Multiple Myeloma with primary manifestation in the mandible: a case report

Multiple myeloma is a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions in the vertebrae, ribs, pelvic bone, skull and jaw. We report on a clinical case of an 81-year-old male patient who presented with a tumefaction in the mandibular symphysis region, which had evolved over the previous seven months. In the radiographic examination, an extensive osteolytic lesion was observed in the region mentioned above. An incisional biopsy was performed and a histopathological study revealed a malignant hematopoietic neoplasm formed by plasmacytoid cells. During the bone gammagraphy a dissemination of the disease was detected in the scapula, clavicle and ribs. The diagnosis was multiple myeloma. Knowledge about the maxillofacial manifestations of multiple myeloma is important for the early diagnosis of the disease, since its primary form can manifest itself in the jaw. In the clinical case presented here, we highlight the interdisciplinarity needed to obtain a diagnosis and treatment of multiple myeloma

Asociación de síndrome de boca ardiente con xerostomía y medicamentos

Objetivo: Identificar factores de riesgo para el síndrome de boca ardiente (SBA) a través de estudio de casos y controles. Material y métodos: Se realizó análisis cuantitativo del flujo salival total en reposo y estimulado; se registraron la xerostomía subjetiva, el consumo de medicamentos y los estados psicológicos de ansiedad y depresión en 40 pacientes con SBA y 40 controles. Resultados: El análisis ANOVA mostró diferencias significativas en las medias del número de medicamentos/día, número de medicamentos xerostomizantes/día, xerostomía subjetiva, ansiedad y depresión, entre los grupos estudiados. No se observaron diferencias significativas en las tasas de flujo salival en reposo y estimulado. El análisis de asociación Odds ratio determinó asociación del SBA con xerostomía y con el consumo de hipotensores y diuréticos. Conclusiones: Según los resultados de este estudio, se puede afirmar que el consumo de hipotensores y diuréticos fue un factor de riesgo para el padecimiento del SBA. La función de las glándulas salivales en los pacientes con SBA no está deteriorada.

Fragile X-syndrome: literature review and report of two cases

Fragile X-syndrome is caused by a mutation in chromosome X. It is one of the most frequent causes of learning disability. The most frequent manifestations of fragile X-syndrome are learning disability, different orofacial morphological alterations and an increase in testicle size. The disease is associated with cardiac malformations, joint hyperextension and behavioural alterations. We present two male patients aged 17 and 10 years, treated in our Service due to severe gingivitis. Both showed the typical facial and dental characteristics of the syndrome. In addition, we detected the presence of root anomalies such as taurodontism and root bifurcation, which had not been associated with fragile X-syndrome in the literature. In some cases these root malformations have been associated with other sex-linked congenital syndromes, though in none of the studies published in the literature have they been related with fragile X-syndrome. This syndrome is relevant due to its high prevalence, the presentation of certain oral and facial characteristics that can facilitate the diagnosis, and the few cases published to date

Patterns of primary growth increments in otoliths of Sparus aurata larvae in relation to water temperature and food consumption

Sparus aurata larvae reared under controlled water-temperature conditions during the first 24 days after hatching displayed a linear relationship between age (t) and standard length (SL): SL = 2.68 + 0.19 t (r2 = 0.91l). Increments were laid down in the sagittae with daily periodicity starting on day of hatching. Standard length (SL) and sagittae radius (OR) were correlated: SL(mm) = 2.65 + 0.012 OR(mm). The series of measurements of daily growth increment widths (DWI), food density and water temperature were analyzed by means of time series analysis. The DWI series were strongly autocorrelated, the growth on any one day was dependent upon growth on the previous day. Time series of water temperatures showed, as expected, a random pattern of variation, while food consumed daily was a function of food consumed the two previous days. The DWI series and the food density were correlated positively at lags 1 and 2. The results provided evidence of the importance of food intake upon the sagittae growth when temperature is optimal (20ºC). Sagittae growth was correlated with growth on the previous day, so this should be taken into account when fish growth is derived from sagittae growth rates.

