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Sample records for oral bisphosphonate-related osteonecrosis

  1. Oral cutaneous sinus tract, vertical root fracture, and bisphosphonate-related osteonecrosis: a case report.

    Science.gov (United States)

    Wigler, Ronald; Steinbock, Nelly; Berg, Tal

    2013-08-01

    Oral cutaneous sinus tracts (OCSTs) of dental origin are often initially misdiagnosed and inappropriately treated. Accurate diagnosis is especially important in cases of bisphosphonate (BP) therapy because extraction may lead to a risk of osteonecrosis. A case report of misdiagnosis related to a tooth with a vertical root fracture in an oncologic patient treated with BPs is reported here. In 2011, a 75-year-old woman was examined at the oral medicine clinic because of pain and swelling of the left submandibular area. The patient's medical history included oral and intravenous BP therapy because she was diagnosed with metastatic breast cancer and left maxillary stage 1 antiresorptive agent-induced osteonecrosis of the jaw. The lower left odontogenic region showed no signs or symptoms, and no apical pathosis was observed on imaging. Although antibiotics were applied, clinical symptoms worsened and an OCST appeared. Intravenous antibiotic treatment was pursued. Biopsy and direct smear from fistula were not conclusive. A diagnosis of a nonexposed variant of stage 3 antiresorptive agent-induced osteonecrosis of the jaw was established. Symptoms resolved after 2 weeks of antibiotic treatment and reappeared a month later. Endodontic examination revealed that the origin of the OCST was tooth no. 18 caused by a vertical root fracture, and the tooth was extracted. The patient was scheduled for routine checkups because of the fact that osteonecrosis may occur in intravenous BP-treated patients. Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and surgical intervention, which is not recommended in intravenous BP cases. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  2. Oral squamous cell carcinoma arising in a patient after hematopoietic stem cell transplantation with bisphosphonate-related osteonecrosis of the jaws.

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    Arduino, Paolo G; Scully, Crispian; Chiusa, Luigi; Broccoletti, Roberto

    2015-01-01

    A 55-year-old man with a history of acute myeloid leukaemia treated with hematopoietic stem cell transplantation and with a 5-year history of bisphosphonate-related osteonecrosis of the jaws, following 12 cycles of intravenous zoledronic acid therapy, presented in December 2009 with a history of increasingly severe unilateral lower jaw pain. Oral examination revealed, as previously, exposed bone in the left mandible, but also a new exophytic mass on the lower-left buccal mucosa. Biopsy confirmed a diagnosis of oral squamous cell carcinoma. To the best of our knowledge, this is the first report of an oral squamous cell carcinoma that appeared adjacent to an area of osteochemonecrosis.

  3. A case of early detection of bisphosphonate-related osteonecrosis of the jaw

    OpenAIRE

    Mori, Miyu; Koide, Tetsuro; Matsui, Yuriyo; Matsuda, Toru

    2015-01-01

    Osteonecrosis of the jaws is an adverse reaction associated with the use of bisphosphonates. Although the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is based on symptomatology, it is often detected late because the patients become symptomatic only after osteonecrosis is well established. We describe a case of early oral BRONJ detected by magnetic resonance imaging (MRI) accidentally. Head MRI revealed low signal of T1-weight images in left mandibula. Patient had been...

  4. Radiographic findings of bisphosphonate-related osteonecrosis of ...

    African Journals Online (AJOL)

    Objective: The aim of this study is to assess radiographic findings of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and to evaluate the efficiency of cone-beam computed tomography (CBCT) and panoramic radiography (PR) by comparing with each other. Materials and Methods: The data of 46 patients treated ...

  5. Bisphosphonate-related osteonecrosis of the jaw: specificities

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    Siri Paulo

    2014-09-01

    Full Text Available Bisphosphonate-related osteonecrosis of the jaws (BRONJ is a severe complication that has recently emerged in patients treated with intravenous bisphosphonates for malignant diseases. This complication usually presents after a minor local trauma during a dental treatment. Several etiopathogenic mechanisms of this pathological condition have been proposed, but no model can explain all morphological changes observed at the macroscopic and microscopic level. BRONJ is likely to be related to direct toxicity in the bone and soft tissue cells, due to nitrogen-containing bisphosphonates. This review elucidates the clinical indications and mechanism of action of bisphosphonates, reports some clinical diagnostic criteria for BRONJ, describe the histopathological criteria for BRONJ diagnosis, the potential triggering pathways and the available treatment strategies.

  6. Microscopic Evaluation of the Effect of Oral Microbiota on the Development of Bisphosphonate-Related Osteonecrosis of the Jaws in Rats

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    Felipe M. Silveira

    2017-01-01

    Full Text Available Objectives: Osteonecrosis of the jaws is a side effect associated with the use of bisphosphonates. Using histologic analysis, this study aimed to evaluate the influence of microbial colonies in the development of osteonecrosis in the jaws of rats subjected to nitrogenous and non-nitrogenous bisphosphonates, undergoing surgical procedures. Material and Methods: Thirty-four rats (Rattus norvegicus, Wistar strain were allocated randomly into three groups: 12 animals treated with zoledronic acid; 12 animals treated with clodronate; and 10 animals treated with saline. Sixty days after the start of treatment, the animals underwent three extractions of the upper right molars. After 120 days of drug administration, the rats were killed. Histologic analysis was performed on specimens stained with hematoxylin and eosin by the technique of manual counting points using Image-Pro Plus software on images of the right hemimaxilla. Results: Osteonecrosis was induced in the test groups. There was no statistically significant association between the presence of microbial colonies and the presence of non-vital bone (Kruskal-Wallis, P > 0.05. Conclusions: Use of zoledronic acid was associated with non-vital bone and the results suggested that the presence of microbial colonies does not lead to osteonecrosis.

  7. Bisphosphonate-related osteonecrosis of the jaw: historical, ethical, and legal issues associated with prescribing.

    Science.gov (United States)

    Faiman, Beth; Pillai, Aiswarya Lekshmi Pillai Chandran; Benghiac, Ana Gabriela

    2013-01-01

    The long-term effects of many drugs are unknown. Established risks are communicated to patients who participate in clinical trials during the informed consent process. However, unknown and unanticipated side effects of medications may occur years after treatment. Patients with metastatic bone cancer experience an imbalance between tumor cells and the bone marrow microenvironment. Increased cytokine release, osteoclastic activity, and uncoupled osteoblastic activity lead to weakened bone structure and osteolytic lesions. The bisphosphonates are a class of drugs available in IV and oral formulations to treat and prevent bone loss and decrease the risk of skeletal-related events. Intravenous bisphosphonates such as zoledronic acid and pamidronate disodium are approved by the US Food and Drug Administration for the treatment of bone pain and hypercalcemia of malignancy and the prevention of painful bone fractures in patients with metastatic bone cancer. Oral bisphosphonates such as alendronate, risedronate, and etidronate are used to reduce the risk of skeletal fractures in patients with osteoporosis and in breast cancer. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but painful complication of treatment characterized by infection, exposed bone, and poor wound healing. In this article, we discuss BRONJ and identify past, present, and future ethical and legal issues surrounding bisphosphonate administration.

  8. Bisphosphonate-Related Osteonecrosis of the Jaws. A Severe Side Effect of Bisphosphonate Therapy

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    Zuzana Janovská

    2012-01-01

    Full Text Available Bisphosphonates (BP are potent inhibitors of bone resorption used mainly in the treatment of metastatic bone disease and osteoporosis. By inhibiting bone resorption, they prevent complications as pathological fracture, pain, tumor-induced hypercalcemia. Even though patient’s benefit of BP therapy is huge, various side effects may develop. Bisphosphonate-related osteonecrosis of the jaws (BRONJ is among the most serious ones. Oncologic patients receiving high doses of BP intravenously are at high risk of BRONJ development. BPs impair bone turnover leading to compromised bone healing which may result in the exposure of necrotic bone in the oral cavity frequently following tooth extraction or trauma of the oral mucosa. Frank bone exposure may be complicated by secondary infection leading to osteomyelitis development with various symptoms and radiological findings. In the management of BRONJ, conservative therapy aiming to reduce the symptoms plays the main role. In patients with extensive bone involvement resective surgery may lead to complete recovery, provided that the procedure is correctly indicated. Since the treatment of BRONJ is difficult, prevention is the main goal. Therefore in high risk patients dental preventive measures should be taken prior to bisphosphonate administration. This requires adequate communication between the prescribing physician, the patient and the dentist.

  9. Osteomalacia: the missing link in the pathogenesis of bisphosphonate-related osteonecrosis of the jaws?

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    Bedogni, Alberto; Saia, Giorgia; Bettini, Giordana; Tronchet, Anita; Totola, Andrea; Bedogni, Giorgio; Tregnago, Paolo; Valenti, Maria Teresa; Bertoldo, Francesco; Ferronato, Giuseppe; Nocini, Pier Francesco; Blandamura, Stella; Dalle Carbonare, Luca

    2012-01-01

    Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented adverse event from treatment with nitrogen-containing bisphosphonates (NBPs). During a preliminary histomorphometric study aimed at assessing the rate of bone remodeling in the jaws of patients with surgically resected BRONJ, we found a defect of bone mineralization (unpublished data). We hypothesized that osteomalacia could be a risk factor for BRONJ in patients taking NBPs. Therefore, we looked for static and dynamic histomorphometric evidence of osteomalacia in biopsies from subjects with and without BRONJ. This case-control study used histomorphometric analysis of bone specimens of patients using NBPs (22 patients with BRONJ and 21 patients without BRONJ) who required oral surgical interventions for the treatment/prevention of osteonecrosis. Patients were given tetracycline hydrochloride according to a standardized protocol before taking bone biopsies from their jaws. Biopsies with evidence of osteomyelitis or necrosis at histology were excluded from the study. Osteomalacia was defined as a mineralization lag time >100 days, a corrected mean osteoid thickness >12.5 mm, and an osteoid volume >10%. In all, 77% of patients with BRONJ were osteomalacic compared with 5% of patients without BRONJ, according to histomorphometry. Because osteomalacia was found almost exclusively in NBP users with BRONJ, this is likely to be a generalized process in which the use of NBPs further deteriorates mechanisms of bone repair. Osteomalacia represents a new and previously unreported risk factor for disease development. This finding may contribute to a better understanding of the pathogenesis of this disease and help with the development of strategies to increase the safety of NBP administration.

  10. Bisphosphonate-Related Osteonecrosis of the Jaw: A Review of the Literature

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    Eder Alberto Sigua-Rodriguez

    2014-01-01

    Full Text Available Bisphosphonates (BPs are a class of drugs used to treat osteoporosis and malignant bone metastasis. BPs show high binding capacity to the bone matrix, especially in sites of active bone metabolism. The American Society for Bone and Mineral Research defines BRONJ as “an area of exposed bone in the maxillofacial region that has not healed within 8 weeks after identification by a healthcare provider in a patient who is receiving or has been exposed to a bisphosphonate and has not had radiation therapy to the craniofacial region.” Bisphosphonate-related osteonecrosis of the jaw (BRONJ can adversely affect quality of life, as it may produce significant morbidity. The American Association of Oral and Maxillofacial Surgeons (AAOMS considers as vitally important that information on BRONJ be disseminated to other dental and medical specialties. The purpose of this work is to offer a perspective on how dentists should manage patients on BPs, to show the benefits of accurately diagnosing BRONJ, and to present diagnostic aids and treatments strategies for the condition.

  11. Quantitative ultrasound at the hand phalanges in patients with bisphosphonate-related osteonecrosis of the jaws

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    Ana Carolina Fragoso MOTTA

    2015-01-01

    Full Text Available Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ who received intravenous or oral bisphosphonates (BP were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI, amplitude-dependent speed of sound (AD-SoS, bone biophysics profile (BBP, and bone transmission time (BTT were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82; 10 (58.8% were male and seven (41.1% were female, of whom 11 (64.7% suffered from multiple myeloma, three (17.6% from osteoporosis, one (5.8% from prostate cancer, one (5.8% from kidney cancer, and one (5.8% from leukemia. Fourteen (82.3% of them received intravenous BP whereas three (17.6% received oral BP. Nine (9/17; 52.9% patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004. The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

  12. Treatment of hemimandibular paresthesia in a patient with bisphosphonate-related osteonecrosis of the jaw (BRONJ) by combining surgical resection and PRGF-Endoret.

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    Anitua, E; Begoña, L; Orive, G

    2013-12-01

    We report a case of a 50-year-old patient with bisphosphonate-related osteonecrosis of the jaws (BRONJs) whose symptoms included severe pain and hemimandibular paraesthesia. The treatment included resection of necrotic bone and the application of plasma rich in growth factors (PRGF(®)-Endoret(®)). We closed the ulcer in the soft tissue and her pain and paraesthesia improved. One year postoperatively sensitivity was totally recovered, pain was absent and bone was partially regenerated. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Is Bisphosphonate-Related Osteonecrosis of the Jaw an Infection? A Histological and Microbiological Ten-Year Summary

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    A. M. Hinson

    2014-01-01

    Full Text Available The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ is poorly understood. Large-scale epidemiological descriptions of the histology and microbiology of BRONJ are not found in the literature. Herein, we present a systematic review of BRONJ histology and microbiology (including demographics, immunocompromised associations, clinical signs and symptoms, disease severity, antibiotic and surgical treatments, and recovery status validating that infection should still be considered a prime component in the multifactorial disease.

  14. Bisphosphonate-Related Osteonecrosis of the Jaw Bone: Radiological Pattern and the Potential Role of CBCT in Early Diagnosis

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    James Olutayo

    2010-04-01

    Full Text Available Objectives: To systematize the clinico-radiological symptoms and course of bisphosphonate-related osteonecrosis of jaw bone and to evaluate the diagnostic potential of various radiological techniques to detect mild osteonecrosis in each stage of the disease.Material and Methods: The sample consisted of 22 patients previously diagnosed with extraoral malignant disease. Diagnosis was based on a clinical examination in conjunction to digital panoramic radiography and cone beam computed tomography (CBCT. Two dentomaxillofacial radiologists reviewed all images.Results: Twenty patients showed mandibular involvement clinically, while two others had a maxillary involvement. Four stages of the disease were proposed based on the clinico-radiological findings. Subclinical cortical and lamina dura thickening was detected with only three-dimensional CBCT and periapical images, while ulceration and cortical bone thickening was detected only by three-dimensional CBCT. Mixed sclerotic, lytic bone destruction involving alveolar and basal bone with or without encroachment on the mandibular canal, pathological mandibular fractures were detected by two-dimensional panoramic and three-dimensional CBCT images. Other findings are non healing extraction sockets, periapical radiolucencies, osteolysis, sequestra, oroantral fistula, and periosteal new bone formation.Conclusions: The present study showed that bisphosphonate-related osteonecrosis of jaw bone occurs in four distinct clinico-radiological stages. For mild cases, panoramic image diagnosis was much less obvious, whereas cone beam computed tomography was able to fully characterise the bony lesions and describe their extent and involvement of neighbouring structures in all cases. Thus cone beam computed tomography might better contribute to the prevention of bisphosphonate-related osteonecrosis of jaw bone as well to the disease management.

  15. Impact of bisphosphonate-related osteonecrosis of the jaw on osteoporotic patients after dental extraction: a population-based cohort study.

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    Yi Fang Huang

    Full Text Available Little is currently known about the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ. This study sought to determine the incidence of BRONJ in osteoporotic patients. We also sought to identify the nature and types of risk factors of osteonecrosis of jaw (ONJ related to the use of oral bisphosphonates (BPs.Data from the National Health Insurance system of Taiwan. This cohort study included 19,399 adult osteoporosis patients received dental extraction in 2000-2010 (osteoporosis cohort and 38,669 age and gender matched comparisons selected from dental extraction people without osteoporosis and osteonecrosis history (comparison cohort. All study subjects were followed from the date of their dental extraction (index date to the development of ONJ and were included in the study up to 2011 or were lost to the study, whichever occurred first. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence intervals for the two cohorts.Patients with osteoporosis had a significantly higher risk to develop ONJ than healthy persons (adjusted HR, 2.05; 95% confidence interval, 1.58-2.65. The risk of ONJ increased with the severity of osteoporosis, no matter whether patient with cancer or not. A cumulative effect of dental extraction frequency may increase the risk of ONJ.We concluded that ONJ is caused by a number of factors. Osteoporosis and past dental history play the very important roles, while BPs play the synergistic effect.

  16. Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features.

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    Lee, Byung-Do; Park, Moo-Rim; Kwon, Kyung-Hwan

    2015-09-01

    A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.

  17. Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features

    International Nuclear Information System (INIS)

    Lee, Byung Do; Kwon, Kyung Hwan; Park, Moo Rim

    2015-01-01

    A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature

  18. Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Do; Kwon, Kyung Hwan [College of Dentistry, Wonkwang University, Iksan (Korea, Republic of); Park, Moo Rim [Dept. of Internal Medicine, School of Medicine, Wonkwang University, Iksan (Korea, Republic of)

    2015-09-15

    A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.

  19. Evaluation of dental implants as a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw in breast cancer patients.

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    Matsuo, Akira; Hamada, Hayato; Takahashi, Hidetoshi; Okamoto, Ayako; Kaise, Hiroshi; Chikazu, Daichi

    2016-09-01

    It remains unclear whether dental implants are a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We retrospectively evaluated the status of dental implants in patients given intravenous bisphosphonates (BPs) in a breast cancer cohort to elucidate the risk for BRONJ at the implant site. We established a BRONJ oral monitoring program for 247 breast cancer patients given intravenous BP in our institution. The 3-year cumulative incidence rate was determined. The systemic and local risk factors of 44 patients who completed comprehensive oral examinations were evaluated by logistic regression analysis. The 3-year cumulative incidence rate of the 247 patients was 0.074 % (8/247, 95 % CI 0.0081-0.014). In the 44 orally examined patients, 6 (13.6 %: 6/44) had dental implants. Of these 6 patients, 1 developed BRONJ at the implant site. There were no significant differences in the age, total BP treatment period, number of residual teeth, time of regular oral monitoring, oral hygiene level, or dental implant insertion. Although a case of ONJ was identified, dental implants which were inserted before intravenous BP administration were not a risk factor for the development of ONJ in breast cancer patients.

  20. Time to onset of bisphosphonate-related osteonecrosis of the jaws

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    Fung, Ppl; Bedogni, G; Bedogni, A

    2017-01-01

    OBJECTIVES: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to esti...

  1. Retrospective analysis of 27 cases of bisphosphonate-related osteonecrosis of the jaw treated surgically or nonsurgically

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    Shin-Yu Lu

    2014-06-01

    Conclusion: Our study demonstrates a high success rate of conservative and surgical treatment of BRONJ. This is the first reported use of GBR to successfully treat oral BPh-related osteonecrosis of the jaw. Irrigation with antimicrobial rinses may result in pain reduction, and regression or even resolution of BRONJ.

  2. Clinical Aspects, Imaging Features, and Considerations on Bisphosphonate-Related Osteonecrosis Risk in a Pediatric Patient with Osteogenesis Imperfecta

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    Fábio Wildson Gurgel Costa

    2014-01-01

    Full Text Available Osteogenesis imperfecta (OI is a rare hereditary condition caused by changes in collagen metabolism. It is classified into four types according to clinical, genetic, and radiological criteria. Clinically, bone fragility, short stature, blue sclerae, and locomotion difficulties may be observed in this disease. OI is often associated to severe dental problems, such as dentinogenesis imperfecta (DI and malocclusions. Radiographically, affected teeth may have crowns with bulbous appearance, accentuated constriction in the cementoenamel junction, narrowed roots, large root canals due to defective dentin formation, and taurodontism (enlarged pulp chambers. There is no definitive cure, but bisphosphonate therapy is reported to improve bone quality; however, there is a potential risk of bisphosphonate-related osteonecrosis of the jaw. In this study we report a case of OI in a male pediatric patient with no family history of OI who was receiving ongoing treatment with intravenous perfusion of bisphosphonate and who required dental surgery. In addition, we discussed the clinical and imaging findings and briefly reviewed the literature.

  3. Effect of bisphosphonates on macrophagic THP-1 cell survival in bisphosphonate-related osteonecrosis of the jaw (BRONJ).

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    Hoefert, Sebastian; Sade Hoefert, Claudia; Munz, Adelheid; Schmitz, Inge; Grimm, Martin; Yuan, Anna; Northoff, Hinnak; Reinert, Siegmar; Alexander, Dorothea

    2016-03-01

    Immune deficiency and bacterial infection have been suggested to play a role in the pathophysiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Zoledronate was previously found to promote THP-1 cell death. To examine this hypothesis with all commonly prescribed bisphosphonates, we tested the effect of (nitrogen-containing) ibandronate, risedronate, alendronate, pamidronate, and (non-nitrogen-containing) clodronate on macrophagic THP-1 cells. Activated THP-1 cells were exposed to .5 to 50 μM of nitrogen-containing bisphosphonates and .5 to 500 μM of clodronate. Cell adherence and survival were assessed in vitro using the xCELLigence real-time monitoring system. Results were confirmed histologically and verified with Live/Dead staining. All bisphosphonates inhibited THP-1 cell adherence and survival dose and time dependently, significant for zoledronate, alendronate, pamidronate, and clodronate in high concentrations (50 μM and 500 μM; P THP-1 cell survival compared with controls (P THP-1 cells exhibited no cytomorphologic changes at all concentrations. Commonly prescribed bisphosphonates inhibit the survival of macrophagic THP-1 cells dose-dependently without altering morphology. This may suggest a local immune dysfunction reflective of individual bisphosphonate potency leading to the pathogenesis of BRONJ. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Resective surgical approach shows a high performance in the management of advanced cases of bisphosphonate-related osteonecrosis of the jaws: a retrospective survey of 347 cases.

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    Graziani, Filippo; Vescovi, Paolo; Campisi, Giuseppina; Favia, Gianfranco; Gabriele, Mario; Gaeta, Giovanni Maria; Gennai, Stefano; Goia, Franco; Miccoli, Mario; Peluso, Franco; Scoletta, Matteo; Solazzo, Luigi; Colella, Giuseppe

    2012-11-01

    The aim of this study was to evaluate the results of the surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a large cohort. A retrospective cohort multicenter study was designed. Patients were enrolled if they were diagnosed with BRONJ and received operative treatment. Data on demographic, health status, perioperative, and surgical factors were collected retrospectively. The primary outcome variable was a change in BRONJ staging (improvement, worsening, or no change). Interventions were grouped by local debridement and resective surgery. Data were collected for other variables as cofactors. Univariate analysis and logistic regressions were then performed. Of the 347 BRONJ-affected subjects, 59% showed improvement, 30% showed no change, and 11% showed worsening. Improvement was observed in 49% of cases treated with local debridement and 68% of cases treated with resective surgery. Multivariate analysis indicated that maxillary location, resective surgery, and no additional corticosteroid treatment were associated with a positive outcome. Surgical treatment of BRONJ appeared to be more effective when resective procedures were performed. Nonetheless, other factors, such as the absence of symptoms and the types of drug administration, should be taken into account before clinical decisions are made. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Leucocyte-rich and platelet-rich fibrin for the treatment of bisphosphonate-related osteonecrosis of the jaw: a prospective feasibility study.

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    Kim, Jin-Woo; Kim, Sun-Jong; Kim, Myung-Rae

    2014-11-01

    Our aim was to assess the feasibility of using leucocyte-rich and platelet-rich fibrin (L-PRF) for the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a single group study. After treatment with L-PRF, the response of each patient was recorded 1 month and 4 months postoperatively. Further assessments were made of the site, stage, concentration of c-terminal crosslinked telopepide of type 1 collagen, and actinomycosis. Among the total of 34 patients, 26 (77%) showed complete resolution, 6 (18%) had delayed resolution, and 2 (6%) showed no resolution. There was a significant association between the response to treatment and the stage of BRONJ (p=0.002) but no other significant associations were detected. This study has shown that it is feasible to use L-PRF for the treatment of BRONJ, but the effectiveness cannot be judged with this study design. Randomised prospective trials are needed to confirm this. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. BISPHOSPHONATE - RELATED MUCOSITIS (BRM: A CASE REPORT

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    Pavel Stanimirov

    2017-03-01

    Full Text Available Bisphosphonates (BPs are the most widely used and effective antiresorptive agents for the treatment of diseases in which there is an increase in osteoclastic resorption, including post-menopausal osteoporosis, Paget’s disease, and tumor-associated osteolysis. Oral and maxillofacial surgeons are well aware of the side effects of bisphosphonates and mainly with bisphosphonate-related osteonecrosis of the jaws (BRONJ. Less known are the mucosal lesions associated with the use of these agents. In the scientific literature, there are only few reports of mucosal lesions due to the direct contact of the oral form of BPs with the mucosa (bisphosphonate-related mucositis. They are mostly related to improper use of bisphosphonate tablets that are chewed, sucked or allowed to melt in the mouth before swallowing. Lesions are atypical and need to be differentiated from other mucosal erosions. We present a case of bisphosphonate-related mucositis due to the improper use of alendronate.

  7. Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction.

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    Bodem, Jens Philipp; Kargus, Steffen; Eckstein, Stefanie; Saure, Daniel; Engel, Michael; Hoffmann, Jürgen; Freudlsperger, Christian

    2015-05-01

    As the most suitable approach for preventing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients undergoing surgical tooth extraction is still under discussion, the present study evaluates the incidence of BRONJ after surgical tooth extraction using a standardized surgical protocol in combination with an adjuvant perioperative treatment setting in patients who are at high-risk for developing BRONJ. High-risk patients were defined as patients who received intravenous bisphosphonate (BP) due to a malignant disease. All teeth were removed using a standardized surgical protocol. The perioperative adjuvant treatment included intravenous antibiotic prophylaxis starting at least 24 h before surgery, a gastric feeding tube and mouth rinses with chlorhexidine (0.12%) three times a day. In the follow-up period patients were examined every 4 weeks for the development of BRONJ. Minimum follow-up was 12 weeks. In 61 patients a total number of 184 teeth were removed from 102 separate extraction sites. In eight patients (13.1%) BRONJ developed during the follow-up. A higher risk for developing BRONJ was found in patients where an additional osteotomy was necessary (21.4% vs. 8.0%; p = 0.0577), especially for an osteotomy of the mandible (33.3% vs. 7.3%; p = 0.0268). Parameters including duration of intravenous antibiotic prophylaxis, the use of a gastric feeding tube and the duration of intravenous BP therapy showed no statistical impact on the development of BRONJ. Furthermore, patients currently undergoing intravenous BP therapy showed no higher risk for BRONJ compared with patients who have paused or completed their intravenous BP therapy (p = 0.4232). This study presents a protocol for surgical tooth extraction in high-risk BP patients in combination with a perioperative adjuvant treatment setting, which reduced the risk for postoperative BRONJ to a minimum. However, the risk for BRONJ increases significantly if an additional osteotomy is necessary

  8. Intraoperative efficiency of fluorescence imaging by Visually Enhanced Lesion Scope (VELscope) in patients with bisphosphonate related osteonecrosis of the jaw (BRONJ).

    Science.gov (United States)

    Assaf, Alexandre T; Zrnc, Tomislav A; Riecke, Björn; Wikner, Johannes; Zustin, Jozef; Friedrich, Reinhard E; Heiland, Max; Smeets, Ralf; Gröbe, Alexander

    2014-07-01

    The purpose of this study was to determine the potential of tissue fluorescence imaging by using Visually Enhanced Lesion Scope (VELscope) for the detection of osteonecrosis of the jaw induced by bisphosphonates (BRONJ). We investigated 20 patients (11 females and 9 males; mean age 74 years, standard deviation ± 6.4 years), over a period of 18 month with the diagnosis of BRONJ in this prospective cohort study. All patients received doxycycline as a fluorescending marker for osseous structures. VELscope has been used intraoperatively using the loss of fluorescence to detect presence of osteonecrosis. Osseous biopsies were taken to confirm definite histopathological diagnosis of BRONJ in each case. Diagnosis of BRONJ was confirmed for every patient. In all patients except one, VELscope was sufficient to differentiate between healthy and necrotic bone by visual fluorescence retention (VFR) and visual fluorescence loss (VFL). 19 cases out of a total of 20 showed no signs of recurrence of BRONJ during follow-up (mean 12 months, range 4-18 months). VELscope examination is a suitable tool to visualize necrotic areas of the bone in patients with bisphosphonate related osteonecrosis of the jaw. Loss of fluorescence in necrotic bone areas is useful intraoperatively as a tool for fluorescence-guided bone resection with relevant clinical interpretation. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Osteonecrosis de los maxilares asociada al uso de bifosfonatos: revisión de ocho casos Bisphosphonate-related jaw osteonecrosis: Review of eight cases

    Directory of Open Access Journals (Sweden)

    J. Joshi Otero

    2011-03-01

    Full Text Available Introducción: A finales de 2003 se comienzan a publicar en forma creciente los primeros casos de exposición ósea en los maxilares con evolución tórpida, asociados al uso de bifosfonatos por vía intravenosa. Estos fármacos son usados en pacientes con osteoporosis, mieloma múltiple, hipercalcemia maligna y cáncer de pulmón, mama y próstata, principalmente por su capacidad de inhibir la resorción ósea. Material y método: Estudio prospectivo de los pacientes en el Hospital Virgen Macarena que presentaban lesiones maxilares asociadas al uso de bifosfonatos desde el año 2006 hasta la actualidad. Las variables que valoramos en el paciente son: sexo, edad, tratamiento con bifosfonatos, inicio de la osteonecrosis, relación con tratamientos dentales, tratamiento realizado y evolución. Resultados: Se estudiaron 8 pacientes con osteonecrosis maxilar secundaria a tratamiento con bifosfonatos intravenosos u orales por su patología previa oncológica u osteoporótica que fueron tratados según su estadio clínico-radiológico con antibioterapia, legrado y/o exéresis del secuestro según el caso. Presentamos los resultados con un seguimiento mínimo de 15 meses. Conclusiones: El aumento en la incidencia de la osteomielitis maxilar en los pacientes asociados al uso de bifosfonatos y la dificultad para su tratamiento hacen necesario establecer pautas terapéuticas estandarizadas. En nuestra experiencia, el tratamiento conservador basado en la antibioterapia además del legrado de la zona bajo anestesia local permite el control y la curación del proceso en algunos de los pacientes con OMRB grado II.Background: In late 2003, an increasing number of case reports began to appear on bone exposure of the jaw with a torpid evolution in association with intravenous bisphosphonate use. Bisphosphonates are used to inhibit bone resorption in patients with osteoporosis, multiple myeloma, hypercalcemia of malignancy, lung cancer, breast cancer and prostate

  10. Treatment of bisphosphonate related osteonecrosis following root canal therapy at the 1-year follow-up: report of two cases

    Directory of Open Access Journals (Sweden)

    Kaptan F

    2013-12-01

    Full Text Available Figen Kaptan,1 Meric Karapinar Kazandag,1 Ufuk Iseri21Yeditepe University, Faculty of Dentistry, Department of Endodontics, 2Department of Prosthodontics, Istanbul, TurkeyAbstract: The objective of this report was to use topical gaseous ozone as an adjunct to conventional treatment methods and to describe the multidisciplinary management of bisphosphonate associated bone necrosis, which developed following endodontic treatment. No complaints were noted by the patients at their 1-year follow-up and the treatment showed favorable prognosis.Keywords: bisphosphonate, osteonecrosis, BRONJ, endodontics, oxygen, ozone

  11. Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters

    International Nuclear Information System (INIS)

    Guggenberger, Roman; Koral, Emrah; Andreisek, Gustav; Zemann, Wolfgang; Jacobsen, Christine; Metzler, Philipp

    2014-01-01

    To assess the diagnostic performance of quantitative and qualitative image parameters in cone-beam computed tomography (CBCT) for diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). A BRONJ (22 patients, mean age 70.0 years) group was age and gender matched to a healthy control group (22 patients, mean age 68.0 years). On CBCT images two independent readers performed quantitative bone density value (BDV) measurements with region and volume-of-interest (ROI and VOI) based approaches and qualitative scoring of BRONJ-associated necrosis, sclerosis and periosteal thickening (1 = not present to 5 = definitely present). Intraoperative and clinical findings served as standard of reference. Interreader agreements and diagnostic performance were assessed by intraclass correlation coefficients (ICC), kappa-statistics and receiver-operating characteristic (ROC) analysis. Twenty-three regions in 22 patients were affected by BRONJ. ICC values for mean BDV VOI and mean BDV ROI were 0.864 and 0.968, respectively (p < 0.001). The area under the curve (AUC) for mean BDV VOI and mean BDV ROI was 0.58/0.83 with a sensitivity of 57/83 % and specificity of 61/77 % for diagnosis of BRONJ, respectively. Kappa values for presence of necrosis, sclerosis and periosteal thickening were 0.575, 0.617 and 0.885, respectively. AUC values for qualitative parameters ranged between 0.90-0.96 with sensitivity of 96 % and specificities between 79-96 % at respective cutoff scores. BRONJ can be effectively diagnosed with CBCT. Qualitative image parameters yield a higher diagnostic performance than quantitative parameters, and ROI-based attenuation measurements were more accurate than VOI-based measurements. (orig.)

  12. New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

    Directory of Open Access Journals (Sweden)

    Simonetta Franco

    2014-01-01

    Full Text Available Bisphosphonate-related osteonecrosis of the jaw (BRONJ is the most serious side effect in patients receiving bisphosphonates (BPs for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. The surgical procedure was complemented by piezosurgery and followed by the application of hyaluronate and amino acids. The new dimensional staging suggests the choice of the surgical approach, and allows the prediction of postoperative complications and soft and hard tissues healing time, guiding the surgical treatment protocol. This protocol could be a successful management strategy for BRONJ, considering the low recurrences rate and the good stabilisation of the surgical sites observed after a long-term follow-up.

  13. Utility of preoperative imaging diagnosis for a malignant tumor of the mandible. A malignant tumor of the mandible is difficult to discriminate from bisphosphonate-related osteonecrosis of the jaw

    International Nuclear Information System (INIS)

    Kamio, Takashi; Imaizumi, Akiko; Nishikawa, Keiichi; Shibui, Takeo; Inoue, Kenji; Matsuzaka, Kenichi; Sakamoto, Junichiro; Sano, Tsukasa

    2014-01-01

    We report our experience of a case with a malignant tumor of the mandible in which diagnostic imaging played an important role in the differential diagnosis and therapeutic strategy decisions. The patient was a 78-year-old woman who visited our hospital because of poor healing after tooth extraction. Multiple cytological diagnoses provided class II results, and a histopathological diagnosis of a biopsy also failed to show malignant findings. Therefore, a definitive diagnosis could not be made. Although the patient had a history of osteoporosis treatment, details of her medications were unclear. Therefore, bisphosphonate-related osteonecrosis of the jaw (BRONJ) could not be excluded, causing difficulty in management of the patient's condition. Eventually, we mainly focused on the diagnostic imaging and planned the therapeutic strategy in accordance with treatment for a malignant tumor. A postoperative histopathological examination of the surgical specimen revealed squamous cell carcinoma. It is sometimes difficult to differentiate among atypical diseases such as malignant tumors of the mandible and BRONJ, based solely on clinical or diagnostic imaging results. However, in the present patient, diagnostic imaging suggested a malignant tumor, and the appropriate treatment could be selected. (author)

  14. Evolution of bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma and Waldenstrom's macroglobulinemia: a retrospective multicentric study

    International Nuclear Information System (INIS)

    Andriani, A; Petrucci, M T; Caravita, T; Montanaro, M; Villivà, N; Levi, A; Siniscalchi, A; Bongarzoni, V; Pisani, F; De Muro, M; Coppetelli, U; Avvisati, G; Zullo, A; Agrillo, A; Gaglioti, D

    2012-01-01

    Bisphosphonates (BPs) are used intravenously to treat cancer-related conditions for the prevention of pathological fractures. Osteonecrosis of the jaw (BRONJ) is a rare complication reported in 4–15% of patients. We studied, retrospectively, 55 patients with multiple myeloma or Waldenstrom's macroglobulinemia followed up from different haematological departments who developed BRONJ. All patients were treated with BPs for bone lesions and/or fractures. The most common trigger for BRONJ was dental alveolar surgery. After a median observation of 26 months, no death caused by BRONJ complication was reported. In all, 51 patients were treated with antibiotic therapy, and in 6 patients, this was performed in association with surgical debridement of necrotic bone, in 16 with hyperbaric O 2 therapy/ozonotherapy and curettage and in 12 with sequestrectomy and O 2 /hyperbaric therapy. Complete response was observed in 20 cases, partial response in 21, unchanged in 9 and worsening in 3. The association of surgical treatment with antibiotic therapy seems to be more effective in eradicating the necrotic bone than antibiotic treatment alone. O 2 hyperbaric/ozonotherapy is a very effective treatment. The cumulative dosage of BPs is important for the evolution of BRONJ. Because the most common trigger for BRONJ was dental extractions, all patients, before BP treatment, must achieve an optimal periodontal health

  15. Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Ho Gui; Hwang, Jae Joon; Lee, Jeong Hee; Kim, Young Hyun; Na, Ji Yeon; Han, Sang Sun [Dept. of Oral and Maxillofacial Radiology, Yonsei University, College of Dentistry, Seoul (Korea, Republic of)

    2017-03-15

    The aim of this study was to investigate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients with osteoporosis on oral bisphosphonates in Korea and to evaluate local factors affecting the development of BRONJ. The clinical records of 320 patients who underwent dental extraction while receiving oral bisphosphonates were reviewed. All patients had a healing period of more than 6 months following the extractions. Each patient's clinical record was used to assess the incidence of BRONJ; if BRONJ occurred, a further radiographic investigation was carried out to obtain a more definitive diagnosis. Various local factors including age, gender, extraction site, drug type, duration of administration, and C-terminal telopeptide (CTx) level were retrieved from the patients' clinical records for evaluating their effect on the incidence of BRONJ. Among the 320 osteoporotic patients who underwent tooth extraction, 11 developed BRONJ, reflecting an incidence rate of 3.44%. Out of the local factors that may affect the incidence of BRONJ, gender, drug type, and CTx level showed no statistically significant effects, while statistically significant associations were found for age, extraction site, and duration of administration. The incidence of BRONJ increased with age, was greater in the mandible than the maxilla, and was associated with a duration of administration of more than 3 years. Tooth extraction in patients on oral bisphosphonates requires careful consideration of their age, the extraction site, and the duration of administration, and close postoperative follow-up should be carried out to facilitate effective early management.

  16. Use of Ultrasonic Bone Surgery (Piezosurgery) to Surgically Treat Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). A Case Series Report with at Least 1 Year of Follow-Up

    Science.gov (United States)

    Blus, Cornelio; Szmukler-Moncler, Serge; Giannelli, Giulio; Denotti, Gloria; Orrù, Germano

    2013-01-01

    This preliminary work documents the use of a powerful piezosurgery device to treat biphosphonate-related osteonecrosis of the jaw (BRONJ) in combination with classical medication therapy. Eight patients presenting 9 BRONJ sites were treated, 2 in the maxilla and 7 in the mandible. Reason for biphosphonate (BiP) intake was treatment of an oncologic disease for 5 patients and osteoporosis for 3. The oncologic and osteoporosis patients were diagnosed with BRONJ after 35-110 months and 80-183 months of BiP treatment, respectively. BRONJ 2 and 3 was found in 4 patients. Resection of the bone sequestrae was performed with a high power ultrasonic (piezo) surgery and antibiotics were administrated for 2 weeks. Soft tissue healing was incomplete at the 2-week control but it was achieved within 1 month. At the 1-year control, soft tissue healing was maintained at all patients, without symptom recurrence. One patient with paraesthesia had abated; of the 2 pa-tients with trismus, one was healed, severity of the second trismus abated. This case report series suggests that bone resection performed with a high power ultrasonic surgery device combined with antibiotics might lead to BRONJ healing. More patients are warranted to confirm the present findings and assess this treatment approach. PMID:24044030

  17. Radiographic Findings of Bisphosphonate-Related Osteonecrosis of ...

    African Journals Online (AJOL)

    2017-03-06

    Mar 6, 2017 ... Nigerian Journal of Clinical Practice ¦ Volume 20 ¦ Issue 3 ¦ March 2017 hypotheses.[1,2] The .... Presence of bone sclerosis, cortical surface irregularity, persistent ..... Schubert MM. Fractal dimension evaluation of cone beam.

  18. DENOSUMAB-RELATED OSTEONECROSIS OF THE JAWS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Milena Petkova

    2017-03-01

    Full Text Available Bisphosphonates are potent and effective drugs frequently used to prevent the skeletal complications associated with postmenopausal osteoporosis in women, to manage patients with multiple myeloma, hypercalcemia, and metastasis of cancer to the bone. The search for new medications with the same therapeutic effectiveness as the bisphosphonates but fewer side effects has resulted in the discovery of Denosumab, a human monoclonal antibody against the receptor activator for nuclear factor kappa B ligand (RANKL, therefore inhibiting osteoclast differentiation and function. Denosumab is a class of drugs that are entirely different from the traditional antiresorptive drugs, the bisphosphonates. Denosumab has several advantages, including better tolerability, ease of subcutaneous injection, a shorter half-life, and a reduced incidence of nephrotoxicity. Patients receiving bisphosphonates are at risk to develop a severe devastating complication - osteonecrosis of the jaws (ONJ - which is challenging to treat. Since 2010 there have been reports of ONJ in patients taking denosumab. In the 2014 position paper of the American Association of Oral and Maxillofacial Surgeons, the nomenclature “bisphosphonate-related osteonecrosis of the jaw” was changed to “medication related osteonecrosis of the jaw” (MRONJ. The change is justified to accommodate the growing number of osteonecrosis cases involving the maxilla and mandible associated with other antiresorptive (denosumab and antiangiogenic therapies. Here we report a development of denosumab-related osteonecrosis of the jaw (DRONJ - a new type of bony necrosis- in patient with bone metastases of breast cancer on Denosumab therapy. The patient has no previous history of taking bisphosphonates.

  19. Degenerative periodontal-diseases and oral osteonecrosis: The role of gene-environment interactions

    International Nuclear Information System (INIS)

    Baldi, D.; Izzotti, A.; Bonica, P.; Pera, P.; Pulliero, A.

    2009-01-01

    Chronic-degenerative dentistry diseases, including periodontal diseases and oral osteonecrosis, are widespread in human populations and represent a significant problem for public health. These diseases result from pathogenic mechanisms created by the interaction between environmental genotoxic risk-factors and genetic assets conferring individual susceptibility. Osteonecrosis occurs in subjects undergoing exposure to high doses of DNA-damaging agents for chemo- and radiotherapy of neoplastic diseases. In susceptible patients, ionizing radiation and biphosphonate-chemotherapy induce severe, progressive, and irreversible degeneration of facial bones, resulting in avascular necrosis of the jaw. This may also occur in patients receiving biphosphonate for osteoporosis therapy. Periodontal diseases include chronic, aggressive, and necrotizing periodontitis, often resulting in severe alteration of periodontal tissues and tooth loss. Cigarette smoking and chronic inflammation caused by specific bacteria are the main risk factors for periodontitis. Oxidative damage plays a fundamental pathogenic role, as established by detection of mitochondrial DNA damage in the gingival tissue of patients with periodontitis. Endogenous risk factors in dental diseases include polymorphisms for metabolic enzymes such as glutathione transferases M1 and T1, N-acetyl transferase 2, and CYP 1A1. Other genetic polymorphisms that confer susceptibility to dentistry diseases affect genes encoding metalloproteases (involved in periodontal tissue remodeling and degradation), cytokines (involved in inflammation), prothrombin, and DNA repair activities. These findings provide evidence that dentistry diseases are related to risk factors associated with environmental mutagenesis. This issue warrants future investigations aimed at improving oral health and preventing oral degenerative diseases using molecular and experimental approaches currently utilized in mutagenicity studies.

  20. Degenerative periodontal-diseases and oral osteonecrosis: The role of gene-environment interactions

    Energy Technology Data Exchange (ETDEWEB)

    Baldi, D. [Department of Medical, Biophysical, and Dentistry Sciences and Technologies, University of Genoa (Italy); Izzotti, A. [Department of Health Sciences, University of Genoa, Via A. Pastore 1 (Italy); Bonica, P.; Pera, P. [Department of Medical, Biophysical, and Dentistry Sciences and Technologies, University of Genoa (Italy); Pulliero, A., E-mail: alessandra.pulliero@unige.it [Department of Health Sciences, University of Genoa, Via A. Pastore 1 (Italy)

    2009-07-10

    Chronic-degenerative dentistry diseases, including periodontal diseases and oral osteonecrosis, are widespread in human populations and represent a significant problem for public health. These diseases result from pathogenic mechanisms created by the interaction between environmental genotoxic risk-factors and genetic assets conferring individual susceptibility. Osteonecrosis occurs in subjects undergoing exposure to high doses of DNA-damaging agents for chemo- and radiotherapy of neoplastic diseases. In susceptible patients, ionizing radiation and biphosphonate-chemotherapy induce severe, progressive, and irreversible degeneration of facial bones, resulting in avascular necrosis of the jaw. This may also occur in patients receiving biphosphonate for osteoporosis therapy. Periodontal diseases include chronic, aggressive, and necrotizing periodontitis, often resulting in severe alteration of periodontal tissues and tooth loss. Cigarette smoking and chronic inflammation caused by specific bacteria are the main risk factors for periodontitis. Oxidative damage plays a fundamental pathogenic role, as established by detection of mitochondrial DNA damage in the gingival tissue of patients with periodontitis. Endogenous risk factors in dental diseases include polymorphisms for metabolic enzymes such as glutathione transferases M1 and T1, N-acetyl transferase 2, and CYP 1A1. Other genetic polymorphisms that confer susceptibility to dentistry diseases affect genes encoding metalloproteases (involved in periodontal tissue remodeling and degradation), cytokines (involved in inflammation), prothrombin, and DNA repair activities. These findings provide evidence that dentistry diseases are related to risk factors associated with environmental mutagenesis. This issue warrants future investigations aimed at improving oral health and preventing oral degenerative diseases using molecular and experimental approaches currently utilized in mutagenicity studies.

  1. Jaw osteonecrosis related to bisphosphonate therapy: a severe secondary disorder.

    Science.gov (United States)

    Dannemann, C; Grätz, K W; Riener, M O; Zwahlen, R A

    2007-04-01

    Bisphosphonate-related osteonecrosis of the jaws (BON), first described in 2003, is gaining importance due to the increasing indication spectrum of bisphosphonate therapy [S. Takeyama, M. Ito, H. Shinoda, A novel bisphosphonate, TRK-530, for periodontitis, Bone 38 (2006) 31-31; M. Tagil, A. W-Dahl, J. Astrand, D. Little, S. Toksvig-Larsen, Decreasing the catabolic response by a single bisphosphonate infusion shortens the healing time in hemicallotasis operations, Bone 38 (2006) 84-85; E. Rodriguez, M.C. Duran, L.M. Rodriguez, R. Ros, M.R. Aleman, M. Rodriguez-Gaspar, A.M. Lopez, E. Garcia-Valdecasas, F. Santolaria, Intravenous (IV) bisphosphonates for osteopenic cancer survivor women: an alternative treatment, Bone 38 (2006) 72-73; D.G. Little, K. Ward, P. Kiely, M.C. Bellemore, J. Briody, C.T. Cowell, Bisphosphonate rescue in distraction osteogenesis: a case series, Bone 38 (2006) 80-80; R. Marx, Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic, J. Oral Maxillofac. Surg. 61 (2003) 1115-1118]. BON patients suffering from varying bony defects and symptoms are extremely restricted in their quality of life. Due to a limited knowledge of the aetiology of BON efficient evidence-based treatment strategies are lacking. Until now 23 patients with bisphosphonate-related osteonecrosis have been admitted to the Department of Cranio-Maxillofacial Surgery of the University of Zurich. A complete history has been recorded. All patients underwent clinical and radiographic examination. CT scans and MRI have been performed in selected cases. All patients had in common that, before signs of BON were observed, a local traumatic incidence had occurred. All patients showed signs of infection which could be remarkably reduced by antibacterial treatment. Furthermore, the period of bisphosphonate treatment was found to be one of the significant factors causing bisphosphonate-related osteonecrosis of the jaws. The aetiology of BON

  2. Bisphosphonates and oral pathology II. Osteonecrosis of the jaws: review of the literature before 2005.

    Science.gov (United States)

    Estefanía Fresco, Ruth; Ponte Fernández, Ruth; Aguirre Urizar, José Manuel

    2006-11-01

    Bisphosphonates are bone-turnover modulating drugs which are used in the management of a number of bone diseases ranging from osteoporosis to neoplasic pathology-associated osteolysis. In the last years a number of cases of osteonecrosis of the jaws associated with these drugs have been reported. In this review we analyze the cases published in the literature indexed from 2003 to December 2005. During this period 246 cases were reported, being more frequently associated with women in the sixth decade of life. More frequently associated bisphosphonates were the nitrogenated bisphosphonates (pamidronate, zolendronic acid) and the most common oral antecedent was a dental extraction. Nevertheless more than 25% of the cases were spontaneous. The most frequent site was the mandible and most of the cases presented clinical evidence of bone exposure and pain. Different treatments have been proposed with different antibiotic therapies with or without surgery, showing in general terms an uncertain prognosis with low healing rates.

  3. Dental extraction following zoledronate, induces osteonecrosis in rat's jaw.

    Science.gov (United States)

    Vidal-Gutiérrez, X; Gómez-Clavel, J-F; Gaitán-Cepeda, L-A

    2017-03-01

    Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) is clinically characterized by the presence of exposed bone in the oral cavity that persists for more than eight weeks. Previous attempts to establish an animal model have not sufficiently considered disease features. Our aim was to establish an inexpensive and replicable animal model that develops BRONJ in a short time. Thirty-two male Wistar rats were randomly divided into two groups: control and experimental. In the experimental group, we administered 0.06mg/kg intraperitoneal dose of zoledronic acid (ZA) 7 and 14 days prior to maxillary second molar extraction. At two, four and six weeks after tooth extraction, the animals were euthanized, and we dissected the maxilla following histological procedures. We stained serial slides with hematoxylin and eosin and Masson's trichrome. The samples were harvested for macroscopic, radiologic and histological evaluation of bone changes. At two weeks postextraction, we observed exposed necrotic bone in dental socket areas in experimental groups. Radiological analysis revealed osteolytic lesions accompanied by extensive destruction and sequestrum formation in the same group. Histological examination confirmed the absence of necrotic bone in control groups in contrast with the experimental groups. The percentage of empty lacunae and the number of osteoclasts and the necrotic bone area were significantly increased (p<0.05) in the experimental groups. The animal model using ZA administration to prior dental extraction successfully mimicked human BRONJ lesions. Also, the model was easily replicated, inexpensive and showed different features than other previous BRONJ models.

  4. United Kingdom nationwide study of avascular necrosis of the jaws including bisphosphonate-related necrosis.

    Science.gov (United States)

    Rogers, S N; Palmer, N O A; Lowe, D; Randall, C

    2015-02-01

    We aimed to record all new patients who presented to departments of oral surgery, oral medicine, and oral and maxillofacial surgery, and to dental hospitals in the UK, with avascular necrosis of the jaws including bisphosphonate-related necrosis (BRONJ) over a 2-year period (1 June 2009-31 May 2011). They were eligible irrespective of age, cause, or coexisting conditions. Data on incidence, clinical characteristics, risk factors, and coexisting conditions were collected. A total of 383 cases were registered: 369 were described as BRONJ, 5 as avascular necrosis, and 9 were unknown. Bisphosphonates had been given orally in 207 (56%), intravenously in 125 (34%), both orally and intravenously in 27 (7%), and was unknown in 9 (2%); one had been given denosumab. The main risk factor was dental extraction, and the mandible was commonly affected. The median duration of administration until onset of BRONJ was 3 years in those treated intravenously and 4 years in those treated orally. Levels of engagement with the study varied between regions, and extrapolation from the 2 most involved (Merseyside and Northern Ireland) found around 8.2-12.8 cases/million/year, which is 508-793 patients/year across the UK. To our knowledge this is one of the first studies to estimate national rates of BRONJ. It confirms that the risk and incidence are low. With changes in trends for antiresorptive bone medication, and increasing numbers of elderly people, it would be useful to repeat the registration in the future. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Bisphosphonate-associated osteonecrosis of jaw reoccurrence after methotrexate therapy: a case report.

    Science.gov (United States)

    Alsalleeh, Fahd; Keippel, Jeffery; Adams, Lyde; Bavitz, Bruce

    2014-09-01

    Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known complication caused by amino-bisphosphonate therapy. We document one case of BRONJ associated with oral administration of methotrexate, a known immunosuppressive drug used to treat rheumatoid arthritis. A 66-year-old woman was referred for evaluation and endodontic surgery of recently re-treated tooth 13. Tooth 14 was extracted 3 months prior, and the extraction site had not completely healed. Her medical history revealed rheumatoid arthritis and osteoporosis. She had been taking Fosamax (alendronate) 70 mg daily. Because of adequate root canal therapy of tooth 13, endodontic surgery was performed. Five months after apicoectomy, her symptoms had not changed. Tooth 13 was extracted, and the socket healed without complications. The socket of extracted tooth 14 was also healing. At the 3-month recall visit, bone exposure and purulent discharge at the site of extracted tooth 14 were noted. The patient had recently received methotrexate. The methotrexate was discontinued, and she was given course of amoxicillin. At the 18-month follow-up, the healing progressed, and the wound was closed. A medication that suppresses the immune system such as methotrexate may complicate the management of BRONJ. Once a diagnosis of BRONJ is made, a closely monitored conservative approach is recommended. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  6. Treatment of bisphosphonate related osteonecrosis following root canal therapy at the 1-year follow-up: report of two cases.

    Science.gov (United States)

    Kaptan, Figen; Kazandag, Meric Karapinar; Iseri, Ufuk

    2013-01-01

    The objective of this report was to use topical gaseous ozone as an adjunct to conventional treatment methods and to describe the multidisciplinary management of bisphosphonate associated bone necrosis, which developed following endodontic treatment. No complaints were noted by the patients at their 1-year follow-up and the treatment showed favorable prognosis.

  7. Treatment of bisphosphonate related osteonecrosis following root canal therapy at the 1-year follow-up: report of two cases

    OpenAIRE

    Kaptan, Figen; Kazandag, Meric Karapinar; Iseri, Ufuk

    2013-01-01

    Figen Kaptan,1 Meric Karapinar Kazandag,1 Ufuk Iseri21Yeditepe University, Faculty of Dentistry, Department of Endodontics, 2Department of Prosthodontics, Istanbul, TurkeyAbstract: The objective of this report was to use topical gaseous ozone as an adjunct to conventional treatment methods and to describe the multidisciplinary management of bisphosphonate associated bone necrosis, which developed following endodontic treatment. No complaints were noted by the patients at their 1-year follow-u...

  8. PRGF exerts a cytoprotective role in zoledronic acid-treated oral cells.

    Science.gov (United States)

    Anitua, Eduardo; Zalduendo, Mar; Troya, María; Orive, Gorka

    2016-04-01

    Bisphosphonates-related osteonecrosis of the jaw (BRONJ) is a common problem in patients undergoing long-term administration of highly potent nitrogen-containing bisphosphonates (N-BPs). This pathology occurs via bone and soft tissue mechanism. Zoledronic acid (ZA) is the most potent intravenous N-BP used to prevent bone loss in patients with bone dysfunction. The objective of this in vitro study was to evaluate the role of different ZA concentrations on the cells from human oral cavity, as well as the potential of plasma rich in growth factors (PRGF) to overcome the negative effects of this BP. Primary human gingival fibroblasts and primary human alveolar osteoblasts were used. Cell proliferation was evaluated by means of a fluorescence-based method. A colorimetric assay to detect DNA fragmentation undergoing apoptosis was used to determine cell death, and the expression of both NF-κB and pNF-κB were quantified by Western blot analysis. ZA had a cytotoxic effect on both human gingival fibroblasts and human alveolar osteoblasts. This BP inhibits cell proliferation, stimulates apoptosis, and induces inflammation. However, the addition of PRGF suppresses all these negative effects of the ZA. PRGF shows a cytoprotective role against the negative effects of ZA on primary oral cells. At present, there is no definitive treatment for bisphosphonates-related osteonecrosis of the jaw (BRONJ), being mainly palliatives. Our results revealed that PRGF has a cytoprotective role in cells exposed to zoledronic acid, thus providing a reliable adjunctive therapy for the treatment of BRONJ pathology.

  9. [Osteonecrosis of the jaws and bisphosphonates].

    Science.gov (United States)

    Junod, A F; Carrel, J-P; Richter, M; Vogt-Ferrier, N

    2005-11-02

    Widely prescribed, bisphosphonates inhibit bone resorption. They are not metabolised and have long half-lives. Two cases of osteonecrosis of the jaws have recently been attributed to bisphosphonates at the University Hospital of Geneva. The recent literature reveals more than a hundred similar cases throughout the world. Bone exposure appears spontaneously or after dental care. Treatment of the osteonecrosis is controversial and cure very difficult. This pathology is usually seen in patients on chemotherapy, steroids and i.v. bisphosphonates, but is sometimes seen with low-dose p.o. bisphosphonates. In view of the strong association between bisphosphonate therapy and osteonecrosis of the jaw, specialists have recommended dental and oral evaluation during bisphosphonate therapy as well as for several years after drug discontinuation.

  10. Retrospective Audit: Does Prior Assessment by Oral and Maxillofacial Surgeons Reduce the Risk of Osteonecrosis of The Jaw in Patients Receiving Bone-Targeted Therapies for Metastatic Cancers to the Skeleton?--Part II.

    Science.gov (United States)

    Turner, Bruce; Ali, Sacha; Pati, Jhumur; Nargund, Vinod; Ali, Enamul; Cheng, Leo; Wells, Paula

    2016-01-01

    Men who receive bone-targeted therapy for metastatic prostate cancer are at increased risk of osteonecrosis of the jaw (ONJ). Development of ONJ has been associated with the administration of bone-targeted therapies in association with other risk factors. ONJ can be distressing for a patient because it can cause pain, risk of jaw fracture, body image disturbance, difficultly eating, and difficulty maintaining good oral hygiene. The aim of this article is to report results of an audit of prior assessment by oral and maxillofacial surgeons (OMFS) before initiation of bone-targeted therapies and whether it may reduce the risk of ONJ in patients receiving bone-targeted therapies for advanced cancers.

  11. The advantages of tomosynthesis for evaluating bisphosphonate-related atypical femur fractures compared to radiography.

    Science.gov (United States)

    Petraszko, Andrew; Siegal, Daniel; Flynn, Michael; Rao, Sudhaker D; Peterson, Ed; van Holsbeeck, Marnix

    2016-05-01

    To investigate the advantages of using tomosynthesis (TS) compared to radiographs in the detection, characterization, and follow-up of bisphosphonate-related atypical femur fractures (BP-AFF). Eight patients were identified retrospectively who underwent TS for radiographic findings suspicious for BP-AFF. Two radiologists independently interpreted 15 radiographs and 16 TS examinations, indicating the presence or absence of the following: (1) cortical "beaking" on radiographs, (2) radiolucent fracture line on radiographs, and (3) fracture lucency on TS corresponding to the site of radiographic abnormality. Radiation dose data were calculated for radiographs and TS using Monte Carlo analysis. There was agreement on 100 % of radiographs regarding the presence or absence of a cortical beak. Regarding the presence or absence of a fracture lucency, there was agreement on 100 % of TS examinations (Kappa = 1.0) and 73 % of radiographs (Kappa = 0.40 ± 0.24). For the 46 % of radiographs in which one or both radiologists did not visualize a fracture line, there was 100 % agreement for the presence of a fracture line on the corresponding TS. The interobserver agreement for fracture line detection was significantly higher for TS than for radiographs (p = 0.012). The effective radiation dose using TS was approximately 96 % lower compared to radiography. TS outperformed radiographs in the detection and characterization of BP-AFF. TS may also have advantages over radiography for BP-AFF follow-up through its unique ability to visualize fracture healing with lower effective radiation doses to the patient.

