Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ).

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw. METHODS: Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study. RESULTS: Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%). CONCLUSIONS: Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments.

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

Point-of-care HbA1c Measurements in Oral Cancer and Control Patients in Hungary.

BACKGROUND/AIM: This study aimed to investigate the link between preoperative glycated hemoglobin (HbA1c) levels and oral cancer patients and diabetes mellitus (DM). We aimed to highlight the importance of point-of-care HbA1c measurements in oral cancer patients. PATIENTS AND METHODS: A total of 214 patients were admitted to the Department of Inpatient Care at Semmelweis University's Department of Oromaxillofacial Surgery and Stomatology between 1 September 2020 and 21 May 2021; individuals, who had undergone maxillofacial surgery under general anesthesia, were included in the study. RESULTS: There was a significant difference between the oral cancer group and the control group in terms of smoking (p=0.009) and alcohol intake (p=0.003). There was no statistically significant difference regarding sex (p=0.132) and DM (p=0.147) between the two groups. The tumor group had an 8.52% greater prevalence of DM, which was not significant. In the oral cancer group, twenty individuals (17.69%) had a higher HbA1c level than the upper level of the optimal metabolic value (6.9%). Nine participants (8.91%) in the control group had an HbA1c value greater than 6.9%, which means that their metabolic level was poor. The oral cancer group did not have higher blood glucose levels than those of the control group. CONCLUSION: No direct connection between high blood glucose levels and oral cancer was found. However, point-of-care HbA1c measurement can be a diagnostic tool to detect DM in the dental office.

Relation between medication-related jaw necrosis and blood glucose levels A retrospective epidemiological study / A gyógyszer okozta állcsontnekrózis és a vércukorszint kapcsolata. Retrospektív epidemiológiai vizsgálat

Maslach and Jackson. Results: In the field of examined dimensions of burnout syndrome, the most characteristic was emotional exhaustion, which has occurred with a frequency of nearly 30% and with typically high intensity among professionals working in neonatal intensive care units (N = 278). In addition, one-fifth were characterized by a high frequency and intensity of depersonalization. At the same time, nearly a third of them experienced a decrease in personal effectiveness. Workplace and time spent in healthcare did not show a significant connection with the incidence of burnout syndrome, however, burnout syndrome occurred with a higher frequency and intensity among those working in level III. neonatal intensive care unit. Conclusion: This is the first comprehensive burnout survey among premature and new born intensive care units in

Oral Health Status of Children Living with Type 1 Diabetes Mellitus.

BACKGROUND: Diabetes is a well-known predisposing factor for oral diseases, so prevention in an early age is mandatory. OBJECTIVE: To provide oral screening for children living with type 1 diabetes. We aimed to investigate the oral and general health indexes of T1DM children and compare these data to healthy siblings and controls. METHODS: In this cross-sectional study, 120 DM patients and 78 siblings, thereafter 80 DM children and 95 controls, took part. A detailed questionnaire, panoramic radiographs, and lateral cephalograms were obtained in every orthodontic consultation. We used Pearson's chi-square test for statistical analysis and compared the data of the study and control groups. RESULTS: The oral health values of DM children were significantly better (DMF-T 0.83-1.3) than the national average (3.8-4.5). A total of 75% (n = 60) of the children needed orthodontic treatment for orthodontic or skeletal anomalies. The prevalence of skeletal anomalies was significantly (p < 0.05) higher among patients with diabetes mellitus (DM) than in the control group. The frequency of coeliac disease was significantly elevated compared to any literature data (1-3.5%) in the study (15%) and in the control sibling group (13%). CONCLUSIONS: Co-morbidities such as CD should get more attention as a prognostic factor for a future higher incidence of diabetes. T1DM children can be motivated and health-conscious patients with excellent oral hygiene and dental status. Orthodontic treatment can help eliminate the oral complications of DM. Special diabetes ambulances may help provide oral care for patients with DM.

