Management of bisphosphonate-related osteonecrosis of the jaw using teriparatide treatment: A systematic review.

OBJECTIVE: To systematically review the current literature and determine whether the additional TPTD administration for patients with BRONJ is an effective treatment modality. MATERIAL AND METHODS: The systematic review was registered in the PROSPERO (CRD42021242796) and conducted according to the PRISMA statement. An electronic search was performed using MEDLINE (PubMed), ScienceDirect, The Cochrane Library and LILACS databases using a combination of the keywords "Bisphosphonate-Associated Osteonecrosis of the Jaw"[Mesh], "treatment" to identify studies published from 2010. RESULTS: The authors found 8 articles that met the inclusion criteria of this systematic review. According to two studies, TPTD was statistically significantly associated with a greater BRONJ lesion resolution, compared to control group (p<0.05). However, one article showed no significant difference in proportion of resolved lesions (p=0.478). Regarding the effectiveness of TPTD treatment according to administration frequency, daily injection group showed no significant changes in the clinical stage of BRONJ, no difference in the percentage of bone formation on patients osteolysis, compared to weekly injections. Concerning bone resorption/regeneration markers, all the included studies showed that bone resorption markers significantly increased after 3-month TPTD administration. In a study which used multivariate analysis between TPTD and non-TPTD groups using age, BMI, duration of BP usage, the difference in s-OC values after 3 months of the treatment was significant (p<0.05). CONCLUSION: This review provides evidence for the potential benefits of additional TPTD administration for patients with BRONJ being an effective treatment modality.

Epidemiology of primary oral cancer diagnostics among dentists and physicians in Lithuania.

OBJECTIVE: Oral cancer is an increasing global health problem, with oral and pharyngeal cancer reported as being the 11th most common malignancy mortality reason. Studies show that even 77% of deaths from oral cancers occurred in less developed regions. Gladly, in some countries mortality from oral cancer is decreasing due to timely proper treatment. Concerning diagnostic and treatment progress, the ability of dental practitioners and physicians to recognize and diagnose oral cancer as early as possible and send patients to the appropriate specialist as quickly as possible is of great significance, and in order to achieve that, doctors must continuously improve their knowledge. MATERIAL AND METHODS: The research was carried out across ten cities located in Lithuania and their districts. In the implementation of the main tasks, the subjects were divided into two groups: A - 256 randomly selected dentists; B - 114 randomly selected physicians. Equal questionnaires were compiled for both groups. The questionnaire divided into 3 parts: 1) demographic data 2) part is devoted to assessing experience in the field of primary oral cancer diagnostic (POCD). 3) part was intended to evaluate the knowledge of POCD and oncological vigilance. RESULTS: The main results of the present study indicate that 208 dentists and 99 physicians (total n=307) answered that they had been visited by a patient with oral cancer. 200 dentists and 73 physicians (total n=273) answered that they had diagnosed or suspected a case of oral cancer. 211 dentists and 61 physicians (n=272) state that they examine the patient's oral cavity for oncodiagnostic reasons. 205 dentists and all surveyed physicians responded (altogether n=319) that they received enough knowledge about oral cancer from their university studies. All the surveyed physicians and even 247 dentists (altogether n=361) said they wanted to have an annual oral cancer diagnosis week at their workplace (free supplementary education and POCD). Most assessed doctors claim that their knowledge about the primary diagnosis of oral cancer is average (n=162) only 16.8% dentists and 25.4% physicians evaluate patient's alcohol usage, contrastingly even 68.4% and 73.7% respectively evaluate patient's tobacco usage in the anamnesis. Regarding the correctly answered questions concerning the most common type of oral cancer, the present study shows low results: 70.3% and 61.4% of dentists and physicians accordingly. CONCLUSIONS: Healthcare providers such as dentists and physicians take up a big part in POCD. Physicians as well as the majority of dentists in Lithuania demonstrate a lack of information regarding mean symptoms of oral cancer and do not perform as thorough anamnesis as foreign clinics, that is why they may often fail to identify oral cancer at an early stage. The vast majority of physicians and dentists in Lithuania who participated in the present study agreed that oral cancer awareness should be raised. Therefore, more education on POCD should be included in dental curriculums.

