Oral health status and dental care for individuals with visual impairment. A narrative review.

Visual impairment is a highly prevalent condition worldwide. Oral health care in this group of patients is not always adequate. This is due to the low awareness of the importance of oral health in this population group and the fact that these patients prioritize their general health over oral health. Therefore, caries and periodontal disease are frequent in this population group. Especially, periodontal status is worse in patients with acquired visual impairment compared to patients with congenital visual impairment. On the other hand, the proportion of treated caries in this group is very low. This may be due to the poorer access of this population to dental care, which is limited by physical, social, and information barriers. Dental phobia and the lack of dental professionals capable of treating this population group have been identified as one of the most important factors. Therefore, establishing oral hygiene routines that are adapted to individuals' skills and needs is essential to achieve good oral health and improve patient's quality of life. This narrative review also updates those dental treatment considerations, depending on each dental specialty, that can help improve patient satisfaction when they come to the dental office.

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.

Clinical and radiographic outcomes of allogeneic block grafts for maxillary lateral ridge augmentation: A randomized clinical trial.

BACKGROUND: A main drawback of bone block graft surgery is the resorption occurring in early stages of healing. To our knowledge, there are no studies comparing outcomes of freeze-dried bone allograft (FDBA) blocks with different architecture. PURPOSE: The aim of this work was to investigate different factors that can affect graft resorption and to compare the resorption rates of two different types of allogeneic blocks, corticocancellous and cancellous. MATERIALS AND METHODS: A randomized clinical trial was designed. Twenty-eight patients referred for onlay bone augmentation prior to implant placement were included in the study. Preoperative computerized tomography (CT) was taken for all patients. Patients received FDBA blocks of either cancellous or corticocancellous bone obtained from the iliac crest. After a 4-month follow-up, postoperative CT was taken. Then, another surgery was performed, with the purpose to place dental implants. The aforementioned groups were compared for bone resorption and implant outcome using analysis of covariance (ANCOVA) and repeated ANOVA measures, respectively. Demographic data, trabecular bone density, and graft sites were also analyzed. RESULTS: A total of 93 implants were placed in the augmented bone sites over 28 patients. A 100% survival rate was achieved during a mean follow-up period of 24 months in both groups. Higher bone resorption rate was found with cancellous bone grafts (29.2% ± 2.6) compared with corticocancellous grafts (19.3% ± 2.3). Moreover, higher resorption rates in patients with lower bone density (<185 Hounsfield Units) (31.7% ± 3.1) and smokers (26.39% ± 2.3) were observed when compared with patients with higher bone density (>185 Hounsfield Units) (16.8% ± 2.1) and nonsmokers (22.1% ± 2.3), respectively. CONCLUSION: Within the limitations of this study, these findings indicate that both corticocancellous and cancellous FDBA grafts constitute a clinical acceptable alternative for bone reconstruction, although cancellous grafts present higher resorption rates. Moreover, host factors such as patient's low bone density and smoking habits may also increase graft resorption rates.

Actualización en el manejo odontológico del paciente con patología hepática / Update on dental handling of the patient with liver disease

La enfermedad o disfunción hepática puede deberse a numerosas causas como infecciones adquiridas, patologías congénitas o el abuso de drogas. Cuando esta disfunción y el daño hepático se prolongan a lo largo del tiempo, puede desembocar en una cirrosis hepática, cuadro irreversible y de graves repercusiones para el enfermo. Las dos patologías hepáticas más frecuentes y principales causas de la cirrosis son la hepatitis o inflamación hepática, la cual se puede deber a numerosos factores siendo el más frecuente las infecciones por virus, y la enfermedad hepática alcohólica, provocada por el abuso de alcohol continuado durante un largo período de tiempo. El manejo odontológico de un paciente con alteraciones hepáticas supone un verdadero reto, ya que el hígado juega un papel vital en numerosas funciones metabólicas, como la secreción de bilis o la excreción de bilirrubina procedente del metabolismo de la hemoglobina. Un fallo en la función hepática puede suponer alteraciones en el metabolismo de aminoácidos, amoníaco, proteínas, hidratos de carbono y triglicéridos. Un paciente con patología hepática tendrá un metabolismo alterado de numerosos fármacos empleados habitualmente por el dentista, tendrá un mayor riesgo de hemorragia debido a anomalías en la síntesis de diferentes factores de coagulación, siendo además un paciente con mayor riesgo de infecciones. La gran repercusión de la enfermedad hepática, así como el notable desconocimiento de muchos profesionales odontólogos en su manejo, justifican este artículo donde se talla tanto las generalidades más importantes de esta entidad como sus principales manifestaciones orales y consideraciones en el manejo odontológico