Stafne bone cavity: a retrospective study of 11 cases

Objective: to describe the clinical and radiological characteristics of patients with Stafne bone cavity. Study design: a retrospective, observational study of 11 cases of Stafne bone cavity. After finding an imagine compatible with Stafne bone cavity in the Orthopantomograph® of 11 patients, a sialography of the mandibular gland was made in 3 cases, computerized tomography (CT) in 6 cases, and in 4 cases surgical intervention to confirm the diagnosis. Results: the average age was 51.5 years, predominantly males. The entity was diagnosed incidentally during a routine radiology in all cases. The sialography revealed glandular tissue within the defect, and the CT demonstrated the conservation of the lingual cortical and the peripheral origin of the lesion. Glandular tissue was found within the lesions of two of the patients who underwent surgery, and in the other two the cavity was empty. No progressive changes were found in any of the 11 cases. Conclusions: Stafne bone cavity was an incidental finding, presenting no evolutionary changes, and as such conservatory therapy based on periodic controls was indicated. Currently, complementary techniques such as CT are sufficient to establish a certain diagnosis.

Orofacial pain of cardiac origin: review literature and clinical cases

The most common types of orofacial pain originate at the dental or periodontal level or in the musculoskeletal structures. However, the patient may present pain in this region even though the source is located elsewhere in the body. One possible source of heterotopic pain is of cardiac origin. Objectives: Report two cases of orofacial pain of cardiac origin and review the clinical cases described in the literature. Study Design: Description of clinical cases and review of clinical cases. Results and conclusions: Nine cases of atypical pain of cardiac origin are recorded, which include 5 females and 4 males. In craniofacial structures, pain of cardiac origin is usually bilateral. At the craniofacial level, the most frequent location described is in the throat and jaw. Pain of cardiac origin is considered atypical due to its location, although roughly 10% of the cases of cardiac ischemia manifest primarily in craniofacial structures. Finally, the differential diagnosis of pain of odontogenic origin must be taken into account with pain of non-odontogenic origin (muscle, psychogenic, neuronal, cardiac, sinus and neurovascular pain) in order to avoid diagnostic errors in the dental practice as well as unnecessary treatments.

Myofascial pain associated to trigger points: A literature review. Part 2: Differential diagnosis and treatment

During the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus required in order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment.

Computer-aided system for morphometric mandibular index computation (Using dental panoramic radiographs)

Objective: We propose and validate a computer aided system to measure three different mandibular indexes: cortical width, panoramic mandibular index and, mandibular alveolar bone resorption index. Study Design: Repeatability and reproducibility of the measurements are analyzed and compared to the manual estimation of the same indexes. Results: The proposed computerized system exhibits superior repeatability and reproducibility rates compared to standard manual methods. Moreover, the time required to perform the measurements using the proposed method is negligible compared to perform the measurements manually. Conclusions: We have proposed a very user friendly computerized method to measure three different morphometric mandibular indexes. From the results we can conclude that the system provides a practical manner to perform these measurements. It does not require an expert examiner and does not take more than 16 seconds per analysis. Thus, it may be suitable to diagnose osteoporosis using dental panoramic radiographs

El autismo en el primer año

Actualmente es posible diagnosticar el autismo con un alto grado de fiabilidad entre los 18 meses y los 2 años. Sin embargo, los primeros síntomas ya están presentes mucho antes del diagnóstico. Ello ha dado pie a que se hayan llevado a cabo múltiples estudios, retrospectivos y prospectivos, orientados a detectar manifestaciones que faciliten un diagnóstico lo más precozmente posible. A partir de estas investigaciones se han podido detectar síntomas cuya aparición se sitúa entre los 6 y 12 meses. Aunque se ha visto que estos síntomas tienen un interés diagnóstico limitado, aportan información muy valiosa para la comprensión del autismo en el marco de los trastornos del neurodesarrollo, en el sentido de destacar un patrón evolutivo que en su inicio es común a diversos trastornos, pero que progresivamente va configurando un fenotipo específico.

