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Pharmacological interactions of vasoconstrictors

  • Gómez Moreno, Gerardo
  • Guardia Muñoz, Javier
  • Cutando Soriano, Antonio
  • Calvo Guirado, José Luis
This article is the first of a series on pharmacological interactions involving medicaments commonly prescribed and/or used in odontology: vasoconstrictors in local anaesthetics and anti-inflammatory and anti-microbial analgesics. The necessity for the odontologist to be aware of adverse reactions as a result of the pharmacological interactions is due to the increase in medicament consumption by the general population. There is a demographic change with greater life expectancy and patients have increased chronic health problems and therefore have increased medicament intake. The presence of adrenaline (epinephrine) and other vasoconstrictors in local odontological anaesthetics is beneficial in relation to the duration and depth of anaesthesia and reduces bleeding and systemic toxicity of the local anaesthetic. However, it might produce pharmacological interactions between the injected vasoconstrictors and the local anaesthetic and adrenergic medicament administered exogenically which the odontologist should be aware of, especially because of the risk of consequent adverse reactions. Therefore the importance of conducting a detailed clinical history of the general state of health and include all medicaments, legal as well as illegal, taken by the patient.

Antibiotic prophylaxis to prevent local infection in Oral Surgery : use or abuse?

  • Sancho Puchades, Manuel
  • Herráez Vilas, José María
  • Berini Aytés, Leonardo
  • Gay Escoda, Cosme
Antibiotics have a well-documented efficacy in the treatment of established infections and as prophylactic agents in medically compromised patients. However, the systematic administration of antibiotics to prevent local infections in fit patients is much more controversial. The aim of this paper is to reflect on the justification for prophylactic usage of antibiotics to prevent wound infection and to reason out the most appropriate antibiotic guidelines taking into account available scientific data and studies by other authors. Numerous clinical trials question the efficacy of antibiotics in preventing wound infection. While some studies establish that antibiotics reduce the incidence of postoperative infections, others compare their efficacy to that of placebo. Thus, scientific literature suggests that every oral surgical intervention is not tributary of systematic antibiotic prophylaxis to prevent local infections. Intrinsic surgical risk factors and the patient?s individual circumstances must be taken into account. Even though the efficacy of other antibiotics cannot be ruled out due to our limited comprehension of the bacteriologic interrelations intervening in the pathogenesis of postextraction local infection, the amoxicillin-clavulanic acid combination theoretically covers the complete odontogenic bacterial spectrum in Spain. When the prophylactic use of antibiotics is indicated, this should be performed preoperatively, at high doses, and its extent should not exceed 24 hours. Special attention should be paid to antiinfectious local measures that can minimize infection risk during the wound?s healing period.

Surgical treatment of temporomandibular joint ankylosis : follow-up of 15 cases and literature review

  • Vasconcelos, Belmiro Cavalcanti
  • Porto, Gabriela Granja
  • Bessa-Nogueira, Ricardo Viana
  • Nascimento, Mirella
Introduction: Ankylosis may be defined as the fusion of the articular surfaces with bony or fibrous tissue. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high incidence of recurrence. Purpose: To report 15 cases treated by either gap arthroplasty, or the articular reconstruction technique using costochondral grafts, coronoid process grafts or alloplastic condylar implants; evaluate the results of these surgeries and make a literature review. Methods: The sample was obtained from the records of the Oswaldo Cruz University Hospital (HUOC-UPE) of patients submitted to ankylosis treatment by alloplastic or autogenous graft between March 2000 and October 2006. Pre- and postoperative assessment included a thorough history and physical examination to determine the cause of ankylosis, the maximal incisal opening, etiology and type of the ankylosis, recurrence rate and presence of facial nerve paralysis. Results: The mean maximal incisal opening in the preoperative period was 8.71 + 6.97 mm and in the postoperative period it was 28.50 + 8.10 mm, the recurrence rate was 20% (n=3), and always occurred in ankylosis type IV. Conclusion: The articular reconstruction with alloplastic or autogenous grafts, or gap arthroplasty for the treatment of ankylosis is shown to be efficient in relation to the post-operative maximal incisal opening, recurrence and articular function.

Chondrosarcoma of the temporomandibular joint : a case report and review of the literature

  • Gallego, Lorena
  • Junquera Gutiérrez, Luis Manuel
  • Fresno Forcelledo, Manuel Florentino
  • Vicente Rodríguez, Juan Carlos de
Chondrosarcoma is a malignant tumor characterized by the formation of cartilage, but not bone, by tumor cells. Only 5% to 10% of chondrosarcomas occur in the head and neck, representing 0.1% of all head and neck neoplasms, with the larynx and the maxillo-nasal region being the most common sites. This report describes an unusual case of chondrosarcoma in a 54-year-old man who presented with pain and swelling in the left preauricular area. Computed tomography demonstrated a soft tissue mass in the left temporomandibular joint without causing erosion of the adjacent bony structures. The tumor was treated by excision in a single block with perilesional tissues, preserving the facial nerve. Histopathologic examination revealed chondrocytes with irregular nuclei with S-100 immunocytochemical staining positive in 30% of the tumor. The diagnosis was a grade I chondrosarcoma. There was no evidence of disease at the 16-month follow-up. The occurrence of chondrosarcoma in the temporomandibular joint (TMJ) is an exceptional event, with only 16 cases described. We report a case of this unusual entity and review the literature.

