Risk factors for oral epithelial dysplasias to become malignant: clinical implications.

There is a lack of effective clinical management of oral epithelial dysplasias to reduce their risk of malignant transformation and considerable gaps in knowledge regarding the most effective means of treating such lesions. A retrospective cohort of biopsy-confirmed oral epithelial dysplasias consecutively diagnosed in the period 1995-2014 and followed-up until 2017 was identified from pathology department files. Demographic, clinical and follow-up information was collected. Multivariate Cox proportional-hazards models were performed to evaluate sociodemographic, clinical and pathological factors associated with progression to oral squamous cell carcinoma. The study included 144 oral epithelial dysplasias, of which 42% progressed to oral cancer at the end of follow-up (21 years). Clinical aspect of the lesion was described for 77 (53.5%) of the patients. Treatment, age, grade of the lesion and diagnostic period were independent prognostic factors for progression. When considering only patients with described clinical aspect, only treatment and grade of the lesion were independently associated with cancer. The results from this non-selected retrospective cohort of oral epithelial dysplasias underscore the existing limitations of the current standard-of-care of the patients and provide novel insights on the management of these lesions with and without described clinical aspect. Well-designed, robust prospective studies, a homogenized staging system and multidisciplinary treatment guidelines are warranted.

Effect of probiotics as a complement to non-surgical periodontal therapy in chronic periodontitis: a systematic review.

BACKGROUND: To improve the results of the classic periodontal treatment, probiotics have been suggested recently to decrease the number of bacteria and the expression of mediators of inflammation. This systematic review aimed to assess the literature for the effectiveness of different probiotic strains as adjuvants to non-surgical periodontal therapy. MATERIAL AND METHODS: The electronic database of MEDLINE (via Pubmed) was searched up to December 2017 for randomised clinical trials in English comparing non-surgical periodontal treatment and probiotics versus periodontal treatment and placebo. The primary outcome investigated was reduction in pocket probing depth. Secondary outcomes were bleeding on probing, plaque index reduction and bacteria counts. RESULTS: Nine trials were included. A narrative data synthesis did not result in any major improvement of overall pocket probing depth but moderate pockets from 4 to 6 mm showed larger reductions in study groups, which could decrease the need for surgery. Sites with bleeding on probing and presence of plaque decreased after treatment. For periimplant mucositis, there was a small tendency to better results in the study group. CONCLUSIONS: With the available data, it is concluded that probiotics may provide an additional benefit to manual debridement in chronic periodontitis. More studies are required on dose, route of administration and strains of probiotics used.

Comparative characteristics of older people with type 1 diabetes treated with continuous subcutaneous insulin infusion or insulin injection therapy: data from the German/Austrian DPV registry.

AIM: To compare clinical characteristics and outcomes in adults with type 1 diabetes aged ≥ 60 years using continuous subcutaneous insulin infusion (CSII) vs. insulin injection therapy. Further, to determine the percentage of older adults with type 1 diabetes using CSII. RESEARCH DESIGN AND METHODS: Retrospective study using data of the Diabetes Prospective Follow-up Registry (DPV). Including percentage CSII use from 2008 to 2018, and the characteristics of 9547 individuals extracted from the DPV in March 2019 (N = 1404 CSII; N = 8143 insulin injection therapy). Wilcoxon rank sum tests were used for continuous variables and chi-square tests for categorical variables to compare clinical characteristics of people using CSII vs. insulin injection therapy. Adjusted analyses used generalized linear models to compare diabetes-related outcomes. RESULTS: CSII usage has increased in older adults (from 12% in 2008 to 23% in 2018). After adjustment, CSII was associated with lower HbA1c [60.7 mmol/mol (7.7 ± 0.1%) vs. 62.8% (7.9 ± 0.1%)], lower daily insulin dose (0.49 ± 0.02 vs. 0.61 ± 0.01 IU/kg), fewer days in hospital (8.1 ± 0.12 vs. 11.2 ± 0.11 days/person-year), fewer severe hypoglycaemic events (0.16 ± 0.02 vs. 0.21 ± 0.03 events/person-year) and fewer diabetic ketoacidosis (0.06 ± 0.01 vs. 0.08 ± 0.01 events/person-year). Individuals on CSII showed lower rates of microalbuminuria and also have a diagnosis of depression and neuropathy. CONCLUSIONS: A growing number of older adults are using insulin pumps. Older age in itself should not be seen as a contraindication for CSII.

