Jacobo Limeres

Management of drooling in disabled patients with scopolamine patches.

AIM To evaluate the efficacy of scopolamine administered transdermally for the treatment of drooling in severely disabled patients. METHODS A prospective, randomized, double-blind, crossover, placebo-controlled clinical trial was designed. The study group consisted of 30 handicapped patients with persistent drooling. The exclusion criteria were the specific contra-indications of scopolamine. Severity of drooling was quantified using a modified Thomas-Stonell and Greenberg visual scale simplified into three grades: 1 = dry; 2 = mild/moderate; 3 = severe/fulsome. The frequency of drooling was estimated using the number of bibs used each day. The baseline observational phase was followed by the application of a 1.5 mg scopolamine (Scopoderm TTS; Novartis Consumer Healthcare, UK) or placebo patch every 72 h for a fortnight. This was followed by a 1 week washout period and then crossover of assignments for 2 weeks. RESULTS At baseline, 77% of patients showed grade 3 of drooling. The placebo administration showed no significant reduction in drooling. We found a significant drooling reduction (P < 0.005) in the scopolamine group in the 1 and 2 week controls (69% and 80% respectively <or= grade 3). The mean number of bibs/day decreased during the scopolamine phase from 6/day at baseline to 3/day at the 2 week control. Four patients (13.3%) dropped out because of scopolamine side effects and minor adverse reactions were observed in three other patients. No blood alterations were found during the study period. CONCLUSION Scopolamine can be useful to control drooling in severely disabled patients although it requires appropriate patient selection and is not free from adverse effects.

Evaluation of chlorhexidine substantivity on salivary flora by epifluorescence microscopy.

OBJECTIVE To evaluate the in vivo antimicrobial activity of chlorhexidine (CHX) in saliva 7 h after its application using an epifluorescence microscopy technique. SUBJECTS AND METHODS Fifteen volunteers performed a single mouthrinse with sterile water (SM-water) and with 0.2% CHX (SM-0.2% CHX). Saliva samples were taken at 30 s and 1, 3, 5 and 7 h after each application. The bacterial suspension was mixed with the SYTO 9/propidium iodide staining and observed using an Olympus BX51 microscope. The mean percentage of viable bacteria was calculated for each sample. RESULTS In comparison with baseline values, the frequency of viable bacteria decreased significantly at 30 s after the SM-0.2% CHX (P < 0.001) and presented significant antibacterial activity up to 7 h after the mouthrinse (P < 0.001). In comparison with SM-water, the prevalence of viable bacteria was significantly lower at 30 s after the SM-0.2% CHX (P < 0.001) and showed a significant antibacterial effect up to 7 h after the mouthrinse (P < 0.001). CONCLUSIONS Epifluorescence microscopy permits evaluating the antimicrobial activity of CHX on the salivary flora in real-time. Fluorescence assays could be particularly useful to analyse simultaneously the effect of antimicrobials that alter the cytoplasmic membrane integrity on different oral ecosystems.

Oral self-injury: an update.

BACKGROUND Self-inflicted oral injuries of organic origin are particularly common in certain diseases, syndromes, and systemic disorders. In this article, we discuss the characteristics of these oral lesions and their treatment. LITERATURE SEARCH The authors have reviewed the most relevant literature relating to oral self-injury through a search in textbooks and published articles included in the Medline database for the years 1970-2010, and selected published cases from the last two decades. RESULTS The majority of the literature on oral self-injury is in the form of case reports. Self-injury is particularly prevalent in patients with Lesch-Nyhan syndrome, a heterogeneous group of neurological disorders, congenital insensitivity to pain with anhidrosis, and mental retardation. It is most common in males in the early years of life, and the sites most frequently involved are the lower lip and the tongue. Therapeutic approaches in these patients have included psychological and pharmacological treatment, intraoral devices, and surgical procedures. CLINICAL IMPLICATIONS Intraoral devices are the best therapeutic option for self-injury of organic origin, although this approach is not free of complications. The current lack of standardized treatment protocols for oral self-injury means that therapy must be individualized.

