Tooth extraction prior to radiotherapy for oropharyngeal cancer increases the risk of osteoradionecrosis.

PURPOSE: Osteoradionecrosis of the jaw is a therapy-resistant condition that may occur after treatment for head and neck cancer. The aim of this study was to investigate the incidence of osteoradionecrosis in patients with oropharyngeal cancer in relation to tooth extraction prior to radiation therapy. METHODS: Patients who had undergone radiation therapy for oropharyngeal cancer 5-10 years earlier were included and evaluated for the development of osteoradionecrosis (n = 75). RESULTS: Among the 75 patients, 62 had molar teeth present in the >50 Gy radiation field and 36 of those patients had teeth extracted prior to radiation therapy. Extraction of molars before radiotherapy significantly increased the risk of developing osteoradionecrosis (P < 0.05). There were no identifiable statistically significant correlations between the time from tooth extraction and the start of radiation therapy, the number of teeth in the radiation field, smoking habits, human papillomavirus-status, gender, age or tumor location and the development of osteoradionecrosis. CONCLUSION: Tooth extraction prior to radiation therapy increases the risk of developing osteoradionecrosis. For patients with good oral hygiene and absence of dental disease, avoidance of tooth extraction in the radiation field could therefore reduce the risk of complications.

Using Electronic Dental Records to Assess Osteoradionecrosis Risk in Irradiated Head and Neck Cancer.

OBJECTIVE: Over the last 2 decades, investigations have demonstrated a decreased trend in the likelihood of osteoradionecrosis of the jaw (ORNJ) after extraction. The aim of this study was to explore the potential risk factors for ORNJ in irradiated head and neck cancer by using patients' electronic dental records (EDRs). METHODS: Patients diagnosed with head and neck cancer who had irradiation between January 2010 and December 2020 were included in this retrospective cohort analysis. Patient charts showing evidence of "head and neck cancer," "oral cancer," "radiotherapy," "radiation," and "oral complication" were identified by an informatics analyst querying the EDR. Subsequently, the charts were manually reviewed, and data quality was assessed on 3 dimensions: completeness, accuracy, and consistency. The patient, tumor, systemic condition/drug, oral condition, treatment/trauma, and radiation were all categorized as potential risk factors. RESULTS: A total of 359 patients were included. With the exception of radiation-related factors, we found that the data quality was generally sufficient to support the research. Multivariate logistic regression analysis demonstrated that the following factors were significant in predicting the occurrence of ORNJ development in irradiated head and neck cancer: smoking (odds ratio [OR], 9.0; 95% CI, 1.9 to 43.0; P = 0.006), steroid use (OR, 6.4; 95% CI, 1.3 to 30.8; P = 0.021), oral health status (OR, 23.7; 95% CI, 2.7 to 211.0; P = 0.005), and postirradiation extraction (OR, 3.8; 95% CI, 1.0 to 14.4; P = 0.050). CONCLUSIONS: A 10-y retrospective analysis of data from an EDR revealed that smoking, steroid use, poor oral status, and postirradiation extraction are all factors linked to an increased risk of developing ORNJ. The quality of EDR data may be systematically assessed by determining the completeness, accuracy, and consistency of the underlying data. Radiation-related factors in particular were poorly documented, highlighting the need for collecting or incorporating this information into the EDR. KNOWLEDGE TRANSFER STATEMENT: EDRs can be used to identify risk factors for developing ORNJ in irradiated head and neck cancer and can help clinicians with selecting treatments by incorporating risk and complication considerations.

Radiographic and Clinical Analysis of Cranio-Maxillofacial Complications of Cavernous Sinus Thrombosis Among 256 COVID-19 Patients.

BACKGROUND: A heavy burden of cranio-maxillofacial complications may be encountered in corona virus disease-2019 patients due to the associated coagulopathy and inflammatory consequences of the disease. This study aims to describe clinical and radiographic features of these complications in 256 patients who developed 1 or more of the following complications: cavernous sinus thrombosis, osteomyelitis or necrosis of the jaws. METHODS: Clinical assessment of cranial nerve function and general clinical assessment were performed. Imaging techniques used were multi-slice computed tomography, magnetic resonance imaging, and MRI with contrast enhancement. RESULTS: Thromboembolism of brain and facial blood vessels were associated with inflammation and necrosis. Multi-slice computed tomography/MR angiography showed thrombotic occlusions of the internal carotid artery in the area of the cavernous sinus, and in the ophthalmic veins. Cavernous sinus thrombosis was attributed to coagulopathy and, inflammation of the paranasal sinuses, especially sphenoiditis. A noticeable increase in the size of the cavernous sinus was detected. Compression of the cranial nerves in the cavernous sinus (CS) region causes dysfunction and pathology in the corresponding regions.

