Sialadenitis of the anterior mandibular vestibule: A subset of burning mouth syndrome.

Burning Mouth syndrome (BMS) is a relatively common oral neurosensory disorder known for oral burning pain. In that there is a relative absence of oral clinical findings and systemic causation, the diagnosis of BMS is challenging. Sialadenitis of the anterior mandibular vestibule appears to be a subset of BMS. The lip component of chronic orofacial pain is potentially an important concern with regard to the diagnosis and treatment of chronic orofacial pain. Discussion regarding the etiology, diagnosis, and therapy of this condition is provided.

Quality appraisal of antibiotic prophylaxis guidelines to prevent infective endocarditis following dental procedures: a systematic review.

OBJECTIVE: To assess the quality of clinical practice guidelines (CPGs) for the use of antimicrobial prophylaxis to prevent infective endocarditis in indicated dental procedures. STUDY DESIGN: We searched on Medline/OVID, CINAHL/EBSCO, and EMBASE from January 2011 to January 2022. We included de novo guidelines and excluded adapted or adopted guidelines, and guidelines published before 2011. The guidelines were independently appraised by 4 reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. RESULTS: Four eligible CPGs were appraised: the European Society of Cardiology, the American Heart Association, the National Institute of Health and Care Excellence (NICE), and the Japanese Circulation Society (JCS). Their AGREE II first overall assessments (OA1) were 63%, 58%, 92%, and 71%, respectively. Both NICE and JCS scored the highest in OA1 (>70%), Domain 3 Rigor of Development (85%, 65%), and Domain 5 Applicability (76%, 48%), respectively. The second overall assessment (OA2) of using the CPGs in daily practice was not significantly variable (recommended for use with modifications). CONCLUSION: Three out of 4 CPGs support that the benefits of prevention of infective endocarditis outweigh the risks of antibiotic resistance.

Survey of opioid prescribing among dentists indicates need for more effective education regarding pain management.

BACKGROUND: Dentists commonly prescribe opioids and are the highest prescribers of opioids to patients 18 years and younger. Little is known about dentists' beliefs regarding opioids and other analgesics. METHODS: The authors conducted a national survey of dentists about their opioid prescribing habits, perceptions regarding opioid effectiveness, beliefs about patient behaviors, and relationships with drug and equipment manufacturers. RESULTS: The authors received 291 responses from 30 states and 2 territories and analyzed 269 completed surveys. Although 84% of respondents reported believing that nonsteroidal anti-inflammatory drug (NSAID)-acetaminophen combinations are equally as effective or more effective than opioids, 43% of respondents also reported regularly prescribing opioid medications. Of those who reported prescribing opioids, 9 of 10 reported they were less likely to prescribe opioids to adolescents aged 11 through 18 years, but only 48% reported they were less likely to prescribe opioids to young adults aged 19 through 25 years. One-half of those who reported prescribing opioids reported prescribing in amounts that would result in unused medication, and 69% reported having had patients divert or misuse opioids. Few dentists reported industry interactions. CONCLUSIONS: The continued prescription of opioids contradicts mounting evidence about the superiority of NSAIDs over opioids in dentistry. Continuing dental education, increased use of prescription drug monitoring programs, and the development of national guidelines are necessary to align clinical practice with current evidence. PRACTICAL IMPLICATIONS: Dentists should seek to minimize opioid prescribing and pill counts and instead opt for safer, more effective NSAID-acetaminophen combinations. Dentists also should refrain from prescribing opioids to patients younger than 25 years because of the high risk of experiencing addiction in this population.

Actinomycosis of the ventral tongue with successful laser ablation therapy: A case report.

BACKGROUND: We present a first case report of an Actinomycosis lesion of the ventral tongue. Actinomycosis of the tongue is an uncommon finding. CASE DESCRIPTION: The 64-year-old female patient presented with a leukoplakic ventral tongue lesion. The diagnosis Actinomycosis was confirmed by histopathologic evaluation. The lesion was successfully treated with antibiotics and laser ablation therapy. PRACTICAL IMPLICATIONS: Diagnostic and therapeutic concerns are discussed. Clinicians are alerted to considering Actinomycosis within the differential diagnosis of leukoplakic tongue lesions.

Diagnosis and Management of Oral Allergy Syndrome, the Itchy Tongue Allergic Reaction.

Oral allergy syndrome (OAS) is a relatively common condition that is strongly associated with seasonal allergic rhinitis. Symptoms include pruritus of the oral mucosa and, in particular, the posterior tongue. Patients with OAS experience symptoms immediately after eating certain fruits, vegetables, spices, and nuts. Typically, for patients with this condition, offending foods may be cooked to avoid the symptoms. For diagnosis and management of OAS, dental clinicians should take a thorough history and be alerted to the possibility of OAS when symptoms such as pruritus of oral mucosal tissues appear immediately after the patient eats foods associated with OAS and has a concomitant history of seasonal allergic rhinitis. Because there is a relatively rare possibility of more serious symptomatology, clinicians should consider referral to the patient's primary care provider or an appropriate medical specialist. This article presents a case series comprising five patients diagnosed with OAS.

Thirteen maxillary full dentures over 10 years: A case of peripheral painful traumatic trigeminal neuropathy.

There are multiple reasons for failure of full maxillary dentures. It is necessary for clinicians to consider the rationale behind the failure of the prosthesis before remaking a maxillary full denture. Diagnostic categories related to pertinent maxillofacial and oral neuropathies and psychosocial issues are also discussed. Here, we present a case with a natural history that supported a diagnosis of peripheral painful traumatic trigeminal neuropathy (PPTTN). Furthermore, the clinical oral examination revealed findings that were consistent with atrophic glossitis, necessitating an investigation of diagnoses of nutritional deficiency-induced neuropathy and/or oral candidiasis.