Epidemiology of primary oral cancer diagnostics in Kaunas.

INTRODUCTION: Ability for general practitioners and dentists to successfully identify oral cancer (OC) and knowledge about it has a huge influence in further primary diagnosis and good specialized treatment and care. It is very important to realize what obstacles appear in medical care professionals (dentists and general medical practitioners(GPs)) way for primary oral cancer diagnostics. PURPOSE: To find out the insight of primary oral cancer diagnostics in Kaunas city. GOALS: to analise knowledge of society about oral cancer and its primary symptoms; to evaluate and compare the insight of POCD for general medical practitioners and dentists; to appraise the oncological awareness and evaluate the experience in oral oncology for mentioned medical care proffesionals. MATERIALS AND METHODS: Questionnaires were prepared for patients and medical professionals. Permission for investigation was confirmed by LUHS Bioethical centre. Questioning was done in Kaunas city (Lithuania) and its districts. RESULTS: 100 questionnaires were collected from random people, questioned at health care centers and 106 questionnaires were given to medical staff (64 for dentists and 42 for general medical practitioners); 81% of GPs and 75% of dentists claims to have low insight on POCD; 83,3% of GPs and 46.9% of dentists claims that they have not enough learning experience on POCD from graduated university. Although, only 4,8% of GPs and 6,2% of dentists updated their knowledge on POCD after graduation. CONCLUSIONS: Society agrees having a poor knowledge on POCD; GPs and dentists are not educated enough for POCD; GPs pay too little attention for oral cavity examinations and are in shortage collaborating with dentists about POCD.

Dental Implant Placement in Patients on Bisphosphonate Therapy: a Systematic Review.

OBJECTIVES: The review aims to study dental implant placement purposefulness for patients who have been treated or are on treatment with bisphosphonate medication. MATERIAL AND METHODS: Structured search strategy was applied on electronic databases: MEDLINE, PubMed, PubMed Central and ResearchGate. Scientific publications in English between 2006 and 2017 were identified in accordance with inclusion, exclusion criteria. Publication screening, data extraction, and quality assessment were performed. Outcome measures included implant failure or implant-related osteonecrosis of the jaw. RESULTS: In total, 32 literature sources were reviewed, and 9 of the most relevant articles that are suitable to the criteria were selected. Heterogeneity between the studies was found and no meta-analysis could be done. Five studies analysed intraoral bisphosphonate medication in relation with implant placement, three studies investigated intravenous bisphosphonate medication in relation with implant placement and one study evaluated both types of medication given in relation with implant placement. Patients with intraoral therapy appeared to have a better implant survival (5 implants failed out of 423) rate at 98.8% vs. patients treated intravenously (6 implants failed out of 68) at 91%; the control group compared with intraoral bisphosphonate group appeared with 97% success implant survival rate (27 implants failed out of 842), showing no significant difference in terms of success in implant placement. CONCLUSIONS: Patients treated with intravenous bisphosphonates seemed to have a higher chance of developing implant-related osteonecrosis of the jaw. The intraorally treated patient group appeared to have more successful results. Implant placement in patients treated intraorally could be considered safe with precautions.

Self-inflicted face gunshot injuries: two case reports.

Self-inflicted gunshot injuries to the head and neck area are challenging cases. Immediate and complex approach is required due to complexity of head and neck anatomy. The extent of injury largely depends on velocity of a rifle and penetrated tissues. Management of these type of patients consist of vital resuscitation, primary wound management, soft and hard tissue reconstruction and rehabilitation. Here we present two cases of self-inflicted gunshot injuries with low and high velocity rifles.