Liver disease or dysfunction may be due to numerous causes such as acquired infections, congenital pathologies or drug abuse. When this dysfunction and liver damage are prolonged overtime, it can lead to hepatic cirrhosis, an irreversible condition and serious repercussions for the patient. The two most frequent liver diseases and major causes of cirrhosis are hepatitis or hepatic inflammation, which may be due to numerous factors being the most frequent virus infections, and alcoholic liver disease, caused by alcohol abuse continued during A long period of time. The dental management of a patient with liver disorders is a real challenge, since the liver plays a vital role in many metabolic functions, such as bile secretion or excretion of bilirubin from hemoglobin metabolism. A failure in liver function can lead to alterations in the metabolismof amino acids, ammonia, proteins, carbohydrates and triglycerides. A patient with liver disease will have an altered metabolism of numerous drugs commonly used by the dentist, will have a greater risk of hemorrhage due to abnormalities in the synthesis of different coagulation factors, being also a patient with a higher risk of infections. The great repercussion of liver disease, as well as the remarkable lack of knowledge of many dental professionals in its management, justify this article where it is detailed both the most important generalities of this entity as its main oral manifestations and considerations in dental management

Manifestaciones orales relacionadas con la artritis reumatoide. Revisión a propósito de un caso / Oral manifestations related to rheumatoid arthritis. Case report and literature review

Objetivo: Mostrar las manifestaciones orales cuya etiología está relacionada con la artritis reumatoide (AR), revisando la literatura más reciente, a propósito de un caso. Caso clínico: El tratamiento de la AR está basado principalmente en la terapia farmacológica, siendo esta responsable de manifestaciones a nivel de la cavidad oral. Se presenta el caso de una mujer de 65 años con AR en tratamiento bajo metotrexato y tocilizumab, que acude a consulta por presentar desde hace 40 días una úlcera en el borde lateral de la lengua. Conclusión: Las manifestaciones orales de la AR derivan principalmente de la terapia farmacológica, que se debe conocer para el correcto diagnóstico y tratamiento de la patología oral de estos pacientes

Objective: The aim of the present article was to describe the oral manifestations whose etiology is related to rheumatoid arthritis (RA), reviewing the most recent literature, in relation to a case. Clinical case: The treatment of RA is based mainly on pharmacological therapy, being responsible for the manifestations at the level of the oral cavity. We present the case of a 65-year-old woman with RA on treatment with methotrexate and tocilizumab, which occurs through 40 days on the lateral border of the tongue. Conclusion: The oral manifestations of RA are derived mainly from pharmacological therapy, which should know the correct diagnosis and treatment of the oral pathology of these patients

Distinct Expression and Clinical Significance of Zinc Finger AN-1-Type Containing 4 in Oral Squamous Cell Carcinomas.

Zinc finger AN1-type containing 4 (ZFAND4) has emerged as a promising prognostic marker and predictor of metastasis for patients with oral squamous cell carcinoma (OSCC). However, further validation is fundamental before clinical implementation. Hence, this study evaluated the expression pattern of ZFAND4 protein expression by immunohistochemistry using an independent cohort of 125 patients with OSCC, and correlations with the clinicopathologic parameters and disease outcome. Remarkably, ZFAND4 expression, while negligible in normal epithelium, exhibited two distinct expression patterns in tumors that did not overlap. A gross granular staining was characteristic of the undifferentiated cells at the invasive front of tumors, whereas the most differentiated cells located at the center of the tumor nests showed diffuse non-granular staining. ZFAND4 staining was higher in undifferentiated than in differentiated areas of tumors. High ZFAND4 expression in differentiated cells was significantly associated to well-differentiated (p = 0.04) and non-recurrent tumors (p = 0.04), whereas ZFAND4 expression in undifferentiated cells correlated with tumor location (p = 0.005). No correlations between the ZFAND4 expression and patient survival were found. These data question the clinical relevance of ZFAND4 expression as a prognostic biomarker in OSCC, and also reveal distinct ZFAND4 expression patterns depending on the differentiation areas of tumors that should be evaluated separately.