Predictors of osteoradionecrosis following irradiated tooth extraction.

BACKGROUND: Tooth extraction post radiotherapy is one of the most important risk factors of osteoradionecrosis of the jawbones. The objective of this study was to determine the predictors of osteoradionecrosis (ORN) which were associated with a dental extraction post radiotherapy. METHODS: A retrospective analysis of medical records and dental panoramic tomogram (DPT) of patients with a history of head and neck radiotherapy who underwent dental extraction between August 2005 to October 2019 was conducted. RESULTS: Seventy-three patients fulfilled the inclusion criteria. 16 (21.9%) had ORN post dental extraction and 389 teeth were extracted. 33 sockets (8.5%) developed ORN. Univariate analyses showed significant associations with ORN for the following factors: tooth type, tooth pathology, surgical procedure, primary closure, target volume, total dose, timing of extraction post radiotherapy, bony changes at extraction site and visibility of lower and upper cortical line of mandibular canal. Using multivariate analysis, the odds of developing an ORN from a surgical procedure was 6.50 (CI 1.37-30.91, p = 0.02). Dental extraction of more than 5 years after radiotherapy and invisible upper cortical line of mandibular canal on the DPT have the odds of 0.06 (CI 0.01-0.25, p < 0.001) and 9.47 (CI 1.61-55.88, p = 0.01), respectively. CONCLUSION: Extraction more than 5 years after radiotherapy, surgical removal procedure and invisible upper cortical line of mandibular canal on the DPT were the predictors of ORN.

Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma.

BACKGROUND: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters. METHODS: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. The Mann-Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan-Meier analyses were performed for cumulative ORNJ incidence estimation. RESULTS: Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3-145) months. The median time to ORNJ development was 27 (range 2-127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001). CONCLUSIONS: V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

Prevalencia, distribución y diagnóstico histopatológico de hallazgos de imágenes radiolúcidas en los maxilares / Prevalence, distribution and histopathologic diagnosis of radiolucid images findings in the jaws

RESUMENObjetivo: el objetivo de este estudio fue identificar la prevalencia, ubicación y diagnóstico histopatológico de las lesiones radiolúcidas presentes en las radiografías panorámicas de pacientes que concurrieron a la cátedra de Cirugía y Traumatología Bucomaxilofacial I de la Facultad de Odontología de la Universidad de Buenos Aires, cuando el motivo de consulta no coincidió con el hallazgo radiográfico.Métodos: se realizó un análisis retrospectivo, observacional y descriptivo que consistió en identificar las imágenes radiolúcidas mayores a 1 cm de diámetro y presentes en radiografías panorámicas a partir de la revisión de historias clínicas de pacientes que concurrieron y fueron tratados quirúrgicamente en la cátedra de Cirugía y Traumatología Bucomaxilofacial I desde marzo de 2014 a diciembre de 2019. A partir de dichas historias clínicas, se registró edad y género del paciente, ubicación de la lesión en el maxilar, asociación o no a una pieza dentaria y resultado anatomopatológico.Resultados: los resultados AP se asociaron significativamente con los rangos etarios, no así con los sectores de piezas, ni con el sexo (AU)

Objective: the objective of this study was to identify the prevalence, location and histopathological diagnosis of radiolucent lesions present in the panoramic radiographs of patients who attended the chair of Bucomaxillofacial Surgery and Traumatology I, when the reason for consultation did not coincide with the radiographic finding.Methods: a retrospective, observational and descriptive analysis was carried out that consisted of identifying radiolucent images larger than 1 cm diameter present in panoramic radiographs from the review of medical records of patients who attended and were treated surgically in the chair of Bucomaxillofacial Surgery and Traumatology I from March 2014 to December 2019. From these medical records, the age and gender of the patient, location of the lesion in the maxilla, its association or not with a tooth, and pathological results were recorded.Results: the anatomopathological results were significantly associated with the age ranges, not with the sectors of pieces or with sex.

