Immunomodulatory drugs: Oral and systemic adverse effects

OBJECTIVES: The main objectives are to present the different adverses effects of the immunomodulatory drugs that can impair the quality of life of the immunosupressed patients and study the impact of immunomodualtion on oral diseases. Immunomodulatory drugs have changed the treatment protocols of many diseases where immune functions play a central role, such as rheumatic diseases. Their effect on oral health has not been systematically investigated, however. Study DESIGN: We review current data on the new immunomodulatory drugs from the oral health perspective based on open literature search of the topic. RESULTS: These target specific drugs appear to have less drug interactions than earlier immunomodulating medicines but have nevertheless potential side effects such as activating latent infections. There are some data showing that the new immunomodulatory drugs may also have a role in the treatment of certain oral diseases such as lichen planus or ameliorating symptoms in Sjögren's syndrome, but the results have not been overly promising. CONCLUSIONS: In general, data are sparse of the effect of these new drugs vs. oral diseases and there are no properly powered randomized controlled trials published on this topic

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Immunomodulatory drugs: oral and systemic adverse effects.

OBJECTIVE: The main objectives are to present the different adverse effects of the immunomodulatory drugs that can impair the quality of life of the immunosuppressed patients and study the impact of immunomodulation on oral diseases. Immunomodulatory drugs have changed the treatment protocols of many diseases where immune functions play a central role, such as rheumatic diseases. Their effect on oral health has not been systematically investigated, however. STUDY DESIGN: We review current data on the new immunomodulatory drugs from the oral health perspective based on open literature search of the topic. RESULTS: These target specific drugs appear to have less drug interactions than earlier immunomodulating medicines but have nevertheless potential side effects such as activating latent infections. There are some data showing that the new immunomodulatory drugs may also have a role in the treatment of certain oral diseases such as lichen planus or ameliorating symptoms in Sjögren's syndrome, but the results have not been overly promising. CONCLUSION: In general, data are sparse of the effect of these new drugs vs. oral diseases and there are no properly powered randomized controlled trials published on this topic.

Evaluation of p53, Caspase-3, Bcl-2, and Ki-67 markers in oral squamous cell carcinoma and premalignant epithelium in a sample from Alava Province (Spain)

Objectives: The objective of this study was to determine whether alterations in the expression of p53, caspase-3 Bcl-2, and ki-67 appear early in premalignant oral epithelium and show clonal behavior. Study Design: Samples from 41 tumors with their adjacent non-tumor epithelia were immunohistochemically analyzed using monoclonal antibodies that recognize p53, caspase-3, Bcl-2, and Ki-67 Results: A statistically significant association was found between the expression in tumor and adjacent epithelium of p53, caspase-3, and Bcl-2 but not of k-67. A significant association was observed between the expression of ki-67 and p53 in both localizations. In non-tumor (premalignant) epithelium samples, there was a significant inverse relationship between the expressions of p53 and caspase-3 and a significant direct relationship between the expressions of p53 and Bcl-2. Conclusions: Alterations in these proteins appear to operate in combination with premalignant epithelia to create hyperproliferative cell states that favor the acquisition of summative oncogenic errors that confer invasive capacity (AU)

Efectos secundarios bucales de la radioterapia y quimioterapia en el cáncer en la región cervicofacial / Oral secondary effects of radiotherapy and chemotherapy in cancer of the cervicofacial region

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Evaluation of p53, caspase-3, Bcl-2, and Ki-67 markers in oral squamous cell carcinoma and premalignant epithelium in a sample from Alava Province (Spain).

OBJECTIVE: The objective of this study was to determine whether alterations in the expression of p53, caspase-3 Bcl-2, and ki-67 appear early in premalignant oral epithelium and show clonal behavior. STUDY DESIGN: Samples from 41 tumors with their adjacent non-tumor epithelia were immunohistochemically analyzed using monoclonal antibodies that recognize p53, caspase-3, Bcl-2, and Ki-67 RESULTS: A statistically significant association was found between the expression in tumor and adjacent epithelium of p53, caspase-3, and Bcl-2 but not of k-67. A significant association was observed between the expression of ki-67 and p53 in both localizations. In non-tumor (premalignant) epithelium samples, there was a significant inverse relationship between the expressions of p53 and caspase-3 and a significant direct relationship between the expressions of p53 and Bcl-2. CONCLUSIONS: Alterations in these proteins appear to operate in combination with premalignant epithelia to create hyperproliferative cell states that favor the acquisition of summative oncogenic errors that confer invasive capacity.