Validation the Oral Health Impact Profile (OHIP-14sp) for adults in Spain

  • Montero Martín, Javier
  • Bravo Pérez, Manuel
  • Albaladejo Martínez, Alberto
  • Hernández Martín, Luis Antonio
  • Rosel Gallardo, Eva
Objectives: The oral health-related quality of life indicators are increasingly used to measure the impact of oral conditions on quality of life to complement clinical data in cross-sectional and longitudinal studies. One of the most internationally spread indicators is the Oral Health Impact Profile (OHIP-14), but it has still never been applied in Spain. The aim of this study was to validate the OHIP-14 for use among adults in Spain. Study design: A cross-sectional study was performed in Granada (Spain). A consecutive sample (n=270) of the Regional Government staff visiting the Employment Risk Prevention Centre for a routine medical check-up participated in this study. All participants self-completed the piloted OHIP-14sp and were examined according to World Health Organization methodology for caries, periodontal disease and prosthesis. Reliability analyses and validity tests were carried out to evaluate the psychometric properties of the OHIP-14sp by using two different methods of total scoring (i.e. the Additive and the Simple Count). Results: The reliability coefficient (Cronbach´s alpha) of the OHIP-14sp was above the recommended 0.7 threshold and considered excellent (alpha: 0.89). Some subjective factors (perceived dental treatment need, complaints about mouth and self-rated oral satisfaction) were strongly associated with both total scoring methods of the OHIP-14sp, supporting the criterion, construct and convergent validity. Moreover the impact levels were mainly influenced by caries data, e.g., number of teeth requiring extraction (r = 0.21; p<0.01) and number of decayed visible teeth (between premolars) (r = 0.17; p<0.01). The prevalence of impacts was 80.7% using the occasional or more frequently threshold. The most prevalently affected OHIP domains were ?psychological discomfort? (53.7%), ?functional limitation? (51.1%) and ?physical pain? (42.2%). Conclusions: The OHIP-14sp is a precise, valid and reliable instrument for assessing oral health-related quality of life among adult population in Spain.

Curing effectiveness of resin composites at different exposure times using LED and halogen units

  • Ceballos García, Laura
  • Fuentes Fuentes, María Victoria
  • Tafalla Pastor, Héctor
  • Martínez, Álvaro
  • Flores, Josefa
  • Rodríguez, Jesús
Objective: To compare the polymerization effectiveness of two resin composites cured with a quartz tungsten halogen (QTH) lamp or a light emitting diodes (LED) unit. Study design: Filtek Z250 (3M ESPE) and Spectrum TPH (Dentsply DeTrey) resin composites were placed in 9 mm deep and 4 mm wide metallic molds and cured using the QTH light Hilux 200 (Benlioglu) or the LED unit Smartlite IQ (Dentsply DeTrey) for 20 or 40 s (three specimens per group). Measurement of depth of cure was carried out by means of a scraping technique, according to ISO 4049. The microhardness measurements were performed using a calibrated Vickers indenter (100 g load, 30 s) at depths of 0.5, 1.5, 2.5, 3.5, 4.5 and 5.5 mm from the top of the composite in the same specimens. Results were analyzed by ANOVA, Student´s t and Student-Newman-Keuls tests (p<0.05). Results: Filtek Z250 exhibited higher depth of cure and Vickers microhardness values than Spectrum TPH under each experimental condition evaluated. Depth of cure and microhardness were not affected by the curing light used. However, hardness values were influenced by the interaction between curing light and exposure time. Specimens irradiated for 20 s exhibited higher microhardness values when the LED curing light was used. Exposure time had no influence on the microhardness values for depths from 0.5 to 2.5 mm. At higher depths, irradiation for 40 s produced greater microhardness values. Conclusions: Curing effectiveness of resin composite is not only dependent on the curing light unit. Results vary greatly with composite brand, thickness of the resin composite and the duration of the exposure.

