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ABSTRACT: Objective: To review the pseudotumors and tumors of the temporomandibular joint (TMJ) published in journals included in Journal Citation Reports (JCR), and to evaluate whether there are clinical and radiological signs capable of differentiating between pseudotumors and tumors and between malignant and benign tumors. Material and methods: A systematic Medline search was made of clinical cases of tumors and pseudotumors of the TMJ covering a 20-year period and published in journals included in JCR. Only cases with histological confirmation were included. A description is provided of the general characteristics of TMJ tumors, with comparison of the clinical, diagnostic, therapeutic and evolutive variables referred to pseudotumors, benign tumors and malignant tumors. Results: We identified 285 TMJ tumors published in 181 articles of 15 journals. The most frequent lesions were pseudotumors (synovial chondromatosis, pigmented villonodular synovitis, eosinophilic granuloma and osteochondroma). The mean age was 42 years and one month ± 16 years and two months. Tumors were more common in females. The mean time from symptoms onset to consultation was 30 months and 8 days ± 41 months and 9 days, and almost 19.6% of the cases initially had been diagnosed and treated as TMJ dysfunction. The most frequent clinical manifestations were pain, swelling and the limitation of joint movements. The most common radiological findings in the case of benign and malignant lesions were radiopacities and radiotransparencies, respectively. No panoramic X-ray alterations were observed in 14.6% of the benign tumors and in 7.7% of the malignant lesions. Surgery was the usual form of treatment. Sequelae were recorded in 18.2% of the cases, with tumor relapse in 9.1%. The four-year survival rate in the case of malignant tumors was 72.2%.
Medicina oral, patologia oral y cirugia bucal 02/2013;
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ABSTRACT: Trigeminal neuropathy is most often secondary to trauma. The present study explores the underlying causes and the factors that influence recovery.
A retrospective case study was made involving 63 patients with trigeminal neuropathy of traumatologic origin, subjected to follow-up for at least 12 months.
Fifty-four percent of all cases were diagnosed after mandibular third molar surgery. In 37 and 19 patients the sensory defect was located in the territory innervated by the mental and lingual nerve, respectively. Pain was reported in 57% of the cases, and particularly among the older patients. Regarding patient disability, quality of life was not affected in three cases, while mild alterations were recorded in 25 subjects and severe alterations in 8. Partial or complete recovery was observed in 25 cases after 6 months, and in 32 after one year. There were few recoveries after this period of time. Recovery proved faster in the youngest patients, who moreover were the individuals with the least pain.
Our patients with trigeminal neuropathy recovered particularly in the first 6 months and up to one year after injury. The older patients more often suffered pain associated to the sensory defect. On the other hand, their discomfort was more intense, and the patients with most pain and the poorest clinical scores also showed a comparatively poorer course.
Medicina oral, patologia oral y cirugia bucal 12/2011; 17(2):e297-300.
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ABSTRACT: To determine whether a series of diseases of the oral mucosa - Sjögren syndrome, ectodermal dysplasia, epidermolysis bullosa and lichen planus - reduce the survival rate of dental implants.
A Medline search was carried out using the key words: " Sjögren syndrome ", "ectodermal dysplasia ", "epidermolysis bullosa ", "lichen planus " and "dental implants ", including those publications involving clinical series comprising more than one patient with the mentioned disorders and treated with dental implants, in the last 10 years.
The study included three articles involving patients with Sjögren syndrome subjected to dental implant treatment, representing a total of 12 patients and 86 implants, with a mean pondered success rate of 86.33%. As regards ectodermal dysplasia, we included 14 articles, of which 11 corresponded to clinical series, two were reviews and one constituted a survey of dental professionals. The percentage success rate of the implants varied between 35.7-100%. In relation to epidermolysis bullosa, we included 6 articles corresponding to clinical series, with a total of 16 patients and 92 implants, and a success rate between 75-100%. In the case of oral lichen planus we found only two articles corresponding to clinical case series, with a total of 5 patients and 14 implants, and an implant survival rate of 100%.
Based on our review of the literature, dental implant rehabilitation in patients of this kind is seen to be a valid treatment option, with a high percentage success rate. Long-term patient follow-up is essential in order to periodically monitor the condition of the disease and of the implants.
