Uremic Stomatitis: A Latin American Case Series and Literature Review.

BACKGROUND: Uremic stomatitis is often unfamiliar to healthcare professionals. This study presents five cases of uremic stomatitis, providing a comprehensive analysis of their demographic distribution, clinicopathological features, and management strategies based on existing literature. METHODS: Data were collected from centers across Brazil, Argentina, Venezuela, and Mexico. Electronic searches were conducted in five databases supplemented by manual scrutiny and gray literature. RESULTS: The series consisted of three men and two women with a mean age of 40.2 years. Lesions mostly appeared as white plaques, particularly on the tongue (100%). The median blood urea level was 129 mg/dL. Histopathological analysis revealed epithelial changes, including acanthosis and parakeratosis, with ballooned keratinocytes in the suprabasal region. Oral lesions resolved subsequent to hemodialysis in three cases (75%). Thirty-seven studies comprising 52 cases of uremic stomatitis have been described hitherto. Most patients were male (65.4%) with a mean age of 43.6 years. Clinically, grayish-white plaques (37.3%) and ulcers/ulcerations (28.9%) were common, particularly on the tongue (30.9%). Hemodialysis was performed on 27 individuals. The resolution rate of oral lesions was 53.3%. CONCLUSION: Earlier recognition of uremic stomatitis, possibly associated with long-term uremia, holds the potential to improve outcomes for patients with undiagnosed chronic kidney disease.

A systematic review assessing occurrence of medication-related osteonecrosis of the jaw following dental procedures

Aim: This study aimed to systematically review existing literature regarding the association between dental procedures­such as tooth extractions and periodontal therapy­and occurrence of medication-related osteonecrosis of the jaw (MRONJ) in individuals using bone-modifying drugs. Methods: Search strategies were performed in PubMed, Scopus, Web of Science and Cochrane Library for a timeframe ending in December 2021. Study selection, data extraction and risk of bias were analyzed independently by two researchers. Three meta-analyses were performed, estimating the crude risk ratio (RR), the adjusted odds ratio (OR) and the adjusted hazard ratio (HR) for the association between tooth extraction and MRONJ. Results: Of the 1,654 studies initially retrieved, 17 were ultimately included. The majority of patients with MRONJ in these studies were female, with a mean age of 64 years. Zoledronic acid was the most commonly used drug among patients with MRONJ, and cancer was the most frequent underlying health condition. Regarding the performed meta-analyses, crude and adjusted analyses demonstrated that tooth extraction increased the risk for MRONJ by 4.28 (95% confidence interval [95%CI]: 1.73­10.58), the OR for MRONJ by 26.94 (95%CI: 4.17­174.17), and the HR for MRONJ by 9.96 (95%CI: 4.04­24.55). Conclusion: It was concluded that performing dental procedures, especially tooth extraction, in patients using bone-modifying drugs increased the risk of MRONJ occurrence and, therefore, should be avoided. Further studies, using adjusted data, are warranted

Prevalence of temporomandibular disorder and possible associated factors in a sample of older adults: population-based cross-sectional study / Prevalência de disfunção temporomandibular e possíveis fatores associados em uma população de idosos: estudo transversal de base populacional

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorders (TMD) are a group of conditions characterized by changes in the movements and function of the orofacial region and one of main reported symptoms is pain. As it has been increasingly described among different age groups, this study aimed to evaluate the presence of symptoms of TMD and their possible associated factors in older people from a city in southern Brazil. METHODS: A cross-sectional household-based study using a per cluster sampling strategy was performed including 282 older adults aged ≥60 years in the city of Veranópolis/RS. A clinical oral examination and a structured questionnaire were applied. TMD symptoms were evaluated with Fonseca Anamnestic Index (FAI) questionnaire and divided into those "without TMD" and "with TMD" (the later including those reporting mild, moderate and severe TMD symptoms). Associations were performed by the chi-square or Mann-Whitney tests based on frequency distribution. Bi and multivariate analyses were performed using Poisson regression with robust variation to verify associations. RESULTS: Prevalence among older adults that reported symptoms of TMD was 30.5% (n=86). In the final multivariate model, female older adults presented higher prevalence ratio (PR) for symptoms of TMD, presenting 62.8% (p=0.040) higher PR to at least mild symptoms of TMD when compared to older adult men. Number of teeth, need for dental prosthesis or other demographic variables were not associated with symptoms of TMD. CONCLUSION: The results demonstrated a prevalence of TMD symptoms in the seniors of approximately 30%, which was most associated with females. Despite its relevance in public health strategies focused on older adults, these findings should be interpreted with caution due to their observational and cross-sectional nature.