Simple bone cyst: description of 60 cases seen at a Brazilian School of Dentistry and review of international literature

BACKGROUND: The aim of this study was to describe the relative frequency and the main demographic and clinic-radiographic features related to patients diagnosed with Simple bone cyst (SBC) in an Oral Diagnosis Service in Southeast Brazil and present a review and discussion of international literature on this topic. MATERIAL AND METHODS: SBC cases from our service encompassing the period between 1978 and 2017 were selected. In addition, a literature search was performed in the Pubmed/MEDLINE online electronic database published between 1951 and 2019. RESULTS: A total of 2,459 cystic lesions were documented in our service, thus 60 patients were diagnosed with the SBC representing 2.4% of all jaw cystic. Most of cases were asymptomatic. Multiple SBC lesions were seen in two patients (3.4%) and association with cemento-osseous dysplasia was seen in one female patient (1.7%). A total of 793 cases were enrolled in this literature review. CONCLUSIONS: The SBC is an asymptomatic lesion often discovered in routine image exams in young patients. The unilocular, well defined margin with scalloped appearance is characteristic and helps the definition of diagnosis. This review suggests a different epidemiologic trend concerning to the sex and it confirms the posterior region of mandible as the more frequent location. The conservative treatment with limited exploration and curettage remains as the gold-standard treatment

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Preradiation tooth extraction and jaw osteoradionecrosis: Nationwide population-based retrospective study in Taiwan.

OBJECTIVE: Radiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national healthcare database, we reviewed the contraindications and analysed other risk factors for ORNJ. DESIGN: A retrospective cohort study. SETTING: By using Taiwan's National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1-21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included. The patients were divided into two groups according to the time of tooth extraction before the index day: 1-7 days and 8-21 days. PARTICIPANTS: Taiwanese patients with head and neck cancer. MAIN OUTCOMES MEASURE: Univariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ. RESULTS: The overall incidence of ORNJ in the included patients was 1.03% (mean follow-up duration, 4.07 ± 3.01 years; range, 1.00-13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio [HR] =0.734; P = .312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488) and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all P < .001). CONCLUSION: In a mean follow-up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7-21 days before RT.

Aromatase inhibitors associated osteonecrosis of jaw: signal refining to identify pseudo safety signals.

Background Signal generation through data mining algorithms is an innovative and emerging field in pharmacovigilance. Early detection of safety signals is important for public health safety. However, the possibility of generating pseudo signals should not be overlooked. Objective Our study aimed to identify potential signals of aromatase inhibitors associated Osteonecrosis of Jaw and assess the possibilities of the safety signal to be a pseudo signal/false positive in FDA Adverse Event Reporting System (FAERS). Setting Spontaneously reported data in FAERS database. Methods Data for this study were obtained from the public release of data in FAERS. OpenVigil, a pharmacovigilance analytical tool was used to access FAERS data. Reporting Odds Ratio (ROR) was used to assess the relation between the drug and adverse event. A value of ROR-1.96SE > 1, (SE-standard error) was considered positive. Main outcome measure Signal strength. Results FAERS database had a total of 15,178 reports for Osteonecrosis of Jaw. Amongst which 617 reports were associated with aromatase inhibitors. Signal strength ROR (lower bound of the 95% CI) for letrozole, anastrozole and exemestane associated Osteonecrosis of Jaw without any background correction was 8.34, 6.64 and 15.14 respectively. Upon removing the reports of concomitantly administered drugs (bisphosphonates and denosumab), signal strength drastically decreased to 0.03, 0.36 and 0.47 for letrozole, anastrozole and exemestane respectively. The signal strength of bisphosphonates and denosumab associated Osteonecrosis of Jaw was not changed significantly upon removal of aromatase inhibitors. Conclusion Our study concluded that the signal generated for aromatase inhibitors associated Osteonecrosis of Jaw in FAERS database can be false positive. Careful background corrections with identification of those risk factors are imperative to exclude false positive results.

Bulbar Problems Self-Reported by Children and Adults with Spinal Muscular Atrophy.

