Principles of dental care of transplanted patients / Transzplantált betegek fogorvosi-szájsebészeti ellátásának alapelvei.

INTRODUCTION: The number of organ transplants is being on the rise. State-of-the-art immunosuppressive therapies and modern peri- and postoperative care have significantly increased life expectancy of transplanted patients, therefore, dentists and oral surgeons may encounter these patients more frequently. Although the number of successful transplants in Hungary has recently exceeded ten thousand; there is still no dental treatment protocol for these patients. AIM: The authors aimed to review and analyse the international literature about the perioperative dental care of transplanted patients based on good practice and evidence-based care protocols. MATERIAL AND METHOD: A review and comparative analysis of the English and Hungarian literature between 2010 and 2019 was conducted in relation to the objective pursued. RESULTS: The number of scientific papers in this topic is limited and their level of evidence is low. In our paper, the risk factors of transplantation and the cornerstones of perioperative, early and late postoperative dental management are described. Organ-specific considerations and possible oral manifestations of the applied medications are also presented. CONCLUSION: Lifelong administered immunosuppressive medications and the resulting artificially weakened immune system require increased attention from dentists and other healthcare professionals during patient aftercare. Close cooperation between the treating physician/surgeon and the dentist is essential to maintain patient safety. Moreover, inflammatory disorders may put the patients at increased risk, so maintaining good oral hygiene is essential. Regular dental check-ups, early detection and adequate therapy can be the cornerstones of long-term uncomplicated survival. Orv Hetil. 2020; 161(36): 1506-1513.

Six cases of Solobacterium moorei isolated alone or in mixed culture in Hungary and comparison with previously published cases.

Solobacterium moorei is a strict anaerobic gram-positive rod. It is found in the human microbiota in different parts of the body, but it also appears to be an opportunistic pathogen in some infectious processes. We describe six cases of severe infections identified in 2016 in which S. moorei was isolated alone or in mixed culture involving other anaerobes or both aerobic and anaerobic bacteria. Three cases were associated with the oral cavity, including a middle ear infection, a wound infection after total laryngectomy, and a mandibular abscess as a result of bisphosphonate therapy. In the other three patients, the sites of infection had no connections with the oral cavity and included chronic osteomyelitis of the tibia, a superinfection of cutaneous tuberculosis associated with hidradenitis suppurativa, and the isolation of S. moorei from the blood culture of a cachectic man with several comorbidities. Based on our findings, S. moorei does not appear to be that virulent of a bacterium; except for the case with bacteraemia, S. moorei was recovered as a co-pathogen in patients with several immunosuppressive predisposing factors. We highlight the finding that the routine use of MALDI-TOF MS in microbiology laboratories can in a timely and detailed manner identify members of mixed infections involving different anaerobic bacteria that may be rare and difficult-to-culture and identify species, such as S. moorei.

Essential new informations for the clinical recognition of COVID-19 infection and the prevention possibilities of healthcare personnel working in the head and neck region / [A COVID­19-vírusfertozés klinikai felismerését szolgáló új információk és a fej-nyaki régióban dolgozó egészségügyi személyzet védekezésének lehetoségei]

The coronavirus (COVID-19) pandemic probably started in China in 2019 and is influencing the whole healthcare system worldwide. As several healthcare interventions are essential even during pandemics, it is necessary for professionals working in such fields to get up-to-date information about the virus and its aspects that can influence patient care and suggested actions. The current article is a literature review, in which the authors elaborated the recently available scientific articles with their relevancy for clinical interventions as primary factor. The processed articles emphasize that during interventions in the head and neck region, especially when using rotating instruments, it is of utmost importance for all personnel being present at the time of intervention to wear full protection, including disposable medical uniforms, glasses and special masks. These single-use items have to be changed after each intervention and the whole team has to be educated for this process in advance. In order to avoid cross-contamination and infection of personnel during intervention, it is essential to keep all work-safety and infection-control precautions extremely strictly. Orv Hetil. 2020; 161(17): 660­666.

