Pedro Diz-Dios

Oral lichen planus: a clinical and morphometric study of oral lesions in relation to clinical presentation

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular or atrophic-erosive. Sixty-two OLP patients were studied to evaluate the clinical-pathologic characteristics of their OLP lesions and to investigate possible differences in their biological behavior. The most common clinical presentation was the reticular type (62.9% vs 37.1%). Atrophic-erosive presentations showed significantly longer evolution (chi square=4.454; p=0.049), more extensive lesions (chi square=16.211; p=0.000) and more sites affected than reticular ones (chi square=10.048; p=0.002). Atrophic-erosive OLP was more frequently found on the tongue, gingiva and floor of the mouth. No statistically significant differences could be identified between reticular and atrophic-erosive clinical presentations in terms of age, sex, tobacco habit, plasma cortisol level and depth of inflammatory infiltrate. We concluded that the classification of OLP lesions as reticular vs atrophic-erosive is a simple, easy to use classification that can identify clinical presentations with different biological behavior.

Use of chalazion forceps to ease biopsy of minor salivary glands.

INTRODUCTION Pathologic features of minor salivary glands are one of the six criteria for classification of Sjogren syndrome. The presence of one or more foci of 50 or more mononuclear cells within 4 mm of gland tissue is considered supportive of this diagnosis.1 Amyloidosis is diagnosed by demonstrating the presence of amyloid protein in the affected organ. It is possible to take biopsies of affected tissues from kidney, liver, or rectum. However, it causes far less morbidity to obtain a sample of tissue from minor salivary glands as a first step toward diagnosis of amyloidosis.2 Chalazion forceps (Moria Dugast, Paris, France) are used by ophthalmologists during chalazion excisions, but its particular design also makes the device useful for taking biopsies from mobile or oral tissues.3

Stomatology and odontology: perspectives of Spanish professors and senior lecturers in dentistry

The curricula of dental faculties in many countries of the European Union can be described as odontological. The faculties of some of the countries who have become and are becoming members of the European Community have traditionally educated dentists in the stomatological tradition. In 1987, the Spanish dental education system initiated movement from the stomatological model to the odontological. Both models have their respective strengths and weaknesses. This study surveyed professors and senior lecturers in Spains public dental faculties to assess their perspectives on 10 items related to the tension between the odontological and the stomatological approach to preparing dentists. Amongst other things, the results of the study indicate that the respondents believe the odontological model, with its emphasis on strengthening technical qualifications, may not prepare individuals for dental practice better than the stomatology tradition; and that the odontological model results in the loss of the strength of the stomatological model, that is, the strong foundation in clinical medicine. The suggestion is advanced that European dental educators consider revising the odontology curriculum to strengthen the education of dental students in clinical medicine. A curriculum in which dental and medical students share the first 3 years of study could accomplish this. It is further suggested that subsequent years in the curriculum be flexible enough for students to earn degrees in both dentistry and medicine, if desired. Such an approach is not inconsistent with the accepted profile and competencies of the European dentist.

Mandibular cortical indices on cone-beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates

OBJECTIVE To evaluate the mandibular cortical indices in osteoporotic women receiving oral bisphosphonates (oBPs). MATERIAL AND METHODS The study group included 46 Caucasian women aged over 55 years on treatment with oBPs for postmenopausal osteoporosis. Information recorded included age, weight, height, type of oBP, duration of treatment, comorbid conditions and coadjuvant medication. Forty-six age-matched Caucasian women with no known diagnosis of osteoporosis were selected as the control group. All participants underwent cone-beam computed tomography, and the mandibular cortical width (MCW) and the height from the inferior mandibular border to the mental foramen (MBMF) were measured. RESULTS The MBMF was similar in the participants with osteoporosis and in controls. MCW was significantly greater in the participants with osteoporosis than in the controls (p < 0.001). CONCLUSION Mandibular cortical width should not be used to predict the risk of bisphosphonate-associated osteonecrosis of the jaws.

Minor salivary gland biopsy in Sjögren's syndrome: a review and introduction of a new tool to ease the procedure

Objectives: To review the existing techniques for minor salivary gland biopsy (MSGB) in the lip and to suggest a new approach to ease the procedure and reduce post-operative complications. Study Design: A comprehensive literature review and a descriptive study of a new surgical technique. Results: Diverse incisions have been suggested for MSGB with different designs (ellipse, circular, linear), different directions (parallel, oblique, vertical) and a wide range of lengths (from 1 mm up to 3 cm), but no comparative studies supporting the advantages of a particular type of incision over the others could be retrieved. A variety of features of the existing techniques for MSGB are linked to undesired events and surgical complications which could be minimized by modifying certain aspects of these procedures. The technique described, together with the use of the S forceps, represents a significant improvement over the already described chalazion forceps because it allows for a better access and positioning of the lower lip, improves the ergonomic conditions of the assistant, and facilitates the identification of lip areas with more superficial gland lobules. Conclusions: The suggested approach for lip MSGB includes a specifically designed instrument whose performance during lip biopsy may contribute to minimize post-operative complications. Key words:Sjögren’s syndrome, diagnosis, minor salivary gland biopsy, surgical technique, lower lip.

Criteria for the prescription of oral bisphosphonates for the treatment of osteoporosis in a series of women referred for tooth extraction

Objective: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. Study design: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I C-telopeptide (CTX) levels were measured. Results: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml. Conclusion: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis. Key words:Osteoporosis, oral bisphosphonates, osteonecrosis of the jaws.

Timing of Oral Cancer Diagnosis: Implications for Prognosis and Survival

Oral cancer has become a global health problem (Parkin, 2005; Gillison, 2007) and its increasing incidence and mortality rates are particularly relevant in certain parts of Europe (France, Hungary, Spain and Croatia), Brazil, and South-Eastern Asia (Sri Lanka, Pakistan, Bangladesh and India) (Warnakulasuriya, 2009). These geographical variations seem to reflect disparities in tobacco, areca nut and alcohol consumption (Warnakulasuriya, 2009). Worldwide, oral cancer has one of the lowest survival rates that remains unaltered despite recent therapeutic advances. Young adults seem to be growingly affected by tongue cancer in Brazil, several European countries and USA (Llewellyn, 2004). However, current reports describe a trend –more marked for tongue carcinomastowards improved survival at each stage and at all ages but ≥75 years (Pulte, 2010).

Does Tumour Biological Behaviour Influence Prognosis More than Diagnostic Delay in Oral Cancer

Worldwide, oral cancer has one of the lowest survival rates (lethal disease for over 50% of cases diagnosed annually) and remains unaffected despite recent therapeutic advances. Unfortunately, almost half of the oral cancers are diagnosed at stages III or IV, probably due to delays in reaching a definitive diagnosis. Many preventive approaches (secondary prevention) have been designed assuming the logical hypothesis that the longer the diagnostic delay, the more advanced the cancer and the worse the prognosis. However, a number of studies failed to prove this association or even found an inverse relationship. We hypothesize that tumour’s biological heterogeneity in terms of aggressiveness may explain shorter delays linked to advanced stages and bad prognosis. The assumption of this hypothesis would entail favouring oral cancer and precancer screening strategies at the preclinical stage of the disease, and therefore strategies of opportunistic screening for oral cancer and precancer on asymptomatic at risk population should be reinforced.