Assembling a consensus on actinic cheilitis: A Delphi study.

AIMS: To discuss the terminology to define and classify actinic cheilitis (AC) and to build a consensus on the diagnostic and therapeutic approaches to AC. METHODS: Two-round Delphi study using a questionnaire including 34 closed sentences (9 on terminology and taxonomy, 5 on potential for malignant transformation, 12 on diagnostic aspects, 8 on treatment) and 8 open questions. Experts' agreement was rated using a Likert scale (1-7). RESULTS: A consensus was reached on 24 out 34 statements (73.5%) and on 5 out of 8 (62.5%) close-ended questions. The response rate was identical in both rounds (attrition of 0%). AC is the term with the highest agreement (median of 7 (strongly agree; IQR: 6-7)) and the lowest dispersion (VC = 21.33). 'Potentially malignant disorder' was the preferred classification group for AC (median of 7) and 85.6% of participants showing some level of agreement (CV < 50). Experts (66.75%) consider AC a clinical term (median: 7; IQR: 4-7) and believe definitive diagnosis can be made clinically (median: 6; IQR: 5-7), particularly by inspection and palpation (median: 5; IQR: 4-6). Histopathological confirmation is mandatory for the management of AC (median: 5; IQR: 2.5-7), even for homogeneous lesions (median: 5; IQR: 3.5-6). Consensus was reached on all treatment statements (VC < 50). CONCLUSIONS: AC is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy. A consensus was reached on nomenclature and management of this disorder.

Head and Neck Lymphomas in HIV Patients: a Clinical Perspective.

Introduction Because of the many HIV-related malignancies, the diagnosis and treatment of lymphoma in patients infected with human immunodeficiency virus are challenging. Objective Here, we review current knowledge of the pathogenesis, epidemiology, symptomatology, diagnosis, and treatment of head and neck lymphomas in HIV patients from a clinical perspective. Data Synthesis Although Hodgkin's lymphoma is not an AIDS-defining neoplasm, its prevalence is ten times higher in HIV patients than in the general population. NHL is the second most common malignancy in HIV patients, after Kaposi's sarcoma. In this group of patients, NHL is characterized by rapid progression, frequent extranodal involvement, and a poor outcome. HIV-related salivary gland disease is a benign condition that shares some features with lymphomas and is considered in their differential diagnosis. Conclusion The otolaryngologist may be the first clinician to diagnose head and neck lymphomas. The increasing survival of HIV patients implies clinical and epidemiological changes in the behavior of this disease. Early diagnosis is important to improve the prognosis and avoid the propagation of HIV infection.

Head and Neck Lymphomas in HIV Patients: a Clinical Perspective

Abstract Introduction Because of the many HIV-related malignancies, the diagnosis and treatment of lymphoma in patients infected with human immunodeficiency virus are challenging. Objective Here, we review current knowledge of the pathogenesis, epidemiology, symptomatology, diagnosis, and treatment of head and neck lymphomas in HIV patients from a clinical perspective. Data Synthesis Although Hodgkin's lymphoma is not an AIDS-defining neoplasm, its prevalence is ten times higher in HIV patients than in the general population. NHL is the second most common malignancy in HIV patients, after Kaposi's sarcoma. In this group of patients, NHL is characterized by rapid progression, frequent extranodal involvement, and a poor outcome. HIV-related salivary gland disease is a benign condition that shares some features with lymphomas and is considered in their differential diagnosis. Conclusion The otolaryngologist may be the first clinician to diagnose head and neck lymphomas. The increasing survival of HIV patients implies clinical and epidemiological changes in the behavior of this disease. Early diagnosis is important to improve the prognosis and avoid the propagation of HIV infection.

Oral manifestations of rheumatoid arthritis. A cross-sectional study of 73 patients.

OBJECTIVE: A study is made of the main oral manifestations of patients with rheumatoid arthritis (RA), particularly salivary flow, and of its possible association to periodontal disease. MATERIAL AND METHODS: A prospective comparative study was made of 146 patients (73 with RA and 73 controls), recording pocket depth, clinical attachment loss, bleeding index, plaque index, and the DMFT index to assess periodontal and dental alterations. Sialometric measurements were also made to determine resting, stimulated, and parotid salivary flow. RESULTS: The patients with RA had greater periodontal pocket depths (with moderate depths in most cases), as well as greater attachment loss and more bacterial plaque. The resting whole saliva and stimulated parotid saliva rates were also clearly decreased in the RA group compared with the controls. CONCLUSIONS: Patients with RA are more likely to present periodontal disease, poorer oral hygiene manifesting as an increased accumulation of bacterial plaque, and decreased salivary flow rates. CLINICAL RELEVANCE: Vulnerability to periodontitis is confirmed in one of the largest samples ever studied of patients with rheumatoid arthritis (RA). Also, there is evidence of hyposialia (decrease in salivary rate) in RA patients without Sjögren's syndrome.