[Current evidence-based approaches and international guidelines in primary and secondary prevention strategies of medication-related osteonecrosis of the jaws]. / Aktualitások a gyógyszer okozta állcsontelhalás primer és szekunder prevenciójának stratégiájában az evidenciák és a nemzetközi ajánlások tükrében.

Introduction: The presumably multifactorial pathomechanisms of medication-related osteonecrosis of the jaws have not been fully elucidated so far. Management of this rare but serious side effect is a real challenge and requires a multidisciplinary approach. Aim: The aim of the authors was to take stock of our present knowledge about the pathogenesis, risk factors, clinical manifestations and the possibilities of prevention and treatment in the medication-related osteonecrosis of the jaws. In addition, the available international guidelines are compared and the evidence-based, stage-specific conservative and adjuvant therapeutic approaches are also reviewed, having regard to special aspects of medical and dental care. Method: In the last 5 years - due to the increasing number of disorder-oriented database - the number of available systematic reviews, recommendations and meta-analyses has escalated significantly which we reviewed and compared. Results: Since the last Position Paper published by the taskforce of the American Association of Oral and Maxillofacial Surgeons, novel pharmacological groups with the potential to induce osteonecrosis have come in the clinical scope, further elaborating the nomenclature of the disease and further specifying patient groups. The sphere of patients at risk has broadened and novel patient groups (rheumatologic-osteological, immunosuppressed, transplanted or oncological patients treated with monoclonal antibody, known as 'target therapy') are expected to develop this serious side effect. Conclusion: Although a number of issues are still open regarding the treatment of the disorder, evidence-based, individualized, stage-adapted therapeutic approaches have replaced the previous empirical treatment. Orv Hetil. 2020; 161(6): 214-223.

Cloud-Based Multicenter Data Collection and Epidemiologic Analysis of Bisphosphonate-Related Osteonecrosis of the Jaws in a Central European Population.

Objective: Bisphosphonate-related osteonecrosis of the jaws is considered to be a rare but severe complication of bisphosphonate therapy. To understand this condition better, data collection is essential. Although the number of scientific papers about this subject is large, to date only a few multicenter reports have been published. Study design: We present a novel cloud-based data collection system for the evaluation of the risk factors of bisphosphonate-related osteonecrosis of the jaws. Web-based questionnaire and database have been set up and made available to voluntary researchers and clinicians in oral and maxillofacial surgery in Hungary and Slovakia. Results: To date, fifteen colleagues from eight maxillofacial units have joined the study. Data of 180 patients have been recorded. Collected data were statistically analysed and evaluated from an epidemiological point of view. Conclusions: Authors consider cloud-based multicenter data collection a useful tool that allows for real-time collaboration between users, facilitates fast data entry and analysis, and thus considerably contributes to widening our knowledge of bisphosphonate-related osteonecrosis of the jaws.

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report.

BACKGROUND: The surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome. CASE PRESENTATION: In this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence. CONCLUSIONS: It is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.

[Current approaches for early detection and treatment of medication-related osteonecrosis of jaw]. / Aktuális trendek a gyógyszer indukálta állcsontnecrosis korai felismerése és kezelési stratégiája terén.

Owing to the increased life expectancy, the incidence of rheumatoid disorders and oncologic cases with bone metastasis has dramatically increased. Despite the beneficial effects of the applied antiresorptive and antiangiogenic drugs (e.g. bisphosphonates), serious side effects such as jaw osteonecrosis may also develop. The aim of the authors was to summarize present knowledge about the possibilities of prevention and treatment in medication-related osteonecrosis of the jaw. Based on literature data, currently used detection methods for medication-related osteonecrosis of the jaw (including their advantages and limitations) are summarized. In addition, novel trends of surgical and adjuvant therapeutic approaches are also reviewed. The authors conclude that possibilities of prevention and efficacy of therapeutic interventions in this disorder are still limited possibly due to an incomplete knowledge of the underlying pathomechanism. An interdisciplinary cooperation for prevention and attentive monitoring in order to decrease the incidence of iatrogenic oral and maxillofacial complications seems to be particularly important.