  12. Surgical treatment of jaw osteonecrosis in "Krokodil" drug addicted patients.

    Science.gov (United States)

    Poghosyan, Yuri M; Hakobyan, Koryun A; Poghosyan, Anna Yu; Avetisyan, Eduard K

    2014-12-01

    Retrospective study of jaw osteonecrosis treatment in patients using the "Krokodil" drug from 2009 to 2013. On the territory of the former USSR countries there is widespread use of a self-produced drug called "Krokodil". Codeine containing analgesics ("Sedalgin", "Pentalgin" etc), red phosphorus (from match boxes) and other easily acquired chemical components are used for synthesis of this drug, which used intravenously. Jaw osteonecrosis develops as a complication in patients who use "Krokodil". The main feature of this disease is jawbone exposure in the oral cavity. Surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". 40 "Krokodil" drug addict patients with jaw osteonecrosis were treated. Involvement of maxilla was found in 11 patients (27.5%), mandible in 21 (52.5%), both jaws in 8 (20%) patients. 35 Lesions were found in 29 mandibles and 21 lesions in 19 maxillas. Main factors of treatment success are: cessation of "Krokodil" use in the pre- (minimum 1 month) and postoperative period and osteonecrosis area resection of a minimum of 0.5 cm beyond the visible borders of osteonecrosis towards the healthy tissues. Surgery was not delayed until sequestrum formation. In the mandible marginal or segmental resection (with or without TMJ exarticulation) was performed. After surgery recurrence of disease was seen in 8 (23%) cases in the mandible, with no cases of recurrence in the maxilla. According to our experience in this case series, surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". Cessation of drug use and jaw resection minimize the rate of recurrences in such patients. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. Machine learning to predict the occurrence of bisphosphonate-related osteonecrosis of the jaw associated with dental extraction: A preliminary report.

    Science.gov (United States)

    Kim, Dong Wook; Kim, Hwiyoung; Nam, Woong; Kim, Hyung Jun; Cha, In-Ho

    2018-04-23

    The aim of this study was to build and validate five types of machine learning models that can predict the occurrence of BRONJ associated with dental extraction in patients taking bisphosphonates for the management of osteoporosis. A retrospective review of the medical records was conducted to obtain cases and controls for the study. Total 125 patients consisting of 41 cases and 84 controls were selected for the study. Five machine learning prediction algorithms including multivariable logistic regression model, decision tree, support vector machine, artificial neural network, and random forest were implemented. The outputs of these models were compared with each other and also with conventional methods, such as serum CTX level. Area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the results. The performance of machine learning models was significantly superior to conventional statistical methods and single predictors. The random forest model yielded the best performance (AUC = 0.973), followed by artificial neural network (AUC = 0.915), support vector machine (AUC = 0.882), logistic regression (AUC = 0.844), decision tree (AUC = 0.821), drug holiday alone (AUC = 0.810), and CTX level alone (AUC = 0.630). Machine learning methods showed superior performance in predicting BRONJ associated with dental extraction compared to conventional statistical methods using drug holiday and serum CTX level. Machine learning can thus be applied in a wide range of clinical studies. Copyright © 2017. Published by Elsevier Inc.

  14. Identification of predisposing factors for osteonecrosis of the jaw after marginal mandibulectomy in the surgical management of oral squamous cell carcinoma.

    Science.gov (United States)

    Ito, Ran; Huang, Jung-Ju; Hsieh, Wei-Chuan; Kao, Huang-Kai; Lao, William Wei-Kai; Fang, Ku-Hao; Huang, Yenlin; Chang, Yu-Liang; Cheng, Ming-Huei; Chang, Kai-Ping

    2018-03-01

    The aim of this study is to evaluate osteonecrosis of the jaw (ONJ) with the extent of marginal mandibulectomy. Between January 2006 and December 2012, 3087 patients undergoing ablative resection were consecutively enrolled. Among them, 345 cases undergoing marginal mandibulectomy were retrospectively reviewed. The occurrence of ONJ was 5.51% and associated with body mass index, overall stage, diabetes, concomitant mandibulotomy, and radiotherapy (P = 0.023, 0.033, 0.009, 0.016, and 0.006, respectively). As for bone parameters based on radiological measurements after marginal mandibulectomy, resected bone height, remaining bone height to original bone height ratio, and resected bone height to original bone height ratio were associated with ONJ. In multivariate logistic analyses, concomitant mandibulotomy, radiotherapy, diabetes, resected bone height of >14.5 mm, resected bone height to original bone height ratio of >49.5%, and remaining bone height to original bone height ratio of marginal mandibulectomy; more caution is necessitated in performing marginal mandibulectomy in patients with multiple risks to prevent ONJ. © 2017 Wiley Periodicals, Inc.

  15. Bisphosphonate-associated osteonecrosis of the jaws

    Directory of Open Access Journals (Sweden)

    Pankaj Agarwal

    2012-01-01

    Full Text Available Bisphosphonates constitute a group of drugs capable of modulating bone turnover and reduce its remodeling when an excessive resorption occurs. This is why they are indicated in a large group of bone diseases like postmenopausal osteoporosis or osteolysis associated with breast cancer or multiple myeloma. Over the last few years and due to their extensive use, many cases of complications associated with their use have been published. Among the most important possible adverse effects are the oral ones, with the appearance of ulcerations and, especially, osteonecrosis of the jaws associated with this therapy. In this paper, we have analyzed the general characteristics of these drugs and their mechanisms of action as well as the described adverse effects, especially oral and maxillofacial, have been made special reference, regarding the prevention of osteonecrosis of the jaws, heightened by cases described in the medical and odontological literature. The preventive protocol backs up the fundamental role of the odontologist in the effective prevention of this process before, during and after the treatment.

  16. Necrotizing gingivostomatitis and osteonecrosis associated with antithyroid drug propylthiouracil therapy.

    Science.gov (United States)

    Xing, Haixia; Guan, Xiaobing

    2015-02-01

    A 43-year-old Chinese female had been diagnosed with hyperthyroidism 15 years ago. She was recently administered 150 mg/day propylthiouracil (PTU). After 3 weeks of PTU administration, she developed necrotizing stomatitis and osteonecrosis, most likely due to secondary effects from the PTU treatment. Her neutrophil count was reduced below normal to 0.24×10(9)/L but normalized after withdrawal of PTU therapy. About 1 month after onset, the patient came to our hospital and began to receive intravenous treatments of metronidazole and amoxicillin. Following review of her medical history and a series of clinical and laboratory examinations, the patient was diagnosed with secondary necrotizing gingivostomatitis and osteonecrosis possibly associated with PTU-induced agranulocytosis. One-year after treatment, the patient's oral manifestations remained unchanged. This case demonstrates the need for dental practitioners to more closely monitor oral symptoms in patients with hyperthyroidism treated with antithyroid drugs. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Bisphosphonates and osteonecrosis of the jaw.

    Science.gov (United States)

    Shannon, Jodi; Shannon, John; Modelevsky, Steven; Grippo, Anne A

    2011-12-01

    Bisphosphonates are used worldwide as a successful treatment for people with osteoporosis, which is the major underlying cause of fractures in postmenopausal women and older adults. These agents are successful at increasing bone mass and bone trabecular thickness, decreasing the risk of fracture, and decreasing bone pain, enabling individuals to have better quality of life. Bisphosphonates are also used to treat multiple myeloma, bone metastasis, and Paget's disease; however, bisphosphonate treatment may result in negative side effects, including osteonecrosis of the jaw (ONJ). ONJ involves necrotic, exposed bone in the jaw, pain, possible secondary infection, swelling, painful lesions, and various dysesthesias, although less-severe cases may be asymptomatic. First-generation bisphosphonates, which do not contain nitrogen, are metabolized into a nonfunctional, cytotoxic analogue of adenosine triphosphate and cause osteoclast death by starvation. Second-generation bisphosphonates are nitrogen-containing agents; these inhibit osteoclast vesicular trafficking, membrane ruffling, morphology, and cytoskeletal arrangement by inhibiting farnesyl diphosphate synthase in the mevalonate pathway. Physicians treating older adults with osteoporosis and cancer should work together with dental practitioners, pharmacists, and other clinicians to inform individuals receiving bisphosphonates of their possible side effects and to suggest precautionary steps that may minimize the risk of osteonecrosis, particularly of the jaw. These include practicing good oral hygiene; scheduling regular dental examinations and cleanings; and cautioning people who are scheduling treatment for periodontal disease, oral and maxillofacial therapy, endodontics, implant placement, restorative dentistry, and prosthodontics. Recommendations for management of people with ONJ include an oral rinse, such as chlorhexidine, and antibiotics. © 2011, Copyright the Authors Journal compilation © 2011, The American

  18. Osteonecrosis of the jaw

    International Nuclear Information System (INIS)

    Reid, Ian R.; Cundy, Tim

    2009-01-01

    Osteonecrosis of the jaw (ONJ) was first reported in the dental literature in 2003. The term was coined to describe a spectrum of dental problems seen in cancer patients treated with high doses of intravenous bisphosphonates for the prevention of skeletal-related events. By consensus, the syndrome is now defined by the presence of exposed bone in the mouth which fails to heal after appropriate intervention over a period of 6 or 8 weeks. It is most common in patients with breast or prostate cancers, or multiple myeloma treated with bisphosphonates, of whom about 5% develop the condition. In patients receiving the much lower drug doses used in osteoporosis, the incidence appears to be ∝1/100,000 patient-years, probably comparable to that in the general population. It is likely that ONJ results from direct drug toxicity to cells of bone and soft tissue. The bone in ONJ lesions does not appear to be 'frozen' but rather there is very active bone resorption taking place, which is likely to be responsible for the local release at high concentrations of bisphosphonates. Infection probably plays a pivotal role in driving this resorption, so its active management is critical. Obvious abnormalities are apparent with a variety of radiologic modalities, and it is not clear that radiographs are inferior to other approaches. Most authors favor a conservative approach to surgical debridement of the lesions. (orig.)

  19. Oroantral fistula from bisphosphonate induced osteonecrosis of the jaw

    Directory of Open Access Journals (Sweden)

    Henry Sharp

    2010-07-01

    Full Text Available Bisphosphonates like alendronic acid, disodium etidronate, and risedronate are effective for preventing postmenopausal and corticosteroid induced osteoporosis. They are also useful in the treatment of Paget’s disease, hypercalcaemia of malignancy and in bony metastases. However osteonecrosis of the jaw has been reported following intravenous bisphosphonate use and rarely in those taking them orally.Increasingly, oroantral fistulae have been shown to occur as sequelae of bisphosphonate-induced osteonecrosis of the jaw and this case report highlights a patient that presented to our ENT department and required sinus surgery in collaboration with maxillofacial surgeons.This case report aims to raise awareness among ENT surgeons to these patients on bisphosphonates that could present to them with sinus disease from oroantral fistulae. There is an on-going audit in the maxillofacial community on this emerging trend.

  20. Technetium-99 conjugated with methylene diphosphonate ameliorates ovariectomy-induced osteoporotic phenotype without causing osteonecrosis in the jaw.

    Science.gov (United States)

    Zhao, Yinghua; Wang, Lei; Liu, Yi; Akiyama, Kentaro; Chen, Chider; Atsuta, Ikiru; Zhou, Tao; Duan, Xiaohong; Jin, Yan; Shi, Songtao

    2012-12-01

    Technetium-99 conjugated with methylene diphosphonate ((99)Tc-MDP) is a novel bisphosphonate derivative without radioactivity and has been successfully used to treat arthritis in China for years. Since bisphosphonate therapy has the potential to induce bisphosphonate-related osteonecrosis of the jaw (BRONJ), we examined whether (99)Tc-MDP represents a new class of bisphosphonate for antiresorptive therapy to ameliorate estrogen deficiency-induced bone resorption with less risk of causing BRONJ. We showed that (99)Tc-MDP-treated, ovariectomized (OVX) mice had significantly improved bone mineral density and trabecular bone volume in comparison to the untreated OVX group by inhibiting osteoclasts and enhancing osteogenic differentiation of bone marrow mesenchymal stem cells. To determine the potential of inducing BRONJ, (99)Tc-MDP/dexamethasone (Dex) or zoledronate/Dex was administered into C57BL/6J mice via the tail vein, followed by extraction of maxillary first molars. Interestingly, (99)Tc-MDP treatment showed less risk to induce osteonecrosis in the maxillary bones compared to zoledronate treatment group, partially because (99)Tc-MDP neither suppressed adaptive regulatory T cells nor activated the inflammatory T-helper-producing interleukin-17 cells. Taken together, our findings demonstrate that (99)Tc-MDP therapy may be a promising approach in the treatment of osteoporosis with less risk of causing BRONJ.

  1. A rare cause of osteonecrosis

    Directory of Open Access Journals (Sweden)

    Paolo Agostinis

    2012-01-01

    Full Text Available IntroductionHereditary hemochromatosis (HH is an autosomal recessive disorder caused by mutations in the HFE gene, which increase intestinal iron absorption. The prevalence of C282Y homozygosity, which causes the disorder, is 0.5% in Caucasian populations. The clinical manifestations are related to excess iron in the tissues, especially the liver, heart, pancreas, pituitary, and skin. They include fatigue, loss of libido or impotence in males, liver disease, skin pigmentation, diabetes mellitus, cardiac enlargement—with or without heart failure, and conduction defects. The classic triad of cirrhosis, diabetes mellitus, and skin pigmentation (“bronze diabetes” results from a combination of iron deposits and melanin. It occurs late in the disease, when the total body iron content is more than five times the normal value, about 20 grams. Left untreated, approximately half of all patients with HH eventually develop arthralgia or arthropathy. Chondrocalcinosis, chronic pseudo-osteoarthritis, and osteoporosis are the major rheumatic manifestations of HH. The cause of the arthropathy is still unknown. Iron deposits within joints may trigger a number of pathologic events, such as free radical generation and crystal deposition, which stimulate immune complex formation and inflammation.Materials and methodsWe describe the case of a 48-year-old male suffering from chronic bilateral ankle pain.ResultsThe work-up revealed osteonecrosis of ankle. The patient also presented high plasma ferritin levels and homozygosity for the C282Y mutation. Other than HH, which was confirmed by liver biopsy, the patient had no other risk factors for osteonecrosis.DiscussionHH represents a rare cause of osteonecrosis, and there are no prior reports of aseptic osteonecrosis of the ankle in a patient with this disease. The pathogenetic mechanism remains unknown.

  2. Osteonecrosis following alcohol, cocaine, and steroid use.

    LENUS (Irish Health Repository)

    Ziraldo, Laura

    2012-02-01

    Alcohol, steroids and cocaine have all been shown to be independent risk factors for osteonecrosis when taken in excess. Here we present a case of a young girl who developed debilitating osteonecrosis secondary to low doses of alcohol, steroids and cocaine. We feel it is important to highlight to those caring for such patients of the potential devastating complication of these three agents.

  3. Osteonecrosis of the knee following arthroscopic meniscectomy

    International Nuclear Information System (INIS)

    Dobado, M. C.; Mota, J.; Roca, M.

    2000-01-01

    Primary osteonecrosis of the knee is characterized by acute onset of pain in elderly individuals who present no risk factors. Osteonecrosis following arthroscopic surgery for meniscal repair is a rare occurrence, the etiology of which remains to be determined. The authors present the magnetic resonance findings in a new case and a review of the related literature. (Author) 7 refs

  4. Osteonecrosis or spontaneous fractures following renal transplantation

    International Nuclear Information System (INIS)

    Andresen, J.; Nielsen, H.E.; Aarhus Univ.

    1981-01-01

    31 renal transplant recipients with posttransplant development of osteonecrosis or spontaneous fractures were evaluated with regard to age, duration of dialysis before transplantation. Determination of metacarpal bone mass at the time of transplantation and registration of bone resorption and soft tissue calcification at the time of transplantation and at the time of onset of osteonecrosis and spontaneous fractures were made. Apart from the increased mean age in patients with spontaneous fractures no difference was seen between the groups. Osteonecrosis and spontaneous fractures occurred in areas of trabecular bone. It seems most likely that after renal transplantation the patients show bone complications of different localization. (orig.) [de

  5. Non-radiation related osteonecrosis of the jaws in dogs: 14 cases (1996 - 2014

    Directory of Open Access Journals (Sweden)

    Santiago ePeralta

    2015-05-01

    Full Text Available Osteonecrosis of the jaws is an entity of major clinical impact characterized by chronically exposed necrotic mandibular or maxillary bone. Its clinicopathological characteristics and possible inciting or risk factors are well described in humans but only anecdotally reported in dogs. Treatment modalities and outcome vary depending on the inciting factors involved and the extent and severity of the lesions. The objectives of this study were to retrospectively describe the clinicopathological features of non-radiation related osteonecrosis of the jaws in a series of 14 dogs, identify possible inciting or risk factors, and report on the surgical treatment and outcome. For all patients, the medical records were used to collect information regarding signalment, clinical signs, characteristics of the oral, jaw and dental lesions, diagnostic imaging findings, histopathological and microbiological analysis, treatment performed and outcome. The data collected showed that non-radiation related osteonecrosis of the jaws appears to be an infrequent clinical entity but of significant impact in dogs; that a history of systemic antibiotics and dental disease is common among affected dogs; that previous dental extractions are commonly associated with ONJ sites; that using a systematic diagnostic approach is essential for diagnosis; and that thorough surgical débridement combined with a course of oral antibiotics was effective in the described dogs affected by advanced non-radiation related osteonecrosis of the jaws.

  6. Osteonecrosis in the knee joint

    International Nuclear Information System (INIS)

    Poeschl, M.

    1981-01-01

    The following forms are discussed: spontaneous osteonecrosis (Ahlbaeck's necrosis), which extends subchondrally into one of the femur condyles. It usually occurs in older patients, especially females. Blunt trauma may cause similar lesions. These often occur with cartilage and bone avulsions (flake fractures), which are often diagnosed much later (arthroscopy). Patellar chondropathy is increasing in frequency due to more intensive participation in sports. Pain localized at the apex of the patella (patellar apex syndrome) can develop from chondropathy, tendon lesions or primary juvenile necrosis of the patellar apex. Gas emboli occur near the knee joint during deep sea diving. Similar cartilage infarctions are seen in many hemoglobinopathies. The incidence of this is increasing due to the increased number of people immigrating from regions were these diseases are common. We have also observed vascular juvenile lesions of the epi- and metaphyses in Klippel-Trenaunay-Weber's syndrome. Their radiological appearance is similar to that of necroses. (orig.) [de

  7. Osteonecrosis in the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Poeschl, M

    1981-12-01

    The following forms are discussed: spontaneous osteonecrosis (Ahlbaeck's necrosis), which extends subchondrally into one of the femur condyles. It usually occurs in older patients, especially females. Blunt trauma may cause similar lesions. These often occur with cartilage and bone avulsions (flake fractures), which are often diagnosed much later (arthroscopy). Patellar chondropathy is increasing in frequency due to more intensive participation in sports. Pain localized at the apex of the patella (patellar apex syndrome) can develop from chondropathy, tendon lesions or primary juvenile necrosis of the patellar apex. Gas emboli occur near the knee joint during deep sea diving. Similar cartilage infarctions are seen in many hemoglobinopathies. The incidence of this is increasing due to the increased number of people immigrating from regions where these diseases are common. We have also observed vascular juvenile lesions of the epi- and metaphyses in Klippel-Trenaunay-Weber's syndrome. Their radiological appearance is similar to that of necroses.

  8. Osteonecrosis de los maxilares inducida por bifosfonatos: prevención y actitud terapéutica Bisphosphonate induced osteonecrosis of the jaws: prevention and therapeutic approach

    Directory of Open Access Journals (Sweden)

    F.J. Barrientos Lezcano

    2007-10-01

    Full Text Available Introducción. La osteonecrosis maxilar o mandibular por bifosfonatos puede convertirse en una epidemia debido a la amplia difusión de estos fármacos entre la población. Material y método. Se muestra un protocolo para la prevención y el tratamiento de esta enfermedad. Se presentan tres casos de osteonecrosis maxilar/mandibular. Resultados. Es difícil lograr una curación completa; sin embargo es posible detener la progresión de la enfermedad. Discusión. La cirugía y la suspensión de la terapia con bifosfonatos han demostrado poca utilidad. Los antibióticos y los enjuagues con clorhexidina son las únicas medidas eficaces. Conclusiones. Es imprescindible una planificación adecuada previa a la instauración del tratamiento con bifosfonatos. Ante una osteonecrosis establecida, la actitud debe ser conservadora.Introduction. Bisphosphonate-induced osteonecrosis of the jaws might reach epidemic proportions due to the widespread use of this therapy. Materials and methods. A protocol for prevention and treatment of this pathology is shown. Three clinical cases are reported. Results. It is quite difficult to reach restitutio ad integrum, but stopping the progress of the disease is possible. Discussion. Surgical treatment and cessation of bisphosphonate therapy are of no use. Only antibiotics and oral chlorhexidine have shown some benefits. Conclusions. An accurate preventive attitude is mandatory prior to undergoing bisphosphonate therapy. If osteonecrosis of the jaws is present, management should be conservative.

  9. Tooth alterations in areas of bisphosphonate-induced osteonecrosis.

    Science.gov (United States)

    de Camargo Moraes, Paulo; Silva, Carolina Amália Barcellos; Soares, Andresa Borges; Passador-Santos, Fabrício; Corrêa, Maria Elvira Pizzigatti; de Araújo, Ney Soares; de Araújo, Vera Cavalcanti

    2015-03-01

    Osteonecrosis of the jaw is a potential side effect when using bisphosphonates. Most studies on the effects of bisphosphonates on teeth have been conducted in vitro or in animal models of tooth development. Therefore, the aim of this study was to describe alterations found in human teeth extracted from areas of bisphosphonate-induced osteonecrosis. Using a retrospective study design, 16 teeth from 13 patients were extracted from areas of bisphosphonate-induced osteonecrosis during surgical debridement. The specimens were decalcified and embedded in paraffin. A series of 5-μm sections were prepared, stained with hematoxylin and eosin (H&E) and observed under a light microscope. The majority of the patients were female (53.85 %), with a mean age of 60.23 ± 13.18 years. Zoledronate (IV) was the most common bisphosphonate used (92.3 %), over a mean period of 2 years. The commonest alteration observed was hypercementosis (87.5 %), followed by pulpar necrosis (81.25 %), pulp stones attached to the dentine and loose pulp stones in the pulp chamber and root canals in addition to linear calcifications (68.75 %), dentinoid/osteoid material formation (18.75 %), and dental ankylosis (6.25 %). Patients undergoing bisphosphonate therapy present diverse tooth alterations, which should be closely monitored by clinicians to prevent complications. It is paramount that the teeth involved in oral lesions are always examined. Attention should be drawn to the need to establish preventive measures, in terms of dental treatment, for patients prior to starting bisphosphonate therapy.

  10. Osteonecrosis

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  11. Osteonecrosis

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  12. Bisphosphonate associated osteonecrosis of the jaw.

    Science.gov (United States)

    Khan, Aliya A; Sándor, George K B; Dore, Edward; Morrison, Archibald D; Alsahli, Mazen; Amin, Faizan; Peters, Edmund; Hanley, David A; Chaudry, Sultan R; Lentle, Brian; Dempster, David W; Glorieux, Francis H; Neville, Alan J; Talwar, Reena M; Clokie, Cameron M; Mardini, Majd Al; Paul, Terri; Khosla, Sundeep; Josse, Robert G; Sutherland, Susan; Lam, David K; Carmichael, Robert P; Blanas, Nick; Kendler, David; Petak, Steven; Ste-Marie, Louis Georges; Brown, Jacques; Evans, A Wayne; Rios, Lorena; Compston, Juliet E

    2009-03-01

    In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.

  13. A case of nasal septal abscess caused by medication related osteonecrosis in breast cancer patient.

    Science.gov (United States)

    Maeda, Mayuka; Matsunobu, Takeshi; Kurioka, Takaomi; Kurita, Akihiro; Shiotani, Akihiro

    2016-02-01

    Antiresorptive drugs have been widely used to treat patients with hypercalcemia caused by malignancy, bone metastasis, multiple myeloma, and osteoporosis. However, it is well known that antiresorptive drugs can cause osteonecrosis of the jaw (ONJ). Herein, we report a rare case of nasal septal abscess caused by medication related osteonecrosis of the jaw (MRONJ) in a breast cancer patient. A 69-year-old woman was referred to our clinic for evaluation of nasal obstruction. Physical examination revealed a cherry-like swelling of the nasal mucosa emanating from the septum that obstructed both nasal cavities and a fistulous tract showing pus discharge after extraction of the bilateral maxillary central incisors (MCI) and the right maxillary lateral incisor (MLI). Computed tomography and panoramic radiography revealed extensive osteonecrosis of the maxilla and swelling of the nasal mucosa. The clinical diagnosis was nasal septal abscess caused by osteonecrosis of the maxilla. Surgical procedure was undertaken for this case. An indwelling drain was placed in the oral cavity, and sequestrectomy was performed with incision and drainage of the anterior portion of left nasal septum. The patient was doing well at the 7-month follow-up. The patient had a medical history of breast cancer with bone, lung, liver metastases, and had received intravenous bisphosphonate, which is one of the antiresorptive medicines, over the past 4 years. We suspect that this history played an important role in MRONJ induced nasal septal abscess. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Osteonecrosis of jawbone associated with the use of zometa

    International Nuclear Information System (INIS)

    Portuguez Morales, Francisco; Vargas Martinez, Jairo; Gamboa M, Rodolfo; Castro, Sergio

    2008-01-01

    Intravenous bisphosphonates are widely used in conjunction with conventional antineoplastic therapy, to treat hypercalcaemia of malignancy, multiple myeloma, and metastasis of solid tumors of head and neck; in which radiation is used. The bisphosphonates are synthetic analogs of pyrophosphates, have had affinity for bone formation and have increased bone resorption. These are potent inhibitors of osteoclast that have induced bone resorption in diseases such as osteoporosis and hypercalcaemia of malignancy. The bisphosphonates have produced adverse effects on kidney, eyes and muscles, but have been linked to osteonecrosis of the jaws, mainly related to the recent extraction of a dental piece. The use of bisphosphonates is related to the development of osteonecrosis of the maxilla in a patient of 50 years that has used for a long time zolendronate to handle bone metastasis due to multiple myeloma. Clinical aspects and treatment are presented. However, patients that have taked bisphosphonates should receive prophylactic care to maintain their oral health, the panoramic radiographs are used to display these conditions. Preventive measures must be taken before, during and after treatment with bisphosphonates. (author) [es

  15. The Challenge Treatment of Medication Related Osteonecrosis of the Jaw: A Case Report

    OpenAIRE

    M Rodríguez Sánchez; Bassi AP; Carvalho PS

    2015-01-01

    Bisphosphonates toxicological effect on alveolar bone could be associated to medication related osteonecrosis of the jaw. (MRONJ) Oral surgical procedures as; tooth extractions, implants placements or trauma are suggested risk factors. The aim of this paper is to describe a case of MRONJ and recurrence after the first right mandibular molar extraction. A 54 years old man was referred to the Department of Surgery and Integrated Clinic of Aracatuba Dental School, Univ. Estadual Paulista - UNESP...

  16. Osteonecrosis in HIV-infected patients

    International Nuclear Information System (INIS)

    Lama, E. de; Narvaez, J. A.; Roca, Y.; Pellicer, J. M.

    2001-01-01

    We present two cases of avascular osteonecrosis, one involving the knees and the other the hips, in patients with human immunodeficiency virus (HIV) infection who met the criteria for acquired immunodeficiency syndrome (AIDS). We review the literature concerning this rare complication of HIV infection, focussing especially on the clinical and radiological features and its possible etiopathogenesis. (Author) 30 refs

  17. Osteomyelitis and Osteonecrosis in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    1997-01-01

    Full Text Available Osteomyelitis and osteonecrosis are skeletal disorders seen in patients with inflammatory bowel disease (IBD. Osteomyelitis usually occurs in the pelvic bones, especially in complicated Crohn's disease, presumably by direct extension from a pelvic inflammatory mass, abscess or fistulous tract. Diagnosis of osteomyelitis may be difficult and can lead to spinal extension of the septic process with a resultant neurological deficit, including paraplegia. Osteonecrosis or avascular necrosis has been reported in patients with either ulcerative colitis or Crohn's disease, often, but not exclusively, during or following steroid treatment. The disease is often multifocal, but its natural history is unknown, especially if diagnosed early with modern imaging methods, such as magnetic resonance. In IBD patients, the relationship between osteonecrosis and steroid use is unknown. An adverse steroid effect on bones, especially the femoral heads, may develop in some patients with IBD but, to date, this hypothesis remains unproven. Critical evaluation of published data reveals no consistent association between osteonecrosis and steroid treatment in IBD patients.

  18. Osteonecrosis. Part 1. Risk factors and pathogenesis

    Directory of Open Access Journals (Sweden)

    Ekaterina Valeriyevna Ilyinykh

    2013-01-01

    Full Text Available The paper considers different risk factors for osteonecrosis (ON and some aspects of its pathogenesis: impairments in the differentiation of stromal cells, the vascular provision of intraand extravasal genesis, the quality of proper bone tissue due to generalized or local osteoporosis, intravascular coagulation factors contributing to microthrombogenesis. The basic types of ON are identified.

  19. Osteonecrosis en pacientes infectados por HIV Osteonecrosis in HIV-infected patients

    Directory of Open Access Journals (Sweden)

    Edgardo G. Bottaro

    2004-08-01

    Full Text Available Según la literatura, la osteonecrosis tiene una mayor incidencia en los pacientes infectados con HIV que en la población general. Ello sería resultado de la confluencia de factores de riesgo clásicos y de otros propios de esta población o más prevalentes en ella, como el tratamiento con inhibidores de proteasa, la dislipemia producto de su consumo, la presencia de anticuerpos anticardiolipina séricos, la hipercoagulabilidad, la restauración inmune y las vasculitis. Presentamos una serie de 13 pacientes infectados con HIV con osteonecrosis. El motivo de consulta fue dolor en grandes articulaciones. Cuatro eran alcoholistas, 8 tabaquistas y 9 tenían dislipemia. Once habían recibido esteroides en algún momento de la vida aunque sólo uno estaba recibiéndolos al momento del inicio del dolor. En 2 se detectaron anticuerpos anticardiolipina séricos. Doce tenían sida y recibían tratamiento antirretroviral de alta eficacia (11 con inhibidores de proteasa. Ellos lograron una adecuada recuperación inmunológica. Consideramos necesario incluir la osteonecrosis como diagnóstico diferencial de artralgia persistente en pacientes infectados con HIV e investigar infección por HIV en todo paciente con osteonecrosis sin claros factores predisponentes.Osteonecrosis, also known as avascular necrosis, is chiefly characterized by death of bone caused by vascular compromise. The true incidence of osteonecrosis in HIV-infected patients is not well known and the pathogenesis remains undefined. Hypothetical risk factors peculiar to HIV-infected individuals that might play a role in the pathogenesis of osteonecrosis include the introduction of protease inhibitors and resulting hyperlipidemia, the presence of anticardiolipin antibodies in serum leading to a hypercoagulable state, immune recovery and vasculitis. Hereby we present a series of 13 HIV-infected patients with osteonecrosis. The most common symptom upon presentation was arthralgia. The majority

  20. Expression of Msx-1 is suppressed in bisphosphonate associated osteonecrosis related jaw tissue-etiopathology considerations respecting jaw developmental biology-related unique features.

    Science.gov (United States)

    Wehrhan, Falk; Hyckel, Peter; Ries, Jutta; Stockmann, Phillip; Nkenke, Emeka; Schlegel, Karl A; Neukam, Friedrich W; Amann, Kerstin

    2010-10-13

    Bone-destructive disease treatments include bisphosphonates and antibodies against the osteoclast differentiator, RANKL (aRANKL); however, osteonecrosis of the jaw (ONJ) is a frequent side-effect. Current models fail to explain the restriction of bisphosphonate (BP)-related and denosumab (anti-RANKL antibody)-related ONJ to jaws. Msx-1 is exclusively expressed in craniofacial structures and pivotal to cranial neural crest (CNC)-derived periodontal tissue remodeling. We hypothesised that Msx-1 expression might be impaired in bisphosphonate-related ONJ. The study aim was to elucidate Msx-1 and RANKL-associated signal transduction (BMP-2/4, RANKL) in ONJ-altered and healthy periodontal tissue. Twenty ONJ and twenty non-BP exposed periodontal samples were processed for RT-PCR and immunohistochemistry. An automated staining-based alkaline phosphatase-anti-alkaline phosphatase method was used to measure the stained cells:total cell-number ratio (labelling index, Bonferroni adjustment). Real-time RT-PCR was performed on ONJ-affected and healthy jaw periodontal samples (n = 20 each) to quantitatively compare Msx-1, BMP-2, RANKL, and GAPDH mRNA levels. Semi-quantitative assessment of the ratio of stained cells showed decreased Msx-1 and RANKL and increased BMP-2/4 (all p Msx-1 (p Msx-1 suppression in ONJ-adjacent periodontal tissue suggested a bisphosphonate-related impairment in cellular differentiation that occurred exclusively jaw remodelling. Further research on developmental biology-related unique features of jaw bone structures will help to elucidate pathologies restricted to maxillofacial tissue.

  1. Expression of Msx-1 is suppressed in bisphosphonate associated osteonecrosis related jaw tissue-etiopathology considerations respecting jaw developmental biology-related unique features

    Directory of Open Access Journals (Sweden)

    Schlegel Karl A

    2010-10-01

    Full Text Available Abstract Background Bone-destructive disease treatments include bisphosphonates and antibodies against the osteoclast differentiator, RANKL (aRANKL; however, osteonecrosis of the jaw (ONJ is a frequent side-effect. Current models fail to explain the restriction of bisphosphonate (BP-related and denosumab (anti-RANKL antibody-related ONJ to jaws. Msx-1 is exclusively expressed in craniofacial structures and pivotal to cranial neural crest (CNC-derived periodontal tissue remodeling. We hypothesised that Msx-1 expression might be impaired in bisphosphonate-related ONJ. The study aim was to elucidate Msx-1 and RANKL-associated signal transduction (BMP-2/4, RANKL in ONJ-altered and healthy periodontal tissue. Methods Twenty ONJ and twenty non-BP exposed periodontal samples were processed for RT-PCR and immunohistochemistry. An automated staining-based alkaline phosphatase-anti-alkaline phosphatase method was used to measure the stained cells:total cell-number ratio (labelling index, Bonferroni adjustment. Real-time RT-PCR was performed on ONJ-affected and healthy jaw periodontal samples (n = 20 each to quantitatively compare Msx-1, BMP-2, RANKL, and GAPDH mRNA levels. Results Semi-quantitative assessment of the ratio of stained cells showed decreased Msx-1 and RANKL and increased BMP-2/4 (all p Conclusions These results explain the sclerotic and osteopetrotic changes of periodontal tissue following BP application and substantiate clinical findings of BP-related impaired remodeling specific to periodontal tissue. RANKL suppression substantiated the clinical finding of impaired bone remodelling in BP- and aRANKL-induced ONJ-affected bone structures. Msx-1 suppression in ONJ-adjacent periodontal tissue suggested a bisphosphonate-related impairment in cellular differentiation that occurred exclusively jaw remodelling. Further research on developmental biology-related unique features of jaw bone structures will help to elucidate pathologies restricted to

  2. Bisphosphonates-induced osteonecrosis of the jaw: pharmacology and clinical procedures.

    Directory of Open Access Journals (Sweden)

    Candice Belchior Duplat

    2012-01-01

    Full Text Available Osteonecrosis of the jaw is a consequent condition of a variety of local and systemic factors that compromises the bone blood flow. Bisphosphonates are a class of compounds widely used for the treatment of disorders of bone metabolism, such as bone metastasis and osteoporosis. Bisphosphonates-induced osteonecrosis of the jaw is a new complication, published for the first time at 2003, and can be defined as an unexpected necrosis development on the oral cavity in patients who received bisphosphonates and were not being treated with head and neck radiotherapy. Radiographies show radiolucent zones or sclerotic bone and, in some cases, show areas with delayed or absent bone remodeling after extraction, remain the socket cavity. The treatment can be done in accordance with the condition stage, since management of 0,12% chlorhexidine and antibiotics until laser utilization, hyperbaric oxygen, surgical debridement and resection. It is important to promote more communication between physicians and dentists to guarantee dental attention during the bisphosphonate administration, establishing oral health and preventing complications, such as osteonecrosis induced by this medication.

  3. BISPHOSPHONATES-INDUCED OSTEONECROSIS OF THE JAW: PHARMACOLOGY AND CLINICAL PROCEDURES.

    Directory of Open Access Journals (Sweden)

    Candice Belchior Duplat

    2012-08-01

    Full Text Available Osteonecrosis of the jaw is a consequent condition of a variety of local and systemic factors that compromises the bone blood flow. Bisphosphonates are a class of compounds widely used for the treatment of disorders of bone metabolism, such as bone metastasis and osteoporosis. Bisphosphonates-induced osteonecrosis of the jaw is a new complication, published for the first time at 2003, and can be defined as an unexpected necrosis development on the oral cavity in patients who received bisphosphonates and were not being treated with head and neck radiotherapy. Radiographies show radiolucent zones or sclerotic bone and, in some cases, show areas with delayed or absent bone remodeling after extraction, remain the socket cavity. The treatment can be done in accordance with the condition stage, since management of 0,12% chlorhexidine and antibiotics until laser utilization, hyperbaric oxygen, surgical debridement and resection. It is important to promote more communication between physicians and dentists to guarantee dental attention during the bisphosphonate administration, establishing oral health and preventing complications, such as osteonecrosis induced by this medication.

  4. Bisphosphonate-associated Osteonecrosis of the jaws and endodontic treatment: two case reports.

    Science.gov (United States)

    Goodell, Gary

    2006-01-01

    Bisphosphonates are commonly used in the management of bone diseases, such as osteoporosis and Paget's disease, and to prevent bone complications and treat malignant hypercalcemia in certain types of cancer. Although this class of drugs has clear evidence of medical efficacy, there are an, increasing number of reports of bisphosphonate-associated osteonecrosis of the jaws that have substantial implications for the patient and for the treating dentist. This article reviews proposed possible mechanisms of bisphosphonate-associated osteonecrosis of the jaws and describes two case reports where non-surgical and surgical root canal treatment were precipitating factors. Recommendations for prevention and treatment of the disease follow. Thorough history-taking and timely consultation with the patient's oral surgeon and oncologist are emphasized.

  5. Capitate Osteonecrosis: A Pediatric Case Report

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    Davod Jafari

    2017-05-01

    Full Text Available Introduction Avascular necrosis (AVN of the capitate is relatively rare. Although there are many factors as etiology; however, there are idiopathic ones. Case Presentation A 15-year-old female presented with wrist pain without the history of previous major trauma and no relief with conservative management; radiographic evaluation revealed capitates osteonecrosis with collapse and sclerosis. She underwent surgery (curettage of necrotic bone and iliac crest bone grafting. Two years fallow-up showed full recovery clinically and radiographically. Conclusions Capitate AVN should be included in the differential diagnosis of wrist pain in pediatric patients. Despite the controversial multiple surgical options to treat capitate osteonecrosis, autogenous iliac crest bone grafting can have a good result, even in the pediatric patient.

  6. Root canal therapy for the prevention of osteonecrosis of the jaws: an evidence-based clinical update.

    Science.gov (United States)

    Kyrgidis, Athanassios; Arora, Amit; Lyroudia, Kleoniki; Antoniades, Konstantinos

    2010-12-01

    Osteonecrosis of the jaws is an adverse effect of bone preservation treatment. There is a sufficient body of evidence to associate osteonecrosis of the jaws development with dental extractions and trauma caused from ill-fitting dentures. In this review, we critically appraise available evidence about the clinical efficacy of root canal therapy in patients receiving bisphosphonates.We review a series of theories to explain why endodontic treatment is a safe clinical intervention to prevent osteonecrosis of the jaws in patients receiving bisphosphonates. Root canal therapy could postpone or even eradicate the need for dental extractions of carious teeth in patients on bisphosphonates who may develop osteonecrosis of the jaws. Patients receiving bisphosphonates should be offered the full range of preventive care to reduce their risk to both dental caries and periodontal disease, so that the need for both endodontic therapy and dental extractions will be reduced. Implementing such a strategy would require both practitioner and patient education through the combined efforts of medical and dental societies. Such an approach is justified, as the risk of compromising the oral health of patients on bisphosphonates undertaking endodontic treatment is negligible compared with the benefit from avoiding dental extractions.

  7. Osteonecrosis of the jaw after dental implant placement. A case report

    Directory of Open Access Journals (Sweden)

    J.L. Calvo-Guirado

    2014-03-01

    Full Text Available Background: In the past few years, the occurrence of an oral lesion, called osteonecrosis of the jaw, has increasingly been reported in patients undergoing treatment with systemic bisphosphonates (BPs; however, few papers dealing with oral biphosphonates related osteonecrosis of the jaws (BRONJ can be found in the literature. The purpose of the present case was to report an occurrence of BRONJ after implant insertion. Case report: Ten years ago, eight dental implants were inserted in the jaw of a 65-year-old female. After 5 years of treatment with alendronic acid, a breakdown of the oral mucosa covering the implants occurred with a purulent discharge in the left side of the jaw; periapical radiolucency was present around both distal implants. An en-block resection of the alveolar bone including the two implants was performed. Thirthy-five hyperbaric sessions were taken and no signs of recurrence of the lesion were observed after a follow-up of 20 months. Before the new implant insertion, the patient had suspended the treatment with alendronic acid for 6 months. At the interface of one of the implants, a gap was observed between bone and implant. This bone was non vital, and many osteocyte lacunae were empty. Moreover, this bone appeared to be partially demineralized. Conclusion: There is certainly a temporal association between oral BPs use and development of BRONJ, but a correlation does not necessarily mean causation. In patients undergoing oraltreatment, clinicians must be aware of the increased risk of implant failure.

  8. Osteonecrosis in HIV-infected patients; Osteonecrosis en pacientes con infeccion por VIH

    Energy Technology Data Exchange (ETDEWEB)

    Lama, E. de; Narvaez, J. A.; Roca, Y.; Pellicer, J. M. [Servicio de Radiodiagnostico y RM Ciutat Sanitaria i Universitaria de bellvitge. L' Hospitalet de Llobregar. Barcelona (Spain)

    2001-07-01

    We present two cases of avascular osteonecrosis, one involving the knees and the other the hips, in patients with human immunodeficiency virus (HIV) infection who met the criteria for acquired immunodeficiency syndrome (AIDS). We review the literature concerning this rare complication of HIV infection, focussing especially on the clinical and radiological features and its possible etiopathogenesis. (Author) 30 refs.

  9. Osteonecrosis of the jaw associated to bisphosphonates treatment in osteoporosis patients: a review

    OpenAIRE

    Gutiérrez Restrepo, Johnayro

    2013-01-01

    La osteonecrosis de mandíbula es una entidad que se viene describiendo desde 2003 y se define como la presencia de un defecto en la mucosa oral que lleva a exposición del hueso de la mandíbula y del maxilar que falla en cicatrizar en un periodo de ocho semanas, en un paciente en tratamiento con bifosfonatos y sin exposición previa a radioterapia en cuello o en la cabeza. En este artículo se hace una revisión de la literatura respecto a la epidemiología, la fisiopatología, los estudios diagnós...

  10. Osteonecrosis due to radiation given for uterus cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Morimoto, Kazuo; Ugai, Kazuhiro; Hasegawa, Kazuo; Hirota, Saeko [Hyogo Medical Center for Adults, Akashi (Japan)

    1992-04-01

    During a period 1984-1991, 18 patients were diagnosed as developing osteonecrosis after radiation therapy for uterine cervical cancer. The patients had Stage I-III. Acute pain occurred in the lumbar spine, pelvis, and/or limbs. There was no correlation between osteonecrosis and either clinical staging or the associated surgery. The most common site of osteonecrosis was lumbar spine (n=13), followed by sacroiliacal joint and head and neck of femur (5 each) and pubic bone (3). The duration from radiation therapy to occurrence of osteonecrosis varied from one to 8 years: the latency period tended to be longer for younger patients. There was correlation between radiation doses and site of osteonecrosis: 60 Gy caused more extensive osteonecrosis, involving the pelvis and head of femur, although 40 Gy confined it to the lumbo-sacral region. Osteonecrosis was sometimes difficult to diagnose: needle biopsy, in addition to imaging modalities, was necessary in 4 patients. It is recommended that patients with uterus cervical cancer treated with radiation be followed up carefully. (N.K.).

  11. Platelet-rich plasma (PRP) in dental and oral surgery: from the wound healing to bone regeneration

    Science.gov (United States)

    2013-01-01

    Platelet-rich plasma (PRP) is a new approach to tissue regeneration and it is becoming a valuable adjunct to promote healing in many procedures in dental and oral surgery, especially in aging patients. PRP derives from the centrifugation of the patient's own blood and it contains growth factors that influence wound healing, thereby playing an important role in tissue repairing mechanisms. The use of PRP in surgical practice could have beneficial outcomes, reducing bleeding and enhancing soft tissue healing and bone regeneration. Studies conducted on humans have yielded promising results regarding the application of PRP to many dental and oral surgical procedures (i.e. tooth extractions, periodontal surgery, implant surgery). The use of PRP has also been proposed in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with the aim of enhancing wound healing and bone maturation. The aims of this narrative review are: i) to describe the different uses of PRP in dental surgery (tooth extractions and periodontal surgery) and oral surgery (soft tissues and bone tissue surgery, implant surgery and BRONJ surgery); and ii) to discuss its efficacy, efficiency and risk/benefit ratio. This review suggests that the use of PRP in the alveolar socket after tooth extractions is certainly capable of improving soft tissue healing and positively influencing bone regeneration but the latter effect seems to decrease a few days after the extraction. PRP has produced better results in periodontal therapy in association with other materials than when it is used alone. Promising results have also been obtained in implant surgery, when PRP was used in isolation as a coating material. The combination of necrotic bone curettage and PRP application seem to be encouraging for the treatment of refractory BRONJ, as it has proven successful outcomes with minimal invasivity. Since PRP is free from potential risks for patients, not difficult to obtain and use, it can be employed

  12. Platelet-rich plasma (PRP) in dental and oral surgery: from the wound healing to bone regeneration.

    Science.gov (United States)

    Albanese, Antonino; Licata, Maria E; Polizzi, Bianca; Campisi, Giuseppina

    2013-06-13

    Platelet-rich plasma (PRP) is a new approach to tissue regeneration and it is becoming a valuable adjunct to promote healing in many procedures in dental and oral surgery, especially in aging patients. PRP derives from the centrifugation of the patient's own blood and it contains growth factors that influence wound healing, thereby playing an important role in tissue repairing mechanisms. The use of PRP in surgical practice could have beneficial outcomes, reducing bleeding and enhancing soft tissue healing and bone regeneration. Studies conducted on humans have yielded promising results regarding the application of PRP to many dental and oral surgical procedures (i.e. tooth extractions, periodontal surgery, implant surgery). The use of PRP has also been proposed in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with the aim of enhancing wound healing and bone maturation. The aims of this narrative review are: i) to describe the different uses of PRP in dental surgery (tooth extractions and periodontal surgery) and oral surgery (soft tissues and bone tissue surgery, implant surgery and BRONJ surgery); and ii) to discuss its efficacy, efficiency and risk/benefit ratio. This review suggests that the use of PRP in the alveolar socket after tooth extractions is certainly capable of improving soft tissue healing and positively influencing bone regeneration but the latter effect seems to decrease a few days after the extraction. PRP has produced better results in periodontal therapy in association with other materials than when it is used alone. Promising results have also been obtained in implant surgery, when PRP was used in isolation as a coating material. The combination of necrotic bone curettage and PRP application seem to be encouraging for the treatment of refractory BRONJ, as it has proven successful outcomes with minimal invasivity. Since PRP is free from potential risks for patients, not difficult to obtain and use, it can be employed

  13. Osteonecrosis of the sesamoid bone: contribution of modern imaging techniques

    International Nuclear Information System (INIS)

    Leleu, J.P.; Heno, P.; Rispal, P.; Joullie, M.; Laurent, F.

    1990-01-01

    We report a case of osteonecrosis of the sesamoid bone or Renander disease in a young male serviceman. Modern imaging techniques proved useful for identifying the lesion. CT scan and above all magnetic resonance imaging established the accurate diagnosis. The combination of a hypointense signal from the sesamoid bone with an effusion in the first metatarsophalangeal joint should be considered as characteristic of osteonecrosis of the sesamoid bone [fr

  14. Asparaginase Potentiates Glucocorticoid-Induced Osteonecrosis in a Mouse Model.

    Directory of Open Access Journals (Sweden)

    Chengcheng Liu

    Full Text Available Osteonecrosis is a common dose-limiting toxicity of glucocorticoids. Data from clinical trials suggest that other medications can increase the risk of glucocorticoid-induced osteonecrosis. Here we utilized a mouse model to study the effect of asparaginase treatment on dexamethasone-induced osteonecrosis. Mice receiving asparaginase along with dexamethasone had a higher rate of osteonecrosis than those receiving only dexamethasone after 6 weeks of treatment (44% vs. 10%, P = 0.006. Similarly, epiphyseal arteriopathy, which we have shown to be an initiating event for osteonecrosis, was observed in 58% of mice receiving asparaginase and dexamethasone compared to 17% of mice receiving dexamethasone only (P = 0.007. As in the clinic, greater exposure to asparaginase was associated with greater plasma exposure to dexamethasone (P = 0.0001. This model also recapitulated other clinical risk factors for osteonecrosis, including age at start of treatment, and association with the systemic exposure to dexamethasone (P = 0.027 and asparaginase (P = 0.036. We conclude that asparaginase can potentiate the osteonecrotic effect of glucocorticoids.

  15. Bisphosphonate Therapy (and Osteonecrosis of the Jaw)

    Science.gov (United States)

    ... you to a specialist in oral medicine or oral surgery to evaluate the best possible therapy. Generally, therapy ... the risk of needing invasive procedures (extractions and oral surgery). Frequent professional cleanings, attention to home care, and ...

  16. Osteonecrosis of the jaw: effect of bisphosphonate type, local concentration, and acidic milieu on the pathomechanism.

    Science.gov (United States)

    Otto, Sven; Pautke, Christoph; Opelz, Christine; Westphal, Ines; Drosse, Inga; Schwager, Joanna; Bauss, Frieder; Ehrenfeld, Michael; Schieker, Matthias

    2010-11-01

    Osteonecrosis of the jaw has been reported in patients receiving high doses of intravenous nitrogen-containing bisphosphonates (N-BPs) because of malignant disease. The exact pathomechanisms have been elusive and questions of paramount importance remain unanswered. Recent studies have indicated toxic effects of bisphosphonates on different cell types, apart from osteoclast inhibition. Multipotent stem cells play an important role in the processes of wound healing and bone regeneration, which seem to be especially impaired in the jaws of patients receiving high doses of N-BPs. Therefore, the aim of the present study was to investigate the effects of different bisphosphonate derivatives and dose levels combined with varying pH levels on the mesenchymal stem cells in vitro. The effect of 2 N-BPs (zoledronate and ibandronate) and 1 non-N-BP (clodronate) on immortalized mesenchymal stem cells was tested at different concentrations, reflecting 1, 3, and 6 months and 1, 3, 5, and 10 years of exposure to standard oncology doses of the 2 N-BPs and equimolar concentrations of clodronate at different pH values (7.4, 7.0, 6.7, and 6.3). Cell viability and activity were analyzed using a WST assay. Cell motility was investigated using scratch wound assays and visualized using time-lapse microscopy. Both types of bisphosphonates revealed remarkable differences. Zoledronate and ibandronate showed a dose- and pH-dependent cellular toxicity. Increasing concentrations of both N-BPs and an acidic milieu led to a significant decrease in cell viability and activity (P key role in the pathogenesis of osteonecrosis of the jaw in patients receiving high doses of N-BPs for malignant diseases. Also the potency of N-BPs might be different, suggesting a greater risk of osteonecrosis of the jaw with zoledronate. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Comparison of nonexposed and exposed bisphosphonate-induced osteonecrosis of the jaws

    DEFF Research Database (Denmark)

    Schiodt, Morten; Reibel, Jesper; Oturai, Peter

    2014-01-01

    Nonexposed osteonecrosis of the jaws (NE-ONJ) does not fit into the current definition of osteonecrosis, which requires exposed bone. A modification of the classification of bisphosphonate-induced osteonecrosis of the jaws (ONJ) is proposed. This study aimed to test proposed criteria for NE...

  18. Endodontic management of nonrestorable teeth in patients at risk of developing osteonecrosis of the jaw: Case series

    Directory of Open Access Journals (Sweden)

    Fahd Alsalleeh

    2016-01-01

    Full Text Available Osteoradionecrosis of the jaws is one of the most serious oral complications of head and neck cancer radiation therapy. It is a self-progressive process of bone destruction that is very difficult to treat. In this report, four patients who are susceptible to osteonecrosis of the jaw presented for endodontic management of nonrestorable teeth. The first patient had two molar teeth with necrotic pulp and was treated with nonsurgical root canal therapy (NSRCT followed by crown amputation and hemisection. The second patient had a molar tooth that was previously treated with acute apical abscess. Crown amputation and hemisection were performed. The third patient had a molar tooth with necrotic pulp and asymptomatic apical periodontitis. NSRCT followed by occlusal reduction were completed. The fourth patient had a molar tooth with necrotic pulp and symptomatic apical periodontitis. NSRCT and crown amputation were performed. All cases had a minimum recall of 12-months. The tooth in case #1 developed a periapical pathosis, and other teeth in case #1–#3 had healing of periapical lesions. The tooth in case #4 was exfoliated. None had developed osteonecrosis. These results suggest that NSRCT is the treatment option to manage nonrestorable teeth in postradiation patients or patients taking bisphosphonate drugs to prevent osteonecrosis.

  19. Dysbaric osteonecrosis in divers and caisson workers. An animal model.

    Science.gov (United States)

    Lehner, C E; Adams, W M; Dubielzig, R R; Palta, M; Lanphier, E H

    1997-11-01

    Dysbaric osteonecrosis was induced successfully in adult sheep after 12 to 13, 24-hour exposures to compressed air (2.6-2.9 atmospheres absolute) during a 2-month period. All exposed sheep had decompression sickness and extensive bone and marrow necrosis in their long bones. Radiographic analysis of these progressive lesions showed mottled to distinct medullary opacities and endosteal thickening characteristic of dysbaric osteonecrosis. Six months after the last hyperbaric exposure, neovascularization of once ischemic fatty marrow was centripetal from the diaphyseal cortex. Proliferating endosteal new bone, fatty marrow calcification, and appositional new bone formation were widespread. Juxtaarticular osteonecrosis involved marrow fibrosis and loss of osteocytes in subchondral cortical bone. Tidemark reduplication in juxtaarticular bone and cartilage thinning suggested possible early osteoarthritis induction by recurrent episodes of transient ischemia after multiple hyperbaric exposures. Dysbaric osteonecrosis appears to involve a bone compartment syndrome of elevated intramedullary pressure initiated by decompression induced N2 bubble formation in the fatty marrow of the long bones. An animal model that can be used to investigate the pathogenesis, diagnosis, and treatment of dysbaric osteonecrosis is discussed.

  20. Osteonecrosis of the femoral head after bone marrow transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Jun, Jeong Su; Park, Chang Suk; Kim, Yong Sik; Kwon, Soon Yong; Kim, Yoo Jin; Kim, Chun Choo [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2003-07-01

    To retrospectively review findings of osteonecrosis of the femoral head after bone marrow transplantation. We reviewed the clinical and MR findings of osteonecrosis of the femoral head in 23 of 1112 patients who underwent marrow transplantation during a five-year follow-up period lasting from 1996 to 2000. Mean age at the time of diagnosis was 31 (range, 20-47) years, and the mean time from transplant to diagnosis was 17 months. All patients developed variable graft-versus-host disease and seventeen were treated with high-dose prednisolone and/or cysclosporin for severe acute or extensive chronic graft versus host disease. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allowed early detection of disease assessment of its stage. At the time of diagnosis, 15 hips were at stage I, 28 at stage II, two at stage III, and none at stage IV, according to the international ARCO classification system. Osteonecrosis of femoral diaphyses, the lower lumbar spine, or pelvic bones in the MR field was also found to have occurred in 11 patients. Initial treatment was conservative: 21 hips underwent surgery [core decompression (n=10), vascularized fibular bone graft (n=5), and joint replacement (n=6)]. In patients receiving high-dose steroids for the treatment of graft-versus-host disease, MR screening might help detect osteonecrosis at an early stage.

  1. Imaging of early spontaneous osteonecrosis and osteoarthritis of the knee

    International Nuclear Information System (INIS)

    Kusayama, Takeshi; Tomatsu, Taisuke

    1999-01-01

    In this paper, the available of MRI in diagnosis on early spontaneous osteonecrosis and osteoarthritis was investigated. Subjects were 5 cases (5 knees) with spontaneous osteonecrosis (stage 1 in Koshino's classification) and 96 cases (104 knees) in osteoarthritis who were more than 50 years old. Patients with an early spontaneous osteonecrosis were elderly females and had night pain and severe spontaneous pain. On MRI, lesions of all cases were clearly detected in early stage. On the other hand, only 47 of 104 knees (45%) were detected in patients with osteoarthritis, and mirror lesions at shank sides were detected in 45 of 47 knees. These results suggest that it is possible to diagnose early spontaneous osteonecrosis from osteoarthritis by MRI image with the clue to mirror lesion at shank sides, incidence, stage, etc. On the diagnosis of early spontaneous osteonecrosis, MRI image should be performed as soon as possible if a patient was older, had no anamnesis of lesions, and no changes by the X-ray radiography in spite of severe pain of the knee joints. (K.H.)

  2. A Case Report of Sequela of Operation of Talus Osteonecrosis

    Directory of Open Access Journals (Sweden)

    Choi Sung-Hun

    2006-02-01

    Full Text Available Objective : The clinic study or report about Oriental Medical treatment about osteonecrosis is very insufficient. Therefore, we report a case about a sequela of operation of talus osteonecrosis treated by Oriental Medical treatments. Methods : The patient was managed by bee venom and Carthami Flos Herbal-Acupuncture, Sa-am and body acupucture, oxibustion, physical theraphy and herbal medicine. We evaluated the patient through Visual Analogue Scale(VAS. Results : After 25 days of treatment, the patient showed that clinical symptoms was decreased and VAS changed from 10 to 2. Conclusion : In this case, Oriental Medical treatments for a sequela of operation of talus osteonecrosis was effective. But further studies are required to confirm the effect of these methods

  3. Early presentation of osteonecrosis in acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Mogensen, Signe Sloth; Harila-Saari, Arja; Frandsen, Thomas Leth

    2017-01-01

    Osteonecrosis (ON) is usually considered treatment related in patients with acute lymphoblastic leukemia (ALL). We report two patients with presentation of ON at the time of ALL diagnosis. Both were females and diagnosed with ALL at age 8 and 14 years. In the latter, some symptoms and radiologica......Osteonecrosis (ON) is usually considered treatment related in patients with acute lymphoblastic leukemia (ALL). We report two patients with presentation of ON at the time of ALL diagnosis. Both were females and diagnosed with ALL at age 8 and 14 years. In the latter, some symptoms...

  4. Lingual mandibular osteonecrosis after dental impressions for orthodontic study models.

    Science.gov (United States)

    Cerruto, Carmen; Ugolini, Alessandro; Cozzani, Mauro

    2018-03-01

    A 43-year-old man sought orthodontic treatment to close anterior diastemas. During the impression procedure for routine documentation, the orthodontic assistant exerted excessive pressure on the metallic tray; 2 days later, the patient reported the detachment of a small piece of mucosa overlying the mylohyoid crest and was referred to a maxillofacial surgeon with a diagnosis of lingual mandibular osteonecrosis. The etiology of bony osteonecrosis is discussed, together with the anatomic variations that can be present in the basal bone and that must be carefully checked before an impression is taken. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  5. Nontraumatic osteonecrosis of the distal pole of the scaphoid

    Directory of Open Access Journals (Sweden)

    Bhavuk Garg

    2011-01-01

    Full Text Available Post traumatic osteonecrosis of distal pole of scaphoid is very rare. We present a case of 34 years old male, drill operator by occupation with nontraumatic osteonecrosis of distal pole of the scaphoid. The patient was managed conservatively and was kept under regular follow-up every three months. The patient was also asked to change his profession. Two years later, the patient had no pain and had mild restriction of wrist movements (less than 15 degrees in either direction. The radiographs revealed normal density of the scaphoid suggesting revascularization.

  6. Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort

    DEFF Research Database (Denmark)

    Borges, Álvaro H; Hoy, Jennifer; Florence, Eric

    2017-01-01

    Background: Antiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes. Methods: EuroSIDA participants were followed to assess...

