Marta Muñoz-Corcuera

Oral ulcers: clinical aspects. A tool for dermatologists. Part II. Chronic ulcers

Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. They can be classified as acute or chronic according to their presentation and progression. Acute oral ulcers are be associated with conditions such as trauma, recurrent aphthous stomatitis, Behçet’s disease, bacterial and viral infections, allergic reactions or adverse drug reactions. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in the oral cavity. In this second part of this two‐part review, chronic oral ulcers are reviewed.

Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers

Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. They can be classified as acute or chronic according to their presentation and progression. Acute oral ulcers are be associated with conditions such as trauma, recurrent aphthous stomatitis, Behçet’s disease, bacterial and viral infections, allergic reactions or adverse drug reactions. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in the oral cavity. In the first part of this two‐part review, acute oral ulcers are reviewed.

Odontogenic Infections in the Etiology of Infective Endocarditis

Revised guidelines for the prevention of infective endocarditis published by the American Heart Association in 2007 do not support the indiscriminate use of antibiotic prophylaxis for dental procedures. However, they still recommend the use of prophylaxis for high-risk patients before dental treatments likely to cause bleeding. Given the high prevalence of bacteremia of dental origin due to tooth-brushing, mastication or other daily activities, it appears unlikely that infective endocarditis from oral microorganisms can be completely prevented. A good oral health status and satisfactory level of oral hygiene are sufficient to control the consequences of the systemic spread of oral microorganisms in healthy individuals. However, caution is still needed and prophylactic antibiotics must be administered to susceptible or medically compromised patients. This review briefly outlines the current concepts of odontogenic bacteraemia and antibiotic prophylaxis for patients undergoing dental treatment.

Diabetes y periodontitis: una relación bidireccional

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, a defect in insulin action or a combination of both. Periodontitis is now considered a chronic localized infection of the oral cavity that can trigger inflammatory host immune responses at local and systemic levels, and can also be a source of bacteremia. It is now known that periodontitis has an influence on the pathogenesis of certain systemic diseases. The biological relationship between diabetes and periodontal disease is well documented. In the mid-90s sufficient scientific support for the association between diabetes and periodontitis was published, and periodontitis was designated as the sixth complication of diabetes. There have been studies that show an improvement in both clinical and immunological parameters of periodontitis and glycemic control in long-term diabetes after treatment of periodontal disease. In addition, scientific evidence confirms that poorer glycemic control contributes to a worse periodontal condition. The interplay between the 2 conditions highlights the importance of the need for a good communication between the internist and dentist about diabetic patients, considering always the possibility that the 2 diseases may be occurring simultaneously in order to ensure an early diagnosis of both.Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, a defect in insulin action or a combination of both. Periodontitis is now considered a chronic localized infection of the oral cavity that can trigger inflammatory host immune responses at local and systemic levels, and can also be a source of bacteremia. It is now known that periodontitis has an influence on the pathogenesis of certain systemic diseases. The biological relationship between diabetes and periodontal disease is well documented. In the mid-90s sufficient scientific support for the association between diabetes and periodontitis was published, and periodontitis was designated as the sixth complication of diabetes. There have been studies that show an improvement in both clinical and immunological parameters of periodontitis and glycemic control in long-term diabetes after treatment of periodontal disease. In addition, scientific evidence confirms that poorer glycemic control contributes to a worse periodontal condition. The interplay between the 2 conditions highlights the importance of the need for a good communication between the internist and dentist about diabetic patients, considering always the possibility that the 2 diseases may be occurring simultaneously in order to ensure an early diagnosis of