Oral medicine (stomatology) across the globe: birth, growth, and future.

Oral medicine (stomatology) is a recognized and increasingly important dental specialty in many parts of the world that recognizes and fosters the interplay between medical health and oral health. Its dental activities rely greatly on the underlying biology of disease and evidence-based outcomes. However, full recognition of the importance of oral medicine to patient care, research, and education is not yet totally universally acknowledged. To address these shortcomings, we outline the birth, growth, and future of oral medicine globally, and record identifiable past contributions to the development of the specialty, providing an accurate, unique, and valuable resource on oral medicine. Although it was challenging to gather the data, we present this information as a review that endeavors to summarize the salient points about oral medicine, based on MEDLINE, other internet searches, communication with oral medicine and stomatological societies across the world, the web page http://en.wikipedia.org/wiki/List_of_dental_organizations, and discussions with a wide range of key senior persons in the specialty.

Does HIV infection have an impact upon dental implant osseointegration? A systematic review

OBJECTIVE: A systematic review is made to determine whether human immunodeficiency virus (HIV) infection has an impact upon dental implant osseointegration. STUDY DESIGN: A PubMed (MEDLINE) literature search was made of articles published up until 14 April 2014. The systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The quality of the studies included in the review was assessed using the Methodological Index for Nonrandomized Studies (MINORS) and levels of evidence (based on the University of Oxford's Center for Evidence Based Medicine criteria). RESULTS: The combinations of search terms resulted in a list of 132 titles. Nine studies finally met the inclusion criteria and were selected for inclusion in the systematic review. A total of 173 dental implants were placed in 80 patients (135 implants in 56 HIV-positive subjects and 38 implants in 24 HIV-negative patients), and a single loss of dental implant osseointegration was recorded in an HIV-positive patient. CONCLUSIONS: Our results suggest that dental implant placement in HIV-positive patients does not increase the dental implant failure rate. Prophylactic antibiotic treatment, the administration of highly active antiretroviral therapy, and control of the CD4+ T lymphocyte counts appear to be the main influencing factors in this respect. Given the few studies included in our systematic review, further prospective studies involving larger sample sizes and longer durations of follow-up are required in order to confirm the results obtained

Does HIV infection have an impact upon dental implant osseointegration? A systematic review.

OBJECTIVE: A systematic review is made to determine whether human immunodeficiency virus (HIV) infection has an impact upon dental implant osseointegration. STUDY DESIGN: A PubMed (MEDLINE) literature search was made of articles published up until 14 April 2014. The systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The quality of the studies included in the review was assessed using the Methodological Index for Nonrandomized Studies (MINORS) and levels of evidence (based on the University of Oxford's Center for Evidence Based Medicine criteria). RESULTS: The combinations of search terms resulted in a list of 132 titles. Nine studies finally met the inclusion criteria and were selected for inclusion in the systematic review. A total of 173 dental implants were placed in 80 patients (135 implants in 56 HIV-positive subjects and 38 implants in 24 HIV-negative patients), and a single loss of dental implant osseointegration was recorded in an HIV-positive patient. CONCLUSIONS: Our results suggest that dental implant placement in HIV-positive patients does not increase the dental implant failure rate. Prophylactic antibiotic treatment, the administration of highly active antiretroviral therapy, and control of the CD4+ T lymphocyte counts appear to be the main influencing factors in this respect. Given the few studies included in our systematic review, further prospective studies involving larger sample sizes and longer durations of follow-up are required in order to confirm the results obtained.

Risk of developing BRONJ among patients exposed to intravenous bisphosphonates following tooth extraction.

OBJECTIVE: A study was designed to measure of the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) following tooth extraction in patients receiving or who have received intravenous bisphosphonates (Zometa, zoledronic acid). METHOD AND MATERIALS: A prospective cohort study was made of 36 patients subjected to 62 tooth extractions. All these 36 patients had been treated or were receiving treatment with zoledronic acid. RESULTS: The incidence of BRONJ following 62 tooth extractions in patients treated with zoledronic acid 4 months after extraction was 14.5%. CONCLUSION: No statistically significant associations were found with patient age, sex, hygiene index, total treatment time, surgical difficulty, or extraction site. However, the factors that significantly influenced the final presence of osteonecrosis were related to tooth extractions in the absence of periodontal disease, and if sockets remained unhealed at the month of extraction.

