J.A. Baart

Dental management of patients using antithrombotic drugs: critical appraisal of existing guidelines

OBJECTIVESnThe aims were: 1) to identify the guidelines available for management of dental invasive procedures in patients on antithrombotic drugs; 2) to assess their quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument; and 3) to summarize their conclusions and recommendations.nnnSTUDY DESIGNnSystematic literature search for guidelines in several electronic databases. Retrieved guidelines were evaluated with the AGREE instrument for quality assessment.nnnRESULTSnThe systematic search yielded 93 results, of which only 4 were evidence-based practice guidelines. Two of these guidelines could be recommended for clinical use on the basis of the AGREE instrument. These 2 guidelines drew 68 conclusions from the existing literature and provided 58 recommendations.nnnCONCLUSIONSnTwo evidence-based clinical practice guidelines, satisfactorily fulfilling the criteria of the AGREE instrument and both published in 2007, advise to not routinely discontinue antiplatelet and anticoagulation medication before dental surgery. The majority of the recommendations, however, were not sufficiently linked to levels of evidence.

The relevance of uniform reporting in oral leukoplakia: Definition, certainty factor and staging based on experience with 275 patients

The aim of the present study was to evaluate the definition of oral leukoplakia, proposed by the WHO in 2005 and taking into account a previously reported classification and staging system, including the use of a Certainty factor of four levels with which the diagnosis of leukoplakia can be established. In the period 1997-2012 a hospital-based population of 275 consecutive patients with a provisional diagnosis of oral leukoplakia has been examined. In only 176 patients of these 275 patients a firm diagnosis of leukoplakia has been established based on strict clinicopathological criteria. The 176 patients have subsequently been staged using a classification and staging system based on size and histopathologic features. For use in epidemiological studies it seems acceptable to accept a diagnosis of leukoplakia based on a single oral examination (Certainty level 1). For studies on management and malignant transformation rate the recommendation is made to include the requirement of histopathologic examination of an incisional or excisional biopsy, representing Certainty level 3 and 4, respectively. This recommendation results in the following definition of oral leukoplakia: “A predominantly white lesion or plaque of questionable behaviour having excluded, clinically and histopathologically, any other definable white disease or disorder”. Furthermore, we recommend the use of strict diagnostic criteria for predominantly white lesions for which a causative factor has been identified, e.g. smokers’ lesion, frictional lesion and dental restoration associated lesion. Key words:Oral epithelial dysplasia, oral leukoplakia, potentially malignant oral disorders.

Congenital epulis of the jaw: a series of five cases and review of literature

This article describes five cases of congenital epulis, a rare and benign swelling in the mouth of a newborn, which is not widely known. We present five cases: four cases presented as single pedunculated nodules of the gingiva and in one case two nodules were present. Of all, 50% were located at the maxilla. Excision was performed in four of the five cases and in one case, spontaneous regression was awaited. No recurrence was reported. The characteristic features of congenital epulis are a pedunculated, flesh-pink coloured tumour with a predominant occurrence on the anterior maxillary alveolar ridge in a female newborn. Although the aetiology is unknown, most authors suggest a mesenchymal, rather than an odontogenic, origin. Endogenous hormonal factors might influence growth prenatally. Histological findings include granular cells with eosinophilic cytoplasm and small, eccentric nuclei. Despite the fact that the lesion can be a striking sight, spontaneous regression is possible and can be awaited. Indications for non-radical excision under local anaesthesia are severe upper airway obstruction and interference with feeding technique. In conclusion, we provide clinical and histological information about congenital epulis, so that this entity will be more easily recognised and relevant information given to parents.

Regional odontodysplasia: Report of three cases

Regional odontodysplasia is a developmental anomaly of dental tissues with characteristic clinical, radiographic, and histologic appearances. It most commonly affects the maxillary anterior teeth of both the primary and permanent dentition, and occurs in females twice as often as in males. The pathogenesis is unknown. The clinical and histopathologic findings of regional odontodysplasia in three patients are discussed.

Oncologic aspects of vermilionectomy in microinvasive squamous cell carcinoma of the lower lip

Twelve patients with microinvasive squamous cell carcinoma of the lower lip were studied in order to determine whether vermilionectomy was justifiable. The maximum tumor thickness (MTT) varied between 1.1 and 3.1 mm. In none of the patients was there local recurrence during a mean follow-up period of 4.4 years (range 4-8). In view of these results and of what has been reported in the literature, it seems warranted to conclude that vermilionectomy is an appropriate procedure in microinvasive carcinoma of the lower lip with a MTT of up to 3 mm.

T-cell lymphoblastic lymphoma of the lower jaw in a young child: a case report.

Among non-Hodgkins lymphomas occurring in childhood two major histologic subgroups can be identified: (1) Burkitts lymphoma and (2) T-cell lymphoblastic lymphoma, an uncommon high-grade malignant non-Hodgkins lymphoma. Although Burkitts lymphoma with maxillofacial involvement is a well-documented disease, T-cell lymphoblastic lymphoma in the perioral region is rare. An unusual case of T-cell lymphoblastic lymphoma with initial oral manifestation in an 18-month-old child is presented.

Unusual behaviour of periapical cementous dysplasia

A case of periapical cementous dysplasia is reported that over the course of 12 years developed into a progressive bone lesion. The diagnostic and therapeutic aspects are discussed.