Manejo odontológico del paciente con EPOC / Dental management of the patient with COPD

El objetivo de este trabajo es revisar la literatura científica disponible sobre las consideraciones odotológicas y las manifestaciones orales que pueden presentar los pacientes con EPOC. Para ello se revisaron los artículos disponibles en Pubmed. De los resultados destacamos que los principales factores de riesgo de la EPOC son el tabaco y la edad. En España se prevé un aumento de pacientes con EPOC debido al envejecimiento paulatino de la población. En la práctica odontológica hay un promedio de 130 pacientes con EPOC de cada 2.000 pacientes que acuden a la consulta. El dentista debe llevar a cabo el tratamiento odontológico siguiendo las consideraciones pre, intra y postoperatorias propuestas para los pacientes con EPOC, e identificar aquellos que son inestables para posponer la cita o considerar su hospitalización. Las lesiones orales más frecuentes son la enfermedad periodontal, xerostomía, caries, y erosiones del esmalte. Conclusiones: Dada la alta prevalencia de la EPOC es necesario tener en cuenta ciertas precauciones a la hora de realizar el tratamiento dental y las contraindicaciones farmacológicas en estos pacientes. El dentista debe estar familiarizado con esta enfermedad y promover la salud oral en estos pacientes

The aim purpose of this work was to review the available scientific literature on the odontologic considerations and oral lesions that can present a patient with COPD. In order to do so, the available articles were checked in Pubmed. The principal risk factors for COPD include smoking and age. In Spain, an increase in the number of patients with COPD is expected due to the gradual aging of the population. In dental practice there is an average of 130 patients with COPD out of every 2000 patients who come to the dental clinic. The dentist must carry out the dental treatment following the considerations proposed for patients with COPD and identify the unstable patients to postpone the dental appointment or consider their hospitalization. The most frequent oral lesions are periodontal disease, xerostomia, caries and enamel erosions. Conclusions: Given the high prevalence of COPD, it is necessary to take into account certain precautions when performing dental treatment and pharmacological contraindications in these patients. The dentist should be familiar with this illness and promote the oral health in these patients

Manejo y consideraciones clínicas de los pacientes asmáticos en la consulta dental / Management and clinical considerations of the asthmatic patients in the dental practice

El objetivo de este trabajo es revisar la literatura científica disponible sobre las consideraciones odontológicas y las manifestaciones orales que pueden presentar los pacientes asmáticos. Se han revisado 34 artículos publicados entre los años 2001 y 2018. En función de su fisiopatología hay 5 tipos de asma, y clínicamente se clasifica en leve, moderada y grave. Entre los factores de riesgo destacan el tabaco, obesidad, genética, factores socioeconómicos y exposición a ciertas sustancias. El tratamiento de elección se basa en los broncodilatadores y glucocorticoides inhalados. Esta medicación disminuye la cantidad de flujo y el pH salival. Por este motivo la cavidad oral es más susceptible de desarrollar patologías como caries, enfermedad periodontal y candidiasis oral. Concluimos que, dada la alta prevalencia del asma, es necesario que el odontólogo tenga en cuenta las consideraciones pre, intra y postoperatorias propuestas para los pacientes asmáticos, y evite los fármacos que puedan precipitar un ataque. El dentista debe estar familiarizado con esta enfermedad, y promover la salud oral en estos pacientes