BACKGROUND: Spinal muscular atrophy (SMA) is hereditary motor neuron disorder, characterised by the degeneration of motor neurons and progressive muscle weakness. It is caused by the homozygous loss of function of the survival motor neuron (SMN) 1 gene. SMA shows a wide variability of disease severity. OBJECTIVE: To investigate self-reported bulbar problems in patients with SMA, and their relationship to age, functional motor scores and active maximum mouth opening. METHODS: We used the Diagnostic List of Dysphagia and Dysarthria in (pediatric) patients and relevant recent clinical data from the national SMA database. RESULTS: The 118 included patients with SMA frequently reported jaw problems (34%), fatigue associated with mastication (44%), choking (56%) and intelligibility problems (27%). Jaw, mastication and swallowing problems frequently occurred in combination with each other. There was an increase of reported bulbar problems in patients with SMA type 3a, older than 30 years of age, compared to younger patients of this SMA type.The Hammersmith Functional Motor Scale Expanded scores showed a negligible correlation with jaw and mastication problems, a low negative correlation with swallowing problems and a moderate negative correlation with intelligibility problems. Reduced mouth opening showed a significant, but low correlation with bulbar complaints in patients with SMA type 2. CONCLUSIONS: Fatigue associated with mastication and swallowing problems were frequently reported complaints. Patients 30 years and older with milder forms of SMA showed an increase of self-reported bulbar problems.

Medication-Related Osteonecrosis of the Jaws.

Medication-related osteonecrosis of the jaw is an oral complication in cancer patients being treated with either antiresorptive or antiangiogenic drugs. The first reports of MRONJ were published in 2003. Hundreds of manuscripts have been published in the medical and dental literature describing the complication, clinical and radiographic signs and symptoms, possible pathophysiology, and management. Despite this extensive literature, the pathobiological mechanisms by which medication-related osteonecrosis of the jaw develops have not yet been fully delineated. The aim of this manuscript is to present current knowledge about the complication ragarding to the definition, known risk factors, and clinical management recommendations. Based on this current state of the science, we also propose research directions that have potential to enhance the management of future oncology patients who are receiving these agents.

Prevalence and normative values for jaw functional limitations in the general population in Sweden.

OBJECTIVES: For jaw functional limitations measured by the Jaw Functional Limitation Scale (JFLS), (a) determining prevalence in the Swedish general adult population, (b) investigating the influence of demographic factors and self-reported dental status and (c) deriving normative values. METHODS: A random sample of the general adult population in Sweden was approached (response rate: 46%, N = 1,372). Prevalence was determined for the JFLS summary score and individual items. The influence of age, gender and dental status was investigated with regression analyses and normative values presented. RESULTS: The JFLS median score was 0, and all items had prevalences ≤30%. Age and gender did not influence jaw functional limitations but dental status did. Normative JFLS scores were 1, 9 and 28 for the 7th, 8th and 9th deciles, respectively. In dental status-stratified norms, 9th deciles were 20, 43 and 100, for subjects with natural teeth only, removable and complete dentures, respectively. CONCLUSIONS: The Swedish general adult population had excellent jaw function, but dental status was major determinant. In the absence of information linking JFLS scores to important patient concerns, the score distribution can serve as a reference with the 9th decile as threshold for functional limitation.

Estudo epidemiológico de pacientes portadores de infecção do complexo bucomaxilofacial tratados no Hospital Universitário de Maringá: estudo retrospectivo ao longo de 8 anos / Epidemiological study of patients with oral maxillofacial infection treated at Universitary Hospital of Maringá: retrospective study about 8 years

Infecções agudas bucomaxilofaciais podem ser condições clínicas graves e de ocorrência comum, caracterizadas pela disseminação do processo infeccioso a tecidos adjacentes e espaços faciais da região de cabeça e pescoço, podendo resultar em várias complicações, até mesmo em óbito, embora seja raro. Objetivo: realizar uma análise epidemiológica de infecções maxilofaciais, relacionando os dados ao tratamento instituído e à sua efetividade, bem como analisar dados referentes a idade, sexo, principais dentes envolvidos e tempo total de internação. Sujeito e método: foram analisados retrospectivamente 240 prontuários de pacientes admitidos no Hospital Universitário de Maringá com infecção odontogênica, atendidos pela equipe de Cirurgia e Traumatologia Bucomaxilofacial no período de janeiro de 2009 a janeiro de 2017. Resultados: a média de idade dos pacientes foi de 38 anos, com 57 mulheres e 54 homens. A média de temperatura de admissão foi 38,5°C. A região mais acometida foi o ramo posterior da mandíbula, tendo uma média de duração de infecção e hospitalização de 6,1 dias. A principal conduta foi drenagem e antibioticoterapia, sendo que cerca de 13 pacientes não precisaram desse tipo de intervenção, e um paciente evoluiu a óbito. Conclusão: com base nestes resultados e na literatura, infecções odontogênicas merecem atenção, pois podem ser fatais e requerem internação rápida e tratamento adequado. Esse, portanto, é um assunto de grande importância para o cirurgião- -dentista, que exerce papel fundamental na prevenção e no tratamento. A resolução precoce ainda é a forma mais adequada para evitar complicações mais graves. (AU)