Actualización en técnicas de blanqueamiento de baja agresividad sobre dientes vitales: una necesidad ética y legal (segunda parte) / Update in whitening techniques lessaggressive on vital teeth: an ethical and legal necessity (second part)

En esta segunda parte se complementan las pautas y recomendaciones de utilización delas técnicas de blanqueamiento seleccionadas como menos agresivas. También se revisan las técnicas de control de resultados clínicos (medición del color) que pueden ser más aplicables en la clínica odontológica. En ella se presentan cuatro casos clínicos tratados con los principios de actuación defendidos como menos nocivos y unas conclusiones a modo de resumen, tanto dela primera como de la segunda parte (AU)

In this second part, the guidelines and recommendations for use of whitening techniques selected as less aggressive are complemented. The control techniques of clinical results (colour measurement) thatcan be more applicable in the dental clinic are also reviewed. Four clinical cases which are treated with the operational principles defended as less harmful and some conclusions in summarized form, from the first as well as the second part, are presented (AU)

Actualización en técnicas de blanqueamiento de baja agresividad sobre dientes vitales: una necesidad ética y legal (primera parte) / Update in whitening techniques less aggressive on vital teeth: an ethical and legal necessity (first part)

El presente trabajo trata de revisar aquellas técnicas de blanqueamiento menos agresivas tanto para los tejidos propios del diente como para los tejidos adyacentes evaluando sus ventajas e inconvenientes frente a otras técnicas más agresivas y que actualmente se encuentran muy difundidas a través de campañas publicitarias muy agresivas, en ocasiones carentes de suficiente sustentación científica. En el mismo presentamos algunos casos clínicos tratados con técnicas de blanqueamiento de baja agresividad, que pueden servir de apoyo a las opiniones que aquí serán vertidas (AU)

This work deals with reviewing those whitening techniques that are less aggressive on tissues of the teeth themselves as well as on the adjacent tissues, evaluating their advantages and disadvantages compared to other more aggressive techniques that are currently disseminated, supported by some very aggressive advertising campaigns and upon occasion lacking sufficient scientific support. In it we present some clinical cases dealing with less aggressive whitening techniques that can serve as support for the opinions that will be presented here (AU)

Current status of the torus palatinus and torus mandibularis

While there is a hereditary component to tori, this does not explain all cases. Tori tend to appear more frequentlyduring middle age of life; the torus palatinus is more commonly observed in females, but this is not the casewith the torus mandibularis. Certain ethnic groups are more prone to one torus or the other. The torus is mainlyremoved due to prostodontic reasons, as it may also be used as biomaterial, not only in periodontology, but alsoin implantology. The aim of this study was a review of the literature from the past twenty years (AU)

Current status of the torus palatinus and torus mandibularis.

While there is a hereditary component to tori, this does not explain all cases. Tori tend to appear more frequently during middle age of life; the torus palatinus is more commonly observed in females, but this is not the case with the torus mandibularis. Certain ethnic groups are more prone to one torus or the other. The torus is mainly removed due to prostodontic reasons, as it may also be used as biomaterial, not only in periodontology, but also in implantology. The aim of this study was a review of the literature from the past twenty years.

Osteochemonecrosis of the jaws due to bisphosphonate treatments. Update.

Bisphosphonates (BP),were initially used in industry and later as a drug due to their great affinity to osseous tissue, because of their powerful antiresorptive effect as a treatment in various osteopathies, such as osteoporosis, Paget disease or hypercalcemia associated with some malignant tumors, as myeloma or breast cancer. They are administered orally or intravenously, and although well tolerated, the most frequent side effects are gastrointestinal, in addition to osteonecrosis when they are administered via endovenous. The aim of this work has been to evaluate the existing publications in accredited scientific literature on biphosphonates and their action mechanism and the relationship with the appearance of osteonecrosis of the jaws. Although the mechanism by which osteonecrosis of the jaws develops is not known exactly, there seems to be influence by osteoclast inhibiton, antiangiogenic action, an inhibitory effect on the cellular cycle by the keratinocytes, as well as, reinforcement of the chemiotoxic action in oncological patients treated with other drugs. Clinically, it ranges from a non-specificity of symptoms to lesions such as osteomyelitis with necrosis and osseous sequesters that may be accompanied by fetor ex oris, with the appearance of many Actinomyces contaminated lesions. As for published antecedents on osteonecrosis due to bisphosphonate treatment found until 2006: 46.5% had a previous diagnosis of multiple myeloma; 38.8% were patients with metastatic breast cancer; 6.2% patients of metastatic prostate cancer; 4.1% suffered from osteoporosis; 3.5% from other metastatic diseases and 0.8% had Paget disease. The drugs that seem to have the highest incidence of osteochemionecrosis are: zoledronate, pamidronate, alendronate, risendronate and ibandronate, from the greatest to the least. Additionally, the risk of osteonecrosis being produced is accumulative and may reach 21% in the third year of intravenous bisphosphonate use.

