet's disease.

Management of prematurely erupted teeth in newborns.

The majority of natal and neonatal teeth are prematurely erupted primary teeth, whereas few are supernumerary in origin. They most commonly occur in mandibular central incisor region and often can lead to difficulty to the mother during breast feeding and tongue ulceration in newborn. Moreover, since majority of these have poorly developed roots and are mobile, there is always a fear of aspiration into respiratory passage. Extraction therefore is the most commonly rendered treatment for these teeth. This paper comprises cases of natal and neonatal teeth describing about their clinical characteristics and sequel. This paper has also highlighted the factor which needs to be considered during the management of natal/neonatal teeth and protocol followed at our centre.

Alternativas sintomáticas en la aftosis oral recidivante / Symptom alternatives in recurrent oral aphthosis

No disponible

Reliability and efficacy of palifermin in prevention and management of oral mucositis in patients with acute lymphoblastic leukemia: a randomized, double-blind controlled clinical trial.

BACKGROUND: Myeloablative and hematopoietic stem cells transplantation therapy (HSCT) often acts as side-effect to oral mucositis (OM) with no effective treatment. This randomized-controlled trial analyzed the efficacy of palifermin, administered as a dose during HSCT therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia (ALL). METHODS: In this study forty-six patients (9-15 years) with B-cell acute lymphoblastic leukemia (B-ALL) were analyzed. The patients underwent allogenic HSCT conditioned by myeloablative regimen. Subsequently to randomization, patients in the palifermin group were assigned to receive palifermin, 60 mg/kg, intravenously as a single dose 3 days before and after transplant conditioning regimen cycle. The patients in the Control group received only a placebo treatment. Maximum severity of OM, incidence and duration of ulcerative OM, incidence and duration of severe OM limitations were evaluated. RESULTS: A statistically significant reduction in the incidence of OM up to grade 3 in the palifermin group compared to the control group was discovered. There was also a reduction, confirmed at 60 days, in the degree of severity of mucositis in the palifermin group, with an average of 1.54 grade in the palifermin group, and of 2.16 in the Control group and in the use of opioid analgesics. CONCLUSIONS: This study indicates that a single dose of palifermin used as primary prophylaxis during HSTC therapy can prevent severe OM in pediatric patients with ALL and used as secondary prophylaxis can prevent the recurrence of severe OM in high-risk patients with previous mucosal injury and improves the quality of life in pediatric patients with ALL.

Placa de acrílico con ansa vestibular para prevenir la úlcera oral traumática en paciente con retraso mental / Acrylic Plate with Vestibular Hanse to Prevent Tramautic Oral Ulcer in a Mental Retarded Patient

Las úlceras orales constituyen una de las urgencias en Estomatología, son lesiones inflamatorias de la mucosa bucal que poseen múltiples etiologías. Se presentó una paciente discapacitada, de nueve años de edad que acudió acompañada de sus padres a la Consulta de Urgencia de la Clínica Estomatológica Frank País del municipio Frank País, provincia Holguín, a los 24 días del mes de enero de 2014 presentando una úlcera oral de origen traumático, muy dolorosa de más menos 15,5 mm de diámetro y 5 mm de profundidad en paladar duro por pérdida dentaria y la consiguiente pérdida de la oclusión. Como tratamiento se le confeccionó una placa atraumática de acrílico con un ansa vestibular. El uso de esta placa permitió aislar la zona del trauma con el posterior alivio del dolor, cicatrización de la úlcera y restitución de la dimensión vertical oclusiva. Además, estimuló el brote dentario y la recuperación de la oclusión dentaria. La placa pasiva de acrílico con ansa vestibular se recomienda como una alternativa viable en situaciones similares(AU)

Oral ulcers are one of the urgencies in stomatology; these are inflammatory injuries of oral mucous that have multiple etiologies. A clinical case of a disabled, female patient of nine years old was presented in this paper. The patient came with her parents to the emergency consulting room of Dental Clinic, Frank País municipality, Holguín province, on January, 2014 presenting an oral extremely painful ulcer of traumatic origin, extra less 15.5 mm of diameter and 5mm of depth in hard palate for dental loss and the decrease of the vertical occlusive dimension. A plate of acrylic with one vestibular hanse was made for the treatment. The use of this splint enabled the relief of the pain, cicatrization of the ulcer and the recuperation of the vertical occlusive dimension. This alternative is recommended in similar situations

Persistent untreated Riga-Fede disease for 6 years.