  7. Evaluation of a pig femoral head osteonecrosis model

    Directory of Open Access Journals (Sweden)

    Kim Harry

    2010-03-01

    Full Text Available Abstract Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve

  8. Duration of treatment with bisphosphonates at the time of osteonecrosis of the jaw onset in patients with rheumatoid arthritis. Review.

    Science.gov (United States)

    Compain, H; Berquet, A; Loison-Robert, L-S; Ahossi, V; Zwetyenga, N

    2018-06-01

    Rheumatoid arthritis (RA) is a frequent and co-morbid condition. One of the main complications is induced osteoporosis. Treatments related to this complication significantly modify oral and implant management. Affected patients represent a population at intermediate risk of osteonecrosis of the jaw (ONJ). The objective was to search the literature for durations of treatment with bisphosphonates at the time of ONJ occurrence in patients with RA in order to obtain an average duration. A bibliographic search in the PubMed/Medline database was carried out using the following equation "(osteonecrosis and jaw) and rheumatoid arthritis" with no time limitation. The primary study endpoint was the duration of treatment with bisphosphonates (BP) at the time of ONJ onset in patients with RA. Twelve articles accounting for 50 patients were included. Patients had had a median of 46.8 months of treatment with BP before ONJ occurred. Mean, minimum and maximum treatment times were 48.68, 6 and 120 months, respectively. The standard deviation was 27.77 months. The median treatment duration in our cohort of patients with RA was less than that reported for osteoporosis. We therefore, recommend that practitioners take additional precautions regarding oral surgery or implant procedures, particularly in patients with RA who have been treated with BP for more than 4 years. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  9. [Toxic phosphorous osteonecrosis of facial bones among drug addicts to desomorphine and pervitin. Part II].

    Science.gov (United States)

    Basin, E M; Medvedev, Yu A

    2015-01-01

    Article describes literature review of "atypical" osteomyelitis--osteonecrosis of facial bones among addicts to synthetic narcotics desomorphine and pervitin, different comorbidities, treatment strategy and prognosis were outlined

  10. Radial tear of posterior horn of the medial meniscus and osteonecrosis of the knee

    International Nuclear Information System (INIS)

    Motoyama, Tatsuo; Ihara, Hidetoshi; Kawashima, Mahito

    2003-01-01

    We studied the relation between a radial tear of the posterior horn of the medial meniscus and osteonecrosis of the knee. Thirty-eight knees of 37 patients were diagnosed as medial meniscus tear and received arthroscopic knee surgery. We divided them into two groups: knees having radial tear of the posterior horn of the medial meniscus (posterior horn group) and knees containing radial tear except for posterior horn, horizontal tear, degenerative tear, and flap tear of the medial meniscus (non-posterior horn group). The posterior horn group consisted of 14 knees (average age: 65.1 years old) and the non-posterior horn group consisted of 24 knees (average age: 59.6 years old). All cases underwent MRI before arthroscopy. MRI findings were classified into three types (typical osteonecrosis, small osteonecrosis, and non-osteonecrosis). In the posterior horn group, typical osteonecrosis were five knees and small osteonecrosis were five knees, while in the non-posterior horn group only three knees were small osteonecrosis. These findings suggest the relevance between radial tear of the posterior horn of the medial meniscus and osteonecrosis of the knee (Mann-Whitney test p<0.01). The etiology of spontaneous osteonecrosis of the knee joint is unknown, however one etiology could be the radial tear of the posterior horn of the medial meniscus. (author)

  11. Osteonecrosis de los maxilares asociada al empleo de bifosfonatos Bisphosphonate-associated osteonecrosis of the jaw

    Directory of Open Access Journals (Sweden)

    J.L. del Castillo Pardo de Vera

    2007-10-01

    Full Text Available Los bifosfonatos constituyen un grupo de fármacos inhibidores de la resorción ósea, utilizados en el tratamiento de numerosas patologías como la osteoporosis, la enfermedad de Paget, el mieloma múltiple, la hipercalcemia maligna y las metástasis óseas asociadas al cáncer de mama o de próstata. El principal efecto farmacológico de los bifosfonatos es la inhibición de la resorción ósea, mediante una disminución de la actividad de los osteoclastos, sin intervenir en la formación y mineralización del hueso. Son fármacos utilizados a nivel mundial con unos claros beneficios contrastados clínicamente. Numerosas publicaciones durante los últimos tres años, y debido a su utilización masiva, consideran que la osteonecrosis de los maxilares está asociada al tratamiento con bifosfonatos. Es importante que los pacientes sean informados del riesgo de presentarse esta complicación, para tener la oportunidad de someterse a procedimientos dentales previos al inicio del tratamiento. Las medidas preventivas deben realizarse antes, durante y después del tratamiento con bifosfonatos. El tratamiento quirúrgico debe reservarse para aquellos pacientes que presenten síntomas. Son necesarias nuevas investigaciones que clarifiquen esta complicación.Bisphosphonates constitute a group of inhibitors of bone resorption that are used for treating many disor-ders such as osteoporosis, Paget´s disease, multiple myeloma, malignant hypercalcemia and bone metas-tases associated with breast and prostate cancer. The main pharmacological effect of bisphosphonates is the inhibition of bone resorption, mediated by a decreased function of osteoclasts without interfering in bone formation and mineralization. These drugs are used worldwide, with clear and clinically proven benefits. Several publications within the last three years consider osteonecrosis of the jaw to be associated with bisphosphonate therapy as a result of their extensive use. It is important

  12. Adverse drug events in the oral cavity.

    Science.gov (United States)

    Yuan, Anna; Woo, Sook-Bin

    2015-01-01

    Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and the new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. Some examples include osteonecrosis, seen with not only bisphosphonates but also antiangiogenic agents, and the distinctive ulcers caused by mammalian target of rapamycin inhibitors. As newer therapeutic agents are approved, it is likely that more adverse drug events will be encountered. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely, xerostomia, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, white lesions, dysesthesia, osteonecrosis, infection, angioedema, and malignancy. Oral health care providers should be familiar with such events, as they will encounter them in their practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Delayed Diagnosis of Osteonecrosis of the Jaw (ONJ Associated with Bevacizumab Therapy in Colorectal Cancer Patients: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Francesco Erovigni

    2016-10-01

    Full Text Available Medication-induced Osteonecrosis of the Jaw (MRONJ has been reported not only after use of antiresorptive agents (bisphosphonates and denosumab, but also in cancer patients receiving antiangiogenic agents, alone or combined with antiresorptive drugs. We report two cases of MRONJ observed in colorectal cancer patients after bevacizumab therapy only. MRONJ was diagnosed, respectively, two and seven months after a tooth extraction; both the patients had received two courses of bevacizumab infusions (for a total of 29 and 10 administrations, respectively. We discuss if tooth extraction during or after antiangiogenic therapy could be a potential trigger of MRONJ, but also if an underlying bone disease not evident before oral surgery might be a possible cause. A careful drug history has to be registered by dental specialists in cancer patients before oral surgery and adequate imaging might be obtained to avoid a delayed diagnosis.

  14. Medication-Related Osteonecrosis of the Jaws (MRONJ: Etiological Update

    Directory of Open Access Journals (Sweden)

    Gianluca Tenore

    2014-12-01

    Full Text Available Osteonecrosis of the jaws (ONJ is an uncommon but severe bone disease, can be related to various medicaments (MRONJ including bisphosphonates (BRONJ, antiangiogenic and antiresorptive medicaments such as Denosumab (DRONJ, human monoclonal antibody to the receptor activator of nuclear factor-kB ligand. The rise in number in the latest years can be explained with many patients treated with all these drugs, assumed for osteometabolic (i.e osteoporosis, osteogenesis imperfecta or neoplastic diseases (multiple myeloma, metastatic breast, prostate and renal cancer. The onset mechanism of MRONJ is not entirely understood, probably different mechanisms are involved, such as inhibition of the osteoclasts differentiation and function, decrease of the angiogenesis and inflammation/infection of the jaw bones. Some pathogenetic mechanisms are different according to the drugs, for example the cases of the RANK-ligand inhibitor related ONJ may occur without considering the period of medication intake; also the risk of ONJ manifestation after bisphosphonates (BF is not significantly diminished after interrupting the drug therapy, because BF bind to the bone matrix for many years. Drugs currently implicated in osteonecrosis pathology are various, therefore the term ONJ was currently replaced by MRONJ; it is necessary that the anamnestic phase and management of the patients to be more detailed and correct, not only to prevent osteonecrosis but also to plan all necessary treatments before start of the drug therapy.

  15. Bone scintigraphy screening for osteonecrosis of the shoulder in patients with non-traumatic osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Sakai, Takashi; Sugano, Nobuhiko; Nishii, Takashi; Miki, Hidenobu; Yoshikawa, Hideki; Ohzono, Kenji

    2002-01-01

    In patients with non-traumatic osteonecrosis of the femoral head (ONFH), the shoulder is one of the major affected sites secondary to the proximal and distal femur in cases of multiple osteonecrosis. The present study attempted to investigate whether technetium bone scintigraphy is useful for screening of non-traumatic osteonecrosis of the shoulder (ONS).Design and patients. A total of 170 shoulder joints in 85 patients with ONFH were evaluated by bone scintigraphy and the findings compared with those of magnetic resonance imaging (MRI). The MR diagnosis was used as the gold standard.Results. Based on the diagnosis by MRI, ONS was detected in 43 shoulders of 27 patients (25%). All necrotic lesions were located in the humeral head. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of bone scintigraphy for ONS detection were 65%, 81%, 77%, 54% and 87%, respectively. When the necrotic angle of the lesions on the mid-coronal MRI was more than 40 , the sensitivity of bone scintigraphy for ONS detection increased to 88% (21/24 shoulders).Conclusion. Bone scintigraphy may be useful for demonstrating medium or large ONS lesions on screening of patients with ONFH. (orig.)

  16. Incidence of hip osteonecrosis among renal transplantation recipients: a prospective study

    International Nuclear Information System (INIS)

    Lopez-Ben, R.; Mikuls, T.R.; Moore, D.S.; Julian, B.A.; Bernreuter, W.K.; Elkins, M.; Saag, K.G.

    2004-01-01

    AIM: To investigate whether a lessened glucocorticoid cumulative dose would lead to a decreased incidence of femoral head osteonecrosis. METHODS: Newly transplanted in-patients (n=49) underwent hip radiographs and magnetic resonance imaging (MRI) a mean of 17.0±4.3 (range 8-29) days after renal transplantation. For the 48 patients without evidence of prevalent osteonecrosis, imaging at a mean of 5.9±0.8 (range 4.8-8.7) months after renal transplantation was graded for presence/absence of femoral head osteonecrosis by two blinded radiologists. Sociodemographic and disease characteristics of patients were compared to identify potential associations with incident osteonecrosis. RESULTS: At 6-month follow-up, only two patients (4%) had osteonecrosis of the femoral head (three hips). The two primary radiologists had excellent agreement between osteonecrosis diagnosis (kappa coefficient=0.78). Both cases of a definite MRI diagnosis of osteonecrosis occurred in patients who were in the highest tertile of glucocorticoid dosage. CONCLUSION: Osteonecrosis was uncommon among a prospective cohort of renal transplant recipients within 6 months after engraftment

  17. Osteonecrosis in children treated for acute lymphoblastic leukemia: a magnetic resonance imaging study after treatment

    Energy Technology Data Exchange (ETDEWEB)

    Ojala, A.; Lanning, F.; Paakko, E.; Lanning, B. [Oulu Univ. (Finland)

    1998-02-01

    The purpose of this study was to find out the prevalence of osteonecrosis in children with acute lymphoblastic leukaemia (ALL) in complete bone marrow remission at the end of the treatment. Finally, the study suggests that the intensification phase of the treatment protocols with intensive dexamethasone medication might be responsible for the development of osteonecrosis. (N.C.)

  18. Osteonecrosis in children treated for acute lymphoblastic leukemia: a magnetic resonance imaging study after treatment

    International Nuclear Information System (INIS)

    Ojala, A.; Lanning, F.; Paakko, E.; Lanning, B.

    1998-01-01

    The purpose of this study was to find out the prevalence of osteonecrosis in children with acute lymphoblastic leukaemia (ALL) in complete bone marrow remission at the end of the treatment. Finally, the study suggests that the intensification phase of the treatment protocols with intensive dexamethasone medication might be responsible for the development of osteonecrosis. (N.C.)

  19. Osteonecrosis of the knee following arthroscopic meniscectomy; Osteoenecrosis de rodilla tras meniscectomia artrosocpica

    Energy Technology Data Exchange (ETDEWEB)

    Dobado, M. C.; Mota, J.; Roca, M. [Instituto Clinico Corachan. Barcelona (Spain)

    2000-07-01

    Primary osteonecrosis of the knee is characterized by acute onset of pain in elderly individuals who present no risk factors. Osteonecrosis following arthroscopic surgery for meniscal repair is a rare occurrence, the etiology of which remains to be determined. The authors present the magnetic resonance findings in a new case and a review of the related literature. (Author) 7 refs.

  20. Osteonecrosis - A rare complication of HIV infection. Association with numerous risk factors

    International Nuclear Information System (INIS)

    Meyer, D.; Behrens, G.; Stoll, M.; Schmidt, R.E.

    2000-01-01

    Osteonecrosis is a rare complication of HIV infection. The presumptive cause of the aseptic osteonecrosis is a disturbed blood supply to the bone. Most cases of osteonecrosis are associated with numerous risk factors, such as use of steroids, alcohol abuse, coagulopathies or metabolic derangements. Since conventional X-rays appear unremarkable, early forms often go unrecognized or are diagnosed late. Methods of establishing the diagnosis are MRI and three-phase skeletal scintigraphy. The pathogenesis of osteonecrosis in HIV infection is unclear. So far, about 30 cases have been reported in the literature. We would recommend that in HIV patients with typical symptoms - in particular when classical risk factors are present - osteonecrosis be included in the differential diagnostic considerations. (orig.) [de

  1. Gadopentetate-dimeglumine-enhanced MR imaging of osteonecrosis and osteochondritis dissecans of the elbow: initial experience

    International Nuclear Information System (INIS)

    Peiss, J.; Adam, G.; Casser, R.; Urhahn, R.; Guenther, R.W.

    1995-01-01

    Magnetic resonance imaging (MRI) was performed on seven patients with aseptic osteonecrosis (n=4) and osteochondritis dissecans (OCD; n=3) of the elbow. Precontrast MRI was superior to plain radiographs, which did not show any abnormality in three cases of osteonecrosis. On gadopentetate-dimeglumine-enhanced T1-weighted images, which were obtained in three patients with osteonecrosis and three patients with OCD, all cases of osteonecrosis demonstrated homogeneous enhancement of the lesions. All cases of OCD were diagnosed on plain radiographs. On MRI one showed significant enhancement of the loose body. In another case an incompletely enhancing loose body was surrounded by a diffusely enhancing region. In the third patient only a small marginal enhancement of the defect was observed. Our results suggest that MRI can improve the accuracy in diagnosis of aseptic osteonecrosis of the elbow. The use of gadopentetate dimeglumine allows the viability of the lesions or the loose bodies to be demonstrated and reparative tissue to be detected. (orig.)

  2. Osteonecrosis de hueso maxilar inducida por bisfosfonatos

    OpenAIRE

    Vera Sempere, Francisco José

    2016-01-01

    Los bisfosfonatos son un grupo de fármacos, análogos de los pirofosfatos, utilizados en administración oral en el tratamiento de la osteoporosis, así como en formulaciones intravenosas para el tratamiento del dolor óseo y de la hipercalcemia ligada a la enfermedad tumoral metastasica (generalmente en el contexto de mieloma múltiple / cáncer de mama o próstata avanzados), actuando como un inhibidor de la reabsorción ósea, mediada por osteoclastos, así como de la apoptosis de los osteobl...

  3. Biophysical stimulation in osteonecrosis of the femoral head

    Directory of Open Access Journals (Sweden)

    Massari Leo

    2009-01-01

    Full Text Available Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary.

  4. Osteonecrosis de los maxilares y bifosfonatos : revisión

    OpenAIRE

    Bongiovanni, Isabel

    2012-01-01

    La osteonecrosis de los maxilares es la necrosis y exposición del hueso de la mandíbula y el maxilar, asociada al consumo de bifosfonatos. Estos son una familia de drogas que se utiliza en el tratamiento de alteraciones óseas causadas principalmente por tumores malignos (mama y próstata) y osteoporosis. No existe irradiación previa. El hueso macroscópicamente se ve sucio avascular. El objetivo de este artículo es profundizar el conoc...

  5. Osteonecrosis related to intraosseous anesthesia: report of a case.

    Science.gov (United States)

    Woodmansey, Karl F; White, Robert K; He, Jianing

    2009-02-01

    Intraosseous anesthesia is an effective and increasingly used technique with few reported complications. The technique uses a specialized drill to perforate the osseous cortex where local anesthetic can then be deposited to anesthetize teeth. It has been reported that separation of the perforation drills from their plastic bases can occur because of the friction generated during osseous perforation. Prolonged rotation of the perforator drills in the bone can also cause excessive heat, which can lead to bone necrosis. This report describes a case of focal osteonecrosis subsequent to intraosseous anesthesia and discusses possible etiologies of this sequela.

  6. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery

    International Nuclear Information System (INIS)

    Al-Kaar, M.; Garcia, J.; Fritschy, D.; Bonvin, J.C.

    1997-01-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors)

  7. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A. [Department of Magnetic Resonance Imaging, IDI Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Gran Via s/n, 08907, L' Hospitalet de Llobregat (Barcelona) (Spain)

    2003-08-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  8. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    International Nuclear Information System (INIS)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A.

    2003-01-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  9. Dentoalveolar trauma and minor trauma as precipitating factors for medication-related osteonecrosis of the jaw (ONJ)

    DEFF Research Database (Denmark)

    Yazdi, Pouya Masroori; Schiodt, Morten

    2015-01-01

    OBJECTIVE: Medication-related osteonecrosis of the jaw (ONJ) is often preceded by dentoalveolar trauma. The aim of this study was to examine the frequency of dentoalveolar trauma precipitated ONJ and compare trauma-precipitated ONJ with spontaneously developing ONJ. STUDY DESIGN......: This was a retrospective study. All patients were examined according to a standard ONJ chart. RESULTS: Among 149 consecutive ONJ patients from the Copenhagen Cohort, 95 (64%) had a dentoalveolar trauma before referral (trauma group): dental extractions (n = 80); denture-related sore mouth (n = 12); and others (n = 3......). The remaining 54 patients had spontaneous ONJ (spontaneous group). The mean time from oral trauma to referral for ONJ was 8 months. CONCLUSION: This study documented that dentoalveolar trauma precipitated ONJ in the majority of cases. However, even minor trauma, such as intubation and impression tray lesions...

  10. An unusual case of osteonecrosis of the jaw associated with dengue fever and periodontitis.

    Science.gov (United States)

    Indurkar, M S; Sethi, R

    2016-03-01

    Osteonecrosis is a disorder rarely occurring in the jaw. Dengue fever is a common mosquito-borne disease prevalent in many countries including India. The following report presents an interesting case of maxillary osteonecrosis in a middle aged male with a history of dengue infection. We also diagnosed symptoms of chronic periodontitis, which may have potentiated the necrosis. This case report will describe a novel clinical presentation and management of osteonecrosis of the jaw (ONJ) of unknown origin and a possible pathogenesis explaining the association of ONJ with dengue fever and periodontitis. © 2015 Australian Dental Association.

  11. An MRI-based semiautomated volumetric quantification of hip osteonecrosis

    International Nuclear Information System (INIS)

    Malizos, K.N.; Siafakas, M.S.; Karachalios, T.S.; Fotiadis, D.I.; Soucacos, P.N.

    2001-01-01

    Objective: To objectively and precisely define the spatial distribution of osteonecrosis and to investigate the influence of various factors including etiology. Design: A volumetric method is presented to describe the size and spatial distribution of necrotic lesions of the femoral head, using MRI scans. The technique is based on the definition of an equivalent sphere model for the femoral head. Patients: The gender, age, number of hips involved, disease duration, pain intensity, limping disability and etiology were correlated with the distribution of the pathologic bone. Seventy-nine patients with 122 hips affected by osteonecrosis were evaluated. Results: The lesion size ranged from 7% to 73% of the sphere equivalent. The lateral octants presented considerable variability, ranging from wide lateral lesions extending beyond the lip of the acetabulum, to narrow medial lesions, leaving a lateral supporting pillar of intact bone. Patients with sickle cell disease and steroid administration presented the largest lesions. The extent of the posterior superior medial octant involvement correlated with the symptom intensity, a younger age and male gender. Conclusion: The methodology presented here has proven a reliable and straightforward imaging tool for precise assessment of necrotic lesions. It also enables us to target accurately the drilling and grafting procedures. (orig.)

  12. Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis

    Science.gov (United States)

    Saito, Masazumi; Ueshima, Keiichiro; Fujioka, Mikihiro; Ishida, Masashi; Goto, Tsuyoshi; Arai, Yuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Fukushima, Wakaba; Kubo, Toshikazu

    2014-01-01

    Background and purpose It has been suggested that avascular osteonecrosis (AVN) of the femoral head occurs early after systemic steroid administration. The purpose of this study was to investigate the risks regarding development of AVN at a very early stage after renal transplantation. Methods The presence or absence of AVN was determined by MRI at 4 weeks, at 6–12 weeks, at 24 weeks, and at 12 months after renal transplantation in 286 patients (183 males) with a mean age of 39 (16–65) years. The relationship between AVN and age, sex, absence or presence of acute rejection (AR), type of transplanted kidney (living or cadaveric), type of immune suppressor, and total dose of orally administered steroids given in the 2-week period after transplantation was investigated. Results There were no statistically significant correlations between the development of AVN and age, sex, absence or presence of AR, type of transplanted kidney, or type of immune suppressor. A significant dose-response relationship was found between development of AVN and the total dose of steroid administered in the first 2 weeks after surgery. Interpretation We found a relationship between AVN development and steroid dose in the early postoperative period, and we also showed a dose-response relationship. PMID:24786907

  13. [Computed tomography semiotics of osteonecrosis and sequestration in chronic hematogenic osteomyelitis].

    Science.gov (United States)

    D'iachkova, G V; Mitina, Iu L

    2007-01-01

    Based on the data of computed tomography, radiography and densitometry in 39 patients the authors describe in detail the signs of osteonecrosis and sequestration of different localization and extension.

  14. Case report 361: Radium intoxication with radium-induced osteonecrosis

    Energy Technology Data Exchange (ETDEWEB)

    Milgram, J.W.; Jasty, M.

    1986-03-01

    In summary, a male patient was treated with radium chloride for arthritis involving both knees at a time when he had gonococcal urethritis. He was then 20 years of age and was followed until his death 40 years later at the age of 60 years. During that interval this individual, who possessed one of the largest burdens of radium ever recorded in man, developed spontaneous fractures of both femori and one humerus, symptomatic osteonecrosis of both femoral heads, dramatic progressive radiological findings of bone, and finally, a carcinoma of the maxillary sinus which proved to be the cause of his death. Tissue was obtained from both cortical and cancellous bone at four different times during the patient's life and again at post-mortem. Progressive ischemia with abnormal calcification and then necrosis of both bone and bone marrow were demonstrated in the skeletal tissues. The pathological chances are correlated superbly with the roentgenograms in this report.

  15. A study on dysbaric osteonecrosis in caisson workers.

    Science.gov (United States)

    Kuang, X Y; Chen, L J; Li, H L; Yao, F; Xu, J M; Huang, F; Guo, L J

    2014-01-01

    To study the effects of exposure to compressed air on tunnel workers' health and to investigate the prevalence of dysbaric osteonecrosis (DON) in caisson workers. 128 tunnel workers were divided into the exposed group (n = 58) and the control group (n = 70), and their shoulders, hips and knees were examined with X-ray, computed tomography (CT) and magnetic resonance imaging (MRI). 1) 34.5% of the exposed group were diagnosed with DON based on the national diagnostic criteria of decompression sickness. 2) The incidental difference of skeletal cystic changes between the exposed group and the control group was highly statistically significant (p < 0.01). 3) CT and MRI examination could detect early onset of DON lesions, and the cystic changes shown in CT and abnormal signals in MRI were diagnostic indicators in cases. Cystic changes in CT and abnormal signals in MRI are key imaging findings of early DON.

  16. Mitochondrial stress and redox failure in steroid-associated osteonecrosis

    Science.gov (United States)

    Tsuchiya, Masanobu; Ichiseki, Toru; Ueda, Shusuke; Ueda, Yoshimichi; Shimazaki, Miyako; Kaneuji, Ayumi; Kawahara, Norio

    2018-01-01

    The purpose of the role of antioxidant enzymes and mitochondria in the developmental mechanism of steroid-associated osteonecrosis in the femur. In the present study Japanese white rabbits (mean weight 3.5kg) were injected into the gluteus with methylprednisolone (MP) 20mg/kg, and killed after 3 days (MP3 group), 5 days (MP5 group), and 14 days (MP14 group) (n=3 each). As a Control group (C group) Japanese white rabbits not administered MP were used. In experiment 1, the expression of the antioxidant enzymes Superoxide dismutade (SOD) and catalase was compared in liver, kidney, heart, humerus, and femur in C group, and the presence/absence of mitochondria transcription factor A (TFAM) expression was determined by Western blotting (WB) and used to evaluate the number of mitochondria and their function. In experiment 2, the presence/absence of necrosis was determined by immunohistochemistry, while changes in the expression of SOD, catalase, and TFAM in the femur after steroid administration were determined by Western blotting (WB). In experiment 1, intense expression of all of SOD, catalase, and TFAM was found in the liver, kidney, and heart as compared to the humerus and femur. In experiment 2, the expression of all of SOD, catalase, and TFAM in MP3 and MP5 groups was decreased on WB as compared with C group, while in MP14 group a tendency to improvement was seen. Accordingly, steroid-associated mitochondrial injury and redox failure are concluded to be important elements implicated in the pathogenesis of osteonecrosis. PMID:29483810

  17. Relationship between post-SARS osteonecrosis and PAI-1 4G/5G gene polymorphisms.

    Science.gov (United States)

    Sun, Wei; Li, Zirong; Shi, Zhengcai; Wang, Bailiang; Gao, Fuqiang; Yang, Yurun; Guo, Wanshou

    2014-05-01

    To explore the correlation between post-severe acute respiratory symptom (SARS) patients with osteonecrosis, investigate the etiology of post-SARS osteonecrosis and select the sensitive molecular symbols for early diagnosis and distinguish the high-risk population. The studied subjects were divided into two groups. Sixty-two post-SARS patients with osteonecrosis were one group, and 52 age- and sex-matched healthy people were as normal controlled group. Empty stomach blood samples from cubital veins were collected from both groups. Plasminogen activator inhibitor (PAI) by means of enzyme-linked immunosorbent assay and PAI-1 4G/5G polymorphism was detected by polymerase chain reaction and solid phase oligonucleotide assay. The blood agents of post-SARS patients changed obviously with 15.64 ± 13.85 U/ml while the control group 7.96 ± 4.27 U/ml; 4G/4G genotype for the PAI-1 polymorphism detected in post-SARS group was more than that of the control group, but had no statistical significance. The plasma PAI activity was related to homozygote 4G/4G genotype. This reveals that homozygote 4G/4G genotype may be a susceptible gene mark to Chinese osteonecrosis patients. Plasminogen activator inhibitor-1 is sensitive blood symbol for screening high-risk susceptible population; 4G/4G PAI-1 genotype may be an etiological factor in osteonecrosis.

  18. Osteonecrosis detected by whole body magnetic resonance in patients with Hodgkin Lymphoma treated by BEACOPP

    Energy Technology Data Exchange (ETDEWEB)

    Albano, Domenico; La Grutta, Ludovico; Grassedonio, Emanuele; Brancatelli, Giuseppe; Lagalla, Roberto; Midiri, Massimo; Galia, Massimo [University of Palermo, Department of Radiology, DIBIMED, Palermo (Italy); Patti, Caterina; Mule, Antonino [Azienda Ospedali Riuniti Villa Sofia-Cervello, Department of Hematology I, Palermo (Italy)

    2017-05-15

    The purpose of our retrospective review of prospectively acquired Whole Body Magnetic Resonance (WB-MRI) scans was to assess the incidence of osteonecrosis in patients who received different chemotherapies. We evaluated the WB-MRI scans performed on 42 patients with Hodgkin Lymphoma treated by three chemotherapy regimens (6ABVD, 2ABVD + 4BEACOPP, 2ABVD + 8BEACOPP), excluding patients with the main risk factors for osteonecrosis. Six out of seven patients (86 %) who received eight BEACOPP and one out of five patients (20 %) treated by four BEACOPP presented osteonecrosis, with a statistically significant difference of frequency between the two groups of patients (p < 0.05); no injury has been reported in patients treated by only ABVD. Among a total of 48 osteonecrotic lesions observed, 48 % were detected in the knee; multifocal osteonecrosis were detected in six out of seven patients (86 %). The development of osteonecrosis is strictly related to the chemotherapy protocol adopted and the number of cycles received, with a strong correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows detecting earlier osteonecrotic lesions in patients treated with corticosteroids. (orig.)

  19. Successful Treatment of Early Talar Osteonecrosis by Core Decompression Combined with Intraosseous Stem Cell Injection: A Case Report.

    Science.gov (United States)

    Nevalainen, Mika T; Repo, Jussi P; Pesola, Maija; Nyrhinen, Jukka P

    2018-01-01

    Osteonecrosis of the talus is a fairly rare condition. Many predisposing factors have been identified including previous trauma, use of corticosteroids, alcoholism, and smoking. As a gold standard, magnetic resonance imaging (MRI) is the most sensitive and specific diagnostic examination to detect osteonecrosis. While many treatment options for talar osteonecrosis exist, core decompression is suggested on young patients with good outcome results. More recently, intraosseous stem cell and platelet-rich plasma (PRP) injection has been added to the core decompression procedure. We report a successful treatment of early talar osteonecrosis ARCO I (Association Research Circulation Osseous) by core decompression combined with stem cell and PRP injection. On 3-month and 15-month follow-up, MRI showed complete resolution of the osteonecrotic changes together with clinical improvement. This modified technique is a viable treatment option for early talar osteonecrosis. Nevertheless, future prospects should include a study comparing this combined technique with plain core decompression.

  20. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw.

    Science.gov (United States)

    Khan, Aliya A; Sándor, George K B; Dore, Edward; Morrison, Archibald D; Alsahli, Mazen; Amin, Faizan; Peters, Edmund; Hanley, David A; Chaudry, Sultan R; Dempster, David W; Glorieux, Francis H; Neville, Alan J; Talwar, Reena M; Clokie, Cameron M; Al Mardini, Majd; Paul, Terri; Khosla, Sundeep; Josse, Robert G; Sutherland, Susan; Lam, David K; Carmichael, Robert P; Blanas, Nick; Kendler, David; Petak, Steven; St-Marie, Louis Georges; Brown, Jacques; Evans, A Wayne; Rios, Lorena; Compston, Juliet E

    2008-07-01

    Following publication of the first reports of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates in 2003, a call for national multidisciplinary guidelines based upon a systematic review of the current evidence was made by the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) in association with national and international societies concerned with ONJ. The purpose of the guidelines is to provide recommendations regarding diagnosis, identification of at-risk patients, and prevention and management strategies, based on current evidence and consensus. These guidelines were developed for medical and dental practitioners as well as for oral pathologists and related specialists. The multidisciplinary task force established by the CAOMS reviewed all relevant areas of research relating to ONJ associated with bisphosphonate use and completed a systematic review of current literature. These evidence-based guidelines were developed utilizing a structured development methodology. A modified Delphi consensus process enabled consensus among the multidisciplinary task force members. These guidelines have since been reviewed by external experts and endorsed by national and international medical, dental, oral surgery, and oral pathology societies. RECOMMENDATIONS regarding diagnosis, prevention, and management of ONJ were made following analysis of all current data pertaining to this condition. ONJ has many etiologic factors including head and neck irradiation, trauma, periodontal disease, local malignancy, chemotherapy, and glucocorticoid therapy. High-dose intravenous bisphosphonates have been identified as a risk factor for ONJ in the oncology patient population. Low-dose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of ONJ. Prevention, staging, and treatment recommendations are based upon collective expert opinion and current data, which has been limited to case

  1. Osteonecrosis of the jaw: a rare and devastating side effect of bisphosphonates.

    LENUS (Irish Health Repository)

    Ryan, P

    2009-12-01

    Evidence has emerged that bisphosphonate use in cancer patients is associated with osteonecrosis of the jaw. This form of osteonecrosis has been termed bisphosphonate induced osteonecrosis of the jaw (BIONJ). BIONJ is commonly precipitated by a tooth extraction in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of myeloma, breast or prostate cancer. The overall prevalence of BIONJ is about 5% in patients with these malignancies. Current evidence shows that the risk of BIONJ in non-cancerous patients, such as those with osteoporosis, is very low and appears to be comparable with that of the general population. Prescribing physicians need to encourage cancer patients to see their dentists before the initiation of bisphosphonate treatment, and regularly thereafter.

  2. Magnetic resonance imaging of knee osteonecrosis: a study of 19 cases

    Energy Technology Data Exchange (ETDEWEB)

    Cunha, Daniel Leme da; Ribeiro, Elisio Jose Salgado; Domingues, Romeu Cortes, E-mail: danielc@predialnet.com.b [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil); Pires Carvalho, Antonio Carlos [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Faculdade de Medicina

    2010-04-15

    Objective: to describe epidemiological, clinical and magnetic resonance imaging findings of osteonecrosis in the distal femur and proximal tibia. Materials and methods: evaluation of 19 patients (12 women and 7 men), with no previous history of causative factors, with magnetic resonance imaging findings suggestive of osteonecrosis in the tibial plateau or femoral condyle. Results: osteochondral abnormalities were observed in 63.1% of the cases; in 73.6% of them, such abnormality was associated with ipsilateral meniscal lesion. Also, a significant association with bone marrow edema (grade III in 16 cases) was observed. Conclusion: magnetic resonance imaging has demonstrated to be a noninvasive method with good sensitivity in the diagnosis of knee osteonecrosis as well as of associated lesions which are most frequently found in women (63% of cases). (author)

  3. Femoral head osteonecrosis: Volumetric MRI assessment and outcome

    International Nuclear Information System (INIS)

    Bassounas, Athanasios E.; Karantanas, Apostolos H.; Fotiadis, Dimitrios I.; Malizos, Konstantinos N.

    2007-01-01

    Effective treatment of femoral head osteonecrosis (FHON) requires early diagnosis and accurate assessment of the disease severity. The ability to predict in the early stages the risk of collapse is important for selecting a joint salvage procedure. The aim of the present study was to evaluate the outcome in patients treated with vascularized fibular grafts in relation to preoperative MR imaging volumetry. We studied 58 patients (87 hips) with FHON. A semi-automated octant-based lesion measurement method, previously described, was performed on the T1-w MR images. The mean time of postoperative follow-up was 7.8 years. Sixty-three hips were successful and 24 failed and converted to total hip arthroplasty within a period of 2-4 years after the initial operation. The rate of failures for hips of male patients was higher than in female patients. The mean lesion size was 28% of the sphere equivalent of the femoral head, 24 ± 12% for the successful hips and 37 ± 9% for the failed (p < 0.001). The most affected octants were antero-supero-medial (58 ± 26%) and postero-supero-medial (54 ± 31%). All but postero-infero-medial and postero-infero-lateral octants, showed statistically significant differences in the lesion size between patients with successful and failed hips. In conclusion, the volumetric analysis of preoperative MRI provides useful information with regard to a successful outcome in patients treated with vascularized fibular grafts

  4. Avascular osteonecrosis in patients treated for Hodgkin`s disease

    Energy Technology Data Exchange (ETDEWEB)

    Enrici, R.M.; Donato, V.; Santoro, M. [La Sapienza Univ. of Rome, Inst. of Radiology, Chair of Radiation Oncology, Rome (Italy); Tombolini, V. [Univ of L`Aquila, Hospital S. Maria di Collemaggio, Dept. of Radiation Oncology, L`Aquila (Italy); Anselmo, A.P. [La Sapienza Univ. of Rome, Dept. of Human Biopathology, Haematology Section, Rome (Italy)

    1998-09-01

    The aim of this study is to assess the risk of avascular osteonecrosis (AVN) of the femoral head in patients treated for Hodgkin`s disease (HD), in relation to the type of treatment they have received. For this purpose, a cohort of 1391 patients treated for HD at University of Rome between 1972 and 1996 was divided into 2 groups according to their initial treatment. The first group contained 784 patients treated, at the onset of HD, either with chemotherapy (CT) containing steroids, combined in some cases with subdiaphragmatic radiotherapy (RT), or with subdiaphragmatic RT combined with CT without steroids. The second group was made up of 607 patients who had received, initially, supradiaphragmatic RT alone or supradiaphragmatic RT combined with CT without steroids. For the purpose of this study, only the 784 patients belonging to the first group were observed for the appearance of AVN, which occurred in 9 cases. The period of time which elapsed between the end of treatment and the radiological evidence of AVN ranged from 23 to 97 months, with an average of 35 months. Because the number of cases of AVN was so small, the pathogenesis of this complication could not be identified. (au) 55 refs.

  5. Avascular osteonecrosis in patients treated for Hodgkin's disease

    International Nuclear Information System (INIS)

    Enrici, R.M.; Donato, V.; Santoro, M.; Tombolini, V.; Anselmo, A.P.

    1998-01-01

    The aim of this study is to assess the risk of avascular osteonecrosis (AVN) of the femoral head in patients treated for Hodgkin's disease (HD), in relation to the type of treatment they have received. For this purpose, a cohort of 1391 patients treated for HD at University of Rome between 1972 and 1996 was divided into 2 groups according to their initial treatment. The first group contained 784 patients treated, at the onset of HD, either with chemotherapy (CT) containing steroids, combined in some cases with subdiaphragmatic radiotherapy (RT), or with subdiaphragmatic RT combined with CT without steroids. The second group was made up of 607 patients who had received, initially, supradiaphragmatic RT alone or supradiaphragmatic RT combined with CT without steroids. For the purpose of this study, only the 784 patients belonging to the first group were observed for the appearance of AVN, which occurred in 9 cases. The period of time which elapsed between the end of treatment and the radiological evidence of AVN ranged from 23 to 97 months, with an average of 35 months. Because the number of cases of AVN was so small, the pathogenesis of this complication could not be identified. (au)

  6. A case of dengue-related osteonecrosis of the maxillary dentoalveolar bone.

    Science.gov (United States)

    Al-Namnam, N M; Nambiar, P; Shanmuhasuntharam, P; Harris, M

    2017-06-01

    Dengue is a mosquito transmitted flaviviral infection which can give rise to severe haemorrhage (dengue haemorrhagic fever) and with capillary leakage induces hypovolaemic shock (dengue shock syndrome). Although dengue symptoms and complications have been known for many decades, there has only been one documented case of osteonecrosis of the maxilla which was treated by excision of the necrotic bone. In this case of dengue infection, extensive maxillary osteonecrosis and minimal root resorption appeared to follow factitious injury with a toothpick but resolved with non-surgical management. © 2016 Australian Dental Association.

  7. Steroid-associated osteonecrosis animal model in rats

    Directory of Open Access Journals (Sweden)

    Li-Zhen Zheng

    2018-04-01

    Full Text Available Summary: Objective: Established preclinical disease models are essential for not only studying aetiology and/or pathophysiology of the relevant diseases but more importantly also for testing prevention and/or treatment concept(s. The present study proposed and established a detailed induction and assessment protocol for a unique and cost-effective preclinical steroid-associated osteonecrosis (SAON in rats with pulsed injections of lipopolysaccharide (LPS and methylprednisolone (MPS. Methods: Sixteen 24-week-old male Sprague–Dawley rats were used to induce SAON by one intravenous injection of LPS (0.2 mg/kg and three intraperitoneal injections of MPS (100 mg/kg with a time interval of 24 hour, and then, MPS (40 mg/kg was intraperitoneally injected three times a week from week 2 until sacrifice. Additional 12 rats were used as normal controls. Two and six weeks after induction, animals were scanned by metabolic dual energy X-ray absorptiometry for evaluation of tissue composition; serum was collected for bone turnover markers, Microfil perfusion was performed for angiography, the liver was collected for histopathology and bilateral femora and bilateral tibiae were collected for histological examination. Results: Three rats died after LPS injection, i.e., with 15.8% (3/19 mortality. Histological evaluation showed 100% incidence of SAON at week 2. Dual energy X-ray absorptiometry showed significantly higher fat percent and lower lean mass in SAON group at week 6. Micro-computed tomography (Micro-CT showed significant bone degradation at proximal tibia 6 weeks after SAON induction. Angiography illustrated significantly less blood vessels in the proximal tibia and significantly more leakage particles in the distal tibia 2 weeks after SAON induction. Serum amino-terminal propeptide of type I collagen and osteocalcin were significantly lower at both 2 and 6 weeks after SAON induction, and serum carboxy-terminal telopeptide was significantly

  8. Development of detection method of early stage nontraumatic osteo-necrosis of the femoral head by dynamic MRI

    International Nuclear Information System (INIS)

    Morita, Fuminori; Ikehira, Hiroo; Kitahara, Hiroshi; Terada, Tomoko; Nakano, Yoshitada; Ishii, Teruyuki; Iida, Tetsu; Ikenouchi, Sumio; Moriya, Hideshige

    1999-01-01

    The early detection methods of nontraumatic osteo-necrosis of the femoral head were demonstrated with the dynamic or static enhancement MR imaging method using gadolinium-DTPA (Gd-DTPA). Even if with these methods we could not detect stage 0 of nontraumatic osteo-necrosis, but these pathological change should be induced at 0 stage in the patients who were medicated high-dose corticosteroids. The authors designed the big ROI (region of interest) dynamic MR imaging method to brake this diagnostic difficulty for 0 stage of femoral, and evaluated the efficacy of this technology with normal and femoral nontraumatic osteo-necrosis patients volunteer. (author)

  9. Pigmented Villonodular Synovitis Causing Osteonecrosis of the Femoral Head: A Case Report

    Directory of Open Access Journals (Sweden)

    Tomohiro Mimura

    2013-01-01

    Full Text Available We report a case of a 27-year-old man with pigmented villonodular synovitis of the hip joint with coincident osteonecrosis of the femoral head. According to our review of the English-language literature, no detailed report of osteonecrosis of the femoral head complicated with pigmented villonodular synovitis has been published. Preoperative X-ray images showed joint narrowing and severe multiple bone erosions at the acetabulum and femoral neck. Magnetic resonance imaging revealed a low-intensity band attributable to osteonecrosis of the femoral head and massive diffuse pigmented villonodular synovitis lesions. Comparison of a three-dimensional computed tomographic image of this patient with an angiographic image of a normal individual demonstrated proximity of the pigmented villonodular synovitis-induced bone erosions to the medial and lateral femoral circumflex arteries and retinacular arteries, suggesting likely the compromise of the latter by the former. We propose that the massive pigmented villonodular synovitis may have contributed to the pathogenesis of osteonecrosis of the femoral head in this patient. We performed open synovectomy and total hip arthroplasty. No operative complications occurred, and no recurrence of the pigmented villonodular synovitis was detected for 3 years after the operation.

  10. Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Takuaki; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Fukuoka (Japan); Schneider, Robert [Hospital for Special Surgery, Department of Radiology, New York (United States); Bullough, Peter G. [Hospital for Special Surgery, Department of Laboratory Medicine, New York, NY (United States)

    2010-02-15

    A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

  11. Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

    International Nuclear Information System (INIS)

    Yamamoto, Takuaki; Iwamoto, Yukihide; Schneider, Robert; Bullough, Peter G.

    2010-01-01

    A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

  12. Magnetic resonance imaging in the evaluation of suspected osteonecrosis of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Pollack, M S; Dalinka, M K; Kressel, H Y; Spritzer, C E; Lotke, P A

    1987-02-01

    Magnetic resonance imaging (MRI) was performed on 19 patients with suspected or proven osteonecrosis of the knee. The results were compared to radionuclide and plain radiographic studies when possible. The patients were grouped into one of three categories: patients with disease predisposing them to osteonecrosis (e.g. systemic lupus erythematosus (SLE), steroid use, and renal transplants), older patients without risk factors with acute onset of symptoms, and patients with knee pain months or years following trauma. In six patients with symptoms and predisposing diseases, MRI was abnormal in four cases, all of whom had bilateral abnormalities. In the ten older patients with classical symptoms, MRI was abnormal in seven, and bilateral abnormalities were present in three patients. The three patients with a history of antecedent trauma had normal MRI studies. Two patients with history and scintigraphic evidence of osteonecrosis had negative MRI scans. MRI may be of value in patients with suspected or proven osteonecrosis of the knee by demonstrating bilateral disease in patients with unilateral symptoms, showing the extent of involvement, and establishing the presence or absence of bone marrow changes in patients with positive bone scans and negative plain films.

  13. Is GERD a Factor in Osteonecrosis of the Jaw? Evidence of Pathology Linked to G6PD Deficiency and Sulfomucins

    Directory of Open Access Journals (Sweden)

    Stephanie Seneff

    2016-01-01

    Full Text Available Osteonecrosis of the jaw (ONJ, a rare side effect of bisphosphonate therapy, is a debilitating disorder with a poorly understood etiology. FDA’s Adverse Event Reporting System (FAERS provides the opportunity to investigate this disease. Our goals were to analyze FAERS data to discover possible relationships between ONJ and specific conditions and drugs and then to consult the scientific literature to deduce biological explanations. Our methodology revealed a very strong association between gastroesophageal reflux and bisphosphonate-induced ONJ, suggesting acidosis as a key factor. Overgrowth of acidophilic species, particularly Streptococcus mutans, in the oral microbiome in the context of insufficient acid buffering due to impaired salivary glands maintains the low pH that sustains damage to the mucosa. Significant associations between ONJ and adrenal insufficiency, vitamin C deficiency, and Sjögren’s syndrome were found. Glucose 6 phosphate dehydrogenase (G6PD deficiency can explain much of the pathology. An inability to maintain vitamin C and other antioxidants in the reduced form leads to vascular oxidative damage and impaired adrenal function. Thus, pathogen-induced acidosis, hypoxia, and insufficient antioxidant defenses together induce ONJ. G6PD deficiency and adrenal insufficiency are underlying factors. Impaired supply of adrenal-derived sulfated sterols such as DHEA sulfate may drive the disease process.

  14. Laser and Platelet-Rich Plasma to treat Medication-Related Osteonecrosis of the Jaws (MRONJ): a case report.

    Science.gov (United States)

    Fornaini, Carlo; Cella, Luigi; Oppici, Aldo; Parlatore, Anna; Clini, Fabio; Fontana, Matteo; Lagori, Giuseppe; Merigo, Elisabetta

    2017-09-30

    The appropriate management of Medication-Related OsteoNecrosis of the Jaw (MRONJ) is still a challenge for dentists and oral surgeons and in these last years high-technology instruments have been proposed at the different steps of interventions, also combined with promoters of tissue repair.The aim of this report is to show the advantages of a combined approach (laser and PRP) for the treatment of MRONJ. It is described the case of a patient positive for MRONJ observed at the Odontostomatology and Maxillo-Facial Surgery Unit of the Hospital of Piacenza where surgical approach was performed by using different devices: Er:YAG laser (2940 nm) to remove and vaporize necrotic hard tissue until bleeding bone; Platelet-Rich Plasma (PRP) to stimulate hard and soft tissue healing; diode laser (808 nm) to biostimulate the surgical site. At the time of suture removal, wound closure was observed and the complete healing of the MRONJ site was observed for the 2 years follow up. This case may suggest that this kind of combined approach during all the steps of MRONJ treatment allows to perform a faster and less invasive surgery with a more comfortable postoperative healing process and it represents an innovative approach in this severe adverse event.

  15. Evaluation of bone mineral density and osteonecrosis in the recovered severe acute respiratory syndrome patients

    International Nuclear Information System (INIS)

    Shang Wei; Yu Wei; Lin Qiang; Li Taisheng; Fan Hongwei; Tian Junping; Meng Wei

    2005-01-01

    Objective: To evaluate the bone mineral density (BMD) and osteonecrosis in the recovered patients with severe acute respiratory syndrome (SARS). Methods: Sixty-four patients with SARS were recruited in the study. There were 19 males with mean age 37 years (26-57 years) and 45 females with mean age 39 years (21-67 years) who divided into ten year cohorts for the analysis. BMD measurements were obtained by dual X-ray absorptiometry (DXA) at the sites of both lumbar spine (L2-4) and hip (neck, Ward's triangle, greater trochanter) which compared with those of the control groups. In addition to BMD measurements, hip MRI examinations were performed on 55 patients among the 64 patients for evaluating the osteonecrosis during an average of 10-12 months follow up after discharged from hospital. The BMD were also compared between the patients with osteonecrosis and without osteonecrosis. Results: BMD results of the 19 male SARS patients were not different from those of the normal reference, except that the 40-49 age-group at the site of L2-4 whose BMD was significantly higher than that of the normal group (P=0.016). For the 45 female recovered SARS patients, the BMD at femur neck of 20-29 age-group and greater trochanter of 40-49 age-group were significantly higher than those of normal reference respectively (P=0.0013, P=0.041). Besides that there were no significant BMD differences between any other age-groups when comparison with each site, although the BMD results of the female group were slightly higher than those of the normal reference in general. Osteonecrosis of the femur was diagnosed by MRI in 6 of the 55 patients. Although BMD results in the patients with osteonecrosis were slightly lower than those patients without osteonecrosis for each site, the difference was not statistically significant (P>0.05). Conclusion: Therapy with glucocorticoids in short period may not influence the BMD results in the recovered SARS patients within this near 10-12 months follow up

  16. The Relationship between Osteoporosis and Osteoarthritis of the Knee: A Report of 2 Cases with Suspected Osteonecrosis

    Directory of Open Access Journals (Sweden)

    Akira Horikawa

    2014-01-01

    Full Text Available Knee specimens of two osteoporotic patients who underwent unilateral knee arthroplasty for suspected osteonecrosis of the knee were examined histologically. Preoperative findings of magnetic resonance images in both patients were consistent with the diagnosis of osteonecrosis of the medial femoral condyles, although plain X-rays showed minimal degenerative changes. In both patients, preoperative bone mineral densities of the femoral condyle and proximal tibia of the affected side were lower than those of the unaffected side. Pathological examination of the resected femoral condyle and proximal tibia showed almost intact joint cartilage, healing of the collapsed subchondral bone, and significant trabecular bone loss. Histologically, no evidence of osteonecrosis, including empty lacunae of the trabecular bone, was observed. These findings indicated that subchondral bone collapse caused by osteoporosis, but not osteonecrosis, initiated the osteoarthritic change of the affected knee. This report emphasizes that there may be cases of progressive local osteoarthritis caused by fracture of subchondral bone because of osteoporosis.

  17. Management of osteonecrosis of the femoral head: A novel technique

    Directory of Open Access Journals (Sweden)

    Ahmed M Samy

    2016-01-01

    Full Text Available Background: Osteonecrosis of the femoral head (ONFH is a debilitating disease in orthopedics, frequently progressing to femoral head collapse and osteoarthritis. It is thought to be a multifactorial disease. ONFH ultimately results in femoral head collapse in 75-85% of untreated patients. Total hip arthroplasty (THA yields satisfactory results in the treatment of the end stage of the disease. However, disease typically affects males between the ages of 20 and 40 years and joint replacement is not the ideal option for younger patients. Recently, mesenchymal stem cells and platelet rich plasma (PRP have been used as an adjunct to core decompression to improve clinical success in the treatment of precollapse hips. Materials and Methods: A prospective study of 40 hips in 30 patients was done. There were 19 males and 11 females with a mean age 36.7 ± 6.93 years. The indication for the operation was restricted primarily to modified Ficat stages IIb and III. 16 hips (40% had stage IIb and 24 hips (60% had stage III ONFH. The period of follow up ranged between 36-50 months with a mean 41.4 ± 3.53 months. All patients were assessed clinically during pre- and post-operative period according to the Harris Hip Score (HHS, Visual Analog Score (VAS and radiologically by X-rays. Magnetic resonance imaging (MRI was done preoperatively to confirm the diagnosis and every 6 months postoperatively for assessment of healing. The operative procedure include removal of necrotic area with drilling then the cavity was filled with a composite of bone graft mixed with PRP. Results: The mean HHS improved from 46.0 ± 7.8 preoperatively to 90.28 ± 19 at the end of followup ( P < 0.0001. The mean values of VAS were 78 ± 21 and 35 ± 19 at preoperatively period and final followup, respectively, with an average reduction of 43 points. Conclusion: We found that the use of PRP with collagen sheet can increase the reparable capacity after drilling of necrotic segment in stage

  18. Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis.

    Science.gov (United States)

    Pakos, Emilios E; Megas, Panayiotis; Paschos, Nikolaos K; Syggelos, Spyridon A; Kouzelis, Antonios; Georgiadis, Georgios; Xenakis, Theodoros A

    2015-11-18

    To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head. The porous tantalum rod was combined with endoscopy, curettage, autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients (58 hips) with a mean age of 38 years. The majority of the patients had idiopathic osteonecrosis, followed by corticosteroid-induced osteonecrosis. Thirty-eight hips were of Steinberg stage II disease and 20 hips were of stage III disease. Patients were followed for 5 years and were evaluated clinically with the Merle D'Aubigne and Postel score and radiologically. The primary outcome of the study was survival based on the conversion to total hip arthroplasty (THA). Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with survival. The Kaplan-Meier survival analysis was performed to evaluate the survivorship of the prosthesis, and the Fisher exact test was performed to test associations between various parameters with survival. No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site morbidity. During the 5-year follow up, 1 patient died, 7 patients had disease progression and 4 hips were converted to THA. The 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%. Stage II disease was associated with statistically significant better survival rates compared to stage III disease (P = 0.04). The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival rates. The clinical evaluation revealed statistically significantly improved Merle d'Aubigne scores at 12 mo postoperatively compared to the

  19. Photodynamic Inactivation of Actinomyces naeslundii in Comparison With Chlorhexidine and Polyhexanide--A New Approach for Antiseptic Treatment of Medication-Related Osteonecrosis of the Jaw?

    Science.gov (United States)

    Hafner, Sigurd; Ehrenfeld, Michael; Storz, Enno; Wieser, Andreas

    2016-03-01

    Local antimicrobial therapy is a fundamental principle in the treatment of lesions of medication-related osteonecrosis of the jaw. Antimicrobial photodynamic therapy (aPDT) as a local application for the treatment of microbial infections has become more widely used in recent years. In the mouth, the bone surface is in constant contact with saliva and thus cannot be kept sterile, making the development of strategies for disinfection even more important. Different methods currently in use include local rinses with chlorhexidine (CHX), polyhexanide (PHX), or aPDT. This study compared the efficiency of these 3 methods. The in vitro activity of 3 different agents against slowly growing Actinomyces naeslundii isolated from a patient with osteonecrosis was evaluated. PHX 0.04% solution, CHX 0.12% solution, and methylene blue (MB) based dye with a laser light of 660-nm wavelength (aPDT) were compared. The decrease in colony-forming units by each method was measured using an in vitro killing assay based on a water-exposed surface in a well plate. MB dye with laser (10 seconds) decreased the bacterial load by more than 4 orders of magnitude and was superior to PHX and CHX exposure for 60 seconds. Laser exposure alone and MB dye exposure alone decreased bacterial loads slightly, but less efficiently than 60-second exposure to PHX or CHX. The most effective means of decreasing colony-forming units was achieved by a combination of laser light and dye, which also can be used clinically. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Abnormal subchondral bone microstructure following steroid administration is involved in the early pathogenesis of steroid-induced osteonecrosis.

    Science.gov (United States)

    Wang, L; Zhang, L; Pan, H; Peng, S; Zhao, X; Lu, W W

    2016-01-01

    Loss of bone microstructure integrity is thought to be related to osteonecrosis. But the relationship between the time when bone microstructure integrity loss appears and the onset of osteonecrosis has not yet been determined. Our study demonstrated abnormal changes of subchondral bone microstructure involved in the early pathogenesis of osteonecrosis. Using a rabbit model, we investigated the changes of subchondral bone microstructure following steroid administration to identify the onset of abnormal bone microstructure development in steroid-induced osteonecrosis. Fifty-five adult female Japanese White rabbits (mean body weight 3.5 kg; mean age 24 months) were used and randomly divided among three time points (3, 7, and 14 days) consisting of 15 rabbits each, received a single intramuscular injection of methylprednisolone acetate (MP; Pfizer Manufacturing Belgium NV) at a dose of 4 mg/kg, and a control group consisting of 10 rabbits was fed and housed under identical conditions but were not given steroid injections. A micro-CT scanner was applied to detect changes in the trabecular region of subchondral bone of excised femoral head samples. Parameters including bone volume fraction (BV/TV), bone surface (BS), trabecular bone pattern factor (Tb.Pf), trabecular thickness/number/separation (Tb.Th, Tb.N, and Tb.Sp), and structure model index (SMI) were evaluated using the software CTAn (SkyScan). After micro-CT scans, bilateral femoral heads were cut in the coronal plane at a thickness of 4 μm. The sections were then stained with haematoxylin-eosin and used for the diagnosis of osteonecrosis and the rate of development of osteonecrosis. The BV/TV, BS, Tb.Th and Tb.N demonstrated a time-dependent decline from 3, 7, and 14 days compared with the control group, while the Tb.Pf, Tb.Sp and SMI demonstrated an increase at 3, 7, and 14 days compared with the control group. For the histopathology portion, osteonecrosis was not seen 3 days after steroid treatment, but was

  1. [The clinical and X-ray classification of osteonecrosis of the low jaw].

    Science.gov (United States)

    Medvedev, Iu A; Basin, E M; Sokolina, I A

    2013-01-01

    To elaborate a clinical and X-ray classification of osteonecrosis of the low jaw in people with desomorphine or pervitin addiction. Ninety-two patients with drug addiction who had undergone orthopantomography, direct frontal X-ray of the skull, and multislice computed tomography, followed by multiplanar and three-dimensional imaging reconstruction were examined. One hundred thirty four X-ray films and 74 computed tomographic images were analyzed. The authors proposed a clinical and X-ray classification of osteonecrosis of the low jaw in people with desomorphine or pervitin addiction and elaborated recommendations for surgical interventions on the basis of the developed classification. The developed clinical and X-ray classification and recommendations for surgical interventions may be used to treat osteonecroses of various etiology.

  2. MRI-guidance in percutaneous core decompression of osteonecrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Kerimaa, Pekka; Vaeaenaenen, Matti; Ojala, Risto; Tervonen, Osmo; Blanco Sequeiros, Roberto [Oulu University Hospital, Department of Radiology (Finland); Hyvoenen, Pekka; Lehenkari, Petri [Oulu University Hospital, Department of Surgery (Finland)

    2016-04-15

    The purpose of this study was to evaluate the usefulness of MRI-guidance for core decompression of avascular necrosis of the femoral head. Twelve MRI-guided core decompressions were performed on patients with different stages of avascular necrosis of the femoral head. The patients were asked to evaluate their pain and their ability to function before and after the procedure and imaging findings were reviewed respectively. Technical success in reaching the target was 100 % without complications. Mean duration of the procedure itself was 54 min. All patients with ARCO stage 1 osteonecrosis experienced clinical benefit and pathological MRI findings were seen to diminish. Patients with more advanced disease gained less, if any, benefit and total hip arthroplasty was eventually performed on four patients. MRI-guidance seems technically feasible, accurate and safe for core decompression of avascular necrosis of the femoral head. Patients with early stage osteonecrosis may benefit from the procedure. (orig.)

  3. MRI-guidance in percutaneous core decompression of osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Kerimaa, Pekka; Vaeaenaenen, Matti; Ojala, Risto; Tervonen, Osmo; Blanco Sequeiros, Roberto; Hyvoenen, Pekka; Lehenkari, Petri

    2016-01-01

    The purpose of this study was to evaluate the usefulness of MRI-guidance for core decompression of avascular necrosis of the femoral head. Twelve MRI-guided core decompressions were performed on patients with different stages of avascular necrosis of the femoral head. The patients were asked to evaluate their pain and their ability to function before and after the procedure and imaging findings were reviewed respectively. Technical success in reaching the target was 100 % without complications. Mean duration of the procedure itself was 54 min. All patients with ARCO stage 1 osteonecrosis experienced clinical benefit and pathological MRI findings were seen to diminish. Patients with more advanced disease gained less, if any, benefit and total hip arthroplasty was eventually performed on four patients. MRI-guidance seems technically feasible, accurate and safe for core decompression of avascular necrosis of the femoral head. Patients with early stage osteonecrosis may benefit from the procedure. (orig.)

