N Kumar

Oral and Dental Aspects of Chronic Renal Failure

The present article reviews, in detail, the current knowledge of the oral and dental aspects of chronic renal failure (CRF). Worldwide, increasing numbers of persons have CRF; thus, oral health care staffs are increasingly likely to provide care for patients with such disease. Chronic renal failure can give rise to a wide spectrum of oral manifestations, affecting the hard or soft tissues of the mouth. The majority of affected individuals have disease that does not complicate oral health care; nevertheless, the dental management of such individuals does require that the clinician understand the multiple systems that can be affected. The clinician should also consider the adverse side-effects of drug therapy and appropriate prescribing, in view of compromised renal clearance.

Oral plasmablastic lymphoma in previously undiagnosed HIV disease

Non-Hodgkins lymphoma is the second most common HIV-associated malignancy. This report details a case of the recently described entity plasmablastic lymphoma of the mouth in a patient who was later found to have severe HIV disease. The tumor manifested as a large ulcerated mass of the left maxillary alveolus, causing bony destruction and tooth mobility. Histologic examination of lesional tissue revealed a lymphoid tumor with a high proliferation rate containing lymphoplasmacytoid cells that were reactive to the plasma cell marker VS38c but not to CD20 or CD79a; these are features of the recently reported non-Hodgkins lymphoma termed plasmablastic lymphoma. This is only the second report of an unusual tumor that has a predilection for the orofacial tissues.

The impact of hospitalization on oral health: a systematic review

BACKGROUND Poor oral health of hospitalized patients is associated with an increased risk of hospital-acquired infections and reduced life quality. OBJECTIVES To systematically review the evidence on oral health changes during hospitalization. DATA SOURCES Cochrane library, Medline, OldMedline, Embase and CINAHL without language restrictions. STUDY ELIGIBILITY CRITERIA Observational longitudinal studies. DATA APPRAISAL AND SYNTHESIS METHODS Two independent reviewers screened studies for inclusion, assessed the risk of bias and extracted data. Risk of bias was assessed using the Newcastle-Ottawa assessment scale. A narrative synthesis was conducted. RESULTS Five before and after studies were included. The data suggest a deterioration in oral health following hospitalization with an increase in dental plaque accumulation and gingival inflammation and a deterioration in mucosal health. LIMITATIONS While before and after studies are at a general risk of bias, other specific study characteristics were judged to have a low risk of bias. However, methodological issues such as unvalidated outcome measures and the lack of assessor training limit the strength of the evidence. CONCLUSION Hospitalization is associated with a deterioration in oral health, particularly in intubated patients.

Effect of human immunodeficiency virus-1 protease inhibitors on the clearance of human herpesvirus 8 from blood of human Immunodeficiency virus-1-infected patients

The effect of human immunodeficiency virus‐1 protease inhibitors on the frequency of human herpesvirus 8 DNA detection from peripheral blood of human immunodeficiency virus‐positive persons was evaluated. Thirty‐three human immunodeficiency virus‐seropositive male patients were studied longitudinally. DNA from open reading frame 26 of the human herpesvirus 8 genome was amplified by the polymerase chain reaction from the CD45+ fraction of peripheral blood before and after the introduction of protease inhibitor therapy. Human herpesvirus 8 IgG status, CD4+ cell counts, and human immunodeficiency virus‐1 plasma viral load were also assessed before and after therapy. When both reverse transcriptase inhibitor and protease inhibitor treatment were introduced at the same time, there was an increase in CD4+ T cell counts (P=0.0041), a decrease in human immunodeficiency virus plasma load (P=0.0584), and a decrease in the detection rate of human herpesvirus 8 DNA (P=0.0077). Introducing protease inhibitor to patients already receiving reverse transcriptase inhibitor treatment was associated with an increase in CD4+ T cell counts (P=0.0003), a decrease in human immunodeficiency virus plasma viral load (P=0.0911), and a decrease in the human herpesvirus 8 detection rate (P=0.0412). No significant changes in the titters of anti‐human herpesvirus 8 IgG were observed. Treatment with human immunodeficiency virus‐1 protease inhibitors is therefore associated with the clearance of human herpesvirus 8 DNA from peripheral blood of human immunodeficiency virus‐infected patients. The concomitant decrease in the human immunodeficiency virus plasma load and increase in the peripheral CD4+ cell count suggest that an amelioration in the immune defect following reduction in the burden of human immunodeficiency virus‐1 infection is responsible for the clearance of human herpesvirus 8 by protease inhibitors. J. Med. Virol. 62:416–420, 2000.

Longstanding trigeminal sensory neuropathy of nontraumatic cause.

OBJECTIVE Trigeminal sensory neuropathy is an uncommon but often significant orofacial symptom. There are few detailed descriptions of the problem in the dental literature. The aim of this study was to evaluate the clinical presentation and management of a cohort of patients presenting with anesthesia/paresthesia affecting one or more divisions of the trigeminal nerve unrelated to any identifiable traumatic cause. STUDY DESIGN Nine patients with trigeminal neuropathy were examined. Each patient underwent a standard protocol of examination and hematologic, serologic, radiologic, and histopathologic investigations, as appropriate. RESULTS Trigeminal neuropathy was found to be secondary to distant malignancy in 4 patients and to connective tissue disease in 2 patients. In each of 3 other patients, there was no obvious cause for the neuropathy. Patients with malignancy as the cause of their neuropathy tended to have involvement of more than one division of the trigeminal nerve and/or other neurologic features. CONCLUSIONS Trigeminal sensory neuropathy may herald underlying distant malignancy or connective tissue disease. Anesthesia and paresthesia of the orofacial region are therefore serious clinical symptoms that must be carefully investigated before a diagnosis of idiopathic disease is made.

Effect of visual impairment upon oral health care: a review

The incidence of visual impairment is increasing globally and in the United Kingdom due to local and systemic disease, medical advances, and the increasing age of population groups. Despite there being a large number of people resident in the UK with a visual impairment, there is little information available regarding the dental health care and needs of such individuals. As reported in other groups of patients with special needs, many individuals with a visual impairment may only seek oral health care when a problem arises, such as pain. Visual impairment may have a negative effect upon oral hygiene with many blind and partially sighted individuals having worse oral hygiene than sighted peers. This review article was undertaken to examine the literature relating to visual impairment, oral health and dental care. This article will discuss the dental aspects of visual impairment, its implications for obtaining dental care, associated oral conditions and medical complications.

Melanocanthoma a rare cause of oral hyperpigmentation

The oral features of a black woman with melanocanthoma of the oral mucosa are detailed, and the current literature of melanocanthoma of the oral mucosa is briefly reviewed.

Dentistry for those requiring special care.

Individuals with special needs, namely those whose dental care is complicated by a physical, mental or social disability, often have a higher level of unmet dental need and poorer oral hygiene than the general population, and offer unique challenges to the dental practitioner. This paper outlines the dental management of the three most common groups of individuals with special needs.

The oral management of oncology patients requiring radiotherapy, chemotherapy and/or bone marrow transplantation

Patients undergoing cancer therapy may experience unwanted side-effects involving the oral cavity and more evidence is emerging regarding the management of these complications. These oral effects have both short and long-term implications. Dentists need to be aware of these implications and liaise closely with the oncology teams to establish pathways of oral care. This enables patients to have appropriate dental support in place before, during and after cancer therapy. This article is an executive summary of a review undertaken for a national clinical guideline, The Oral Management of Oncology Patients following Radiotherapy, Chemotherapy and/or Bone Marrow Transplanation. The full text is available on the FDS website: www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/