Biomaterials coated by dental pulp cells as substrate for neural stem cell differentiation.

This study is focused on the development of an in vitro hybrid system, consisting in a polymeric biomaterial covered by a dental pulp cellular stroma that acts as a scaffold offering a neurotrophic support for the subsequent survival and differentiation of neural stem cells. In the first place, the behavior of dental pulp stroma on the polymeric biomaterial based on ethyl acrylate and hydroxy ethyl acrylate copolymer was studied. For this purpose, cells from normal human third molars were grown onto 0.5-mm-diameter biomaterial discs. After cell culture, quantification of neurotrophic factors generated by the stromal cells was performed by means of an ELISA assay. In the second place, survival and differentiation of adult murine neural stem cells on the polymeric biomaterials covered by dental pulp stromal cells was studied. The results show the capacity of dental pulp cells to uniformly coat the majority of the material's surface and to secrete neurotrophic factors that become crucial for a subsequent differentiation of neural stem cells. The use of stromal cells cultured on scaffolding biomaterials provides neurotrophic pumps that may suggest new criteria for the design of cell therapy experiments in animal models to assist the repair of lesions in Central Nervous System.

Idiopathic trigeminal neuropathies: a presentation of 15 cases.

PURPOSE: The aim of this study is to present a clinical series of patients with trigeminal neuropathy and their treatment. PATIENTS AND METHODS: We present a retrospective study of 15 cases of idiopathic trigeminal neuropathies, with unilateral involvement of 1 or more divisions of the trigeminal nerve. The clinical, radiologic, and laboratory data of the patients, in addition to the treatment and clinical evolution, were reviewed. The patients were followed up for a mean of 34.4 months (range, 12-120 months). RESULTS: The study consisted of 11 women and 4 men. The numbness was predominantly located in the innervated mental area and extended in some cases to the first and second trigeminal divisions. Seven patients had slight continuous discomfort in association with the numbness, one of whom had added bouts of typical neurogenic pain. Of the 15 cases, 8 (53%) had acute idiopathic trigeminal neuropathies and fully recovered within 3 months and 7 (47%) were chronic cases, without full recovery after 3 months. Mild pain was felt by 57% of the chronic patients and 37% of the acute patients; treatment with amitriptyline achieved complete or partial improvement in over half of these patients. CONCLUSION: Of the idiopathic trigeminal neuropathies, half were acute and half were chronic. Mild pain presented more frequently in the chronic patients and was relieved with amitriptyline.

Foreign body granulomatous reactions to cosmetic fillers: a clinical study of 15 cases.

INTRODUCTION: Subcutaneous or submucosal infiltration of cosmetic materials is a very common practice, because of the ease with which such materials can be deposited, and their presumed innocuousness. However, in recent years there have been reports of foreign body granulomatous reactions occurring many years after infiltration. METHOD: Data were collected on the clinical manifestations, histopathological findings, treatment, and course of the lesions of 15 patients. RESULTS: One male and 14 females presented orofacial swelling an average of 7 years after the infiltration of silicone (n = 9), hyaluronic acid (n = 2), collagen (n = 2), methacrylate (n = 1), and polyalkylimide (n = 1). The patients were treated mainly with systemic corticosteroids, and were followed for an average of 17 months. CONCLUSIONS: Systemic corticosteroids are able to control granulomatous reactions, which manifest in the form of outbreaks and tend to undergo spontaneous remission over the years.

Correlation of radiographic size and the presence of radiopaque lamina with histological findings in 70 periapical lesions.

PURPOSE: This study was conducted to relate the histological diagnosis of chronic inflammatory periapical lesions with the radiographic images of these lesions. MATERIALS AND METHODS: A total of 70 biopsy specimens obtained during periapical surgery were stained with hematoxylin and eosin and examined under a microscope. Histological analysis established the diagnosis as granuloma, cyst, or scar tissue. The location of the lesion was recorded, as were the radiographic size (maximum and minimum diameter in mm and area in mm(2)) and the presence of radiopaque lamina around the lesion, using an image analyzing system. RESULTS: The distribution of the biopsy specimens was 65.7% granulomas, 25.7% scar tissue, and 8.6% cysts, 1 of which was a keratocyst. The largest lesions were cysts and epithelialized granulomas, with statistically significant differences. Radiopaque lamina was observed around 9 lesions; of these, only 2 were histologically diagnosed as cysts, with the rest as granulomas. CONCLUSIONS: Most of the apical lesions were granulomas. Cysts had the largest radiotransparent images; however, in the 70 cases studied, neither the radiographic size nor the presence of associated radiopaque lamina alone was sufficient to determine the type of lesion. Histological analysis is required.

