Jose M. Sanchis

Osteonecrosis of the jaws in intravenous bisphosphonate use: Proposal for a modification of the clinical classification

Osteonecrosis of the jaws induced by bisphosphonates, first reported by Marx is now widely recognised: more than 260 reports appear in Medline-PubMed. There are many series of cases presented in the last years. A clinical stage classification has been proposed, based on clinical symptoms (mainly pain) and the presence of lesions and complications such as jaw fractures and skin fistulas by Ruggiero et al. There are three stages in this Ruggiero classification: Stage 1 is exposed bone necrosis without symptoms; Stage 2 is exposed bone necrosis with symptoms; and Stage 3 is where there are jaw fractures, skin fistulas or osteolysis extending to the inferior border. This classification is used to guide treatment and may also be useful to establish international criteria. However, based on observations made since the original paper, we now propose the following two modifications of Stages 1 and 2; Stage 1. That the inclusion criteria include patients with an oral fistula without obvious bone exposure, since these patients cannot be classified in the original Ruggiero’s classification and yet must have a small intraoral fistula (Table 1). Stage 2. That the Ruggiero classification, which consists of a patient who has an exposed necrotic jaw bone with symptoms, should be divided.

Erythema multiforme: diagnosis, clinical manifestations and treatment in a retrospective study of 22 patients

BACKGROUND Erythema multiforme (EM) is an acute disorder of the skin and mucosal membranes manifesting in the oral cavity (60-70% of all patients) as polymorphic erosive, ampullar, and bloodstained crusts. The etiology is unclear, although an autoimmune mechanism is involved. Infections and drugs have been implicated in the etiopathogenesis. With the exception of corticosteroids, no specific treatment for EM is available. METHODS Data were collected on the clinical manifestations, antecedents of viral infection, and the use of drugs substances as possible etiological factors, treatment, and response to topical and systemic corticotherapy. RESULTS A total of 22 patients were studied (14 males and 8 females), with a mean age of 47±20.4 years. A relationship was clearly suspected between drug use and lesion outbreak in 6 patients (27.2%). On the contrary, in 7 patients (31.8%) the triggering factor could have been herpes virus infection (herpes labialis). One half of the patients (11 cases) were classified as presenting minor EM, 36.4% (8 cases) presented major forms of the disease, and 13.6% (3 cases) were classified as corresponding to Stevens-Johnson syndrome. Systemic and/or topical corticosteroids proved effective in controlling the outbreaks in all of our patients. CONCLUSION The oral mucosa is the most affected mucosal region in EM, with a predilection for the lip mucosa, erosive forms and bloodstained crusts. Systemic corticosteroids are effective in controlling the outbreaks, although their use as maintenance therapy is not clearly indicated.

Mental Neuropathy as a Manifestation Associated With Malignant Processes : Its Significance in Relation to Patient Survival

PURPOSE Mental neuropathy (MN) is characterized by the presence of a sensory defect in the form of paresthesias or dysesthesias in the territory innervated by the mental nerve. MN may be the first manifestation of systemic cancer, a symptom of spread of an established tumor, or a sign of infiltration in an intraoral lesion. In any of these cases, the symptom is indicative of a very poor patient prognosis. MATERIALS AND METHODS A total of 22 cancer patients with chin paresthesia were studied. Group 1 comprised patients with chin paresthesia who had a primary tumor in some other region at a distance from the oral cavity or maxillofacial zone. Group 2 in turn comprised patients with primary malignancies of the oral and/or maxillofacial territory and who likewise presented with chin paresthesia. Data were collected relating to patient age, gender, primary intraoral lesion (location, size, histologic diagnosis), primary systemic tumor, and mean patient survival. RESULTS Group 1 consisted of 11 patients (8 men and 3 women), aged between 36 and 81 years (mean, 58.09 +/- 14.99 years), with different systemic cancers. The mean survival after the diagnosis of chin paresthesia was 14.8 +/- 16.5 months, and only 1 patient was still alive after 9 months. Group 2 consisted of 11 patients (8 men and 3 women), aged between 33 and 72 years (mean, 56.18 +/- 15.69 years). All presented with oral squamous cell carcinoma, with the single exception of 1 case of fibrosarcoma. In this group the mean survival of the 8 patients who died was 28.2 +/- 29.6 months. Three patients survived for a mean of 17 months. CONCLUSIONS Chin paresthesia is a very important prognostic symptom determining the degree of infiltration of intraoral lesions, and in some cases it may be indicative of the existence of a primary tumor (identified or otherwise), with poor short-term survival--given that 81.9% of the patients studied (18 cases) had died before a mean of 20 months. Although mean survival was shorter (14.8 months) among the patients in group 1 than in group 2 (28.2 months), the difference was not statistically significant.

Oxidative stress and recurrent aphthous stomatitis

ObjectivesThis study analyzed the oxidative stress status in patients with recurrent aphthous stomatitis (RAS) in the presence and absence of active ulceration.Material and methodsOxidative stress was analyzed in peripheral mononuclear cells of 28 RAS patients with active ulceration and 29 controls. A further blood sample was collected from nine subjects randomly selected from the 28 RAS cases, during the period in which the patients did not have active oral ulceration. The reduced glutathione (GSH), malondialdehyde (MDA), and oxidized glutathione (GSSG) levels were measured in these samples.ResultsThe mean MDA and GSSG levels were significantly higher in patients with active RAS than in the controls, while GSH was lower in the RAS group (p < 0.01). There was a nonsignificant tendency toward higher MDA and GSSG levels in patients with major RAS compared with minor RAS. On comparing the serum findings in the nine RAS patients in the presence and absence of lesions, the presence of ulceration was associated with even higher MDA and GSSG levels and lower GSH concentrations (p < 0.05)ConclusionsOxidative stress was detected in our RAS patients.