Acute Oral maxillofacial infections can be serious and relatively common clinical conditions, characterized by the spread of the infectious process to adjacent tissues and facial spaces of the head and neck region, which can result in several complications and lead to even death, although it is rare. Objective: the objective of this study was to perform an epidemiological analysis of maxillofacial infections and relate their data to the treatment instituted and the effectiveness of the same, as well as to analyze data regarding the age, sex, main teeth involved and total time of hospitalization. Subjects and method: in order to carry out study, 240 medical recordswere analyzed retrospectivelyat the University Hospital of Maringá of the patients with odontogenic infection attended by the Oral Maxillofacial Surgeon in the period of January 2009 to January 2017. Results: as a result, mean age was 38 years, with 57 women and 54 men and mean intake temperature was 38.5 °. The most affected region was the posterior branch of the mandible, with a mean duration of infection and hospitalization of 6.1 days. The main conduct was drainage and antibiotic therapy, and about 13 patients did not need this intervention and only 1 died. Conclusion: Based on these results and in literature, attention should be paid to odontogenic infections, which can be fatal and require proper treatment. This is a subject of great importance for the dentist, who plays a key role in prevention and proper treatment, its early resolution is still the most appropriate way to avoid serious complications. (AU)

[A clinicopathological retrospective epidemiological analysis of benign tumors and tumor-like lesions in the oral and maxillofacial region, diagnosed at the University of Szeged, Department of Oral Medicine (1960-2014)]. / A szegedi Fogászati és Szájsebészeti Klinikán diagnosztizált, az orofacialis régiót érinto jóindulatú daganatok és daganatszeru laesiók klinikopatológiai retrospektív epidemiológiai analízise (1960­2014).

INTRODUCTION: In a clinicopathological retrospective epidemiological study we investigated benign tumors and tumor-like lesions located in the orofacial region, diagnosed at the Universiy of Szeged, Department of Oral Medicine. METHOD: During a 54-year period (1960-2014), 14 661 biopsies were taken. The included subjects were 7491 patients diagnosed with benign tumors and tumor-like lesions. RESULTS: The average age of patients was 55.3 years, 2823 (37.7%) patients were male and 4668 (62.3%) female. The male : female ratio was 1 : 1.65. Most of the patients included in the study were aged 51-60 (1280, 17.1%). The number of children was 1014 (13.6%) and the number of adults was 6477 (86.3%). The number of non-neoplasms was 6420 (85.7%), being significantly higher than the number of neoplasms (1071, 14.3%). Most of the lesions were of mesenchymal origin (5574, 77.4%); the number of lesions of non-mesenchymal origin was 982 (13.1%). The most prevalent type of lesions was traumatic fibroma (fibrosis): 1806 (32.4%). The most common lesion type in the group of lesions of infectious/inflammational origin was pyogenic granuloma, the number of which was 465 (8.3%). The most common cystic lesion was mucocele (805, 10.7%). Hemangioma was the most frequent lesion type among developmental anomalies with the number of 815 (14.6%). The most common location of the lesions was the lip in 2081 cases (27.8%), followed by the gingiva in 2024 cases (27.0%), bucca in 1069 cases (14.3%), tongue in 981 cases (13.1%), and the facial skin in 695 cases (9.3%). After taking biopsy, the majority of benign lesions were treated with cryo-, laser-, or combined (cryo and laser) surgery. CONCLUSION: The present computer-aided study showed that irritational fibroma was the most common orofacial benign tumor, and the lip was the most frequent location. The diagnostic classification and the methodology are considerably different in the majority of the studies, which may hinder the exact comparison with other surveys from different regions of the world. Orv Hetil. 2018; 159(37): 1516-1524.