The purpose of this work is to review the available scientific literature on the dental considerations and the oral manifestations that may present asthmatic patients. 34 articles published between 2001 and 2018 were reviewed. According to its pathophysiology, there are 5 types of asthma, and clinically, the asthma severity classification is divided into mild, moderate and severe. The principal risk factors for asthma include tobacco, obesity, genetics, socioeconomic factors and exposure to substances. The treatment of choice is based on inhaled bronchodilators and glucocorticoids. This medication decreases the amount of flow and salivary pH. For this reason, the oral cavity is more susceptible to developing pathologies such as caries, periodontal disease and oral candidiasis. Conclusions. Given the high prevalence of asthma, the dentist must carry out the dental treatment following the considerations proposed for patients with asthma and should know the pharmacological contraindications in these patients. The dentist should be familiar with this illness and promote the oral health in these patients

Manejo odontológico del paciente con trastornos de la alimentación / Dental management of the patient with eating disorders

El objetivo del presente trabajo es realizar una revisión narrativa acerca del manejo y las manifestaciones orales de los pacientes que presentan trastornos alimenticios, centrándose en la anorexia y la bulimia nerviosa. Ambos trastornos frecuentemente se manifiestan por primera vez de forma oral: caries, erosión de las caras linguales y oclusales de los dientes, mucosas atróficas y traumatizadas, agrandamiento de las glándulas parótida y submandibular, etc. Es importante detectar a este tipo de pacientes y advertir al paciente y/o a los padres de las posibles complicaciones que pueden desencadenarse, y consecuentemente derivar al paciente para su correcto diagnóstico y tratamiento. Desde punto de vista odontológico, el profesional debe instruir al paciente en técnicas de higiene oral e introducirlo en un programa de prevención individualizado

The objective of this paper is to perform a narrative review about the management and oral manifestations of patients who present eating disorders, focusing on anorexia and bulimia nervosa. Both disorders are often manifested orally for the first time: teeth decay, erosion of the lingual and occlusal surfaces of the teeth, atrophic and traumatized oral mucosa, parotid and submandibular enlargement, etc. It is important to detect these types of patients and remark the patient and/or their parents of the possible complications that may occur, and consequently refer the patient for a correct diagnosis and treatment. The professional must instruct the patient in oral hygiene techniques and introduce him into an individualized prevention program

Manifestaciones orales y manejo odontológico en el paciente con síndrome de Rendu-Osler-Weber. A propósito de un caso clínico / Oral manifestations and dental management int he patient with Rendu-Osler-Weber síndrome. A case report

El objetivo del trabajo es describir el caso clínico de un hombre de 67 años con el Síndrome de Rendu-Osler-Weber (SROW). A la exploración, se pueden apreciar múltiples telangiectasias en la región facial, algunas puntiformes en los lóbulos de ambos pabellones auriculares y otras lineales en el área nasogeniana. A nivel intraoral, se observan telangiectasias de pequeño tamaño en labio, lengua, paladar, encía, y mucosa yugal. Así mismo, presenta lesiones vasculares clínicamente identificadas como hemangiomas intraorales. Según la literatura, la epistaxis es el signo clínico más frecuente en los pacientes con el SROW y el principal motivo de consulta. También es frecuente la presencia de telangiectasias que se pueden observar principalmente en labios (34%), lengua (33%), mucosa yugal (17%), paladar (10%) y encía (6%). Los odontólogos pueden ser los primeros en sospechar el cuadro por la presencia de lesiones orales y ayudar a un diagnóstico precoz por lo que pueden desempeñar un papel clave en el manejo de estos pacientes que incluirá un control y tratamiento multidisciplinar debido a las diferentes manifestaciones de esta entidad

The aim of this study is to describe the clinical case of a 67-yeart-old man with SROW. At the exploration, multiple telangiectasias can be seen in the facial region, some punctiform in the lobes of both atrial and other linear in the nasogenian area. At the oral level, small telangiectasias are seen on the lip, tongue, palate, gums, and buccal mucosa. it also presents vascular lesions clinically identified as intraoral hemangiomas. According to the literature, epistaxis is the most frequent clinical sign in patients with SROW and the main reason for consultation. It is also frequent the presence of telangiectasias that can be seen mainly on lips (34%), tongue (33%), yugal mucosa (17%), palate (10%) and gums (6%). Dentists may be the first to suspect the condition due to the presence of oral lesions and to help early diagnosis, so they can play a key role in the management of these patients, including multidisciplinary treatment and control due to the different manifestations of this condition. Entity