Consideraciones sobre etiopatogenia y prevención del cáncer orofaríngeo / Aetiopathology and prevention of oropharyngeal cancer

El cáncer orofaríngeo ocupa la sexta posición de incidencia mundial (después de los cánceres colorrectal, de mama, próstata, vejiga y útero); más del 90% son carcinomas de células escamosas. Puede originarse en el labio, en la cavidad oral, en la faringe y en la laringe. Son bien conocidos factores de riesgo como el tabaco, el alcohol y la mala higiene bucal; sin embargo, parecen ganar protagonismo las infecciones por virus del papiloma humano (VPH) y la disbiosis oral. Las lesiones cancerizables obedecen a gran variedad de factores, cuyo control entra en el ámbito de actuación del profesional. Aparte de controlar los factores locales, la posición del profesional de la salud es idónea para aconsejar al paciente respecto a hábitos saludables de vida que contribuyan a prevenir o tratar síndromes metabólico-endocrinos, por otra parte favorecedores de patología precancerosa y cancerosa en diversas ubicaciones orgánicas

Oropharyngeal cancer is in the sixth position of cancer incidence in the world (after colorectal, breast, prostate, bladder, and cervix uteri cancer). More than 90% of them are squamous cell carcinoma. This type of cancer can originate on the lip, oral cavity, pharynx, and larynx. The risk factors associated with oropharyngeal cancer are tobacco, alcohol, and poor oral hygiene. However, other conditions, such as infection with human papilloma virus (HPV) and oral dysbiosis, are gaining prominence. Pre-malignant and malignant lesions are related to diverse factors that can be monitored by the health professional. These professionals are also in an ideal position to influence and advise patients on healthy life habits that contribute to prevent or treat metabolic-endocrine syndromes associated with the development of pre-cancerous disease and cancer located in different organs

[Aetiopathology and prevention of oropharyngeal cancer]. / Consideraciones sobre etiopatogenia y prevención del cáncer orofaríngeo.

Oropharyngeal cancer is in the sixth position of cancer incidence in the world (after colorectal, breast, prostate, bladder, and cervix uteri cancer). More than 90% of them are squamous cell carcinoma. This type of cancer can originate on the lip, oral cavity, pharynx, and larynx. The risk factors associated with oropharyngeal cancer are tobacco, alcohol, and poor oral hygiene. However, other conditions, such as infection with human papilloma virus (HPV) and oral dysbiosis, are gaining prominence. Pre-malignant and malignant lesions are related to diverse factors that can be monitored by the health professional. These professionals are also in an ideal position to influence and advise patients on healthy life habits that contribute to prevent or treat metabolic-endocrine syndromes associated with the development of pre-cancerous disease and cancer located in different organs.

Betel and tobacco chewing habit and its relation to risk factors for periodontal disease.

OBJECTIVES: To comparatively assess periodontal status in patients who chew different products and patients who do not have this habit and to assess how this practice interacts with predisposing factors and risk indicators of disease. METHODS: Patients included in the dental care carried out in a rural community in India were considered for a cross-sectional study. The simplified oral hygiene index and the community periodontal index (CPI) were assessed. Furthermore, a validated survey with items concerning chewing habits was administered. Statistical analysis of the effects of age range, gender, chewing products and hygiene status on CPI was performed. RESULTS: In total, 1,023 patients met the inclusion criteria. The chewer patients (430) exhibited a significantly higher CPI than the non-chewers (593). The chewing habit increased the likelihood of a higher CPI by 6.76-fold, while excellent-good oral hygiene status decreased the probability of a higher CPI by approximately 45%. CPI did not differ significantly among chewers of different products. CONCLUSION: In the population studied, a chewing habit was associated with a worse periodontal status, and this association was not modified by gender and age as predisposing factors. Oral hygiene could decrease the effect of chewing habit on periodontal health.

Letter to Editor: Support to the Spanish language, from Oral Medicine.

In the form of a letter to the director, the author provides linguistic comments related to Spanish. He draws attention to some often misused words and suggests some expressions that may improve the use of the Spanish language in scientific texts.