Medicina oral, patologia oral y cirugia bucal 01/2011; 16(6):e787-93.
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ABSTRACT: Erythema multiforme (EM) is an acute disorder of the skin and mucosal membranes manifesting in the oral cavity (60-70% of all patients) as polymorphic erosive, ampullar, and bloodstained crusts. The etiology is unclear, although an autoimmune mechanism is involved. Infections and drugs have been implicated in the etiopathogenesis. With the exception of corticosteroids, no specific treatment for EM is available.
Data were collected on the clinical manifestations, antecedents of viral infection, and the use of drugs substances as possible etiological factors, treatment, and response to topical and systemic corticotherapy.
A total of 22 patients were studied (14 males and 8 females), with a mean age of 47±20.4 years. A relationship was clearly suspected between drug use and lesion outbreak in 6 patients (27.2%). On the contrary, in 7 patients (31.8%) the triggering factor could have been herpes virus infection (herpes labialis). One half of the patients (11 cases) were classified as presenting minor EM, 36.4% (8 cases) presented major forms of the disease, and 13.6% (3 cases) were classified as corresponding to Stevens-Johnson syndrome. Systemic and/or topical corticosteroids proved effective in controlling the outbreaks in all of our patients.
The oral mucosa is the most affected mucosal region in EM, with a predilection for the lip mucosa, erosive forms and bloodstained crusts. Systemic corticosteroids are effective in controlling the outbreaks, although their use as maintenance therapy is not clearly indicated.
Journal of Oral Pathology and Medicine 11/2010; 39(10):747-52. · 1.63 Impact Factor
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ABSTRACT: Aneuploidy has been associated with malignant and premalignant oral lesions. In the past few years, its application in oral precancerous lesions and its prognostic meaning have been controversial issues. The aim of our study was to characterize alterations in DNA content by automated DNA image cytometry in oral scrapings of patients with oral lichen planus.
Cytological samples from 40 patients clinicopathologically diagnosed with oral lichen planus were analysed by DNA image cytometry.
All the cases were classified as diploid, showing a predominant population of cells with normal DNA content (DNA index, 0.85-1.15). Atrophic/erosive lesions showed a higher percentage of tetraploid cells when compared with reticular/papular lesions but this was not statistically significant (P = 0.09).
Aneuploidy does not seem a common event in oral lichen planus lesions. However, we consider that the use of DNA image cytometry of oral scrapings may be an easy and helpful methodology in the follow-up of patients with these lesions.
Cytopathology 05/2010; 22(2):106-10. · 1.59 Impact Factor
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ABSTRACT: To determine the changes in smoking habit among patients with oral squamous cell carcinoma (OSCC) diagnosed and treated in the Service of Stomatology (Valencia University General Hospital. Valencia, Spain).
The study involved 123 patients with a history of OSCC interviewed by telephone on their smoking habits at the time of the diagnosis and modifications in habits subsequently. The mean age at diagnosis was 60 years and 9 months (standard deviation, SD +/- 12 years and 2 months). Males predominated (61.8%) over females (38.2%). The mean time from the diagnosis of OSCC to the survey was 4 years and 6 months (SD +/- 3 years and 6 months).
Almost one-half of the patients (45.5%) were active smokers at the time of the diagnosis, with a mean duration of the habit of 34.9 years (SD +/- 12 years and 7 months). In turn, 19.5% of the patients were ex-smokers at diagnosis, with an average of 13 years and 9 months (SD +/- 9 years and 4 months) from smoking cessation to the development of cancer. A total of 57.1% of the smokers abandoned the habit at diagnosis, 8.9% continued to smoke to the same extent as before, and 33.9% reduced smoking.
A full 44.4 % of our patients diagnosed with OSCC continued to smoke despite warnings of the risks, and although the majority claimed to have reduced their smoking habit, interventional strategies would be indicated to help ensure complete smoking cessation.
Medicina oral, patologia oral y cirugia bucal 04/2010; 15(5):e721-6.
