Medication-related osteonecrosis of the jaw: evolving research for multimodality medical management.

PURPOSE: Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating side effect of antiresorptive and antiangiogenic agents that can lead to progressive bone destruction in the maxillofacial region. Dental surgery, including tooth extractions, commonly trigger the onset of MRONJ. While guidelines suggest avoiding extraction when possible, complete avoidance is not always feasible, as necrosis can develop from dental and periodontal disease without dental procedures. The goal of this article is to provide an update review of current preventive and therapeutic approaches for MRONJ. METHODS: A comprehensive electronic search was conducted on PubMed/MEDLINE, Embase, and Scopus databases. All English articles encompassing randomized controlled trials, systematic reviews, observational studies, and case studies were reviewed. The current medical treatments and adjuvant therapies for managing MRONJ patients were critically assessed and summarized. RESULTS: Pentoxifylline and alpha tocopherol (PENT-E), teriparatide, photobiomodulation (PBM), photodynamic therapy (PDT), and the use of growth factors have shown to enhance healing in MRONJ patients. Implementing these methods alone or in conjunction with surgical treatment has been linked to reduced discomfort and improved wound healing and increased new bone formation. DISCUSSION: While several adjuvant treatment modalities exhibit promising results in facilitating the healing process, current clinical practice guidelines predominantly recommend antibiotic therapy as a non-surgical approach, primarily addressing secondary infections in necrotic areas. However, this mainly addresses the potential infectious complication of MRONJ. Medical approaches including PENT-E, teriparatide, PBM, and PDT can result in successful management and should be considered prior to taking a surgical approach. Combined medical management for both preventing and managing MRONJ holds potential for achieving optimal clinical outcomes and avoiding surgical intervention, requiring further validation through larger studies and controlled trials.

The Contribution of Insomnia and Obstructive Sleep Apnea on the Transition from Acute to Chronic Painful Temporomandibular Disorders and their Persistence: A Prospective 3-Month Cohort Study.

Background: Insomnia, and Excessive Daytime Sleepiness (EDS), a surrogate marker of Obstructive Sleep Apnea (OSA), are common sleep-related conditions among painful temporomandibular disorders (TMD) patients. OSA was found to increase the risk of chronic painful TMD. Aims: This prospective cohort study aims to determine the contribution of insomnia and EDS on acute to chronic painful TMD transition as well as its persistence when chronic pain is defined by: (i) duration (> 3 months), and (ii) dysfunction (Graded Chronic Pain Scale [GCPS II-IV]). Methods: From 456 patients recruited between 2015 to 2021, through four locations in Canada, 378 completed the follow-up. A diagnosis was obtained using the Research Diagnostic Criteria or the Diagnostic Criteria for TMD. Insomnia was assessed with the Insomnia Severity Scale (ISS), and OSA was assessed using the Epworth Sleepiness Scale (ESS) which measures EDS, both at baseline. Patients completed the GCPS form at baseline and 3-month follow-up. Results: Borderline associations were found between EDS and the transition or persistence of chronic painful TMD when chronic pain was defined by pain duration (RR adjusted_duration = 1.11, P = 0.07) and dysfunction (RRadjusted_dysfunction =1.40, P = 0.051). Furthermore, EDS was specifically associated with persistent painful TMD when chronic pain was defined by pain duration (RR = 1.13, 95%CI: 1.00-1.26, P = 0.04). Insomnia was not related to the study outcomes (RRadjusted_duration = 0.94, P = 0.27, RRadjusted_dysfunction =1.00, P = 0.99). Conclusion: Results indicate that EDS contrary to insomnia predicted the persistence of chronic painful TMD at a 3-month follow-up.