Riga-Fede disease is an uncommon, benign, ulcerative condition due to dental trauma that can occur at any age. A 9-year-old boy with a painful tongue is presented. Physicians need to recognize Riga-Fede disease and Riga-Fede-like disease to intervene early.

[Systemic Adamantiades-Behçet's disease: adverse effects of an otherwise successful therapy with interferon-α-2a]. / Morbus Adamantiades-Behçet: erfolgreiche Therapie mit ungewöhnlichen Komplikationen.

BACKGROUND: Adamantiades-Behçet's disease is an immune-mediated vasculitis with relapsing course. It is characterised by the classic clinical trias of oral aphthous ulcers, genital ulcers and uveitis. HISTORY AND FINDINGS: A 37-year-old woman suffered from systemic Adamantiades-Behçet disease with recurrent uveitis, oral ulcers, genital ulcers, arthralgia, erythema nodosum and folliculitis. COURSE AND TREATMENT: Longterm interferon-α-2a (IFNα-2a) led to reduction of the clinical manifestations except for occasional occurrence of oral ulcers. One year after initiation of treatment however, the patient developed symptomatic hyperprolactinemia of unknown etiology. CONCLUSION: Even in otherwise successful treatment with IFNα-2a possible side effects and complications of treatment can affect the course. Mastodynia and hyperprolactinemia have not yet been described as potential side effects of IFNα-2a.

Conservative management of Riga-Fede disease.

Riga-Fede disease presents in early infancy and is characterized by firm, verrucous plaques arising on the oral mucosal surfaces or tongue due to repetitive trauma. Treatment focuses on eliminating the source of trauma. The purpose of this report is to present a case involving preservation of the natal teeth using a protective mouthguard. At the follow-up, the ulcer had healed and the infant was feeding without difficulties.

Management of oral lesions in Lesch-Nyham syndrome.

Lesh-Nyhan Syndrome is a hereditary disorder that affects the way in which the body handles the production and breakdown of purines. One of its main characteristic is self-mutilation. We present a new appliance which allows healing to occur.

Wegener granulomatosis as an uncommon cause of panhypopituitarism in childhood.

Wegener granulomatosis (WG) is a cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA)-associated, multi-system, necrotizing granulomatous vasculitis. Inflammation of the nasal or oral mucosa, and lung and kidney involvements are typical in the course of the disease. In rare cases, pituitary involvement may occur and cause panhypopituitarism. Pituitary involvement is very rare, and only two pediatric case reports have been published to date out of a total of 24 cases. This is a case report of an adolescent patient who presented with panhypopituitarism symptoms and was later diagnosed with WG. A 16-year-old female patient complained of fever, headache, purulent nasal discharge and severe muscle and joint pain. Additionally, she had polyuria and polydipsia. Investigations revealed a pituitary mass and panhypopituitarism. Positivity of c-ANCA and renal biopsy result compatible with WG confirmed the diagnosis.

Riboflavin laurate nanosuspensions as an intramuscular injection for long-term riboflavin supplementation.

The aim of this study was to prepare riboflavin laurate (RFL) nanosuspensions as an intramuscular injection for long-term riboflavin supplementation. Stable RFL nanosuspensions were obtained by injecting RFL/poloxamer solution in N,N-dimethyl formamide into a trehalose solution. Long soft nanostructures initially appeared and then tube-like rigid nanostructures were obtained after removal of solvents according to the transmission electron microscopic images. The nanosuspensions had narrow size distribution and the mean size was about 300 nm. Molecular self-assembly of RFL may drive the formation of nanostructures. RFL formed a monolayer at the air/water interface and poloxamer 188 could insert into the monolayer. The nanosuspensions were intramuscularly injected into rats to provide long-term riboflavin supplementation for more than 30 days in light of body weight, food intake, and urinary riboflavin. The nanosuspensions were also used to resist the riboflavin deficiency induced by methotrexate chemotherapy. RFL nanosuspensions are a promising nanomedicine for long-term riboflavin supplementation.