Nivel de mercurio en cabello de niños peruanos expuestos en una zona minera de Arequipa y de la ciudad de Lima / Level of mercury in hair of peruvian children exposed in a mining area of Arequipa and Lima city

Objetivo: El propósito del estudio fue comparar los niveles de mercurio en cabello en dos muestras de niños peruanos provenientes de dos zonas geográficas distintas: una zona rural minera y una zona urbana. Material y métodos: La zona minera correspondió al poblado de Mollehuaca (Arequipa), de donde se obtuvieron 52 muestras de cabello; la zona urbana no expuesta a minería correspondió al distrito de Los Olivos (Lima), de donde se obtuvieron 40 muestras. Se determinó el nivel de mercurio con la técnica estandarizada de plasma de inducción acoplado con un espectrómetro de masas (ICP-MS). Resultados: En la zona rural, en promedio, se obtuvo un nivel de mercurio de 7,47 ppb ± 26,9. En la zona urbana, el nivel de mercurio alcanzó un promedio de 2,47 ppb ± 1,28. No se encontraron diferencias significativas en el nivel de mercurio según edad o género. Conclusión: Se concluye que el grupo expuesto a minería aurífera informal y de zona rural presentó niveles de mercurio en cabello en promedio mayores a los del grupo de zona urbana, pero esta diferencia no fue significativa (p=0,188, alfa=0,05)

Objective: The aim of this study is to compare the mercury levels tested in two groups of children from different locations from Peru: a mining countryside and a metropolitan area. Methods: The rural area was Mollehuaca (Arequipa), where children are exposed to mercury by artisanal mining. Fifty-two hair samples from children from the rural area were obtained. The urban area was District of Olives (Lima), where there is not mercury exposure by mining. Forty hair samples from children from the urban area were obtained. Mercury level was determined by induction coupled plasma mass spectrometer (ICP-MS) standard technique. Results: In the rural area, an average of level of mercury 7.47 ppb ± 26.9 was obtained; in urban areas the mercury level reached an average of 2.47 ppb±1.28. Not significant differences in the level of mercury according to age or gender were found. Conclusion: It is concluded that the group exposed to rural and informal gold mining presented an average of mercury levels in hair higher than those of the urban group, but this difference was not significant (p=0.188, alfa=0.05)

Boca seca y boca ardiente / Dry mouth and burning mouth

La saliva es esencial para mantener la salud oral. El 99% de su composición es agua. El desencadenante más común de boca seca es la toma de medicamentos, generalmente acompañada de escasa ingesta de líquidos. Entre sus complicaciones cabe destacar xerostomía, disgeusia y ardor bucal, entre otras. Estos síntomas son tríada frecuente del síndrome de boca ardiente (SBA). Su etiología es imprecisa y multifactorial, sin datos clínicos o de laboratorio específicos. En su patogenia intervienen factores locales, sistémicos y psicológicos. Es común la asociación de hábitos parafuncionales evidentes, dentarios y linguales, con repercusión en tejidos duros (desgaste, ATM) y blandos (lesiones facticias, irritación de papilas linguales). Afecta más a mujeres en edad perimenopáusica, en proporción hasta 7:1 respecto a los hombres. A menudo se asocian ansiedad o depresión. En este trabajo se propone la parafunción deglutoria como parte integrante del síndrome (AU)

Saliva is essential to maintain the oral health. 99% of its composition is water. The most common trigger of dry mouth is taking medication, usually accompanied with low fluid intake. Its complications include xerostomia, dysgeusia and burning mouth, among others. These symptoms are a common triad of burning mouth syndrome (BMS). Its etiology is multifactorial, vague and without specific clinical or laboratorial data. In its pathogenesis are involved local, systemic and psychological factors. As common associations are evident dental and lingual parafunctional habits, with impact on hard tissues (dental wear, TMJ) and soft tissues (factitious injury, irritation of tongue papillae). BMS affects more women in perimenopausal age, in proportion up to 7:1 compared to men. Often anxiety or depression are associated. In this work the swallowing parafunction as part of the syndrome is discussed (AU)

Estado periodontal y de la mucosa oral en un grupo de embarazadas: Estudio clínico / Periodontal and mucosal status in a group of pregnant women: Clinical study