Contexte: L'insomnie et la somnolence excessive en journée, un marqueur substitut de l'apnée du sommeil obstructive, sont des affections courantes liées au sommeil chez les patients souffrant de troubles temporo-mandibulaires douloureux. On a découvert que l'apnée obstructive du sommeil augmentait le risque de troubles temporo-mandibulaires douloureux chroniques.Objectifs: Cette étude de cohorte prospective vise à déterminer la contribution de l'insomnie et de la somnolence excessive en journée à la transition des troubles temporo-mandibulaires douloureux aigus à chroniques, ainsi qu'à leur persistance lorsque la douleur chronique est définie par : (i) la durée (> 3 mois), et (ii) la dysfonction (Échelle de douleur chronique graduée [GCPS II-IV]).Méthodes: Sur 456 patients recrutés entre 2015 et 2021 dans quatre endroits au Canada, 378 ont terminé le suivi. Un diagnostic a été établi en utilisant les Critères de diagnostic pour la recherche ou les Critères de diagnostic pour les troubles temporo-mandibulaires douloureux. L'insomnie a été évaluée à l'aide de l'Indice de sévérité de l'insomnie (ISI) et l'apnée obstructive du sommeil a été évaluée à l'aide de l'Échelle de somnolence d'Epworth (ESS), qui mesure la somnolence excessive en journée, tous deux au début de l'étude. Les patients ont rempli le formulaire GCPS au début de l'étude et lors du suivi à trois mois.Résultats: Des associations marginales ont été trouvées entre la somnolence excessive en journée et la transition ou la persistance des troubles temporo-mandibulaires douloureux chroniques lorsque la douleur chronique était définie par la durée de la douleur (RR ajusté pour la durée = 1,11, P = 0,07) et la dysfonction (RR ajusté pour la dysfonction = 1,40, P = 0,051). De plus, la somnolence excessive en journée était spécifiquement associée à la persistance des troubles temporo-mandibulaires douloureux lorsque la douleur chronique était définie par la durée de la douleur (RR = 1,13, IC à 95 % : 1,00-1,26, P = 0,04). L'insomnie n'était pas liée aux résultats de l'étude (RR ajusté pour la durée = 0,94, P = 0,27, RR ajusté pour la dysfonction = 1,00, P = 0,99).Conclusion: Les résultats indiquent que la somnolence excessive en journée, contrairement à l'insomnie, prédisait la persistance des troubles temporo-mandibulaires douloureux chroniques lors du suivi de trois mois.

A Rare Case of Lipomatous Variant Mammary-Type Myofibroblastoma of the Lateral Tongue.

Mammary-type myofibroblastoma (MTMF) is an unusual and rare benign tumor that typically presents in older men or post-menopausal females. A 53-year-old female presented with a 6-month history of an asymptomatic pink/white submucosal nodule involving the left lateral tongue. Clinical examination showed a 5 mm × 5 mm × 5 mm firm submucosal nodule with intact overlying mucosa. Differential diagnoses focused on benign nodular connective tissue tumors. An excisional biopsy was performed and submitted for histopathological examination. The patient underwent conservative local excision. Histopathology and immunocytochemistry revealed a lipomatous variant of MTMF. Hematoxylin and eosin sections revealed an unencapsulated soft tissue lesion with a lobular growth pattern. The neoplasm was biphasic, comprising adipose tissue and cellular fibrous components. By immunohistochemistry, tumor cells were positive for desmin, estrogen receptor, and CD34. In summary, we presented an unusual case of a lipomatous variant of myofibroblastoma on the tongue. MTMF rarely occurs in the head and neck and its accurate diagnosis necessitates awareness of its histomorphological spectrum and application of appropriate immunohistochemical stains.

Patient Characteristics Associated with the Development of Oral Lichen Planus in Two Provinces in Canada.

OBJECTIVES: To understand the risk factors that may be associated with the development of oral lichen planus (OLP) and its progression. STUDY DESIGN: We conducted retrospective chart reviews of adult patients with OLP who presented to oral medicine and oral pathology clinics in 2 provinces between September 2016 and January 2020. Data regarding age, sex, disease duration, sites of involvement, comorbidities, medications, allergies, smoking, alcohol use, treatment and follow up were collected. Descriptive statistics were assessed. RESULTS: Among the 94 patients with OLP, mean age was 62 years and most were female (73%). Mean disease duration was 3.1 years. Hypertension, thyroid disorders and diabetes were present in 32%, 28% and 17% of patients, respectively. A significant proportion of patients reported a major surgical procedure (47%) as a preceding event and an additional 7% reported a preceding stressful life event. Three OLP patients (3%) developed squamous cell carcinoma or dysplasia. The mean disease duration for these patients was 4.06 years and the frequency of biopsy in our study was approximately 14%. CONCLUSIONS: Female sex, endocrine and immunological comorbidities, such as thyroid disease and diabetes, and psychological stress may play a role in the development of OLP in the Canadian population. A small percentage of patients may develop malignant transformation and, thus, require long-term monitoring.

