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.

The use of piezoelectric surgery to lateralize the inferior alveolar nerve with simultaneous implant placement and immediate buccal cortical bone repositioning: a prospective clinical study.

A prospective study was conducted to assess a variation of inferior alveolar nerve (IAN) lateralization. This study included 13 patients. An osteotomy was made with a piezoelectric device, and the IAN bundle was moved buccally. Dental implants were then inserted medial to the nerve bundle, and the inner surface of the buccal cortical bone plate was shaped to reduce its thickness. Finally, the bone plate was repositioned to restore the original shape and contour of the mandible. Neurosensory examinations of the lower lip and chin were performed using three tests: light touch, pain, and two-point discrimination. Three months after surgery, the function of the IAN was judged to be completely restored at 11 of the 13 surgical sites. Differences in the tests comparing the operated and non-operated sides were not significant. No implants were lost, and all patients were satisfied with the result. Although IAN lateralization in conjunction with dental implant placement is rarely indicated, the use of a piezoelectric device to perform a buccal osteotomy with final repositioning of the buccal cortical plate over the bony defect contributes to the recovery of the contour and shape of the mandible, without impairment of IAN function.

Upper aerodigestive tract and lung tumors after liver transplantation.

BACKGROUND: The purpose of this study was to analyze the incidence, clinical characteristics, treatment, and outcome of upper aerodigestive (UAD) and lung de novo tumors after ortothopic liver transplantation (OLT). PATIENTS AND METHODS: Between April 1986 and June 2002, we performed 851 OLT in 753 patients. We excluded pediatric, partial, and hepatorenal transplants and recipients who died within 2 months after OLT. Thus, we analyzed the incidence and outcome of these tumors in 605 patients after OLT. RESULTS: We found 21 (3.5%) tumors in 20 (3.3%) recipients: 14 were UAD tumors (three in floor of the mouth, two in tonsil, one in tongue, one in pharynx, three in larynx, and four in esophagus) and seven were lung tumors. Nineteen patients were men and one was a woman, with a mean age at transplantation of 47.7+/-8.6 years. Mean time from OLT to tumor diagnosis was 61.7+/-35.1 years. As risk factors, 70% were heavy smokers, 75% were heavy drinkers, and 70% developed acute rejection. The incidence of these tumors was significantly higher in transplanted patients for alcoholic cirrhosis compared to the nonalcoholic cirrhosis (8.1% vs 0.8%; P<.0001). After surgical excision in 65% of patients, 1-, 2-, and 3-year patient survival were 47.6%, 37.0%, and 19.7%, respectively. CONCLUSION: There is a significantly higher incidence of these tumors in male heavy drinkers and/or smokers who underwent OLT for alcoholic cirrhosis; in spite of aggressive surgical treatment, the prognosis is poor.

Presence of lichen planus during a course of interferon alpha-2a therapy for a viral chronic C hepatitis.

We present the case of a 66-year-old woman with a diagnosis of chronic active viral C hepatitis, for whom a course of interferon alpha-2A was prescribed at a dose of 4.5 MU per day for a 2 month period, followed by the same dose on alternate days for 4 months. After completion of a month of therapy, the patient presented with painful oral lesions that made normal oral food intake impossible. These lesions persisted, in spite of withdrawal of interferon therapy. Intraoral examination revealed erosive intraoral lesions in both yugal mucosae, the upper vestibular gum, the floor of the mouth, the ventral region of the tongue, and the lower lip. A diagnosis of erosive lichen planus induced by interferon therapy was established. The prescribed treatment was 0.1% triamcinolone acetonide in orabase applied 3 times a day for 4 weeks. Following the therapeutical course, the erosive lesions disappeared, and the symptoms stopped, although the reticular lesions remained visible.

Myxoma of the jaws. Report of three cases.

Odontogenic myxoma is a locally aggressive, uncommon benign tumour which arises from mesenchymal tissues normally present in developing teeth. The most frequent locations of odontogenic myxoma are the posterior regions of the mandible, as well as the condylar region. Since odontogenic myxomas are not associated with any specific clinical or radiological sign, a histopathological examination of the specimen is required for confirmation of the primary diagnosis. We report three cases of myxoma diagnosed during the last 18 years. Two of them were located in atypical regions of the mandible and one was located in the maxilla. Presence of a slow-growing swelling associated with expansion of the bone plates raised suspicion of a tumour in two cases, while in the third patient the myxoma was an incidental finding during radiological examination. Due to the unspecific nature of these lesions, in every case a histopathological examination of the surgical specimen was required for diagnostic confirmation. In one of the three reported cases, we shall underline the need to follow a correct diagnostic work-up of all radiolucent lesions of the jaws, in order to avoid contraindicated therapeutic procedures.

