[Avascular necrosis of the jaw bone after bisphosphonate therapy].

Bisphosphonates have an antiosteolytic effect by the inhibition of osteoclastic action. Although the exact mode of action is not completely understood, major progress on both the cellular and molecular levels has been made in recent years. Bisphosphonates alleviate pain and reduce complications, such as pathologic fractures, or hypercalcemia. Dental and periodontal research has shown great interest in clinical applications of bisphosphonates' antiosteolytic and antiosteoclastic traits, since they can be applied to counteract bone loss in chronic periodontitis. Investigations have associated avascular necrosis events in the jawbones with bisphosphonate therapy. Maxillary and mandibular osteonecrotic foci accompanied by pain, inconvenience and purulent exudates were incidentally found in patients who were taking pamidronate (Aredia), zolendronate (Zometa) and even alendronate (Fosalan). Our institutional database search over the past year yielded ten patients who were admitted to the Oral and Maxillofacial Surgery Unit at the Tel Aviv Sourasky Medical Center, due to an osteonecrotic bone lesion coupled with a prior history of bisphosphonate therapy. All these patients also had a recent dental extraction. They were all treated according to the osteomyelitis protocol, and their response to therapy varied from several weeks to many months, with some cases requiring repeat surgical intervention (curettage or sequestrectomy). This article strives to alert on the possible linkage between drug therapy using bisphosphonates and the serious event of avascular jawbone necrosis. The important role of the oral surgeon in following up on this group of patients should not be underestimated.

Evaluation of adverse reactions to local anesthetics: experience with 236 patients.

BACKGROUND: Adverse reactions to local anesthetics (LAs) are frequently reported. Although most of these reactions are not immune mediated, many patients are referred to allergy clinics and undergo extensive evaluation. OBJECTIVE: To determine the prevalence of true LA allergy among the patients referred for suspected hypersensitivity and to evaluate the usefulness of the currently used evaluation protocol. METHODS: A total of 236 patients referred to our allergy clinic for investigation of LA hypersensitivity were included in this study. The evaluation protocol was composed of skin prick and intradermal tests, followed by subcutaneous challenge with unrelated LA preparations that contained preservatives. RESULTS: Skin prick and intradermal test results were negative for all subjects. No objective adverse reactions were observed during the challenge in all but 1 patient, who developed local erythema at the site of injection and later underwent an uneventful challenge with a different LA. CONCLUSIONS: Allergic reactions were not reproduced during testing and challenge with LA preparations that contained preservatives or preservatives with adrenaline in our large group of patients with suspected LA allergy. Since both prick and intradermal skin test results were negative in all the patients and did not provide us with useful information, we propose to modify the standard protocol by omitting intradermal tests and shortening the challenge. We also suggest that the whole procedure be performed with LAs that contain preservatives, which are usually the preferred preparations widely used in daily practice.

[Fractures of the atrophic mandible--our experience at Tel-Aviv Medical Center].

UNLABELLED: Fractures of the atrophic edentulous mandible are relatively uncommon. The treatment poses a real challenge due to the underlying medical condition of the geriatric population affected. The complication rate such as infection or malunion is higher compared to fractures in younger patients. Twenty-three cases of fractures of edentulous mandible were reviewed and analyzed. CONCLUSION: The geriatric maxillofacial trauma patients can be treated with open reduction and rigid fixation which allows a quick return to normal function. The conservative approach "close reduction with Gunning-type splints is still an adequate mode of treatment in clinical settings where a more aggressive surgical approach is contraindicated.

Artrocentese e lavagem da articulaçäo temporomandibular: indicaçöes no tratamento da abertura de boca limitada / Artrocenthesis and lavage of the temporomandibular joint: its indications in the treatment of limited mouth opening

Artrocentese e lavagem da articulaçäo temporomandibular é um processo simples que proporciona bons resultados em pacientes apresentando limitaçäo da abertura de boca decorrente de determinadas disfunçöes articulares. Descriçäo da técnica de artrocentese e lavagem, suas indicaçöes e possíveis complicaçöes säo discutidas nesse artigo