  4. Dysbaric Osteonecrosis in Divers. 1. A Survey of 611 Selected U. S. Navy Divers

    Science.gov (United States)

    1976-02-24

    mality have been observed in individuals with a history of exposure to hyperbaric or hypobaric environments.7 In Caisson or tunnel workers an...individuals who have been exposed to a hyperbaric or hypobaric environment. Initial efforts led to the conclusion that several radiographic views and a...insight into those aspects of the hyperbaric environment that contribute to the ultimate occurrence of dysbaric osteonecrosis. FINDINGS Twelve juxta

  5. Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California

    OpenAIRE

    Adesina, Oyebimpe; Brunson, Ann; Keegan, Theresa H. M.; Wun, Ted

    2017-01-01

    Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California's Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates ...

  6. The classification of osteonecrosis in patients with cancer: validation of a new radiological classification system

    International Nuclear Information System (INIS)

    Niinimäki, T.; Niinimäki, J.; Halonen, J.; Hänninen, P.; Harila-Saari, A.; Niinimäki, R.

    2015-01-01

    Aim: To validate a new, non-joint-specific radiological classification system that is suitable regardless of the site of the osteonecrosis (ON) in patients with cancer. Material and methods: Critical deficiencies in the existing ON classification systems were identified and a new, non-joint-specific radiological classification system was developed. Seventy-two magnetic resonance imaging (MRI) images of patients with cancer and ON lesions were graded, and the validation of the new system was performed by assessing inter- and intra-observer reliability. Results: Intra-observer reliability of ON grading was good or very good, with kappa values of 0.79–0.86. Interobserver agreement was lower but still good, with kappa values of 0.62–0.77. Ninety-eight percent of all intra- or interobserver differences were within one grade. Interobserver reliability of assessing the location of ON was very good, with kappa values of 0.93–0.98. Conclusion: All the available radiological ON classification systems are joint specific. This limitation has spurred the development of multiple systems, which has led to the insufficient use of classifications in ON studies among patients with cancer. The introduced radiological classification system overcomes the problem of joint-specificity, was found to be reliable, and can be used to classify all ON lesions regardless of the affected site. - Highlights: • Patients with cancer may have osteonecrosis lesions at multiple sites. • There is no non-joint-specific osteonecrosis classification available. • We introduced a new non-joint-specific osteonecrosis classification. • The validation was performed by assessing inter- and intra-observer reliability. • The classification was reliable and could be used regardless of the affected site.

  7. Widespread osteonecrosis of the foot in systemic lupus erythematosus: Radiographic and gross pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Resnick, D; Pineda, C; Trudell, D

    1985-01-01

    A patient with systemic lupus erythematosus required an amputation of the foot related to the presence of vascular disease and infection. Radiographs obtained prior to amputation revealed osteonecrosis in virtually every bone of the foot. Radiographic-pathologic correlation documented this widespread osseous involvement. Although ischemic necrosis of bone is a well-known feature of systemic lupus erythematosus, its localization in the small bones of the foot is rare.

  8. Widespread osteonecrosis of the foot in systemic lupus erythematosus: Radiographic and gross pathologic correlation

    International Nuclear Information System (INIS)

    Resnick, D.; Pineda, C.; Trudell, D.; California Univ., San Diego, La Jolla

    1985-01-01

    A patient with systemic lupus erythematosus required an amputation of the foot related to the presence of vascular disease and infection. Radiographs obtained prior to amputation revealed osteonecrosis in virtually every bone of the foot. Radiographic-pathologic correlation documented this widespread osseous involvement. Although ischemic necrosis of bone is a well-known feature of systemic lupus erythematosus, its localization in the small bones of the foot is rare. (orig.)

  9. Magnetic resonance imaging of osteonecrosis in divers: comparison with plain radiographs

    International Nuclear Information System (INIS)

    Shinoda, S.; Hasegawa, Y.; Kawasaki, S.; Tagawa, N.; Iwata, H.

    1997-01-01

    Objective. To assess the diagnostic value of magnetic resonance imaging (MRI) as compared with radiographic findings in osteonecrosis in divers. Design and patients. MRI scans and conventional radiographs of the shoulder, hip and knee joints of 23 professional male scuba divers were reviewed together with their clinical findings and personal histories. Correlations between the MRI findings and the radiographic evaluation, clinical symptoms, and personal history were then investigated. Results and conclusions. Lesions found on MRI in 23 divers included 27 in 39 proximal humeri, 17 in 36 proximal femora, 13 in 32 distal femora, and 12 in 32 proximal tibiae. Diffuse, marginated, or irregular patterns were observed. No lesions were seen in epiphyses of the distal femur or proximal tibia. We tried to classify these MRI findings by location and appearance. MRI showed no patients with only one affected bone. A close correlation between the MRI findings and maximum diving depth was observed in the proximal humerus. MRI depicted bone lesions that could not be detected on the radiographs. A routine MRI investigation of the hip joints should be performed in every diver in whom osteonecrosis is diagnosed at another site, for early detection of femoral head osteonecrosis. MRI of the shoulder joint is also the best surveillance in divers who dive deeper than 15 m. (orig.). With 4 figs., 5 tabs

  10. Detection of dysbaric osteonecrosis in military divers using magnetic resonance imaging

    International Nuclear Information System (INIS)

    Bolte, H.; Heller, M.; Reuter, M.; Koch, A.; Tetzlaff, K.; Bettinghausen, E.

    2005-01-01

    This was a controlled cross-sectional study to investigate the prevalence of dysbaric osteonecrosis (DON) in military divers. MRI examinations of the large joints and adjacent bones were performed in a cross-sectional group of 32 highly experienced military divers and 28 non-divers matched for age and anthropometric data. Additional plain radiographs and follow-up controls were performed in all persons with signs certain or suspicious of DON. In two subject groups (one of divers and one of non-divers), lesions characteristic of DON were detected. From this controlled study, it may be concluded that MRI is a highly sensitive method to detect signs of osteonecrosis. It could be shown that the prevalence of bone lesions characteristic of osteonecrosis in highly experienced military divers is not higher than in non-diving subjects of comparable age. The outcome of this comparably small study group fits to the results of previous extensive studies performed with radiographs. The detected low incidence of DON in this collective may be due to the fact that military divers follow stricter selection criteria, decompression schemes and medical surveillance than commercial divers. (orig.)

  11. Osteonecrosis in patients with malignant lymphoma: a review of twenty-five cases

    International Nuclear Information System (INIS)

    Engel, I.A.; Straus, D.J.; Lacher, M.; Lane, J.; Smith, J.

    1981-01-01

    A retrospective study of 25 patients with malignant lymphoma who had osteonecrosis of either the femoral or humeral head(s) was undertaken. The common factor present among all patients was the administration of intermittent steroid-containing combination chemotherapy. Seventeen Hodgkin's disease patients received chemotherapy predominantly consisting of an alkylating agent, vincristine, procarbazine, and moderate amounts of prednisone. The non-Hodgkin's lymphoma patients were on various moderate dosage steroid-containing protocols, except three who received prolonged high-dose steroid-containing chemotherapy regimens. Sixteen of the 17 Hodgkin's disease patients and five of the eight non-Hodgkin's lymphoma patients received radiotherapy to the bones that subsequently developed osteonecrosis. Two of the three non-Hodgkin's lymphoma patients who were not irradiated were treated with high-dose steroid-containing chemotherapy regimens. Symptoms developed in patients 12 months to 32 months after completion of chemotherapy and radiotherapy, respectively. Osteonecrosis was a long-term complication of treatment between 1970 and 1979 and occurred in 1.6% of the Hodgkin's disease and 0.12% of the non-Hodgkin's lymphoma patients treated. The authors conclude that the patients at highest risk for this complication are those who receive both radiotherapy to the affected bone(s) and intermittent steroid-containing multiple drug chemotherapy

  12. Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

    Science.gov (United States)

    Novais, Eduardo N; Sink, Ernest L; Kestel, Lauryn A; Carry, Patrick M; Abdo, João C M; Heare, Travis C

    2016-08-01

    The modified Dunn procedure, which is an open subcapital realignment through a surgical dislocation approach, has gained popularity for the treatment of unstable slipped capital femoral epiphysis (SCFE). Intraoperative monitoring of the femoral head perfusion has been recommended as a method of predicting osteonecrosis; however, the accuracy of this assessment has not been well documented. We asked (1) whether intraoperative assessment of femoral head perfusion would help identify hips at risk of developing osteonecrosis; (2) whether one of the four methods of assessment of femoral head perfusion is more accurate (highest area under the curve) at identifying hips at risk of osteonecrosis; and (3) whether specific clinical features would be associated with osteonecrosis occurrence after a modified Dunn procedure for unstable SCFE. Between 2007 and 2014, we performed 29 modified Dunn procedures for unstable SCFE (16 boys, 11 girls; median age, 13 years; range, 8-17 years); two were lost to followup before 1 year. During this period, six patients with unstable SCFE were treated by other procedures. All patients undergoing modified Dunn underwent assessment of epiphyseal perfusion by the presence of active bleeding and/or by intracranial pressure (ICP) monitoring. In the initial five patients perfusion was recorded once, either before dissection of the retinacular flap or after fixation by one of the two methods. In the remaining 22 patients (81%), perfusion was systematically assessed before dissection of the retinacular flap and after fixation by both methods. Minimum followup was 1 year (median, 2.5 years; range, 1-8 years) because osteonecrosis typically develops within the first year after surgery. Patients were assessed for osteonecrosis by the presence of femoral head collapse at radiographs obtained every 3 months during the first year after surgery. Seven (26%) of the 27 patients developed osteonecrosis. Measures of diagnostic accuracy including sensitivity

  13. Increased frequency of white matter lesions in patients with osteonecrosis (WMLeOn) of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Hadjigeorgiou, Georgios M. E-mail: gmhadji@med.uth.gr; Karantanas, Apostolos H.; Zibis, Aristidis; Dardiotis, Efthimios; Aggelakis, Konstantinos; Papadimitriou, Alexandros; Malizos, Konstantinos

    2004-06-01

    White matter lesions (WML) are commonly seen in cerebral MR imaging in normal and demented elderly people or young people suffering from migraine. We present data showing that WML are detected in an unexpectedly high frequency (56.9%) in patients with non-traumatic osteonecrosis of the femoral head compared to age and sex-matched controls. We designated the coexistence of WML and osteonecrosis as white matter lesions in osteonecrosis (WMLeON). We examined the possible association of WMLeON with hyperlipidaemia and other risk factors for WML or osteonecrosis of the femoral head. The frequency of history of corticosteroid treatment was statistically lower in patients with WMLeON (58.6%) compared to those without it (90.1%) (P=0.03). We found no association of WMLeON with diabetes, stroke, hyperlipidaemia, migraine, smoking, alcohol consumption, hypertension, atrial fibrillation, or systemic lupus erythematosus. Although, the clinical significance of WMLeON is still unknown, this finding supports, at least, the hypothesis that non-traumatic osteonecrosis is indeed a multisystem disorder rather than a disease of human skeleton.

  14. Poor results of drilling in early stages of juxta-articular osteonecrosis in 12 joints affected by Gaucher disease

    Science.gov (United States)

    Lebel, Ehud; Phillips, Mici; Zimran, Ari; Itzchaki, Menachem

    2009-01-01

    Background and purpose Gaucher disease is heterogeneous. One of the most devastating complications is bone involvement, ranging from mild osteopenia to osteonecrosis, but no markers have been discovered to predict onset and/or progression. We describe our experience in a large referral center using drilling for juxta-articular osteonecrosis in young patients with Gaucher disease. Patients and methods We retrospectively reviewed medical data from all patients who were recommended to undergo drilling for osteonecrosis of juxta-articular bone of the femoral head, the humeral head, or upper tibia for acute osteonecrosis at a pre-collapse stage. Results 11 patients (mean age 34 years) underwent drilling of 12 joints with juxta-articular osteonecrosis; 3 (mean age 51 years) refused intervention. 9 joints that were drilled showed advancing joint degeneration within 0.5 to 4 years. 3 joints have undergone replacement. Of the 3 joints that did not undergo drilling, 2 have undergone replacement and 1 has collapsed with osteoarthritis. Interpretation We found equally poor outcome with and without drilling. Effective intervention can only be achieved by improving our understanding of bone physiology and pathophysiology in Gaucher disease. PMID:19404804

  15. Osteonecrosis of the jaw (ONJ) in patients who receive Bone Targeting Agents (BTAs): the power of e-learning.

    Science.gov (United States)

    Nicolatou-Galitis, Ourania; Migliorati, Cesar

    2018-01-01

    The definition, pathobiology and risk factors of ONJ in cancer patients who receive BTAs are discussed in the recent ecancer module for osteonecrosis of the jaw (http://ecancer.org/education/module/276-osteonecrosis-of-the-jaw.php). ONJ prevention, early diagnosis and management are presented. The critical question of the performance of dental extraction, during BTA therapy, as indicated with the recent studies, is supported. The importance of the collaboration between dental and oncology professionals and the patients is highlighted and can be achieved through appropriate education. The ecancer modules are valuable tools for successful e-learning in medical oncology education, including ONJ.

  16. A prospective cohort study of the clinical presentation of non-traumatic osteonecrosis of the femoral head: spine and knee symptoms as clinical presentation of hip osteonecrosis.

    Science.gov (United States)

    Hauzeur, Jean-Philippe; Malaise, Michel; de Maertelaer, Viviane

    2016-07-01

    To study the clinical presentation of femoral head osteonecrosis (ONFH). Publications dedicated to this aspect of ONFH are rare. Our aim was to systematically collect and describe the clinical data. A prospective survey was conducted in a cohort of ONFH recruited from a dedicated clinic for osteonecrosis. The history of symptoms, medical management, and physical findings were obtained from 88 patients suffering from 125 ONFH. Subgroups were formed: bilateral versus unilateral ONFH, radiological stages 1-2 (pre-fractured) versus fractured stage 3 versus stage 4. ONFH was bilateral in 63 %, especially in corticosteroid users and in sickle-cell cases. These patients were younger but had similar BMIs compared to the unilateral cases. The pain was mechanical in 79 % of hips and inflammatory in 21 %. Acute pain at the onset was present in 55 % of hips. The localization of this pain was variable, including in the groin, the buttocks, or diffused in the lower limbs. A limp was present in 50 % of the patients, only when one hip was painful. The physical examination of the hip was normal in 31 %, especially in stages 1-2 (55 %). The diagnosis delay was 12 months, with inadequate medical management in 51 % of patients. In ONFH cases, no typical clinical pattern was found. The clinical presentation was very variable, sometimes having spine or knee symptoms with a normal physical examination of the hip. ONFH should be systematically suspected in cases of onset of pain in the pelvis, buttocks, groin, and lower limbs.

  17. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting

    Directory of Open Access Journals (Sweden)

    Babhulkar Sudhir

    2009-01-01

    Full Text Available Background: Femoral head-preserving core decompression and bone grafting have shown excellent result in preventing collapse. The use of vascularized grafts have shown better clinical results. The vascular pedicle bone graft is an easy to perform operation and does not require special equipment. We analyzed and report a series of patients of osteonecrosis of femoral head treated by core decompression and vascular pedicle grafting of part of iliac crest based on deep circumflex iliac vessels. Materials and Methods: The article comprises of the retrospective study of 31 patients of osteonecrosis of femoral head in stage II and III treated with core decompression and vascular pedicle grafting by using part of iliac crest with deep circumflex iliac vessels from January 1990 to December 2005. The young patients with a mean age 32 years (18-52 years with a minimum follow-up of five years were included for analysis. Sixteen patients had osteonecrosis following alcohol abuse, 12 patients following corticosteroid consumption, 3 patients had idiopathic osteonecrosis. Nine patients were stage IIB, and 22 patients were stage IIIC according to ARCO′s system. The core decompression and vascular pedicle grafting was performed by anterior approach by using part of iliac crest with deep circumflex iliac vessels. Results: Digital subtraction arteriography performed in 9 patients at the end of 12 weeks showed the patency of deep circumflex artery in all cases, and bone scan performed in 6 other patients showed high uptake in the grafted area of the femoral head proving the efficacy of the operative procedure. Out of 31 patients, only one patient progressed to collapse and total joint replacement was advised. At the final follow up period of 5-8 years, Harris Hip Score improved mean ± SD of 28.2 ± 6.4 ( p < 0.05. Forty-eight percent of patients had an improvement in Harris Hip Score of more that 28 points. Conclusion: The core decompression and vascular pedicle

  18. Attrition tendinitis of long head of biceps brachii in relation to humeral head osteonecrosis: case report.

    Science.gov (United States)

    Wiesler, Ethan R; Sarlikiotis, Thomas; Mavrogenis, Andreas F; Kokkalis, Zinon T

    2013-01-01

    This case report identifies a 41-year-old male patient who developed anterior shoulder pain in the setting of humeral head osteonecrosis. As a consequence of the cartilage degeneration, multiple loose bodies formed and migrated into the bicipital tendon sheath, causing attrition tendinitis, which was a feature of the clinical presentation. The patient was treated by a combination of arthroscopic glenohumeral joint debridement and open tenodesis of the biceps using a suture anchor. Follow-up revealed asymptomatic shoulder function by 18 months. This is the first report in the literature of bicipital tendinitis in the context of avascular necrosis of the shoulder.

  19. Osteonecrosis mandibular asociada a bifosfonatos: Presentación de caso clínico

    OpenAIRE

    Fernández López, Rocío Gloria; Arellano Flores, Águeda M; Velázquez Serrano, Sayra Nayelli

    2013-01-01

    El objetivo del trabajo es presentar la asociación de la osteonecrosis mandibular y el uso de bifosfonatos con fines terapéuticos. Los bifosfonatos son fármacos utilizados en el manejo de los desórdenes primarios y secundarios del hueso. Principalmente en la osteoporosis tanto local como general, enfermedades metabólicas óseas, calcificación de tejidos blandos y estados de hipercalcemia, entre otras. Asimismo también pueden actuar como antineoplásicos al inhibir la activación de proteínas vin...

  20. Manejo endodóntico en pacientes con riesgo de osteonecrosis asociada a bifosfonatos: Scoping review

    OpenAIRE

    Rojas, Carolina; Rivera, Carolina; Villanueva, Julio; Yanine, Nicolás

    2015-01-01

    El objetivo de este artículo es revisar la evidencia disponible que asocia la aparición de osteonecrosis maxilar por bifosfonatos (OMB) al tratamiento endodóntico, con sus eventuales consideraciones terapéuticas. Se realizó una búsqueda amplia de la literatura en bases de datos como MEDLINE, EMBASE y CENTRAL. Se definieron previamente criterios de selección que consideraran la endodoncia y la OMB. Se extrajo la evidencia relevante de los artículos que cumplieron con los criterios de selección...

  1. Bisphosphonate-Induced Osteonecrosis of the Maxilla Resembling a Persistent Endodontic Lesion.

    Science.gov (United States)

    Mosaferi, Hossein; Fazlyab, Mahta; Sharifi, Sanaz; Rahimian, Sepideh

    2016-01-01

    A 52-year-old Caucasian woman suffering from pain in the anterior maxillary region, presented to the clinic. Examination revealed a draining sinus tract in the buccal vestibule of the maxilla in the left anterior segment and expansion in the middle of palate. On conventional radiographic examination the lesion was initially assumed to be a periapical problem related to the incisors but subsequently it was diagnosed to be a bisphosphonate osteonecrosis. Acquiring a comprehensive medical history from the patients, conducting the clinical vitality tests and most importantly being familiar with the non-odontogenic lesions that can be side effects of specific medications are important requirements for reaching a correct diagnosis.

  2. Bilateral knee and right ankle osteonecrosis in an adolescent girl with acute lymphoblastic leukemia

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    Ülker Koçak

    2009-03-01

    Full Text Available Although rare, avascular necrosis of bone is a serious and incapacitating complication seen in children with acute lymphoblastic leukemia receiving high dose steroids. Here we present a 16 year-old girl who developed bilateral knee and right ankle avascular osteonecrosis one year after intensive chemotherapy for medium risk acute lymphoblastic leukemia. Indirect curettage of necrotic tissue and bone grafting were performed for both knees whereas conservative measures had been sufficient for the ankle. Early recognition of this condition is important in prevention of disabling sequela in skeletal system.

  3. Hyperlipidaemia - a risk factor for femoral head osteonecrosis (Legg-Calvè-Perthes-Like disease in children with AIDS: case report

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    Paula Aguiar de Aragão

    Full Text Available Although treatment of children infected with HIV with protease inhibitors has improved the survival of these patients, various adverse side effects have been reported, including metabolic abnormalities, such as hyperlipidaemia. We describe a case of hip osteonecrosis in an adolescent with AIDS who was being treated with protease inhibitors. There is a possible relation with hyperlipidemia. F.M.G., white, 11 years old, AIDS A2, started to receive AZT and DDI when he was 7 years old. In April 1999, the patient had a significant increase in viral load and so the antiretroviral therapy was switched to d4T, 3TC and Ritonavir. Triglyceride plasma levels reached 460mg/dl after this switch and were always above the reference value. In December 1999, the patient complained of pain in the right hip. On physical examination, he had limited movement of this joint. Magnetic resonance imaging of the right hip showed flattening, deformity and fragmentation of the femoral head, compatible with osteonecrosis. Few cases of femoral head osteonecrosis have been associated with HIV infection, in the absence of the classic risk factors for osteonecrosis. Metabolic risk factors include hypertriglyceridaemia. The immunological disorders that occur in the HIV infection may predispose the patient to avascular osteonecrosis and metabolic disorders, particularly hypertriglyceridemia, while the use of protease inhibitors, may be considered an additional risk factor for osteonecrosis. Given the importance of premature diagnosis and to avoid complications of osteonecrosis, we recommend evaluation of musculoskeletal symptoms in children receiving protease inhibitors.

  4. A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis?

    Science.gov (United States)

    Vallier, Heather A; Reichard, Stephen G; Boyd, Alysse J; Moore, Timothy A

    2014-02-05

    Osteonecrosis and posttraumatic arthritis are common after talar neck fracture. We hypothesized that delay of definitive fixation would not increase the rate of osteonecrosis, but that the amount of initial fracture displacement, including subtalar and/or tibiotalar dislocations, would be predictive. We investigated the possibility of dividing the Hawkins type-II classification into subluxated (type-IIA) and dislocated (type-IIB) subtalar joint subtypes. The cases of eighty patients with eighty-one talar neck and/or body fractures who had a mean age of 36.7 years were reviewed. The fractures included two Hawkins type-I, forty-four type-II (twenty-one type-IIA and twenty-three type-IIB), thirty-two type-III, and three type-IV fractures. Open fractures occurred in twenty-four patients (30%). One deep infection, two nonunions, and two malunions occurred. After a mean of thirty months of follow-up, sixteen of sixty-five fractures developed osteonecrosis, but 44% of them revascularized without collapse. Osteonecrosis never occurred in fractures without subtalar dislocation (Hawkins type I and IIA), but 25% of Hawkins type-IIB patterns developed osteonecrosis (p = 0.03), and 41% of Hawkins type-III fractures developed osteonecrosis (p = 0.004). Osteonecrosis occurred after 30% of open fractures versus 21% of closed fractures (p = 0.55). Forty-six fractures were treated with urgent open reduction and internal fixation (ORIF) at a mean of 10.1 hours, primarily for open fractures or irreducible dislocations. With the numbers studied, the timing of reduction was not related to the development of osteonecrosis. Thirty-five patients had delayed ORIF (mean, 10.6 days), including ten with Hawkins type-IIB and ten with Hawkins type-III fractures initially reduced by closed methods, and one (5%) of the twenty developed osteonecrosis. Thirty-five patients (54%) developed posttraumatic arthritis, including 83% of those with an associated talar body fracture (p Hawkins type

  5. Femoral perfusion after pulsed electromagnetic field stimulation in a steroid-induced osteonecrosis model.

    Science.gov (United States)

    Ikegami, Akira; Ueshima, Keiichiro; Saito, Masazumi; Ikoma, Kazuya; Fujioka, Mikihiro; Hayashi, Shigeki; Ishida, Masashi; Fujiwara, Hiroyoshi; Mazda, Osam; Kubo, Toshikazu

    2015-07-01

    This study was designed to evaluate femoral perfusion after pulsed electromagnetic field (PEMF) stimulation in a steroid-induced osteonecrosis rabbit model by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Steroid-induced osteonecrosis was produced by single intramuscular injection of methylprednisolone in 15 rabbits. Eight rabbits underwent PEMF stimulation (PEMF group) and seven did not (control group). DCE-MRI was performed before PEMF stimulation, immediately before steroid administration, and 1, 5, 10, and 14 days after steroid administration. Regions of interest were set in the bilateral proximal femora. Enhancement ratio (ER), initial slope (IS), and area under the curve (AUC) were analyzed. ER, IS, and AUC in the control group significantly decreased after steroid administration compared with before administration (P<0.05). In PEMF group, IS significantly decreased; however, ER and AUC showed no significant differences after steroid administration compared with before. ER and IS in PEMF group were higher than in control group until 10th day, and AUC was higher until 5th day after steroid administration (P<0.05). PEMF stimulation restrains the decrease in blood flow after steroid administration. © 2015 Wiley Periodicals, Inc.

  6. Spontaneous osteonecrosis of the knee associated with ipsilateral tibial plateau stress fracture: report of two patients and review of the literature

    International Nuclear Information System (INIS)

    Sokoloff, R.M.; Farooki, S.; Resnick, D.

    2001-01-01

    Two cases are presented of spontaneous osteonecrosis of the knee (SONK) associated with stress fractures of the tibial plateau. This association lends further credence to the postulate that SONK has a traumatic etiology. (orig.)

  7. Marrow pattern in the proximal femoral metaphysis of patients with osteonecrosis of femoral head and normal subjects: comparison on MR images

    International Nuclear Information System (INIS)

    Chun, Ho Jong; Park, Jeong Mi; Kim, Jee Young; Lim, Gye Yeon; Yang, Po Song; Kim, Euy Neyong; Kim, Choon Yul; Shinn, Kyung Sub

    1996-01-01

    To predict early risk of osteonecrosis of the femoral head by comparison of the bone marrow pattern of the proximal femoral metaphysis(PFM) in normal subjects and patients with osteonecrosis of the femoral head on T1-weighted magnetic resonance(MR) images. The authors retrospectively reviewed T1(TR 525/TE 25 msec) weighted coronal MR images of 67 hips with osteonecrosis and 65 normal hips in 39 patients with osteonecrosis of the femoral head and in 27 normal subjects. On the basis of bright signal intensity of fat, the proportion of remaining hematopoietic marrow in PFM was subdivided into 4 grades (0 to 3) by two radiologists. No evidence of remaining hematopoietic marrow was assigned grade 0, and grades 1, 2 and 3 represented scanty, moderate, and prominent hematopoietic marrow, respectively. Grades 0 and 1 were collectively defined as 'predominantly fatty', grades 2 and 3 as 'predominantly hematopoietic'. The frequency of the predominantly fatty marrow in PFM was analyzed in relation to three age groups (<25, 25-50, 50<) and both sexes. The overall frequency of predominantly fatty marrow in PFM was higher in hips with osteonecrosis than in normal hips (p<0.001). Especially in the male population under the age of 50, the frequency was apparently higher in hips with osteonecrosis, compared with normal hips (p<0.0001). However, the male population aged over 50 or female population showed no statistically significant difference in our series. In proximal femoral metaphysis with osteonecrosis of the femoral head, fatty marrow conversion occurs apparently earlier than in normal subject. T1-weighted MR imaging could therefore be useful in predicting early risk of osteonecrosis of the femoral head because of early fatty marrow conversion of the proximal femoral metaphysis

  8. Bisphosphonate-associated osteonecrosis of the jaw is linked to suppressed TGFβ1-signaling and increased Galectin-3 expression: A histological study on biopsies

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    Schlegel Karl A

    2011-07-01

    Full Text Available Abstract Background Bisphosphonate associated osteonecrosis of the jaw (BRONJ implies an impairment in oral hard- and soft tissue repair. An understanding of the signal transduction alterations involved can inform therapeutic strategies. Transforming growth factor β1 (TGFβ1 is a critical regulator of tissue repair; galectin-3 mediates tissue differentiation and specifically modulates periodontopathic bacterial infection. The aim of this study was to compare the expression of TGFβ1-related signaling molecules and Galectin-3 in BRONJ-affected and healthy mucosal tissues. To discriminate between BRONJ-specific impairments in TGFβ1 signaling and secondary inflammatory changes, the results were compared to the expression of TGFβ1 and Galectin-3 in mucosal tissues with osteoradionecrosis. Methods Oral mucosal tissue samples with histologically-confirmed BRONJ (n = 20, osteoradionecrosis (n = 20, and no lesions (normal, n = 20 were processed for immunohistochemistry. Automated staining with an alkaline phosphatase-anti-alkaline phosphatase kit was used to detect TGFβ1, Smad-2/3, Smad-7, and Galectin-3. We semiquantitatively assessed the ratio of stained cells/total number of cells (labeling index, Bonferroni-adjustment. Results TGFβ1 and Smad-2/3 were significantly decreased (p Conclusion Our results showed that disrupted TGFβ1 signaling was associated with delayed periodontal repair in BRONJ samples. The findings also indicated that impairments in TGFβ1-signaling were different in BRONJ compared to osteoradionecrosis. BRONJ appeared to be associated with increased terminal osseous differentiation and decreased soft tissue proliferation. The increase in Galectin-3 reflected the increase in osseous differentiation of mucoperiosteal progenitors, and this might explain the inflammatory anergy observed in BRONJ-affected soft tissues. The results substantiated the clinical success of treating BRONJ with sequestrectomy, followed by strict mucosa

  9. A large case-control study reveals a positive association between bisphosphonate use and delayed dental healing and osteonecrosis of the jaw.

    Science.gov (United States)

    Borromeo, Gelsomina L; Brand, Caroline; Clement, John G; McCullough, Michael; Crighton, Lisa; Hepworth, Graham; Wark, John D

    2014-06-01

    This study sought to investigate, using a case-control study design, the association between bisphosphonate therapy and delayed dental healing and osteonecrosis of the jaw. Identification of potential cases of delayed dental healing was by consecutive screening of Specialist Oral and Maxillofacial and Special Needs Dentist clinic records for patients aged older than 50 years, during a 6-month window, in Victoria, Australia. Cases were confirmed by a case adjudication panel blinded to bisphosphonate status. Cases associated with malignancy or local radiotherapy were excluded. Controls were matched for age, sex, and source of dental referral (1:4, n = 160 controls). Variables of interest were dental precipitants, dental clinic type, smoking history, and medical comorbidities. A total of 4212 of 22,358 patients met inclusion criteria, of which 69 were potential cases with 40 (0.95%) confirmed cases. The odds ratio (OR) for developing delayed dental healing when taking an oral bisphosphonate was 13.1 (95% confidence interval [CI] 4.4 to 39.3; p associated with intravenous bisphosphonate use. There was some evidence of an interaction with age, sex, and clinic type. When adjusted for smoking, the estimated odds ratio was 11.6 (95% CI 1.9 to 69.4; p = 0.01). There was an association between having another illness and delayed dental healing (OR = 2.3; 95% CI 1.0 to 5.2). A dental precipitant was present in 39 of 40 (97.5%) delayed dental healing cases. An important association between bisphosphonate use and delayed dental healing in the setting of benign bone disease, predominately in individuals with a dental precipitant, has been demonstrated. © 2014 American Society for Bone and Mineral Research.

  10. Osteonecrose dos maxilares associada ao uso de bisfosfonatos: importante complicação do tratamento oncológico Bisphosphonate-associated jaws osteonecrosis: an important complication of oncology treatment

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    Marco Antonio T. Martins

    2009-02-01

    Full Text Available Os bisfosfonatos são um grupo de medicamentos utilizados no tratamento de doenças malignas metastáticas e em outras doenças ósseas como osteoporose e doença de Paget. A despeito dos seus benefícios, uma importante complicação denominada de osteonecrose dos maxilares vem sendo observada nos pacientes usuários crônicos dos bisfosfonatos que se caracteriza clinicamente por exposições ósseas na região maxilofacial persistente, acompanhadas de osteomielite, geralmente sintomáticas e cujo tratamento é complexo. Este estudo tem por objetivo revisar a literatura sobre a osteonecrose associada ao uso dos bisfosfonatos, em especial, em oncologia, no período de 2003 a 2008. Serão apresentados e discutidos os fatores de risco, aspectos etiopatogênicos, clínicos, imagenológicos, terapêuticos e preventivos desta doença. Devido à dificuldade de tratamento da osteonecrose associada aos bisfosfonatos, o foco deve ser a prevenção, sendo o ideal a eliminação de quadros infecciosos orais antes da terapia com os bisfosfonatos ter sido iniciada e minimizar traumas em boca após o uso destes medicamentos.Bisphosphonates are drugs used in the treatment of malignant metastatic diseases and in other bone lesions such as osteoporosis and Paget´s disease. Besides their benefits, jaw osteonecrosis, an important side effect, has been observed in long-term users of these drugs. Jaw osteonecrosis is clinically characterized by prolonged maxillary and mandible bone exposure accompanied by osteomyelitis. These lesions are usually symptomatic and difficult to treat. This study has the objective of reviewing publications from 2003 to 2008 about bisphosphonate-associated jaw osteonecrosis, in particular in relation to oncology. Risk factors, and etiopathological, clinical, radiographic, therapeutic, and preventive aspects of this condition are presented and discussed. Due to the difficulty to treat this disease, the focus must be prevention, with the

  11. Articular reconstruction of the humeral head with autogenous allograft in the treatment of the osteonecrosis

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    Alberto Naoki Miyazaki

    Full Text Available ABSTRACT The authors describe a surgical biological reconstruction of the humeral head with frozen autogenous allograft technique for the treatment of young patients with focal osteonecrosis of the humeral head. This represents a possible alternative, maybe even definitive for some patients, when compared to hemiarthroplasty or total shoulder arthroplasty. The technique consists of the fixation of a frozen autogenous allograft with previously-molded articular cartilage from the humeral head, after cleansing the osteonecrotic focus. Five patients under 50 years of age were treated, with three very satisfactory results, one patient was lost to follow-up, and one patient had an unsatisfactory result (converted to hemiarthroplasty. The study describes the technique in detail and the three cases with a longer follow-up time.

  12. MRI and X-ray findings of osteonecrosis in the knee

    International Nuclear Information System (INIS)

    Shimizu, Koh

    2009-01-01

    This paper describes the retrospective comparison of MRI and X-ray findings of steroid-induced and idiopathic osteonecrosis in the knee to see their similarity and difference for the ultimate purpose of making the early diagnosis and treatment as well as knowing their pathogenesis. Subjects are images of 250 steroid-induced osteonecrotic knees of 136 patients (M 23/F 113, av. age of 39 y) among whom 114 patients (84%) having the bilateral disease, and of 50 knees of 48 patients (10/38, 71 y) with the idiopathic disease. The former group has the treatment history with a large dose (>30 mg/day) of predonisolone. X-ray images are classified as previously reported. T1-weighted spin echo (SE) and short inversion time inversion recovery (STIR) MRI is done with 1.5 T superconducting machine Gyroscan and images giving the necrotic finding are classified in the band (bright), mixed (dark in the bright) and diffuse (dark) types according to the contrast distribution in the lesion. The site of steroidal lesion is found to occur more frequently in the order of posterior lateral condyle, distal metaphysis and posterior medial condyle of femur, and necrosis, at the end of blood stream in the marrow, giving the band and mixed types. Idiopathic one occurs limitedly at the center of medial condyle of femur, giving the diffuse type. Idiopathic osteonecrosis thus differs from steroidal disease and its imaging findings do not lead to the conclusion that fracture is the cause of the idiopathy. (R.T)

  13. The Protective Effect of Cordycepin On Alcohol-Induced Osteonecrosis of the Femoral Head

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    Yi-Xuan Chen

    2017-08-01

    Full Text Available Background: Alcohol abuse is known to be a leading risk factor for atraumatic osteonecrosis of the femoral head (ONFH, in which the suppression of osteogenesis plays a critical role. Cordycepin benefits bone metabolism; however, there has been no study to determine its effect on osteonecrosis. Methods: Human bone mesenchymal stem cells (hBMSCs were identified by multi-lineage differentiation. Alkaline phosphatase (ALP activity, RT-PCR, western blots, immunofluorescent assay and Alizarin red staining of BMSCs were evaluated. A rat model of alcohol-induced ONFH was established to investigate the protective role of cordycepin against ethanol. Hematoxylin & eosin (H&E staining and micro-computerized tomography (micro-CT were performed to observe ONFH. Apoptosis was assessed by TdT-mediated dUTP nick end labeling (TUNEL. Immunohistochemical staining was carried out to detect OCN and COL1. Results: Ethanol significantly suppressed ALP activity, decreased gene expression of OCN and BMP2, lowered levels of RUNX2 protein, and reduced immunofluorescence staining of OCN and COL1 and calcium formation of hBMSCs. However, these inhibitory effects were attenuated by cordycepin co-treatment at concentrations of 1 and 10 µg/mL Moreover, it was revealed that the osteo-protective effect of cordycepin was associated with modulation of the Wnt/β-catenin pathway. In vivo, by micro-CT, TUNEL and immunohistochemical staining of OCN and COL1, we found that cordycepin administration prevented alcohol-induced ONFH. Conclusion: Cordycepin treatment to enhance osteogenesis may be considered a potential therapeutic approach to prevent the development of alcohol-induced ONFH.

  14. Radiofrequency ablation of osteoid osteoma using tissue impedance as a parameter of osteonecrosis

    International Nuclear Information System (INIS)

    Al-Omari, Ma'moon H.; Al-Muqbel, Kusai M.; Rousan, Liqa A.; Ata, Khalid J.; Mohaidat, Ziyad M.; Haddad, Waleed H.

    2012-01-01

    The aim of this study is to assess the safety and the efficacy of radiofrequency ablation (RFA) of osteoid osteoma with Soloist monopolar electrode using tissue impedance, rather than temperature, as an indicator of osteonecrosis. The medical records and imaging studies of 30 patients (males 18, females 12) who underwent RFA of osteoid osteoma at our institution were reviewed. The mean age of the patients was 15.3 years (range 5–34 years) and the mean duration of follow up was 26.9 months (range 3–52 months). The lesions were located in the femur (n = 6, 53%), tibia (n = 8, 27%), hand (n = 3, 10%), foot (n = 2, 6%) and humerus (n = 1, 3%). The procedure was performed with general anaesthesia under CT guidance. The nidus was accessed with 11-gauge bone biopsy needle and then the stylet was removed and replaced by monopolar 16.5G radiofrequency probe with a 9-mm active tip through the coaxial axis. Power delivery via the radiofrequency generator was started at 2 W and increased gradually until the end point of 450–500 Ω reached and ‘Roll-Off’ achieved indicating coagulation necrosis of the target lesion. The procedure was technically successful in all patients. The mean procedure time was 72 min and the mean RFA time was 12.7 min. The clinical success rate was 93%. In one patient, the procedure was abandoned due to immature Roll-Off despite all measures. In one patient (3%), recurrence occurred 39 months after the procedure. No major complications were encountered. Two minor skin burns occurred that were resolved with conservative measures. RFA of osteoid osteoma using Soloist monopolar electrode is a safe and effective treatment. Tissue impedance could be used as an alternative to temperature to indicate osteonecrosis of osteoid osteoma during RFA.

  15. Fate of bone marrow mesenchymal stromal cells following autologous transplantation in a rabbit model of osteonecrosis.

    Science.gov (United States)

    Sugaya, Hisashi; Mishima, Hajime; Gao, Ran; Kaul, Sunil C; Wadhwa, Renu; Aoto, Katsuya; Li, Meihua; Yoshioka, Tomokazu; Ogawa, Takeshi; Ochiai, Naoyuki; Yamazaki, Masashi

    2016-02-01

    Internalizing quantum dots (i-QDs) are a useful tool for tracking cells in vivo in models of tissue regeneration. We previously synthesized i-QDs by conjugating QDs with a unique internalizing antibody against a heat shock protein 70 family stress chaperone. In the present study, i-QDs were used to label rabbit mesenchymal stromal cells (MSCs) that were then transplanted into rabbits to assess differentiation potential in an osteonecrosis model. The i-QDs were taken up by bone marrow-derived MSCs collected from the iliac of 12-week-old Japanese white rabbits that were positive for cluster of differentiation (CD)81 and negative for CD34 and human leukocyte antigen DR. The average rate of i-QD internalization was 93.3%. At 4, 8, 12, and 24 weeks after transplantation, tissue repair was evaluated histologically and by epifluorescence and electron microscopy. The i-QDs were detected at the margins of the drill holes and in the necrotized bone trabecular. There was significant colocalization of the i-QD signal in transplanted cells and markers of osteoblast and mineralization at 4, 8, and 12 weeks post-transplantation, while i-QDs were detected in areas of mineralization at 12 and 24 weeks post-transplantation. Moreover, i-QDs were observed in osteoblasts in regenerated tissue by electron microscopy, demonstrating that the tissue was derived from transplanted cells. These results indicate that transplanted MSCs can differentiate into osteoblasts and induce tissue repair in an osteonecrosis model and can be tracked over the long term by i-QD labeling. Copyright © 2015 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  16. Costo-osteochondral graft for post-traumatic osteonecrosis of the radial head in an adolescent boy.

    Science.gov (United States)

    Iwai, S; Sato, K; Nakamura, T; Okazaki, M; Itoh, Y; Toyama, Y; Ikegami, H

    2011-01-01

    We present a case of post-traumatic osteonecrosis of the radial head in a 13-year-old boy which was treated with costo-osteochondral grafts. A satisfactory outcome was seen at a follow-up of two years and ten months. Although costo-osteochondral grafting has been used in the treatment of defects in articular cartilage, especially in the hand and the elbow, the extension of the technique to manage post-traumatic osteonecrosis of the radial head in a child has not previously been reported in the English language literature. Complete relief of pain was obtained and an improvement in the range of movement was observed. The long-term results remain uncertain.

  17. The usefulness of 3D quantitative analysis with using MRI for measuring osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Hwang, Ji Young; Lee, Sun Wha; Park, Youn Soo

    2006-01-01

    We wanted to evaluate the usefulness of MRI 3D quantitative analysis for measuring osteonecrosis of the femoral head in comparison with MRI 2D quantitative analysis and quantitative analysis of the specimen. For 3 months at our hospital, 14 femoral head specimens with osteonecrosis were obtained after total hip arthroplasty. The patients preoperative MRIs were retrospectively reviewed for quantitative analysis of the size of the necrosis. Each necrotic fraction of the femoral head was measured by 2D quantitative analysis with using mid-coronal and mid-sagittal MRIs, and by 3D quantitative analysis with using serial continuous coronal MRIs and 3D reconstruction software. The necrotic fraction of the specimen was physically measured by the fluid displacement method. The necrotic fraction according to MRI 2D or 3D quantitative analysis was compared with that of the specimen by using Spearman's correlation test. On the correlative analysis, the necrotic fraction by MRI 2D quantitative analysis and quantitative analysis of the specimen showed moderate correlation (r = 0.657); on the other hand, the necrotic fraction by MRI 3D quantitative analysis and quantitative analysis of the specimen demonstrated a strong correlation (r = 0.952) (ρ < 0.05). MRI 3D quantitative analysis was more accurate than 2D quantitative analysis using MRI for measuring osteonecrosis of the femoral head. Therefore, it may be useful for predicting the clinical outcome and deciding the proper treatment option

  18. A comparative assessment of the value of imaging methods in diagnostic of osteonecrosis of the femoral head in adults

    International Nuclear Information System (INIS)

    Peshev, A.; Mlachkova, D.; Mlachkov, N.

    2006-01-01

    Full text: The aim of the presentation is to study the possibilities of contemporary methods for early diagnosis of osteonecrosis of the femoral head in adults with a view to make a suitable diagnostic protocol. 156 hip joints were examined. A conventional radiography was performed in all, CT - in 112, bone scan - in 123, MRI - in 42. The findings of the imaging methods were compared. The results of imaging methods were put together with the extension of the clinical complaints. The findings of conventional radiography were classified according to Ficat and Arlet, CT findings were classified according to Magit. The size and location of the necrotic area as a prognostic factor was evaluated. MRI was the most sensitive method in the early stages of necrosis of femoral head, followed by bone scan and CT. Conventional radiography is suitable for late stages of osteonecrosis. On the basis of our investigations we propose a diagnostic protocol for early diagnosis of osteonecrosis of the femoral head in adults

  19. MRI evaluation of osteonecrosis in knee joints after intravenous administration of corticosteroids in patients with severe acute respiratory syndrome

    International Nuclear Information System (INIS)

    Gao Yong'an; Liu Hualiang; Dong Yanqing; Liu Ying; Li Kuncheng; Wang Zhongwei; Li Ping

    2005-01-01

    Objective: To evaluate MRI features of osteonecrosis in knee joints after intravenous administration of exogenous corticosteroids in patients with severe acute respiratory syndrome (SARS). Methods: MRI was done in 18 patients (medical staff from 4 hospitals) suffered from SARS and treated with intravenous use of exogenous corticosteroids in hip joints and knee joints to indicate the findings and characteristics of osteonecrosis as well as their relation with hormone amount. Results: Eleven patients showed lesions of osteonecrosis in knee joints with bilateral in 7 and unilateral in 4, and 3 patients were complicated with avascular necrosis in bilateral femoral heads. Among the 38 lesions in knee joints, 34 lesions were located in medial condylu, lateral condylus and shaft of femur, and 4 in medial condylus or lateral condylus of tibia. Large-middle lesions showed geographic focus of typically heterogeneous signal (low or intermediate signal intensity on T 1 WI and high or intermediate signal intensity T 2 WI) within the marrow that was surrounded by characteristic low signal intensity, serpentine border on T 1 , T 2 WI. This border showed a classic double-line sign on T 2 WI in 4 lesions. Small lesions showed low signal intensity on T 1 and low or high signal intensity on T 2 WI. Subchondral avascular necrosis in middle-upper femoral heads showed intermediate signal intensity on T 1 weighted images and high or complicated signal intensity on T 2 WI encircled with characteristic low signal intensity, serpentine border on T 1 and T 2 WI. This border showed a classic double-line sign on T 2 weighted images in avascular necrosis of bilateral femoral heads in 1 case. Conclusion: In these cases, osteonecrosis in knee joints was more than in femoral heads in patients with SARS after intravenous use of exogenous corticosteroids, mostly located in medial condylus, lateral condylus and shaft of femur as well as in medial condylus or lateral condylus of tibia. So, MRI should

  20. The effect of core decompression on local expression of BMP-2, PPAR-γ and bone regeneration in the steroid-induced femoral head osteonecrosis

    Directory of Open Access Journals (Sweden)

    Wang Wei

    2012-08-01

    Full Text Available Abstract Background To investigate the efficacy of the sole core decompression surgery for the treatment of steroid-induced femoral head osteonecrosis. Methods The model was established by administration of steroids in combination with horse serum. The rabbits with bilateral femoral head osteonecrosis were randomly selected to do the one side of core decompression. The other side was used as the sham. Quantitative RT-PCR and western blot techniques were used to measure the local expression of BMP-2 and PPAR-γ. Bone tissues from control and operation groups were histologically analyzed by H&E staining. The comparisons of the local expression of BMP-2 and PPAR-γ and the bone regeneration were further analyzed between different groups at each time point. Results The expression of BMP-2 in the osteonecrosis femoral head with or without decompression was significantly lower than that in normal animals. BMP-2 expression both showed the decreasing trend with the increased post-operation time. No significant difference of BMP-2 expression occurred between femoral head osteonecrosis with and without decompression. The PPAR-γ expression in the femoral head osteonecrosis with and without core decompression both was significantly higher than that in control. Its expression pattern showed a significantly increased trend with increased the post-operation time. However, there was no significant difference of PPAR-γ expression between the femoral head osteonecrosis with and without decompression at each time point. Histopathological analysis revealed that new trabecular bone and a large number of osteoblasts were observed in the steroid-induced femoral head osteonecrosis with lateral decompression at 8 weeks after surgery, but there still existed trabecular bone fractures and bone necrosis. Conclusions Although decompression takes partial effect in promoting bone regeneration in the early treatment of femoral head osteonecrosis, such an effect does not

  1. Does the Addition of Bone Morphogenetic Protein 2 to Platelet-Rich Fibrin Improve Healing After Treatment for Medication-Related Osteonecrosis of the Jaw?

    Science.gov (United States)

    Park, Jung-Hyun; Kim, Jin-Woo; Kim, Sun-Jong

    2017-06-01

    To investigate the effect of the addition of bone morphogenetic protein 2 (BMP-2) to leukocyte-rich and platelet-rich fibrin (L-PRF) on the treatment of medication-related osteonecrosis of the jaws (MRONJ), this study compared the healing outcome of combined use of BMP-2 and L-PRF with single use of L-PRF. Of 55 patients who were diagnosed with MRONJ, 25 were treated with L-PRF alone and 30 were treated with L-PRF and recombinant human BMP-2. For each patient, surgical sites were evaluated postoperatively at 4 and 16 weeks. Associations between the treatment method and the resolution of MRONJ were analyzed with the adjustment of patient-specific factors that may influence the treatment outcome. At 4 and 16 weeks postoperatively, patients with MRONJ who were treated with both L-PRF and BMP-2 showed favorable outcomes with complete resolution of the lesions, which was statistically significant compared with that of the therapy using L-PRF alone (P = .028). Therefore, the additional use of BMP-2 considerably improved MRONJ healing. Among patient-specific factors, the existence of a bacterial colony in the biopsy specimen was a significant factor that negatively affected disease resolution (P = .017). The combined use of BMP-2 and L-PRF leads to the early resolution of MRONJ; thus patients who need to continue antiresorptive therapy may benefit from the combined regimen. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Osteonecrosis - A rare complication of HIV infection. Association with numerous risk factors; Osteonekrose: eine seltene Komplikation der HIV-Infektion. Assoziation mit bestimmten Risikofaktoren

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, D.; Behrens, G.; Stoll, M.; Schmidt, R.E. [Medizinische Hochschule Hannover (Germany). Abt. Klinische Immunologie

    2000-03-13

    Osteonecrosis is a rare complication of HIV infection. The presumptive cause of the aseptic osteonecrosis is a distrubed blood supply to the bone. Most cases of osteonecrosis are associated with numerous risk factors, such as use of steroids, alcohol abuse, coagulopathies or metabolic derangements. Since conventional X-rays appear unremarkable, early forms often go unrecognized or are diagnosed late. Methods of establishing the diagnosis are MRI and three-phase skeletal scintigraphy. The pathogenesis of osteonecrosis in HIV infection is unclear. So far, about 30 cases have been reported in the literature. We would recommend that in HIV patients with typical symptoms - in particular when classical risk factors are present - osteonecrosis be included in the differential diagnostic considerations. (orig.) [German] Die Osteonekrose ist eine seltene Komplikation der HIV-Infektion. Als Ursache werden Stoerungen in der Gefaessversorgung des Knochengewebes angenommen. Aufgrund unauffaelliger Befunde im konventionellen Roentgen werden Fruehformen haeufig verkannt oder erst verspaetet diagnostiziert. Methoden zur Diagnosesicherung sind die Kernspintomographie oder die 3-Phasen-Knochenszintigraphie. Die Pathogenese der Osteonekrose bei der HIV-Infektion ist unklar. Bisher sind in der Literatur etwa 30 Kasuistiken beschrieben. Wir empfehlen, bei Vorliegen einer typischen Symptomatik bei HIV-Patienten - insbesondere wenn typische Risikofaktoren vorliegen - die Osteonekrose in die differenzialdiagnostischen Ueberlegungen mit einzubeziehen. (orig.)

  3. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis.

    Science.gov (United States)

    Martin, John R; Houdek, Matthew T; Sierra, Rafael J

    2013-06-01

    The aim of this paper is to describe our surgical procedure for the treatment of osteonecrosis of the femoral head using a minimally invasive technique. We have limited the use of this procedure for patients with pre-collapse osteonecrosis of the femoral head (Ficat Stage I or II). To treat osteonecrosis of the femoral head at our institution we currently use a combination of outpatient, minimally invasive iliac crest bone marrow aspirations and blood draw combined with decompressions of the femoral head. Following the decompression of the femoral head, adult mesenchymal stem cells obtained from the iliac crest and platelet rich plasma are injected into the area of osteonecrosis. Patients are then discharged from the hospital using crutches to assist with ambulation. This novel technique was utilized on 77 hips. Sixteen hips (21%) progressed to further stages of osteonecrosis, ultimately requiring total hip replacement. Significant pain relief was reported in 86% of patients (n=60), while the rest of patients reported little or no pain relief. There were no significant complications in any patient. We found that the use of a minimally invasive decompression augmented with concentrated bone marrow and platelet rich plasma resulted in significant pain relief and halted the progression of disease in a majority of patients.

  4. Elevated adipogenesis of marrow mesenchymal stem cells during early steroid-associated osteonecrosis development

    Directory of Open Access Journals (Sweden)

    Lee Kwong

    2007-10-01

    Full Text Available Abstract Background Increased bone marrow lipid deposition in steroid-associated osteonecrosis (ON implies that abnormalities in fat metabolism play an important role in ON development. The increase in lipid deposition might be explained by elevated adipogenesis of marrow mesenchymal stem cells (MSCs. However, it remains unclear whether there is a close association between elevated adipogenesis and steroid-associated ON development. Objective The present study was designed to test the hypothesis that there might be a close association between elevated adipogenesis and steroid-associated ON development. Methods ON rabbit model was induced based on our established protocol. Dynamic-MRI was employed for local intra-osseous perfusion evaluation in bilateral femora. Two weeks after induction, bone marrow was harvested for evaluating the ability of adipogenic differentiation of marrow MSCs at both cellular and mRNA level involving adipogenesis-related gene peroxisome proliferator-activated receptor gamma2 (PPARγ2. The bilateral femora were dissected for examining marrow lipid deposition by quantifying fat cell number, fat cell size, lipid deposition area and ON lesions. For investigating association among adipogenesis, lipid deposition and perfusion function with regard to ON occurrence, the rabbits were divided into ON+ (with at least one ON lesion group and ON- (without ON lesion group. For investigating association among adipogenesis, lipid deposition and perfusion function with regard to ON extension, the ON+ rabbits were further divided into sub-single-lesion group (SON group: with one ON lesion and sub-multiple-lesion group (MON group: with more than one ON lesion. Results Local intra-osseous perfusion index was found lower in either ON+ or MON group when compared to either ON- or SON group, whereas the marrow fat cells number and area were much larger in either ON+ or MON group as compared with ON- and SON group. The adipogenic differentiation

  5. Oral Cancer

    Science.gov (United States)

    Oral cancer can form in any part of the mouth. Most oral cancers begin in the flat cells that cover the ... your mouth, tongue, and lips. Anyone can get oral cancer, but the risk is higher if you are ...

  6. Osteonecrosis of the jaws. Clinicopathologic and radiologic characteristics, preventive and therapeutic Strategies

    International Nuclear Information System (INIS)

    Vassiliou, Vassilios; Tselis, Nikolaos; Kardamakis, Dimitrios

    2010-01-01

    Background: bisphosphonate (BP) use has increased dramatically in recent years, becoming an integral part of the overall antineoplastic management of patients with metastatic bone disease. Even though their application has shown to be effective in reducing pain and minimizing the risk of skeletal-related events, their administration may bring also adverse events such osteonecrosis of the jaws (ONJ). Methods: after a thorough review of the literature, important aspects of the pathophysiology, diagnosis, prevention, and treatment of ONJ are presented. Results: ONJ is evident in up to 10% of patients receiving intravenous BP treatment. Despite the fact that its exact pathophysiology is unknown, it is characterized by bone necrosis that can occur either spontaneously or after dental surgery or tooth extraction. Panoramic radiographs are useful for the diagnosis and routine assessment of patients and computed tomography can differentiate between ONJ and metastatic disease. Additionally, magnetic resonance imaging depicts local disease extension readily, and scintigraphy is the most sensitive imaging modality for detecting early involvement. Preventive measures and routine dental evaluations are essential components of the overall patient management. In the event of ONJ, stage I or II should be managed conservatively, whereas more advanced stages (III and IV) should be treated surgically. Conclusion: ONJ is a well-defined clinical entity that all medical and dental doctors should be aware of, since if it is not dealt with readily and effectively, it may deteriorate the clinical status and quality of life of affected patients. (orig.)

  7. The role of Iloprost on bone edema and osteonecrosis: Safety and clinical results.

    Science.gov (United States)

    Pountos, Ippokratis; Giannoudis, Peter V

    2018-03-01

    Iloprost is a commercially available prostaglandin I 2 (PGI 2 ) analogue that is shown to have antithrombotic, vasodilatative and antiproliferative effects. A number of clinical studies have shown that Iloprost can be effective in the management of bone marrow oedema and the treatment of avascular necrosis. The aim of this manuscript is to present our current understanding on the effect of Iloprost on the treatment of these conditions. Areas covered: The authors offer a comprehensive review of the existing literature on the experimental and clinical studies analysing the effect of Iloprost on bone, bone marrow oedema and avascular necrosis. Expert opinion: The available data from the clinical studies suggest that Iloprost has limited effect in advanced stages of avascular necrosis. However, literature suggests that Iloprost administration can be a viable option in the management of bone marrow oedema and early stages of osteonecrosis. Despite these promising results its effect on bone homeostasis needs further elucidation. Moreover, further data on its safety, dosage and efficiency through randomized multicenter studies are desirable in order to reach final conclusions.

  8. Evaluation of instability after transtrochanteric anterior rotational osteotomy for nontraumatic osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Hiranuma, Yasunari; Atsumi, Takashi; Kajiwara, Toshihisa; Tamaoki, Satoshi; Asakura, Yasuhiro

    2009-01-01

    Transtrochanteric anterior rotational osteotomy results in improvement of joint congruity and prevention of progressive collapse and osteoarthritic changes in patients with femoral head osteonecrosis. However, this procedure remains controversial for patients with extensive collapse due to potential osteoarthritis caused by postoperative instability. The purpose of this study was to evaluate hip instability after osteotomy and determine the relation between instability and radiological and clinical outcomes. In all, 27 hips of 24 patients that were followed up for a mean period of 3.8 years were included. Instability was defined as more than 1 mm translation of the femoral head in transverse computed tomography scans obtained at 0 deg and 45 deg flexion of the hip joint. Hips were divided into instability and stability groups. Eleven hips (40%) developed instability after surgery. Osteophytes on the femoral head in 10 hips of the instability group and 2 hips of the stability group had increased in size at follow-up. There was a significant relation between postoperative instability and osteophyte formation. Joint space narrowing was not seen in any of the cases. There was no significant difference between the groups in either the postoperative intact ratio of the femoral head or the Japanese Orthopaedic Association hip score. Neither instability nor osteophyte formation on the femoral head after transtrochanteric anterior rotational osteotomy correlated with progressive osteoarthritic changes or clinical outcome in the presence of an adequate femoral head intact ratio facing the weight-bearing area. (author)

  9. Metastatic Breast Cancer in Medication-Related Osteonecrosis Around Mandibular Implants.

    Science.gov (United States)

    Favia, Gianfranco; Tempesta, Angela; Limongelli, Luisa; Crincoli, Vito; Piattelli, Adriano; Maiorano, Eugenio

    2015-09-15

    Many authors have considered dental implants to be unrelated to increased risk of medication-related osteonecrosis of the jaw (MRONJ). Nevertheless, more recently, more cases of peri-implant MRONJ (PI-MRONJ) have been described, thus becoming a challenging health problem. Also, metastatic cancer deposits are not infrequently found at peri-implant sites and this may represent an additional complication for such treatments. We present the case of a breast cancer patient with PI-MRONJ, presenting a clinically and radiologically undetected metastasis within the necrotic bone, and highlight the necessity of an accurate histopathological analysis. A 66-year-old female patient, who had received intravenous bisphosphonates for bone breast cancer metastases, came to our attention for a non-implant surgery-triggered PI-MRONJ. After surgical resection of the necrotic bone, conventional and immunohistochemical examinations were performed, which showed breast cancer deposits within the necrotic bone. Cancer patients with metastatic disease, who are undergoing bisphosphonate treatment, may develop unusual complications, including MRONJ, which is a site at risk for hosting additional metastatic deposits that may be clinically and radiologically overlooked. Such risk is increased by previous or concomitant implant procedures. Consequently, clinicians should be prudent when performing implant surgery in cancer patients with advanced-stage disease and consider the possible occurrence of peri-implant metastases while planning adequate treatments in such patients.