Treatment of xerostomia. A review.

Saliva plays a fundamental role in the maintenance of oral health. Xerostomia is defined as a subjective sensation of oral dryness that usually implies a marked decrease in saliva secretion and may be due to a number of causes. Oral equilibrium is affected as a result, and buccal problems may develop. The present study reviews the different treatment modalities available for the management of xerostomia, destined to stimulate the production of saliva by chewing, administering gustatory substances, prescribing sialogogues such as pilocarpine, or using saliva substitutes or artificial saliva. The adoption of one treatment option or other in turn depends on the cause underlying xerostomia and on the functionality of the salivary glands. The review also evaluates preventive therapeutic measures and addresses the complications that may develop secondary to oral dryness.

Mixoma de los maxilares. A propósito de tres casos / Myxoma of the jaws. Report of three cases

El mixoma odontogénico es un tumor benigno poco frecuente, con agresividad local, que se origina a partir de los tejidos mesenquimales de los dientes en desarrollo. Su localización preferente son las zonas posteriores de la mandíbula, así como el área condilar. Clínica y radiográficamente no muestra signos de especificidad, por lo que en su diagnóstico es necesario el estudio histopatológico del tejido para confirmar la tumoración.Presentamos tres casos de mixomas recogidos en los últimos 18 años, dos localizados en zonas atípicas mandibulares y uno en la maxilar. La presencia de un crecimiento lento, con expansión de la cortical ósea en do permitió s casos permitio sospechar la presencia del tumor, y el tercer caso constituye un hallazgo casual durante la exploración radiográfica. En todas las ocasiones ha sido necesario el estudio histopatológico de la pieza quirúrgica para confirmar el diagnóstico dada la inespecificida de la lesión; en uno de ellos llamamos la atención sobre la necesidad de realizar un correcto protocolo diagnóstico de las lesiones radiotransparentes de los maxilares, a efectos de evitar procedimientos terapéuticos contraindicados (AU)

[Conceptual review of Behçet's syndrome. Diagnostic and therapeutic criteria]. / Revisión conceptual del sindrome de Behçet. Criterios diagnósticos yterapéuticos.

A review of the literature on clinical, diagnostic and therapeutic aspects on Behcet Syndrom is done.

Unusual periodontal findings in an AIDS patient with Burkitt's lymphoma. A case report.

This report deals with a case of AIDS-related Burkitt's lymphoma in which some of the earliest findings were dental and periodontal in nature. The patient presented initially with painless and extremely loose teeth accompanied by progressive paresthesia of the lower jaw. Unique radiographic findings included extensive periodontal ligament space widening and bulbous, granuloma-like lesions about the apices of the teeth. These findings were associated with progressive tumor infiltration of the mandible and do not appear to be related to other reports of aggressive periodontitis associated with impaired immunologic functions in AIDS patients.

[Identification of cell types in periodontal pockets with scanning electron microscopy]. / Identificación de tipos celulares en la bolsa periodontal con microscopio electrónico de barrido.

Sixteen teeth from patients with advanced periodontal disease were processed with the direct fixative technique for observation with a Scanning Electron Microscope in order to test the adequacy of this technique and to observe the components of the tooth wall of the periodontal pocket. Different cell populations are described emphasizing the appearance of intact neutrophils. The results suggest that this fixative method may be an improvement on the conventional techniques for SEM.

[Clinical and clinico-histological markers in chronic destructive adult periodontitis]. / Estudio de marcadores clínicos y clínico-histológico en la periodontitis crónica destructiva del adulto.

This study was designed to evaluate the significance and interrelationship of clinical parameters and their association with histologic changes in advanced destructive periodontitis. 158 patients with PDI greater than 4 (Ramfjord) were selected, evaluating the size, contouring, bleeding, consistency, colour and gingival pain. Epithelial ulceration of soft periodontal pockets were also evaluated. The results showed a statistically significant association between purplish colour and gingival fibrosis and advanced stage of the disease. Gingival bleeding on probing was the most important clinical parameter in advanced phases of the disease, either alone or in association with other parameters such as the presence of epithelial ulcerations. The Periodontal Disease Index (Ramfjord) has proven effective in the evaluation of generalized patterns of disease.