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ABSTRACT: Osteonecrosis of the jaw has been described in patients taking bisphosphonates after oral surgery procedures, including the placement of dental implants. This review is an update of the relationship between bisphosphonates and dental implants. Results obtained by different authors are compared, contrasting earlier studies where an improvement in implant osseointegration using bisphosphonates was observed, with ones where statistically significant differences were found, and more recent studies disagreeing with the use of bisphosphonates for causing necrosis of the jaw. The differing results obtained between animal studies and the situation observed in humans may be due to a short medication and follow-up period, as well as to the existence of few research studies where dental implants are placed in the oral cavity. Currently, dental implants are contraindicated in patients being treated with intravenous bisphosphonates. In 2007, the American Association of Oral and Maxillofacial Surgeons suggested guidelines for patients treated with oral bisphosphonates, based on the clinical situation of the patient and the length of treatment with the drug, and that greater caution prior and subsequent to surgery should be taken for three years after treatment. All patients treated with bisphosphonates must have the risk of possible loss of implants and the risk of suffering a bony necrosis of the operated jaw explained to them, and give their informed consent prior to dental implant surgery.
Medicina oral, patologia oral y cirugia bucal 08/2009; 14(7):E355-60.
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ABSTRACT: To investigate the prevalence and aetiology of bacteraemia following third molar extractions (B-TME), analysing the factors affecting its development.
The study group was formed of 100 patients undergoing third molar extractions under general anaesthesia. Peripheral venous blood samples were collected at baseline, 30 s after a mandibular third molar extraction and 15 min after completing the final extraction. Samples were inoculated into BACTEC aerobic and anaerobic blood culture bottles and were processed in the BacT/Alert. Subculture and further identification of the bacteria isolated was performed using conventional microbiological techniques.
The prevalence of bacteraemia following third molar surgery was 62% at 30 s after the first dental extraction and 67% at 15 min after finishing the final extraction. The bacteria most frequently identified in the positive blood cultures were Streptococcus viridans (87.9%).
In our series, the prevalence of B-TME at 30 s after a single third molar extraction was high, principally being of streptococcal aetiology, and was independent of the oral health status and the magnitude of the surgical procedure. Positive blood cultures persisted for at least 15 min after three to four dental extractions in a higher number of patients, questioning the supposedly transient nature of bacteraemia following dental extractions.
Oral Diseases 02/2008; 14(1):89-94. · 2.49 Impact Factor
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ABSTRACT: The postoperative course was excellent for this type of surgery, and the functional recovery was comparable to that obtained with much more laborious techniques.
To compare the advantages and disadvantages of the described technique and oropharyngectomy with labial mandibulotomy.
A total of 46 patients underwent surgery by means of an oropharyngectomy without mandibulotomy. The pharynx was reconstructed using a plasty made of four regional flaps.
In addition to obvious esthetic benefits, complications of the osteotomy were absent and surgical time was reduced. Some patients undergoing pull-through oropharyngectomy also underwent a marginal mandibulectomy, markedly reducing the frequency of radionecrosis compared with other statistics of techniques using mandibulotomy.
Acta Oto-Laryngologica 09/2007; 127(8):874-9. · 1.08 Impact Factor
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ABSTRACT: Trigeminal neuropathies (TNs) are well recognized disorders characterized and manifesting as skin and mucosal numbness in the region innervated by the trigeminal nerve. Facial numbness indicates trigeminal sensory alteration affecting the trigeminal system. TNs always pose differential location difficulties as multiple diseases are capable of producing them: they can be the result of traumatism, tumors, or diseases of the connective tissue, infectious or demyelinating diseases, or may be of idiopathic origin. Their importance is explained by the fact that TN may represent the first manifestation of tumor disease, or of relapse in patients with prior neoplastic processes. As such, these manifestations are ominous, and patient life expectancy is often short. The clinical exploration reveals a loss of sensitivity in the cutaneous territory corresponding to the affected nerve, which can be partial (hypoesthesia) or complete (anesthesia). The sensory defect is occasionally associated with hyperesthesia (i.e., the patient suffers a decrease in sensory perception, but when sensation is perceived, it may cause considerable discomfort). Complementary studies are needed to establish the etiologic diagnosis, with laboratory tests to discard the possible causative diseases underlying the trigeminal neuropathy, and the opportune radiographic examinations in the form of plain X-rays or a routine cranial computed tomography scan.