Inflammatory reaction of the anterior dorsal tongue presumably to sodium lauryl sulfate within toothpastes: a triple case report.

BACKGROUND: Sodium lauryl sulfate (SLS), a popular surface active agent ingredient within toothpastes, is known for its foaming action. Surface active agents increase the effectiveness of toothpastes with respect to dental plaque removal. SLS is a known irritant and also has allergenic potential. The authors report 3 patients with oral pain secondary to inflammation of the dorsal anterior tongue. These patients were all using toothpastes with SLS as an ingredient. RESULTS: The dorsal tongue lesions and oral pain resolved upon switching to toothpastes without SLS as an ingredient. CONCLUSIONS: Clinicians should be aware of the potential of SLS within toothpastes to cause oral mucosal inflammatory reactions of the anterior dorsal tongue. To our knowledge, these are the first case reports of oral mucosal inflammatory reactions of the anterior dorsal tongue associated with SLS containing toothpastes.

Oral Radiographic Evidence of Secondary Hyperparathyroidism in an End-Stage Renal Failure Patient: A Case Report.

BACKGROUND: The authors report a case of a 42-year-old woman with End Stage Renal Disease (ESRD) undergoing dialysis therapy with the relative loss of tooth root lamina dura and several mandibular radiolucencies. Secondary hyperparathyroidism related to End Stage Renal Disease may result in the loss of bone density and radiolucent lesions, which has been previously described as Brown tumor. Findings significant for hyperparathyroidism may befound on routine dental imaging. RESULTS: The patient was evaluated, and treatment was initiated for her dental conditions. She is at present still on the kidney transplant waiting list. CONCLUSION: Patients with End Stage Renal Disease and hyperparathyroidism require communication and cooperation between dentists and physicians. PRACTICAL IMPLICATIONS: It is important for dentists to consider Brown tumor as a possible diagnosis of radiolucent jaw lesions.

Risk-benefit assessment for antibiotic prophylaxis in asplenic dental patients.

A review of the published literature revealed that discourse on the topic of antibiotic prophylaxis guidelines for the asplenic dental patient is limited and that guidelines regarding this issue have not been updated for years. The review determined that the professional protocol for the treatment of asplenic dental patients has changed over the last 30 years, particularly with reference to adult patients. Furthermore, as dentists and physicians now understand that blood-borne bacteremias are produced from everyday occurrences such as chewing and toothbrushing, bacteremias secondary to dental procedures are no longer viewed as seriously as in the past; therefore, the guidelines for antibiotic prophylaxis have changed. Antibiotic prophylaxis is not routinely indicated prior to dental procedures for asplenic adult dental patients without risk factors. However, antibiotic prophylaxis should be considered for young children, immunocompromised patients with underlying causative disease, or any patient during the first 3 years after a splenectomy.

Erythema multiforme major secondary to a cosmetic facial cream: first case report.

BACKGROUND: Oral erythema multiforme (EM) major is an acute immune-mediated disorder typically involving the oral mucosa, triggered by a hypersensitivity reaction to an antigen. CASE SUMMARY: A 59-year-old woman presented to an oral medicine clinic with a chief complaint of "mystery disease" of 1 year's duration. The condition was described as repeated episodes of severe, painful, asymmetric oral lesions that responded to systemic steroid therapy. A previous oral biopsy described fibrinoid necrosis, mixed inflammation, and granulation tissue. A regimen of descending-dose prednisone was administered, and 3 weeks later the tissues appeared to be partially healed. Direct immunofluorescence staining of a biopsied oral mucosal lesion was negative. To rule out a drug causation, the patient discontinued hydrochlorothiazide and escitalopram oxalate. However, on steroid tapering, episodic lesions recurred. The patient was placed on combination systemic prednisone and azathioprine. The oral lesions resolved again, but new episodes occurred immediately after tapering. The patient's daily facial cosmetics were evaluated, and she was asked to stop using cosmetics with the active ingredient octocrylene. After eliminating the use of facial cosmetics containing octocrylene, the episodes no longer recurred. CONCLUSIONS: We report a case of cosmetic-induced EM major and suggest that the triggering allergen is octocrylene.

Emerging Dental Specialties and Ethics.

This paper discusses ethical dimensions related to the formal recognition of emerging dental specialties. It explores several issues related to the potential emergence of several new dental specialty areas. There are good reasons that dentistry should open the door to these new specialties, and patients would benefit. The ethical considerations for and against formal acceptance are examined.

A topical imiquimod-induced oral mucosal lichenoid reaction: a case report.

BACKGROUND: Imiquimod (IMI) is a topical immune response modifier used in the treatment of actinic keratosis and cheilitis. Actinic cheilitis is a potentially premalignant condition that requires therapeutic intervention. IMI therapy is noted for producing cutaneous and mucosal adverse effects. The authors report the case of an 88-year-old woman who was treated for actinic cheilitis of the upper lip with IMI and who consequently experienced an oral mucosal lichenoid reaction of the lower lip and right buccal mucosa. RESULTS: The patient was treated successfully with high-dose steroid therapy, and the oral lesions resolved in 17 days. CONCLUSIONS: To our knowledge, this is the first case report regarding an IMI-induced oral mucosal lichenoid reaction. Clinicians should be aware of the potential of IMI to cause lichenoid reactions. PRACTICAL IMPLICATIONS: IMI is an efficacious therapeutic agent when used in the treatment of actinic cheilitis, but it is prone to cause oral mucosal side effects such as lichenoid reactions. Therefore, it is important for dentists to be knowledgeable concerning potential mucosal IMI side effects.