Prevalence of Diabetes and Impaired Fasting Glycemia in Patients With Oral Cancer: A Retrospective Study in Hungary.

BACKGROUND/AIM: Diabetes mellitus (DM) is one of the most common chronic metabolic disorders. Our research aimed to demonstrate the relationship between DM and oral cancer. PATIENTS AND METHODS: We pursued a retrospective research study in Hungary between January 2019 and December 2020. We investigated 597 inpatient records and compared them to the results of our previous studies (1998-2002 and 2012-2015). RESULTS: The frequency of patients with DM in the oral cancer group is 2.45 times higher today than 20 years ago. The prevalence rate of DM and oral malignancies increased from 14.6% to 35.8%. In the oral cancer group, 54.4% of the patients had elevated blood glucose levels and of these, 61.1% of them had type 2 diabetes, 34.2% had impaired fasting glycemia, and only 4.7% had type 1 diabetes. We observed that 45.3% of them were smokers. Of those whose blood sugar levels were under 6.1 mmol/l, the mean body mass index was 25.33 [standard deviation (SD)=±4.5; range=15.57-39.84], while among patients with DM, it was 26.92 (SD=±5.8; range=18.36-44.08). CONCLUSION: It may be necessary to continuously monitor the patient's blood sugar level to maintain euglycemic levels when managing patients with malignant oral lesions.

[Incidence of type 2 diabetes among oral cancer patients in Hungary]. / A 2-es típusú diabetes mellitus prevalenciájának változása szájüregi carcinomás betegek körében.

INTRODUCTION: Data proves that Hungary has a leading role in the statistics of oral cancer and patients living with type 2 diabetes. AIM: Our aim was to understand the statistical correlation between oral cancer and metabolic disorder (diabetes mellitus and impaired fasting glucose) due to the valuable data from the Semmelweis University. METHOD: We analyzed the data of 835 patients diagnosed with malignant oral cancer and 587 tumor-free control patients. We investigated the incidence and location of oral cancer among patients living with diabetes, and compared these datasets with our previous data from 14 years earlier. RESULTS: We found that in oral cancer patients, 26.1% had diabetes and 20.8% had impaired fasting glucose; in the control group these ratios were 10.8% and 11.1%. This difference is significant (p<0.05). 14 years ago in the tumor group 14.6%, in the control group 5.6% had diabetes, while 9.7% and 5.5% had impaired fasting glucose. Lip cancer had the biggest incidence. CONCLUSIONS: The rise of type 2 diabetes in the tumor group was significant. This could be a burden for the health care system. We want to highlight the importance of interdisciplinary cooperation between health care professionals. Orv Hetil. 2018; 159(20): 803-807.

Type-2 Diabetes Mellitus and Oral Tumors in Hungary: A Long-term Comparative Epidemiological Study.

BACKGROUND: Hungary has a leading place in global statistics of oral cancer and there is a high incidence of type-2 diabetes. PATIENTS AND METHODS: A retrospective diabetes and impaired fasting glucose (IFG) screening of 758 inpatients with histologically-confirmed oral malignancies was performed. The control group comprised of 534 tumor-free adults. The results were compared to data collected 14 years earlier. RESULTS: Diabetes mellitus (DM) was found in 25.9% and IFG in 20.6% of patients with oral cancer. Fourteen years earlier, DM was diagnosed in 14.6% and IFG in 9.7% of cancer patients. Among diabetic patients, the labial tumor location showed long-term dominance. The smoking rate of diabetes patients with oral cancer was higher in the present than in the previous study. CONCLUSION: The prevalence of type 2 diabetes and IFG increased significantly among oral cancer patients in the last 14 years.

[Change in the incidence of diabetes mellitus in oral cancer patients based on a long-term comparative study]. / A diabetes mellitus elofordulási gyakoriságának változása a malignus szájüregi daganatos betegek körében hosszútávú összehasonító vizsgálat alapján.