[Statistical information about the inflammatory processes of the jaw-facial part in children].

OBJECTIVE: Introduction: The acute and chronic inflammatory processes prevail in the structure of the dental surgical diseases in children. Notably, various forms of lymphadenitis, adenophlegmon and odontogenous osteomyelitis dominate in the specialized surgical units; however, it is not possible to resolve a number of organizational problems without clear understanding of the statistical situation. The aim: The paper is aimed at the analysis of the incidence rate of major nosological forms of the acute suppurative inflammations of the maxillofacial area in children for the prospective planning of arrangements to provide them with high-quality specialized care. PATIENTS AND METHODS: Materials and methods: The paper involves findings of comprehensive examination and treatment of 537children with acute purulent lymphadenitis, adenophlegmon and odontogenous osteomyelitis that was carried out within 6 years. RESULTS: Results: The resulting clinical data have shown that three abovementioned nosological forms of the disease accounted for 42% of the overall number of the inpatient dental patients and 11% of the total number of children with acute surgical pathology. Out of 537 patients, 240 patients (44.8%) with acute purulent lymphadenitis, 150 (27,9%) patients with adenophlegmon and 147 (27.3%) patients with acute odontogenous osteomyelitis have been observed (318 (59,2%) boys and 219 (40,8%) girls aged from 2 months to 15 years). The study of the past history of the disease has established that in the majority of patients burdened premorbid history and occurrence of concomitant chronic general somatic diseases was presented prior to the onset of acute inflammation. CONCLUSION: Conclusions: The factors, mentioned above, greatly contributed to increase in protective-adaptive properties of child body and create the prerequisites for the formation of pathological symptomocomplex in children, which can be implemented even in the minimal effect of antigen load on the tissues of maxillofacial area. Such situation requires a balanced multidisciplinary approach to the planning of preventive measures in this category of patients at all stages of the observation.

Medication-related osteonecrosis of the jaw: An update on the memorial sloan kettering cancer center experience and the role of premedication dental evaluation in prevention.

OBJECTIVE: The aim of this study was to investigate the relationship between type of antiresorptive medication and medication-related osteonecrosis of the jaw (MRONJ) onset and the role of premedication dental evaluation (PMDE) in the prevention of MRONJ. STUDY DESIGN: Our database of patients with MRONJ was reviewed. The Kruskal-Wallis test was used to analyze the onset dose of the 3 frequent medication types associated with MRONJ. To evaluate the role of PMDE in the prevention of MRONJ, all patients on antiresorptive and/or antiangiogenic medications seen in the Dental Service of Memorial Sloan Kettering Cancer Center during a 10-year period were subclassified into 2 groups. Group I comprised patients seen for PMDE before the commencement of A/A and group II patients seen after prior exposure to antiresorptive and/or antiangiogenic medications. Fischer's exact test was used to compare the incidence of MRONJ in both groups. RESULTS: Patients on denosumab developed MRONJ earlier compared with zoledronate and pamidronate (P = .003). Group I had a significantly reduced incidence of MRONJ (0.9%) compared with group II (10.5%) (P < .0001). Dentoalveolar trauma as a precipitating factor between groups I and II was not statistically significant. CONCLUSIONS: Denosumab was associated with an earlier occurrence of MRONJ compared with zoledronate and pamidronate. The role of PMDE may be an effective preventive strategy in reducing the incidence of MRONJ.

Survey of Torus Palatinus in Patients with End-Stage Renal Disease Undergoing Hemodialysis.

