 |
ORAL PATHOLOGY
|
|---|
Bisphosphonate-associated osteonecrosis of the jaw: does it occur in children?
Brown JJ, Ramalingam L, Zacharin MR. Clin Endocrinol (Oxf) 2008;68(6):863–867.[Medline]
Adults treated with bisphosphonates are at risk of experiencing osteonecrosis of the jaw (ONJ). Since bisphosphonates are accepted treatment for various bone disorders in children and adolescents, the authors conducted this cohort study to investigate whether ONJ also occurs in pediatric patients, with special reference to patients who have undergone an invasive dental procedure while receiving the drug. The authors present data for 42 patients, most of whom had osteogenesis imperfecta. The patients had a mean (standard deviation) bisphosphonate treatment period of 6.5 (2.7) years and age of 8.25 (4.1) years at the start of treatment; the mean number of bisphosphonate infusions was 29.6. The investigators obtained a dental treatment history for each patient and determined his or her oral health status via panoramic radiographs and an oral examination. None of the patients had evidence of ONJ. Eleven patients underwent an invasive dental procedure during the time they were receiving bisphosphonate treatment, including dental extractions and surgical exposure of permanent teeth, without postoperative complications. Although none of the pediatric patients in this cohort developed ONJ, until additional safety data are available, the authors advise completing necessary dental and oral surgical treatment before the start of bisphosphonate therapy, as well as conducting ongoing dental surveillance in consultation with the treating physician to reduce any potential risk of ONJ.
Significance.
This study is not definitive because of its small sample size and limitation to a patient population at a single clinical site. However, it calls attention to the fact that pediatric patients with certain bone disorders may be treated with bisphosphonates and to the need for coordination of treatment with the patient’s physician to minimize the risk of oral complications.
|
ORAL/SYSTEMIC DISEASE CONNECTION
|
|---|
Bacteremia associated with toothbrushing and dental extraction
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Circulation 2008;117(24):3118–3125.[Abstract/Free Full Text]
The authors conducted this prospective, controlled study to compare bacteremias associated with dental procedures at the extremes of invasiveness—namely, toothbrushing and single-tooth extraction. They randomly assigned 290 subjects needing the extraction of at least one erupted tooth who satisfied study inclusion and exclusion criteria into three groups: tooth-brushing; single-tooth extraction with amoxicillin prophylaxis following American Heart Association recommendations; or single-tooth extraction with placebo. Subjects in the toothbrushing group brushed all surfaces of their teeth adjacent to the gingivae with a new toothbrush without dentifrice for a timed two minutes, with 30 seconds allotted to each of the maxillary and mandibular quadrants. The tooth extractions were performed one hour after subjects ingested amoxicillin or placebo. The investigators obtained a baseline blood sample and subsequent samples at 1.5 and five minutes after the initiation of surgery or toothbrushing and at 20, 40 and 60 minutes after the conclusion of the procedure. They identified and quantified bacteria in the blood samples by using culture and/or polymerase chain reaction methods, focusing on 32 oral bacterial species known to cause infectious endocarditis. With the exception of one patient, all the baseline blood cultures were negative. The investigators found a significant difference (P < .05) in incidence of positive cultures of endocarditis-associated organisms among the three groups for the 1.5-minute through the 40-minute samples. The highest incidence of positive cultures was found during the first five minutes of the procedure (samples two and three), with 19 percent, 33 percent and 58 percent, respectively, of the toothbrushing, extraction-amoxicillin and extraction-placebo groups being positive for bacteria. Although for most of the subjects with bacteremia (93 percent) the duration of bacteremia was less than 20 minutes, the extraction-placebo group had a significantly greater number of positive cultures at 20 minutes (10 percent) than did the other two groups (1 percent) (P = .001), with this pattern persisting to 40 minutes. In addition, 5 percent of subjects in the extraction-placebo group and 2 percent in the toothbrushing group still had bacteremia at 60 minutes. All of the analyzed samples had fewer than 104 colony-forming units per milliliter of blood.
Significance.
The investigators in this study used a sensitive method of detecting bacteria, and the results provide an indication of the comparative risk of infective endocarditis resulting from invasive procedures such as tooth extraction and routine activities such as toothbrushing. The authors note that even though amoxicillin had a significant impact on bacteremia associated with dental extraction, a sizable number of patients in the extraction-amoxicillin group still developed bacteremia. This study’s results confirmed that daily activities such as toothbrushing may place people susceptible to infectious endocarditis at risk and support the need for emphasis on oral disease prevention for susceptible patients.
|
ORAL PHYSIOLOGY
|
|---|
Involvement of sensory input from anterior teeth in deglutitive tongue function
Yagi S, Fukuyama E, Soma K. (published online ahead of print May 31, 2008). Dysphagia 2008.