RESUMO JUSTIFICATIVA E OBJETIVOS: As disfunções temporomandibulares (DTM) são um grupo de condições caracterizadas por alteração dos movimentos e função da região orofacial e um dos maiores sintomas relatados é a dor. Como estas disfunções têm sido descritas de forma crescente entre diversas faixas etárias, o objetivo deste estudo foi avaliar a presença de sintomas de DTM e seus possíveis fatores associados em idosos de uma cidade do sul do Brasil. MÉTODOS: Estudo transversal de base domiciliar com amostra probabilística por conglomerado incluindo 282 idosos com idade ≥60 anos da cidade de Veranópolis/RS. Um exame clínico de saúde bucal e questionário estruturado foram aplicados. Sintomas de DTM foram avaliados pelo Índice Anamnésico de Fonseca (IAF) e categorizados em "Sem DTM" e "Com DTM", sendo que o último incluiu aqueles com sintomas compatíveis com DTM, moderada ou grave. Associações foram avaliadas pelos testes de Qui-quadrado ou Mann-Whitney por distribuição de frequências. Análises bi e multivariadas foram realizadas utilizando-se regressão de Poisson com variância robusta para verificar associações. RESULTADOS: A prevalência de idosos que relataram sintomas de DTM foi de 30,5% (n=86). No modelo multivariado final, idosas do sexo feminino apresentaram maior razão de prevalência (RP) para sintomas de DTM, apresentando 62,8% maior RP (p=0,040) de ter, pelo menos, sintomas leves de DTM quando comparados a idosos do sexo masculino. O número de dentes presentes, necessidade de prótese ou outras variáveis demográficas não estiveram associadas com a presença de sintomas de DTM. CONCLUSÃO: Os achados do presente estudo demonstraram prevalência de sintomas de DTM em idosos de aproximadamente 30%, com maior associação com o sexo feminino. Apesar de relevantes para delineamento de estratégias de saúde para idosos, os achados do presente estudo devem ser interpretados com cautela por sua natureza observacional e transversal.

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis.

OBJECTIVES: To assess and compare the pharmacological effect of different drugs on pain relief after periodontal surgery. MATERIALS AND METHODS: Five databases were searched up to September 2019. The eligible studies comprised randomized clinical trials, involving only adult individuals that received any periodontal surgery and presenting two distinct groups of therapeutic regimens to control postoperative pain. Placebo groups could be included. The risk of bias was assessed with the RoB 2 Cochrane tool and the GRADE system. Meta-analyses were performed using different follow-up and drug comparisons. RESULTS: Overall, 2398 studies were identified, of which 35 were included. Low risk of bias was determined for the majority of the studies. The meta-analyses showed that the comparison of dexamethasone or non-steroidal anti-inflammatory drugs (NSAID) versus placebo favored the use of both interventions in a follow-up of 1 to 8 h for open flap procedures (OFP). However, no statistical difference was found for the comparison between NSAID and dexamethasone for OFP. CONCLUSIONS: Patients may benefit from several pharmacological schemes for pain relief after periodontal surgeries. However, due to the high heterogeneity among studies, no fixed pharmacological protocol could be proposed. CLINICAL RELEVANCE: There is not enough evidence to recommend one therapeutic scheme. However, untreated pain is harmful to the patients and it is not advisable.