Manejo y consideraciones clínicas de la enfermedad inflamatoria intestinal en la consulta dental / Management and clinical considerations of the inflammatory bowel disease in the dental office

El objetivo de este trabajo es realizar una revisión bibliográfica sobre la enfermedad inflamatoria intestinal (EII) y sus manifestaciones clínicas orales. La EII es un término que abarca dos enfermedades idiopáticas del tracto gastrointestinal: la colitis ulcerosa y la enfermedad de Crohn. Cuando un paciente que tiene una de estas condiciones se presenta para el tratamiento en nuestra consulta dental, es necesario ser consciente de la condición del paciente, controlar los síntomas indicativos de enfermedad inicial o recaída, y haber realizado una correcta historia clínica que incluya los fármacos que interactúan con medicamentos gastrointestinales o que pueden agravar la situación del paciente. Además, las manifestaciones orales de la enfermedad gastrointestinal no son infrecuentes, por lo que el dentista también debe estar familiarizado con los patrones orales de la enfermedad

The objective was to perform a literature review of the inflammatory bowel disease (IBD) and it's clinical oral manifestations. It is a term that encompasses two idiopathic diseases of the gastrointestinal tract: ulcerative colitis and Crohn’s disease. When a patient who has one of these conditions comes for treatment at our dental office, it is necessary to be aware of the patient's condition, to control the symptoms indicative of initial illness or relapse, and to have a correct medical history including the drugs which interact with gastrointestinal drugs or which may aggravate the patient's condition. In addition, oral manifestations of gastrointestinal disease are not infrequent, so the dentist should also be familiar with the oral patterns of the disease

Formas de tabaco no fumado y lesiones asociadas en cavidad oral / Smokeless tobacco and associated lesions of the oral cavity

El consumo de tabaco y, en concreto las formas de éste sin humo, son determinantes en el desarrollo de carcinoma en cavidad oral y fibrosis oral submucosa, entre otras entidades. El objetivo de este trabajo es hacer una revisión de la literatura sobre las diferentes formas de consumo de tabaco sin humo y el desarrollo de lesiones orales asociadas a su uso continuado. Se estima que el 90% de los consumidores de las formas de tabaco sin humo se encuentran en el Sur de Asia, lo que supone una cifra de 100 millones de personas. En general, el tabaquismo comienza a una edad joven y se sabe que aumenta el riesgo de padecer enfermedades crónicas durante toda la vida (AU)

Tobacco consumption and, in particular, smokeless forms are determinant in the development of oral carcinoma and oral submucosal fibrosis, among other entities. The aim of this paper is to review the existing literature on the different forms of smokeless tobacco use and the development of oral lesions associated with its continued use. It is estimated that 90% of consumers of smokeless tobacco are found in South Asia, which represents a figure of 100 million people. In general, smoking begins at a young age and is known to increase the risk of chronic diseases throughout life (AU)

Dental management in patients with antiplatelet therapy: A systematic review.

INTRODUCTION: Cardiovascular diseases are the most frequent cause of death in the Western world. Its treatment frequently needs therapy with antiplatelet agents, which increases the haemorrhage risk after oral surgical procedures. The aim of this study is to present a review on the dental management of the patients under antiplatelet treatment. MATERIAL AND METHODS: A systematic review was carried out following PRISMA recommendations including studies searched in Pubmed-Medline, Embase and Cochrane databases. RESULTS: The current trend is to maintain the treatment during the surgical procedure, assuring a good control of the haemorrhage with local haemostatic measures. However, new antiplatelet drugs protocols are not firmly established. CONCLUSIONS: In spite of the existing recommendations, it is always advisable to consult with the internist or cardiologist of every patient before any intervention. Key words:Antiplatelet, Oral Surgery, Exodontia, Dental Management.

