Thinking Outside the Tooth: Diagnosis and Management of Patients with Neuropathic Orofacial Pain.

Nonodontogenic orofacial pain exists, and diagnosis and management of those conditions can be challenging. This article highlights and discusses how to take a complete and systematic pain history and the important red flags to recognize in patients presenting with perplexing nonodontogenic orofacial pain. Cause and epidemiology, clinical presentation, clinical evaluation and diagnosis, and management options for common neuropathic pain conditions are included. Neuralgia and neuropathic pain conditions and red flags as secondary cause of orofacial pain are more common in older-aged patients.

Efficacy of denture adhesives in complete denture wearers compared to denture wearers not using denture adhesives. A systematic review.

AIM: The objective of this systematic review was to evaluate the efficacy of denture adhesives (DAs) in completely edentulous denture wearers compared to not using DAs. METHODS AND RESULTS: PubMed, Web of Science, Cochrane Library, and EMBASE were searched from the database inception up to 6 February 2020 for Randomized Controlled Trials (RCTs) involving patients with complete dentures in both arches where the use of DAs was compared to no use of DAs. A total of 497 abstracts were reviewed, resulting in inclusion of 10 RCTs. Outcomes reported in the included trials were thoroughly reviewed and tabulated. The Cochrane risk of bias tool was used. All 10 studies were assessed at unclear (10%) or high risk of bias (90%). Studies showed DAs improved mainly retention/stability, and masticatory/chewing ability/performance, compared to no adhesives. CONCLUSION: Most studies showed favorable results for DAs on retention and stability of complete dentures, masticatory performance, patient's comfort and satisfaction. Due to the heterogeneity of the outcomes, unclear/high risk of bias and small sample sizes, the quality of the evidence was very low. More high-quality research is needed with improved blinding and use of standardized methods to evaluate the efficacy of DAs.

Efficacy of saliva substitutes and stimulants in the treatment of dry mouth.

AIMS: To evaluate the efficacy of saliva substitutes and stimulants compared to placebo in improving findings of dry mouth not caused by SjÓ§gren's. METHODS AND RESULTS: Four databases were searched (PubMed, Web of Science, Cochrane Library, and EMBASE) through March 2018. Only randomized controlled trials (RCT) using placebo interventions with dry mouth patients were included. Outcomes included salivary flow and self-reported patient improvement. The Cochrane Collaboration's tool for assessing risk of bias was used. A total of 348 references were reviewed, resulting in 7 RCTs with 257 dry mouth patients with 5 studies at high risk of bias, 1 unclear and 1 low risk being included. Topical spray of 1% malic acid increased unstimulated (Difference in Means [DM] = 0.096, 95% CI = 0.092-0.100; P < 0.001) and stimulated (DM = 0.203, 95% CI = 0.106-0.300; P < 0.001) salivary flow in 2 studies. Patients using 1% malic acid topical spray were 5.4 times more likely to report improvement compared to placebo (95% CI = 2.634-11.091; P < 0.001) in 2 studies. No significant improvements were found with other products when compared to placebo. CONCLUSION: Use of 1% malic acid topical spray seems to improve dry mouth compared to placebo. Quality of the evidence was low due to risk of bias and imprecision.

Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses.

The objective of this systematic review was to determine the effect on oral health-related outcomes from mandibular implant-retained dentures opposing maxillary complete dentures in edentulous middle-age and older adults, compared with complete removable dentures in both arches. Randomized controlled trials included participants with an average age of 65 years or older. The Cochrane Library, MEDLINE, and Web of Science were searched. A total of 228 abstracts were reviewed for inclusion criteria, with 14 trials included and analyzed for risk of bias. Eleven of these studies were assessed as being at an unclear risk of bias, and 3 were at high risk. Mandibular implant-retained overdenture therapy showed statistically significant improvements in the patients' general satisfaction ( P = .003), oral health-related quality of life ( P < .001), and chewing ability ( P < .001), over the patients with complete dentures. There were no significant differences in the percentage of patients who were satisfied with their overdentures vs complete dentures for comfort, retention, esthetics, or chewing ability; however, only 2 studies reported these outcomes. In terms of nutritional status 1 year after treatment, vitamin B12 blood levels increased significantly in the implant-retained group ( P = .003), but not the other nutritional values. Implant-retained mandibular overdentures are an option for middle-aged and elderly edentulous patients as they significantly improve some of the outcomes; however, the quality of the evidence was moderate/low, due to the small number of studies included and the risk of bias. Future research should include objective outcomes such as masticatory performance, chewing efficacy, and muscular coordination.

A pigmented calcifying cystic odontogenic tumor associated with compound odontoma: a case report and review of literature.

BACKGROUND: Pigmented intraosseous odontogenic lesions are rare with only 47 reported cases in the English literature. Among them, pigmented calcifying cystic odontogenic tumor, formerly known as calcifying odontogenic cyst, is the most common lesion with 20 reported cases. METHODS: A case of pigmented calcifying cystic odontogenic tumor associated with odontoma occurring at the mandibular canine-premolar region of a young Japanese boy is presented with radiographic, and histological findings. Special staining, electron microscopic study and immunohistochemical staining were also done to characterize the pigmentation. RESULTS: The pigments in the lesion were confirmed to be melanin by Masson-Fontana staining and by transmission electron microscopy. The presence of dendritic melanocytes within the lesion was also demonstrated by S-100 immunostaining. CONCLUSION: The present case report of pigmented calcifying cystic odontogenic tumor associated with odontoma features a comprehensive study on melanin and melanocytes, including histochemical, immunohistochemical and transmission electron microscopic findings.