Introducción: Los cambios hormonales en el embarazo se reflejan en la salud periodontal de las pacientes, se pretende cuantificar y evaluar estos cambios en la cavidad oral de 165 pacientes embarazadas, así como el estado de su mucosa oral y relacionar su percepción de salud oral con los resultados de su estado periodontal. Métodos: Pacientes de revisión de rutina de un centro de atención primaria. Se les realiza una exploración donde se evalúa el estado periodontal, mediante el Índice de Necesidad de Tratamiento Periodontal de la Comunidad (C.P.I.T.N.), y el estado de las mucosas. Los dientes escogidos para el sondaje fueron el 16, 11, 26, 36, 31 y 46 de cada paciente y se tomó como valor representativo el más alto de todos los sextantes. 56 acudieron para realizarse una reevaluación. Resultados: De las 165 embarazadas el 5% (9) fueron consideradas invalorables. El 35% dieron como resultado valor 0 (57); el 46% valor 1 (76); el 12% valor 2 (20); y el 2% valor 3 (1). De las 56 que acudieron a la reevaluación el 23% (13) mejoraron, el 10% (6) empeoraron y el 66% (37) se mantuvieron. De las 165 sólo una presentó una lesión en mucosas, una ránula. Conclusiones: Aunque hubo un porcentaje sin patología periodontal, 35%, la mayoría padecía gingivitis(46%) y algunas periodontitis (14%). Por tanto consideramos importante recomendar a las pacientes embarazadas una exploración bucodental y realizar una labor preventiva en todas las pacientes en edad fértil con el fin de evitar consecuencias negativas (AU)

Background: The hormonal changes during pregnancy are reflected in the periodontal health, the aim of this study is to evaluate and quantify these changes in the oral cavity of 165 patients as well as their mucosal status and to compare the perception pregnant women have of their own oral health and the obtained results of their periodontal status. Methods: Patients included in the study were selected from the routine dental revision program of a public health centre. An oral exploration was performed. Periodontal status was evaluated by means of the Community Periodontal Index of Treatment Needs (CPITN). Teeth 16, 11, 26, 36, 31 and 46 from each patient were proben and the chosen value was the highest one of all sextants. 56 patients came back for reevaluation. The status of the oral mucosa was also inspected. Results: Among the 165 patients, the 5% were considered non-valuable (9), the 35% scored value 0 (57), the 46% scored value 1 (76), the 12% value 2 (20) and the 2% value 3 (1). Among the 56 who came back for reevaluation 13 of them did improve (23%), 6 got worse (10%) and 37 (66%) maintained. Only one person had an oral lesion: a ranula. Conclusions: Despite there was a group free of periodontal pathology, 35%, the majority of the patients (46%) had gingivitis and some of them periodontitis (14%). It is important for us to recommend the pregnant patients to come for a buccal exploration as well as carrying out a preventive labour in all patients in fertile age (AU)

Response to topical clonazepam in patients with burning mouth syndrome: a clinical study.

Burning Mouth Syndrome (BMS) is a difficult disease for patients and clinicians. Moreover, there is not a general consensus on how to treat the disease. The main objective of this paper is to evaluate BMS patients' response to topical clonazepam treatment. A double blind study was performed. Among a total of 66 patients, 33 were treated with tablets of clonazepam and another 33 were treated with a placebo. Symptoms were evaluated after 1 month and 6 months of treatment and scored on an analogical scale from 0 to 10. Among the 33 patients treated with clonazepam, 23 showed at least a 50% reduction in symptoms after 1 month of treatment. On the contrary, only 4 in the placebo group exhibited significant improvement. After 6 months, significant differences were observed again, as 23 of the 33 patients treated with the drug reported at least a 50% reduction in symptoms, whereas only 2 among those treated with the placebo significantly improved. However, when measured in terms of a complete cure (lack of symptoms), the differences were not significant: 5 drug-treated patients and one belonging to the placebo group were asymptomatic after one month of treatment. In summary, it seems that clonazepam applied topically was effective in treating BMS in a large proportion of patients.

Linfangioma capilar: Revisión de la literatura y reporte de un caso caso pediátrico

hamartomatoso o de displasia congénita. Afectan piel o mucosas, así como tejidos subcutáneos o submucosos, en cualquier localización. Se clasifican en superficiales (circunscritos) y profundos (cavernosos, higromas quísticos), en base a su asiento y al tamaño de las formaciones vasculares linfáticas. Presentación del caso. Niña adoptada, de 11 años de edad, de etnia hindú. Tenía varias pápulas granulosas en el dorso lingual, indoloras, de consistencia blanda, de entre 1 y varios milímetros de diámetro y coloración algo más rosada que el tejido circundante, por delante de la V lingual. Se barajaron los diagnósticos de sospecha de papilomas y de linfangioma. Se tomó una biopsia de la lesión más anterior. Histopatología. Mucosa escamosa, con engrosamiento del epitelio, sin desorden madurativo ni atipia y con marcada papilomatosis. La submucosa del eje de las papilas mostraba numerosos conductos vasculares de endotelio aplanado y muy ectásicos, en contacto directo con el epitelio, compatibles con el diagnóstico de linfangioma capilar. Tratamiento. Ante la extensión y localización poco comprometidas de la lesión y dada la edad de la paciente, se optó por mantener una conducta expectante. En el presente artículo se revisa la literatura y se presenta el caso clínico, resaltando la importancia del conocimiento de los aspectos clínicos de los linfangiomas en el ámbito odontológico y estomatológico, al tratarse de una patología de asiento preponderante en la región cervicofacial.