  10. Role of Periapical Diseases in Medication-Related Osteonecrosis of the Jaws

    Directory of Open Access Journals (Sweden)

    Nian Jing Rao

    2017-01-01

    Full Text Available Objective. The present study aimed to investigate the role of periapical diseases in inducing medication-related osteonecrosis of the jaws (MRONJ using an ovariectomized (OVX mice model. Materials and Methods. Twenty C57BL/6N female mice were randomly assigned to two groups. All mice were subjected to bilateral ovariectomy and then treated with oncologic dose of zoledronic acid (ZA or vehicle for twelve weeks. Eight weeks after commence of drug administration, a pulpal exposure (PE operation was performed on the first right lower molar to induce periapical periodontitis; the contralateral non-PE tooth was used as control. All animals were sacrificed four weeks after pulpal exposure, and the mandibles were harvested for radiological and histomorphometrical analysis. Results. Micro computed tomography (μ-CT examination demonstrated that periapical diseases significantly increased alveolar bone resorption, and the resorption was greatly attenuated by ZA treatment. Concurrent ZA therapy significantly increased bone density and histological osteocyte necrosis in the presence of periapical lesions. Conclusion. ZA treatment reduced bone absorption resulting from periapical disease but increased the risk of developing MRONJ in the ovariectomized mouse model.

  11. The treatment effect of porous titanium alloy rod on the early stage talar osteonecrosis of sheep.

    Directory of Open Access Journals (Sweden)

    Xiao-Kang Li

    Full Text Available Osteonecrosis of the talus (ONT may severely affect the function of the ankle joint. Most orthopedists believe that ONT should be treated at an early stage, but a concise and effective surgical treatment is lacking. In this study, porous titanium alloy rods were prepared and implanted into the tali of sheep with early-stage ONT (IM group. The curative effect of the rods was compared to treatment by core decompression (DC group. No significant differences in bone reconstruction were observed between the two groups at 1 month after intervention. After 3 months, the macroscopic view of gross specimens of the IM group showed ordinary contours, but the specimens of the DC group showed obvious partial bone defects and cartilage degeneration. Quantitative analysis of the reconstructed trabeculae by micro-CT and histological study suggested that the curative effect of the IM group was superior to that of the DC group at 3 months after intervention. These favorable short-term results of the implantation of porous titanium alloy rods into the tali of sheep with early-stage ONT may provide insight into an innovative surgical treatment for ONT.

  12. Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment

    DEFF Research Database (Denmark)

    Eiken, P. A.; Prieto-Alhambra, D.; Eastell, R.

    2017-01-01

    register-based cohort study containing one nested case-control study. Patients were treatment-naïve incident users of alendronate 1996–2007 in Denmark, both genders, aged 50–94 at the time of beginning treatment (N = 61,990). Participants were followed to 31 December 2013. Results: Over a mean of 6.8 years...... pump inhibitors were independently associated with surgically treated ONJ. Conclusions: Our data suggest that recent, long-term, and compliant uses of alendronate are associated with an increased risk of surgically treated ONJ. Nevertheless, the rates remain low, even in long-term adherent users. ONJ...

  13. Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach

    Directory of Open Access Journals (Sweden)

    Mariana Comparotto Minamisako

    2016-01-01

    Full Text Available Medication-related osteonecrosis of the jaws (MRONJ can be considered an inability of the alveolar bone to respond to an injury, which frequently leads to severe local and systemic complications. Once the problem is installed, dentist must use all therapeutic approaches recommended. This manuscript reports a successful management of MRONJ handled with antibiotics, conservative debridement, low-level laser therapy (LLLT, and photodynamic therapy (PDT up to 12 months. As healing of MRONJ may be very slow, combined therapeutic approaches are required. Besides the recommended conventional treatment protocol, LLLT and PDT are important tools to contribute to healing and improvement of patient’s quality of life.

  14. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery; Osteonecrose aseptique du condyle femoral apres meniscectomie par voie arthroscopique

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kaar, M.; Garcia, J. [Hopital Cantonal Geneve, Geneva (Switzerland); Fritschy, D.; Bonvin, J.C. [Policlinique de Chirurgie, Hopital Cantonal Universitaire, Geneve (Switzerland)

    1997-04-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors). 21 refs.

  15. Unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee: A meta-analysis.

    Science.gov (United States)

    Jauregui, Julio J; Blum, Christopher L; Sardesai, Neil; Bennett, Craig; Henn, R Frank; Adib, Farshad

    2018-01-01

    Spontaneous osteonecrosis of the knee (SONK) is a poorly understood but debilitating disease entity. Total knee arthroplasty (TKA) is the standard of care for those patients who fail conservative management, but considering SONK's predilection for affecting a single knee compartment, unicompartmental knee arthroplasty (UKA) appears to be a more tailored option. Unfortunately, conflicting data exist on the utility of UKA in SONK. Thus, the purpose of this study was to evaluate functional outcomes and revision rates of UKA in the setting of SONK. A systematic literature search was performed to evaluate all studies examining patients who underwent UKA for SONK. Screening of the articles was performed using multiple Boolean search strings, methodological index for non-randomized studies criteria, and other selected exclusion criteria. Seven studies were included, with a total of 276 knees (273 patients). The mean age was 68 years (64-74 years), with a mean body mass index of 26 kg/m 2 (25-29 kg/m 2 ). The final range of motion was 125° (124-126°). Standardized mean difference (SMD) of clinical improvement pre- and post-outcome was 3.39 ( p < 0.001). The improvement in the visual analog score was 57.03 points, with an SMD of 4.57 ( p < 0.001). Revision rates were determined to be 5.51% (95% confidence interval of 1.96-10.69%). Our meta-analysis demonstrated that in properly selected patients, UKA could be an excellent alternative to TKA for patients with SONK. These data show that UKA has few complications, significant improvements on functional outcomes, and good survivorship at a mean follow-up of 6 years.

  16. Increased Dickkopf-1 expression accelerates bone cell apoptosis in femoral head osteonecrosis.

    Science.gov (United States)

    Ko, Jih-Yang; Wang, Feng-Sheng; Wang, Ching-Jen; Wong, To; Chou, Wen-Yi; Tseng, Shin-Ling

    2010-03-01

    Intensive bone cell apoptosis contributes to osteonecrosis of femoral head (ONFH). Dickkopf-1 (DKK1) reportedly mediates various types of skeletal disorders. This study investigated whether DKK1 was linked to the occurrence of ONFH. Thirty-nine patients with various stages of ONFH were recruited. Bone specimens were harvested from 34 ONFH patients underwent hip arthroplasty, and from 10 femoral neck fracture patients. Bad, Bcl2 TNFalpha, DKK1, Wnt3a, LRP5, and Axin1 expressions were analyzed by quantitative RT-PCR and ELISA. Apoptotic cells were assayed using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labelling (TUNEL). Primary bone-marrow mesenchymal cells were treated with DKK1 RNA interference and recombinant DKK1 protein. ONFH patients with the histories of being administrated corticosteroids and excessive alcohol consumption had significantly higher Bad and DKK1 mRNA expressions in bone tissue and DKK1 abundances in serum than femoral neck fracture patients. Bone cells adjacent to osteonecrotic bone displayed strong DKK1 immunoreactivity and TUNEL staining. Increased DKK1 expression in bone tissue and serum correlated with Bad expression and TUNEL staining. Serum DKK1 abundance correlated with the severity of ONFH. The DKK1 RNA interference and recombinant DKK1 protein regulated Bad expression and apoptosis of primary bone-marrow mesenchymal cells. Knock down of DKK1 reduced dexamethasone-induced apoptosis of mesenchymal cells. Taken together, promoted DKK1 expression was associated with bone cell apoptosis in the occurrence of ONFH patients with the histories of corticosteroid and alcohol intake and progression of ONFH. DKK1 expression in injured tissue provides new insight into ONFH pathogenesis.

  17. Oral myiasis

    Directory of Open Access Journals (Sweden)

    Thalaimalai Saravanan

    2015-01-01

    Full Text Available Myiasis is a pathologic condition in humans occurring because of parasitic infestation. Parasites causing myiasis belong to the order Diptera. Oral myiasis is seen secondary to oral wounds, suppurative lesions, and extraction wounds, especially in individuals with neurological deficit. In such cases, neglected oral hygiene and halitosis attracts the flies to lay eggs in oral wounds resulting in oral myiasis. We present a case of oral myiasis in 40-year-old male patient with mental disability and history of epilepsy.

  18. Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status

    Science.gov (United States)

    Louie, Brian E.; McKee, Michael D.; Richards, Robin R.; Mahoney, James L.; Waddell, James P.; Beaton, Dorcas E.; Schemitsch, Emil H.; Yoo, Daniel J.

    1999-01-01

    Objective To evaluate the limb-specific outcome and general health status of patients with osteonecrosis of the femoral head treated with vascularized fibular grafting. Design A retrospective review. Setting A single tertiary care centre. Patients Fifty-five consecutive patients with osteonecrosis of the femoral head who underwent fibular grafting (8 bilaterally). Intervention Vascularized fibular grafting. Outcome measures Limb-specific scores (Harris Hip Score, St. Michael’s Hospital Hip Score), general health status (Nottingham Health Profile, SF-36 health status survey) and radiographic outcome measures (Steinberg stage). Results Patients were young (mean age 34 years, range from 18 to 52 years) and 80% had advanced osteonecrosis (Steinberg stages IV and V). Fifty-nine hips were followed up for an average of 50 months (range from 24 to 117 months) after vascularized fibular grafting. Sixteen hips (27%) were converted to total hip arthroplasty (THA). To date, 73% of hips treated with vascularized fibular grafting have required no further surgery. Preoperative and postoperative Harris Hip Scores were 57.3 and 83.6 respectively (p < 0.001). As measured by patient-oriented health status questionnaires (SF-36, Nottingham Health Profile) and compared with population controls, patients had normal mental health scores and only slight decreases in physical component scores. Conclusions Free vascularized fibular grafting for osteonecrosis of the femoral head provides satisfactory pain relief, functional improvement and general health status and halts the progression of symptomatic disease. PMID:10459327

  19. The importance of early diagnosis in spontaneous osteonecrosis of the knee - A case series with six year follow-up.

    Science.gov (United States)

    Jordan, Robert W; Aparajit, Prasad; Docker, Charles; Udeshi, Umesh; El-Shazly, Mohi

    2016-08-01

    Spontaneous osteonecrosis of the knee has an unknown aetiology. Management options include conservative, surgical and pharmacological interventions. The aim of this study was to report the experience of the authors in conservative management of SONK using non-operative measures by analysing the functional outcome and need for surgical intervention. All patients treated for SONK between 1st August 2001 and 1st April 2014 were retrospectively reviewed. Treatment consisted of touch-down weight bearing for around six weeks. MR imaging was evaluated for size of lesion, the condyles involved and the time taken for resolution. Tegner Activity Scale, VAS pain, Lysholm, WOMAC and IKDC scores were recorded at presentation and final follow-up (mean six years, range six months to 13years). Forty cases were included; the mean age of the group was 55.3years and 67.5% were male. The medial femoral condyle was the most commonly affected (52.5%). A statistically significant improvement was reported in all functional outcome measures (p<0.001). Only one patient required arthroscopic surgical intervention and no patients required arthroplasty during the follow-up period. Early stage spontaneous osteonecrosis of the knee can be managed successfully without surgery if diagnosed early. Thus early investigation of acute knee pain with MRI scanning is recommended. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Bisphosphonate-modified gold nanoparticles: a useful vehicle to study the treatment of osteonecrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Fanord, Fedena; Fairbairn, Korie; Bhethanabotla, Venkat; Gupta, Vinay K [Department of Chemical and Biomedical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENB 118, Tampa, FL 33620 (United States); Kim, Harry [Shriners Hospitals for Children, 12502 USF Pine Drive, Tampa, FL 33612 (United States); Garces, Amanda, E-mail: vkgupta@usf.edu [Lisa Muma Weitz Microscopy and Cell Imaging, Department of Pathology and Cell Biology, University of South Florida, 12901 Bruce B Downs Boulevard, Tampa, FL 33612 (United States)

    2011-01-21

    Legg-Calve-Perthes disease (LCPD) is a juvenile form of osteonecrosis of the femoral head that presents in children aged 2-14 years. To date, there is no effective medical therapy for treating LCPD largely due to an inability to modulate the repair process, including the predominance of bone resorption. This investigation aims to evaluate the feasibility of using gold nanoparticles (GNPs) that are surface modified with a bisphosphonate compound for the treatment of osteonecrosis at the cellular level. Studies have found osteoclast-mediated resorption to be a process that contributes significantly to the pathogenesis of femoral head deformities arising from Perthes disease. Our in vitro model was designed to elucidate the effect of alendronate-(a bisphosphonate) modified GNPs, on osteoclastogenesis and osteoclast function. RAW 264.7 macrophage cells were cultured with recombinant mouse receptor activator of NF-{kappa}B ligand (RANKL), which stimulates osteoclastogenesis, and were then treated with alendronate-modified GNPs for 24, 48, and 72 h. Cell proliferation, osteoclast function, and osteoclast morphology were evaluated by trypan blue dye exclusion assay, tartrate-resistant acid phosphatase (TRAP) staining, and transmission electron microscopy (TEM) imaging. Comparative studies were performed with GNPs that were only stabilized with citrate ions and with alendronate alone. Neither osteoclastogenesis nor osteoclast function were adversely affected by the presence of the citrate-GNP. Alendronate-modified GNPs had an enhanced effect on inducing osteoclast apoptosis and impairing osteoclast function when compared to unbound alendronate populations.

  1. Bisphosphonate-modified gold nanoparticles: a useful vehicle to study the treatment of osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Fanord, Fedena; Fairbairn, Korie; Bhethanabotla, Venkat; Gupta, Vinay K; Kim, Harry; Garces, Amanda

    2011-01-01

    Legg-Calve-Perthes disease (LCPD) is a juvenile form of osteonecrosis of the femoral head that presents in children aged 2-14 years. To date, there is no effective medical therapy for treating LCPD largely due to an inability to modulate the repair process, including the predominance of bone resorption. This investigation aims to evaluate the feasibility of using gold nanoparticles (GNPs) that are surface modified with a bisphosphonate compound for the treatment of osteonecrosis at the cellular level. Studies have found osteoclast-mediated resorption to be a process that contributes significantly to the pathogenesis of femoral head deformities arising from Perthes disease. Our in vitro model was designed to elucidate the effect of alendronate-(a bisphosphonate) modified GNPs, on osteoclastogenesis and osteoclast function. RAW 264.7 macrophage cells were cultured with recombinant mouse receptor activator of NF-κB ligand (RANKL), which stimulates osteoclastogenesis, and were then treated with alendronate-modified GNPs for 24, 48, and 72 h. Cell proliferation, osteoclast function, and osteoclast morphology were evaluated by trypan blue dye exclusion assay, tartrate-resistant acid phosphatase (TRAP) staining, and transmission electron microscopy (TEM) imaging. Comparative studies were performed with GNPs that were only stabilized with citrate ions and with alendronate alone. Neither osteoclastogenesis nor osteoclast function were adversely affected by the presence of the citrate-GNP. Alendronate-modified GNPs had an enhanced effect on inducing osteoclast apoptosis and impairing osteoclast function when compared to unbound alendronate populations.

  2. Is instillation of bone marrow stem cells at the time of core decompression useful for osteonecrosis of the femoral head?

    Directory of Open Access Journals (Sweden)

    Jorge Cabrolier

    2016-03-01

    Full Text Available La osteonecrosis de cabeza femoral lleva a degeneración de la cabeza y finalmente al desarrollo de artrosis de cadera. La descompresión constituye el tratamiento más utilizado, sin embargo su eficacia es limitada. Se ha planteado que la instilación de células madre en conjunto con la descompresión tendría mejores resultados. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto incluyen dos estudios controlados aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que instilar células madre de médula ósea al momento de la descompresión ósea en la osteonecrosis de cabeza femoral probablemente disminuye la progresión a artrosis de cadera y podría disminuir la necesidad de cirugías posteriores. No está claro si tiene algún efecto sobre la funcionalidad porque la certeza de la evidencia es muy baja.

  3. Osteonecrosis de los maxilares asociada a denosumab en una paciente con osteoporosis: un caso clínico

    Directory of Open Access Journals (Sweden)

    Blas Garcia Garcia

    2015-07-01

    Full Text Available Desde la comercialización de fármacos que actúan sobre el remodelado óseo se han registrado numerosos casos de osteonecrosis de los maxilares (ONM, pero hasta hace poco solo se habían descrito casos de ONM asociados a la administración de bifosfonatos. Con la introducción de nuevos agentes antirresortivos han aparecido varios casos de ONM asociados a denosumab. Presentamos el caso de una paciente de 84 años con osteoporosis, que presentó osteonecrosis mandibular tras la colocación de 6 implantes 5 meses después de la administración de denosumab. Una ortopantomografía y una TC mostraron pérdida ósea de la cresta mandibular y exposición ósea periimplantar. Tras el tratamiento conservador con antibióticos y la suspensión de denosumab, se inició el tratamiento con teriparatida reduciéndose la infección del hueso necrótico y se observó nueva remodelación ósea. La patogénesis de la ONM por denosumab no está claramente definida, pero parece que la tasa del éxito de curación es superior a la ONM por bifosfonatos.

  4. Design and methods for a Scandinavian pharmacovigilance study of osteonecrosis of the jaw and serious infections among cancer patients treated with antiresorptive agents for the prevention of skeletal-related events

    Directory of Open Access Journals (Sweden)

    Acquavella J

    2016-07-01

    Full Text Available John Acquavella,1 Vera Ehrenstein,1 Morten Schiødt,2 Uffe Heide-Jørgensen,1 Anders Kjellman,3,4 Svein Hansen,5 Cecilia Larsson Wexell,6,7 Bente Brokstad Herlofson,8 Sven Erik Noerholt,9 Haijun Ma,10 Katarina Öhrling,11 Rohini K Hernandez,12 Henrik Toft Sørensen1 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen, Denmark; 3Department of Urology, Karolinska University Hospital, 4Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; 5Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway; 6Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, Borås, Sweden; 7Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 8Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway; 9Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark; 10Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA; 11Clinical Development, Amgen Inc., Thousand Oaks, CA, USA; 12Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA Objective: Osteonecrosis of the jaw (ONJ is a recognized complication of potent antiresorptive therapies, especially at the doses indicated to prevent skeletal complications for cancer patients with bone metastases. This paper describes the rationale and methods for a prospective, post-authorization safety study of cancer patients treated with antiresorptive therapies. Methods: As part of a comprehensive pharmacovigilance plan, developed with regulators’ input, the study will estimate incidence of ONJ and of serious infections among adult cancer patients with bone metastases treated with denosumab (120 mg subcutaneously or zoledronic acid (4 mg intravenously, adjusted for renal function

  5. Oral cancer

    Science.gov (United States)

    Cancer - mouth; Mouth cancer; Head and neck cancer; Squamous cell cancer - mouth; Malignant neoplasm - oral ... National Cancer Institute. PDQ lip and oral cavity cancer ... September 25, 2015. www.cancer.gov/types/head-and-neck/hp/lip- ...

  6. Oral Ketamine

    African Journals Online (AJOL)

    Oral Ketamine: A Four-years Experience in ... Key words: Oral Ketamine, Premedication and Oncology. .... form of a letter published in 19835. .... Acta. Anaesthesiol Scandinavica, 1998; 42: 750-758. 4. Murray P. Substitution of another opioid ...

  7. High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head.

    Science.gov (United States)

    Xie, Kai; Mao, Yuanqing; Qu, Xinhua; Dai, Kerong; Jia, Qingwei; Zhu, Zhenan; Yan, Mengning

    2018-02-02

    Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH. Fifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I-III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI). The mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years. The results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration

  8. Incidence of Severe Osteonecrosis Requiring Total Joint Arthroplasty in Children and Young Adults Treated for Leukemia or Lymphoma

    DEFF Research Database (Denmark)

    Niinimäki, Riitta; Hansen, Lene Mølgaard; Niinimäki, Tuukka

    2013-01-01

    diagnosis codes given before the age of 40 were also retrieved. Results: The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia. It was considerably lower in patients with acute...... the age of 10 (HR=24; 95% CI: 3.1-176 and HR=26; 95% CI: 3.6-192 respectively). Conclusion: The incidence of ON requiring TJA was highest among patients with myeloid leukemias and lowest in patients treated for ALL. Allo-SCT and age ≥10 years at diagnosis were the most important risk factors......Purpose: The population-based incidence of severe osteonecrosis (ON) necessitating total joint arthroplasty (TJA) in patients with hematological cancer is unknown. This study assessed the incidence of ON requiring primary TJA in children and young adults treated for leukemia or lymphoma. Methods...

  9. MR appearance of the temporal evolution and resolution of spontaneous osteonecrosis of the knee: a case report.

    Science.gov (United States)

    Geijer, Mats; Jureus, Jan; Hanni, Mari; Shalabi, Adel

    2017-02-01

    Spontaneous osteonecrosis of the knee (SONK) is a feared condition of unknown cause, in its classic form appearing in the medial femoral condyle in middle-aged or elderly subjects. Diagnosis with radiography is notoriously difficult with a long latency before typical changes appear. Magnetic resonance imaging (MRI) is regarded as a diagnostic tool with the possibility to give an earlier diagnosis with improved chances for treatment. However, also with MRI there may be an initial diagnostic blind spot before typical changes appear. Little is known about the temporal evolution of the MRI changes. In the current case report, a case of SONK is reported where serial imaging with MRI was performed, from initial symptoms to eventual resolution after almost three years.

  10. Mandibular Osteonecrosis due to the Pulpal-Periodontal Syndrome: a Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sven Seiwerth

    2017-01-01

    Full Text Available Objective: Ishemic bone disease has multifactorial etiologies. Cronic dental infections should be eliminated to prevent osteonecrosis of the jaw. Case report: We report an unusual case of osteonecrosis due to the pulpal-peridontal syndrome and subsequent pulp necrosis. A case of 38 year old woman who presented with exposed bone, 8 mm in diameter, in the lingual area of the right lower third molar. The patient was otherwise healthy and was not taking any medications. A detailed medical history showed no previous diseases. Patient denied any type of local trauma. A complete blood count showed no abnormalities. The panoramic radiograph revealed a deep periodontal pocket between teeth 47 and 48. The CBCT revealed a deep periodontal pocket between molars and bone sequestrum of the lingual plate. Topical treatment consisted of adhesive periodontal dressing based on the cellulose and betamethasone oitnment together with orabase, without improvement. Therefore, peroral amoxycillin was prescribed for a week. Since there was no improvement, the third molar was removed as well as necrotic bone; the alveolar bone was remodelled and utures were placed. After suturing, the whole area was covered using intraoral resorbable bandage. Microbial swab of the wound aspirate did not reveal polymorphonuclears or the presence of icroorganisms. Microbial swab of the biopsy specimen of the necrotic bone particle and sequestrum showed a large amount of gram-positive coccae, however, polymorphonuclears were not found. Histopathological analysis revealed acute chronic inflammation. One week after the surgery, the area healed completely. Conclusion: This case highlights the fact that in some patients bone exposure might develop due to the pulpal-peridontal syndrome i.e. pulp necrosis.

  11. Corticosteroid administration in oral and orthognathic surgery: a systematic review of the literature and meta-analysis

    DEFF Research Database (Denmark)

    Dan, Anne E B; Thygesen, Torben H; Pinholt, Else M

    2010-01-01

    was made. The primary predictor variable was CS administration and the outcome variables were edema, pain, and infection. A meta-analysis was performed. The risk of other side effects was evaluated through a simple review. RESULTS: In oral surgery, most clinical trials showed a significant decrease...... toward a neuroregeneration effect, but no statistical analysis could be performed. Regarding the risk of other side effects, in oral surgery, a minimal risk of chronic adrenal suppression was seen; in orthognathic surgery, an elevated risk of avascular osteonecrosis, steroid-induced psychosis......, and adrenal suppression was seen. There were no reports of decreased healing. CONCLUSION: These findings suggest that the administration of CS in oral surgery decreases edema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects....

  12. Risk factors for avascular osteonecrosis in children with malignant tumors after thermochemotherapy

    International Nuclear Information System (INIS)

    Balzer, S.; Wessalowski, R.; Mils, O.; Schneider, D.; Bernbeck, B.; Goebel, U.; Jaeger, M.; Krauspe, R.

    2005-01-01

    Full text: In children with locally advanced malignant tumors or recurrences after first-line treatment, loco-regional deep hyperthermia (RHT) at temperatures between 42-44 o C and platinum-based chemotherapy ± radiotherapy were administered in order to facilitate complete surgical resection. Growing understanding and clinical experience with RHT techniques disclosed an increasing number of children achieving a long-term remission. Therefore, we have also to focus on risk factors for late sequelae. Based on the current data available, in our patient population the most important and severe complication after RHT is avascular osteonecrosis of the femoral head. Although this complication can also be found after chemo- and/or radiotherapy alone, RHT may also be a risk factor for this complication. Aseptic ON in children and adolescents in caused by an interruption of the capital femoris epiphysis blood supply. Most children present with mild or intermittent pain in the anterior thight and a limb. The pertinent early physical findings include antalgic gait; muscle spasm with mild restriction of motion, especially abduction and internal rotation. In order to determine whether RHT contributes to development of ON in our patient population, we compared different treatment parameters in children and adults. In this analysis 72 patients aged between 1 - 72 years (median 16,1 years) with pelvic malignancies were included. Twenty-four patients were male and 48 female. RHT was performed with 3 annular phased array applicators constructed in the same way (Sigma-30, -40 and -60, BSD 2000, Medical Corporation, Salt Lake City, Utah, USA). The number of heat sessions per patient was 2-30. Frequencies ranged between 87-140 MHz. Maximum power supply ranged between 130-1300 Watts (W). Five different age groups were assigned: 1-5 years (22 pts), 6-10 years (6 pts), 11-15 years (7 pts), 16-20 years (9 pts), > 20 years (27 pts). The number of heat sessions was subdivided in the

  13. Oral Hygiene

    DEFF Research Database (Denmark)

    Sørensen, Marie Toftdahl; Villadsen, Dorte Buxbom

    The aim of the study was to explore how adults with schizo- phrenia describe their lived experiences with oral hygiene. 23 adults with schizophrenia were interviewed within a period of four months in late 2015. Transcriptions of the interviews were analysed using the Reflective Lifeworld Research...... health care professionals and adults with schizophrenia in order to improve oral health, well-being and recovery....

  14. Oral Hygiene

    DEFF Research Database (Denmark)

    Villadsen, Dorte Buxbom; Sørensen, Marie Toftdahl

    2017-01-01

    The aim of the study is to explore how adults with schizophrenia describe their lived experiences with oral hygiene. 23 adults with schizophrenia were interviewed within a period of four months in late 2015. Transcriptions of the interviews were analysed using the Reflective Lifeworld Research ph...... health care professionals and adults with schizophrenia in order to improve oral health, well-being and recovery....

  15. Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity

    OpenAIRE

    Mallet, C.; Abitan, A.; Vidal, C.; Holvoet, L.; Mazda, K.; Simon, A.-L.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. Methods All ...

  16. Interest of bone scintigraphy in the care of maxillary osteo-necroses induced by bis-phosphonates

    International Nuclear Information System (INIS)

    Agossa, Kevimy

    2012-01-01

    First cases of bis-phosphonates related osteonecrosis of jaws (BRONJ) have been described in 2003. Since then, this subject is one of the central concerns of several scientific communities, well beyond the oral sphere. The prevalence of BRONJ is evolving. Their etiology is not well established and the results of the treatments are inconstant. So many points that make the care to patients under bis-phosphonates really complex. Early diagnosis is essential in treatment outcome. So nuclear imaging including scintigraphy with technetium 99m seems to be helpful. It may allow detection before the onset of symptoms, facilitate localization of necrosis and it may be useful for the monitoring of such lesions after surgery. These are new applications for oncologist and dentist, in order to improve the management of patients treated by bis-phosphonates. (author) [fr

  17. Oral leukoplakia

    DEFF Research Database (Denmark)

    Holmstrup, Palle; Dabelsteen, Erik

    2016-01-01

    The idea of identifying oral lesions with a precancerous nature, i.e. in the sense of pertaining to a pathologic process with an increased risk for future malignant development, of course is to prevent frank malignancy to occur in the affected area. The most common oral lesion with a precancerous...... nature is oral leukoplakia, and for decades it has been discussed how to treat these lesions. Various treatment modalities, such as systemic therapies and surgical removal, have been suggested. The systemic therapies tested so far include retinoids, extracts of green tea, inhibitors of cyclooxygenase-2...

  18. Oral cancer.

    Science.gov (United States)

    Gerson, S J

    1990-01-01

    In the U.S. oral cancer accounts for 2.1% of all cancers and 1% of cancer deaths. Two to three times as many males as females are affected. Blacks have more intra-oral cancer than whites, and their incidence and mortality rates have increased in recent years. The etiologic process very likely involves several factors. The major etiologic agents are tobacco (all types) and alcoholic beverages. Herpes simplex virus, human papilloma virus, and Candida have been implicated. Host factors include poor state of dentition, nutritional aberrations, cirrhosis of liver, lichen planus, and immunologic impairmant. Cellular changes include amplification of some oncogenes, alterations in antigen expression, production of gamma-glutamyl transpeptidase, and disturbance of keratin and involucrin production. Experimentally, cancer is readily produced on the hamster cheek pouch and rat oral mucosa. Unlike oral cancer in humans, most experimental lesions are exophytic, and they rarely metastasize.

  19. Oral sex.

    Science.gov (United States)

    1996-04-05

    The Gay and Lesbian Medical Association urges HIV prevention specialists to regard male-to-male oral-genital sex as a low-risk activity and concentrate instead on the danger of unprotected anal intercourse. According to the association, the confusion and mixed messages surrounding oral sex are harming efforts to encourage gay men to make rational choices about truly risky behavior. The recommendations appear in the association's position paper issued March 19, 1996.

  20. Histology of peri-implant bone in a failed implant retrieved from an area of osteonecrosis of the jaw in a patient suffering from multiple myeloma and treated with intravenous bisphosphonates

    Directory of Open Access Journals (Sweden)

    Marco Degidi

    2012-03-01

    Full Text Available Background: Osteonecrosis of the jaw (ONJ has been reported in the past few years in patients undergoing treatment with bisphosphonates (BP. Few published histological studies of ONJ can be found in the literature and no study has been reported on the peri-implant bone around a dental implant retrieved from an area of ONJ. The aim of the present case was to report the histology of the peri-implant bone around an implant retrieved from an area of ONJ. Materials and methods: Multiple myeloma was diagnosed to a 72-year-old male. The patient underwent treatment with intravenous pamidronate for 2 years and with intravenous zoledronate for additional 3 years. Five years after the diagnosis, 7 immediately loaded dental implants were inserted in the mandible. A preoperative panoramic radiography did show no pre-existing bone lesions. No healing of the post-extraction sockets of the right third molar and of the left second molar was observed. Three years after the implant insertion a breakdown of the oral mucosa covering the implants was observed. The most distal implant was retrieved with a trephine bur, due to mobility. Discussion: The histological findings showed some areas with osseointegration in patients undergoing BP treatment for malignant disease. Conclusion: There is certainly a temporal association between BP use and development of ONJ, but a correlation does not necessarily mean causation. Moreover, generalisations about this complex relationship cannot be made on the basis of a single case report. In patients undergoing intravenous treatment, clinicians must be aware of the increased risk of implant failure and, probably, implant insertion should be avoided at all, until more conclusive data are available.

  1. Oral Cancer Screening

    Science.gov (United States)

    ... decrease the risk of oral cavity and oropharyngeal cancer. Oral cavity, pharyngeal, and laryngeal cancer are diseases in ... and treatment of oral cavity, pharyngeal, and laryngeal cancer: Oral Cavity and Oropharyngeal Cancer Prevention Lip and Oral ...

  2. Medication--related osteonecrosis of the jaws. The first reported cases in the Baltic States and a literature review.

    Science.gov (United States)

    Zaleckas, Linas; Stacevičius, Mindaugas; Proškutė, Dovilė; Povilaitytė, Jurgita

    2015-01-01

    Medication-related osteonecrosis of the jaws (MRONJ) is a severe side effect of antiresorptive or antiangiogenic therapy that manifests as an exposed bone, accompanied by clinical signs of infection, persisting for more than 8 weeks, without history of radiation therapy or metastases to the jaws. The aim of the study was to present first MRONJ cases in Lithuania and review trends in the modern research literature on the subject. We retrospectively reviewed patient charts with a diagnosis of "Inflammatory conditions of the jaws" treated in Vilnius University Hospital Žalgiris Clinic, Department of maxillofacial surgery in 2007-2014. Patients diagnosed with MRONJ were selected for the study. Demographic data, characteristics of the disease and treatment modalities were analysed. Nine cases (five male and four female) of MRONJ were analysed. The mean patient age was 69±7,9 years. Predominant primary malignancy was prostate cancer. Osteonecrotic lesions were located both in maxilla and mandible. In all cases we started with a conservative treatment first. After the antibiotic therapy with or without sequestrectomy, the condition of all patients stabilized and improved to stage I MRONJ. MRONJ is a disturbing condition resulting in a severely worsened quality of life in the affected patients. This is the first case series of successfully treated patients suffering from stage II or III MRONJ in the Baltic States. A more comprehensive understanding of MRONJ will hopefully allow clinicians to enhance accuracy in risk assessment and forecast positive and negative outcomes of antiresorptive or antiangiogenic therapy.

  3. Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: a review of the current literature.

    Science.gov (United States)

    Uzun, Gunalp; Mutluoglu, Mesut; Ersen, Omer; Yildiz, Senol

    2016-01-01

    To review the current literature on the use of hyperbaric oxygen (HBO₂) therapy in the treatment of osteonecrosis of the femoral head (ONFH). We searched PubMed, Directory of Open Access Journals (DOAJ), EMBASE, Web of Science, Academic Search Complete, CINAHL and MEDLINE through April 2015. We hand-searched relevant textbooks, conference proceedings and the reference lists of review articles and clinical studies Randomized controlled trials (RCT) and observational studies (cohort study, case-control study, case series) that reported the outcome of patients who received HBO₂therapy for ONFH were included. Only English-language articles were included. Study quality was not used as an exclusion criterion. Two authors independently assessed trials for inclusion, extracted data and presented to other authors. Disagreements were resolved by consensus. We identified eight clinical studies; two randomized controlled trials (RCTs); one historically controlled study; and five case series. The majority of the studies were small-scale, heterogeneous and methodologically weak. In four of the studies HBO₂therapy was combined with other treatment modalities, making it impossible to draw firm conclusions on the specific effects of HBO₂therapy. Hip survivorship in studies wherein HBO₂therapy was used alone was 95.5% in Steinberg Stage I lesions, 89% in Steinberg Stage II lesions and 100% in Ficat Stage II lesions. There is a room for HBO₂therapy in the management ONFH. Further RCTs, however, are required to better elucidate the role of HBO₂therapy in the treatment of ONFH.

  4. Radionuclide bone scintigraphy in early detection of avascular osteonecrosis occurred in recovered SARS patients after hormone therapy

    International Nuclear Information System (INIS)

    Wang Qian; Huang Lili; Qin Shuling; Wang Yu; Nie Yuxin; Liang Tiejun; Zhang Caiqun; Zhao Yamei

    2005-01-01

    Objective: To analyze the characteristics of bone scintigraphy in patients who recovered from the severe acute respiratory syndrome (SARS), and to evaluate the clinical value of bone scintigraphy in the early diagnosis of avascular osteonecrosis (AVN) after hormone therapy. Methods: Bone scintigraphy was performed in 66 SARS patients. Among them 54 underwent MRI in bilateral hips and knees. Both images were compared and followed up clinically. Results: Abnormal scintigraphy was found in 30 (45.5%) of the 66 recovered SARS patients. Total 82 foci were found in hip, knee, ankle, elbow, shoulder, wrist and the middle of the tibia. Hip and knee joints were the most involved sites. 25 patients with 71 lesions were symptomatic, whereas 11 in 5 patients were asymptomatic, lesions in 8 patients were multifocal. The lesions found in scintigraphy and MRI were concordant in 92.6% of the joints. But more lesions could be detected by bone scintigraphy. Conclusions: SARS patients have a high occurrence of AVN, usually involved in multiple sites. Bone scintigraphy should be the first choice method used for early detection of AVN. (authors)

  5. Oral candidiasis.

    Science.gov (United States)

    Millsop, Jillian W; Fazel, Nasim

    2016-01-01

    Oral candidiasis (OC) is a common fungal disease encountered in dermatology, most commonly caused by an overgrowth of Candida albicans in the mouth. Although thrush is a well-recognized presentation of OC, it behooves clinicians to be aware of the many other presentations of this disease and how to accurately diagnose and manage these cases. The clinical presentations of OC can be broadly classified as white or erythematous candidiasis, with various subtypes in each category. The treatments include appropriate oral hygiene, topical agents, and systemic medications. This review focuses on the various clinical presentations of OC and treatment options. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Oral myiasis

    Directory of Open Access Journals (Sweden)

    Treville Pereira

    2010-01-01

    Full Text Available Myiasis is a relatively rare condition arising from the invasion of body tissues or cavities of living animals or humans by maggots or larvae of certain species of flies. It is an uncommon clinical condition, being more frequent in underdeveloped countries and hot climate regions, and is associated with poor hygiene, suppurative oral lesions; alcoholism and senility. Its diagnosis is made basically by the presence of larvae. The present article reports a case of oral myiasis involving 20 larvae in a patient with neurological deficiency.

  7. Osteonecrose de mandíbula em pacientes com lúpus eritematoso sistêmico juvenil observada em exame de imagem Osteonecrosis of the jaw on imaging exams of patients with juvenile systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Elisabeth Gonzaga Canova Fernandes

    2010-02-01

    joint (TMJ in patients with juvenile systemic lupus erythematosus (JSLE and a control group. PATIENTS AND METHODS: Panoramic radiographies of the TMJ of 26 JSLE patients and 28 healthy individuals were evaluated. Multislice computed tomography (MCT was performed on those patients who presented flattening and/or destruction of mandibular condyles. Demographic data, oral health indices, clinical manifestations, laboratorial exams, and treatment were evaluated. RESULTS: Important radiographic changes consistent with osteonecrosis of the mandible, confirmed by MCT of the TMJ, were observed in 2/26 (8% JSLE patients versus 0% in the control group (P = 0.22. Mild clinical dysfunction and abnormal TMJ mobility were observed in 67% and 54% of the patients, respectively. Age of onset, disease duration, and current age were similar in JSLE patients with and without severe radiographic changes of TMJ (9.3 versus 10.8 years, P = 0.77; 3.3 versus 2 years, P = 0.63; 12.6 versus 13.5 years, P = 0.74, respectively. Significant differences in gender, socioeconomical status, oral health indices, clinical manifestations, laboratorial exams, and treatment were not observed between both subgroups (P 0.05. Both JSLE patients with osteonecrosis of the mandible had active chronic disease, used corticosteroids for a prolonged period, and had mild TMJ dysfunction. Antiphospholipid antibodies were not observed in those two patients, and neither one had been treated with bisphosphonate. CONCLUSIONS: Osteonecrosis of the mandible with mild TMJ dysfunction was observed in some of the patients, demonstrating the importance of odontological assessment during clinical follow-up.

  8. Oral calcitonin

    Directory of Open Access Journals (Sweden)

    Hamdy RC

    2012-09-01

    Full Text Available Ronald C Hamdy,1,2 Dane N Daley11Osteoporosis Center, College of Medicine, East Tennessee State University, 2Veterans Affairs Medical Center, Johnson City, TN, USAAbstract: Calcitonin is a hormone secreted by the C-cells of the thyroid gland in response to elevations of the plasma calcium level. It reduces bone resorption by inhibiting mature active osteoclasts and increases renal calcium excretion. It is used in the management of postmenopausal osteoporosis, Paget's disease of bone, and malignancy-associated hypercalcemia. Synthetic and recombinant calcitonin preparations are available; both have similar pharmacokinetic and pharmacodynamic profiles. As calcitonin is a peptide, the traditional method of administration has been parenteral or intranasal. This hinders its clinical use: adherence with therapy is notoriously low, and withdrawal from clinical trials has been problematic. An oral formulation would be more attractive, practical, and convenient to patients. In addition to its effect on active osteoclasts and renal tubules, calcitonin has an analgesic action, possibly mediated through β-endorphins and the central modulation of pain perception. It also exerts a protective action on cartilage and may be useful in the management of osteoarthritis and possibly rheumatoid arthritis. Oral formulations of calcitonin have been developed using different techniques. The most studied involves drug-delivery carriers such as Eligen® 8-(N-2hydroxy-5-chloro-benzoyl-amino-caprylic acid (5-CNAC (Emisphere Technologies, Cedar Knolls, NJ. Several factors affect the bioavailability and efficacy of orally administered calcitonin, including amount of water used to take the tablet, time of day the tablet is taken, and proximity to intake of a meal. Preliminary results looked promising. Unfortunately, in two Phase III studies, oral calcitonin (0.8 mg with 200 mg 5-CNAC, once a day for postmenopausal osteoporosis and twice a day for osteoarthritis failed to

  9. Oral care.

    Science.gov (United States)

    Hitz Lindenmüller, Irène; Lambrecht, J Thomas

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable. Copyright © 2011 S. Karger AG, Basel.

  10. Osteonecrose maxilar em pacientes portadores de doenças neoplásicas sob uso de bisfosfonatos Jaw osteonecrosis in patients with neoplastic diseases taking bisphosphonates

    Directory of Open Access Journals (Sweden)

    Paulo S. S. Santos

    2008-12-01

    Full Text Available A osteonecrose induzida por bisfosfonatos é uma complicação que pode ocorrer em pacientes acometidos por doença osteolítica tais como mieloma múltiplo, portadores de metástases tumorais em tecido ósseo, osteoporose e que fizeram uso de droga do grupo dos bisfosfonatos. A despeito dos benefícios do uso destes fármacos, a osteonecrose maxilar é uma importante complicação. Seu mecanismo de ação reduz a reabsorção óssea, o estímulo à atividade osteoblástica, a inibição do recrutamento e promoção da apoptose de osteoclastos. Até o presente momento, não há na literatura um protocolo de tratamento para a osteonecrose por bisfosfonatos. No presente trabalho, os autores fazem uma revisão da literatura e descrevem dois casos clínicos em pacientes do sexo feminino, com diferentes doenças, mieloma múltiplo e metástases ósseas por carcinoma de mama, acometidas por osteonecrose em mandíbula induzida por bisfosfonatos.The use of bisphosphonates among patients affected by osteolytic diseases, such as multiple myeloma, metastatic bone lesions and osteoporosis has been associated with the risk of osteonecrosis of the jaws. Bisphosphonates are found in areas of the bone that are undergoing inflammation or resorption. They are phagocytosed and internalized by osteoclasts. Once in the bone, these bisphosphonates cause apoptosis or cell death of the osteoclasts and as a result they may inhibit osteoclast-mediated bone resorption. Bisphosphonates seem to affect osteoclasts when it comes to both numbers and function. Although bisphosphonates are potent and valuable inhibitors of osteoclastic bone lesions, several unanswered questions exist regarding the risk of developing osteonecrosis and the management of this complication. This study reports two clinical cases of osteonecrosis of the jaws associated with the use of bisphosphonates. According to the findings, the two patients (women with different neoplasms: multiple myeloma and

  11. Oral Health and Aging

    Science.gov (United States)

    ... please turn JavaScript on. Feature: Oral Health and Aging Oral Health and Aging Past Issues / Summer 2016 Table of Contents Jerrold ... they may need. Read More "Oral Health and Aging" Articles Oral Health and Aging / 4 Myths About ...

  12. Laser for bone healing after oral surgery: systematic review.

    Science.gov (United States)

    Noba, Claudio; Mello-Moura, Anna Carolina Volpi; Gimenez, Thais; Tedesco, Tamara Kerber; Moura-Netto, Cacio

    2018-04-01

    The purpose of this study is to perform a systematic review on the use of lasers in oral surgery for bone healing. Selection of articles was carried out by two evaluators in Pubmed and Web of Science databases for published articles and OpenGray for gray literature. Search strategy was developed based on the PICO Question "Does the use of lasers after oral surgery improve bone healing?". Eligibility criteria were: being on laser; evaluate bone healing; involve oral surgery; do not be about implant, periodontics, orthodontics, osteonecrosis or radiotherapy, nor revisions, clinical cases, etc. Data were collected from each article in a structured spreadsheet and a descriptive analysis was performed. Risk assessment of bias of the articles was carried out through the tool elaborated by the Cochrane collaboration. A total of 827 potentially relevant references were identified. No articles were found in OpenGray. Eleven articles met the eligibility criteria and were included in the systematic review. Most of studies were in vivo and in jaw, being conducted with low-power lasers which were applied immediately after the surgical procedure of extraction. Neoformation and bone density were the outcomes of choice and there was a tendency of increase in bone density, neoformation, regeneration, mineralization, or bone condensation when laser was applied. Regarding the bias risk assessment, studies were not clear in reporting most of the parameters. Low-power laser therapy seems to reduce time of bone healing in oral surgery, although there are no defined protocols and the level of evidence is still considered weak.

  13. RANK ligand inhibition in bone metastatic cancer and risk of osteonecrosis of the jaw (ONJ): non bis in idem?

    Science.gov (United States)

    Van den Wyngaert, Tim; Wouters, Kristien; Huizing, Manon T; Vermorken, Jan B

    2011-12-01

    The purpose of this study was to assess the necessity of post-marketing safety monitoring focused on osteonecrosis of the jaw (ONJ) in patients with bone metastatic cancer treated with denosumab (AMG162). The ONJ safety data from three randomized phase III trials were pooled, and risk ratios and power were computed using traditional methods and simulation. A total of 89 ONJ cases (1.57%; 95% CI, 1.26-1.92) were reported with 52 (1.83%; 95% CI, 1.37-2.39) occurring in the denosumab group (n = 2,841) and 37 (1.30%; 95% CI, 0.92-1.79) in the zoledronic acid group (n = 2,836). Overall, the pooled risk ratio (RR) for ONJ was 1.40 (95% CI, 0.92-2.13; p = 0.11). In the trials reporting superior therapeutic efficacy of denosumab, the RR for ONJ was 1.61 (95% CI, 0.99-2.62; p = 0.052). However, neither separately nor pooled had any trial adequate power (>80%) to detect excess relative risks of ONJ of up to 76%, assuming fixed ONJ rates in the control arms. The joint power of the trials to detect the observed excess relative risk of 40% was only 36%. The rate of mucosal healing in patients with ONJ appeared similar in both groups (RR, 1.28; 95% CI, 0.66-2.45; p = 0.5). Although the overall frequency of ONJ was low, post-marketing risk-benefit studies with this novel compound appear warranted focusing specifically on this rare toxicity, which can potentially have a high impact on quality of life.

  14. Osteonecrosis of the Jaw and Rebound Hypercalcemia in Young People Treated With Denosumab for Giant Cell Tumor of Bone.

    Science.gov (United States)

    Uday, Suma; Gaston, Czar Louie; Rogers, Luke; Parry, Michael; Joffe, Johnathan; Pearson, John; Sutton, David; Grimer, Robert; Högler, Wolfgang

    2018-02-01

    Denosumab, an inhibitor of receptor activator of nuclear factor κ-B ligand, is an approved treatment of giant cell tumor of bone (GCTB) in adults and "skeletally mature" adolescents. Safety concerns include oversuppression of bone remodelling, with risk of osteonecrosis of the jaw (ONJ) and atypical femur fractures during treatment in adults and rebound hypercalcemia after treatment cessation in children. To date, ONJ has never been reported in children or adolescents. To describe serious adverse effects during and following high-dose denosumab therapy in GCTB patients. Two adolescents (14 and 15 years) and a young adult (40 years) received fixed-dose denosumab for GCTB for 1.3 to 4 years (cumulative dose, 47 to 98 mg/kg), which was stopped because of development of ONJ in one adolescent and bilateral femoral cortical stress reactions in the young adult. All three patients developed rebound hypercalcemia with acute kidney injury 5.5 to 7 months after denosumab cessation. The ONJ necessitated surgical debridement. Rebound hypercalcemia (serum calcium, 3.1 to 4.3 mmol/L) was unresponsive to hyperhydration alone, requiring repeated doses of calcitonin or intravenous bisphosphonate treatment. Hypercalcemia recurred in two patients within 4 weeks, with normal serum calcium profiles thereafter. All patients were naive to chemotherapy, radiotherapy, bisphosphonates, and corticosteroids and were metastases free, confirming the causative role of denosumab in these complications. These suppression-release effects of high-dose denosumab on bone remodeling raise questions about safety of fixed dosing and treatment duration. In young people, weight-adjusted dosing and safety monitoring during and after antiresorptive therapy is required. Copyright © 2017 Endocrine Society

  15. Relative volume measured with magnetic resonance imaging is an articular collapse predictor in hematological pediatric patients with femoral head osteonecrosis.

    Science.gov (United States)

    Ippolito, Davide; Masetto, Alessandro; Talei Franzesi, Cammillo; Bonaffini, Pietro A; Casiraghi, Alessandra; Sironi, Sandro

    2016-08-28

    To assess the potential value of femoral head (FH) volume measurements to predict joint collapse, as compared to articular surface involvement, in post-treatment osteonecrosis (ON) in pediatric patients affected by lymphoproliferative diseases. Considering 114 young patients with lymphoproliferative diseases undergone a lower-limbs magnetic resonance imaging (MRI) examination between November 2006 and August 2012 for a suspected post-treatment ON, we finally considered a total of 13 cases (7 males, mean age 15.2 ± 4.8 years), which developed a FH ON lesions (n = 23). The MRI protocol included coronal short tau inversion recovery and T1-weighted sequences, from the hips to the ankles. During the follow-up (elapsed time: 9.2 ± 2 mo), 13/23 FH articular surface (FHS) developed articular deformity. The first MRI studies with diagnosis of ON were retrospectively analyzed, measuring FH volume (FHV), FHS, ON volume (ONV) and the articular surface involved by ON (ONS). The relative involvement of FHS, in terms of volume [relative volume (RV): ONV/FHV] and articular surface [relative surface (RS): ONS/FHS], was then calculated. By using receiver operating characteristic curve analysis (threshold of 23% of volume involvement), RV predicted articular deformity in 13/13 FHS [sensitivity 100%, specificity 90%, accuracy 95%, positive predictive value (PPV) 93%, negative predictive value (NPV) 100%]. Considering a threshold of 50% of articular involvement, RS predicted articular deformity in 10/13 femoral heads (sensitivity 77%, specificity 100%, accuracy 87%, PPV 100%, NPV 77%). RV might be a more reliable parameter than RS in predicting FH deformity and could represent a potential complementary diagnostic tool in the follow-up of femoral heads ON lesions.

  16. Interferon β protects against avascular osteonecrosis through interleukin 6 inhibition and silent information regulator transcript-1 upregulation.

    Science.gov (United States)

    Kim, Kyoung Min; Wagle, Sajeev; Moon, Young Jae; Wang, Sung Il; Park, Byung-Hyun; Jang, Kyu Yun; Kim, Jung Ryul

    2018-01-09

    Synovitis of the affected joint is a common in avascular osteonecrosis (AVN). Increased levels of pro-inflammatory cytokine interleukin-6 (IL-6) have been reported in AVN, but the mechanism of this increase remains unclear. Silent information regulator transcript-1 (SIRT1), an NAD-dependent deacetylase, inhibits the release of inflammatory cytokines. Interferon β (IFN-β) has clear anti-inflammatory properties. We sought to investigate the effects of IFN-β treatment on AVN and to evaluate the specific signal pathway relating to IL-6 and SIRT1 affected during AVN. Using a dissection microscope, AVN was surgically induced in the distal femurs of mice. Exogenous IFN-β was administered to the model mice. The effects of exogenous IFN-β on AVN model mice were assessed using hematoxylin eosin and safranin-O staining, and bone resorption activity was measured using tartrate-resistant acid phosphatase (TRAP) and CD68 staining. Western blots, real-time RT-PCR, and immunohistochemical staining were performed to evaluate the production of SIRT1 and IL-6 in tissues. The RAW 264.7 cell line and bone marrow derived osteoclasts treated with exogenous IFN-β. Histological findings indicated well preserved trabecular bone and decreased osteoclast bone resorption activity in IFN-β treated mice compared with mice in the AVN group. Treatment with IFN-β increased SIRT1 expression and inhibited secretion of IL-6 in this AVN mouse model. IFN-β decreased IL-6 secretion by activating SIRT1 in the RAW 264.7 cell and bone marrow derived osteoclasts. Our work suggests that IFN-β could be used to treat AVN and that both SIRT1 and IL-6 are useful targets for treating patients with AVN.

  17. Necrosis avascular de cabeza y cuello de fémur en un paciente con sida Avascular osteonecrosis of femoral head and neck in an AIDS patient

    Directory of Open Access Journals (Sweden)

    María F. Villafañe

    2004-04-01

    Full Text Available La osteonecrosis avascular (ONA es una complicación que se describe con frecuencia creciente en pacientes infectados por el virus de la inmunodeficiencia humana tipo-1 (HIV-1. En su localización más común compromete la cabeza y cuello del fémur con dolor e impotencia funcional, en una o ambas caderas. Su etiología es multifactorial y la terapia antirretroviral de alta eficacia (HAART con inhibidores de proteasa (IP puede estar relacionada con la patogenia. En su evolución puede requerir el reemplazo total de la cadera con la colocación de una prótesis. Se presenta un paciente hemofílico, HIV-1 seropositivo, que desarrolló una ONA bilateral de cabeza y cuello de fémur mientras se encontraba bajo HAART.Avascular osteonecrosis (AON has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1. The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART with protease inhibitors (PI is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.

  18. Autologous Concentrated Bone Marrow Grafting for the Treatment of Osteonecrosis of the Humeral Head: A Report of Five Shoulders in Four Cases

    Directory of Open Access Journals (Sweden)

    Takeshi Makihara

    2017-01-01

    Full Text Available Five shoulders in four patients affected by advanced osteonecrosis of the humeral head were treated with autologous concentrated bone marrow grafting. Bone marrow sample was aspirated from the iliac crests, concentrated by a centrifugation technique, and injected into the necrotic site. The shoulders were evaluated radiologically with X-ray scoring and clinically with measurement of range of motion and pain score (visual analogue scale, VAS. The mean follow-up period was 49.4 (range, 24–73 months. The concentration ratio of nucleated cells was calculated and the number of transplanted mesenchymal stem cells (MSC was estimated by a colony-forming assay. All four shoulders with stage 3 disease achieved joint sparing. One shoulder with stage 4 disease required replacement surgery. Clinical evaluation of the spared joints showed improvement in range of motion in two cases and deterioration in two cases. VAS scores were 0 after surgery in three cases. The mean concentration ratio was 2.73, and the mean number of transplanted MSC was 1125. The outcomes of autologous concentrated bone marrow grafting for advanced osteonecrosis of the humeral head were varied. Further research is needed to determine the effectiveness and the indications of the present surgery.

  19. Spontaneous osteonecrosis of the knee joint: MR imaging before and after administration of gadopentetate-dimeglumine, comparison to CT, scintigraphy, and histology

    International Nuclear Information System (INIS)

    Lang, P.; Grampp, S.; Vahlensieck, M.; Mauz, M.; Steiner, E.; Schwickert, H.; Gindele, A.; Felix, R.; Genant, H.K.

    1995-01-01

    Eight patients with spontaneous osteonecrosis of the knee joint underwent MR imaging before and after i.v. administration of Gd-DTPA. Nuclear scintigraphy was performed in all 8 patients, three patients also had CT scans of the knee area. Histologic correlation was available in three patients. Increased radionuclide uptake was observed in all patients. In one patient, however, scintigraphy showed increased radionuclide uptake consistent with ostenecrosis only in the medial femoral condyle, while MR imaging demonstrated osteonecrosis both in the medial as well as the lateral femoral condyles. MR demonstrated areas of low signal intensity on precontrast T 1 -weighted images in the femoral condyle in all patients. All these areas showed high signal intensity on T 2 -weighted images. On postcontrast T 1 -weighted images, signal intensity increase was either homogeneous throughout the lesion or it was seen at the periphery of the lesion in a band-like pattern. Histologically, the areas of high signal intensity on T 2 -weighted and on postcontrast T 1 -weighted images corresponded to granulation tissue. (orig./MG) [de

  20. Major complications of radiotherapy in cancer of the oral cavity and oropharynx. A 10 year retrospective study

    International Nuclear Information System (INIS)

    Larson, D.L.; Lindberg, R.D.; Lane, E.; Goepfert, H.

    1983-01-01

    In an attempt to determine the late effects and associated morbidity of radiotherapy on normal tissue, patients with squamous carcinoma of the oral cavity and oropharynx were retrospectively reviewed. Between 1964 and 1975, 569 patients with cancer of the floor of the mouth, oral tongue, tonsil, and retromolar trigone region of the anterior faucial pillar had their primary lesions treated by radiotherapy alone for cure. One hundred twenty-eight of the patients were evaluable for this study. Bone and soft tissue morbidity were graded according to the late radiation scoring scheme of the radiation therapy oncology group of the European Organization on Research and Treatment of Cancer, tallying only grade 4 changes. Patients were further classified according to site of tumor, age, sex, tumor stage, histologic grade, and dental status--none of which had a positive correlation with complications. Of 31 evaluable patients with cancer of the floor of the mouth (median follow-up 136 months), 71 percent (22 of 31 patients) had at least one complication involving bone (osteonecrosis, pathologic fracture) or mucus membrane (ulcer). Sixty-one percent (25 of 41 patients) with primary cancer of the oral tongue had grade 4 sequelae (median follow-up 112 months). In 26 patients with cancer of the tonsil, 13 (50 percent) had grade 4 sequelae (median follow-up 113 months). This included 11 patients with clinical and radiographic evidence of osteonecrosis, 6 of whom required mandibulectomy. Patients with cancer of the retromolar trigone region of the anterior faucial pillar fared the best (median follow-up 122 months). Late sequelae were noted in 40 percent (12 of 30 patients). The morbidity attendant to cure by radiotherapy included at least one significant complication of bone or soft tissue in 40 to 70 percent of the patients, depending on the location of the primary tumor. There was also a positive correlation with dose of radiation received

  1. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  2. Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs.

    Science.gov (United States)

    Edwards, Beatrice J; Hellstein, John W; Jacobsen, Peter L; Kaltman, Steven; Mariotti, Angelo; Migliorati, Cesar A

    2008-12-01

    and Overview. In 2005, the American Dental Association (ADA) Council on Scientific Affairs convened an expert panel to develop clinical recommendations for dentists treating patients who are receiving oral bisphosphonate therapy. The Journal of the American Dental Association published the resulting report in 2006. This 2008 advisory statement is the first of projected periodic updates of the 2006 clinical recommendations. This 2008 advisory statement concludes, on the basis of a review of the current literature, that for patients receiving bisphosphonate therapy, the risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw apparently remains low. It also newly concludes that current screening and diagnostic tests are unreliable for predicting a patient's risk of developing the condition. This statement updates the 2006 recommendations regarding general dentistry, management of periodontal diseases, implant placement and maintenance, oral and maxillofacial surgery, endodontics, restorative dentistry and prosthodontics, and orthodontics.

  3. Towards understanding oral health

    NARCIS (Netherlands)

    Zaura, E.; ten Cate, J.M.

    2015-01-01

    During the last century, dental research has focused on unraveling the mechanisms behind various oral pathologies, while oral health was typically described as the mere absence of oral diseases. The term ‘oral microbial homeostasis' is used to describe the capacity of the oral ecosystem to maintain

  4. [Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head].