Patogenia del cáncer oral por el virus del papiloma humano / Pathogenesis of oral cancer for human papiloma virus

Introducción: El cáncer oral representa el 1-2% de todos los cánceres del organismo, correspondiendo el 90% a carcinomas orales de células escamosas (COCE). Los factores de riesgo clásicamente implicados en el desarrollo del cáncer oral son la edad avanzada, el sexo masculino y la exposición prolongada a hábitos como el alcohol, el tabaco y la nuez de betel. Sin embargo, el incremento en los últimos años de la incidencia de COCE en pacientes jóvenes sin exposición a factores de riesgo clásicos ha puesto en manifiesto la presencia de otros posibles agentes etiopatogénicos, entre los que destaca el virus del papiloma humano (VPh). Objetivos: Poner de manifiesto el desarrollo molecular del COCE por la intervención del VPh como oncovirus y sus características. Resultados: Los estudios determinan el alto riesgo oncogénico que presenta el subtipo 16 y 18 del VPh actuando a través de sus proteínas E6 y E7, afectando directamente al p53, a la proteína del Retinoblastoma (pRb) y otras enzimas implicadas en la regulación del ciclo celular como la PI3K, alterándose así los procesos de apoptosis, proliferación y diferenciación celular. Conclusiones: El VPh juega un papel importante como carcinógeno en la aparición del COCE, con un pronóstico más favorable respecto a otros factores etiológicos. El proceso de oncogénesis en el desarrollo del COCE a partir del VPh está determinado por los subtipos de alto riesgo, así como la expresión de las proteínas virales E6 y E7, responsables de inhibir la actividad de los genes supresores de tumores del ciclo celular (AU)

Introduction: Oral cancer represents 1-2% of all cancer in the organism, 90% corresponding to oral squamous cell carcinomas (OSCC). Risk factors traditionally involved in the development of oral cancer are advanced age, male sex, and prolonged exposure to habits such as alcohol, tobacco, and betel nut. The increase in the incidence of OSCC in young patients without exposure to classical risk factors in recent years has revealed the presence of other possible etiopathogenic agents, especially the human Papilloma Virus (hPV). Objectives: Describe the molecular development of the OSCC by the hPV intervention as oncovirus and its characteristics. Results: Different studies show the high oncogenic risk of hPV 16 and 18 subtypes acting through their E6 and E7 proteins, directly affecting p53, Retinoblastoma protein (pRb) and other enzymes involved in the regulation of the cycle Cell as the PI3K, altering the processes of apoptosis, cell proliferation and differentiation. Conclusions: hPV plays an important role as a carcinogen in the onset of OSCC, with a more favorable prognosis regarding other etiological factors. The process of oncogenesis in the development of COCE from hPV is determined by the high risk subtypes as well as the expression of the viral proteins E6 and E7 responsible for inhibiting the activity of the cell cycle tumor suppressor genes (AU)

Quality of life and oral health in elderly.

BACKGROUND: We want to assess quality of life in elderly patients in relation to the number of remaining teeth, the number of ingested drugs and xerostomía and to determine the correlation between an increased intake of drugs and a greater feeling of dry mouth and to know the most commonly used measures to control xerostomia. MATERIAL AND METHODS: 30 subjects aged between 65 and 95 years (14 males, 16 females) completed the OHIP questionnaire to determine quality of life. For oral status, the number of remaining teeth according to WHO criteria and xerostomia using the xerostomia index (XI) were studied. In cases of dry mouth sensation, the measures to alleviate it were asked. RESULTS: The average quality of life according to the OHIP rate is 19.23 (Dt = 10.58), being 56 the worst quality of life. The Pearson correlation coefficient indicates that quality of life is not related to the number of remaining teeth (r = -0.046; p = 0.810) nor the number of ingested drugs (r = 0.226; p = 0.23) but a greater sensation of dry mouth is related to a poorer quality of life (r = 0.678; p = 0.230). There is no association between the number of ingested drugs and the xerostomia index (r = 0.144; p = 0.447). The most frequently measures used against dry mouth were drinking water (21 subjects) and sugarless candies (15 subjects). CONCLUSIONS: Quality of life is not related to the number of remaining teeth nor the number of ingested drugs. However, a higher level of xerostomia was significantly associated with a poorer quality of life. There is no association between the number of drugs ingested and xerostomia index. Sugarless candies and drinking water are the more frequently used measures to alleviate dry mouth. Key words:Quality of life, oral health, elderly.