Calidad de vida global en personas con demencia

Objetivo: Evaluar la calidad de vida (CV) global en personas con demencia e investigar las variables asociadas con la percepción subjetiva de la CV. Pacientes y métodos: Se llevó a cabo un estudio transversal en seis centros de Barcelona y Tarragona. Un total de 99 personas con demencia leve-moderada que vivían en casa con un cuidador conocido completaron una entrevista cara-cara que incluía información sociodemográfica, percepción del estado de salud, un listado de problemas crónicos de salud, sintomatología depresiva, estado funcional, aspectos positivos, sentido de la vida y satisfacción con las relaciones personales. La CV global se evaluó con la pregunta global del World Health Organization Quality of Life-BREF. Resultados: El 40,6% de los entrevistados consideró su CV como buena/muy buena. Los análisis univariados de regresión logística ordinal y binaria no mostraron asociación entre CV con datos sociodemográficos, gravedad de la demencia ni estado funcional, pero sí con las otras variables de estudio. Los análisis multivariados de la regresión logística ordinal y binaria mostraron que una mejor percepción de salud y mayor satisfacción con las relaciones personales se asociaban con mejor CV. Asimismo, en el análisis multivariado de regresión logística ordinal, mejor CV se asoció con un menor número de síntomas depresivos, y en el análisis de regresión logística binaria, con disfrutar de la vida y menor gravedad de la demencia. Conclusiones: Personas con demencia leve-moderada pueden informar sobre su CV y estados subjetivos. Además de los aspectos relacionados con la salud, aspectos positivos y las relaciones personales deberían evaluarse sistemáticamente en esta población.

Tratamiento del carcinoma de labio mediante braquiterapia de alta tasa de dosis

Dado los diferentes métodos terapéuticos para el cáncer de labio, el objetivo del presente estudio es valorar los resultados obtenidos en un grupo prospectivo de 28 pacientes afectos de carcinoma de labio tratados mediante moldes externos de braquiterapia de alta tasa de dosis. Tanto por la remisión completa que ocurrió en todos los casos, la buena tolerancia a la terapia, la ausencia de complicaciones y de recurrencias, la facilidad de empleo de los moldes, la precisión en el posicionamiento de la fuente en la repetición diaria del tratamiento y la seguridad que ofrece en cuanto a radioprotección, concluímos que esta terapéutica probablemente se convierta en la de uso habitual en los próximos años.

Analysis of the antibiotic prophylaxis prescribed by Spanish oral surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infection

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Comparative study of two needle models in terms of deflection during inferior alveolar nerve block

Objectives: The purpose of this study is to determine the possible differences in deflection between two needles of same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The initial working hypothesis was that greater deflection may be expected with larger internal gauge needles. Study design: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle was used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm or an XL Monoprotect® 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was systematically recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the practitioner performing the technique, and blood aspiration (either positive or negative). Results: 346 needles were used in total. 190 were standard needles (27-gauge x 35-mm needle with an internal gauge of 0.215 mm) and 156 were XL Monoprotect®. Incidence of deflection was observed in 49.1% of cases (170 needles) where 94 were standard needles and 76 XL Monoprotect®. Needle torsion ranged from 0º and 6º. Conclusions: No significant differences were recorded in terms of deflection and internal gauge, operator, patient-extraction side, the anesthetic technique involved and the number of bone contacts during the procedure

Complications of guided surgery and immediate loading in oral implantology: a report of 12 cases

Objectives: The growing interest in minimally invasive surgery, together with the possibility of fitting prostheses with immediate function, have led to the development of software capable of planning and manufacturing a surgical guide and prosthesis that can be placed upon conclusion of the implant surgery step. The present study evaluates the surgical and prosthetic complications of implant treatment with the guided surgery technique, together with patient comfort during and after treatment. Patients and methods: A retrospective observational study was made of 19 patients with partially or totally edentulous upper and/or lower maxillae, involving the placement of a total of 122 implants. All cases were planned and operated upon with the guided surgery technique. Results: A total of 122 implants were placed in 14 males and 5 females. The intraoperative surgical complications comprised a lack of primary stability, while the postoperative complications consisted of infections and a lack of implant osteointegration. Ten implants failed. The prosthetic complications in turn comprised loosening of the provisional prosthesis screws, prosthesis tooth fracture, and a lack of passive fit of the immediate prosthesis. The degree of patient satisfaction was evaluated using a verbal scale. Conclusions: Implant restoration with the guided surgery technique and immediate functional loading is a predictable procedure, provided patient selection and the surgical technique are adequate, affording lesser postoperative morbidity and increased patient satisfaction thanks to the immediate restoration of esthetics and function