    Science.gov (United States)

    Li, Ji; Li, Zhongli; Su, Xiangzheng; Liu, Chunhui; Zhang, Hao; Wang, Ketao

    2017-09-01

    To evaluate the effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head (ONFH). Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompression combined with hip arthroscopy in 39 cases (53 hips, group A) or with drilling decompression alone in 52 cases (74 hips, group B). The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups ( P >0.05). All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [(73.3±10.6) minutes] than in group B [(41.5±7.2) minutes] ( t =8.726, P =0.000). Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months (mean, 39.3 months) in group A and 24-48 months (mean, 34.6 months) in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups ( t =-4.247, P =0.029) and when compared with preoperative values in 2 groups ( t =-10.327, P =0.001; t =-8.216, P =0.008). X-ray films showed that the collapse of the femoral head was observed in 6 hips (1 hip at stage Ⅰand 5 hips at stage Ⅱ) in group A, and in 16 hips (4 hips at stageⅠand 12 hips at stage Ⅱ) in group B; and hip arthroplasty was performed. The total effective rates were 88.68% (47/53) in group A and 78.38% (58/74) in group B, respectively; showing significant difference between 2 groups ( χ 2 =5.241, P =0.041). Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement of hip function, slowing-down the

  5. [CLINICAL APPLICATION OF THREE DIMENSIONAL PRINTED NAVIGATION TEMPLATES FOR TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD WITH PEDICLED ILIAC BONE GRAFT].

    Science.gov (United States)

    Yu, Kaifu; Xu, Yongqing; Tan, Hongbo; He, Xiaoqing; Cai, Dixin; Zhou, Tianhua; Luo, Haotian; Duan, Jiazhang

    2016-03-01

    To investigate the feasibility and early effectiveness to treat osteonecrosis of the femoral head (ONFH) with pedicled iliac bone graft assisted by individual digital design and three dimensional (3D) printed navigation templates. Between February and June 2014, 15 patients (24 hips) with ONFH underwent pedicled iliac bone graft assisted by individual digital design and 3D printed navigation templates. There were 11 males (17 hips) and 4 females (7 hips) with a mean age of 38 years (range, 18-56 years) and a mean disease duration of 7.5 months (range, 1-24 months); the left hip was involved in 2 cases, the right hip in 4 cases, and both hips in 9 cases. There were 7 cases (12 hips) of steroid-induced ONFH, 5 cases (8 hips) of alcohol-induced ONFH, 1 case (1 hip) of traumatic ONFH, and 2 cases (3 hips) of idiopathic ONFH. The preoperative Harris score was 56.60 ± 6.97. According to Association Research Circulation Osseous (ARCO) staging system, 5 hips were classified as stage IIB, 8 hips as stage IIC, 6 hips as stage IIIB, and 5 hips as stage IIIC. The navigation templates were designed and printed to assist accurate location and debridement of necrosis area according to preoperative CT scanning at the beginning of pedicled iliac bone grafting procedure. The mean operation time was 135 minutes (range, 120-160 minutes), mean amount of bleeding was 255 mL (range, 200-300 mL). All the wounds healed primarily, no complication of deep vein thrombosis or infection was observed. All patients were followed up 12-16 months (mean, 14 months). The location of necrosis area was in accordance with preoperative design, which was removed completely without penetration of joint surface, pedicled iliac bone graft was performed at the right site according to postoperative imaging examination. Radiographically, graft fusion was achieved at 2.7 months (range, 2-3 months) in all patients. All the hips had no collapse during follow-up. Hip pain was relieved, and range of motion was

  6. Superimposition of maximal stress and necrosis areas at the top of the femoral head in hip aseptic osteonecrosis.

    Science.gov (United States)

    Escudier, J-C; Ollivier, M; Donnez, M; Parratte, S; Lafforgue, P; Argenson, J-N

    2018-05-01

    Recent reports described possible mechanical factors in the development and aggravation of osteonecrosis of the femoral head (OFH), but these have yet to be confirmed on dedicated mechanical study. We therefore developed a 3D finite element model based on in-vivo data from patients with incipient OFH, with a view to determining whether the necrosis area was superimposed on the maximal stress area on the femoral head. The location of the necrosis area is determined by stress on the femoral head. All patients from the rheumatology department with early stage OFH in our center were investigated. Analysis of CT scans showed stress distribution on the head by 3D finite elements models, enabling determination of necrosis volume within the maximal stress area and of the percentage intersection of necrosis within the stress area (%I n/s: necrosis volume in stress area divided by total stress area volume and multiplied by 100) and of stress within the necrosis area (%I s/n: stress volume in necrosis area divided by total necrosis area volume and multiplied by 100). Nineteen of the 161 patients assessed retrospectively for the period between 2006 and 2015 had incipient unilateral OFH, 10 of whom (4 right, 6 left) had CT scans of sufficient quality for inclusion. Mean age was 52 years (range, 37-81 years). Mean maximal stress was 1.63MPa, mean maximal exported stress volume was 2,236.9 mm 3 and mean necrosis volume 6,291.1 mm 3 . Mean %I n/s was 83% and mean %I s/n 35%, with no significant differences according to gender, age, side or stress volume. There was a strong inverse correlation between necrosis volume and %I s/n (R 2 =-0.92) and a strong direct correlation between exported stress volume and %I s/n (R 2 =0.55). %I s/n was greater in small necrosis (stress area on the femoral head. The present results need confirmation by larger-scale studies. We consider it essential to take account of these mechanical parameters to reduce failure rates in conservative treatment of

  7. Hemoglobin to Hematocrit Ratio: The Strongest Predictor of Femoral Head Osteonecrosis in Children With Sickle Cell Disease.

    Science.gov (United States)

    Worrall, Douglas; Smith-Whitley, Kim; Wells, Lawrence

    2016-03-01

    Femoral head osteonecrosis (ON) secondary to sickle cell disease (SCD) often progresses to femoral head collapse, requiring total hip arthroplasty. However, this treatment has a limited durability and patients with SCD have higher rates of complications, requiring multiple revision operations. Identifying risk factors linked to ON in SCD can facilitate earlier precollapse diagnosis and surgical treatment aimed at preservation of the native hip joint. Fifty-nine children treated at our institution between January 2001 and April 2012 with SCD and ON, as diagnosed by magnetic resonance imaging or radiographic imaging, were compared with age-matched and sickle cell phenotype-matched (SS, SC, Sβ, Sβ) controls with no evidence of ON. Two sided t-tests assuming unequal variances determined statistically risk factors and threshold values were assigned to calculate odds ratios. Systolic blood pressure (P=1.2×10, OR=3.68), diastolic blood pressure (P=0.0084, OR=1.41), weight in the SCD-SS population (P=0.04, OR=1.85), and hemoglobin (Hb) in the SCD-SS population (P=0.036, OR=2.56) were elevated in cases. Curiously, dividing the Hb by the hematocrit to serve as a clinical proxy for the mean corpuscular Hb concentration (MCHC) produced an excellent predictor of ON (P=2.06×10, OR=5.17), which was especially pronounced in the SCD-SS subpopulation (P=2.28×10, OR=8.65). Among children with SCD, the overall prevalence of ON was 9% (59/658) and the phenotype with the highest prevalence of ON was Sβ thalassemia with an ON prevalence of 11.1%. There was no observed correlation between ON and height, body mass index, cholesterol, mean corpuscular volume, hematocrit, or glucocorticoid use. These data support a novel clinical marker, the MCHC proxy, as the strongest predictor of ON in children with SCD. High-risk children should receive hip magnetic resonance imaging to diagnose early ON and facilitate interventions focused on hip preservation, forestalling, or possibly preventing

  8. Oral dirofilariasis

    Directory of Open Access Journals (Sweden)

    Mahija Janardhanan

    2014-01-01

    Full Text Available Filariasis affecting animals can rarely cause infections in human beings through the accidental bite of potential vectors. The resulting infection in man, known as zoonotic filariasis occur worldwide. Human dirofilariasis, the most common zoonotic filariasis, is caused by the filarial worm belonging to the genus Dirofilaria. Dirofilarial worms, which are recognized as pathogenic in man can cause nodular lesions in the lung, subcutaneous tissue, peritoneal cavity or eyes. Oral dirofilariasis is extremely rare and only a few cases have been documented. We report an interesting case of dirofilariasis due to Dirofilaria repens involving buccal mucosa in a patient who presented with a facial swelling. The clinical features, diagnostic issues and treatment aspects are discussed. This paper stresses the importance of considering dirofilariasis as differential diagnosis for subcutaneous swelling of the face, especially in areas where it is endemic.

  9. Oral dirofilariasis.

    Science.gov (United States)

    Janardhanan, Mahija; Rakesh, S; Savithri, Vindhya

    2014-01-01

    Filariasis affecting animals can rarely cause infections in human beings through the accidental bite of potential vectors. The resulting infection in man, known as zoonotic filariasis occur worldwide. Human dirofilariasis, the most common zoonotic filariasis, is caused by the filarial worm belonging to the genus Dirofilaria. Dirofilarial worms, which are recognized as pathogenic in man can cause nodular lesions in the lung, subcutaneous tissue, peritoneal cavity or eyes. Oral dirofilariasis is extremely rare and only a few cases have been documented. We report an interesting case of dirofilariasis due to Dirofilaria repens involving buccal mucosa in a patient who presented with a facial swelling. The clinical features, diagnostic issues and treatment aspects are discussed. This paper stresses the importance of considering dirofilariasis as differential diagnosis for subcutaneous swelling of the face, especially in areas where it is endemic.

  10. Oral sex, oral health and orogenital infections

    Directory of Open Access Journals (Sweden)

    Rajiv Saini

    2010-01-01

    Full Text Available Oral sex is commonly practiced by sexually active male-female and same-gender couples of various ages, including adolescents. The various type of oral sex practices are fellatio, cunnilingus and analingus. Oral sex is infrequently examined in research on adolescents; oral sex can transmit oral, respiratory, and genital pathogens. Oral health has a direct impact on the transmission of infection; a cut in your mouth, bleeding gums, lip sores or broken skin increases chances of infection. Although oral sex is considered a low risk activity, it is important to use protection and safer sex precautions. There are various methods of preventing infection during oral sex such as physical barriers, health and medical issues, ethical issues and oral hygiene and dental issues. The lesions or unhealthy periodontal status of oral cavity accelerates the phenomenon of transmission of infections into the circulation. Thus consequences of unhealthy or painful oral cavity are significant and oral health should be given paramount importance for the practice of oral sex.

  11. Biostimulatory effects of low-level laser therapy on epithelial cells and gingival fibroblasts treated with zoledronic acid

    Science.gov (United States)

    Basso, F. G.; Pansani, T. N.; Turrioni, A. P. S.; Kurachi, C.; Bagnato, V. S.; Hebling, J.; de Souza Costa, C. A.

    2013-05-01

    Low-level laser therapy (LLLT) has been considered as an adjuvant treatment for bisphosphonate-related osteonecrosis, presenting positive clinical outcomes. However, there are no data regarding the effect of LLLT on oral tissue cells exposed to bisphosphonates. This study aimed to evaluate the effects of LLLT on epithelial cells and gingival fibroblasts exposed to a nitrogen-containing bisphosphonate—zoledronic acid (ZA). Cells were seeded in wells of 24-well plates, incubated for 48 h and then exposed to ZA at 5 μM for an additional 48 h. LLLT was performed with a diode laser prototype—LaserTABLE (InGaAsP—780 nm ± 3 nm, 25 mW), at selected energy doses of 0.5, 1.5, 3, 5, and 7 J cm-2 in three irradiation sessions, every 24 h. Cell metabolism, total protein production, gene expression of vascular endothelial growth factor (VEGF) and collagen type I (Col-I), and cell morphology were evaluated 24 h after the last irradiation. Data were statistically analyzed by Kruskal-Wallis and Mann-Whitney tests at 5% significance. Selected LLLT parameters increased the functions of epithelial cells and gingival fibroblasts treated with ZA. Gene expression of VEGF and Col-I was also increased. Specific parameters of LLLT biostimulated fibroblasts and epithelial cells treated with ZA. Analysis of these in vitro data may explain the positive in vivo effects of LLLT applied to osteonecrosis lesions.

  12. Biostimulatory effects of low-level laser therapy on epithelial cells and gingival fibroblasts treated with zoledronic acid

    International Nuclear Information System (INIS)

    Basso, F G; Pansani, T N; Turrioni, A P S; Hebling, J; De Souza Costa, C A; Kurachi, C; Bagnato, V S

    2013-01-01

    Low-level laser therapy (LLLT) has been considered as an adjuvant treatment for bisphosphonate-related osteonecrosis, presenting positive clinical outcomes. However, there are no data regarding the effect of LLLT on oral tissue cells exposed to bisphosphonates. This study aimed to evaluate the effects of LLLT on epithelial cells and gingival fibroblasts exposed to a nitrogen-containing bisphosphonate—zoledronic acid (ZA). Cells were seeded in wells of 24-well plates, incubated for 48 h and then exposed to ZA at 5 μM for an additional 48 h. LLLT was performed with a diode laser prototype—LaserTABLE (InGaAsP—780 nm ± 3 nm, 25 mW), at selected energy doses of 0.5, 1.5, 3, 5, and 7 J cm −2 in three irradiation sessions, every 24 h. Cell metabolism, total protein production, gene expression of vascular endothelial growth factor (VEGF) and collagen type I (Col-I), and cell morphology were evaluated 24 h after the last irradiation. Data were statistically analyzed by Kruskal–Wallis and Mann–Whitney tests at 5% significance. Selected LLLT parameters increased the functions of epithelial cells and gingival fibroblasts treated with ZA. Gene expression of VEGF and Col-I was also increased. Specific parameters of LLLT biostimulated fibroblasts and epithelial cells treated with ZA. Analysis of these in vitro data may explain the positive in vivo effects of LLLT applied to osteonecrosis lesions. (paper)

  13. Clinical outcome of high-dose-rate interstitial brachytherapy in patients with oral cavity cancer

    International Nuclear Information System (INIS)

    Lee, Sung Uk; Cho, Kwan Ho; Moon, Sung Ho; Choi, Sung Weon; Park, Joo Yong; Yun, Tak; Lee, Sang Hyun; Lim, Young Kyung; Jeong, Chi Young

    2014-01-01

    To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.

  14. Intraoperative fat embolism during core decompression and bone grafting for osteonecrosis of the hip: report of 3 cases and literature review.

    Science.gov (United States)

    Schaffer, Joseph Christopher; Adib, Farshad; Cui, Quanjun

    2014-06-01

    Osteonecrosis (ON) of the femoral head, without timely intervention, often progresses to debilitating hip arthritis. Core decompression (CD) with bone grafting was used to treat patients with early-stage ON. In 3 cases, intraoperative oxygen saturation, end-tidal carbon dioxide fluctuations, and/or vital sign fluctuations were observed during insertion of the graft, a mixture of bone marrow and demineralized bone matrix. In 1 case, continued postoperative pulmonary symptoms required admission to intensive care. In this article, we describe these cases and provide supporting evidence that they were caused by fat emboli secondary to forceful insertion of bone graft. We review the literature and present complications data. Although no cases of fat emboli were reported as complications of any CD series with or without bone grafting, CD augmented with bone graft may carry risks not seen before in CD alone. Care should be taken to avoid these complications, possibly through technique modification.

  15. Degeneration of articular cartilage in osteonecrosis of the femoral head begins at the necrotic region after collapse: a preliminary study using T1 rho MRI

    Energy Technology Data Exchange (ETDEWEB)

    Sonoda, Kazuhiko; Motomura, Goro; Nakashima, Yasuharu [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan); Kawanami, Satoshi; Takayama, Yukihisa; Honda, Hiroshi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan); Yamamoto, Takuaki [Fukuoka University, Department of Orthopaedic Surgery, Faculty of Medicine, Jonan-ku, Fukuoka (Japan)

    2017-04-15

    The purpose of this study is to evaluate the role of collapse on the degeneration of articular cartilage in patients with osteonecrosis of the femoral head (ONFH). Sixteen hips in 12 patients (four men, eight women; mean age, 34.8 years) with a history of systemic corticosteroid treatment were studied using T1 rho magnetic resonance imaging (MRI). Six hips had collapsed ONFH, five had non-collapsed ONFH, and five had no osteonecrosis (controls). Using oblique coronal images, we divided the articular surface of necrotic femoral heads into a region just above the necrotic bone (necrotic zone) and another above the living bone (living zone). T1 rho value was evaluated for each zone. The mean T1 rho value in the necrotic zone was significantly higher in the collapsed ONFH group (48.4 ± 2.7 ms) than in the non-collapsed ONFH group (41.0 ± 0.9 ms). In the collapsed ONFH group, the mean T1 rho value was significantly higher in the necrotic zone (48.4 ± 2.7 ms) than in the living zone (43.5 ± 2.5 ms). In the non-collapsed ONFH group, there was no significant difference between the mean T1 rho values of the necrotic and living zones. In the collapsed ONFH group, the mean T1 rho value of the necrotic zone and the interval from pain onset to the MRI examination were positively correlated. The current T1 rho MRI study suggested that the degeneration of articular cartilage in ONFH begins at the necrotic region after collapse. (orig.)

  16. Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity

    Science.gov (United States)

    Mallet, C.; Abitan, A.; Vidal, C.; Holvoet, L.; Mazda, K.; Simon, A.-L.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. Methods All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. Results A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Conclusion Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. Level of Evidence IV PMID:29456754

  17. Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity.

    Science.gov (United States)

    Mallet, C; Abitan, A; Vidal, C; Holvoet, L; Mazda, K; Simon, A-L; Ilharreborde, B

    2018-02-01

    Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. IV.

  18. Risk factors influencing the duration of treatment with bisphosphonates until occurrence of an osteonecrosis of the jaw in 963 cancer patients.

    Science.gov (United States)

    Gabbert, Tatjana I; Hoffmeister, Bodo; Felsenberg, Dieter

    2015-04-01

    Osteonecrosis of the jaw (ONJ) is an adverse effect that is associated with bisphosphonate (BP) use. Little data are available on risk factors influencing the time of treatment until an osteonecrosis occurs. From 1 Dec 2004 until 21 Sep 2012, the German Register collected all patients with validated diagnoses of ONJ (N = 1,229) that were reported to the national pharmaco-vigilance system or to the Register directly. We analysed 963 patients with cancerous disease and an ONJ during i.v. BP treatment. Duration of BP treatment until first diagnosis of ONJ and Kaplan-Meier curves of ONJ-free survival were analysed stratified by gender, type of BP and type of cancer. Main indications for BP treatment were breast cancer (36%), multiple myeloma (24%), prostate cancer (16%) and kidney cancer (4%). Men suffered from their ONJ earlier than women. A total of 780 patients (81%) had their ONJ during zoledronate treatment, 93 (10%) under pamidronate and 90 (9%) under ibandronate treatment. ONJ-free survival in single BP users was significantly longer in pamidronate-treated patients than in zoledronate or ibandronate users. Ibandronate users had the shortest median duration of treatment (17 months), similar to that of zoledronate users (21.5 months). Sequential prescription of two different BPs prolonged the period of overall BP treatment until an ONJ occurred. Time of BP treatment was shortest in patients with kidney cancer. Age or a concomitant osteoporosis did not influence the time to event of an ONJ. Systemic risk factors such as gender play a significant role in certain subgroups only. Comparative analysis of different cancer patients helps the treating oncologist/dentist to identify patients with a more imminent risk to develop an ONJ (i.e. kidney cancer, ibandronate/zoledronate use).

  19. Oral contraceptives induced hepatotoxicity

    OpenAIRE

    B. Akshaya Srikanth; V. Manisree

    2013-01-01

    Oral Contraceptives are the pharmacological agents used to prevent pregnancy. These are divided as the combined and progestogen methods and are administered orally, transdermally, systemically and via vaginal route. All these methods contain both oestrogen and progestogen. Vigorous usage of oral contraceptives and anabolic steroids as associated with cholestasis, vascular lesions and hepatic neoplasm. Benign hepatic neoplasms are clearly associated with oral contraceptives. In this article we...

  20. Oral vaccination of fish

    OpenAIRE

    Embregts, Carmen W.E.; Forlenza, Maria

    2016-01-01

    The limited number of oral vaccines currently approved for use in humans and veterinary species clearly illustrates that development of efficacious and safe oral vaccines has been a challenge not only for fish immunologists. The insufficient efficacy of oral vaccines is partly due to antigen breakdown in the harsh gastric environment, but also to the high tolerogenic gut environment and to inadequate vaccine design. In this review we discuss current approaches used to develop oral vaccines fo...

  1. Diffusion-weighted magnetic resonance imaging of femoral head osteonecrosis in two groups of patients: Legg-Perthes-Calve and Avascular necrosis.

    Science.gov (United States)

    Ozel, Betul Duran; Ozel, Deniz; Ozkan, Fuat; Halefoglu, Ahmet M

    2016-03-01

    The aim of this prospective study was to evaluate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with osteonecrosis. Patients were divided into two subgroups as avascular necrosis (AVN) of femoral head for adult group and Legg-Calvé-Perthes (LCP) patients for children. Seventeen patients with femoral head AVN (mean age 42.3 years) and 17 patients with LCP (mean age 8.2 years) were included in this study. Diagnosis confirmed with clinical and other imaging procedures among the patients complaining hip pain. DW images were obtained using the single-shot echo planar sequence and had b values of 0, 500, 1000 s/mm(2). The apparent diffusion coefficient (ADC) values were measured from ADC maps in epiphysis of patients with AVN, both from metaphysis and epiphysis in patients with LCP, respectively. Mann-Whitney U test was used to compare ADC values. The mean ADC value of femoral heads (1.285 ± 0.204 × 10(-3) mm(2)/s) was increased in patients with AVN when compared to normal bone tissue (0.209 ± 0.214 × 10(-3) mm(2)/s) (p < 0.01). The mean ADC values (×10(-3) mm(2)/s) of both metaphysis (0.852 ± 0.293) and epiphysis (0.843 ± 0.332) were also increased in patients with LCP and differences were statistically significant (p < 0.01). As a result, osteonecrosis shows increased ADC values. But it is a controversial concept that DWI offers a valuable data to conventional MRI or not. However, as there are report states, there is a correlation between the stage of the disease with ADC values in the LCP disease. DWI is a fast, without-contrast administration technique and provides quantitative values additional to conventional MR techniques; we believe DWI may play an additional assistance to the diagnosis and treatment for LCP patients. Multicentric larger group studies may provide additional data to this issue.

  2. Oral vaccination of fish

    NARCIS (Netherlands)

    Embregts, Carmen W.E.; Forlenza, Maria

    2016-01-01

    The limited number of oral vaccines currently approved for use in humans and veterinary species clearly illustrates that development of efficacious and safe oral vaccines has been a challenge not only for fish immunologists. The insufficient efficacy of oral vaccines is partly due to antigen

  3. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... to detect oral cancer during your routine dental examinations. Don't risk it. Perform an oral cancer ... oral cancer self-exam each month. An oral examination is performed using a bright light and a ...

  4. Essentials of oral cancer.

    Science.gov (United States)

    Rivera, César

    2015-01-01

    Oral cancer is one of the 10 most common cancers in the world, with a delayed clinical detection, poor prognosis, without specific biomarkers for the disease and expensive therapeutic alternatives. This review aims to present the fundamental aspects of this cancer, focused on squamous cell carcinoma of the oral cavity (OSCC), moving from its definition and epidemiological aspects, addressing the oral carcinogenesis, oral potentially malignant disorders, epithelial precursor lesions and experimental methods for its study, therapies and future challenges. Oral cancer is a preventable disease, risk factors and natural history is already being known, where biomedical sciences and dentistry in particular are likely to improve their poor clinical indicators.

  5. Screening for oral cancer.

    Science.gov (United States)

    Jitender, Solanki; Sarika, Gupta; Varada, Hiremath R; Omprakash, Yadav; Mohsin, Khan

    2016-11-01

    Oral cancer is considered as a serious health problem resulting in high morbidity and mortality. Early detection and prevention play a key role in controlling the burden of oral cancer worldwide. The five-year survival rate of oral cancer still remains low and delayed diagnosis is considered as one of the major reasons. This increases the demand for oral screening. Currently, screening of oral cancer is largely based on visual examination. Various evidence strongly suggest the validity of visual inspection in reducing mortality in patients at risk for oral cancer. Simple visual examination is accompanied with adjunctive techniques for subjective interpretation of dysplastic changes. These include toluidine blue staining, brush biopsy, chemiluminescence and tissue autofluorescence. This review highlights the efficacy of various diagnostic methods in screening of oral cancer. © 2016 Old City Publishing, Inc.

  6. Oral biopsy: Oral pathologist′s perspective

    Directory of Open Access Journals (Sweden)

    K L Kumaraswamy

    2012-01-01

    Full Text Available Many oral lesions may need to be diagnosed by removing a sample of tissue from the oral cavity. Biopsy is widely used in the medical field, but the practice is not quite widespread in dental practice. As oral pathologists, we have found many artifacts in the tissue specimen because of poor biopsy technique or handling, which has led to diagnostic pitfalls and misery to both the patient and the clinician. This article aims at alerting the clinicians about the clinical faults arising preoperatively, intraoperatively and postoperatively while dealing with oral biopsy that may affect the histological assessment of the tissue and, therefore, the diagnosis. It also reviews the different techniques, precautions and special considerations necessary for specific lesions.

  7. Incidence of osteonecrosis of the jaw in women with postmenopausal osteoporosis in the health outcomes and reduced incidence with zoledronic acid once yearly pivotal fracture trial.

    Science.gov (United States)

    Grbic, John T; Landesberg, Regina; Lin, Shou-Qing; Mesenbrink, Peter; Reid, Ian R; Leung, Ping-Chung; Casas, Noemi; Recknor, Christopher P; Hua, Ye; Delmas, Pierre D; Eriksen, Erik F

    2008-01-01

    The authors determined incidence of osteonecrosis of the jaw (ONJ) in a large, prospective three-year clinical trial of zoledronic acid in women with postmenopausal osteoporosis (PMO). A total of 7,714 women with PMO received intravenous zoledronic acid 5 mg or a placebo. No spontaneous reports of ONJ were received. An independent, blinded adjudication committee searched the trial's adverse event database by using 60 terms. On an ongoing basis, the committee reviewed the identified events, and it defined ONJ as exposed bone in the maxillofacial area with delayed healing for more than six weeks despite appropriate care. One participant who received a placebo and one participant who received zoledronic acid experienced delayed healing associated with infection. Both conditions resolved after antibiotic therapy, débridement or both. The occurrence of ONJ is rare in a PMO population, and delayed healing of lesions can occur with and without bisphosphonate use over three years. The low incidence of ONJ must be assessed in the context of the clinical benefit of zoledronic acid therapy in reducing hip, vertebral and nonvertebral fractures in this at-risk population. There is no evidence to suggest that healthy patients with osteoporosis who are receiving bisphosphonates require any special treatment beyond routine dental care or to support altering standard treatment practices.

  8. HGF-transgenic MSCs can improve the effects of tissue self-repair in a rabbit model of traumatic osteonecrosis of the femoral head.

    Directory of Open Access Journals (Sweden)

    Qian Wen

    Full Text Available BACKGROUND: Osteonecrosis of the femoral head (ONFH is generally characterized as an irreversible disease and tends to cause permanent disability. Therefore, understanding the pathogenesis and molecular mechanisms of ONFH and developing effective therapeutic methods is critical for slowing the progress of the disease. METHODOLOGY/PRINCIPAL FINDINGS: In this study, an experimental rabbit model of early stage traumatic ONFH was established, validated, and used for an evaluation of therapy. Computed tomography (CT and magnetic resonance (MR imaging confirmed that this model represents clinical Association Research Circulation Osseous (ARCO phase I or II ONFH, which was also confirmed by the presence of significant tissue damage in osseous tissue and vasculature. Pathological examination detected obvious self-repair of bone tissue up to 2 weeks after trauma, as indicated by revascularization (marked by CD105 and expression of collagen type I (Col I, osteocalcin, and proliferating cell nuclear antigen. Transplantation of hepatocyte growth factor (HGF-transgenic mesenchymal stem cells (MSCs 1 week after trauma promoted recovery from ONFH, as evidenced by a reversed pattern of Col I expression compared with animals receiving no therapeutic treatment, as well as increased expression of vascular endothelial growth factor. CONCLUSIONS/SIGNIFICANCE: These results indicate that the transplantation of HGF-transgenic MSCs is a promising method for the treatment for ONFH and suggest that appropriate interference therapy during the tissue self-repair stage contributes to the positive outcomes. This study also provides a model for the further study of the ONFH etiology and therapeutic interventions.

  9. Clinical Effects of Novel Nanoscaled Core Decompression Rods Combined with Umbilical Cord Mesenchymal Stem Cells on the Treatment of Early Osteonecrosis of the Femoral Head

    Directory of Open Access Journals (Sweden)

    Hongyang Gao

    2015-01-01

    Full Text Available Osteonecrosis of the femoral head (ONFH is one of the most common diseases in orthopedics. In this study, we investigated the clinical effects of novel nanoscaled core decompression rods combined with mesenchymal stem cells on the treatment of the ONFH. 12 adult patients with early ONFH (at the stage of Ficat II received the treatment using the implantation of novel nanoscaled core decompression rods combined with umbilical cord mesenchymal stem cells. The grade of the patients’ hip was scored by Harris marking system before and after the surgery, and then paired t-test was done. We assessed the curative efficiency based on the change of the patients before and after the surgery. In particular, the survival rate of femoral head was assessed at 12 months after the surgery. The results demonstrated that according to the standard of Harris Scoring, the average grade of hip joint before the surgery was 54.16 ± 4.23 points while average grade of hip joint at 12 months after the surgery was 85.28 ± 3.65 points. So, the implantation of the novel nanoscaled core decompression rods combined with mesenchymal stem cells had satisfactory clinical effects, suggesting that this implantation should be effective to treat early ONFH.

  10. Evaluation of femoral perfusion in a rabbit model of steroid-induced osteonecrosis by dynamic contrast-enhanced MRI with a high magnetic field MRI system.

    Science.gov (United States)

    Hayashi, Shigeki; Fujioka, Mikihiro; Ikoma, Kazuya; Saito, Masazumi; Ueshima, Keiichiro; Ishida, Masashi; Kuribayashi, Masaaki; Ikegami, Akira; Mazda, Osam; Kubo, Toshikazu

    2015-04-01

    To evaluate perfusion during the early phase after steroid administration in vivo using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with a high magnetic field MRI system. The main pathogenesis of steroid-induced osteonecrosis is considered to be ischemia. A single dose of methylprednisolone (MPSL) was injected into nine rabbits. DCE-MRI was performed for these rabbits before MPSL administration and 1, 5, 10, and 14 days after administration. Time-signal intensity curves were created for each femur based on the signal intensity to evaluate perfusion. Enhancement ratio (ER), initial slope (IS), and area under the curve (AUC) were calculated and the value before MPSL administration and the minimal value after administration were compared statistically. ER, IS, and AUC values after MPSL administration significantly decreased (P < 0.05, P < 0.01, and P < 0.01, respectively). All of them decreased by the 5th day in 56% of the femora and by the 14th day in 83%, and some femora even showed a decrease from the 1st day. In this study, decreased perfusion in the femora after steroid administration was proven. Additionally, we could show that it occurred from the early days after steroid administration. © 2014 Wiley Periodicals, Inc.

  11. MR imaging of osteonecrosis using frequency selective chemical shift sequences; Neue Aspekte in der MR-Diagnostik der Osteonekrose: Selektive Fett/Wasser-Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Duda, S H [Abt. fuer Radiologische Diagnostik, Tuebingen Univ. (Germany); Laniado, M [Abt. fuer Radiologische Diagnostik, Tuebingen Univ. (Germany); Schick, F [Inst. fuer Physik, Tuebingen Univ. (Germany)

    1994-12-31

    The MR appearance of osteonecrosis was assessed on selective fat- and water images to further evaluate the nature of double-line sign. Conventional T1- and T2-weighted SE and frequency selective chemical shift images of eight patients with avascular necrosis of the femoral head and three patients with bone infarcts were retrospectively reviewed. Eight of 11 patients showed a double-line sign on T2-weighted SE images. In these cases, correlation with selective water images revealed that a chemical shift artifact contributed to appearance and location of the hyperintense line. The authors conclude that chemical shift imaging improves our understanding of the nature of the double-line sign. (orig.) [Deutsch] Das MR-tomographische Erscheinungsbild der Osteonekrose auf selektiven Fett- und Wasserbildern wurde analysiert, um das in der Literatur beschriebene Doppellinienzeichen naeher zu untersuchen. Hierfuer wurden sowohl die herkoemmlichen T1- und T2-gewichteten Spin-Echo-Sequenzen herangezogen, als auch frequenzselektive Bilder, die aufgrund chemischer Verschiebung gewonnen wurden (1,5 T). Es wurden die Untersuchungen von acht Patienten mit avaskulaerer Hueftkopfnekrose und von drei Patienten mit Knocheninfarkten retrospektiv ausgewertet. Acht von 11 Patienten zeigten ein Doppellinienzeichen auf den T2-gewichteten Bildern. Die Korrelation mit den selektiven Wasserbildern ergab, dass durch chemische Verschiebung bedingte Artefakte das Erscheinungsbild und den Ort der hyperintensen Linie beeinflussten. Die Bildgebung mit Hilfe der chemischen Verschiebung verbessert unser Verstaendnis der MRT-Charakteristika der Osteonekrose. (orig.)

  12. Oral manifestations of lupus.

    Science.gov (United States)

    Menzies, S; O'Shea, F; Galvin, S; Wynne, B

    2018-02-01

    Mucosal involvement is commonly seen in patients with lupus; however, oral examination is often forgotten. Squamous cell carcinoma arising within oral lupoid plaques has been described, emphasizing the importance of identifying and treating oral lupus. We undertook a retrospective single-centre study looking at oral findings in patients attending our multidisciplinary lupus clinic between January 2015 and April 2016. A total of 42 patients were included. The majority of patients were female (88%) and had a diagnosis of discoid lupus erythematosus (62%). Half of the patients had positive oral findings, 26% had no oral examination documented, and 24% had documented normal oral examinations. Our findings suggest that oral pathology is common in this cohort of patients. Regular oral examination is warranted to identify oral lupus and provide treatment. Associated diseases such as Sjogren's syndrome may also be identified. Patients should be encouraged to see their general dental practitioners on a regular basis for mucosal review. Any persistent ulcer that fails to respond to treatment or hard lump needs urgent histopathological evaluation to exclude malignant transformation to squamous cell carcinoma.

  13. Radiation induced oral mucositis

    Directory of Open Access Journals (Sweden)

    P S Satheesh Kumar

    2009-01-01

    Full Text Available Patients receiving radiotherapy or chemotherapy will receive some degree of oral mucositis The incidence of oral mucositis was especially high in patients: (i With primary tumors in the oral cavity, oropharynx, or nasopharynx; (ii who also received concomitant chemotherapy; (iii who received a total dose over 5,000 cGy; and (iv who were treated with altered fractionation radiation schedules. Radiation-induced oral mucositis affects the quality of life of the patients and the family concerned. The present day management of oral mucositis is mostly palliative and or supportive care. The newer guidelines are suggesting Palifermin, which is the first active mucositis drug as well as Amifostine, for radiation protection and cryotherapy. The current management should focus more on palliative measures, such as pain management, nutritional support, and maintenance, of good oral hygiene

  14. Oral microbiota and cancer

    OpenAIRE

    Meurman, Jukka H.

    2010-01-01

    Inflammation caused by infections may be the most important preventable cause of cancer in general. However, in the oral cavity the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites and certain oral bacterial species have been linked with malignancies but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the...

  15. Towards understanding oral health.

    Science.gov (United States)

    Zaura, Egija; ten Cate, Jacob M

    2015-01-01

    During the last century, dental research has focused on unraveling the mechanisms behind various oral pathologies, while oral health was typically described as the mere absence of oral diseases. The term 'oral microbial homeostasis' is used to describe the capacity of the oral ecosystem to maintain microbial community stability in health. However, the oral ecosystem itself is not stable: throughout life an individual undergoes multiple physiological changes while progressing through infancy, childhood, adolescence, adulthood and old age. Recent discussions on the definition of general health have led to the proposal that health is the ability of the individual to adapt to physiological changes, a condition known as allostasis. In this paper the allostasis principle is applied to the oral ecosystem. The multidimensionality of the host factors contributing to allostasis in the oral cavity is illustrated with an example on changes occurring in puberty. The complex phenomenon of oral health and the processes that prevent the ecosystem from collapsing during allostatic changes in the entire body are far from being understood. As yet individual components (e.g. hard tissues, microbiome, saliva, host response) have been investigated, while only by consolidating these and assessing their multidimensional interactions should we be able to obtain a comprehensive understanding of the ecosystem, which in turn could serve to develop rational schemes to maintain health. Adapting such a 'system approach' comes with major practical challenges for the entire research field and will require vast resources and large-scale multidisciplinary collaborations. 2015 S. Karger AG, Basel

  16. Global Oral Health Inequalities

    Science.gov (United States)

    Garcia, I.; Tabak, L.A.

    2011-01-01

    Despite impressive worldwide improvements in oral health, inequalities in oral health status among and within countries remain a daunting public health challenge. Oral health inequalities arise from a complex web of health determinants, including social, behavioral, economic, genetic, environmental, and health system factors. Eliminating these inequalities cannot be accomplished in isolation of oral health from overall health, or without recognizing that oral health is influenced at multiple individual, family, community, and health systems levels. For several reasons, this is an opportune time for global efforts targeted at reducing oral health inequalities. Global health is increasingly viewed not just as a humanitarian obligation, but also as a vehicle for health diplomacy and part of the broader mission to reduce poverty, build stronger economies, and strengthen global security. Despite the global economic recession, there are trends that portend well for support of global health efforts: increased globalization of research and development, growing investment from private philanthropy, an absolute growth of spending in research and innovation, and an enhanced interest in global health among young people. More systematic and far-reaching efforts will be required to address oral health inequalities through the engagement of oral health funders and sponsors of research, with partners from multiple public and private sectors. The oral health community must be “at the table” with other health disciplines and create opportunities for eliminating inequalities through collaborations that can harness both the intellectual and financial resources of multiple sectors and institutions. PMID:21490232

  17. Oral microbiota and cancer

    Directory of Open Access Journals (Sweden)

    Jukka H. Meurman

    2010-08-01

    Full Text Available Inflammation caused by infections may be the most important preventable cause of cancer in general. However, in the oral cavity the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites and certain oral bacterial species have been linked with malignancies but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the complex metabolic pathways and may thus be involved in carcinogenesis. Poor oral health associates statistically with prevalence of many types of cancer, such as pancreatic and gastrointestinal cancer. Furthermore, several oral micro-organisms are capable of converting alcohol to carcinogenic acetaldehyde which also may partly explain the known association between heavy drinking, smoking, poor oral health and the prevalence of oral and upper gastrointestinal cancer. A different problem is the cancer treatment-caused alterations in oral microbiota which may lead to the emergence of potential pathogens and subsequent other systemic health problems to the patients. Hence clinical guidelines and recommendations have been presented to control oral microbiota in patients with malignant disease, but also in this area the scientific evidence is weak. More controlled studies are needed for further conclusion.

  18. African Journal of Oral Health Sciences

    African Journals Online (AJOL)

    The African Journal of Oral Health Sciences is devoted to research into oral diseases and encourages a multidisciplinary approach. Emphasis is on oral pathology, oral microbiology, oral medicine, oral physiology and biochemistry and related clinical sciences.

  19. Oral candidosis in relation to oral immunity.

    Science.gov (United States)

    Feller, L; Khammissa, R A G; Chandran, R; Altini, M; Lemmer, J

    2014-09-01

    Symptomatic oral infection with Candida albicans is characterized by invasion of the oral epithelium by virulent hyphae that cause tissue damage releasing the inflammatory mediators that initiate and sustain local inflammation. Candida albicans triggers pattern-recognition receptors of keratinocytes, macrophages, monocytes and dendritic cells, stimulating the production of IL-1β, IL-6 and IL-23. These cytokines induce the differentiation of Th17 cells and the generation of IL-17- and/or IL-22-mediated antifungal protective immuno-inflammatory responses in infected mucosa. Some immune cells including NKT cells, γδ T cells and lymphoid cells that are innate to the oral mucosa have the capacity to produce large quantities of IL-17 in response to C. albicans, sufficient to mediate effective protective immunity against C. albicans. On the other hand, molecular structures of commensal C. albicans blastoconidia, although detected by pattern-recognition receptors, are avirulent, do not invade the oral epithelium, do not elicit inflammatory responses in a healthy host, but induce regulatory immune responses that maintain tissue tolerance to the commensal fungi. The type, specificity and sensitivity of the protective immune response towards C. albicans is determined by the outcome of the integrated interactions between the intracellular signalling pathways of specific combinations of activated pattern-recognition receptors (TLR2, TLR4, Dectin-1 and Dectin-2). IL-17-mediated protective immune response is essential for oral mucosal immunity to C. albicans infection. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Effect of Osteonecrosis Intervention Rod Versus Core Decompression Using Multiple Small Drill Holes on Early Stages of Necrosis of the Femoral Head: A Prospective Study on a Series of 60 Patients with a Minimum 1-Year-Follow-Up.

    Science.gov (United States)

    Miao, Haixiong; Ye, Dongping; Liang, Weiguo; Yao, Yicun

    2015-01-01

    The conventional CD used 10 mm drill holes associated with a lack of structural support. Thus, alternative methods such as a tantalum implant, small drill holes, and biological treatment were developed to prevent deterioration of the joint. The treatment of CD by multiple 3.2 mm drill holes could reduce the femoral neck fracture and partial weight bearing was allowed. This study was aimed to evaluate the effect of osteonecrosis intervention rod versus core decompression using multiple small drill holes on early stages of necrosis of the femoral head. From January 2011 to January 2012, 60 patients undergoing surgery for osteonecrosis with core decompression were randomly assigned into 2 groups based on the type of core decompression used: (1) a total of 30 osteonecrosis patients (with 16 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with a porous tantalum rod insertion. The diameter of the drill hole for the intervention rod was 10mm.(2) a total of 30 osteonecrosis patients (with 14 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with core decompression using five drill holes on the lateral femur, the diameter of the hole was 3.2 mm. The average age of the patient was 32.6 years (20-45 years) and the average time of follow-up was 25.6 months (12- 28 months) in the rod implanted group. The average age of the patient was 35.2 years (22- 43 years) and the average time of follow-up was 26.3 months (12-28 months) in the small drill holes group. The average of surgical time was 40 min, and the mean volume of blood loss was 30 ml in both surgical groups. The average of Harris score was improved from 56.2 ± 7.1 preoperative to 80.2 ± 11.4 at the last follow-up in the rod implanted group (p holes group (pholes group. No significant difference was observed in radiographic stage between the two groups. There was no favourable result on the outcome of a tantalum intervention implant compared to multiple small drill holes. CD via

  1. Uso de células troncales mesenquimales derivadas de la grasa y plasma rico en plaquetas para el tratamiento preventivo de osteonecrosis de los maxilares relacionada con la toma de bisfosfonatos. Estudio experimental en ratas

    OpenAIRE

    Barba Recreo, Paula

    2018-01-01

    Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 8-09-2017 La osteonecrosis de los maxilares relacionada con la toma de bisfosfonatos (BRONJ) es una patología de frecuencia creciente, asociada a estos fármacos antirresortivos de amplio uso. El principal reto en el manejo de BRONJ es la ausencia de un tratamiento efectivo establecido. El objetivo de este trabajo fue comparar diferentes tratamiento...

  2. Sarcoidosis: Oral and extra-oral manifestation

    Directory of Open Access Journals (Sweden)

    Sanjay Gupta

    2015-01-01

    Full Text Available Sarcoidosis is a multisystem granulomatous disease, which is usually associated with the formation of noncaseating granulomas in affected tissues and organs. It is mostly present with bilateral hilar lymphadenopathy, pulmonary infiltration, ocular, and cutaneous lesions. Oral manifestations of this disease are relatively rare. The present case report shows a 40-year-old male with lesions in the soft tissue of oral cavity (buccal mucosa, gingiva, and palate and a diagnosis of sarcoidosis was established following hematological, biochemical and pulmonary function tests, chest radiograph, and histopathological investigation.

  3. Oral cavity and jaw

    International Nuclear Information System (INIS)

    Solntsev, A.M.; Koval', G.Yu.

    1984-01-01

    Radioanatome of oral cavity and jaw is described. Diseases of the teeth, jaw, large salivary glands, temporo-mandibular articulation are considered. Roentgenograms of oral cacity and jaw of healthy people are presented and analyzed as well as roentgenograms in the above-mentioned diseases

  4. Oral Microbiology and Immunology

    DEFF Research Database (Denmark)

    Dahlén, Gunnar; Fiehn, Nils-Erik; Olsen, Ingar

    , dental assistants and trainees may find it a useful source of reference. The contents are based on general microbiology and immunology. Oral microbiology is given particular attention, with examples relevant to oral infectious diseases. Each chapter opens with a relatively short pre-reading section...

  5. Brachytherapy for oral cancer

    International Nuclear Information System (INIS)

    Monzen, Yoshio; Ajimu, Akira; Morikawa, Minoru; Hayashi, Nobuyuki; Yoshida, Shintarou; Ashizawa, Kazuto; Hayashi, Kuniaki; Ikenaga, Kouji; Sakamoto, Ichirou.

    1988-01-01

    13 cases with oral cancer were treated using brachytherapy at the Department of Radiology, Nagasaki University Hospital from September 1985 to February 1988. Among 11 cases of tongue cancer, T1 and T2 cases were well controlled by radiation therapy using 226 Ra needles. Cancer of oral floor and buccal mucosa were controlled by the use of 192 Au grains. (author)

  6. [Three-dimensional gait analysis of patients with osteonecrosis of femoral head before and after treatments with vascularized greater trochanter bone flap].

    Science.gov (United States)

    Cui, Daping; Zhao, Dewei

    2011-03-01

    To provide the objective basis for the evaluation of the operative results of vascularized greater trochanter bone flap in treating osteonecrosis of the femoral head (ONFH) by three-dimensional gait analysis. Between March 2006 and March 2007, 35 patients with ONFH were treated with vascularized greater trochanter bone flap, and gait analysis was made by using three-dimensional gait analysis system before operation and at 1, 2 years after operation. There were 23 males and 12 females, aged 21-52 years (mean, 35.2 years), including 8 cases of steroid-induced, 7 cases of traumatic, 6 cases of alcoholic, and 14 cases of idiopathic ONFH. The left side was involved in 15 cases, and right side in 20 cases. According to Association Research Circulation Osseous (ARCO) classification, all patients were diagnosed as having femoral-head necrosis at stage III. Preoperative Harris hip functional score (HHS) was 56.2 +/- 5.6. The disease duration was 1.5-18.6 years (mean, 5.2 years). All incisions healed at stage I without early postoperative complications of deep vein thrombosis and infections of incision. Thirty-five patients were followed up 2-3 years with an average of 2.5 years. At 2 years after operation, the HHS score was 85.8 +/- 4.1, showing significant difference when compared with the preoperative score (t = 23.200, P = 0.000). Before operation, patients showed a hip muscles gait, short gait, reduce pain gait, and the pathological gaits significantly improved at 1 year after operation. At 1 year and 2 years after operation, step frequency, pace, step length and hip flexion, hip extension, knee flexion, ankle flexion were significantly improved (P petronas wave appeared at swing phase; the preoperative situation was three normal phase waves. These results suggest that three-dimensional gait analysis before and after vascularized greater trochanter for ONFH can evaluate precisely hip vitodynamics variation.

  7. Associations of IGFBP3 Gene Polymorphism and Gene Expression with the Risk of Osteonecrosis of the Femoral Head in a Han Population in Northern China.

    Science.gov (United States)

    Song, Yang; Du, Zhenwu; Yang, Qiwei; Ren, Ming; Sui, Yujie; Wang, Qingyu; Wang, Ao; Zhao, Haiyue; Wang, Jincheng; Zhang, Guizhen

    2016-12-01

    The critical roles of IGFBP3 in regulating the osteogenic and adipogenic differentiation of bone marrow mesenchymal stem cells strongly indicate its potential effects on the pathogenesis of osteonecrosis of the femoral head (ONFH). In this study, we investigated the association of IGFBP3 gene polymorphism and its protein expression with the development of ONFH to further explore its molecular pathogenesis. Ligase detection reactions and enzyme-linked immunosorbent assay were used to detect the polymorphisms of rs2453839[C/T] and rs3110697[A/G] and the serum protein expression of IGFBP3 gene in 182 cases and 179 controls, respectively. The serum lipids level was also measured by automatic biochemistry analyzer. The results revealed that the recessive model of rs3110697 and the dominant model of rs2453839 were significantly associated with the increased risk of ONFH (p = 0.048, p = 0.047, respectively). The genotypes of rs2453839 were also significantly related to the clinical stages of ONFH (p = 0.017). More importantly, the serum protein expression of IGFBP3 and insulin-like growth factor 1 (IGF1) in the ONFH group were statistically increased compared with the control group (p = 0.044, p = 0.007). The serum triglyceride and low-density lipoprotein cholesterol level in the ONFH group were significantly higher than the control group (p = 0.01, p = 0.005, respectively), but the serum high-density lipoprotein cholesterol level of the ONFH group was dramatically lower than the control group (p = 0.0001). Our results showed that both the gene polymorphisms of IGFBP3 and the abnormal protein expression of serum IGFBP3 and IGF1 closely associated with the development of ONFH.

  8. Evaluation of femoral perfusion using dynamic contrast-enhanced MRI after simultaneous initiation of electrical stimulation and steroid treatment in an osteonecrosis model.

    Science.gov (United States)

    Yamamoto, Hiroki; Ueshima, Keiichiro; Saito, Masazumi; Ikoma, Kazuya; Ishida, Masashi; Goto, Tsuyoshi; Hayashi, Shigeki; Ikegami, Akira; Fujioka, Mikihiro; Mazda, Osam; Kubo, Toshikazu

    2018-04-30

    This study aimed to evaluate femoral perfusion using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for two weeks after the simultaneous initiation of electrical stimulation (ES) and steroid treatment in a steroid-induced osteonecrosis (ON) model. A single dose of methylprednisolone was injected into 14 rabbits. Seven rabbits underwent ES (ES group), and seven rabbits did not (control group). DCE-MRI was performed before steroid administration and 1, 5, 10, and 14 days after steroid administration. Regions of interest were set in the bilateral proximal femora. The enhancement ratio, initial slope, and area under the curve were analyzed. These parameters were evaluated after steroid administration in each group and between the two groups, and the ratios of ON in both groups were compared. In the control group, the minimum values of all parameters decreased significantly after steroid administration (P < 0.05), but in the ES group, the parameters did not decrease. In the ES group, all parameter values were significantly increased on the 10th and 14th days (P < 0.05). All parameter values in the ES group were significantly higher than those in the control group on the 14th day (P < 0.05). In the control group, ON was detected in three of five rabbits (in three of ten femora). In the ES group, ON was not detected. These results suggest that increased femoral blood flow elicited by ES may be related to ON prevention after steroid administration.

  9. A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head.

    Science.gov (United States)

    Kuroda, Yutaka; Asada, Ryuta; So, Kazutaka; Yonezawa, Atsushi; Nankaku, Manabu; Mukai, Kumi; Ito-Ihara, Toshiko; Tada, Harue; Yamamoto, Michio; Murayama, Toshinori; Morita, Satoshi; Tabata, Yasuhiko; Yokode, Masayuki; Shimizu, Akira; Matsuda, Shuichi; Akiyama, Haruhiko

    2016-08-01

    We evaluated the safety and clinical outcomes of a single local administration of gelatin hydrogel impregnated with recombinant human fibroblast growth factor (rhFGF)-2 for the treatment of the precollapse stage of osteonecrosis of the femoral head (ONFH). Patients with ONFH (precollapse stage ≤2) received a single local administration of 800 μg of rhFGF-2-impregnated gelatin hydrogel and were followed up for one year. The surgery was performed using a minimally invasive technique involving a 1-cm skin incision, and walking was allowed from day one postoperatively. The primary outcomes included occurrence of adverse events and complications. The secondary outcomes included changes in the Harris hip scores, visual analog scale for pain scores, University of California, Los Angeles (UCLA) activity scores, and radiological images. We included ten patients, of which five experienced 14 adverse events, including one complication from spinal anesthesia. However, patients completely recovered from all adverse events. The mean clinical scores significantly improved by one year postoperatively compared with the pre-operative scores (before vs. after: visual analog score for pain, 21.2 vs. 5.3 mm; UCLA activity score, 5.5 vs. 6.6; Harris hip score, 81.0 vs. 96.9 points). There was only one case of femoral head collapse; however, this occurred in a hip with extensive necrosis. Stage progression and collapse did not occur in the other nine cases. Computed tomography confirmed bone regeneration in the femoral heads. Clinical application of rhFGF-2-impregnated gelatin hydrogel for patients with precollapse ONFH was feasible and safe.

  10. Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

    International Nuclear Information System (INIS)

    Vande Berg, Bruno C.; Gilon, Raphael; Malghem, Jacques; Lecouvet, Frederic; Depresseux, Genevieve; Houssiau, Frederic A.

    2006-01-01

    Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p = 0.0298). Conclusion: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy

  11. Is Administration of Trastuzumab an Independent Risk Factor for Developing Osteonecrosis of the Jaw Among Metastatic Breast Cancer Patients Under Zoledronic Acid Treatment?

    Science.gov (United States)

    Pilanci, Kezban Nur; Alco, Gul; Ordu, Cetin; Sarsenov, Dauren; Celebi, Filiz; Erdogan, Zeynep; Agacayak, Filiz; Ilgun, Serkan; Tecimer, Coskun; Demir, Gokhan; Eralp, Yesim; Okkan, Sait; Ozmen, Vahit

    2015-01-01

    Abstract One of the most important adverse effects of zoledronic acid (ZA) is osteonecrosis of the jaw (ONJ). In previous literature, several risk factors have been identified in the development of ONJ. In this study, we aimed to determine the role of trastuzumab, an antiangiogenic agent, as an independent risk factor for the development of this serious side effect. Our study included 97 patients (mean age: 54 ± 10 years) with breast cancer, recorded in the archives of the Istanbul Florence Nightingale Breast Study Group, who received ZA therapy due to bone metastases between March 2006 and December 2013. We recorded the patients’ ages, weights, duration of treatment with ZA, number of ZA infusions, dental procedures, anticancer treatments (chemotherapy, aromatase inhibitor, trastuzumab), the presence of diabetes mellitus or renal dysfunction, and smoking habits. Thirteen patients (13.40%) had developed ONJ. Among the patients with ONJ, the mean time of exposure to ZA was 41 months (range: 13–82) and the mean number of ZA infusions was 38 (range: 15–56). The duration of treatment with ZA and the use of trastuzumab were observed to be 2 factors that influenced the development of ONJ (P = 0.049 and P = 0.028, respectively). The development of ONJ under ZA treatment may be associated solely with the duration of ZA treatment and the concurrent administration of trastuzumab. These findings show that patients who are administered trastuzumab for metastatic breast cancer while undergoing ZA treatment are prone to developing ONJ. Therefore, we recommend intense clinical observation to avoid this particular condition in patients receiving ZA and trastuzumab. PMID:25950681

  12. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  13. American Academy of Oral Medicine

    Science.gov (United States)

    ... Statements Newsletters AAOM: Representing the Discipline of Oral Medicine Oral Medicine is the discipline of dentistry concerned with the ... offers credentialing, resources and professional community for oral medicine practitioners. Our membership provides care to thousands. We ...

  14. What Is an Oral Piercing?

    Science.gov (United States)

    ... to your desktop! more... What Is an Oral Piercing? Article Chapters What Is an Oral Piercing? print full article print this chapter email this article Oral piercing can cause pain, swelling, infection, drooling, taste loss, ...

  15. Bilateral femoral head avascular necrosis with a very low dose of oral corticosteroid used for panhypopituitarism.

    Science.gov (United States)

    Dharmshaktu, Pramila; Aggarwal, Anshita; Dutta, Deep; Kulshreshtha, Bindu

    2016-01-13

    Avascular necrosis (AVN) of the femoral head is a rare complication related to glucocorticoid administration and traditionally has been associated with high doses and/or prolonged therapy. Occurrence of osteonecrosis with a physiological replacement dose of glucocorticoids has not been reported previously. We report a 38-year-old man with non-secreting pituitary adenoma who developed bilateral AVN while on a very small dose of oral prednisolone for secondary adrenal insufficiency after surgery for pituitary adenoma. The patient was switched to hydrocortisone. Zolindronic acid was administered and the patient underwent bilateral core decompressive surgery resulting in a reduction of hip pain and improvement. When last evaluated, 2 years after diagnosis of AVN, the patient was functionally independent, and was able to do his routine activities with mild pain. The report intends to highlight the occurrence of AVN of the femur even with a very small dose of prednisolone used for treatment of panhypopituitarism. Glucocorticoids may have to be continued in the lowest possible dose using the most physiological preparation such as hydrocortisone when stoppage is not possible. 2016 BMJ Publishing Group Ltd.

  16. Bilateral femoral head avascular necrosis with a very low dose of oral corticosteroid used for panhypopituitarism

    Science.gov (United States)

    Dharmshaktu, Pramila; Aggarwal, Anshita; Dutta, Deep; Kulshreshtha, Bindu

    2016-01-01

    Avascular necrosis (AVN) of the femoral head is a rare complication related to glucocorticoid administration and traditionally has been associated with high doses and/or prolonged therapy. Occurrence of osteonecrosis with a physiological replacement dose of glucocorticoids has not been reported previously. We report a 38-year-old man with non-secreting pituitary adenoma who developed bilateral AVN while on a very small dose of oral prednisolone for secondary adrenal insufficiency after surgery for pituitary adenoma. The patient was switched to hydrocortisone. Zolindronic acid was administered and the patient underwent bilateral core decompressive surgery resulting in a reduction of hip pain and improvement. When last evaluated, 2 years after diagnosis of AVN, the patient was functionally independent, and was able to do his routine activities with mild pain. The report intends to highlight the occurrence of AVN of the femur even with a very small dose of prednisolone used for treatment of panhypopituitarism. Glucocorticoids may have to be continued in the lowest possible dose using the most physiological preparation such as hydrocortisone when stoppage is not possible. PMID:26762348

  17. Literatura Oral Hispanica (Hispanic Oral Literature).

    Science.gov (United States)

    McAlpine, Dave

    As part of a class in Hispanic Oral Literature, students collected pieces of folklore from various Hispanic residents in the region known as "Siouxland" in Iowa. Consisting of some of the folklore recorded from the residents, this paper includes 18 "cuentos y leyendas" (tales and legends), 48 "refranes" (proverbs), 17…

  18. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Oral and maxillofacial surgeons surgically treat the soft tissues of the face, mouth ... involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial ...

  19. Design and methods for a Scandinavian pharmacovigilance study of osteonecrosis of the jaw and serious infections among cancer patients treated with antiresorptive agents for the prevention of skeletal-related events

    DEFF Research Database (Denmark)

    Acquavella, John; Ehrenstein, Vera; Schiødt, Morten

    2016-01-01

    OBJECTIVE: Osteonecrosis of the jaw (ONJ) is a recognized complication of potent antiresorptive therapies, especially at the doses indicated to prevent skeletal complications for cancer patients with bone metastases. This paper describes the rationale and methods for a prospective, post-authoriza......OBJECTIVE: Osteonecrosis of the jaw (ONJ) is a recognized complication of potent antiresorptive therapies, especially at the doses indicated to prevent skeletal complications for cancer patients with bone metastases. This paper describes the rationale and methods for a prospective, post...... (120 mg subcutaneously) or zoledronic acid (4 mg intravenously, adjusted for renal function). Patients will be identified using routinely collected data combined with medical chart review in Denmark, Sweden, and Norway. Followup will extend from the first administration of antiresorptive treatment...... to the earliest of death, loss-to-follow-up, or 5 years after therapy initiation. Results will be reported for three treatment cohorts: denosumab-naïve patients, zoledronic acid-naïve patients, and patients who switch from bisphosphonate treatment to denosumab. ONJ cases will be identified in three newly...

  20. Examining the association between oral health and oral HPV infection.

    Science.gov (United States)

    Bui, Thanh Cong; Markham, Christine M; Ross, Michael Wallis; Mullen, Patricia Dolan

    2013-09-01

    Oral human papillomavirus (HPV) infection is the cause of 40% to 80% of oropharyngeal cancers; yet, no published study has examined the role of oral health in oral HPV infection, either independently or in conjunction with other risk factors. This study examined the relation between oral health and oral HPV infection and the interactive effects of oral health, smoking, and oral sex on oral HPV infection. Our analyses comprised 3,439 participants ages 30 to 69 years for whom data on oral HPV and oral health were available from the nationally representative 2009-2010 National Health and Nutrition Examination Survey. Results showed that higher unadjusted prevalence of oral HPV infection was associated with four measures of oral health, including self-rated oral health as poor-to-fair [prevalence ratio (PR) = 1.56; 95% confidence interval (CI), 1.25-1.95], indicated the possibility of gum disease (PR = 1.51; 95% CI, 1.13-2.01), reported use of mouthwash to treat dental problems in the past week (PR = 1.28; 95% CI, 1.07-1.52), and higher number of teeth lost (Ptrend = 0.035). In multivariable logistic regression models, oral HPV infection had a statistically significant association with self-rated overall oral health (OR = 1.55; 95% CI, 1.15-2.09), independent of smoking and oral sex. In conclusion, poor oral health was an independent risk factor of oral HPV infection, irrespective of smoking and oral sex practices. Public health interventions may aim to promote oral hygiene and oral health as an additional measure to prevent HPV-related oral cancers.