Relationship between histological diagnosis and evolution of 70 periapical lesions at 12 months, treated by periapical surgery.

PURPOSE: To relate the histologic diagnosis and radiographic size with the prognosis of 70 biopsies obtained via periapical surgery. MATERIALS AND METHODS: Seventy biopsies obtained during periapical surgery were histologically analyzed following curettage of the tissue, establishing the diagnosis as either apical granuloma, radicular cyst, or scar tissue. The radiographic size of the lesion (area in mm(2)) before surgery and after 1 year of follow-up was measured. The evolution at 12 months after surgery was evaluated according to the criteria of von Arx and Kurt. A statistical study was made, the inter-variable relationships were studied using analysis of variance with subsequent Tukey testing and calculation of Pearson correlation coefficient. RESULTS: Results indicated that 65.7% of lesions were granulomas, 25.7% scar tissue, and 8.6% cysts. The larger lesions had the worst prognosis. Cysts had the worst evolution at 12 months after surgery, this result being statistically significant. CONCLUSIONS: The prognosis for the periapical lesion depended on the type of lesion and its radiographic size, with cysts and larger lesions having the worst evolution.

Mental neuropathy as a manifestation associated with malignant processes: its significance in relation to patient survival.

PURPOSE: Mental neuropathy (MN) is characterized by the presence of a sensory defect in the form of paresthesias or dysesthesias in the territory innervated by the mental nerve. MN may be the first manifestation of systemic cancer, a symptom of spread of an established tumor, or a sign of infiltration in an intraoral lesion. In any of these cases, the symptom is indicative of a very poor patient prognosis. MATERIALS AND METHODS: A total of 22 cancer patients with chin paresthesia were studied. Group 1 comprised patients with chin paresthesia who had a primary tumor in some other region at a distance from the oral cavity or maxillofacial zone. Group 2 in turn comprised patients with primary malignancies of the oral and/or maxillofacial territory and who likewise presented with chin paresthesia. Data were collected relating to patient age, gender, primary intraoral lesion (location, size, histologic diagnosis), primary systemic tumor, and mean patient survival. RESULTS: Group 1 consisted of 11 patients (8 men and 3 women), aged between 36 and 81 years (mean, 58.09 +/- 14.99 years), with different systemic cancers. The mean survival after the diagnosis of chin paresthesia was 14.8 +/- 16.5 months, and only 1 patient was still alive after 9 months. Group 2 consisted of 11 patients (8 men and 3 women), aged between 33 and 72 years (mean, 56.18 +/- 15.69 years). All presented with oral squamous cell carcinoma, with the single exception of 1 case of fibrosarcoma. In this group the mean survival of the 8 patients who died was 28.2 +/- 29.6 months. Three patients survived for a mean of 17 months. CONCLUSIONS: Chin paresthesia is a very important prognostic symptom determining the degree of infiltration of intraoral lesions, and in some cases it may be indicative of the existence of a primary tumor (identified or otherwise), with poor short-term survival--given that 81.9% of the patients studied (18 cases) had died before a mean of 20 months. Although mean survival was shorter (14.8 months) among the patients in group 1 than in group 2 (28.2 months), the difference was not statistically significant.

Restoration with implants in patients with recessive dystrophic epidermolysis bullosa and patient satisfaction with the implant-supported superstructure.

PURPOSE: The use of endosseous implants in the prosthetic restoration of edentulous patients with recessive dystrophic epidermolysis bullosa (RDEB) may provide improved outcomes when compared with traditional prosthetic methods. The aim of this study was to evaluate the feasibility of placing endosseous implants in patients with RDEB and to compare the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla or mandible with the main emphasis on patient response. MATERIALS AND METHODS: Six patients with RDEB were treated with implants. All patients were completely edentulous in either the maxilla or mandible and had marked oral involvement, with alterations in the soft and hard tissues in all cases. Three patients were treated with fixed, screw-retained implant-supported prostheses, and 3 were treated with removable implant-supported prostheses. Six months after prosthetic restoration, patients were given a questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration marked on a visual analog scale. RESULTS: A total of 38 dental implants (21 maxillary, 17 mandibular) were placed in 6 patients. The implant success rate was 97.9%. The average follow-up from implant placement was 5.5 years (range, 1 to 9). The fixed and removable implant-supported prostheses were associated with improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. The level of satisfaction was slightly higher in patients with a fixed prosthesis. CONCLUSION: These findings suggest that endosseous implants can be successfully placed and provide support for prostheses in patients with RDEB. Patients with fixed prostheses and overdentures were satisfied with their implant-supported prostheses in the edentulous maxilla and mandible.