INTRODUCTION: This study attempted to survey the oral findings of hemodialysis patients and analyze the prevalence and predictors for torus palatinus (TP) in this patient population. METHODS: A total of 322 hemodialysis patients were recruited. Patients were organized into two groups, based on the presence (n=93) or absence (n=229) of TP. Demographic, laboratory, and dialysis-related data were obtained for analysis. RESULTS: The prevalence of TP was 28.9% in this study. Patients with TP were younger in age [57.8±10.0 (37.4-86.9) versus 62.4±12.3 (25.0-87.8) years old; P=0.001] and predominantly female (60.2% versus 38.0%; P<0.001), compared to patients without TP. All TPs (100.0%) were symmetrical and located along the midpalatal suture. Most TPs were flat-shaped (55.9%) and near premolars (78.5%). The blood tests revealed higher blood concentrations of phosphate (5.4±1.1 versus 4.9±1.1 mg/dL; P=0.001) and lower blood concentrations of bicarbonate (20.9±2.4 versus 22.0±2.3 mmol/L; P<0.001) in patients with TP. Multivariate regression modeling showed that younger age [odds ratio (OR) 0.968; 95% confidence interval (CI) 0.939-0.982; P<0.001], female gender (OR 2.305; 95% CI 1.374-3.867; P=0.002), higher blood concentration of phosphate (OR 1.411; 95% CI 1.110-1.794; P=0.005), and lower blood concentration of bicarbonate (OR 0.868; 95% CI 0.791-0.994; P=0.040) were significant predictors for TP. CONCLUSION: The prevalence of TP is 28.9%, and the majority of patients suffering TP are female. Younger age, female gender, elevated blood concentration of phosphate, and lower blood concentration of bicarbonate are predictors for TP.

Vitamin D (25-OHD) deficiency may increase the prevalence of medication-related osteonecrosis of the jaw.

INTRODUCTION: Osteonecrosis of the jaw (ONJ) is a severe complication of antiresorptive medication (AM) in the treatment of bone-affecting cancer-related conditions and osteoporosis. Aim of this study was to reveal whether patients treated with AM and show Medication Related OsteoNecrosis of the Jaw (MRONJ) are vitamin D deficient or not. MATERIALS AND METHODS: A 2 year retrospective study evaluated hospital records of 63 patients who received AM. Patients were divided into two groups. One group (n = 45) consisted of patients who presented a stage 2 ONJ (eb+ = exposed bone). Second group patients (n = 18) (eb- = no exposed bone) presented for extraction of teeth. Serum levels of vitamin D (25-OHD) were analysed. P values ≤ 0.05 in t-test were regarded as statistically significant. RESULTS: Serum levels of 25-OHD were significantly higher in the eb(-) group (29.5 ng/ml), than in the eb(+) group (20.49 ng/ml). Blood levels of calcium were also significantly higher in eb(-) group (2.25 mmol/L; 0.11 SD) than in eb(+) group (2.175 mmol/L; 0.16 SD). CONCLUSION: Prevalence of MRONJ in AM treated patients seems to be increased by low serum 25-OHD. A measurable tendency in the role of 25-OHD for the development of MRONJ was recorded and leads to the recommendation for a sufficient vitamin D substitution in patients treated with AM.

Retrospective analysis of jaw biopsies in young adults. A study of 1599 cases in Southern Brazil.

BACKGROUND: To evaluate the prevalence and the characteristics of jaw lesions diagnosed in young adults aged 20 to 30 years in a southern Brazil reference center, over a period of 25 years. And to analyze the concordance between clinical and histological diagnosis. MATERIAL AND METHODS: In this cross-sectional retrospective study, the biopsies files from this center were retrieved and data regarding sex, age, bone localization, clinical and histological diagnosis were collected. The histological diagnosis were grouped into the categories Cystic lesions of odontogenic origin, Periapical inflammation, Odontogenic tumors, Bone diseases, Health tissue and Nonspecific diagnostic. Absolute and relative frequencies were estimated with descriptive analysis. The agreement between clinical and histological diagnosis was measured through Kappa statistic. RESULTS: A total of 18,181 histopathological analysis were performed during the period of the study, registering 1,599 jaw lesions in young adults. The average age of individuals was 24,59 years (SD 3,1). Nine hundred ninety-one (62%) lesions were found in females and 608 (38%) in males. More than half of pathologies were cystic lesions of odontogenic origin (822/51.4%), followed by periapical inflammation (282/17.6%). Regarding the site of lesions, more than half occurred in posterior mandible (877/54.8%), followed by posterior maxilla (339/21.2%). The most frequent entities were periapical cyst, chronic periapical granuloma, dental follicle and paradental cyst, corresponding to a total of 1,202 (75.2%) evaluated cases. In relation to the analysis of concordance between clinical and histological diagnosis the general Kappa index was 0.5, which is considered moderate. Finally, the findings confirm data from literature about the most frequent jaw pathologies in young adults and serve as aid for preventive measures of some entities. Additionally, they can improve the formulation of differential diagnosis and the patient management.