  1. Prevention of gingival trauma : Oral hygiene devices and oral piercings

    NARCIS (Netherlands)

    Hoenderdos, N.L.

    2017-01-01

    Maintaining healthy teeth and soft oral tissues for life is important. Oral hygiene devices and oral piercings can damage the soft oral tissues. This thesis investigates the safety of manual toothbrushes, interdental brushes and rubber bristles interdental cleaners by analysing the gingival abrasion

  2. Cromolyn Oral Inhalation

    Science.gov (United States)

    ... your doctor.Cromolyn oral inhalation helps to prevent asthma attacks (sudden episodes of shortness of breath, wheezing, and coughing) but will not stop an asthma attack that has already started. Your doctor will prescribe ...

  3. Intravenous versus oral etoposide

    DEFF Research Database (Denmark)

    Ali, Abir Salwa; Grönberg, Malin; Langer, Seppo W.

    2018-01-01

    High-grade gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs, G3) are aggressive cancers of the digestive system with poor prognosis and survival. Platinum-based chemotherapy (cisplatin/carboplatin + etoposide) is considered the first-line palliative treatment. Etoposide is frequently...... administered intravenously; however, oral etoposide may be used as an alternative. Concerns for oral etoposide include decreased bioavailability, inter- and intra-patient variability and patient compliance. We aimed to evaluate possible differences in progression-free survival (PFS) and overall survival (OS......) in patients treated with oral etoposide compared to etoposide given as infusion. Patients (n = 236) from the Nordic NEC study were divided into three groups receiving etoposide as a long infusion (24 h, n = 170), short infusion (≤ 5 h, n = 33) or oral etoposide (n = 33) according to hospital tradition. PFS...

  4. Fostering oral presentation performance

    NARCIS (Netherlands)

    Ginkel, van Stan; Gulikers, Judith; Biemans, Harm; Mulder, Martin

    2017-01-01

    Previous research revealed significant differences in the effectiveness of various feedback sources for encouraging students’ oral presentation performance. While former studies emphasised the superiority of teacher feedback, it remains unclear whether the quality of feedback actually differs

  5. Oral Cancer Foundation

    Science.gov (United States)

    ... Get involved Understanding Dental Research People Resources About Understanding Events Get involved Dental Research Resources Contact Sitemap The Oral Cancer Foundation admin 2017-11-12T16:49:25+ ...

  6. Maintaining women's oral health.

    Science.gov (United States)

    McCann, A L; Bonci, L

    2001-07-01

    Women must adopt health-promoting strategies for both general health and the oral cavity, because the health of a woman's body and oral cavity are bidirectional. For general health-maintenance strategies, dental practitioners should actively advise women to minimize alcohol use, abstain from or cease smoking, stay physically active, and choose the right foods to nourish both the body and mind. For oral health-maintenance strategies, dental practitioners should advise women on how to prevent or control oral infections, particularly dental caries and periodontal diseases. Specifically, women need to know how to remove plaque from the teeth mechanically, use appropriate chemotherapeutic agents and dentifrices, use oral irrigation, and control halitosis. Dental practitioners also need to stress the importance of regular maintenance visits for disease prevention. Adolescent women are more prone to gingivitis and aphthous ulcers when they begin their menstrual cycles and need advice about cessation of tobacco use, mouth protection during athletic activities, cleaning orthodontic appliances, developing good dietary habits, and avoiding eating disorders. Women in early to middle adulthood may be pregnant or using oral contraceptives with concomitant changes in oral tissues. Dental practitioners need to advise them how to take care of the oral cavity during these changes and how to promote the health of their infants, including good nutrition. Older women experience the onset of menopause and increased vulnerability to osteoporosis. They may also experience xerostomia and burning mouth syndrome. Dental practitioners need to help women alleviate these symptoms and encourage them to continue good infection control and diet practices.

  7. ON ORAL CANCER

    Directory of Open Access Journals (Sweden)

    P. V. Svetitsky

    2012-01-01

    Full Text Available The paper analyzes a rise in the incidence of oral cancer in the Rostov Region since the 1990s. The study has indicated that this rise is associated with regional population growth due to the forced migrants after the collapse of the USSR. Financial problems, unbalanced nutrition, poor oral hygiene, and depression in this group of patients have contributed to the higher incidence of precancers and cancers.

  8. Oral vs. salivary diagnostics

    Science.gov (United States)

    Marques, Joana; Corby, Patricia M.; Barber, Cheryl A.; Abrams, William R.; Malamud, Daniel

    2015-05-01

    The field of "salivary diagnostics" includes studies utilizing samples obtained from a variety of sources within the oral cavity. These samples include; whole unstimulated saliva, stimulated whole saliva, duct saliva collected directly from the parotid, submandibular/sublingual glands or minor salivary glands, swabs of the buccal mucosa, tongue or tonsils, and gingival crevicular fluid. Many publications state "we collected saliva from subjects" without fully describing the process or source of the oral fluid. Factors that need to be documented in any study include the time of day of the collection, the method used to stimulate and collect the fluid, and how much fluid is being collected and for how long. The handling of the oral fluid during and post-collection is also critical and may include addition of protease or nuclease inhibitors, centrifugation, and cold or frozen storage prior to assay. In an effort to create a standard protocol for determining a biomarker's origin we carried out a pilot study collecting oral fluid from 5 different sites in the mouth and monitoring the concentrations of pro- and anti-inflammatory cytokines detected using MesoScaleDiscovery (MSD) electrochemiluminesence assays. Our data suggested that 3 of the cytokines are primarily derived from the submandibular gland, while 7 of the cytokines come from a source other than the major salivary glands such as the minor salivary glands or cells in the oral mucosae. Here we review the literature on monitoring biomarkers in oral samples and stress the need for determining the blood/saliva ratio when a quantitative determination is needed and suggest that the term oral diagnostic be used if the source of an analyte in the oral cavity is unknown.

  9. Immunologically mediated oral diseases

    OpenAIRE

    Jimson, Sudha; Balachader, N.; Anita, N.; Babu, R.

    2015-01-01

    Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect imm...

  10. Determinants of Oral Health: Does Oral Health Literacy Matter?

    OpenAIRE

    Naghibi Sistani, Mohammad Mehdi; Yazdani, Reza; Virtanen, Jorma; Pakdaman, Afsaneh; Murtomaa, Heikki

    2013-01-01

    Objective. To evaluate oral health literacy, independent of other oral health determinants, as a risk indicator for self-reported oral health. Methods. A cross-sectional population-based survey conducted in Tehran, Iran. Multiple logistic regression analysis served to estimate the predictive effect of oral health literacy on self-reported oral health status (good versus poor) controlling for socioeconomic and demographic factors and tooth-brushing behavior. Results. In all, among 1031 partici...

  11. Oral Carcinogenesis and Oral Cancer Chemoprevention: A Review

    OpenAIRE

    Tanaka, Takuji; Tanaka, Mayu; Tanaka, Takahiro

    2011-01-01

    Oral cancer is one of the major global threats to public health. The development of oral cancer is a tobacco-related multistep and multifocal process involving field cancerization and carcinogenesis. The rationale for molecular-targeted prevention of oral cancer is promising. Biomarkers of genomic instability, including aneuploidy and allelic imbalance, are possible to measure the cancer risk of oral premalignancies. Understanding of the biology of oral carcinogenesis will yield important adv...

  12. Oral microbiome and oral and gastrointestinal cancer risk

    OpenAIRE

    Ahn, Jiyoung; Chen, Calvin Y.; Hayes, Richard B.

    2012-01-01

    A growing body of evidence implicates human oral bacteria in the etiology of oral and gastrointestinal cancers. Epidemiological studies consistently report increased risks of these cancers in men and women with periodontal disease or tooth loss, conditions caused by oral bacteria. More than 700 bacterial species inhabit the oral cavity, including at least 11 bacterial phyla and 70 genera. Oral bacteria may activate alcohol and smoking-related carcinogens locally or act systemically, through c...

  13. Ethnicity and oral cancer.

    Science.gov (United States)

    Scully, C; Bedi, R

    2000-09-01

    Oral squamous-cell carcinoma, the main type of oral cancer, is among the ten most common cancers in the world. The aims of this paper were first, to consider whether there was evidence of marked ethnic variations in the incidence, management, and survival of oral cancer, and then, to review possible explanations for these variations. Evidence from the literature suggests that there is marked, inter-country variation in both the incidence and mortality from oral cancer. There is also growing evidence of intracountry ethnic differences, mostly reported in the UK and USA. These variations among ethnic groups have been attributed mainly to specific risk factors, such as alcohol and tobacco (smoking and smokeless), but dietary factors and the existence of genetic predispositions may also play a part. Variations in access to care services are also an apparent factor. The extent of ethnic differences in oral cancer is masked by the scarcity of information available. Where such data are accessible, there are clear disparities in both incidence and mortality of oral cancer between ethnic groups.

  14. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  15. Head, Neck, and Oral Cancer

    Science.gov (United States)

    ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  16. Strengthening of oral health systems

    DEFF Research Database (Denmark)

    Petersen, Poul Erik

    2014-01-01

    is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral...... diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work......Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care...

  17. R & D of an Innovative Composite Scaffold Incorporated with Phytoestrogenic Icaritin for Treatment of Steroid-associated Osteonecrosis Lesion in Rabbits

    Science.gov (United States)

    Xie, Xinhui

    Bone defect is a common orthopaedic problem caused by many pathologic disorders such as tumor, trauma or metabolic diseases, including osteonecrosis (ON). ON is a disabling clinical condition characterized by the death of osteocytes, aggregation of marrow fat cells, a decrease in activity of bone marrow stem cells (BMSCs) pool, and degeneration of trabecular bone matrix, which affect more frequently young adults that usually leads to bone and articular cartilage destruction in joints, especially in hip and knee. High dose of steroid is one of the risk factors associated with ON, which sometimes is used for treatment of some medical conditions such as systemic lupus erythematosus (SLE), organ transplantation, asthma, rheumatologic arthritis (RA), and severe acute respiratory syndrome (SARS). Core decompression has been efficacious for treatment of early ON stages when the necrotic lesion is still small in size. However, ON lesion, weakens the cancellous bone within and adjacent to the necrotic region. Thus orthopaedic challenges in repair for steroid-associated ON lesion after core decompression may include the impaired osteogenic potential of stem-cell-pool under the influence of pulsed steroid and lack of platform for bone or/and neovascularization ingrowth after removal of large size necrotic bone. The proposed strategies for treatment of steroid-associated ON lesion are to provide biocompatible scaffold with required structure to fill the defect area after core decompression and osteogenic stimulator facilitating the repair of ON lesion. Previous works show that the PLGA (poly-lactic glycolic acid) and TCP (tricalcium phosphate) have good biocompatibility, osteoconduction and biodegradation to be used in bone defect repair, however no significant osteopromotive effects. Many endogenous factors are osteopromotive and also eventually osteoinductive, such as bone morphogenic proteins (BMPs). As an extraneous molecular, Icaritin, a small molecule derived from

  18. ORAL MYIASIS CONVERTING TO ORAL SQUAMOUS CELL CARCINOMA

    Directory of Open Access Journals (Sweden)

    Akshay

    2015-10-01

    Full Text Available INTRODUCTION: Oral Myiasis, a condition of infestation of the body by fly larvae (maggots is a rare pathology in humans. It is associated with poor oral hygiene, alcoholism, senility, suppurating lesions, severe halitosis. It is seen frequently in tropical countries and hot climatic regions. The reported cases in literature of oral Myiasis associated with oral cancer are few. The treatment is a mechanical removal of the maggots but a systemic treatment with Ivermectin, a semi - synthetic macrolide antibiotic, has been used successfully for treatment for oral m yiasis. We present a case of 55 yr old male alcoholic patient with oral myiasis with extensive proliferative growth of oral cavity. Our patient was managed with manual debridement and administration of systemic ivermect in along with antibiotic coverage. Incisional biopsy of the proliferative lesion showed well differentiated squamous cell carcinoma. Thus our patient showed presence of oral myiasis in association with oral squamous cell carcinoma.

  19. Whole-body MR imaging in children with suspected osteonecrosis after intensive chemotherapy: preliminary results; Ganzkoerper-MRT bei Kindern mit Verdacht auf Osteonekrose nach intensiver Chemotherapie: Erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Beer, M.; Stenzel, M.; Darge, K. [Universitaetsklinikum Wuerzburg (Germany). Inst. fuer Roentgendiagnostik; Girschick, H.; Schlegel, P.G. [Universitaetsklinikum Wuerzburg (Germany). Kinderklinik

    2008-03-15

    Purpose: use of multidrug chemotherapy poses the risk of avascular osseous necroses in children. Depiction of the whole body, including clinically non-apparent sites is mandatory for starting early and proper treatment, including surgical approaches in lesions near the joints. We analyzed the value of whole-body MRI in the detection of osteonecrosis, (1) in relation to conventional X-ray imaging and clinical symptoms, (2) using different MRI sequences, (3) with follow-up examinations. Materials and methods: 5 patients suffering from an oncological disease, 13 to 16 years old (3 x ALL, 1 x medulloblastoma, 1 x CML), and recently developing bone pain were examined with X-ray imaging of the particular region and a whole-body MRI (T2w TIRM, T1w TSE sequences, pre- and post-contrast GD-DTPA, including fat suppression techniques). Neck/thorax/abdomen/pelvis, and upper and lower extremities were acquired in the coronal plane, and the feet in sagittal orientation. 4 of 5 patients had at least one follow-up examination (in the mean after 10 {+-} 4 months). Results: none of the initial X-ray images revealed an abnormal finding. The whole-body MRI showed in 4 of 5 children bone marrow lesions compatible with osteonecrosis. The locations were around the knee joints (n = 3) and the tibiae/ankle joints (n = 4). In addition to the symptomatic sites, MRI revealed additional lesions at the following sites: humerus (n = 5), hip joints (n = 4), knee joints (n = 6), ankle joints (n = 4). The size varied from small focal lesions to lesions measuring 90% of the whole transverse diameter of the bone. The lesions were able to be detected most easily with heavily T2-weighted (TIRM) sequences, and the diagnosis was most easily established using the non-enhanced TSE T1-weighted sequences. As a consequence of the results of the whole-body MRI, all patients with lesions compatible with osteonecrosis received symptomatic (n = 2) or specific (n = 2) therapy. In the follow-up examinations, a

  20. Communication among Oral Bacteria

    Science.gov (United States)

    Kolenbrander, Paul E.; Andersen, Roxanna N.; Blehert, David S.; Egland, Paul G.; Foster, Jamie S.; Palmer, Robert J.

    2002-01-01

    Human oral bacteria interact with their environment by attaching to surfaces and establishing mixed-species communities. As each bacterial cell attaches, it forms a new surface to which other cells can adhere. Adherence and community development are spatiotemporal; such order requires communication. The discovery of soluble signals, such as autoinducer-2, that may be exchanged within multispecies communities to convey information between organisms has emerged as a new research direction. Direct-contact signals, such as adhesins and receptors, that elicit changes in gene expression after cell-cell contact and biofilm growth are also an active research area. Considering that the majority of oral bacteria are organized in dense three-dimensional biofilms on teeth, confocal microscopy and fluorescently labeled probes provide valuable approaches for investigating the architecture of these organized communities in situ. Oral biofilms are readily accessible to microbiologists and are excellent model systems for studies of microbial communication. One attractive model system is a saliva-coated flowcell with oral bacterial biofilms growing on saliva as the sole nutrient source; an intergeneric mutualism is discussed. Several oral bacterial species are amenable to genetic manipulation for molecular characterization of communication both among bacteria and between bacteria and the host. A successful search for genes critical for mixed-species community organization will be accomplished only when it is conducted with mixed-species communities. PMID:12209001

  1. [Oral health in pregnancy].

    Science.gov (United States)

    Blagojević, Duska; Brkanić, Tatjana; Stojić, Sinisa

    2002-01-01

    Good oral health care during pregnancy is essential but often overlooked factor of dental growth as well as of other structures of oral cavity. Pregnancy is the time when conscious approach to preventive oral care should increase. Preventive measures during pregnancy mean usage of fluorides, special dietary measures and increased oral hygiene habits. Preventive measures in pregnant women have one goal: providing conditions for development of fetal teeth as well as preventing tooth decay in pregnant women. The optimal period for introducing preventive measures is the first trimester of pregnancy. Because of hormonal alterations there is an increased incidence of dental diseases: gingivitis and low salivary pH (inflammation and bleeding gums). Eating habits of pregnant women may lead to frequent snacking on candy or other decay-promoting foods, thereby increasing the risk of caries. However, very poor oral health, possible dental complications and their consequences to the health as well as emotional status represent very strong reasons for activation of dental health care in this period.

  2. The Oral Microbiota.

    Science.gov (United States)

    Arweiler, Nicole B; Netuschil, Lutz

    2016-01-01

    The oral microbiota represents an important part of the human microbiota, and includes several hundred to several thousand diverse species. It is a normal part of the oral cavity and has an important function to protect against colonization of extrinsic bacteria which could affect systemic health. On the other hand, the most common oral diseases caries, gingivitis and periodontitis are based on microorganisms. While (medical) research focused on the planktonic phase of bacteria over the last 100 years, it is nowadays generally known, that oral microorganisms are organised as biofilms. On any non-shedding surfaces of the oral cavity dental plaque starts to form, which meets all criteria for a microbial biofilm and is subject to the so-called succession. When the sensitive ecosystem turns out of balance - either by overload or weak immune system - it becomes a challenge for local or systemic health. Therefore, the most common strategy and the golden standard for the prevention of caries, gingivitis and periodontitis is the mechanical removal of this biofilms from teeth, restorations or dental prosthesis by regular toothbrushing.

  3. Oral health during pregnancy.

    Science.gov (United States)

    Silk, Hugh; Douglass, Alan B; Douglass, Joanna M; Silk, Laura

    2008-04-15

    Oral health care in pregnancy is often avoided and misunderstood by physicians, dentists, and patients. Evidence-based practice guidelines are still being developed. Research suggests that some prenatal oral conditions may have adverse consequences for the child. Periodontitis is associated with preterm birth and low birth weight, and high levels of cariogenic bacteria in mothers can lead to increased dental caries in the infant. Other oral lesions, such as gingivitis and pregnancy tumors, are benign and require only reassurance and monitoring. Every pregnant woman should be screened for oral risks, counseled on proper oral hygiene, and referred for dental treatment when necessary. Dental procedures such as diagnostic radiography, periodontal treatment, restorations, and extractions are safe and are best performed during the second trimester. Xylitol and chlorhexidine may be used as adjuvant therapy for high-risk mothers in the early postpartum period to reduce transmission of cariogenic bacteria to their infants. Appropriate dental care and prevention during pregnancy may reduce poor prenatal outcomes and decrease infant caries.

  4. Canine oral melanoma.

    Science.gov (United States)

    Bergman, Philip J

    2007-05-01

    Melanoma is the most common oral malignancy in the dog. Oral and/or mucosal melanoma has been routinely considered an extremely malignant tumor with a high degree of local invasiveness and high metastatic propensity. Primary tumor size has been found to be extremely prognostic. The World Health Organization staging scheme for dogs with oral melanoma is based on size, with stage I = or = 4cm tumor and/or lymph node metastasis, and stage IV = distant metastasis. Median survival times for dogs with oral melanoma treated with surgery are approximately 17 to 18, 5 to 6, and 3 months with stage I, II, and III disease, respectively. Significant negative prognostic factors include stage, size, evidence of metastasis, and a variety of histologic criteria. Standardized treatments such as surgery, coarse-fractionation radiation therapy, and chemotherapy have afforded minimal to modest stage-dependent clinical benefits and death is usually due to systemic metastasis. Numerous immunotherapeutic strategies have been employed to date with limited clinical efficacy; however, the use of xenogeneic DNA vaccines may represent a leap forward in clinical efficacy. Oral melanoma is a spontaneous syngeneic cancer occurring in outbred, immunocompetent dogs and appears to be a more clinically faithful therapeutic model for human melanoma; further use of canine melanoma as a therapeutic model for human melanoma is strongly encouraged. In addition, the development of an expanded but clinically relevant staging system incorporating the aforementioned prognostic factors is also strongly encouraged.

  5. Oral pregnancy tumor

    Directory of Open Access Journals (Sweden)

    Shailesh M Gondivkar

    2010-01-01

    Full Text Available Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous growth on a pedunculated or sometimes sessile base, which is usually hemorrhagic. Although excisional surgery is the treatment of choice , some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroids, and sodium tetradecyl sulfate sclerotherapy have been proposed. We present the case of a 25-year-old pregnant woman with large oral pyogenic granuloma.

  6. Shared Oral Care

    DEFF Research Database (Denmark)

    Hede, Børge; Elmelund Poulsen,, Johan; Christophersen, Rasmus

    2014-01-01

    Shared Oral Care - Forebyggelse af orale sygdomme på plejecentre Introduktion og formål: Mangelfuld mundhygiejne hos plejekrævende ældre er et alment og veldokumenteret sundhedsproblem, der kan føre til massiv udvikling af tandsygdomme, og som yderligere kan være medvirkende årsag til alvorlige...... ressourceanvendelse er muligt at skabe en betydeligt forbedret mundhygiejne hos plejekrævende ældre Key words: Geriatric dentistry, nursing home, community health services, prevention, situated learning...

  7. Oral lichen planus

    International Nuclear Information System (INIS)

    Rasool, S.; Katpar, S.; Ali, A.

    2007-01-01

    Lichen planus is a mucocutaneous dermatological disorder, with intraoral manifestation. Skin lesions prevail with oral mucosal lesions. Prevalence of lichen planus, as an oral pre-malignant lesion, is 1-2 % population. Lateral border, dorsal tongue, gingiva, hard palate and vermilion border are common sites and lesions appear as reticular, plaque-like and papular intraoral types. Skin presents with pururitic, polygonal papules. Atrophic and erosive are the known intraoral pre-malignant types. A case report is presented, which responded well to steroid therapy. (author)

  8. Dysbaric osteonecrosis (caisson disease of bone): are active oxygen species and the endocrine system responsible, and can control of the production of free radicals and their reaction products confer protection?

    Science.gov (United States)

    Jones, G R

    1987-01-01

    The development of osteonecrosis after exposure to altered air pressures is consistent with cellular injury brought about by active oxygen species. The syndrome is considered to arise as a result of an unusual combination of circumstances in which hyperoxia itself, together with the additive responses of the endocrine system to hyperoxia, hypothermia and exertion, each appear to play a part; the net result is thought to increase the mitochondrial generation of superoxide. It is suggested that effective prophylaxis may be possible primarily by establishing a nutritional status that is adequate to ensure that the functional activities of radical-scavenging systems are not hampered by deficiencies either of essential trace elements or of vitamin E. Pharmacological pretreatments designed both to decrease excessive levels of superoxide through increased catalysis of anionic dismutation and to attenuate enzyme-dependent peroxidation may provide an additional line of defence.

  9. Inequalities in oral health and oral health promotion

    OpenAIRE

    Moysés, Samuel Jorge

    2012-01-01

    This article offers a critical review of the problem of inequalities in oral health and discusses strategies for disease prevention and oral health promotion. It shows that oral health is not merely a result of individual biological, psychological, and behavioral factors; rather, it is the sum of collective social conditions created when people interact with the social environment. Oral health status is directly related to socioeconomic position across the socioeconomic gradient in almost all...

  10. Probiotics as oral health biotherapeutics.

    Science.gov (United States)

    Saha, Shyamali; Tomaro-Duchesneau, Catherine; Tabrizian, Maryam; Prakash, Satya

    2012-09-01

    Oral health is affected by its resident microorganisms. Three prominent oral disorders are dental caries, gingivitis and periodontitis, with the oral microbiota playing a key role in the initiation/progression of all three. Understanding the microbiota and the diseases they may cause is critical to the development of new therapeutics. This review is focused on probiotics for the prevention and/or treatment of oral diseases. This review describes the oral ecosystem and its correlation with oral health/disease. The pathogenesis and current prevention/treatment strategies of periodontal diseases (PD) and dental caries (DC) are depicted. An introduction of probiotics is followed by an analysis of their role in PD and DC, and their potential role(s) in oral health. Finally, a discussion ensues on the future research directions and limitations of probiotics for oral health. An effective oral probiotic formulation should contribute to the prevention/treatment of microbial diseases of the oral cavity. Understanding the oral microbiota's role in oral disease is important for the development of a therapeutic to prevent/treat dental diseases. However, investigations into clinical efficacy, delivery/dose optimization, mechanism(s) of action and other related parameters are yet to be fully explored. Keeping this in mind, investigations into oral probiotic therapies are proving promising.

  11. Oral hygiene practices and risk of oral leukoplakia | Macigo | East ...

    African Journals Online (AJOL)

    Objective: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. Design: Case control study. Setting: Githongo sublocation in Meru District. Subjects: Eighty five cases and 141 controls identified in a house-to-house screening. Results: The relative risk (RR) of oral ...

  12. Metabolomic Studies of Oral Biofilm, Oral Cancer, and Beyond

    Directory of Open Access Journals (Sweden)

    Jumpei Washio

    2016-06-01

    Full Text Available Oral diseases are known to be closely associated with oral biofilm metabolism, while cancer tissue is reported to possess specific metabolism such as the ‘Warburg effect’. Metabolomics might be a useful method for clarifying the whole metabolic systems that operate in oral biofilm and oral cancer, however, technical limitations have hampered such research. Fortunately, metabolomics techniques have developed rapidly in the past decade, which has helped to solve these difficulties. In vivo metabolomic analyses of the oral biofilm have produced various findings. Some of these findings agreed with the in vitro results obtained in conventional metabolic studies using representative oral bacteria, while others differed markedly from them. Metabolomic analyses of oral cancer tissue not only revealed differences between metabolomic profiles of cancer and normal tissue, but have also suggested a specific metabolic system operates in oral cancer tissue. Saliva contains a variety of metabolites, some of which might be associated with oral or systemic disease; therefore, metabolomics analysis of saliva could be useful for identifying disease-specific biomarkers. Metabolomic analyses of the oral biofilm, oral cancer, and saliva could contribute to the development of accurate diagnostic, techniques, safe and effective treatments, and preventive strategies for oral and systemic diseases.

  13. Oral Hygiene and Oral Flora Evaluation in Psychiatric Patients in ...

    African Journals Online (AJOL)

    Conclusions: The oral hygiene of most patients was insufficient. The presence of Gram‑negative Bacilli growth in the oral flora can be explained by poor hand hygiene. These findings suggest that it is useful to educate individuals about oral hygiene and hand hygiene and to inform the staff and families about this issue.

  14. The New Orality: Oral Characteristics of Computer-Mediated Communication.

    Science.gov (United States)

    Ferris, Sharmila Pixy; Montgomery, Maureen

    1996-01-01

    Considers the characteristics of orality and literacy developed in the work of scholars such as Walter Ong to consider computer-mediated communication (CMC) as the potential site of a "new orality" which is neither purely oral or literate. Notes that the medium of CMC is writing, which has traditionally represented the…

  15. Metabolomic Studies of Oral Biofilm, Oral Cancer, and Beyond.

    Science.gov (United States)

    Washio, Jumpei; Takahashi, Nobuhiro

    2016-06-02

    Oral diseases are known to be closely associated with oral biofilm metabolism, while cancer tissue is reported to possess specific metabolism such as the 'Warburg effect'. Metabolomics might be a useful method for clarifying the whole metabolic systems that operate in oral biofilm and oral cancer, however, technical limitations have hampered such research. Fortunately, metabolomics techniques have developed rapidly in the past decade, which has helped to solve these difficulties. In vivo metabolomic analyses of the oral biofilm have produced various findings. Some of these findings agreed with the in vitro results obtained in conventional metabolic studies using representative oral bacteria, while others differed markedly from them. Metabolomic analyses of oral cancer tissue not only revealed differences between metabolomic profiles of cancer and normal tissue, but have also suggested a specific metabolic system operates in oral cancer tissue. Saliva contains a variety of metabolites, some of which might be associated with oral or systemic disease; therefore, metabolomics analysis of saliva could be useful for identifying disease-specific biomarkers. Metabolomic analyses of the oral biofilm, oral cancer, and saliva could contribute to the development of accurate diagnostic, techniques, safe and effective treatments, and preventive strategies for oral and systemic diseases.

  16. Imaging in oral cancers

    International Nuclear Information System (INIS)

    Arya, Supreeta; Chaukar, Devendra; Pai, Prathamesh

    2012-01-01

    Oral cavity squamous cell cancers form a significant percentage of the cancers seen in India. While clinical examination allows direct visualization, it cannot evaluate deep extension of disease. Cross-sectional imaging has become the cornerstone in the pretreatment evaluation of these cancers and provides accurate information about the extent and depth of disease that can help decide the appropriate management strategy and indicate prognosis. Early cancers are treated with a single modality, either surgery or radiotherapy while advanced cancers are offered a combination of surgery, radiotherapy and chemotherapy. Imaging can decide resectability, help plan the precise extent of resection, and indicate whether organ conservation therapy should be offered. Quality of life issues necessitate preservation of form and function and pretreatment imaging helps plan appropriate reconstruction and counsel patients regarding lifestyle changes. Oral cavity has several subsites and the focus of the review is squamous cancers of the gingivobuccal region, oral tongue and retromolar trigone as these are most frequently encountered in the subcontinent. References for this review were identified by searching Medline and PubMed databases. Only articles published in English language literature were selected. This review aims to familiarize the radiologist with the relevant anatomy of the oral cavity, discuss the specific issues that influence prognosis and management at the above subsites, the optimal imaging methods, the role of imaging in accurately staging these cancers and in influencing management. A checklist for reporting will emphasize the information to be conveyed by the radiologist

  17. IDEA: Stimulating Oral Production.

    Science.gov (United States)

    Easley, Jacob J.

    1995-01-01

    Presents daily activities that facilitate complete sentence response, promote oral production, and aid the learning of vocabulary in foreign-language classes. Because speech is the primary form of communication in the foreign-language classroom, it is important to stimulate students to converse as soon as possible. (Author/CK)

  18. Fluoride and Oral Health

    DEFF Research Database (Denmark)

    O'Mullane, D M; Baez, R J; Jones, S

    2016-01-01

    and strategies is noteworthy. This updated version of ‘Fluoride and Oral Health’ has adopted an evidence-based approach to its commentary on the different fl uoride vehicles and strategies and also to its recommendations. In this regard, full account is taken of the many recent systematic reviews published...

  19. Oral Health and Women

    Centers for Disease Control (CDC) Podcasts

    2009-05-12

    This women's health podcast focuses on the importance of maintaining good oral health during pregnancy.  Created: 5/12/2009 by Office of Women’s Health (OWH) and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/12/2009.

  20. History of oral contraception.

    Science.gov (United States)

    Dhont, Marc

    2010-12-01

    On the 50th birthday of the pill, it is appropriate to recall the milestones which have led to its development and evolution during the last five decades. The main contraceptive effect of the pill being inhibition of ovulation, it may be called a small miracle that this drug was developed long before the complex regulation of ovulation and the menstrual cycle was elucidated. Another stumbling block on its way was the hostile climate with regard to contraception that prevailed at the time. Animal experiments on the effect of sex steroids on ovulation, and the synthesis of sex steroids and orally active analogues were the necessary preliminaries. We owe the development of oral contraceptives to a handful of persons: two determined feminists, Margaret Sanger and Katherine McCormick; a biologist, Gregory Pincus; and a gynaecologist, John Rock. Soon after the introduction of the first pills, some nasty and life-threatening side effects emerged, which were due to the high doses of sex steroids. This led to the development of new preparations with reduced oestrogen content, progestins with more specific action, and alternative administration routes. Almost every decade we have witnessed a breakthrough in oral contraception. Social and moral objections to birth control have gradually disappeared and, notwithstanding some pill scares, oral contraceptives are now one of the most used methods of contraception. Finally, all's well that ends well: recent reports have substantiated the multiple noncontraceptive health benefits paving the way for a bright future for this 50-year-old product.

  1. Oral Lichen Planus.

    Science.gov (United States)

    Ion, Daniela I; Setterfield, Jane F

    2016-02-01

    Lichen planus (LP) is a relatively common autoimmune T-cell-mediated disease of unknown aetiology affecting the mucous membranes, skin and nails. Its prevalence varies between 0.5 and 2.2% of the population in epidemiological studies with a peak incidence in the 30-60 years range and with a female predominance of 2:1. Mucosal lichen planus tends to follow a chronic course with acute exacerbations. Spontaneous remission of oral lichen planus (OLP) is uncommon, and indeed mucosal LP may become worse with time. In contrast, cutaneous lichen planus may follow a milder clinical course though some variants may be severe such as those affecting the palms and soles and the scalp and the genital tract in females (vulvovaginal gingival LP) where scarring leads to significant complications. It is important to identify those cases that may be drug induced or be associated with a contact allergic or irritant reaction (lichenoid reaction) or the rarer oral presentation of discoid lupus erythematosus. There is a very small risk of malignancy (approximately 1:200 patients/year) associated with oral lichen planus; thus patients should be informed that long term monitoring via their general dental practitioner is appropriate. This review will focus on the clinical presentation and management of oral lichen planus.

  2. Oral lichen planus

    Directory of Open Access Journals (Sweden)

    Šehalić Meliha

    2014-01-01

    Full Text Available 29 - year Lichen planus is a chronic, inflammatory, autoimmune skin disease, that is often manifested, except on the skin, in the oral cavity in a variety of clinical forms. The prevalence of the disease in the general population is about 1-2%. Etiopathogenesis is not still well understood. Histopathology, in addition to the basic methods, anamnesis and physical examination, is vital for proper diagnosis of oral lichen planus (OLP. Very diverse and loaded histological findings are common for all forms of oral lichen planus. We reported the case of oral lichen planus in a 49 years old male patient, who presented to the Dentistry clinic of Medical faculty of Priština with burning and itching symptoms and changes in the buccal mucosa. Histopathological analysis of biopsy tissue conformed clinical diagnosis of lichen planus. Due to the possibility for malignant transformation of lesions, the long-term follow-up of patients with this disease is of great importance.

  3. Porous bioceramic beta-tricalcium phosphate for treatment of osteonecrosis of the femoral head%磷酸三钙多孔生物陶瓷修复股骨头坏死

    Institute of Scientific and Technical Information of China (English)

    孙伟; 李子荣; 高福强; 史振才; 王佰亮; 郭万首

    2014-01-01

    BACKGROUND:It is a clinical difficult in the treatment of osteonecrosis with joint preservation, and to solve this problem, a variety of bone graft substitutes are at the exploration stage. OBJECTIVE:To evaluate the clinical outcome of lightbulb operation with porous bioceramic β-tricalcium phosphate in a consecutive series of patients with osteonecrosis of the femoral head. METHODS:From January to December 2008, 58 patients (88 hips) who had undergone lightbulb operation with porous bioceramic β-tricalcium phosphate were involved in this study. Al patients were evaluated both clinicaly and radiographicaly at postoperative 3, 6, 12 months and annualy. Functional improvement was assessed with the Harris hip score. RESULTS AND CONCLUSION: Among these patients, 56 patients (85 hips) were folowed up for 2-5 years. According to the ARCO staging system, there were 27 hips of stage II, 40 hips of stage IIIa, 18 hips of IIIb. According to the hospital’s classification, type C was in 4 hips, L1 in 15 hips, L2 in 28 hips, and L3 in 38 hips. According to the Harris hip score system, excelent outcome was in 55 hips, good in 12 hips, fair in 5 hips and poor in 13 hips. Nine of 11 patients who failed to preserve their own joints were subjected to hip replacement. The  mean preoperative and postoperative Harris scores were 61.2 and 85.3, respectively, with a mean improvement of 24.1 points (P < 0.001). All hips were radiologically stable, with no progress of osteonecrosis, and bone density in the bone graft area increased obviously. The replacement time of porous bioceramic β-tricalcium phosphate was 1-1.5 years. These findings suggest that the porous bioceramic β-tricalcium phosphate provides an option to treat osteonecrosis of the femoral head with satisfactory clinical outcomes, and profits the repair and reconstruction of femoral head osteonecrosis. When in the lateral column of femoral head, the porous bioceramic β-tricalcium phosphate can play a supporting role

  4. Antibiotics and oral contraceptives.

    Science.gov (United States)

    DeRossi, Scott S; Hersh, Elliot V

    2002-10-01

    With the exception of rifampin-like drugs, there is a lack of scientific evidence supporting the ability of commonly prescribed antibiotics, including all those routinely employed in outpatient dentistry, to either reduce blood levels and/or the effectiveness of oral contraceptives. To date, all clinical trials studying the effects of concomitant antibiotic therapy (with the exception of rifampin and rifabutin) have failed to demonstrate an interaction. Like all drugs, oral contraceptives are not 100% effective with the failure rate in the typical United States population reported to be as high as 3%. It is thus possible that the case reports of unintended pregnancies during antibiotic therapy may simply represent the normal failure rate of these drugs. Considering that both drug classes are prescribed frequently to women of childbearing potential, one would expect a much higher rate of oral contraceptive failure in this group of patients if a true drug:drug interaction existed. On the other hand, if the interaction does exist but is a relatively rare event, occurring in, say, 1 in 5000 women, clinical studies such as those described in this article would not detect the interaction. The pharmacokinetic studies of simultaneous antibiotic and oral contraceptive ingestion, and the retrospective studies of pregnancy rates among oral contraceptive users exposed to antibiotics, all suffer from one potential common weakness, i.e., their relatively small sample size. Sample sizes in the pharmacokinetic trials ranged from 7 to 24 participants, whereas the largest retrospective study of pregnancy rates still evaluated less than 800 total contraceptive users. Still, the incidence of such a rare interaction would not differ from the accepted normal failure rate of oral contraceptive therapy. The medico-legal ramifications of what looks like at best a rare interaction remains somewhat "murky." On one hand, we have medico-legal experts advising the profession to exercise caution

  5. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ...

  6. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to ... and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to ...

  7. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... mouth and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ... mouth and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ...

  8. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who We ... surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and oral ...

  9. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... and Neck Pathology Close to 49,750 Americans will be diagnosed with oral or pharyngeal cancer this ... and Neck Pathology Close to 49,750 Americans will be diagnosed with oral or pharyngeal cancer this ...

  10. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... tissues of the face, mouth and gums to improve function, appearance and oral health. Click here to ... tissues of the face, mouth and gums to improve function, appearance and oral health. Click here to ...

  11. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial ... and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial ...

  12. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ... and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ...

  13. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to ... in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to ...

  14. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  15. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... for further information Your oral and maxillofacial surgeon (OMS) is the expert for diagnosing and surgically treating ... late in its development. Your family dentist or OMS is in the best position to detect oral ...

  16. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ...

  17. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and ... education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and ...

  18. MRI of aseptic osteonecrosis in children with acute lymphoblastic leukemia; Kernspintomographie von aseptischen Osteonekrosen bei Kindern und Jugendlichen mit einer akuten lymphoblastischen Leukaemie

    Energy Technology Data Exchange (ETDEWEB)

    Engelbrecht, V.; Scherer, A.; Moedder, U. [Duesseldorf Univ. (Germany). Inst. fuer Diagnostische Radiologie; Bruder, M. [Duesseldorf Univ. (Germany). Kinderklinik; Koerholz, D. [Leipzig Univ. (Germany). Kinderonkologie

    2000-04-01

    Purpose: To evaluate the incidence, localisation, and course of symptomatic aseptic osteonecrosis (AON) in children undergoing treatment for acute lymphoblastic leukemia (ALL). Methods: 72 MRI examinations obtained from 26 children with bone pain selected from a group of 121 children with ALL were evaluated retrospectively. The area of the AON was determined by computer assisted planimetry. Follow-up examinations after 2-5 years were considered. Results: 10/121 (8.3%) of the children had symptomatic AON, the number of lesions varied between 1 and 24 per child. 62/66 lesions were localized within the lower extremities. 58% of the AON were positioned in the epiphysis and 42% in the meta- and diaphysis. The mean area of AON was 7.6 cm{sup 2} with a range of 0.5 to 50 cm{sup 2}. Follow-up examinations revealed a regression in 19 AON, no change in 43 and a progression in 4 lesions. AON within the epiphysis with joint involvement or lesions greater than 9 cm{sup 2} more frequently showed a progression of AON with final joint destruction. An elevated risk for AON was seen in children older than 10 years and in children with intensified chemotherapy due to high-risk ALL. Conclusion: AON is a common complication in ALL-children under chemotherapy. Most frequently, the course is benign but large AON with joint involvement have an elevated risk for progression of AON with final joint destruction. (orig.) [German] Ziel: Erfassung von Haeufigkeit, Lokalisation und Verlauf von symptomatischen aseptischen Osteonekrosen (AON) bei Kindern und Jugendlichen unter der Therapie einer akuten lymphoblastischen Leukaemie (ALL). Methoden: In einer Gruppe von 121 Kindern mit ALL (Alter 1-17 Jahre) wurden retrospektiv 72 MRT der Extremitaeten bei 26 Kindern mit Knochenschmerzen bezueglich der Zahl, Groesse und Lokalisation von AON ausgewertet. Die Flaeche von AON wurde planimetrisch bestimmt. Verlaufskontrollen erstreckten sich ueber 2-5 Jahre. Ergebnisse: 10/121 (8,3%) der Kinder wiesen

  19. Age-related oral changes.

    LENUS (Irish Health Repository)

    Mckenna, Gerald

    2010-10-01

    Age-related oral changes are seen in the oral hard and soft tissues as well as in bone, the temporomandibular joints and the oral mucosa. As older patients retain their natural teeth for longer, the clinical picture consists of normal physiological age changes in combination with pathological and iatrogenic effects. Clinical Relevance: With an ageing population retaining more of its natural teeth for longer, dental professionals should expect to observe oral age changes more frequently.

  20. Oral yeast colonization throughout pregnancy

    OpenAIRE

    Rio, Rute; Sim?es-Silva, Liliana; Garro, Sofia; Silva, M?rio-Jorge; Azevedo, ?lvaro; Sampaio-Maia, Benedita

    2017-01-01

    Background Recent studies suggest that placenta may harbour a unique microbiome that may have origin in maternal oral microbiome. Although the major physiological and hormonal adjustments observed in pregnant women lead to biochemical and microbiological modifications of the oral environment, very few studies evaluated the changes suffered by the oral microbiota throughout pregnancy. So, the aim of our study was to evaluate oral yeast colonization throughout pregnancy and to compare it with n...

  1. Oral Lichen Planus in Children

    OpenAIRE

    Mohan Das, Usha; JP, Beena

    2009-01-01

    Oral lichen planus which is one of the most common oral mucosal diseases in adults, it has been rarely described in children. There are very reports in the literature regarding oral lichen planus in children, here we report a case of intraoral lesions of lichen planus. Lichen planus should be considered in the differential diagnosis of hyperkeratotic or erosive lesions of the oral mucosa in children.

  2. Oral Biopsy: A Dental Gawk

    African Journals Online (AJOL)

    Sir,. Dermatologists are often confronted with neoplasms and diseases of the oral cavity. Although many may be reluctant to perform oral surgical procedures, a biopsy is often needed to establish a definitive diagnosis, and biopsy of the oral cavity is a safe and useful technique that can be easily employed by dermatologists.

  3. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... cancer of the head, neck and mouth. The Oral Cancer Foundation estimates that close to 42,000 Americans ... diagnosed with oral or pharyngeal cancer this year. Oral cancer’s mortality is particularly high, not because it is ...

  4. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Americans will be diagnosed with oral or pharyngeal cancer this year. Oral cancer’s mortality is particularly high, not because it is ... OMS is in the best position to detect oral cancer during your routine dental examinations. Don't risk ...

  5. Oral health: equity and social determinants

    DEFF Research Database (Denmark)

    Kwan, Stella; Petersen, Poul Erik

    2010-01-01

    This book chapter discusses the social determinants of oral health, and identifies interventions that have been, or can be, used in addressing oral health inequities (e.g. oral health promotion, education programmes, improving access to oral health care)....

  6. Scandinavian Fellowship for Oral Pathology and Oral Medicine

    DEFF Research Database (Denmark)

    Kragelund, Camilla; Reibel, J; Hietanen, J

    2012-01-01

    as new approaches, treatments and diagnostic possibilities develop. Likewise, the role of the dentist in the community changes and may vary in different countries. As members of the Scandinavian Fellowship for Oral Pathology and Oral Medicine and subject representatives of oral pathology and oral......In Scandinavia, as in many European countries, most patients consult their general dentist once a year or more. This gives the dentist a unique opportunity and an obligation to make an early diagnosis of oral diseases, which is beneficial for both the patient and the society. Thus, the dentist must...... medicine, we feel obliged to contribute to the discussion of how the guidelines of the dental curriculum support the highest possible standards of dental education. This article is meant to delineate a reasonable standard of oral pathology and oral medicine in the European dental curriculum and to guide...

  7. Effect of Fixed Metallic Oral Appliances on Oral Health.

    Science.gov (United States)

    Alnazzawi, Ahmad

    2018-01-01

    There is a substantial proportion of the population using fixed metallic oral appliances, such as crowns and bridges, which are composed of various dental alloys. These restorations may be associated with a number of effects on oral health with variable degrees of severity, to review potential effects of using fixed metallic oral appliances, fabricated from various alloys. The MEDLINE/PubMed database was searched using certain combinations of keywords related to the topic. The search revealed that burning mouth syndrome, oral pigmentation, hypersensitivity and lichenoid reactions, and genotoxic and cytotoxic effects are the major potential oral health changes associated with fixed prosthodontic appliances. Certain oral disorders are associated with the use of fixed metallic oral appliances. Patch test is the most reliable method that can be applied for identifying metal allergy, and the simultaneous use of different alloys in the mouth is discouraged.

  8. Bisphosphonates and osteonecrosis of jaws

    Directory of Open Access Journals (Sweden)

    Geetha Vijay

    2012-01-01

    The purpose of the present article is to enlighten the dental fraternity about this frequently prescribed class of drugs with regard to its types and mode of action, and the implication of bisphosphonates-induced ONJ.

  9. Osteonecrosis of the Jaw (ONJ)

    Science.gov (United States)

    ... in patients taking potent antiresorptive therapies. For instance, endodontic (root canal) treatment is preferred to dental extraction ... Corporate Relations Opportunities Exhibit Affiliate Events Industry Supported Sessions Mailing Lists Supporters About Us Leadership Careers at ...

  10. An orthodontic oral appliance.

    Science.gov (United States)

    Marklund, Marie; Legrell, Per Erik

    2010-11-01

    This pilot study was performed to test the hypothesis that an orthodontic oral appliance (OA) that is designed to work against the backwardly directed forces on the upper incisors may counteract the reduction in overjet from these devices. Thirty patients with normal bites, good oral health, and milder sleep apnea were randomized to treatment with either OAs or orthodontic OAs. Bite changes were evaluated on plaster casts and radiographs and by questionnaires after a mean of 2.4 years in 19 frequent users. Four of nine patients in the orthodontic OA group increased their overjet by > or =0.4 mm, while none of the 10 patients in the OA group experienced that effect. Only the orthodontic OA increases the overjet; this design may therefore be beneficial to patients at risk of negative effects on their bite during OA treatment.

  11. Immunologically mediated oral diseases.

    Science.gov (United States)

    Jimson, Sudha; Balachader, N; Anita, N; Babu, R

    2015-04-01

    Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect immunoflouresence, immune precipitation and immunoblotting. Therapeutic agents should be selected after thorough evaluation of immune status through a variety of tests and after determining any aggravating or provoking factors. Early and appropriate diagnosis is important for proper treatment planning contributing to better prognosis and better quality of life of patient.

  12. Immunologically mediated oral diseases

    Directory of Open Access Journals (Sweden)

    Sudha Jimson

    2015-01-01

    Full Text Available Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect immunoflouresence, immune precipitation and immunoblotting. Therapeutic agents should be selected after thorough evaluation of immune status through a variety of tests and after determining any aggravating or provoking factors. Early and appropriate diagnosis is important for proper treatment planning contributing to better prognosis and better quality of life of patient.

  13. Fluoride and Oral Health.

    Science.gov (United States)

    O'Mullane, D M; Baez, R J; Jones, S; Lennon, M A; Petersen, P E; Rugg-Gunn, A J; Whelton, H; Whitford, G M

    2016-06-01

    The discovery during the first half of the 20th century of the link between natural fluoride, adjusted fluoride levels in drinking water and reduced dental caries prevalence proved to be a stimulus for worldwide on-going research into the role of fluoride in improving oral health. Epidemiological studies of fluoridation programmes have confirmed their safety and their effectiveness in controlling dental caries. Major advances in our knowledge of how fluoride impacts the caries process have led to the development, assessment of effectiveness and promotion of other fluoride vehicles including salt, milk, tablets, toothpaste, gels and varnishes. In 1993, the World Health Organization convened an Expert Committee to provide authoritative information on the role of fluorides in the promotion of oral health throughout the world (WHO TRS 846, 1994). This present publication is a revision of the original 1994 document, again using the expertise of researchers from the extensive fields of knowledge required to successfully implement complex interventions such as the use of fluorides to improve dental and oral health. Financial support for research into the development of these new fluoride strategies has come from many sources including government health departments as well as international and national grant agencies. In addition, the unique role which industry has played in the development, formulation, assessment of effectiveness and promotion of the various fluoride vehicles and strategies is noteworthy. This updated version of 'Fluoride and Oral Health' has adopted an evidence-based approach to its commentary on the different fluoride vehicles and strategies and also to its recommendations. In this regard, full account is taken of the many recent systematic reviews published in peer reviewed literature.

  14. Per-oral cholangioscopy

    OpenAIRE

    Monga, Amitabh; Ramchandani, Mohan; Reddy, D Nageshwar

    2011-01-01

    Direct endoscopic views of bile duct have been described in literature since the 1970s. Since then rapid strides have been made with the advent of technologically advanced systems with better image quality and maneuverability. The single operator semi-disposable per-oral cholangioscope and other novel methods such as the cholangioscopy access balloon are likely to revolutionize this field. Even though cholangioscopy is currently used primarily for characterization of indeterminate strictures ...

  15. Challenges in Comparative Oral Epic

    Directory of Open Access Journals (Sweden)

    John Miles Foley

    2012-10-01

    Full Text Available Originally written in 2001 and subsequently published in China, this collaborative essay explores five questions central to comparative oral epic with regard to Mongolian, South Slavic, ancient Greek, and Old English traditions: “What is a poem in oral epic tradition?” “What is a typical scene or theme in oral epic tradition?” “What is a poetic line in oral epic tradition?” “What is a formula in an oral epic tradition?” “What is the register in oral epic poetry?” Now available for the first time in English, this essay reflects a foundational stage of what has become a productive and long-term collaboration between the Center for Studies in Oral Tradition and the Institute of Ethnic Literature of the Chinese Academy of Social Sciences.

  16. Fractal analysis in oral leukoplakia

    Directory of Open Access Journals (Sweden)

    Prashant Bhai Pandey

    2015-01-01

    Full Text Available Introduction: Fractal analysis (FA quantifies complex geometric structures by generating a fractal dimension (FD, which can measure the complexity of mucosa. FA is a quantitative tool used to measure the complexity of self-similar or semi-self-similar structures. Aim and Objective: The study was done to perform the FA of oral mucosa with keratotic changes, as it is also made up of self-similar tissues, and thus, its FD can be calculated. Results: In oral leukoplakia, keratinization increases the complexity of mucosa, which denotes fractal geometry. We evaluated and compared pretreated and post-treated oral leukoplakia in 50 patients with clinically proven oral leukoplakia and analyzed the normal oral mucosa and lesional or keratinized mucosa in oral leukoplakia patients through FA using box counting method. Conclusion: FA using the fractal geometry is an efficient, noninvasive prediction tool for early detection of oral leukoplakia and other premalignant conditions in patients.

  17. Evaluation of an ICD-10 algorithm to detect osteonecrosis of the jaw among cancer patients in the Danish National Registry of Patients

    DEFF Research Database (Denmark)

    Ehrenstein, Vera; Gammelager, Henrik; Schiødt, Morten

    2015-01-01

    recorded in 2005-2010 among cancer patients at the hospital Departments of Oral and Maxillofacial Surgery (DOMS) in three Danish regions, using a set of codes from the International Classification of Diseases, 10th revision (ICD-10). We abstracted DOMS charts of the potential cases, had the ONJ status...

  18. Oral cancer screening practices of oral health professionals in Australia.

    Science.gov (United States)

    Mariño, Rodrigo; Haresaku, Satoru; McGrath, Roisin; Bailey, Denise; Mccullough, Michael; Musolino, Ross; Kim, Boaz; Chinnassamy, Alagesan; Morgan, Michael

    2017-12-15

    To evaluate oral cancer-related screening practices of Oral Health Professionals (OHPs - dentists, dental hygienists, dental therapists, and oral health therapists) practising in Victoria, Australia. A 36-item survey was distributed to 3343 OHPs. Items included socio-demographic and work-related characteristics; self-assessed knowledge of oral cancer; perceived level of confidence in discussing oral health behaviors with patients; oral cancer screening practices; and self-evaluated need for additional training on screening procedures for oral cancer. A total of 380 OHPs responded this survey, achieving an overall response rate of 9.4%. Forty-five were excluded from further analysis. Of these 335 OHP, 72% were dentists; (n = 241); either GDP or Dental Specialists; 13.7% (n = 46) were dental hygienists; 12.2% (n = 41) were oral health therapists, and the remaining 2.1% (n = 7) were dental therapists. While the majority (95.2%) agreed that oral cancer screening should be routinely performed, in actual practice around half (51.4%) screened all their patients. Another 12.8% "Very rarely" conducted screening examinations. The probability of routinely conducting an oral cancer screening was explored utilising Logistic Regression Analysis. Four variables remained statistically significant (p oral cancer screening rose with increasing levels of OHPs' confidence in oral cancer-related knowledge (OR = 1.35; 95% CI: 1.09-1.67) and with higher levels of confidence in discussing oral hygiene practices with patients (OR = 1.25; 95% CI: 1.03-1.52). Results also showed that dental specialists were less likely to perform oral cancer screening examinations compared with other OHPs (OR = 0.18; 95% CI: 0.07-0.52) and the likelihood of performing an oral cancer screening decreased when the "patient complained of a problem" (OR = 0.21; 95% CI: 0.10-0.44). Only half the study sample performed oral cancer screening examinations for all of their patients

  19. Betel nut chewing, oral premalignant lesions, and the oral microbiome.

    Science.gov (United States)

    Hernandez, Brenda Y; Zhu, Xuemei; Goodman, Marc T; Gatewood, Robert; Mendiola, Paul; Quinata, Katrina; Paulino, Yvette C

    2017-01-01

    Oral cancers are attributed to a number of causal agents including tobacco, alcohol, human papillomavirus (HPV), and areca (betel) nut. Although betel nut chewing has been established as an independent cause of oral cancer, the mechanisms of carcinogenesis are poorly understood. An investigation was undertaken to evaluate the influence of betel nut chewing on the oral microbiome and oral premalignant lesions. Study participants were recruited from a dental clinic in Guam. Structured interviews and oral examinations were performed. Oral swabbing and saliva samples were evaluated by 454 pyrosequencing of the V3- V5 region of the 16S rRNA bacterial gene and genotyped for HPV. One hundred twenty-two adults were enrolled including 64 current betel nut chewers, 37 former chewers, and 21 with no history of betel nut use. Oral premalignant lesions, including leukoplakia and submucous fibrosis, were observed in 10 chewers. Within-sample bacterial diversity was significantly lower in long-term (≥10 years) chewers vs. never chewers and in current chewers with oral lesions vs. individuals without lesions. Between-sample bacterial diversity based on Unifrac distances significantly differed by chewing status and oral lesion status. Current chewers had significantly elevated levels of Streptococcus infantis and higher and lower levels of distinct taxa of the Actinomyces and Streptococcus genera. Long-term chewers had reduced levels of Parascardovia and Streptococcus. Chewers with oral lesions had significantly elevated levels of Oribacterium, Actinomyces, and Streptococcus, including Streptococcus anginosus. In multivariate analyses, controlling for smoking, oral HPV, S.anginosus, and S. infantis levels, current betel nut chewing remained the only predictor of oral premalignant lesions. Our study provides evidence that betel nut chewing alters the oral bacterial microbiome including that of chewers who develop oral premalignant lesions. Nonetheless, whether microbial changes

  20. Irradiation mucositis and oral flora

    International Nuclear Information System (INIS)

    Spijkervet, F.K.L.

    1989-01-01

    This study, which is motivated by the substantial morbidity of local signs of mucositis and generalized symptoms that result from mucositis induced by therapeutic irradiation, has the following objectives: To investigate if it is possible to prevent irradiation mucositis via oral flora elimination, and, if it is true that flora plays a role in irradiation mucositis, what fraction of the oral flora may be involved; to evaluate oral Gram-negative bacillary carriage; to investigate the possibility to eradicate Gram-negative bacilli from the oral cavity; to evaluate oral yeast carriage; to investigate the possibility to eradicate yeasts stomatitis and the 'selectivity' of elimination of flora. Two methods are described for monitoring alterations of mucositis of the oral cavity and changes in oral flora. Chlorhexidine has been tested as the commonly used prophylaxis. The effect of chlorhexidine 0.1% rinses on oral flora and mucositis has been studied in a prospective placebo controlled double blind randomized programme. The results of the influence of saliva on the antimicrobial activity of chlorhexidine and the results of selective elimination of oral flora in irradiated patients who have head and neck cancer are reported. Salivary inactivation of the topical antimicrobials used for selective elimination of oral flora has been studied and the results are reported. Finally, the objectives that have been achieved (or not) are delineated. The significance of the results of the study are discussed in terms of published information and further lines of research are suggested. (author). 559 refs.; 29 figs.; 20 tabs

  1. [New oral anticoagulant drugs].

    Science.gov (United States)

    Berkovits, Alejandro; Aizman, Andrés; Zúñiga, Pamela; Pereira, Jaime; Mezzano, Diego

    2011-10-01

    Thromboembolic disease (TED) is the leading cause of morbidity and mortality worldwide. The hallmark of oral long-term anticoagulant therapy has been the use of vitamin K antagonists, whose anticoagulant effect is exerted inhibiting vitamin K epoxide reductase. Warfarin and acenocoumarol are the most commonly used. In the last five years several new drugs for long term anticoagulation have been developed, which can inhibit single clotting factors with the purpose of improving drug therapeutic range and, ideally, minimizing bleeding risks. This review addresses the state of the art on the clinical use of inhibitors of activated factor X and thrombin.

  2. Oral complications in cancer patients

    International Nuclear Information System (INIS)

    Carl, W.

    1983-01-01

    Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications

  3. Drug Reactions in Oral Mucosa

    Directory of Open Access Journals (Sweden)

    Emine Derviş

    2012-12-01

    Full Text Available Both immunologic and nonimmunologic drug reactions can be seen in oral mucosa. Since considerable number of these reactions heals spontaneously without being noticed by the patients, exact frequency of the lesions is unknown. Most common lesions are xerostomia, taste disorders, mucosal ulcerations and edema. In this article, oral lesions resulting from drug intake similar to those from oral lesions of local and systemic diseases, and diagnostic problems caused by these similarities, have been reviewed.