The contribution of pain and disability on the transition from acute to chronic pain-related TMD: A 3-month prospective cohort study.

Although most cases of pain-related temporomandibular disorders (TMD) are mild and self-limiting, about 10% of TMD patients develop severe disorders associated with chronic pain and disability. It has been suggested that pain intensity contributes to the transition from acute to chronic pain-related TMD. Therefore, the aims of this current prospective cohort study were to assess if pain intensity, pain always being present, pain or stiffness on awakening, jaw activities, and interference, were associated with the transition from acute to chronic pain-related TMD at 3 months of follow-up. One hundred and nine participants, recruited from four clinics in Montreal and Ottawa, received examinations and completed the required instruments at baseline and at the 3rd month of follow-up. In a multivariable analysis including sex, age, characteristic pain index (CPI) (OR = 1.03, 95%CI = 1.01-1.06, P = 0.005), moderate to severe average pain intensity (OR = 3.51, 95%CI = 1.24-9.93, P = 0.02), disability points score (OR = 1.29, 95%CI = 1.06-1.57, P = 0.01), interferences (ORs = 1.30-1.32, P = 0.003-0.005), screening score (OR = 1.37, 95%CI = 1.08-1.76, P = 0.01), and pain always present (OR = 2.55, 95%CI = 1.08-6.00, P = 0.03) assessed at first-visit were related to the transition outcome at the 3rd month of follow-up. Further, we found that if 4 patients with acute pain-related TMD on average were exposed to these risk factors at baseline, 1 would have the transition from acute to chronic pain at 3 months of follow-up. Results indicate that these factors are associated with the transition from acute to chronic pain-related TMD, and therefore should be considered as important factors when evaluating and developing treatment plans for patients with pain-related TMD.

Oral pain in the cancer patient.

PURPOSE OF REVIEW: Oral pain is a common complaint in patients with cancer. This review aims to summarize the knowledge on the causes and approach to management of oral pain garnered over the past 2 years. RECENT FINDINGS: A systematic review and meta-analysis included in the review, assessed cannabinoid versus placebo and showed only a small effect on pain, physical function, and sleep quality. Another review showed that chemical neurolysis as an adjunctive therapy, is effective in patients with pain of shorter chronicity and refractory head and neck cancer-related pain. SUMMARY: Patients with cancer frequently experience oral pain because of a variety of factors. Factors inherent in the type and location of the malignancy, the modality of cancer treatment, and a holistic approach to management together contribute to their overall pain experience. Basic oral care should be implemented wherever possible, before, during, and after cancer treatment.

Back and neck pain: A comparison between acute and chronic pain-related Temporomandibular Disorders.

Background: Temporomandibular disorders (TMDs) are common and cause persistent pain. Comorbidities are associated with TMDs and can affect the effectiveness of their treatments. The literature is lacking enough evidence on the difference between acute and chronic pain, particularly in TMDs. Investigating this difference could highlight potential risk factors for the transition from acute to chronic pain-related TMDs. Aim: To compare the likelihood of back and neck pain (BP, NP) between acute and chronic pain-related TMDs (AP-TMD, CP-TMD) as defined by pain duration and pain-related disability. . Methods: Participants with AP-TMDs (≤3 months) and CP-TMDs (>3 months) were recruited according to the diagnostic criteria and research diagnostic criteria of TMD. BP and NP were assessed using a self-reported checklist. CP-TMDs defined by disability (chronic disability) and depression and anxiety symptoms were assessed using validated instruments. Logistic regression analyses were employed. Results: This study enrolled 487 adults with AP-TMD (n = 118) and CP-TMD (n = 369). Relative to AP-TMD, participants with CP-TMD had twice the odds of reporting NP (odds ratio [OR] = 2.17 , 95% CI 1.27-3.71) but not BP (OR = 0.96, 95% CI 0.57-1.64). Participants with chronic disability were twice as likely to report NP (OR = 1.95 , 95% CI 1.20-3.17 ) but not BP (OR = 1.13, 95% CI 0.69-1.82) compared to those without. All analyses were adjusted for age, sex, and anxiety and depression symptoms. Conclusions: Within the limitations of this study, results suggest that central dysregulation or trigeminocervical convergence mechanisms are implicated in the process of pain-related TMD chronification and highlight the relevance of considering disability when defining CP-TMDs.