Osteochemonecrosis of the Jaws due to Bisphosphonate Treatments. Update

Bisphosphonates (BP),were initially used in industry and later as a drug due to their great affinity to osseous tissue, because of their powerful antiresorptive effect as a treatment in various osteopathies, such as osteoporosis, Paget disease or hypercalcemia associated with some malignant tumors, as myeloma or breast cancer.They are administered orally or intravenously, and although well tolerated, the most frequent side effects are gastrointestinal, in addition to osteonecrosis when they are administered via endovenous. The aim of this work has been to evaluate the existing publications in accredited scientific literature on biphosphonatesand their action mechanism and the relationship with the appearance of osteonecrosis of the jaws. Although the mechanism by which osteonecrosis of the jaws develops is not known exactly, there seems to be influence by osteoclast inhibiton, antiangiogenic action, an inhibitory effect on the cellular cycle by the keratinocytes, as well as, reinforcement of the chemiotoxic action in oncological patients treated with other drugs. Clinically, it ranges from a non-specificity of symptoms to lesions such as osteomyelitis with necrosis and osseous sequesters that may be accompanied by fetor ex oris, with the appearance of many Actinomyces contaminated lesions.As for published antecedents on osteonecrosis due to bisphosphonate treatment found until 2006: 46.5% had a previous diagnosis of multiple myeloma; 38.8% were patients with metastatic breast cancer; 6.2% patients of metastatic prostate cancer; 4.1% suffered from osteoporosis; 3.5% from other metastatic diseases and 0.8% had Paget disease. The drugs that seem to have the highest incidence of osteochemionecrosis are: zoledronate, pamidronate, alendronate, risendronate and ibandronate, from the greatest to the least.Additionally, the risk of osteonecrosis being produced is accumulative and may reach 21% in the third year of intravenous bisphosphonate use (AU)

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Aprovechamiento de raíces en pacientes ancianos con postes de fi bra de vidrio. Una solución de baja agresividad. A propósito de algunas experiencias clínicas / No disponible

Se realiza una revisión de las posibilidades de aprovechamiento de restos radiculares en pacientes ancianos, y basados en experiencias clínicas, se propone la utilización de postes de fibra de vidrio reforzados con composites (FRC) como una alternativa de primera elección (AU)

Revision of the possibilities of making good use of root rest in elderly patients based in clinical experiences, we suggest the usefulness of glass fibre post strengthened with dental composite as an alternative of first choice (AU)

Efectos del láser sobre los tejidos orales y su posible aplicación en adhesión / Effects on laser related with oral tissues and its posibilites in the search of adhesion

En este artículo se hace una revisión sobre los efectos de los láser de alta potencia, sobre los tejidos dentarios y se aportan imágenes de entrenamiento preclínico originales. Se apuntan las posibilidades de la utilización de los láser como equipamientos clínicos de primera elección cuando se trata de eliminar caries imprevistas durante la realización de tallados dentarios con instrumentos rotatorios tradicionales y se aportan imágenes clínicas originales al respecto. También se hace una valoración basada en la experiencia clínica de los autores sobre las posibilidades de algunos de estos láser en la búsqueda de adhesión de materiales a los tejidos dentarios (AU)

In this article we have realised a revision about the effects on high powered lasers related with dental tissues and we have completed this information with images of original preclinic training. We discussed the possibilities of the uses of laser as first election clinic equipments when deals with the elimination of sudden caries during the achievement of dental carved with classic rotatory instruments and we give original clinical images about this .We have also created an evaluation based in the clinical experience of others authors about the possibilities of some of this lasers in the search of the adhesion of materials to dental tissues (AU)

Influence of smoking upon the postoperative course of lower third molar surgery.