Oral Diseases 04/2007; 13(2):141-50. · 2.49 Impact Factor
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ABSTRACT: Rofecoxib is an inhibitor of the enzyme cyclo-oxygenase 2 (COX-2) used as an analgesic and anti-inflammatory agent especially in rheumatoid arthritis and osteoarthritis. The adverse effects are generally less than with other anti-inflammatory drugs (NSAIDs), and no oral adverse reactions have been reported in the literature. We present three cases of oral lesions caused by rofecoxib. Extensive erosions appeared, which in all cases resolved on withdrawal of the drug.
Oral Diseases 12/2004; 10(6):401-3. · 2.49 Impact Factor
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ABSTRACT: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia.
A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups.
Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage.
Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.
Oral Diseases 12/2004; 10(6):346-8. · 2.49 Impact Factor
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ABSTRACT: Oral lichen planus (OLP) is a frequent immunological chronic disease, having different clinical forms: asymptomatic and symptomatic. Symptomatic OLP has been palliated with topical corticosteroids with different levels of efficacy and safety. The purpose of this pilot phase II clinical trial was to determine the efficacy of mometasone furoate microemulsion upon the symptoms and signs of erosive-ulcerative OLP.
Forty-nine patients with clinical and histologically confirmed erosive-ulcerative OLP were enrolled in this study (36 women and 13 men). Their average age was 56.4 years (from 28 to 78). The treatment consisted of 0.1% mometasone furoate microemulsion mouthwash three times a day over 30 days. Pain, erythema and ulceration were assessed after 15 and 30 days of treatment. The data was processed and statistically analysed by student's t-test for paired samples.
Mometasone caused a statistically significant reduction in pain (3.58 vs. 0.65, P = 0.0000). Treatment significantly reduced the surface area of erythema (155.2 vs. 21.9 mm(2), P = 0.0001) and ulceration (30.7 vs. 7.3 mm(2), P = 0.0000). None of these patients suffered severe adverse effects.
Mometasone furoate microemulsion is a safe and effective therapy in the treatment of symptomatic erosive-ulcerative OLP.
Journal of Oral Pathology and Medicine 09/2004; 33(7):381-5. · 1.63 Impact Factor
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ABSTRACT: The possible malignant potential of oral lichen planus (OLP) is still controversial. We present three new oral lichen planus (OLP) patients who developed oral squamous-cell carcinoma (OSCC). In all cases, were analyzed variables like sex, age, clinical type, localization, extension, follow-up study and treatment, moreover were considered the patient's habits, localization, stage and treatment of cancer. The average age was 59 years and both of them were non smoker or with no alcohol habits. The follow-up period was greater than two years and the malignant lesion developed after mean of nine years, after the diagnosis of OLP had been established. Oral squamous-cell carcinoma (OSCC) arose on lesions previously diagnosed clinically and histologically as atrophic and erosive oral lichen planus in two of our patients and on a plaque lesion LP in a patient. All of them had been using topical corticoids before the cancer was diagnosed. The appearance of new cases of OLP malignization framed inside the established approaches, suggests the realization of new researches in order to determine the factors involved in this process.
Acta Otorrinolaringológica Española 02/2004; 55(1):41-4.
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ABSTRACT: To evaluate the presence of oral disease, as assessed by dental and periodontal indices, in the anterior maxilla of a group of 76 patients with leprosy, compared with a group of matched control subjects.
The study included 76 patients with leprosy (age range 40-82 years; 39 males), resident in the sanatorium of San Francisco de Borja de Fontilles (Alicante, Spain). Clinical examination was carried out to evaluate the decayed missing and filled index, and the periodontal status in the anterior maxilla, using the Löe-Silness dental plaque index, mean periodontal probing depth and the average periodontal attachment loss.
In the leprosy patients, a large proportion of maxillary incisors and canines were missing. The mean plaque index in leprosy was 2.35 +/- 0.7, with a probing depth of 2.96 +/- 0.8, and an average attachment loss of 4.18 +/- 1.3, indices all statistically greater than in controls. There were no differences detected in the oral indices measured according to the presence or absence of facial destruction or the type of leprosy.
Patients with leprosy show a tendency to poor dental and periodontal health, unrelated to the presence of facial destruction or the type of leprosy.