Long and short term management of implant-supported mandibular overdentures.

UNLABELLED: Common problems with the long term clinical use of implant-supported mandibular overdentures (ISMDs) include fractures of dentures, bars and clips, and reactivation of clips. Many general dental practitioners (GDPs) are reticent to be involved in the maintenance of ISMDs, especially if they have not had any further training or are unfamiliar with implant components and systems. This article highlights the need for the training of GDPs in maintenance and management of ISMDs as an increasing number of edentulous patients are being provided with ISMDs, resulting in an increasing need for the maintenance of the prosthesis in the primary care setting at a possible cost to the patient. CLINICAL RELEVANCE: Implant-supported overdentures are becoming a common treatment option for edentulous patients, however, they are not without their clinical challenges, many of which can be easily rectified in a primary care environment, such as general practice.

Retrospective review of the reduction of oral pressure ulcers in mechanically ventilated patients: a change in practice.

Hospital-acquired pressure ulcers (HAPU) are a growing concern in patient care. Mucosal pressure ulcers (PUs) on the lips, mouth, gums, and tongue caused by oral intubation and their securement devices can be difficult to identify and prevent. In an effort to address this problem and reduce mucosal PU, implementation of an alternative securement device, the Hollister ETAD endotracheal (ET) tube securing device, in conjunction with the B&B Medical Universal Bite Block, was introduced at our institution, a level 1 trauma and burn center, in July 2007. The ETAD was later replaced by the Hollister AnchorFast ET tube securing device in December 2007. By April 2009, they became the standard devices and method used to secure oral ET tubes. We hypothesized the use of the new securement devices and bite block would lead to a decrease of HAPUs on the lips, mouth, gums, and tongue of orally intubated critical care patients because these allow for better oral assessment and ET tube manipulation to redistribute pressure. Using data collected from our electronic medical record and our HAPU incidence tracking system, we analyzed the number of PUs on the lips, mouth, gums, and tongue of orally intubated patients in our preintervention (phase 1) group compared with the data from our postintervention (phases 2 and 3) groups. A clinically significant decrease in the reported incidence of HAPUs on the lips, mouth, gums, and tongue was noted in our phases 2 and 3 groups following introduction of the ETAD, AnchorFast, and Universal Bite Block in our institution.

Miniscrew covering: an alternative to prevent traumatic lesions.

During orthodontic treatment with miniscrews, complications such as aphthous ulceration, soft-tissue coverage of the miniscrew head, soft-tissue inflammation, infection, and peri-implantitis can occur. Good hygiene can prevent inflammation by infection but does not prevent traumatic oral mucosal lesions at the buccal mucosa. The purpose of this article was to describe the use of a physical barrier--a light-cured temporary filling material--to cover the miniscrew head and prevent soft-tissue trauma.

[Planning dental care and orthodontic treatment for children afflicted with malignant hematological diseases]. / Planification des soins bucco-dentaires et des traitements ODF chez les enfants atteints d'une hémopathie maligne.

THE PROBLEM: In France, cancer affects 1 to 3% of all children and represents the second most frequent cause of mortality among children younger than fifteen. Malignant blood diseases are the most frequently occurring childhood cancers. Although their mortality rate has been tending to decrease, they often seem to develop after "opportunistic" latent infections persist, undetected, in un-eradicated sites that may be of dental origin. This infectious risk, frequently undiagnosed in hospitals, should be of concern to both general dentists and orthodontists. OBJECTIVES: General dentists and orthodontists each have specific roles to play in teaching children about oral health at an early age and in detecting and eradicating infection as well as in seeing at risk children in regular follow-up visits. DISCUSSION: Dentists should examine children on regularly scheduled preventive appointments and treat dental caries when they discover it. Orthodontists, who see the children they are treating on frequently scheduled appointments, should always be on the alert for incipient caries in their patients and be careful to make the appliances they wear as well fitting and non-irritating as possible to minimize the risk of inflammation and development of sore spots. Both dentists and orthodontists should teach their patients how to maintain healthy diets and good oral hygiene. They may be called upon to provide local relief for acute lesions that chemotherapy sometimes causes in the soft tissues of patients with hematological cancers and to modify irritating appliances.