Contexte : Les troubles temporo-mandibulaires (TTM) sont fréquents et provoquent des douleurs persistantes. Des comorbidités sont associées aux TTM et peuvent affecter l'efficacité de leur traitement. Il n'y a pas suffisamment de données probantes dans la litt\érature sur la différence entre la douleur aiguë et la douleur chronique, en particulier dans les TTM. L'étude de cette différence pourrait mettre en évidence les facteurs de risque potentiels pour la transition des TTM liés à la douleur aiguë aux TTM liés à la douleur chronique.Objectif : Comparer la probabilité de douleur au dos et de douleur cervicale (DD, DC) entre les TTM liés à la douleur aiguë et les TTM liés à la douleur chronique (TTM-DA, TTM-DC), telles que définis par la durée de la douleur et l'incapacité liée à la douleur.Méthodes : Les participants atteints de TTM-DA (≤3 mois) et de TTM-DC (>3 mois) ont été recrutés selon les critères diagnostiques et les critères diagnostiques pour la recherche en matière de TTM. La douleur au dos et la douleur cervicale ont été évaluées à l'aide d'une liste de contrôle autodéclarée. Les TTM-DC définis par l'invalidité (invalidité chronique) et les symptômes de dépression et d'anxiété ont été évalués à l'aide d'instruments validés. Des analyses de régression logistique ont été utilisées.Résultats : Cette étude a inclus 487 adultes atteints de TTM-DA (n = 118) et de TTM-DC (n = 369). Comparativement aux patients atteints de TTM-DA, les participants atteints de TTM-DC étaient deux fois plus susceptibles de déclarer de la douleur cervicale (rapport de cotes [RC] = 2,17, IC à 95 % 1,27-3,71) mais pas de douleur au dos (RC = 0,96, IC à 95 % 0,57-1,64). Les participants ayant une incapacité chronique étaient deux fois plus susceptibles de déclarer de la douleur cervicale (RC = 1,95, IC à 95 % 1,20-3,17), mais pas de douleur au dos (RC = 1,13, IC à 95 % 0,69-1,82) que ceux n'en ayant pas. Toutes les analyses ont été ajustées en fonction de l'âge, du sexe, de l'anxiété et des symptômes de dépression.Conclusions : Dans les limites de cette étude, les résultats indiquent que la dysrégulation centrale ou les mécanismes de convergence trigéminocervicale sont impliqués dans le processus de chronicisation des TTM liés à la douleur et soulignent la pertinence de tenir compte de l'incapacité au moment de définir les TTM-DC.

Retrospective study of factors associated with late detection of oral cancer in alberta: A qualitative study.

Oral cancer continues to be diagnosed in advanced stages, giving patients lower chances of survival. The objective of this study was to explore reasons for delayed diagnosis of oral cancer in Alberta. A retrospective qualitative design was implemented through seven steps suggested for conducting a narrative clinical document. Data was retrieved from the Alberta Cancer Registry database between 2005 and 2017. A sample of initial consultation notes (ICN) of oral and oropharyngeal cancer patients were identified through a purposeful sampling method and added to the study until saturation was achieved. A deductive analysis approach inspired by the model pathways to treatment health care provider (HCP) was employed. From the 34 ICN included in our analysis, five main categories were identified: appraisal interval, help-seeking interval, diagnosis interval, pre-treatment interval, and other contributing factors such as health-related behaviours, system delay, and tumor characteristics. These factors negatively contributed to early detection of oral and oropharyngeal cancers and affect treatment wait time with patients, providers, and the healthcare system. Patient's lack of awareness, provider's oversight and prolonged access to care were the main reasons of delay in cancer diagnosis and management in our study. A sustainable plan for public awareness interventions and implementation of a solid curriculum for medical and dental students is needed to enhance their related knowledge, competence in clinical judgement, and treatment managements.

