Alteraciones odonto-estomatológicas en el niño con síndrome de Down / Odonto-stomatology alterations in the child with Down’s syndrome

Las personas con síndrome de Down presentan una variedad de complicaciones médicas y de características odontoestomatológicas específicas. Muchas de estas características pueden tener relación directa con la salud oral y con la calidad de vida del niño afectado. El objetivo de este artículo es revisar las manifestaciones orales, dentales y oclusales más frecuentes del niño con síndrome de Down, así como la relación de estas con la patología bucodental más frecuente. En este grupo de pacientes se ha descrito una menor prevalencia de lesiones de caries dental y una mayor frecuencia de enfermedades del periodonto con especial referencia a la enfermedad periodontal que tiene un inicio más precoz y un carácter agresivo (AU)

Persons with Down’s syndrome have a variety of medical complications and specific odonto-stomatology characteristics. Many of these characteristics may have a direct relation with oral health and the quality of life of the affected child. This article has aimed to review the most frequent oral, dental and occlusal manifestations found in the child with Down’s syndrome and their relation with the most frequent buccodental conditions. A lower prevalence of cavities and greater frequency of periodontal disease has been described in this group of patient, special emphasis being placed on the periodontal disease who onset is earlier and has an aggressive character (AU)

Buccodental pathology in patients with insulin-dependent diabetes mellitus: a clinical study.

OBJECTIVE: A study is made to determine whether patients with type 1 (insulin-dependent) diabetes mellitus (IDDM) suffer oral complications attributable to the disease, or whether some disorder of the oral cavity can be regarded as pathognomonic of diabetes. MATERIAL AND METHODS: Thirty juvenile diabetics and 30 healthy individuals were evaluated for dental caries and oral mucosal lesions, with the performance of basal and stimulated sialometry in all cases, to assess possible alterations in salivary flow. In addition, an study of periodontal variables was made such as the presence of bacterial plaque, gingival status and attachment losses. RESULTS AND CONCLUSIONS: The diabetics were found to have significantly greater periodontal attachment loss, even though oral hygiene was significantly better among these patients. There were no differences between the two groups in terms of the number of caries, the presence of mucosal lesions or salivary flow.

Estudio clínico sobre la patología bucodentaria en el paciente diabético tipo 1 / Buccodental pathology in patients with insulin-dependent diabetes mellitus: a clinical study

Objetivo: Comprobar si los pacientes diabéticos insulino-dependientes presentaban complicaciones a nivel bucal debidas a su enfermedad o si existía alguna patología patognomónica de la diabetes mellitus en la cavidad oral. Material y métodos: Se realizó una exploración de 30 individuos diabéticos juveniles (DM 1) y 30 individuos sanos en el que se consignó la existencia de caries dental y la posible existencia de lesiones en la mucosa oral, se realizó una sialometría basal y estimulada en la totalidad de los pacientes para estudiar posibles alteraciones en el flujo salival, y se realizó un estudio de variablesperiodontales tales como la presencia de placa bacteriana, estudio de las condiciones gingivales y de la pérdida de inserción. Resultados y conclusiones: Los diabéticos tenían una mayor pérdida de inserción en su periodonto, siendo esta diferencia significativa. Este hecho ocurría incluso cuando las condiciones de higiene oral eran significativamente mejores para el grupo diabético. No había diferencias en el número de caries encontradas, en la presencia de lesiones en la mucosa o en la tasa de flujo salival (AU)

A comparative study between INR and the determination of prothrombin time with the Coaguchek(r) portable coagulometer in the dental treatment of anticoagulated patients.

OBJECTIVE: To assess the usefulness of the Coaguchek(r) portable coagulometer for determining the International Normalized Ratio (INR) in dental practice. STUDY DESIGN: A total of 139 INR determinations were made in 88 patients anticoagulated with acenocoumarol (Sintrom(r)) for thrombotic pathology, based on the habitual laboratory procedure (Sample 1). Posteriorly and prior to dental treatment, INR was again determined using the Coaguchek(r) portable device (Sample 2). Both determinations were subsequently compared to evaluate possible significant differences between them, applying the Student t-test for paired data and regression measures. RESULTS: The mean INR in Sample 1 was not significantly different to that recorded with the Coaguchek(r) portable device (Sample 2) (2,31 0,81 versus 2,28 0,82, respectively, t= 0,98; p= 0,32). A statistically significant relation was observed between the two samples (R= 0,92; p< 0,01). CONCLUSIONS: The Coaguchek(r) portable coagulometer is a valid instrument for determining INR in anticoagulated individuals, and constitutes an effective method in application to the outpatient dental treatment of such patients.

Recurrent infection of a complex odontoma following eruption in the mouth.