Enfermedades periimplantarias III: tratamiento / Peri-implant diseases III: treatment

La rehabilitación oral mediante implantes dentales es una opción altamente predecible con una alta tasa de éxito. Sin embargo, las enfermedades que afectan a los tejidos que rodean al implante, como la mucositis periimplantaria y la periimplantitis pueden dar lugar a la pérdida del mismo. Por esta razón es de especial importancia la organización de un programa de citas en los que se debe analizar los signos indicativos de enfermedad periimplantaria, además de realizar técnicas de prevención y eliminación de los factores de riesgo. Existen numerosas estrategias de tratamiento frente a las enfermedades periimplantarias. La mucositis periimplantaria puede ser manejada de forma conservadora, similar al tratamiento de la gingivitis. El tratamiento de la periimplantitis puede ser conservador, mediante terapia mecánica apoyada por terapia química o laser. En casos avanzados, la terapia debe ser quirúrgica. Dependiendo de diversos factores como la configuración del defecto óseo, puede seleccionarse técnicas quirúrgicas resectivas, para la eliminación del tejido enfermo y favorecer la higiene oral o pueden realizarse técnicas de regeneración ósea (AU)

Dental implants are a predictable treatment option with high success rate in oral rehabilitation. However, those diseases affecting tissues around the implants, like periimplant mucositis or peri-implantitis, could cause their loss. Therefore, it is esential to establish scheduled check-ups, in order to analyse any signs related to preiimplant disease and to carry out risk factor elimination and prevention techniques. There are several treatment strategies for periimplant diseases. Periimplant mucositis may be treated in a conservative way, similar to gingivitis treatment. Periimplantitis treatment can also be conservative, using a mechanic therapy based on chemical or laser therapy. In advanced cases, therapy must be surgical. Depending on several factors, such as bone defect configuration, resective surgical techniques may be used to eliminate the granulation tissue and to favour oral hygine. Bone regeneration techniques may also be used (AU)

Dabigatran: A new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature

BACKGROUND: Dabigatran is a newly commercialized drug that is replacing other anticoagulants in the prevention of venous thromboembolism, stroke and systemic arterial valve embolism. It acts directly on thrombin presenting in a dynamic and predictable way, which does not require monitoring these patients. Therefore, we consider the need to assess whether their use increases the risk of bleeding involved before any dental treatment. MATERIAL AND METHODS: We performed a systematic review with a bibliographic search in PubMed/Medline along with the Cochrane Library. We excluded articles dealing with all anticoagulants other than dabigatran, and works about surgical treatments in anatomical locations other than the oral cavity. RESULTS: We included a total of 13 papers of which 1 was a randomized clinical trial, 9 narrative literature reviews, 1 case series, 2 clinical cases and 1 expert opinion. Because we did not obtain any properly designed clinical trials, we were unable to conduct a meta-analysis. CONCLUSIONS: Currently, there is no consensus on the procedure to be followed in patients taking dabigatran. However, all authors agree to treat each case individually in accordance to the risk of embolism, postoperative bleeding and renal function. Also, it is necessary to perform minimally invasive interventions, and take the appropriate local anti-hemolytic measures

Enfermedades Periimplantarias I: Definición Y Etiopatogenia / Peri-implant diseases I: definition and etiopathogenesis

El éxito del tratamiento con implantes dentales como método para reemplazar dientes perdidos se ha convertido en un método predecible. Sin embargo, es cada vez mayor el número de éstos que sufren enfermedades periimplantarias. Estas enfermedades ocurren por la falta de equilibrio entre la respuesta del individuo y la carga bacteriana, sobre todo flora anaerobia gram-negativa. Los tratamientos actuales carecen de eficacia. Es por tanto fundamental conocer la etiopatogenia de dicha entidad para prevenir su formación. Actualmente se conocen diferentes factores etiológicos relacionados con la aparición de periimplantitis y mucositis periimplantaria, como la infección bacteriana, la sobrecarga oclusal, el tabaco, la mala higiene oral, la historia previa de enfermedad periodontal, la diabetes y otras enfermedades sistémicas (AU)