Complete fixed prostheses over implants in patients with oral epidermolysis bullosa.

PURPOSE: This study was conducted to evaluate the feasibility of placing fixed prostheses over endosseous implants in edentulous patients with recessive dystrophic epidermolysis bullosa. PATIENTS AND METHODS: Three cases of dental implants with fixed prostheses are presented. All 3 patients had marked oral involvement, with devastating alterations in the soft and hard tissues. The use of fixed prostheses avoids contact between the prosthesis itself and the oral mucosa, thus preventing the formation of blisters. RESULTS: A total of 27 implants (15 maxillary and 12 mandibular) were placed. One maxillary implant failed; the rest integrated successfully, allowing crown placement. The average follow-up after implant placement was 3 years (range, 1 to 5 years). CONCLUSIONS: Our findings suggest that endosseous implants are not contraindicated and can be placed successfully to improve these patients' quality of life. Implants can provide support for complete fixed prosthesis restoration in patients with epidermolysis bullosa. This procedure keeps the prosthesis from rubbing on the oral mucosa and prevents the development of ulcerations, improving mastication and esthetics.

Antibiotic use in dental practice. A review.

Antibiotics are commonly used in dental practice. It has been estimated that 10% of all antibiotic prescriptions are related with dental infections. The association amoxicillin-clavulanate was the drug most frequently prescribed by dentists during 2005, at least in the Valencian Community (Spain). The use of antibiotics in dental practice is characterized by empirical prescription based on clinical and bacteriological epidemiological factors, with the use of broad spectrum antibiotics for short periods of time, and the application of a very narrow range of antibiotics. The simultaneous prescription of nonsteroidal antiinflammatory drugs (NSAIDs) can modify the bioavailability of the antibiotic. In turn, an increased number of bacterial strains resistant to conventional antibiotics are found in the oral cavity. Antibiotics are indicated for the treatment of odontogenic infections, oral non-odontogenic infections, as prophylaxis against focal infection, and as prophylaxis against local infection and spread to neighboring tissues and organs. Pregnancy, kidney failure and liver failure are situations requiring special caution on the part of the clinician when indicating antibiotic treatment. The present study attempts to contribute to rational antibiotic use, with a review of the general characteristics of these drugs.

Uso de antibióticos en la práctica dental. Revisión / Antibiotic use in dental practice. A review

Los antibióticos son fármacos de uso cotidiano en odontología. Se estima que el 10% de las prescripciones antibióticas están relacionadas con la infección odontogénica. La asociación amoxicilina-clavulánico fue el fármaco más prescrito por dentistas durante 2005, al menos en la Comunidad Autónoma Valenciana. El uso de antibióticos en odontología se caracteriza por una prescripción empírica basada en epidemiología clínica y bacteriana, el uso de antibióticos de amplio espectro durante periodos breves de tiempo y el manejo de una batería muy reducida de antibióticos. La prescripción simultánea de AINES (antiinflamatorios no esteroideos) puede modificar la biodisponibilidad del antibiótico. Se detecta un aumento de número de cepas resistentes a los antibióticos convencionales en la cavidad oral.La indicación antibiótica se realiza para tratamiento de la infección odontogénica, de infecciones orales no odontogénicas, como profilaxis de la infección focal y como profilaxis de la infección local y la extensión a tejidos y órganos vecinos.El embarazo, la insuficiencia renal y la insuficiencia hepática son situaciones que requieren una especial atención del clínico antes de indicar un tratamiento antibiótico.El objetivo del presente trabajo es intentar contribuir a un uso racional de los antibióticos revisando sus características generales

Antibiotics are commonly used in dental practice. It has been estimated that 10% of all antibiotic prescriptions are related with dental infections. The association amoxicillin-clavulanate was the drug most frequently prescribed by dentists during 2005, at least in the Valencian Community (Spain). The use of antibiotics in dental practice is characterized by empirical prescription based on clinical and bacteriological epidemiological factors, with the use of broad spectrum antibiotics for short periods of time, and the application of a very narrow range of antibiotics. The simultaneous prescription of nonsteroidal antiinflammatory drugs (NSAIDs) can modify the bioavailability of the antibiotic. In turn, an increased number of bacterial strains resistant to conventional antibiotics are found in the oral cavity.Antibiotics are indicated for the treatment of odontogenic infections, oral non-odontogenic infections, as prophylaxis against focal infection, and as prophylaxis against local infection and spread to neighboring tissues and organs.Pregnancy, kidney failure and liver failure are situations requiring special caution on the part of the clinician when indicating antibiotic treatment.The present study attempts to contribute to rational antibiotic use, with a review of the general characteristics of these drugs