Patients' Perception of Recovery After Third Molar Surgery Following Postoperative Treatment With Moxifloxacin Versus Amoxicillin and Clavulanic Acid: A Randomized, Double-Blind, Controlled Study

PURPOSE To analyze the impact of the postoperative administration of moxifloxacin (MXF) on oral function and quality of life after third molar (TM) surgery. MATERIALS AND METHODS A single-center, prospective, randomized, double-blind, controlled clinical trial was designed. The study population consisted of 100 patients who underwent impacted TM extractions. Patients were distributed into 2 groups of 50 individuals each. Postoperatively, one group was administered MXF (400 mg/24 hours for 5 days); the positive control group received amoxicillin and clavulanic acid (AMX-CLV) (500/125 mg/8 hours for 5 days). Follow-up was performed for 7 postoperative days, during which the patient recorded information on pain, the use of rescue analgesia, undesirable effects of the medication, difficulty in speaking, difficulty in chewing, diet consistency, difficulty performing oral hygiene, asthenia, time in bed, going out of the house, and returning to work. RESULTS The administration of MFX was significantly associated with headache, and AMX-CLV was significantly associated with diarrhea. Greater difficulty in chewing and performing oral hygiene was observed in the AMX-CLV group compared with the MXF group. The percentage of patients who tolerated a diet of normal consistency was significantly higher in the MXF group compared with the AMX-CLV group. During the first 4 days of follow-up, the percentage of patients who returned to work was significantly higher in the MXF group than in the AMX-CLV group. CONCLUSIONS Moxifloxacin shortens the period of postoperative recovery in terms of oral function and return to work. Therefore, MXF could be a useful option in TM surgery when antibiotics are indicated, particularly if patients are allergic to beta-lactams, their oral flora is resistant to macrolides, or they are intolerant of either of these antibiotics.

Orthodontic treatment for disabled children: a survey of parents' attitudes and overall satisfaction.

BackgroundMany patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities.MethodsThe parents of 60 disabled Spanish children with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and level of satisfaction with the outcomes. The survey consisted of 23 questions in 4 sections: attitude and adaptation, benefits, adverse effects, and level of satisfaction after completion of OT. A control group formed of the parents of 60 healthy children undergoing OT at the same institution were also surveyed.ResultsParents of disabled children undergoing OT showed a high level of motivation and they are willing to collaborate in oral hygiene procedures. Adaptation to the removable appliances was poorer in disabled children but adaptation to fixed appliances was excellent. OT can provide a marked improvement in quality of life, social relationships and oral functionality in disabled children.ConclusionsAmong parents of disabled children undergoing OT, the perceived level of overall satisfaction was very high and expectations were often exceeded.

Prevention of medication-related osteonecrosis of the jaws secondary to tooth extractions. A systematic review.

Background A study was made to identify the most effective protocol for reducing the risk of osteonecrosis of the jaws (ONJ) following tooth extraction in patients subjected to treatment with antiresorptive or antiangiogenic drugs. Material and Methods A MEDLINE and SCOPUS search (January 2003 - March 2015) was made with the purpose of conducting a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All articles contributing information on tooth extractions in patients treated with oral or intravenous antiresorptive or antiangiogenic drugs were included. Results Only 13 of the 380 selected articles were finally included in the review: 11 and 5 of them offered data on patients treated with intravenous and oral bisphosphonates, respectively. No randomized controlled trials were found – all publications corresponding to case series or cohort studies. The prevalence of ONJ in the patients treated with intravenous and oral bisphosphonates was 6,9% (range 0-34.7%) and 0.47% (range 0-2.5%), respectively. The main preventive measures comprised local and systemic infection control. Conclusions No conclusive scientific evidence is available to date on the efficacy of ONJ prevention protocols in patients treated with antiresorptive or antiangiogenic drugs subjected to tooth extraction. Key words:Bisphosphonates, angiogenesis inhibitors, antiresorptive drugs, extraction, osteonecrosis.