Treatment success with dental implants as a way to replace missing teeth has become a predictable method. However, it is increasing the number of dental implants suffering from peri-implant diseases. These diseases are described as the result of an imbalance between host response and bacterial load, especially gram-negative anaerobic flora. Current treatments are ineffective. It is therefore essential to understand the pathogenesis of this entity to prevent its formation. Currently several risk factors related to the occurrence of peri-implantitis and peri-implant mucositis, as bacterial infection, occlusal overload, smoking habit, poor oral hygiene, previous history of periodontal disease, diabetes and other systemic diseases are known (AU)

Enfermedades Periimplantarias II: diagnóstico / Peri-implant diseases II: diagnosis

La utilización de implantes dentales como método para reemplazar dientes perdidos ha demostrado ser un tratamiento con una alta tasa de éxito. No obstante, el número de implantes que se colocan continua incrementándose y con ello también la prevalencia de enfermedades periimplantarias como son la mucositis periimplantaria y la periimplantitis, lo que puede dar lugar a un fracaso de los implantes. La capacidad del clínico para detectar y diagnosticar estas enfermedades periimplantarias son fundamentales para saber cuándo es necesario el tratamiento. Para ello existen diferentes métodos diagnósticos disponibles como la movilidad del implante, la profundidad de sondaje, el sangrado al sondaje o la evaluación radiográfica. Fundamentalmente se identificará clínicamente la mucositis periimplantaria con el sangrado al sondaje junto con la ausencia de reabsorción ósea y la periimplantitis con una profundidad de sondaje profunda acompañada siempre de pérdida ósea marginal (AU)

The use of dental implants as a way to replace missing teeth is proven to be a treatment with a high success rate. However, the number of implants placed continues to increase as well as the prevalence of peri-implant diseases such as peri-implant mucositis and peri-implantitis, which can lead to implant failure. The ability of the clinicians to detect and diagnose these peri-implant diseases is essential to know when the treatment is necessary. There are several diagnostic methods available as implant mobility, probing depth, bleeding on probing and radiographic evaluation. Basically, peri-implant mucositis can be identified with bleeding on probing with no bone resorption and periimplantitis with a deep probing depth always accompanied by marginal bone loss (AU)

Sinusitis maxilar secundaria al tratamiento con implantes cigomáticos / Maxillary sinusitis due to treatment with zygomatic implants

El uso de implantes cigomáticos en la rehabilitación de pacientes con atrofia maxilar severa es una alternativa más de tratamiento a tener en cuenta. A pesar de ser una técnica predecible, consolidada y ampliamente documentada por numerosos estudios y profesionales, no está exenta de complicaciones. El objetivo de esta revisión es evaluar la prevalencia y causas de sinusitis maxilar secundaria al tratamiento con implantes cigomáticos. Se ha observado que la sinusitis es la complicación postquirúrgica más frecuente asociada a esta técnica. Sin embargo, se da en un pequeño porcentaje de pacientes, lo que corrobora el éxito del tratamiento con implantes cigomáticos. La aparición de sinusitis se relaciona con la técnica original intrasinusal. Para evitarla, han aparecido técnicas como la colocación extrasinusal de los implantes o la utilización de técnicas quirúrgicas combinadas como la elevación de seno simultánea a la colocación del implante o la utilización de la bola adiposa de Bichat (AU)

The use of zygomatic implants in the prosthetic rehabilitation of the patient with severe maxillary bone atrophy is a therapeutic alternative to consider. In spite of being a technique which is considered predictable, consolidated and widely documented by numerous studies and professionals, it is not exempt from complications. The main objective of this review is to evaluate the prevalence and causes of maxillary sinusitis associated with the use of zygomatic implants. It has been reported that maxillary sinusitis is the most frequent surgical complication linked to this technique. However, it appears in a few number of patients, fact that supports the high success rates of the use of zygomatic implants. Sinusitis has been related to the original intrasinusal technique. To avoid this complication, some techniques such as the extramaxillary approach, the combination with sinus graft or the use of buccal fat pad have been developed (AU)