Reacciones adversas a medicamentos en la cavidad oral

A pesar de que los farmacos son la herramienta terapeutica mas potente de la que disponemos para mejorar la calidad de vida de la poblacion, su uso no esta exento de efectos adversos. Hoy en dia son muchos los pacientes polimedicados, siendo complicado encontrar la causa de los efectos adversos generados por la medicacion y aumentando estos de manera exponencial cuando se combinan mas de 4 farmacos. Existe un amplio numero de farmacos que pueden dar lugar a numerosos efectos adversos en la cavidad bucal. Los mas frecuentes son la xerostomia, las alteraciones del gusto, el agrandamiento gingival y las mucositis producidas por el tratamiento oncologico. Tambien se revisan otras alteraciones de las glandulas salivales, las alteraciones de la mucosa oral, las pigmentaciones, la halitosis, la osteonecrosis, las infecciones oportunistas y las diatesis hemorragicas.Although drugs are the most powerful therapeutic tools we have for improving the quality of life of the population, their use is not free of adverse effects. Today there are many polymedicated patients, and it is difficult to find the cause of their adverse effects that increase exponentially when more than 4 drugs are combined. There are a large number of drugs that can result in numerous adverse effects in the oral cavity. The most common are xerostomia, altered taste, gingival enlargement and mucositis caused by cancer treatment. We also review other disorders of the salivary glands, oral mucosal changes, pigmentations, halitosis, osteonecrosis, opportunistic infections and bleeding diathesis.

Manifestaciones clínicas de las hemopatías no neoplásicas en Odontología

Systemic disease can cause clinical manifestations in the oral and maxillofacial area, which is important to recognize because it could be the first symptom of an undiagnosed illness. There are different oral signs that could suggest the clinician a blood disorder, such as pallor, petechiae, ecchymosis, ulcerations, gingival hypertrophy or spontaneous gingival bleeding. In addition, blood disorders will determine the dental management of these patients and the protocol for limiting possible complications that may arise due to the treatment itself. This paper reviews the oral manifestations and dental management of non-neoplastic alterations of red cells, white cells and hemostasis, with emphasis on two-way relationship that must exist between the dentist and the patients hematologist for making a treatment plan.

Oral Manifestations of Pemphigus Vulgaris: Clinical Presentation, Differential Diagnosis and Management

Pemphigus vulgaris is a chronic autoimmune mucocutaneous disease characterized by the formation of intraepithelial blisters. It results from an autoimmune process in which antibodies are produced against desmoglein 1 and desmoglein 3, normal components of the cell membrane of keratinocytes. The first manifestations of pemphigus vulgaris appear in the oral mucosa in the majority of patients, followed at a later date by cutaneous lesions. The diagnosis is based on clinical findings and laboratory analyses, and it is usually treated by the combined administration of corticosteroids and immunosuppressants. Detection of the oral lesions can result in an earlier diagnosis. We review the oral manifestations of pemphigus vulgaris as well as the differential diagnosis, treatment, and prognosis of oral lesions in this uncommon disease.

Actualización en los protocolos de extracción dental en pacientes anticoagulados

espanolLas intervenciones de cirugia oral y las simples extracciones dentales pueden ser objeto de complicaciones inmediatas y mediatas desde un punto de vista hemorragico para el profesional que interviene sobre pacientes en tratamiento con anticoagulantes orales. Los protocolos clinicos publicados en relacion al enfoque terapeutico a seguir en estos casos se basa en dos vertientes: la que postula una disminucion de la ingesta farmacologica del anticoagulantes y sustitucion por heparina o bien aquella que preconiza su mantenimiento y el control del INR junto con unas medidas hemostaticas especificas del proceso. Nuestro proposito es evaluar los protocolos descritos en la literatura y por las sociedades medicas con el fin de iniciar unas pautas aclaratorias actualizadas. EnglishOral surgery and easy dental extractions could be potential mediate or immediate clinical hemorrhagic complications that dental clinicians may encounter when treating patients on anticoagulant oral medication. The clinical protocols published regarding which therapeutic procedure to follow when dealing with these patients are based on two approaches: One that postulates a decrease of the pharmacological ingestion of the anticoagulants and their substitution with heparin; another which recommends their maintenance and the control of INR (international normalized ratio) together with a few haemostatic specific procedures. Our aim is, therefore, to evaluate the protocols described in the literature in order to establish a few explanatory updated guidelines for the medical associations.