The authors conducted this study to determine whether sensory inputs from the anterior teeth affect tongue pressure during swallowing, given that previous findings showed that peripheral sensory information from certain regions of the oral mucosa modulates tongue movement. They enrolled eight healthy volunteers, four male and four female, aged 26 to 31 years, who had a complete dentition except for third molars, as well as an "acceptable" occlusion. They monitored tongue pressure on the palate from anterior to posterior by using an eight-channel sensor held in place by a custom-made palatal plate. The authors measured the following parameters at each of the eight locations while each subject swallowed 10 milliliters of water 10 times, before and after administration of local anesthetic by means of interligamental injection to the maxillary and mandibular incisors and cuspids: time to tongue-pressure onset, time to maximum pressure, time to pressure release, duration of tongue pressure, maximum pressure exerted and "pressure integral" (area under the duration of pressure/maximum pressure curve) during swallowing. The authors found that deprivation of sensory input from the anterior teeth resulted in decreases in maximum tongue pressure and the pressure integral, especially at the anterior palate, and an increase in the duration of tongue pressure during swallowing. These findings indicate that sensory input from periodontal mechanoreceptors of anterior teeth, and possibly from the gingivae as well, can provide feedback that modulates the neurophysiologic control of tongue movement during swallowing.
Significance.
The role of the tongue during swallowing is complex and affects movement of the food bolus in both the oral and the pharyngeal phase. This study’s results suggest that changes involving anterior teeth, such as tooth extraction, may have an indirect effect on oral function in addition to the more obvious effects on appearance and speech.
|
ORAL PATHOLOGY
|
|---|
Malignant tumors of intraoral minor salivary glands
Copelli C, Bianchi B, Ferrari S, Ferri A, Sesenna E. Oral Oncol 2008;44(7):658–663.[Medline]
The American Cancer Society estimates that the minor salivary glands account for approximately 10 to 15 percent of oral cancers. The authors conducted this retrospective study of 43 minor salivary gland cancers treated across a 10-year period to identify factors affecting treatment outcome. The patients’ ages at the time of diagnosis ranged from 15 to 83 years, with a mean age of 53.9 years, and the majority of lesions (65.1 percent) were diagnosed when the patients were between the ages of 41 and 60 years. The lesions occurred most frequently in the palate (53.5 percent of lesions), with the remainder distributed among the retromolar region, floor of the mouth, alveolar mucosa, tongue, lip, cheek and mandible. The tumors typically manifested as a mass ranging from 0.5 to 8.0 centimeters in diameter, either asymptomatic and discovered during a routine oral examination or associated with slight-to-moderate intermittent pain. The tumors most frequently were diagnosed as adenoid cystic carcinoma (60.6 percent) and mucoepi-dermoid carcinoma (27.9 percent). At the time of diagnosis, 12 patients had early-stage lesions and 31 had late-stage lesions, with cervical lymph node metastasis present in eight patients and more distant metastases present in four patients. Treatment consisted of surgery and radiation (20 patients), surgery alone (14 patients) or surgery, radiation and neck dissection (nine patients). During the 24- to 132-month follow-up period, 12 patients died as a result of their disease, seven of distant metastases and five of local recurrence. All patients with early-stage tumors were alive at the end of the study, compared with 87.1 percent, 61.2 percent and 56.8 percent of patients with late-stage tumors at two years, five years and 10 years, respectively. Patients with low-grade mucoepidermoid carcinoma had the best survival rates. The authors present a detailed histologic and clinical description of findings that may have affected survival rates and note that their data confirm the importance of the American Joint Committee on Cancer’s staging criteria for oral squamous cell carcinoma in establishing a prognosis for survival and tumor control.
Significance.
It has been estimated that there are as many as 750 to 1,000 minor salivary glands distributed throughout the mouth. Although minor salivary gland tumors occur less frequently than do other forms of oral cancer, such as squamous cell carcinoma, the large number of potential lesion sites—and, in many cases, the lack of associated symptoms—can confound a clinical differential diagnosis. Results of this study reinforce the need to recognize that, while they are relatively rare, minor salivary gland carcinomas can produce significant morbidity and mortality and, as in the case of any malignancy, need to be detected and treated as early as possible.
TOP
ORAL PATHOLOGY
ORAL/SYSTEMIC DISEASE CONNECTION