CAPILLAR LYMPHANGIOMA. Review of the literature and report of a pediatric case Lymphangiomas are congenital uncommon malformations of the lymphatic system, that different authors consider to have neoplasic, hamartomatous or congenital dysplasia characters. They can affect skin, mucosal, as well as subcutaneal or submucosal areas, in any location. According to their location and the size of the vascular lymphatic formation they are classified as superficial (circumscribed) and deep (cavernous, cystic hygromas). Case presentation: An eleven-years-old adopted girl of hindu ethnic group presented several granular papules on the lingual back, painless and soft consistent. They were located ahead of lingual V, with a diameter between one and several millimetres. Their colour were slightly more pink than the surrounding tissues. Under a suspection diagnosis of papillomas or lymphangiomas, a biopsy of the most anterior lesion was taken. Histopathology: Squamous mucosa, with enlarged epithelium, without maturative disorder nor atypia, and a marked papillomatosis was found. The submucosa of papilla axis showed numerous vascular ducts of flat endothelium with vascular ectasia. These ducts were in direct contact with the epithelium. The histopathologic diagnosis was of capillar lymphangioma. Treatment: Due to the extension and location of the lesion, without risk and taking into account the age of the patient, an expectant behaviour was chosen. In this paper the literature about lymphangioma is reviewed and a clinical case is presented, highlighting the importance of the knowledge of the clinical aspects of the lymphangioma in the odontologic and estomatologic area. This kind of pathology places with preponderance in the cervicofacial area.

Alimentos contra el cáncer oral / Foods against the oral cancer

El cáncer oral representa el 5% de todas las neoplasias y el 30% de los cánceres de cabeza y cuello. El porcentaje de supervivencia a los 5 años es de tan sólo el 25%, por lo que el diagnóstico y tratamiento precoces pueden salvar muchas vidas. La mayoría de los cánceres se relacionan con factores externos al organismo (tabaco, alcohol, betel, dieta y radiaciones solares, principalmente), que pueden modificarse o evitarse, es decir, prevenibles. Alrededor del 35% de los casos de cáncer están relacionados con la alimentación. Por este motivo, es importante que los profesionales de la salud informen a sus pacientes acerca de las enormes posibilidades profilácticas de la dieta. El objetivo de este trabajo de actualización bibliográfica es destacar la importancia de una alimentación saludable para la prevención del cáncer oral (AU)

Oral cancer means 5% of all malignancies and 30% of head and neck cancers. The percentage of survival at 5years is only 25%; therefore, diagnosis and early treatment can save many lives. Most cancers are related to factors outside the body (mainly tobacco, alcohol, betel, diet and solar radiation) that can be modified or avoided, i.e., they are preventable. About 35% of cancer cases are related to food. For this reason, it is important that health professionals inform their patients about the huge prophylactic potential of diet. The aim of this work of update is to highlight the importance of a healthy diet in order to prevent the oral cancer (AU)

Síndrome de ardor bucal: actualización diagnóstica y terapéutica / Burning mouth syndrome: diagnostic and therapeutic actualisation

El síndrome de boca ardiente (SBA) es una entidad patológica caracterizada por la presencia de síntomas crónicos de ardor o dolor en la mucosa bucal clínicamente normal. El SBA afecta principalmente a mujeres peri y posmenopáusicas. Su causa es desconocida, pero su relación con una compleja asociación de factores biológicos y psicológicos hace suponer una etiología multifactorial. Aunque se han encontrado tratamientos eficaces en casos particulares, se sigue buscando un tratamiento que resulte eficaz en la mayoría de los casos. Esta revisión hace especial referencia a los factores etiológicos y al tratamiento del síndrome (AU)

