Kahina Bouferrache

Osteoradionecrosis: An update

Osteoradionecrosis (ORN) of the mandible is the most serious and severe side effect of combined treatment of head and neck tumors. A new theory for the pathogenesis of ORN has been proposed relating it to a fibro-atrophic mechanism including free radical formation, endothelial dysfunction, inflammation, microvascular thrombosis leading to bone and tissue necrosis. Risk factors mainly include radiation related risk factors, surgery and, tobacco and alcohol abuse. Removing of diseased teeth after and even probably after radiotherapy is generally considered the main risk factor in ORN. Conversely, steroid use before or after radiation may have a protective effect related to the inhibition of the initial inflammatory phase of ORN. Prevention of ORN is still based on the preventive extractions of decayed or periodontally compromised teeth before radiotherapy. Based on the current understanding of ORN pathophysiology, new preventive and therapeutic protocols have been suggested for mild to moderate stages. Free tissue surgical transfers is the treatment of choice of severe, extensive and long established ORN.

Bisphosphonate-related osteonecrosis of the jaws: How to manage cancer patients

Bisphosphonate related osteonecrosis of the jaw (BRONJ) is defined as exposed necrotic bone appearing in the jaws of patients treated by systemic IV or oral BPs never irradiated in the head and neck area and that has persisted for more than 8 weeks. More than 90% of cases of osteonecrosis of the jaw have been in patients with cancer who received IV-BPs. The estimate of cumulative incidence of BRONJ in cancer patients with IV-BPs ranges from 0.8% to 18.6%. The pathogenesis of BRONJ appeared related to the potent osteoblast-inhibiting properties of BPs which act by blocking osteoclast recruitment, decreasing osteoclast activity and promoting osteoclast apoptosis. Dental extractions are the most potent local risk factor. Cancer patients wearing a denture could also be at increased risk of BRONJ. Non-healing mucosal breaches caused by dentures could be a portal for the oral flora to access bone, while the oral mucosa of patients on IV-BPs could also be defective. Whether periodontal disease is a risk factor for BRONJ remains controversial. Preventive measures are fundamental. Nevertheless, some teams have questioned its cost-effectiveness. The perceived limitations of surgical therapy of BRONJ led to the restriction of aggressive surgery to symptomatic patients with stage 3 BRONJ. The evidence-based literature on BRONJ is growing but there are still many controversial aspects.

Failure in Implant Rehabilitation in a Patient With Severe Congenital Neutropenia (Kostmann Syndrome)

0 It is well known that various drug treatments and systemic diseases may compromise the integrity of the oral tissues. Likewise, these conditions may also affect the viability of dental implants and their surrounding tissue. Although recommendations exist for the avoidance of dental implants with certain systemic diseases, the scintific evidence to support such guidance is lacking. oreover, estimating the risk of implant failure in these atient populations is challenging because, often, these atients rarely receive endosseous implants. Severe congenital neutropenia (SCN) is one such disease that may affect the survival rate of dental implants. SCN, also known as Kostmann syndrome, is inherited in either an autosomal recessive (HAX1 mutation) or autosomal dominant (ELA2 mutation) manner. The estimated incidence of SCN is 1 to 2 cases per million persons with equal distribution among genders. The condition is usually diagnosed in the peripartum period and presents with impaired bone marrow myelopoiesis and a chronic absolute neutrophil count of less than 500/ L. Bone marrow examination often shows promyelocyte/myelocyte arrest, with little evidence of mature granulocyte formation. Most patients with SCN are successfully treated with granulocyte colony-stimulating factor. Treatment can lead to a 10to 12-fold increase in neutro-

Stomatodynies primaire et secondaire : un diagnostic difficile

Primary stomatodynia involves mainly women after menopause presenting somatization, depression and anxiety at values higher than control subjects. This chronic pain is often an intense burning pain beginning in the tongue the entire oral cavity, increasing in intensity through the day with a high level of emotional after effects. These patients often describe two associated symptoms: mouth dryness sensation and altered taste. The causes remain uncertain. The participation of female sexual hormones and neuropathic factors has been suggested possibly through a sensory neuropathy of small fibers of the oral mucosa. Normal clinical examinations and non clinical tests differentiate primary from secondary stomatodynia. The management consists in using low doses of topical clonazepam without swallowing or systemic clonazepam. The association of this drug with tricyclic antidepressants has given variable results. A cognitive behavioural management has been successfully attempted.

Seltene, aber hartnäckige Affektionen der Mundschleimhaut

Die Mundschleimhaut ist eine Fortsetzung der Haut, dermatologische Erkrankungen konnen daher ungeachtet der Lippengrenze auch die Mundschleimhaut befallen: Lichen planus, autoimmune oder erworbene Dermatitiden und Psoriasis sind einige Beispiele fur Dermatitiden, die die Mundhohle - manchmal auch als Erstmanifestation - befallen konnen.

La cavité buccale de retour dans le corps humain

La bouche est la porte d’entree de maladies infectieuses dont la carie est de tres loin la plus prevalente. Associe a la consommation excessive d’hydrates de carbone, la transmission verticale du streptocoque mutans est l’une des composantes majeures de la maladie carieuse.

Rares mais rebelles affections de la muqueuse buccale

La muqueuse buccale est un continuum de la peau. Les maladies dermatologiques l’affectent donc sans egard pour la limite des levres: le lichen plan, les dermatites auto-immunes ou acquises, le psoriasis sont quelques exemples de dermatites a expression orale, parfois inaugurale.