Odontomas are the most common odontogenic tumors, and are classified as either compound or complex lesions. Although its underlying etiology remains unclear, a number of factors appear to be involved (e.g., prior trauma). The lesions are generally diagnosed in the second decade of life, often in the context of routine dental X-ray examinations. A complex odontoma is described in a 22-year-old woman referring discomfort due to overinfection following its aperture into the oral cavity in the distal alveolar region of 2.6. Initial treatment consisted of antibiotics and antiinflammatory drugs. Computed axial tomography revealed a solid, irregular mass in the distal zone of the left maxilla, imprinting upon the region of the maxillary sinus on the same side. Surgical resection was performed, raising the alveolar mucosa and upper left vestibular fundus. The surgical piece contained the amorphous adenoma mass and the tooth 2.7.

Hereditary epidermolysis bullosa. Dental management of three cases.

Hereditary epidermolysis bullosa (EB) is a mucocutaneous disorder characterized by the appearance of blisters and vesicles in response to minimum friction. The digestive mucosa is one of the most frequently affected regions--including the oral mucosa. Three types of EB have been established according to the histological level of the lesion. Thus, simple EB involves intraepidermal bullae that leave no scars, while junctional EB exhibit blisters between the lamina lucida and lamina densa of the basal membrane. These lesions heal leaving atrophy and involve important hypoplastic lesions in the dental enamel. In turn, dystrophic EB presents synechiae-forming subepidermal blisters--the recessive form being the variant involving the greatest oral lesions (microstomia, ankyloglossia, milium cysts and rampant caries). Three cases of EB are presented and their clinical-dental management difficulties are described. The oral manifestations are described, along with the dental treatments provided and the evolution of the periodontal indices over a two-year period following the application of hygiene-preventive and therapeutic measures.

Oral lichen planus. An evolutive clinical and histological study of 45 patients followed up on for five years.

A study is made of 45 patients clinically and histologically diagnosed of oral lichen planus, and followed up on for 5 years. The course of the disease was monitored after three months and one, two and five years. The patients were classified in terms of lesion evolution (healed, improved, stationary or worse). Two evolutive groups were established for statistical purposes: (a) favorable (healed or improved lesions) and unfavorable cases (stationary or worsened oral lesions); and (b) healed and non-healed cases. Statistical correlations were established between these evolutive groups and different clinical and histological parameters, in an attempt to identify parameters of predictive value in the course of the disease. No statistically significant results were obtained, with the exception of inflammatory infiltrate. Thus, the depth of this infiltrate was found to be greater in patients with an unfavorable evolution (p = 0.02) than in those with a favorable course. Likewise, the inflammatory infiltrate was greater in non-healed than in healed cases.

[Sjögren's syndrome]. / El sindrome de Sjögren.

We carry out an updated review of Sjögren's syndrome on occasion of the presentation of three new clinical cases whose oral manifestations led the patients to first seek help. Each patient was subjected to clinical exploration, together with complementary evaluations, aimed at establishing an early and precise diagnosis of the syndrome. We consider it important to adopt a series of standardized diagnostic criteria and revise treatment to maintain the orodental conditions as favorable as possible.

[Sialoadenosis of the parotid glands: diagnostic considerations]. / Sialoadenosis de las glándulas parótidas: consideraciones diagnósticas.

We present 3 cases of Sialoadenosis of the parotid glands, one male and two females, who presented associated systemic pathology (liver cirrhosis and diabetes mellitus), detected following clinically suspect syaloadenosis (the patients were unaware of their systemic disease). In all three cases definitive diagnosis was established by needle aspiration of the gland. Which revealed great acinar dilatation. Finally, differential diagnosis was established between sialoadenosis and those conditions with clinical presentations similar to those described for sialoadenosis.

[Clinico-pathological study of oral mucoceles]. / Estudio clínico-patológico de los mucoceles de la cavidad oral.

We present a clinical and histopathological study of 25 mucoceles of the oral cavity. Incidence was found to be greatest between age 10 and 20 (12 cases), with no significant differences in terms of sex. The lower lip was most frequently affected (17 cases), other locations being much less common. In 72% of cases there were etiological antecedents of traumatism. Mucocele size varied from 3 to 13 mm. although a great many of them were between 10 and 13 mm. Evolution period was 1-16 months, incidence being highest between 1 and 4 months. Finally, histology showed 95% to be due extravasation, the remaining 5% being the result of retention. Among the extravasation mucoceles, 11.7% were in the initial phase, another 11.7% in the reabsorption stage, and 76.4% in the final phase.

[Xerostomia]. / La xerostomía.

A great many conditions may lead to dry mouth; indeed, xerostomy is a very frequent clinical finding that occasionally does not receive the attention deserved. A review of this condition is carried out, providing a practical perspective for the general stomatologist regarding the physiopatological mechanisms involved, the clinical manifestations, diagnostic procedures and current therapeutic approaches.

[Facial pain of cardiac origin]. / Douleur faciale d'origine cardiaque.

Two cases of anginal pain limited to the mandible with secondary radiation of the pain to the neck and clavicular region are presented. Although the pain was initially diagnosed as odontogenic in origin, further historial workup suggest the suspicion of referred pain from coronary insufficiency. Appropriate medical referral confirmed diagnostic suspicions. Important aspects involved with differential diagnosis of referred anginal pain are also discussed.