Histopathological findings of pleomorphic adenomas of the salivary glands

  • Ito, Fabio Augusto
  • Jorge, Jacks
  • Vargas, Pablo Agustín
  • Lopes, Márcio Ajudarte
Objectives: To describe the histopathological features of pleomorphic adenoma (PA) with special reference to the epithelial and mesenchymal components. Study design: 189 PA were selected and classified as myxoid or stroma-rich, cellular or cell-rich and classic (balanced amount of epithelial and stromal components). The epithelial component was analyzed according to the presence of plasmacytoid, spindle, clear, squamous, basaloid, cubic, oncocytoid and mucous cells and the morphological pattern (trabecular, ductal, cystic and solid). The stromal component was analyzed according to the presence of myxoid, hyaline, chondroid or calcified tissue. Results: Plasmacytoid cells were the most commonly found cellular type followed by fusiform and cuboidal cells. Trabeculae and duct-like structures were the most frequent patterns formed by the epithelial cells. Myxoid and chondroid stroma were the most frequently found mesenchymal-like tissue usually forming the so called myxochondroid stroma. Conclusion: The knowledge of the immense variety of cells, architectures and morphological characteristics present in PA of the salivary gland is essential for a correct diagnosis.

Association between oral HSV-1 and survival in allogeneic hematopoietic stem cell transplanted patients

  • Guimaraes, Andre Luiz Sena
  • Gomes, Carolina Cavalieri
  • Marques-Silva, Luciano
  • Correira Silva, Jeane de Fátima Silva
  • Victoria, Junia Maria Neto
  • Gomez, Ricardo Santiago
  • Bittencourt, Henrique
Introduction: This study was designed to investigate the effect of oral HSV-1 shedding on the survival of allogeneic hematopoietic stem cell transplanted (allo-HSCT) patients. Methods: One hundred nineteen allo-HSCT patients were included in the study and divided in three groups: before transplant, 100 days after transplant and 1 year of allo-HSCT. Healthy volunteers matched by age and gender were also selected. Oral swabs were performed and the nested PCR was used to detect HSV-1 presence in the oral mucosa. In statistical analysis, chi-square test was used to test the distribution of HSV1 shedding among the three groups. Time to death after allo-HSCT was displayed by means of the Kaplan-Meier method and the results were compared by the log-rank test. Cox proportional hazards multivariate model was used to evaluate the survival. Results: We observed that HSV-1 shedding was similar at different points after allo-HSCT. However, HSV-1 shedding before allo-HSCT was associated with worst survival rates after allo-HSCT in multivariate analysis. Conclusion: Our data demonstrates that HSV-1 shedding in oral mucosa before transplant is associated with worst survival rate of allo-HSCT patients.

Multiple dens invaginatus, mulberry molar and conical teeth : case report and genetic considerations

  • Sedano, Heddie O.
  • Ocampo Acosta, Fabian
  • Naranjo Corona, Rosa I.
  • Torres Arellano, María Eleuteria
Dens in dente, also known as dens invaginatus and dilated compound odontoma, is a malformation that can occur on primary, permanent, or supernumerary teeth that is characterized by a deep invagination of the surface of a crown or root covered with enamel. This abnormality in tooth morphology generally affect the maxillary lateral incisors but several cases of multiple dens invaginatus have been reported in the literature. A 15 year-old female patient is reported here presenting five dens invaginatus: four in the permanent mandibular incisors and one in the permanent, maxillary left central incisor, additionally the following dental findings were observed: a permanent mandibular left mulberry molar, molarization of some premolars, several microdontic conoid teeth, retention of five primary teeth, absence of several permanent teeth germs, a macrodontic molar with abnormal roots and several periapical radiolucencies associated to the dens invaginatus. There was no family history of similar dental findings to those observed in the patient. There are several genes that participate in the development of teeth, of those, the following five genes could be implicated as responsible or co-participators for some of the dental anomalies present in this patient: MSX1 (Muscle segment homeobox 1), DLX1 and DLX2 (Distal-less homeobox 1 and 2 genes), PAX9 (Paired box gene) and PITX2 (Pituitary homeobox transciption factor 2).

Pleomorphic adenoma of the palate in a child: : a case report

  • Dhanuthai, Kittipong
  • Sappayatosok, Kraisorn
  • Kongin, Kusak
Salivary gland tumors are rare in children and the incidence differs from the adult counterpart. When salivary gland tumors do arise in children, they preferentially affect major salivary glands, but minor salivary gland tumors have also been reported. We reported the first case of palatal pleomorphic adenoma in a 13 year-old child from Thailand. She came to Sawanpracharak hospital with the chief complaint of a swelling at the left side of the palate. The oral mucosa covering the lesion was intact. Occlusal radiograph revealed no bony destruction. Incisional biopsy was performed on this patient. The biopsy showed several ducts which were lined by cuboidal cells. These ducts were surrounded by myoepithelial cells, some of which had the plasmacytoid appearance The patient was treated by wide local excision and no recurrence was observed 8 years after the surgery. Differential diagnoses of a palatal swelling in children and treatment of pleomorphic adenoma at the palate were also discussed.

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