A novel mutation in the OFD1 (Cxorf5) gene may contribute to oral phenotype in patients with oral-facial-digital syndrome type 1

BACKGROUND Oral-facial-digital syndrome (OFDS) type 1 (OFD1) is an X-linked dominant condition associated with embryonic male lethality. It almost always affects the oral cavity, face, and digits. It is considered to be a ciliopathy caused by mutations in the OFD1 gene. A variety of mutations have been described, and a genotype-phenotype correlation has been suggested. OBJECTIVE AND METHODS The proband was an 8-year-old Spanish girl with suspected OFD1. We extended the pedigree to three probands generations, performing a thorough physical examination and screening for OFD1 mutations in nine individuals. RESULTS The proband, her mother, and her sister showed oral findings consistent with OFD1. Ultrasound evaluation revealed the existence of renal cysts only in the probands mother. The rest of the family (all male) had no relevant morphological abnormalities. A single-base deletion in exon 16 of OFD1 (c.2183delG) leading to a frameshift was detected in the proband, her mother, and her sister. CONCLUSION Because all three women had a similar oral phenotype, this new mutation might be involved in the development of the OFD1 oral manifestations. In cases of OFDS, physical examination (including the oral cavity and renal function) and genetic screening of the probands and their relatives are mandatory.

Subcutaneous emphysema related to air-powder tooth polishing: a report of three cases

Subcutaneous emphysema is a rare complication of dental procedures and can occasionally give rise to potentially life-threatening complications. We describe three cases of subcutaneous emphysema diagnosed in the same dental clinic. All cases occurred during tooth or implant cleaning using air polishing (KavoProphyflex® ) with a sodium bicarbonate powder (Air-N-Go Classic® ). The diagnosis was based on clinical findings and was confirmed radiologically. The cervical and facial regions were affected in all three cases, and spread to the mediastinum occurred in one case. All the episodes resolved within 3-5 days. Tooth cleaning using air polishing combined with an abrasive powder is a risk factor for subcutaneous emphysema, especially when the powder and device are from different manufacturers. Radiological assessment must be performed to rule out involvement of deep tissue planes.

In Vivo Antiplaque Effect of Three Edible Toothpastes

Objectives: The objective of this study was to analyse the antibacterial and antiplaque activity of three edible toothpastes with the widest worldwide distribution: KidScents™, which contains essential oils; Browning B&B™, with medicinal plants; and Wysong Probiodent™, which contains probiotics. Study Design: The study group was formed of twenty healthy volunteers (dental students) with a good oral health status. Using a balanced randomisation system, all volunteers performed toothbrushing with four products (the three edible toothpastes and water) at intervals of one week. Bacterial vitality in the saliva was analysed by epifluorescence microscopy and plaque regrowth was evaluated using the Turesky-Quigley-Hein plaque index. Results: Bacterial vitality in the saliva was significantly higher after toothbrushing with water (positive control) than with the three toothpastes (P=0.002, P=0.003 and P<0.001, respectively). The plaque index was significantly higher after using these three toothpastes than after toothbrushing with water (P=0.047, P=0.032 and P<0.001, respectively). Conclusions: The three edible toothpastes analysed have some antimicrobial activity but favour plaque regrowth. Key words:Edible toothpaste, dental plaque, oral bacteria.

Orthodontic Treatment in Children with Cerebral Palsy

Cerebral palsy is a permanent neuromuscular motor disorder that gives rise to many functional problems, including impaired swallowing, chewing and speech. Maxillary transverse deficiency and Angle Class II malocclusion are common. Some of these functional problems can be due to maxillary malocclusion. To our knowledge, no case series has yet been published on orthodontic treatment in children with cerebral palsy. In this chapter, we provide an overview of this topic based on the literature and on our own clinical experience. We consider that some patients with cerebral palsy are susceptible to orthodontic treatment. The keys to success are appropriate patient selection, based on anatomical, physiological and behavioural characteristics, and the degree of involvement of parents and caregivers. Among parents of cerebral palsy children undergoing orthodontic therapy, the perceived level of overall satisfaction was very high and expectations were often exceeded; however, these results are condi‐ tioned by factors such as the Peer Assessment Rating (PAR) index. Although some authors reported improvements in aesthetics, speech and oral function, an objective assessment of functional improvement is still lacking. In our experience, correction of resting position and management of neuromuscular alterations are essential if successful orthodontic treatment is to be achieved and relapses avoided.