Estomatitis Asociada a Metotrexato: Un Reto Diagnóstico / Methotrexate Associated Stomatitis: A Diagnostic Challenge

RESUMEN: Las úlceras orales (UO) son uno de los signos de toxicidad por metotrexato (Mtx) aún en pacientes con esquemas de dosis bajas para el control de artritis reumatoide (AR). En estos casos establecer un diagnóstico correlacionando UO con el medicamento puede ser un reto. Presentamos 2 casos clínicos de pacientes con AR en tratamiento con Mtx, las cuales desarrollaron UO. En los dos casos, interesantemente los pacientes fueron evaluados tanto por especialistas del área médica y oral sin tener un resultado satisfactorio después de múltiples tratamientos. Las UO resolvieron posterior a la suspensión del medicamento. Se estableció el diagnóstico de Estomatitis por Metotrexato (EMtx) por un especialista en medicina oral. El manejo multidisciplinario en estos casos es clave para el establecimiento de un diagnóstico y tratamiento oportuno.

ABSTRACT: Oral ulcers (OU) are a sign of methotrexate (Mtx) toxicity, even in patients with rheumatoid arthritis (RA) that are under a low-dose regime. In those cases, establishing a diagnosis correlating OU with the medication can be quite a challenge. Here we present 2 clinical cases of RA patients under Mtx treatment that developed OU. Interestingly, in both cases the patients were evaluated by two specialists in the medical and dentistry area, and following multiple treatments there was no satisfactory result. However, oral ulcers resolved after stopping the treatment. A diagnosis of Metotrexato stomatitis was established (SMtx) by a specialist in oral medicine. Multidisciplinary management in these cases is key for the establishment of an opportune diagnosis and treatment.

Relationship between overweight-obesity and periodontal disease in Mexico

The aim of this study was to examine the association between overweight-obesity and periodontal disease in subjects who attended the clinic of Periodontics, Faculty of Dentistry, San Luis de Potosi, Mexico. This was cross-sectional study involving 88 subjects - 60 without overweight-obesity and 28 with overweight-obesity. The following clinical parameters were evaluated: dental bacterial plaque, index of calculus, gingivitis, probing depth and periodontal disease index (PDI). When comparing the group of subjects with overweight-obesity to the control, there were statistically significant differences in the variables calculus (p=0.0015), gingivitis (p=0.0050) and periodontal disease (p=0.0154). Regarding the logistic regression analysis, the dependent variable was subjects with and without overweight-obesity and the independent variables were sex, age and periodontal disease. We found statistically significant differences (p=0.0162) with OR=3.16 in periodontal disease. Periodontal disease showed statistically significant differences in the group of subjects with overweight-obesity. The oral health of subjects with overweight- obesity should be supervised and checked in order to prevent oral alterations.

El objetivo fue asociar el sobrepeso-obesidad con la enfermedad periodontal en sujetos que asistieron a la clinica de Periodoncia de la Facultad de Estomatologia de la Universidad Autonoma de San Luis Potosi (UASLP) Mexico. Se realizo un estudio transversal con un total de 88 sujetos, 60 con sobrepeso-obesidad y 28 sin sobrepeso-obesidad. Los siguientes parametros clinicos fueron evaluados en el estudio: placa dentobacteriana, indice de calculo, profundidad de bolsa y enfermedad periodontal (PDI). Al comparar el grupo de sujetos con sobrepeso-obesidad con el control se encontraron diferencias estadisticamente significativas en las variables calculo (p=0.0015), gingivitis (p=0.0050) y enfermedad periodontal (p=0.0154). En relacion con el analisis de regresion logistica, la variable dependiente fue sujetos sin y con sobrepeso-obesidad y las independientes fueron: sexo, edad y enfermedad periodontal. Encontramos diferencias estadisticamente significativa (p=0.0162) con un OR=3.16 en enfermedad periodontal. La enfermedad periodontal mostro diferencias al comparar el grupo de sujetos con sobrepeso-obesidad con el control. Es necesario la prevencion, supervision y revision del estado de salud bucal de los pacientes con sobrepeso y obesidad para prevenir alteraciones bucales.

Relationship between overweight-obesity and periodontal disease in Mexico.

The aim of this study was to examine the association between overweight-obesity and periodontal disease in subjects who attended the clinic of Periodontics, Faculty of Dentistry, San Luis de Potosi, México. This was cross-sectional study involving 88 subjects--60 without overweight-obesity and 28 with overweight-obesity. The following clinical parameters were evaluated: dental bacterial plaque, index of calculus, gingivitis, probing depth and periodontal disease index (PDI). When comparing the group of subjects with overweight-obesity to the control, there were statistically significant differences in the variables calculus (p = 0.0015), gingivitis (p = 0.0050) and periodontal disease (p = 0.0154). Regarding the logistic regression analysis, the dependent variable was subjects with and without overweight-obesity and the independent variables were sex, age and periodontal disease. We found statistically significant differences (p = 0.0162) with OR = 3.16 in periodontal disease. Periodontal disease showed statistically significant differences in the group of subjects with overweight-obesity. The oral health of subjects with overweight-obesity should be supervised and checked in order to prevent oral alterations.