Ramesh Balasubramaniam

Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health interventions.

Aspiration pneumonia is a leading cause of morbidity and mortality of elderly residents in long-term care facilities. The microflora present in the oral cavity because of poor oral hygiene has been associated with aspiration pneumonia. There is evidence that improved oral care can reduce the risk of developing aspiration pneumonia in the elderly. The purpose of this paper is to review aspiration pneumonia and provide oral health care guidelines in an effort to help reduce the risk of aspiration pneumonia in the elderly residing in long-term care facilities.

Pharmacologic Management of Temporomandibular Disorders

Although there are theoretically numerous pharmacologic targets for relieving temporomandibular disorder (TMD)-associated pains, evidence-based literature clearly establishing the efficacy and safety of drugs in the TMD population is limited at best. This article reviews the pharmacology, toxicology, and research supporting the use of a host of pharmacologic agents that have been used in patients who have TMD, including nonsteroidal anti-inflammatory drugs, corticosteroids, benzodiazepines, nonbenzodiazepine sedative hypnotics, opioids, skeletal muscle relaxants, capsaicin, transdermal lidocaine, antidepressants, and anticonvulsants. Recommendations regarding the proper use of each drug class are also made.

Oromandibular dystonia revisited: a review and a unique case.

Oromandibular dystonia (OD) is a focal dystonia whereby repetitive or sustained spasms of the masticatory, facial, or lingual muscles result in involuntary, and possibly painful jaw opening, closing, deflecting, retruding, or a combination of the above. 1-3,4 There have been numerous publications since the French neurologist Henry Meige published this condition in 1910. Nevertheless, OD is often misdiagnosed and subsequently patients are managed incorrectly by dentists. The diagnosis of dystonia and the distinction between the different focal types are purely clinical and can be affected by several factors, including the circumstances of the examination, the psychologic status of the patient, and the attitude of the observer. The diagnosis of OD may well challenge 6 the astute clinician. This is primarily due to the numerous forms and severities in the presentation of OD. In particular, the diagnosis is elusive in selected patients with unrecognized triggers, presenting during periods of quiescence. There is an absence of a gold standard (a diagnostic test or biomarker) for validity of the diagnosis, and therefore the different types of focal dystonia cannot be assessed. 8 Misdiagnosis commonly includes temporomandibular disorders (TMD) such as bruxism or spontaneous condylar disloca tion, hemimasticatory or hemifacial spasms, 13

Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma

Burning mouth syndrome (BMS) is characterized by burning pain in the tongue or other oral mucous membrane often associated with symptoms such as subjective dryness of the mouth, paraesthesia and altered taste for which no medical or dental cause can be found. The difficulty in diagnosing BMS lies in excluding known causes of oral burning. A pragmatic approach in clarifying this issue is to divide patients into either primary (essential/idiopathic) BMS, whereby other disease is not evident or secondary BMS, where oral burning is explained by a clinical abnormality. The purpose of this article was to provide the practitioner with an understanding of the local, systemic and psychosocial factors which may be responsible for oral burning associated with secondary BMS, therefore providing a foundation for diagnosing primary BMS.

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

The purpose of this review is to provide guidelines for the use of oral appliances (OAs) for the treatment of snoring and obstructive sleep apnoea (OSA) in Australia. A review of the scientific literature up to June 2012 regarding the clinical use of OAs in the treatment of snoring and OSA was undertaken by a dental and medical sleep specialists team consisting of respiratory sleep physicians, an otolaryngologist, orthodontist, oral and maxillofacial surgeon and an oral medicine specialist. The recommendations are based on the most recent evidence from studies obtained from peer reviewed literature. Oral appliances can be an effective therapeutic option for the treatment of snoring and OSA across a broad range of disease severity. However, the response to therapy is variable. While a significant proportion of subjects have a near complete control of the apnoea and snoring when using an OA, a significant proportion do not respond, and others show a partial response. Measurements of baseline and treatment success should ideally be undertaken. A coordinated team approach between medical practitioner and dentist should be fostered to enhance treatment outcomes. Ongoing patient follow-up to monitor treatment efficacy, OA comfort and side effects are cardinal to long-term treatment success and OA compliance.

Update on Oral Herpes Virus Infections

Oral herpes virus infections (OHVIs) are among the most common mucosal disorders encountered by oral health care providers. These infections can affect individuals at any age, from infants to the elderly, and may cause significant pain and dysfunction. Immunosuppressed patients may be at increased risk for serious and potential life-threatening complications caused by OHVIs. Clinicians may have difficulty in diagnosing these infections because they can mimic other conditions of the oral mucosa. This article provides oral health care providers with clinically relevant information regarding etiopathogenesis, diagnosis, and management of OHVIs.

Burkitt lymphoma of the oral cavity: an atypical presentation

Burkitt lymphoma (BL) is an aggressive form of non-Hodgkin B-cell lymphoma with 3 variants: endemic, sporadic, and immunodeficiency-associated types. The sporadic form, most commonly involving the abdomen and ileocecal region, presents as an abdominal mass, rarely presenting in the orofacial region. A 36-year-old Indian female presented to the Hospital of the University of Pennsylvania for evaluation of a persistent intraoral swelling ulceration of the lower right mandibular alveolar ridge with minimal bony invasion. Progressive systemic symptoms of fatigue, weakness, and fever developed without resolution following treatment for a presumed odontogenic infection in the 4 weeks before presentation. An incisional biopsy revealed a diffuse proliferation of intermediate- to large-sized lymphocytes with multiple small peripheral nucleoli, scant cytoplasm, and nuclear pleomorphism. Nearly all cells displayed Ki67 expression. A final diagnosis of BL was rendered following confirmation of a cMYC translocation by fluorescence in situ hybridization. This article presents a case of the sporadic form of BL with atypical presentation clinically and morphologically, primarily involving the oral soft tissue.

Drug therapy in Alzheimer disease: an update for the oral health care provider

Alzheimer disease (AD) is a progressive neurologic disorder that manifests as memory loss, personality changes, global cognitive dysfunction, and functional impairment. As the United States population continues to age, the prevalence of AD will rise. Accordingly, oral health care providers will be more likely to treat patients affected by this disease; therefore, it is necessary to understand the pharmacologic agents used for the management of AD. This article provides an update of the available drug therapies for AD and discusses their implications on the oral and dental health of patients.

Oral health considerations in muscular dystrophies

Muscular dystrophies (MD) are a heterogeneous group of inherited neuromuscular disorders characterized by muscle necrosis and progressive muscle weakness. It is important for oral healthcare providers to be familiar with MD as special considerations are necessary to provide appropriate and safe dental care for these medically complex patients. This article briefly reviews the more common types of MD, namely, Duchenne MD, Becker MD, Emery-Dreifuss MD, facioscapulo-humeral MD, limb-girdle MD, oculopharyngeal MD, and myotonic dystrophy. Aspects of their epidemiology, pathophysiology, clinical presentation, diagnosis, and medical management as well as oral health considerations are discussed.

Orofacial Pain Syndromes: Evaluation and Management

Patients will often visit their primary medical practitioner with orofacial pain complaints. Hence, it is important to recognize and have an understanding of these conditions to properly evaluate and potentially manage these disorders. If the practitioner is uncertain or uncomfortable with these conditions, then patient referral to a knowledgeable health care practitioner should be considered for further evaluation and management. In this article, the evaluation and management of various neuropathic, neurovascular, and vascular pains are discussed.