The burning mouth syndrome (BMS) is characterized by the presence of chronic symptoms of burning or paining clinically normal oral mucosa. This syndrome primarily affects peri and postmenopausal women. The cause is unknown, but the relationship between the BMS and a complex association of biological and psychological factors suggest a multifactorial etiology. Although some treatments have been found effective in particular cases, the clinical searchers are still looking for a treatment that can be effective in most cases. This review makes particular reference to the etiological factors and the treatment of the síndrome (AU)

Aspectos prácticos en la prevención del cáncer oral / Practical aspects in the prevention of oral cancer

El cáncer es una de las principales causas de morbilidad y mortalidad en el mundo. Por esta razón, la lucha contra el cáncer debe ser interdisciplinaria. Entre un 80 y un 90% de las neoplasias se relacionan con factores externos al organismo. Alrededor del 35% de estos factores tienen relación con la alimentación. La mayoría delos tumores malignos tienen una latencia de 10-20 años. Todos estos aspectos hacen que sea posible su prevención. La quimioprevención del cáncer persigue retrasar la aparición de la carcinogénesis, mediante agentes que previenen, suprimen o revierten transformaciones malignas. El objetivo de este trabajo radica en destacar aspectos etiopatogénicos del cáncer, así como proponer medidas de prevención frente al mismo (AU)

Cancer is one of the main causes of morbidity and mortality in the world. For that reason, it must to be fight in an interdisciplinary way. Between 80 and 90% of neoplasms are related to external factors to the organism. About 35% of these factors are in relationship with the feeding. Most of the malign tumors have a latency of 10-20 years. All those aspects make possible their prevention. The chemiprevention of cancer pursuits delaying of carcinogenesis with the use of chemical agents that prevent, suppress or revert malign transformations. The objective of this work is to emphasize some etiopathogenical aspects of cancer, as well as to propose prevention measures (AU)

Estudio de una muestra de pacientes con síndrome de boca ardiente / Study of a sample of patients with burning mouth syndrome

El síndrome de boca ardiente (SBA) es una enfermedad que, a pesar de conocerse desde hace muchos años, sigue planteando problemas de diagnóstico y tratamiento. Se manifiesta clínicamente como sensación de ardor o escozor en alguna zona de la mucosa oral, no existiendo ninguna lesión que pueda justificar dicha sintomatología. Se presenta fundamentalmente en mujeres postmenopáusicas, que suelen presentar sus molestias durante periodos prolongados. El ardor bucal puede acompañarse de otras alteraciones sensitivas, como sensación de sequedad o alteraciones gustativas. Objetivos: Estudiar una muestra de pacientes con SBA y describir los factores epidemiológicos, las enfermedades que padecen y los fármacos que consumen. Pacientes y métodos: La muestra estaba formada por 83 pacientes que consultaban en la clínica odontológica por ardor bucal. Se efectuó en todos ellos una historia clínica detallada y se registraron todas las características en una hoja de protocolo. Resultados: El 90,4% de los pacientes de nuestro estudio eran mujeres y sólo el 9,6% eran hombres. La media de edad de la muestra fue de 64,9 años. Todos los pacientes presentaban ardor en la lengua y el 64% lo presentaban en los labios. La mayoría de los pacientes estudiados (76%) presentaban una evolución de más de 12 meses, mientras que los de menos de 6 meses únicamente llegaban al 6%. De los 83 pacientes estudiados, 52 presentaban trastornos psicológicos (63%) y más de la mitad de ellos consumía algún fármaco psicoactivo. Conclusiones: Nuestra muestra de pacientes es equiparable a las descritas en otros estudios. El SBA predomina en mujeres postmenopáusicas, que presentan con gran frecuencia ansiedad y/o depresión (AU)

The burning mouth syndrome (BMS) is known since many years ago, but it is still difficult to be diagnosed and treated. The unique clinical manifestation is a kind of burning sensation on the oral mucosa, without any lesions justifying this symptom. It presents mainly in postmenopausal women, showing their discomfort during long periods. Burning mouth sensation can be accompanied by other sensitive alterations, like dryness or gustative changes. Objetives: To study a sample of BMS patients, describing the epidemiological factors, their diseases and drug consumption. Patients and methods: The sample was represented by 83 patients, consulting because their burning mouth sensation. All of them were accurately interrogated and examined and the data were registered in a protocol sheet. Results: 90.4% of patients were women and 9.6% were men. The mean of age was 64.9%. All the patients presented burning sensation on the tongue and 64% on the lips. The majority of the studied patients (76%) presented an evolution of the symptoms during more than 12 months; only 6% presented this evolution during less than 6 months. 52 (63%) of the 83 patients had psychological manifestations and more than the half of them consumed some psychoactive drug. Conclusions: Our sample of patients is comparable to those of other studies. BMS is more prevalent in postmenopausal women, presenting frequently anxiety and/or depression (AU)