Our research is focused on the incidence of diabetes mellitus and glucose metabolic disorders among oral cancer patients and the frequency of different oral localizations of cancer. Diabetes mellitus affects 7% of the Hungarian population. This study uses data spanning 14 years, with 2 datasets of 1998-1999 and 2012-2013, collected first hand by the authors. These datasets have led us to examine the blood glucose level in 267 patients with histologically confirmed malignant tumours in the oral cavity. Diabetes mellitus was found in 59 of them (22.1%), The blood glucose was elevated in 32 cases (12%). The most frequent tumor locations among the diabetic patients: labial, lingual and gingival tumors gingivae. Comparative epidemiological study demonstrates that in 2012-2013 dataset there was an increased observed percentage of people with diabetes mellitus [17.6% to 22.1%]. The percentage of patients with IFG (impaired fasting glucose) also increased from 9.8% to 12%. Overall the number of patients with glucose metabolic disorders climbed from 27.4% to 34.1%, (p > 0.05). Our intention of this introductory analysis is to emphasize the close connection of these two very important disease groups, and the wider spread of diabetes mellitus.

[Dentigerous cyst associated with a wisdom tooth in the maxillary sinus. Case reports, review of the literature]. / Arcüreg felé attöro, follikuláris cisztával körülvett bölcsességfogak. Esetismertetés, irodalmi attekintés.

Wisdom teeth are often impacted or in an ectopic position. One rather special localisation is the maxillary sinus. Usually these teeth are associated with dentigerous cysts, which can occupy the maxillary sinus partially or totally and can be the cause of various symptoms. We can find it at routine radiographic examination or the patient could have typical, sinus-related symptoms. This signs can be swelling, pain of the cheek, headeache and nasolacrimal obstruction. We report four cases (one of them detailed) with review of the literature where the upper wisdom tooth is situated in the maxillary sinus.

[A rare case of fatal outcome due to extensive facial trauma caused by dogbite]. / Kiterjedt arcsérüléssel járó, halálos kimenetelu kutyatámadás ritka esete.

Statistically 10% of head and neek trauma is caused by animal bite, more often inflicted by dogs. More than 50% of victims are infants and small children. Generally, the result of dogbite is superficial trauma but there are cases of deep soft tissue defects with amputation and multiple bone fractures. In case described in this article, an elderly woman suffered a dog attack, wich resulted in extensive face and head injuries. In spite of receiving proper treatment, the patient passed away. It is highly probable that underlying Syncumar therapy caused complications which contributed to the fatal outcome. Because of it's unusual nature we found this case to be of interest for publication.

[Comparison of postoperative complications following bone harvesting from two different donor sites for autologous bone replacement (hip bone and proximal epiphysis of the tibia)]. / Autológ csontpótláshoz igénybe vett két, különbözo donorhely (csípolapát és tibia proximalis epiphysise) mutét utáni szövodményeinek összehasonlítása.

Whereas autologous bone replacement was earlier applied in maxillofacial surgery virtually only for the restoration of mandibular defects and for the osteoplasty of patients with cleft alveolar process, the free transplantation of autologous bone (spongiosa or cortical bone or both) is nowadays primarily used for implantation purposes. Autologous bone is still the gold standard for bone replacement. This is the case even though a wide selection of bone substitutes is currently available, with which new bone equivalent to autologous bone can be produced in certain cases. Autologous bone is often obtained from intraoral sources, but if a larger quantity of spongiosa is required, these sites (the chin, the retromolar area of the mandible, the muscular process, etc.) are not suitable. Of the extraoral donor sites, the most frequently used site is the iliac crest, but the proximal epiphysis of the tibia is also appropriate for this purpose since we have recently performed bone transplantations on appreciable numbers of patients, we decided to compare the morbidity data relating to the two donor sites. In the 9 months between March and November 2007, sinus elevations were carried out on 14 patients with bone taken from the tibia, while in 38 patients bone was taken from the iliac crest for osteoplasty on clefted alveolar process. The comparison was based on postoperative clinical examinations, the complaints of the patients and objective study of the morbidity relating to the two donor sites. Clinically the patients tolerated both interventions well. Mobilization took place on the day of intervention. There were no major complications; one minor haematoma was observed after each type of surgery. The postoperative complaints of the patients did not reveal any essential difference. Following bone harvesting from the iliac crest, the gait of the patients slightly hampered for up to 10 to 14 days. In the tibia cases, the patients experienced no pain on walking by the second day. As regards donor site morbidity, protracted (1-2 weeks) oedema was observed after hip surgery, with paraesthesia of the area of innervation of the n. cutaneous femoris lateralis in 1 case, while there was a minor seroma following tibia surgery in 1 case. Our clinical experience suggests that, if 10-15 cm(3) spongiosa is required for augmentation purposes and there is no need for cortical bone, the patient is exposed to less stress when bone is taken from the proximal epiphysis of the tibia.