Oral Care for Hematopoietic Stem Cell Transplantation Patients: A Narrative Review.

PURPOSE: Patients undergoing hematopoietic stem cell transplantation (HSCT) are at high risk of oral complications with the potential of causing significant morbidity and mortality. Dental professionals should play a fundamental role in the prevention and treatment of oral sequelae of HSCT. However, the dental community is not well informed and experienced in providing oral care of the oral complications for HSCT patients. This narrative review attempts to fill the knowledge gap through reviewing the oral complications and current recommendations for oral and dental care for the patient before, during and after HSCT. RESULTS: Oral care in the HSCT process was divided into five stages with the goal being to provide practical guidance for dental care providers to assist in managing these patients. It is well known that the maintenance of good oral health is important in cancer patients, including patients with hematologic malignancies. In addition to negatively impacting quality of life, oral pain and/or infections can cause delays, modification and discontinuation of life-saving cancer treatment. Oral complications can lead to new or extended hospitalization. By providing a preventive and treatment algorithm based on currently available literature reports and expert opinion, we can hope to achieve better patient outcomes. CONCLUSION: We present oral and dental management recommendations with a focus on oral health maintenance, infection prevention, pain control and oral complication management to support oral and general health of this medically complex patient population prior to, during and following HSCT.

Oral and dental health in head and neck cancer survivors.

Therapeutic improvements and epidemiologic changes in head and neck cancer (HNC) over the last three decades have led to increased numbers of survivors, resulting in greater need for continuing management of oral and dental health in this population. Generally, the HNC patient oral health needs are complex, requiring multidisciplinary collaboration among oncologists and dental professionals with special knowledge and training in the field of oral oncology. In this review, we focus on the impact of cancer treatment on oral health, and the oral care protocols recommended prior to, during and after cancer therapy. The management of oral complications such as mucositis, pain, infection, salivary function, taste and dental needs are briefly reviewed. Other complications and their management, including osteonecrosis of the jaw and recurrent/new primary malignancies are also described. This review offers clinical protocols and information for medical providers to assist in understanding oral complications and their management in HNC patients and survivors, and their oral and dental health care needs. Oral and dental care is impacted by the patient's initial oral and dental status, as well as the specific cancer location, type, and its treatment; thus, close communication between the dental professional and the oncology team is required for appropriate therapy.

Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment.

Erythema multiforme (EM) is an acute, immune-mediated disorder affecting the skin and/or mucous membranes, including the oral cavity. Target or iris lesions distributed symmetrically on the extremities and trunk characterize the condition. Infections are the most common cause of EM and the most frequently implicated infectious agent causing clinical disease is the herpes simplex virus. The diagnosis of EM is typically based on the patient's history and clinical findings. Management involves controlling the underlying infection or causative agent, symptom control, and adequate hydration. The epidemiology, pathogenesis, clinical features, diagnosis, and treatment of EM are reviewed in this article.

A conventional microwave oven for denture cleaning: a critical review.

INTRODUCTION: Denture cleaning should be quick and easy to perform, especially in long-term care facilities. The lack of proper oral hygiene can put older adults at higher risk from opportunistic oral infections, particularly fungal. As an alternative to regular brushing, the use of a microwave oven has been suggested for cleaning and disinfecting dentures. OBJECTIVES: To synthesise and discuss the advantages and disadvantages of the use of a conventional microwave oven for cleaning and disinfecting complete dentures. METHODS: A brief literature search focused on papers dealing with microwave therapy for denture cleaning through PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, Ovid MEDLINE(R) In-Process, and Scifinder Scholar. RESULTS: One hundred and sixty-seven manuscripts published in English with full text were found, and 28 were accepted and discussed in the light of the advantages and disadvantages of the use of conventional microwave oven for cleaning and disinfecting complete dentures. CONCLUSIONS: There was no standardisation for microwave use for denture cleaning. Manual cleaning still seemed to be the optimal method for controlling fungal infection and denture stomatitis. However, such a daily routine appeared to be underused, particularly in long-term care facilities.