OBJECTIVES: To determine whether smoking influences the postoperative course (pain and trismus) of lower third molar surgery, with a clinical evaluation of surgical wound condition and analysis of the possible differences between smokers and nonsmokers. DESIGN: The study subjects were randomly distributed into two groups (smokers and nonsmokers) and subjected to lower third molar extraction in the Unit of Oral and Maxillofacial Surgery (Madrid Complutense University, Spain). The study variables were trismus after 7 days, the intensity of pain and the need for rescue medication during a period of one week. The surgical wound was also assessed (color, presence of plaque, etc). RESULTS: Two cases of postoperative infection were documented among the smokers, and postoperative trismus was found to be greater among the latter (p=0.05). CONCLUSIONS: There were no statistically significant differences between the two groups in terms of pain, though trismus was greater among the smokers. Smoking did not influence wound condition (color, marginal inflammation, appositioning of the margins, ulceration, etc).

Influencia del hábito tabáquico en el postoperatorio de la cirugía del tercer molar inferior / Influence of smoking upon the postoperative course of lower third molar surgery

Objetivos: Determinar si tras la cirugía del tercer molar inferior el tabaco influye en el postoperatorio (dolor y trismo) y valorar clínicamente el estado de la herida, analizando las posibles diferencias entre fumadores y no fumadores.Diseño del estudio: Los pacientes que participaron en el estudio fueron distribuidos de forma aleatoria en dos grupos: Fumadoresy no fumadores. Se les realizó la extracción quirúrgica de los terceros molares inferiores en la Unidad de Cirugía Bucal y Maxilofacial de la Universidad Complutense de Madrid. Las variables registradas fueron el trismo a los 7 días, la intensidad del dolor y la necesidad de medicación de rescate durante un periodo de una semana. Se analizó también el estado de la herida (coloración, presencia de placa, etc.)Resultados: Hubo dos casos de infección postoperatoria en el grupo de pacientes fumadores. El trismo postoperatorio fue mayor en los fumadores (p=0.05)Conclusiones: No hubo diferencias estadísticamente significativas en cuanto a dolor, pero sí se observó un mayor trismo en el grupo de fumadores. El tabaco no influyó en el estado de la herida ( color, inflamación de los bordes, confrontación de los mismos, ulceración, etc.)

Objectives: To determine whether smoking influences the postoperative course (pain and trismus) of lower third molar surgery, with a clinical evaluation of surgical wound condition and analysis of the possible differences between smokers and nonsmokers.Design: The study subjects were randomly distributed into two groups (smokers and nonsmokers) and subjected to lower third molar extraction in the Unit of Oral and Maxillofacial Surgery (Madrid Complutense University, Spain). The study variables were trismus after 7 days, the intensity of pain and the need for rescue medication during a period of one week. The surgical wound was also assessed (color, presence of plaque, etc.).Results: Two cases of postoperative infection were documented among the smokers, and postoperative trismus was found to be greater among the latter (p=0.05).Conclusions: There were no statistically significant differences between the two groups in terms of pain, though trismus was greater among the smokers. Smoking did not influence wound condition (color, marginal inflammation, appositioning of the margins, ulceration, etc.)

Efectos del láser sobre los tejidos orales y su posible aplicación en adhesión / Effects on laser related with oral tissues and its posibilites in the search of adhesion

En este artículo se hace una revisión sobre los efectos de los láser de alta potencia, sobre los tejidos dentarios y se aportan imágenes de entrenamiento preclínico originales. Se apuntan las posibilidades de la utilización de los láser como equipamientos clínicos de primera elección cuando se trata de eliminar caries imprevistas durante la realización de tallados dentarios con instrumentos rotatorios tradicionales y se aportan imágenes clínicas originales al respecto. También se hace una valoración basada en la experiencia clínica de los autores sobre las posibilidades de algunos de estos láser en la búsqueda de adhesión de materiales a los tejidos dentarios (AU)

In this article we have realised a revision about the effects on high powered lasers related with dental tissues and we have completed this information with images of original preclinic training. We discussed the possibilities of the uses of laser as first election clinic equipments when deals with the elimination of sudden caries during the achievement of dental carved with classic rotatory instruments and we give original clinical images about this .We have also created an evaluation based in the clinical experience of others authors about the possibilities of some of this lasers in the search of the adhesion of materials to dental tissues (AU)