[The proximal tibia. A possible donor site in preprosthetic surgery]. / A tibia proximalis epiphysise mint lehetséges autológ csontvételi hely.

With the development of oral implantology the augmentation of the alveolar process and the maxillary sinus has become a more and more frequent procedure. Even though a vast array of bone replacement materials is available commercially, they all just have an osteoconductive effect. By now it has become clear that the 'gold standard' of bone grafts is autologous bone that is both osteoconductive and osteoinductive. Autologous bone is mostly harvested from intraoral sources. If a larger quantity of spongious bone is needed, it is from extraoral sites, mainly from the iliac crest. In some countries the use of the proximal epiphysis of the tibia for bone harvesting is more widespread. In our Department a sinus lift was performed with spongious bone harvested from the tibia in 14 patients within 9 months. A mean 20 cc of bone can be harvested from one site, which is sufficient for the augmentation of both sinus floors in all cases. The patients tolerated surgery well, healing was without complications. Patients were mobilised immediately after surgery. Patients tolerated the postoperative period significantly better than after bone harvesting from the iliac crest.

Disorders of glucose metabolism and risk of oral cancer.

Alcohol and tobacco are considered as major risk factors for oral cancer (OC). In the developed countries reduction of alcohol and tobacco consumption has achieved favorable decreasing trends in OC morbidity and mortality over the last decades. At the same time the earlier very high male-female OC ratio showed a declining tendency all over the world. This trend used to be simply interpreted by the increasing exposure to tobacco and alcohol among women. However, literary data support an enhanced prevalence of women among non-smoker non-drinker OC cases. These findings focused the attention for further underlying mechanisms in the initiation of OC, such as metabolic and hormonal disorders. Insulin resistant states (metabolic syndrome and type-2 diabetes) are sources of many human diseases. Reactive hyperinsulinemia, increased production of insulin-like growth factors, hyperglycemia and its serious consequences are all proven cancer promoters. Decreased blood perfusion of the tissues caused by diabetic macro- and microvascular lesions, extracellular matrix alterations, and defects of inflammatory and immunologic reactions in type-2 diabetes are also predictors of OC. The literary data and the authors' own results on their OC cases support the strong association of type-2 diabetes and increased cancer risk. Moreover, type-2 diabetes has a significant impact on the local invasion and metastatic progression of OC. The correlations between glucose metabolism disorders and malignancies reveal new possibilities in the prevention and treatment of OC.

[Prognostic significance of type 2 diabetes in patients treated with surgery and irradiation for gingival cancer]. / A 2. típusú diabetes mellitus prognosztikai jelentôsége a sebészileg kezelt és irradiált gingiva carcinomás betegeknél.