Oral Diseases 02/2004; 10(1):19-21. · 2.49 Impact Factor
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ABSTRACT: To study the prevalence of oral lesions in 35 patients diagnosed with generalized recessive dystrophic epidermolysis bullosa (RDEBg), with a quantification of their microstomia in comparison with a control group.
The presence of oral mucosal lesions and interincisal maximum oral aperture (MOA) was determined, classifying microstomia according to the method of Naylor, Douglass and Mix (1984).
Blister lesions were identified in 92% of the patients at the time of exploration--the tongue being the most affected location. Microstomia and palatal atrophy were the most prevalent sequelae (100%), while ankyloglossia, vestibular obliteration and lingual depapillation were recorded in over 90%. In 80% of the patients interincisal MOA was <30 mm (severe microstomia), while in the remaining cases maximum aperture was in the range of 31-40 mm (moderate microstomia).
Blister lesions were found throughout the oral mucosa in our series of patients with RDEBg, the most frequently affected location being the tongue. These lesions in turn led to invalidating sequelae such as microstomia and ankyloglossia.
Oral Diseases 10/2003; 9(5):264-8. · 2.49 Impact Factor
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ABSTRACT: Lichen sclerosus et atrophicus (LSA) is a chronic mucocutaneous inflammatory disorder of uncertain aetiology that is clinically characterized by the appearance of well delimited white plaques or papules, preferentially affecting the skin and genitals, and more rarely the oral cavity. We present the case of a woman with LSA limited to the oral cavity in the form of a well delimited, flat whitish lesion affecting the vestibular gingiva of the right upper incisors and left central incisor, and extending towards the vestibular fundus and frenulum of the upper lip. Widening of the periodontal space was observed, with gingival recession and attachment loss limited to these teeth. Local corticosteroid injections caused the mucosal lesion but not the periodontal alterations to resolve. Emphasis is placed on the importance of knowledge of this condition in relation to establishing a diagnosis, and on its periodontal repercussions.
Oral Diseases 12/2002; 8(6):310-3. · 2.49 Impact Factor
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Journal of Oral and Maxillofacial Surgery 11/2002; 60(10):1211-4. · 1.64 Impact Factor
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ABSTRACT: Leishmaniasis is a parasitic disease caused by a protozoon (Leishmania), with different clinical forms that are endemic in certain countries. The association of this disease in patients who are seropositive to human immunodeficiency virus (HIV) has recently been described. Leishmaniasis can develop in any stage of HIV infection, although the clinical manifestations - and hence the diagnosis - tend to coincide with the periods of maximum immune depression. We present the case of a HIV-positive, ex-intravenous drug abuser (in stage B2 of the CDC, 1992) with concomitant hepatitis C infection who presented with palatinal pain and bleeding for the past 2 months. Exploration revealed a vegetating tumoration of the hard palate. Hematoxylin-eosin and Giemsa staining of the biopsy confirmed the diagnosis of leishmaniasis. The definitive diagnosis was mucocutaneous leishmaniasis (MCL), for a bone marrow aspirate proved negative, and no further lesions could be established. The patient was treated with meglumine antimoniate (Glucantime), followed by improvement of the lesions.
Oral Diseases 02/2002; 8(1):59-61. · 2.49 Impact Factor
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ABSTRACT: We sought to evaluate the possible relationship between oral surgery and endodontic procedures and the subsequent appearance of cluster headache (CH) in 54 patients.
This study included 54 patients diagnosed and treated for episodic CH. The characteristics of pain, the extractions, and the endodontic procedures performed in the same or a contralateral quadrant were recorded and analyzed by using the chi-square test.
Prior tooth extraction or endodontics had been performed in the pain-affected quadrant in 58% of cases and in the contralateral quadrant in 33%. The differences between quadrants were statistically significant. After the onset of pain, extractions were performed in the affected quadrant in 44% of patients.
Although the appearance of pain after dental extraction could suggest a relationship between damage to the nerve supply and the development of CH, the possibility that dental extraction and endodontics may have been performed in response to CH-related pain must also be taken into account. With respect to the differential diagnosis of pain, it is easy for CH to be misdiagnosed as dental pulp pain.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 12/2001; 92(5):499-502. · 1.46 Impact Factor