Osteonecrosis de los maxilares asociada a bifosfonatos: revisión sistemática / Osteonecrosis of the jaws associated to biphosphonates: systematical review

En los últimos años se ha descrito una nueva complicación en la terapia con bifosfonatos: la osteonecrosis de los maxilares. Esta complicación no había sido detectada en los ensayos clínicos previos. En esta revisión sistemática de 340 casos, los pacientes afectados presentan como diagnóstico primario principalmente: mieloma múltiple (51,2%), cáncer de mama (31,4%), cáncer de próstata (7,1%) y osteoporosis (4,1%). La mandíbula resulta más afectada que el maxilar, con el 59,1%. La relación entre género femenino y masculino es de 2:2,6. El pamidronato es el bifosfonato más asociado a los casos de osteonecrosis (35,3%). Los factores de riesgos desencadenantes incluyen: exposición a bifosfonatos, infecciones orales, traumas, procedimientos quirúrgicos orales previos y terapias contra el cáncer (quimioterapia, corticoides y otros agentes citostáticos). La alteración en el equilibrio óseo, factores antiangiogénicos, inhibición en el ciclo celular de los queratinocitos y mecanismos osteolíticos generados en la infección podrían explicar la etiopatogenia en el desarrollo de esta complicación (AU)

In the last years a new complication has been described in the therapy with biphosphonates: biphosphonateassociated osteonecrosis of the jaws. This complication had not been detected in previous clinical tests. In this systematic review of 340 cases, the patients had as primary diagnosis principally: multiple myeloma (51.2%), breast cancer (31.4%), prostate cancer (7.1%) and osteoporosis (4.1%). The mandible is more affected than the maxilla, with 59.1%. The relationship between femenine and masculine gender was 2:2.6. The pamidronate was the biphosphonate more associated to the cases of osteonecrosis (35.3%). The risk factors associated include: use of biphosphonates, presence of oral infections, trauma, oral surgical procedures and therapies against cancer (chemoterapy, corticosteroids and other cytostatics agents). Effects on bone turnover, antiangiogenic property of biphosphonates, inhibitory effect of biphosphonates on the keratinocyte cell cycle and osteolysis mechanisms induced in the bacterial infection could explain the etiological mechanisms in the development of this complication (AU)

Cancerización de campo: revisión del concepto / Field cancerization: revision of the concept

El concepto de cancerización de campo sugiere que las mucosas del tracto aerodigestivo superior de un determinado paciente, sometidas de forma similar a los agentes cancerígenos habituales, tienen un mayor riesgo de desarrollar nuevos carcinomas. Desde su acuñamiento, el término se ha empleado para describir múltiples terrenos de enfermedad premaligna, con una prevalencia mayor de la esperada de aparición de múltiples tumores primarios o secundarios locales y la presencia de tumores distantes sincrónicos. Las técnicas moleculares han permitido profundizar en el conocimiento de la relación entre estas lesiones. Si bien hay diferencias metodológicas en la forma de identificar los orígenes clonales de las lesiones, algunos estudios indican que es frecuente la extensión clonal lateral de la enfermedad premaligna o maligna. Ante esta patología, se están investigando diversas alternativas preventivas y terapéuticas, como el screening poblacional, los retinoides o la terapia génica, que pueden aportar beneficios a los pacientes con lesiones premalignas y malignas en la región de cabeza y cuello (AU)

The concept of field cancerization is related to a greater risk of develop one or more carcinomas, on those patients in usual contact with cancerous agents. This term designs several fields of precancerous disease, with more prevalence of multiple primary or secondary local tumours, and distant syncronical tumours as well. Some studies indicate frequent lateral clonal extension of the precancerous and cancerous lesions. The molecular technology has permitted to deep in the knowledge of the relationship between these lesions. In front of this pathology, there are investigated several preventive and therapeutical alternatives, like screening of the population, or administration of retinoids and genic therapy, that can be benefit for these patients (AU)