Type 2 diabetes may be regarded as a risk factor for cancers in different sites. The aim of this study was to compare the progression of primary gingival cancers in type 2 diabetic and non-diabetic patients. This retrospective follow-up study involved 48 diabetic and 52 non-diabetic control patients with gingival squamous cell carcinoma in stage T2-3N0M0. Their treatment comprised surgical tumor extirpation, block resection of the mandible, functional cervical dissection and 60 Gy adjuvant irradiation. Progression data was recorded after a 2-year period of clinical follow-up. Surgical samples were assessed histopathologically from the aspect of tumor spread. At the end of a 2-year follow-up period, there were significantly worse clinical results in the diabetic group concerning the cervical lymph node metastases (P <0.05) and the rate of deaths (P< 0.001). Histologically, the degree of tumor invasion was significantly different in the diabetic group compared to the controls (P < 0.01). Type 2 diabetes can be regarded as a possible prognostic factor in cases of gingival carcinoma, forecasting an unfavorable course.

[Osteonecrosis of the jaws by using bisphosphonates]. / Biszfoszfonátok alkalmazása következtében kialakuló osteonecrosis az allcsontokban.

The new generation of bisphosphonates are often used in the treatment of osteoporosis or for certain tumors with bone defects. Between the period of September 2005 and May 2006 we have treated 8 patients at our clinic with a bisphosphonate-induced osteonecrosis in the maxillofacial region. All of these patients went through intravenous bisphosphonate treatment earlier. We have chosen two cases, where the appearance of side effects can be named as typical. Based upon the increasing number of international articles reporting and our own experiences in this matter, we would like to draw attention to the importance of prevention in treating these patients. In case of symptoms, if temporary suspension of the bisphosphonate therapy does not have severe consequences, combination of surgical and long-term antibiotic therapy could be the solution.

[Report of a rare case of temporomandibular ankylosis as a result of rheumatoid arthritis]. / Rheumatoid arthritis következtében kialakult temporomandibularis ízületi ankylosis ritka esete.

The case and surgical treatment of a patient with rheumatoid arthritis causing bony ankylosis of the temporomandibular joint are presented. The main characteristics of polyarthritis are also surveyed.

A preliminary comparative study of the prognostic implications of type 2 diabetes mellitus for patients with primary gingival carcinoma treated with surgery and radiation therapy.

PURPOSE: Type 2 diabetes mellitus (DM2) may be a risk factor in determining cancer progression. The aim of this study was to compare the progression of primary gingival cancer in patients with DM2 and nondiabetic patients. PATIENTS AND METHODS: Prospective follow-up studies involved patients with gingival squamous cell carcinoma in stage T2-3N0M0. Treatment comprised surgical tumor extirpation, block resection of the mandible, functional cervical dissection, and 60 Gy of adjuvant irradiation. The patients were divided into a group of patients with DM2 (DM group) and a nondiabetic, control group. Progression data was recorded after a 2-year period of clinical follow-up. Surgical samples were assessed histopathologically from the aspect of tumor spread. RESULTS: At the end of a 2-year follow-up period, the DM group demonstrated significantly worse clinical results in terms of cervical lymph node metastases (P<.05) and mortality rate (P<.001). Histologically, the degree of tumor invasion was significantly different in the DM group and controls (P<.01). CONCLUSION: DM2 can be considered a possible prognostic factor in cases of gingival carcinoma, forecasting an unfavorable course.

[Malignant melanoma metastasis in the oral cavity]. / Melanoma malignum metastásisok a szájüregben.

Malignant melanoma occurs only rarely as a primary tumour in the oral cavity, with an incidence of 1-2 percent. Oral melanomas are predominantly to be found in the hard and soft palate, and less often in the gingiva and mandible. Mucosal malignant melanomas are much more aggressive than those situated in the skin. In two-thirds of the cases the route of formation of the metastases is lymphogenic, and haematogenic in the remainder. The typical sites of the distant metastases are the skin, the lungs, the brain, the liver, and the bones. Metastatic malignant melanoma in the oral cavity, a rarity in the literature, is associated with a very poor prognosis. This paper reports on two cases in which an isolated distant metastasis developed in the oral cavity.