  4. Oral cancer: A multicenter study.

    Science.gov (United States)

    Dhanuthai, K; Rojanawatsirivej, S; Thosaporn, W; Kintarak, S; Subarnbhesaj, A; Darling, M; Kryshtalskyj, E; Chiang, C-P; Shin, H-I; Choi, S-Y; Lee, S-S; Aminishakib, P

    2018-01-01

    To determine the prevalence and clinicopathologic features of the oral cancer patients. Biopsy records of the participating institutions were reviewed for oral cancer cases diagnosed from 2005 to 2014. Demographic data and site of the lesions were collected. Sites of the lesion were subdivided into lip, tongue, floor of the mouth, gingiva, alveolar mucosa, palate, buccal/labial mucosa, maxilla and mandible. Oral cancer was subdivided into 7 categories: epithelial tumors, salivary gland tumors, hematologic tumors, bone tumors, mesenchymal tumors, odontogenic tumors, and others. Data were analyzed by descriptive statistics using SPSS software version 17.0. Of the 474,851 accessioned cases, 6,151 cases (1.30%) were diagnosed in the category of oral cancer. The mean age of the patients was 58.37±15.77 years. A total of 4,238 cases (68.90%) were diagnosed in males, whereas 1911 cases (31.07%) were diagnosed in females. The male-to-female ratio was 2.22:1. The sites of predilection for oral cancer were tongue, labial/buccal mucosa, gingiva, palate, and alveolar mucosa, respectively. The three most common oral cancer in the descending order of frequency were squamous cell carcinoma, non-Hodgkin lymphoma and mucoepidermoid carcinoma. Although the prevalence of oral cancer is not high compared to other entities, oral cancer pose significant mortality and morbidity in the patients, especially when discovered late in the course of the disease. This study highlights some anatomical locations where oral cancers are frequently encountered. As a result, clinicians should pay attention to not only teeth, but oral mucosa especially in the high prevalence area as well since early detection of precancerous lesions or cancers in the early stage increase the chance of patient being cured and greatly reduce the mortality and morbidity. This study also shows some differences between pediatric and elderly oral cancer patients as well as between Asian and non-Asian oral cancer patients.

  5. Pathogenesis of oral FIV infection.

    Directory of Open Access Journals (Sweden)

    Craig Miller

    Full Text Available Feline immunodeficiency virus (FIV is the feline analogue of human immunodeficiency virus (HIV and features many hallmarks of HIV infection and pathogenesis, including the development of concurrent oral lesions. While HIV is typically transmitted via parenteral transmucosal contact, recent studies prove that oral transmission can occur, and that saliva from infected individuals contains significant amounts of HIV RNA and DNA. While it is accepted that FIV is primarily transmitted by biting, few studies have evaluated FIV oral infection kinetics and transmission mechanisms over the last 20 years. Modern quantitative analyses applied to natural FIV oral infection could significantly further our understanding of lentiviral oral disease and transmission. We therefore characterized FIV salivary viral kinetics and antibody secretions to more fully document oral viral pathogenesis. Our results demonstrate that: (i saliva of FIV-infected cats contains infectious virus particles, FIV viral RNA at levels equivalent to circulation, and lower but significant amounts of FIV proviral DNA; (ii the ratio of FIV RNA to DNA is significantly higher in saliva than in circulation; (iii FIV viral load in oral lymphoid tissues (tonsil, lymph nodes is significantly higher than mucosal tissues (buccal mucosa, salivary gland, tongue; (iv salivary IgG antibodies increase significantly over time in FIV-infected cats, while salivary IgA levels remain static; and, (v saliva from naïve Specific Pathogen Free cats inhibits FIV growth in vitro. Collectively, these results suggest that oral lymphoid tissues serve as a site for enhanced FIV replication, resulting in accumulation of FIV particles and FIV-infected cells in saliva. Failure to induce a virus-specific oral mucosal antibody response, and/or viral capability to overcome inhibitory components in saliva may perpetuate chronic oral cavity infection. Based upon these findings, we propose a model of oral FIV pathogenesis

  6. Oral yeast colonization throughout pregnancy.

    Science.gov (United States)

    Rio, R; Simões-Silva, L; Garro, S; Silva, M-J; Azevedo, Á; Sampaio-Maia, B

    2017-03-01

    Recent studies suggest that placenta may harbour a unique microbiome that may have origin in maternal oral microbiome. Although the major physiological and hormonal adjustments observed in pregnant women lead to biochemical and microbiological modifications of the oral environment, very few studies evaluated the changes suffered by the oral microbiota throughout pregnancy. So, the aim of our study was to evaluate oral yeast colonization throughout pregnancy and to compare it with non-pregnant women. The oral yeast colonization was assessed in saliva of 30 pregnant and non-pregnant women longitudinally over a 6-months period. Demographic information was collected, a non-invasive intra-oral examination was performed and saliva flow and pH were determined. Pregnant and non-pregnant groups were similar regarding age and level of education. Saliva flow rate did not differ, but saliva pH was lower in pregnant than in non-pregnant women. Oral yeast prevalence was higher in pregnant than in non-pregnant women, either in the first or in the third trimester, but did not attain statistical significance. In individuals colonized with yeast, the total yeast quantification (Log10CFU/mL) increase from the 1st to the 3rd trimester in pregnant women, but not in non-pregnant women. Pregnancy may favour oral yeast growth that may be associated with an acidic oral environment.

  7. Association between Oral Anticoagulation Knowledge ...

    African Journals Online (AJOL)

    Association between Oral Anticoagulation Knowledge, Anticoagulation Control, and Demographic Characteristics of Patients Attending an Anticoagulation Clinic in Saudi Arabia: A Cross-Sectional Prospective Evaluation.

  8. Spontaneous osteonecrosis of the knee joint: MR imaging before and after administration of gadopentetate-dimeglumine, comparison to CT, scintigraphy, and histology; Spontane Osteonekrose des Kniegelenkes: MRT im Vergleich zur CT, Szintigraphie und Histologie

    Energy Technology Data Exchange (ETDEWEB)

    Lang, P. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States); Grampp, S. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States); Vahlensieck, M. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)]|[Radiologische Klinik, Bonn Univ. (Germany); Mauz, M. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)]|[Radiologische Klinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Steiner, E. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Schwickert, H. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)]|[Radiologische Klinik, Universitaetsklinik Mainz (Germany); Gindele, A. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States); Felix, R. [Radiologische Klinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Genant, H.K. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)

    1995-06-01

    Eight patients with spontaneous osteonecrosis of the knee joint underwent MR imaging before and after i.v. administration of Gd-DTPA. Nuclear scintigraphy was performed in all 8 patients, three patients also had CT scans of the knee area. Histologic correlation was available in three patients. Increased radionuclide uptake was observed in all patients. In one patient, however, scintigraphy showed increased radionuclide uptake consistent with ostenecrosis only in the medial femoral condyle, while MR imaging demonstrated osteonecrosis both in the medial as well as the lateral femoral condyles. MR demonstrated areas of low signal intensity on precontrast T{sub 1}-weighted images in the femoral condyle in all patients. All these areas showed high signal intensity on T{sub 2}-weighted images. On postcontrast T{sub 1}-weighted images, signal intensity increase was either homogeneous throughout the lesion or it was seen at the periphery of the lesion in a band-like pattern. Histologically, the areas of high signal intensity on T{sub 2}-weighted and on postcontrast T{sub 1}-weighted images corresponded to granulation tissue. (orig./MG) [Deutsch] Wir untersuchten acht Patienten mit einer spontanen Osteonekrose des Kniegelenkes mit der MRT. Ein Vergleich zum szintigraphischen Befund wurde bei allen 8 Patienten und zur CT bei drei Patienten angestellt. Eine histologische Korrelation war bei drei Patienten moeglich. Bei allen 8 Patienten zeigten die T{sub 1}-gewichteten MR-Tomographien Zonen mit reduzierter Signalintensitaet in den Kondylen, waehrend die Laesionen in den T{sub 2}-gewichteten Aufnahmen eine hoehere Signalintensitaet als das normale Knochenmark hatten. Nach Gabe von Gd-DTPA war entweder eine homogene Signalerhoehung oder eine bandfoermige Signalintensitaetszunahme in der Peripherie der Laesion zu sehen. Die Zonen mit hoher Signalintensitaet in der T{sub 2}-gewichteten Aufnahme oder mit Kontrastmittelanreicherung entsprachen histologisch Granulationsgewebe an der

  9. ORAL ALLERGY SYNDROME

    Directory of Open Access Journals (Sweden)

    A. V. Sergeev

    2011-01-01

    Full Text Available Abstract. Oral allergy syndrome (OAS is defined as a set of clinical manifestations caused by IgE-mediated allergic  reactions  that  occur  at  oral  and  pharyngeal  mucosae  in  the  patients  with  pollen  sensitization  after ingestion of certain fruits, vegetables, nuts and spices. OAS arises from cross-reactivity between specific pollen and food allergens, due to similarity of a configuration and amino acid sequence of allergenic molecules. OAS is considered as class II food allergy, being caused by thermo- and chemolabile allergens, and it is rarely combined with generalized manifestations of food allergy. Prevalence and spectrum of the causal allergens depend on a kind of pollen sensitization. In Moscow region, as well as in Northern Europe, allergic sensitization most commonly occurs to the pollen of leaf trees, whereas OAS is mostly connected with ingestion of fruits from Rosaceae family and nuts. Since last years, a newly developed technique of component-resolved molecular diagnosis (CR diagnostics allows of more precise detection of OAS-causing allergen molecules. These data are of extreme importance for administration of adequate nutritional therapy and prediction of SIT efficiency. (Med. Immunol., 2011, vol. 13, N 1, pp 17-28

  10. Role of oral microbiome on oral cancers, a review.

    Science.gov (United States)

    Gholizadeh, Pourya; Eslami, Hosein; Yousefi, Mehdi; Asgharzadeh, Mohammad; Aghazadeh, Mohammad; Kafil, Hossein Samadi

    2016-12-01

    The oral cavity is inhibited by many of the bacterial species. Some of them have a key role in the development of oral disease. Interrelationships between oral microbiome and systemic conditions such as head-and-neck cancer have become increasingly appreciated in recent years. Emerging evidence also suggests a link between periodontal disease and oral cancer, and the explanation being that chronic inflammation could be a major factor in both diseases. Squamous cell carcinoma is that the most frequently occurring malignancy of the oral cavity and adjacent sites, representing over 90% of all cancers. The incidence of oral cancer is increasing, significantly among young people and women. Worldwide there are 350,000-400,000 new cases diagnosed every year. Bacteria, viruses, and fungi are strongly implicated as etiological factors in certain cancers. In this review we will discuss the association between the development of oral cancer in potentially malignant oral lesions with chronic periodontitis, chronic Porphyromonas gingivalis, Fusobacterium nucleatum, candida, other microbes and described mechanisms which may be involved in these carcinoma. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Oral Insulin – Fact or Fiction? - Possibilities of Achieving Oral ...

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 8; Issue 5. Oral Insulin – Fact or Fiction? - Possibilities of Achieving Oral Delivery of Insulin. K Gowthamarajan Giriraj T Kulkarni. General Article Volume 8 Issue 5 May 2003 pp 38-46 ...

  12. Can the oral microflora affect oral ulcerative mucositis?

    NARCIS (Netherlands)

    Laheij, A.M.G.A.; de Soet, J.J.

    2014-01-01

    Purpose of review: Oral mucositis is one of the most prevalent toxicities after hematopoietic stem cell transplantation. Mucositis is initiated by the chemotherapy or radiotherapy preceding the transplantation. It is commonly accepted that microorganisms play a role in the process of oral mucositis.

  13. Assessing Oral Hygiene in Hospitalized Older Veterans.

    Science.gov (United States)

    Jennings, Andrea

    2015-01-01

    Poor oral health for all older adults can result in higher risk for heart disease, stroke, diabetes, and oral cancer. Findings from this study indicated older veterans needed to improve their oral hygiene habits but barriers to oral hygiene performance prevented them from receiving and performing oral hygiene measures.

  14. Oral health in frail elderly

    NARCIS (Netherlands)

    Hoeksema, Albert

    2016-01-01

    Ageing points towards increasing health problems and rising costs for the society. One of these health problems is the deteriorating oral health in care dependent elderly. The latter is related to the high need for care on many levels in these elderly. The lack of attention for oral care can be

  15. Oral health problems and mortality

    Directory of Open Access Journals (Sweden)

    Jung Ki Kim

    2013-06-01

    Conclusion: Individual oral health conditions—tooth loss, root caries, and periodontal disease—were not related to mortality when sociodemographic, health, and/or health behavioral factors were considered, and there was no differential pattern between the three conditions. Multiple oral health problems were associated with a higher risk of dying.

  16. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... be diagnosed with oral or pharyngeal cancer this year. Here’s what you need to know. Click here ... be diagnosed with oral or pharyngeal cancer this year. Here’s what you need to know. Click here ...

  17. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... will be diagnosed with oral or pharyngeal cancer this year. Here’s what you need to know. Click here ... will be diagnosed with oral or pharyngeal cancer this year. Here’s what you need to know. Click here ...

  18. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... the cancer is often discovered late in its development. Your family dentist or OMS is in the best position to detect oral cancer during your routine dental examinations. Don't risk it. Perform an oral cancer self-exam each month. Perform a Self-Exam Monthly ...

  19. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Americans will be diagnosed with oral or pharyngeal cancer this year. Here’s what you need to know. ... Americans will be diagnosed with oral or pharyngeal cancer this year. Here’s what you need to know. ...

  20. BETTER ORAL HEALTH TO ALL

    Directory of Open Access Journals (Sweden)

    Heikki Murtomaa

    2016-12-01

    The behavioral science experts are of opinion that only comprehensive and integrated common-risk-factor-based health promotion activities can enhance oral health and its equity as a part of general health. Are health professionals ready to assume their responsibility for promoting better oral health?

  1. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ... more. TMJ and Facial Pain TMJ and Facial ... Teeth Management Wisdom Teeth Management An impacted wisdom tooth can ...

  2. Scandinavian Fellowship for Oral Pathology and Oral Medicine: statement on oral pathology and oral medicine in the European Dental Curriculum

    DEFF Research Database (Denmark)

    Kragelund, C; Reibel, J; Hadler-Olsen, E S

    2010-01-01

    source in revisions of dental curricula throughout Europe converging towards a European Dental Curriculum. In order to render the best conditions for future curriculum revisions providing the best quality dentist we feel obliged to analyse and comment the outlines of oral pathology and oral medicine...

  3. [Drug-induced oral ulcerations].

    Science.gov (United States)

    Madinier, I; Berry, N; Chichmanian, R M

    2000-06-01

    Different side effects of drugs have been described in the oral cavity, including oral ulcerations. Direct contact between drugs and oral mucosa may induce chemical burn or local hypersensitivity. Less frequently, these drug-induced oral ulcerations are part of a complex reaction with cutaneous or systemic manifestations. Sometimes, one or more oral ulcerations appear as the main side-effect of a drug, or exceptionally as solitary lesions. Solitary oral ulcerations usually appear after few weeks of treatment. In most of cases, these lesions resist to conventional treatments, with a rapid healing following the suppression of the responsible drug. This diagnosis is usually difficult, particularly with patients receiving multiple drug therapy. Besides, special attention must be paid to new drugs. Oral ulcerations following symptoms of burning mouth, metallic taste, dysgueusia or agueusia are strongly suggestive of a pharmacological origin. Most of the molecules able to induce solitary oral ulcerations are commonly prescribed in a) rheumatology: NSAI (diclofenac, flurbiprofen, indomethacin, naproxen), long-term rheumatoid arthritis therapy (azathioprine, methotrexate, penicillamine, gold compounds, tiopronin); b) cardiology: angiotensin-converting-enzyme inhibitors (captopril, enalapril), angiotensin 2-receptor antagonist (losartan), anti-angorous (nicorandil), c) psychiatry: antidepressants (fluoxetine, lithium), d) AIDS therapy (foscarnet, zalcitabine).

  4. The Oral Paradigm and Snapchat

    Directory of Open Access Journals (Sweden)

    Oren Soffer

    2016-09-01

    Full Text Available In this short essay, I argue that the ephemeral nature of emerging instant-messaging applications, such as Snapchat, applies an oral paradigm. While online discourse of computer-mediated communication shares many qualities with oral communication, the case of ephemeral applications is unique, as the oral features are already integrated in the application technology design and as orality is often implemented on highly visual products. Snapchat applies technology that fades visual contents as if they were spoken words fading in the air after utterance. Moreover, Snapchat’s promise to delete all messages from its database after they are viewed echoes a key characteristic of primary oral culture: that is, the inability (and in our case, the obligation not to store knowledge. In this, Snapchat demonstrates counter-logic to the contemporary grammar of new media, which is based on information aggregation.

  5. Direct oral anticoagulants: An update.

    Science.gov (United States)

    Franco Moreno, Ana Isabel; Martín Díaz, Rosa María; García Navarro, María José

    2017-12-30

    Vitamin K antagonists were the only choice for chronic oral anticoagulation for more than half a century. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). In randomised controlled trials comparing direct oral anticoagulants with traditional vitamin K antagonists, the direct oral anticoagulants all showed a favourable benefit-risk balance in their safety and efficacy profile, in prevention of thromboembolic events in patients with atrial fibrillation and in the prevention and treatment of venous thromboembolism and acute coronary syndrome. In 2008, dabigatran was the first direct oral anticoagulant approved by the European Medicine Agency. Subsequently, rivaroxaban, apixaban and edoxaban were also authorised. This article reviews the evidence related to the use of these drugs. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  6. Oral candidiasis and angular cheilitis.

    Science.gov (United States)

    Sharon, Victoria; Fazel, Nasim

    2010-01-01

    Candidiasis, an often encountered oral disease, has been increasing in frequency. Most commonly caused by the overgrowth of Candida albicans, oral candidiasis can be divided into several categories including acute and chronic forms, and angular cheilitis. Risk factors for the development of oral candidiasis include immunosuppression, wearing of dentures, pharmacotherapeutics, smoking, infancy and old age, endocrine dysfunction, and decreased salivation. Oral candidiasis may be asymptomatic. More frequently, however, it is physically uncomfortable, and the patient may complain of burning mouth, dysgeusia, dysphagia, anorexia, and weight loss, leading to nutritional deficiency and impaired quality of life. A plethora of antifungal treatments are available. The overall prognosis of oral candidiasis is good, and rarely is the condition life threatening with invasive or recalcitrant disease.

  7. Oral epithelial dysplasia classification systems

    DEFF Research Database (Denmark)

    Warnakulasuriya, S; Reibel, J; Bouquot, J

    2008-01-01

    At a workshop coordinated by the WHO Collaborating Centre for Oral Cancer and Precancer in the United Kingdom issues related to potentially malignant disorders of the oral cavity were discussed by an expert group. The consensus views of the Working Group are presented in a series of papers....... In this report, we review the oral epithelial dysplasia classification systems. The three classification schemes [oral epithelial dysplasia scoring system, squamous intraepithelial neoplasia and Ljubljana classification] were presented and the Working Group recommended epithelial dysplasia grading for routine...... use. Although most oral pathologists possibly recognize and accept the criteria for grading epithelial dysplasia, firstly based on architectural features and then of cytology, there is great variability in their interpretation of the presence, degree and significance of the individual criteria...

  8. Oral Pathology in Forensic Investigation.

    Science.gov (United States)

    Shamim, Thorakkal

    2018-01-01

    Forensic odontology is the subdiscipline of dentistry which analyses dental evidence in the interest of justice. Oral pathology is the subdiscipline of dentistry that deals with the pathology affecting the oral and maxillofacial regions. This subdiscipline is utilized for identification through oral and maxillofacial pathologies with associated syndromes, enamel rod patterns, sex determination using exfoliative cytology, identification from occlusal morphology of teeth, and deoxyribonucleic acid profiling from teeth. This subdiscipline is also utilized for age estimation studies which include Gustafson's method, incremental lines of Retzius, perikymata, natal line formation in teeth, neonatal line, racemization of collagen in dentin, cemental incremental lines, thickness of the cementum, and translucency of dentin. Even though the expertise of an oral pathologist is not taken in forensic investigations, this paper aims to discuss the role of oral pathology in forensic investigation.

  9. Oral lichen planus: An overview

    Directory of Open Access Journals (Sweden)

    R Jayasri Krupaa

    2015-01-01

    Full Text Available Lichen planus is an immunologically mediated mucocutaneous disease that is triggered by varied etiological agents. The oral lichenoid reaction is considered a variant of the disease that needs to be clearly diagnosed as a separate entity from oral lichen planus and treated. They follow a strict cause-effector relationship, protocols that suggest the differentiation. Lichen planus has varied clinical forms in the oral mucosa and cutaneously that has different prognosis. This condition also arises in association with various other systemic conditions such as hypertension, diabetes mellitus. There have been cases reported in the esophagus, larynx, scalp, nail, cutaneous areas, especially arms and wrists, trunk. There is reported malignant transformation that essentiates careful examination, treatment protocol and regular follow-up sessions. This article throws light on the disease condition of oral lichen planus and oral lichenoid reaction that is essential for the differentiation and treatment.

  10. Oral lichen planus: An overview

    Science.gov (United States)

    Krupaa, R. Jayasri; Sankari, S. Leena; Masthan, K. M. K.; Rajesh, E.

    2015-01-01

    Lichen planus is an immunologically mediated mucocutaneous disease that is triggered by varied etiological agents. The oral lichenoid reaction is considered a variant of the disease that needs to be clearly diagnosed as a separate entity from oral lichen planus and treated. They follow a strict cause-effector relationship, protocols that suggest the differentiation. Lichen planus has varied clinical forms in the oral mucosa and cutaneously that has different prognosis. This condition also arises in association with various other systemic conditions such as hypertension, diabetes mellitus. There have been cases reported in the esophagus, larynx, scalp, nail, cutaneous areas, especially arms and wrists, trunk. There is reported malignant transformation that essentiates careful examination, treatment protocol and regular follow-up sessions. This article throws light on the disease condition of oral lichen planus and oral lichenoid reaction that is essential for the differentiation and treatment. PMID:26015696

  11. The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.

    Science.gov (United States)

    Gagala, J; Tarczynska, M; Gaweda, K; Matuszewski, L

    2014-09-01

    Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Why Is Oral Health Important for Women?

    Science.gov (United States)

    ... 2018 About | Contact InfoBites Quick Reference Learn more Oral Health and Overal Health Gum Disease and Cardiovascular Health ... delivered directly to your desktop! more... Why Is Oral Health Important for Women? Article Chapters Why Is Oral ...

  13. Pregnancy Cravings Can Harm Your Oral Health

    Science.gov (United States)

    ... 2018 About | Contact InfoBites Quick Reference Learn more Oral Health and Overal Health Gum Disease and Cardiovascular Health ... your desktop! more... Pregnancy Cravings Can Harm Your Oral Health Article Chapters Pregnancy Cravings Can Harm Your Oral ...

  14. The Fungal Biome of the Oral Cavity.

    Science.gov (United States)

    Chandra, Jyotsna; Retuerto, Mauricio; Mukherjee, Pranab K; Ghannoum, Mahmoud

    2016-01-01

    Organisms residing in the oral cavity (oral microbiota) contribute to health and disease, and influence diseases like gingivitis, periodontitis, and oral candidiasis (the most common oral complication of HIV-infection). These organisms are also associated with cancer and other systemic diseases including upper respiratory infections. There is limited knowledge regarding how oral microbes interact together and influence the host immune system. Characterizing the oral microbial community (oral microbiota) in health and disease represents a critical step in gaining insight into various members of this community. While most of the studies characterizing oral microbiota have focused on bacterial community, there are few encouraging studies characterizing the oral mycobiome (the fungal component of the oral microbiota). Our group recently characterized the oral mycobiome in health and disease focusing on HIV. In this chapter we will describe the methods used by our group for characterization of the oral mycobiome.

  15. Need for Oral Health Policy in India

    African Journals Online (AJOL)

    implementation of National Oral Health Policy in India in order to expand the oral health care to ... Professional dental organizations can also support government programs to .... who can play effective role in providing oral health care services.

  16. Oral candidiasis following steroid therapy for oral lichen planus.

    Science.gov (United States)

    Marable, D R; Bowers, L M; Stout, T L; Stewart, C M; Berg, K M; Sankar, V; DeRossi, S S; Thoppay, J R; Brennan, M T

    2016-03-01

    The purpose of this multicentre study was to determine the incidence of oral candidiasis in patients treated with topical steroids for oral lichen planus (OLP) and to determine whether the application of a concurrent antifungal therapy prevented the development of an oral candidiasis in these patients. Records of 315 patients with OLP seen at four Oral Medicine practices treated for at least 2 weeks with steroids with and without the use of an antifungal regimen were retrospectively reviewed. The overall incidence of oral fungal infection in those treated with steroid therapy for OLP was 13.6%. There was no statistically significant difference in the rate of oral candidiasis development in those treated with an antifungal regimen vs those not treated prophylactically (14.3% vs 12.6%) (P = 0.68). Despite the use of various regimens, none of the preventive antifungal strategies used in this study resulted in a significant difference in the rate of development of an oral candidiasis in patients with OLP treated with steroids. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Nutrition and Oral Health: Experiences in Iran

    OpenAIRE

    Zohre Sadat Sangsefidi; Amin Salehi-Abargouei

    2017-01-01

    Background: Oral health is a crucial factor for overall well-being and there is a mutual relationship between nutrition and oral health. The aim of this study was to review the publications which have examined the association between nutrition or diet and oral health status or oral disease in Iran. Methods: The electronic databases of PubMed, Scopus, Google scholar, scientific information database (SID), and Magiran were searched using key words of diet, nutrition, oral health, oral disease, ...

  18. The oral microbiome - an update for oral healthcare professionals

    DEFF Research Database (Denmark)

    Kilian, M; Chapple, I L C; Hannig, M

    2016-01-01

    disease-promoting bacteria to manifest and cause conditions such as caries, gingivitis and periodontitis. For practitioners and patients alike, promoting a balanced microbiome is therefore important to effectively maintain or restore oral health. This article aims to give an update on our current...... and health. The mouth houses the second most diverse microbial community in the body, harbouring over 700 species of bacteria that colonise the hard surfaces of teeth and the soft tissues of the oral mucosa. Through recent advances in technology, we have started to unravel the complexities of the oral...

  19. Oral cancer: A multicenter study

    Science.gov (United States)

    Rojanawatsirivej, Somsri; Thosaporn, Watcharaporn; Kintarak, Sompid; Subarnbhesaj, Ajiravudh; Darling, Mark; Kryshtalskyj, Eugene; Chiang, Chun-Pin; Shin, Hong-In; Choi, So-Young; Lee, Sang-shin; Shakib, Pouyan-Amini

    2018-01-01

    Background To determine the prevalence and clinicopathologic features of the oral cancer patients. Material and Methods Biopsy records of the participating institutions were reviewed for oral cancer cases diagnosed from 2005 to 2014. Demographic data and site of the lesions were collected. Sites of the lesion were subdivided into lip, tongue, floor of the mouth, gingiva, alveolar mucosa, palate, buccal/labial mucosa, maxilla and mandible. Oral cancer was subdivided into 7 categories: epithelial tumors, salivary gland tumors, hematologic tumors, bone tumors, mesenchymal tumors, odontogenic tumors, and others. Data were analyzed by descriptive statistics using SPSS software version 17.0. Results Of the 474,851 accessioned cases, 6,151 cases (1.30%) were diagnosed in the category of oral cancer. The mean age of the patients was 58.37±15.77 years. A total of 4,238 cases (68.90%) were diagnosed in males, whereas 1911 cases (31.07%) were diagnosed in females. The male-to-female ratio was 2.22:1. The sites of predilection for oral cancer were tongue, labial/buccal mucosa, gingiva, palate, and alveolar mucosa, respectively. The three most common oral cancer in the descending order of frequency were squamous cell carcinoma, non-Hodgkin lymphoma and mucoepidermoid carcinoma. Conclusions Although the prevalence of oral cancer is not high compared to other entities, oral cancer pose significant mortality and morbidity in the patients, especially when discovered late in the course of the disease. This study highlights some anatomical locations where oral cancers are frequently encountered. As a result, clinicians should pay attention to not only teeth, but oral mucosa especially in the high prevalence area as well since early detection of precancerous lesions or cancers in the early stage increase the chance of patient being cured and greatly reduce the mortality and morbidity. This study also shows some differences between pediatric and elderly oral cancer patients as well as

  20. Oral symptoms and salivary findings in oral lichen planus, oral lichenoid lesions and stomatitis

    DEFF Research Database (Denmark)

    Larsen, Kristine Roen; Johansen, Jeanne Duus; Reibel, Jesper

    2017-01-01

    BACKGROUND: To examine if patients with oral lichen planus, oral lichenoid lesions and generalised stomatitis and concomitant contact allergy have more frequent and severe xerostomia, lower unstimulated and chewing-stimulated saliva and citric-acid-stimulated parotid saliva flow rates, and higher...... of xerostomia, clinical examination, sialometry, mucosal biopsy and contact allergy testing. RESULTS: Nineteen patients had oral lichen planus, 19 patients had oral lichenoid lesions and 11 patients had generalised stomatitis. 38.8% had contact allergy. Xerostomia was significantly more common and severe...... in the chewing stimulated saliva samples from patients when compared to healthy controls. The differences were not significant and they were irrespective of the presence of contact allergy. CONCLUSION: Xerostomia is prevalent in patients with oral lichen planus, lichenoid lesions and generalised stomatitis...

  1. Amiloidosis bucal Oral amyloidosis

    Directory of Open Access Journals (Sweden)

    Isabella Lima Arrais Ribeiro

    2012-03-01

    Full Text Available A amiloidose é uma doença complexa rara de difícil diagnóstico que ocorre devido à deposição de substância amilóide no meio extracelular. Ao ser diagnosticado na cavidade bucal, deve-se monitorar o paciente a fim de avaliar possíveis complicações sistêmicas da doença. Diante disso, o objetivo do presente estudo é relatar um caso de amiloidose oral em uma paciente do gênero feminino de 72 anos de idade. Baseado nos sinais clínicos observados, a hipótese diagnóstica foi de fibroma traumático. Após realização de biópsia e exame histopatológico, o diagnóstico foi de amiloidose oral, o que foi confirmado com a coloração do espécime com o reagente vermelho congo. Depósitos de amilóide foram encontrados no tecido conjuntivo, na avaliação através da luz polarizada, que apresentou birrefringência. Tal achado foi preocupante, já que a amiloidose geralmente acomete diversos tecidos levando a comprometimentos sistêmicos. Por essa razão a paciente foi encaminhada a procurar atendimento médico. No entanto, houve abandono do tratamento e a mesma veio a óbito 6 meses após o diagnóstico da doença. Lesões orais aparentemente simples podem revelar doenças raras e de difícil tratamento. O diagnóstico preciso e acompanhamentos médicos são fundamentais na sobrevida do paciente.La amiloidosis es una enfermedad compleja, rara, de difícil diagnóstico, que ocurre debido al depósito de sustancia amiloidea en medio extracelular. Al ser diagnosticada en la cavidad bucal, el paciente debe tener supervisión médica para evaluar las posibles complicaciones sistémicas de la enfermedad. El objetivo del presente estudio fue presentar un caso de amiloidosis bucal en un paciente del género femenino de 72 años de edad. Basados en las señales clínicas observadas, la hipótesis diagnóstica fue de un fibroma traumático. Después de la realización de una biopsia y del examen histopatológico, el diagnóstico fue de amiloidosis

  2. Criteria for Evaluating Oral History Interviews.

    Science.gov (United States)

    Fonsino, Frank J.

    1980-01-01

    Discusses the rationale for establishing criteria for evaluating oral history interviews. Presents seven evaluation categories relating to oral history tapes and three categories relating to typescripts. (CK)

  3. Genetic etiology of oral cancer.

    Science.gov (United States)

    Ali, Johar; Sabiha, Bibi; Jan, Hanif Ullah; Haider, Syed Adnan; Khan, Abid Ali; Ali, Saima S

    2017-07-01

    Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. It accounts for 2.5% of all new cancer cases and 1.9% of all cancer deaths annually. More than 90% of oral cancers (occurring in the mouth, lip, and tongue) are oral squamous cell carcinoma. The incidence rate of oral cancer varies widely throughout the world, with an evident prevalence in South Asian countries. This high incidence occurs in correlation with oral cancer-associated behaviors such as alcohol, tobacco use. Researchers have reported that these behaviors lead to genetic variations in tumor suppressor genes (APC, p53), proto-oncogenes (Myc), oncogene (Ras) and genes controlling normal cellular processes (EIF3E, GSTM1). Processes such as segregation of chromosomes, genomic copy number, loss of heterozygosity, telomere stabilities, regulations of cell-cycle checkpoints, DNA damage repairs and defects in notch signaling pathways are involved in causing oral cancer. In order to develop preventive and therapeutic options, it is necessary to comprehend the basic molecular mechanisms forcing oral tumorigenesis. This review examines, in detail, the mechanisms of genetic alteration which are considered to be responsible for the initiation of oral cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. ORAL HYGIENE PRACTICES AND RISK OF ORAL LEUKOPLAKIA

    African Journals Online (AJOL)

    2006-04-01

    Apr 1, 2006 ... EAST AFRICAN MEDICAL JOURNAL ... Faculty of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, ... Poor oral hygiene is a product of plaque and ..... University of Nairobi and Kenya Medical Research.

  5. Oral hygiene and oral flora evaluation in psychiatric patients in ...

    African Journals Online (AJOL)

    2015-03-02

    Mar 2, 2015 ... Key words: Bacteria types, oral and dental illnesses, psychiatric patients. Date of Acceptance: .... patients, and difficulties such as insufficient sedation.[7]. This study .... Despite the general notion that stress triggers bruxism ...

  6. Oral lichen planus to oral lichenoid lesions: Evolution or revolution

    Science.gov (United States)

    Dudhia, Bhavin B; Dudhia, Sonal B; Patel, Purv S; Jani, Yesha V

    2015-01-01

    The diagnosis between different diseases may be impaired by clinical and histopathologic similarities, as observed in the oral lichen planus (OLP) and oral lichenoid lesion (OLL). Inspite of similar clinicopathological features; etiology, diagnosis and prognosis differ which mandates separation of OLL from OLP. Hence, it is essential for the oral physician and oral pathologist to be familiarized with the individual variations among clinicopathological features of OLP and OLL as well as to obtain a thorough history and perform a complete mucocutaneous examination in addition to specific diagnostic testing. The difficulties faced to establish the diagnosis between these two pathologies are widely investigated in the literature with a lack of definite conclusion. This review is an attempt to throw some light on these clinicopathologic entities with the aim to resolve the diagnostic dilemma. PMID:26980966

  7. Recurrent oral angioleiomyoma

    Directory of Open Access Journals (Sweden)

    V G Mahima

    2011-01-01

    Full Text Available Angioleiomyomas are vascular variant of leiomyomas which are benign tumors of smooth muscle. They are exceedingly rare in the oral cavity. Malignant transformation of these tumors has also been reported occasionally which warrants knowledge of this soft tissue tumor. A 57 year old male patient reported with a 15 day history of an asymptomatic growth that had started insidiously in his lower left back tooth region. Clinical examination revealed a solitary, oval, sessile growth in the mandibular left retro molar region. Excisional biopsy was suggestive of Angioleiomyoma. A recurrence of the same was noted two months later which was also histopathologically reported as Angioleiomyoma. The same was confirmed using special stains. This case reports an unusual presentation of Angioleiomyoma with regards to both recurrence as well as rapid growth. It is important to be well aware of this uncommon entity as these tumors often can mimic or transform into malignancy. Precise clinicopathological examinations are therefore invaluable in establishing an accurate diagnosis and delivering suitable treatment.

  8. Oral contraception following abortion

    Science.gov (United States)

    Che, Yan; Liu, Xiaoting; Zhang, Bin; Cheng, Linan

    2016-01-01

    Abstract Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. However, limited data exist supporting the effective use of OCs postabortion. We conducted this systematic review and meta-analysis in the present study reported immediate administration of OCs or combined OCs postabortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, increase endometrial thickness 2 to 3 weeks after abortion, and reduce the risk of complications and unintended pregnancies. A total of 8 major authorized Chinese and English databases were screened from January 1960 to November 2014. Randomized controlled trials in which patients had undergone medical or surgical abortions were included. Chinese studies that met the inclusion criteria were divided into 3 groups: administration of OC postmedical abortion (group I; n = 1712), administration of OC postsurgical abortion (group II; n = 8788), and administration of OC in combination with traditional Chinese medicine postsurgical abortion (group III; n = 19,707). In total, 119 of 6160 publications were included in this analysis. Significant difference was observed in group I for vaginal bleeding time (P = 0.0001), the amount of vaginal bleeding (P = 0.03), and menstruation recovery period (P abortion (P abortion, and reduce the risk of complications and unintended pregnancies. PMID:27399060

  9. Oral sensations and secretions.

    Science.gov (United States)

    Running, Cordelia A

    2018-04-10

    Sensations experienced in the mouth influence food choices, both immediately and in the long term. Such sensations are themselves influenced by experience with flavors, the chemical environment of the mouth, genetics of receptors for flavors, and individual behavior in the chewing of food. Gustation, the sense of taste, yields information about nutrients, influences palatability, and feeds into the human body's preparation to receive those nutrients. Olfaction, the sense of smell, contributes enormously to defining and identifying food flavors (and is experienced even after placing food inside the mouth). Another vital component of food flavor is texture, which contributes to palatability, especially if a food's texture violates a person's expectations. Next, chemesthesis is the sense of chemically induced irritancy and temperature, for example spiciness and stinging. All of these sensations are potentially modified by saliva, the chemical and physical media of the mouth. As a person experiences the culmination of these oral sensations, modified through an individual's own unique saliva, the flavors in turn influence both what and how a person eats. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Oral cavity eumycetoma

    Directory of Open Access Journals (Sweden)

    Gisele Alborghetti Nai

    2011-06-01

    Full Text Available Mycetoma is a pathological process in which eumycotic (fungal or actinomycotic causative agents from exogenous source produce grains. It is a localized chronic and deforming infectious disease of subcutaneous tissue, skin and bones. We report the first case of eumycetoma of the oral cavity in world literature. CASE REPORT: A 43-year-old male patient, complaining of swelling and fistula in the hard palate. On examination, swelling of the anterior and middle hard palate, with fistula draining a dark liquid was observed. The panoramic radiograph showed extensive radiolucent area involving the region of teeth 21-26 and the computerized tomography showed communication with the nasal cavity, suggesting the diagnosis of periapical cyst. Surgery was performed to remove the lesion. Histopathological examination revealed purulent material with characteristic grain. Gram staining for bacteria was negative and Grocott-Gomori staining for the detection of fungi was positive, concluding the diagnosis of eumycetoma. The patient was treated with ketoconazole for nine months, and was considered cured at the end of treatment. CONCLUSION: Histopathological examination, using histochemical staining, and direct microscopic grains examination can provide the distinction between eumycetoma and actinomycetoma accurately.

  11. Loggerhead oral cavity morphometry study

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Standard external morphometrics and internal oral cavity morphometrics data were collected on wild and captive reared loggerhead sea turtles in size classes ranging...

  12. Oral candidosis in lichen planus

    DEFF Research Database (Denmark)

    Kragelund, Camilla; Kieffer-Kristensen, L; Reibel, J

    2012-01-01

    OBJECTIVES: Candida albicans is the most common fungal pathogen in humans, but other Candida species cause candidosis. Candida species display significant differences in their susceptibility to antimycotic drugs. Patients with symptomatic or erythematous oral lichen planus (OLP) commonly have...

  13. Hydroxyurea-induced oral ulceration.

    Science.gov (United States)

    Badawi, Maha; Almazrooa, Soulafa; Azher, Fatima; Alsayes, Fatin

    2015-12-01

    Hydroxyurea is an antimetabolite that is widely used in the treatment of many benign and malignant conditions. This drug is usually well tolerated but has a number of side effects that vary in incidence. In cases of clinically significant adverse events, hydroxyurea is usually discontinued either temporarily or permanently, depending on treatment need versus harm caused by side effects. Here, we report a case of oral ulceration associated with hydroxyurea treatment in a patient who had chronic myelogenous leukemia. The patient rapidly developed an oral ulcer 12 days after administration of the drug. Hydroxyurea was discontinued, and the oral lesion appreciably decreased in size and severity. Physicians and dentists should be aware of the association between hydroxyurea and oral lesions. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... of the face, mouth and gums to improve function, appearance and oral health. Click here to find ... the need for harmony between facial appearance and function. As a result, OMSs are uniqely qualified to ...

  15. Oral delivery of anticancer drugs

    DEFF Research Database (Denmark)

    Thanki, Kaushik; Gangwal, Rahul P; Sangamwar, Abhay T

    2013-01-01

    The present report focuses on the various aspects of oral delivery of anticancer drugs. The significance of oral delivery in cancer therapeutics has been highlighted which principally includes improvement in quality of life of patients and reduced health care costs. Subsequently, the challenges...... incurred in the oral delivery of anticancer agents have been especially emphasized. Sincere efforts have been made to compile the various physicochemical properties of anticancer drugs from either literature or predicted in silico via GastroPlus™. The later section of the paper reviews various emerging...... trends to tackle the challenges associated with oral delivery of anticancer drugs. These invariably include efflux transporter based-, functional excipient- and nanocarrier based-approaches. The role of drug nanocrystals and various others such as polymer based- and lipid based...

  16. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively ...

  17. Diabetes mellitus and oral health

    Directory of Open Access Journals (Sweden)

    Đorđević N.

    2015-01-01

    Full Text Available Diabetes mellitus is one of the most common non-communicable chronic diseases, which is the combined action of genetic factors, environmental factors and lifestyle. Specific conditions occur in the oral cavity in the course of diabetes that cause changes in all oral tissues with different symptoms and signs. Increased salivary glucose level is followed by increased accumulation of dental plaque and decreased resistance to noxious agents. The most common oral manifestations in diabetic patients include higher prevalence of periodontal desease, burning mouth syndrome, disruption in salivary flow, opportunistic infections, higher prevalence of denture stomatitis, oral lichen planus, fissured tongue, angular cheilitis etc. Dental interventions in patients with well-controlled diabetes are not different from those applied to nondiabetic patients. Regular monitoring of these patients is required because of the complications that can occur.

  18. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... one of your body's most important early warning systems. Don't ignore any suspicious lumps or sores. ... and maxillofacial surgeon. Oral and maxillofacial surgeons: The experts in face, mouth and jaw surgery Contact Us ...

  19. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... It can also invite bacteria that lead to gum disease. Click here to find out more. Oral, Head ...

  20. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral ... of sedation and general anesthesia. Click here to find out more. Cleft Lip/Palate and Craniofacial Surgery ...

  1. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Neck Pathology Download Download the ebook for further information Your oral and maxillofacial surgeon (OMS) is the ... well be the key to complete recovery. The information provided here is not intended as a substitute ...

  2. Oncofetal fibronectins in oral carcinomas

    DEFF Research Database (Denmark)

    Mandel, U; Gaggero, B; Reibel, J

    1994-01-01

    -B-containing isoform and the oncofetal FN isoform derived by O-glycosylation, in oral squamous cell carcinomas, premalignant lesions, and normal oral mucosa. A selective expression of the ED-B-containing isoform was demonstrated in close relation to the invading carcinoma (38/38), whereas there was virtually...... no staining in submucosa underlying premalignant lesions (1/11) and normal epithelium (0/5). The ED-B-containing FN showed close co-distribution and staining pattern with the oncofetal isoform derived by O-glycosylation. These results demonstrate that accumulation of FN adjacent to oral carcinomas includes...... in breast and oral tumors. Another oncofetal FN isoform containing the ED-B sequence is derived by alternative splicing, and FN containing ED-B has been found to be a stromal marker of malignancies in various tissues. Here we report a comparative study by immunohistology of the distribution of the ED...

  3. Oral contraceptives and neuroactive steroids.

    Science.gov (United States)

    Rapkin, Andrea J; Biggio, Giovanni; Concas, Alessandra

    2006-08-01

    A deregulation in the peripheral and brain concentrations of neuroactive steroids has been found in certain pathological conditions characterized by emotional or affective disturbances, including major depression and anxiety disorders. In this article we summarize data pertaining to the modulatory effects of oral contraceptive treatment on neuroactive steroids in women and rats. Given that the neuroactive steroids concentrations are reduced by oral contraceptives, together with the evidence that a subset of women taking oral contraceptives experience negative mood symptoms, we propose the use of this pharmacological treatment as a putative model to study the role of neuroactive steroids in the etiopathology of mood disorders. Moreover, since neuroactive steroids are potent modulators of GABA(A) receptor function and plasticity, the treatment with oral contraceptives might also represent a useful experimental model to further investigate the physiological role of these steroids in the modulation of GABAergic transmission.

  4. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... teeth or become infected. It can also invite bacteria that lead to gum disease. Click here to find out ... and surgically treating cancer of the head, neck and mouth. The Oral Cancer Foundation estimates that close to ...

  5. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... attune the oral and maxillofacial surgeon to the need for harmony between facial appearance and function. As ... or pharyngeal cancer this year. Here’s what you need to know. Click here to find out more. ...

  6. Oral Insulin - Fact or Fiction?

    Indian Academy of Sciences (India)

    attempts have explored the following options, either singly, or together: • Protecting ... derivative of insulin has been seen to maintain its biological activity and also have .... that in the short future any oral preparation that can achieve consistent ...

  7. Oral phenoxymethylpenicillin treatment during pregnancy

    DEFF Research Database (Denmark)

    Czeizel, A.E.; Rockenbauer, M.; Olsen, Jørn

    2000-01-01

    The objective of the study was to examine the human teratogenic potential of oral penicillin V: phenoxymethylpenicillin treatment during pregnancy in the large population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980–1996. The dataset included 22......, i.e. in the critical period for most major congenital abnormalities in case-matched control pairs. Thus, treatment with oral phenoxymethylpenicillin during pregnancy presents very little if any teratogenic risk to the fetus....

  8. Peran 'Oral Splint' pada Bruxisme

    Directory of Open Access Journals (Sweden)

    Antonia Tanzil

    2013-07-01

    Full Text Available Oral splints have been frequently used in the treatment of bruxism to protect teeth and periodontium from damage, but the mechanism of action and efficacy of oral splints remain controversial. It has been suggested that they can be used to treat bruxism, based on the assumption that the device can eliminate or remove occlusal interference. Currently there are no reliable data to support the assumption of occlusion as an etiologic factor for bruxism, because several other factors have a role in bruxism, such as psychiatric, neurological and systemic disorders. In this paper, the mechanism of action and efficacy of oral splints in bruxism are discussed. Conclusions: although oral splint may be beneficial in protecting the dentition, the efficacy of this device in reducing bruxism is still not confirmed. There are several aspects that would support the broad usage of oral splints in the treatment of bruxism, but there are also limitations associated with each of these aspects. In conclusion, oral splints can be considered as useful adjuncts in the management of sleep bruxism but not as a definitive treatment.DOI: 10.14693/jdi.v15i1.82

  9. 31 CFR 103.83 - Oral communications.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Oral communications. 103.83 Section... AND REPORTING OF CURRENCY AND FOREIGN TRANSACTIONS Administrative Rulings § 103.83 Oral communications... response to oral requests. Oral opinions or advice by Treasury, the Customs Service, the Internal Revenue...

  10. Effect of different oral hygiene measures on oral malodor in children aged 7-15 years.

    Science.gov (United States)

    Patil, Piyusha S; Pujar, Pallavi; Subbareddy, V V

    2015-01-01

    To evaluate the effect of various oral hygiene measures individually and in combination in reducing oral malodor. A total number of 120 children diagnosed as having oral malodor (oral malodor scores 2 and above) were included in the study. Children were then grouped under four oral hygiene categories (tooth brushing, tongue cleaning, mouth rinsing, and a combination group). There were 30 children in each group. The children were asked to perform oral hygiene methods individually and in combination. The children were then reassessed for oral malodor 2 h later. The results were analyzed and compared. Both individual oral hygiene measure or in combination of tooth brushing, tongue cleaning, and mouth rinsing; all were effective in reducing oral malodor. Significant reduction (P oral malodor was seen when all three oral hygiene measures performed together. Oral malodor was significantly reduced after performing oral hygiene measures individually, but reduced more when used in combination.

  11. Perceived oral health, oral self-care habits and dental attendance ...

    African Journals Online (AJOL)

    Perceived oral health, oral self-care habits and dental attendance among pregnant women in Benin-City, Nigeria. ... Results: The majority of the respondents (81.7%) rated their oral health as excellent/good using the global oral health rating scale. Seventy one percent of the respondents did not change their oral self-care ...

  12. Oral symptoms and functional outcome related to oral and oropharyngeal cancer

    NARCIS (Netherlands)

    Kamstra, Jolanda I.; Jager-Wittenaar, Harriet; Dijkstra, Pieter U.; Huisman, Paulien M.; van Oort, Rob P.; van der Laan, Bernard F. A. M.; Roodenburg, Jan L. N.

    Purpose This study aimed to assess: (1) oral symptoms of patients treated for oral or oropharyngeal cancer; (2) how patients rank the burden of oral symptoms; (3) the impact of the tumor, the treatment, and oral symptoms on functional outcome. Methods Eighty-nine patients treated for oral or

  13. Oral Cryotherapy for Preventing Oral Mucositis in Patients Receiving Cancer Treatment.

    Science.gov (United States)

    Riley, Philip; McCabe, Martin G; Glenny, Anne-Marie

    2016-10-01

    In patients receiving treatment for cancer, does oral cryotherapy prevent oral mucositis? Oral cryotherapy is effective for the prevention of oral mucositis in adults receiving fluorouracil-based chemotherapy for solid cancers, and for the prevention of severe oral mucositis in adults receiving high-dose melphalan-based chemotherapy before hematopoietic stem cell transplantation (HSCT).

  14. Association of gene variants of transcription factors PPARγ, RUNX2, Osterix genes and COL2A1, IGFBP3 genes with the development of osteonecrosis of the femoral head in Chinese population.

    Science.gov (United States)

    Song, Yang; Du, Zhenwu; Ren, Ming; Yang, Qiwei; Wang, Qingyu; Chen, Gaoyang; Zhao, Haiyue; Li, Zhaoyan; Wang, Jincheng; Zhang, Guizhen

    2017-08-01

    The molecular pathogenesis of osteonecrosis of the femoral head (ONFH) has been remained obscure so that its prevalence has been increasing in recent decades. Different transcription factors play critical roles in maintaining the balance between osteogenesis and adipogenesis. However, it has been unclear that the genes variants of the transcription factors exert the effects on the imbalance between steogenesis and adipogenesis during the development of ONFH. Here, we selected the 11SNPs from steogenesis, adipogenesis-specific transcription factors RUNX2, Osterix, and PPARγ genes, chondrogenesis or adipogenesis key factors COL2A1, IGFBP3 genes and analysed the genotypes, alleles, haplotypes and their association with the risk and clinical phenotypes of ONFH through Mass ARRAY® platformin in 200 ONFH patients and 177controls. The patients with ONFH (132 males, 68 females; age: 53.46±11.48yr) were consecutively enrolled at the Department of Orthopedics, the Second Clinical College of Jilin University, from March 2014 to June 2015 and were diagnosed and classified into 10 cases of stage II (5.6%), 54 cases of stage III (30.2%) and 115 cases (64.2%) of stage IV and alcohol-induced (71 cases (39.7%)), idiopathic (64 cases (34.0%)), and steroid-induced osteonecrosis (47 cases (26.3%)) subgroup, respectively. Our results showed that all models of logistical regression analysis, the co-dominants, dominants, and recessives of PPARγrs2920502, significantly associated with the increased risk of ONFH (p=0.004, p=0.013, p=0.016), respectively. Both the minor homozygous CC genotype and the allele C of rs2920502 were evidently correlated with the enhanced risk of ONFH (p=0.005, p=0.0005),respectively. The recessives models of IGFBP3rs2132572 (G/A) as well as RUNX2 rs3763190(G/A) were statistically associated with the higher ONFH risk, p=0.030, p=0.029, respectively; the minor homozygous(AA) of IGFBP3rs2132572 (G/A) was also related to the increased risk of bilateral hips

  15. Understanding Carcinogenesis for Fighting Oral Cancer

    OpenAIRE

    Tanaka, Takuji; Ishigamori, Rikako

    2011-01-01

    Oral cancer is one of the major global threats to public health. Oral cancer development is a tobacco-related multistep and multifocal process involving field cancerization and carcinogenesis. The rationale for molecular-targeted prevention of oral cancer is promising. Biomarkers of genomic instability, including aneuploidy and allelic imbalance, are able to measure the cancer risk of oral premalignancies. Understanding of the biology of oral carcinogenesis will give us important advances for...

  16. Vitamin K2 Ameliorates Damage of Blood Vessels by Glucocorticoid: a Potential Mechanism for Its Protective Effects in Glucocorticoid-induced Osteonecrosis of the Femoral Head in a Rat Model.

    Science.gov (United States)

    Zhang, Yuelei; Yin, Junhui; Ding, Hao; Zhang, Changqing; Gao, You-Shui

    2016-01-01

    Glucocorticoid has been reported to decrease blood vessel number and harm the blood supply in the femoral head, which is recognized to be an important mechanism of glucocorticoid-induced osteonecrosis of the femoral head (ONFH). To prevent glucocorticoid-induced ONFH, medication that promotes both bone formation and angiogenesis would be ideal. Vitamin K2 has been revealed to play an important role in bone metabolism; however, few studies have focused on the effect of Vitamin K2 on new vascular formation. Thus, this study aimed to investigate whether Vitamin K2 promoted new blood vessel formation in the presence of glucocorticoids, both in vitro and in vivo. The effect of Vitamin K2 on viability, migration, in vitro tube formation, and VEGF, vWF, CD31, KDR, Flt and PDGFB in EAhy926 incubated with or without dexamethasone were elucidated. VEGF, TGF-β and BMP-2, angiogenesis-related proteins secreted by osteoblasts, were also detected in the osteoblast-like cell line of MG63. In addition, blood vessels of the femoral head in rats administered with or without methylprednisolone and Vitamin K2 were evaluated using angiography and CD31 staining. In vitro studies showed that Vitamin K2 significantly protected endothelial cells from dexamethasone-induced apoptosis, promoted endothelial cell migration and in vitro tube formation. Angiogenesis-related proteins both in EAhy926 and MG63 were also upregulated by Vitamin K2 when cotreated with dexamethasone. In vivo studies showed enhanced blood vessel volume and CD31-positive staining cells in rats cotreated with VK2 and methylprednisolone compared to rats treated with methylprednisolone only. Collectively, Vitamin K2 has the ability to promote angiogenesis in vitro and to ameliorate vessels of the femoral head in glucocorticoid-treated rats in vivo, indicating that Vitamin K2 is a promising drug that may be used to prevent steroid-induced ONFH.

  17. Adolescents and oral contraceptives.

    Science.gov (United States)

    Sanfilippo, J S

    1991-01-01

    Oral contraceptive (OC) options for adolescents are provides. Clarification for those desiring a birth control method is necessary and the benefits of decreased acne and dysmenorrhea with low dose OCs should be stressed along with the importance of compliance. A community effort is suggested to communicate the sexual and contraceptive alternatives, including abstinence and outercourse (sexual stimulation to orgasm without intercourse). Attention is given to concerns associated with teenage sexual activity, prevention of adolescent pregnancy, contraceptive options for the adolescent patient, adolescent attitudes toward birth control OCs, management of the adolescent OC user, manipulation of steroid components of OCs to respond to adolescent concerns, and other hormonal contraceptive options such as minipills or abstinence. The text is supplemented with tables: the % of US women by single years of age for 1971, 1976, 1979, and 1982; comparative pregnancy and abortion rates for the US and 5 other countries; federal cost for teen childbearing; adolescent nonhormonal contraceptive methods (advantages, disadvantages, and retail cost); checklist to identify those at risk for noncompliance with OCs; hormonal side effects of OCs; risks from OCs to adolescents; and benefits of OCs. Concern about adolescent pregnancy dates back to Aristotle. A modern profile shows girls form single-parent families are sexually active at an earlier age, adolescent mothers produce offspring who repeat the cycle, victims of sexual abuse are more likely to be sexually active, and teenagers in foster care are 4 times more likely to be sexually active and 8 times more likely to become pregnant. Prevention involves a multifaceted approach. OCs are the most appropriate contraceptive choice for adolescents. Frequency of intercourse is closely associated with OC use after approximately 15 months of unprotected sexual activity. At risk for noncompliance variables are scales of personality development

  18. Changes in Abundance of Oral Microbiota Associated with Oral Cancer

    Science.gov (United States)

    Schmidt, Brian L.; Kuczynski, Justin; Bhattacharya, Aditi; Huey, Bing; Corby, Patricia M.; Queiroz, Erica L. S.; Nightingale, Kira; Kerr, A. Ross; DeLacure, Mark D.; Veeramachaneni, Ratna; Olshen, Adam B.; Albertson, Donna G.

    2014-01-01

    Individual bacteria and shifts in the composition of the microbiome have been associated with human diseases including cancer. To investigate changes in the microbiome associated with oral cancers, we profiled cancers and anatomically matched contralateral normal tissue from the same patient by sequencing 16S rDNA hypervariable region amplicons. In cancer samples from both a discovery and a subsequent confirmation cohort, abundance of Firmicutes (especially Streptococcus) and Actinobacteria (especially Rothia) was significantly decreased relative to contralateral normal samples from the same patient. Significant decreases in abundance of these phyla were observed for pre-cancers, but not when comparing samples from contralateral sites (tongue and floor of mouth) from healthy individuals. Weighted UniFrac principal coordinates analysis based on 12 taxa separated most cancers from other samples with greatest separation of node positive cases. These studies begin to develop a framework for exploiting the oral microbiome for monitoring oral cancer development, progression and recurrence. PMID:24887397

  19. Graphite oral tattoo: case report.

    Science.gov (United States)

    Moraes, Renata Mendonça; Gouvêa Lima, Gabriela de Morais; Guilhermino, Marinaldo; Vieira, Mayana Soares; Carvalho, Yasmin Rodarte; Anbinder, Ana Lia

    2015-10-16

    Pigmented oral lesions compose a large number of pathological entities, including exogenous pigmentat oral tattoos, such as amalgam and graphite tattoos. We report a rare case of a graphite tattoo on the palate of a 62-year-old patient with a history of pencil injury, compare it with amalgam tattoos, and determine the prevalence of oral tattoos in our Oral Pathology Service. We also compare the clinical and histological findings of grafite and amalgam tattoos. Oral tattoos affect women more frequently in the region of the alveolar ridge. Graphite tattoos occur in younger patients when compared with the amalgam type. Histologically, amalgam lesions represent impregnation of the reticular fibers of vessels and nerves with silver, whereas in cases of graphite tattoos, this impregnation is not observed, but it is common to observe a granulomatous inflammatory response, less evident in cases of amalgam tattoos. Both types of lesions require no treatment, but in some cases a biopsy may be done to rule out melanocytic lesions.

  20. Oral submucous fibrosis: an update

    Directory of Open Access Journals (Sweden)

    Wollina U

    2015-04-01

    Full Text Available Uwe Wollina,1 Shyam B Verma,2 Fareedi Mukram Ali,3 Kishor Patil4 1Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany; 2Nirvana Skin Clinic, Vadodara, Gujarat, India; 3Departments of Oral and Maxillofacial Surgery, SMBT Dental College, Sangamner, Maharashtra, India; 4Departments of Oral Pathology and Microbiology, SMBT Dental College, Sangamner, Maharashtra, India Abstract: Oral submucous fibrosis (OSF is a premalignant condition caused by betel chewing. It is very common in Southeast Asia but has started to spread to Europe and North America. OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. OSF is a diagnosis based on clinical symptoms and confirmation by histopathology. Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis. A variety of extracellular and intracellular signaling pathways might be involved. Treatment of OSF is difficult, as not many large, randomized controlled trials have been conducted. The principal actions of drug therapy include antifibrotic, anti-inflammatory, and antioxygen radical mechanisms. Potential new drugs are on the horizon. Surgery may be necessary in advanced cases of trismus. Prevention is most important, as no healing can be achieved with available treatments. Keywords: betel nut, betel quid, oral disease, squamous cell carcinoma, tobacco, fibrosis

  1. Oral health information systems--towards measuring progress in oral health promotion and disease prevention

    DEFF Research Database (Denmark)

    Petersen, Poul Erik; Bourgeois, Denis; Bratthall, Douglas

    2005-01-01

    and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information...... been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health...... programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers...

  2. Oral medicine and the elderly.

    LENUS (Irish Health Repository)

    McCreary, Christine

    2011-03-15

    A focus often exists in dental practice on the maintenance and management of the dentition and the periodontium, however, conditions of the oral mucosa and orofacial pain can cause significant problems for older patients. Oral mucosal conditions are more prevalent in older patients and many orofacial pain disorders, such as burning mouth syndrome and trigeminal neuralgia, are more common in patients over the age of 50 years. Although these conditions may not be routinely managed in general practice, identification of these patients in primary care and appropriate referral will lead to more prompt and effective treatment. CLINICAL RELEVANCE: Dental practitioners need to be able to identify what is considered to be within the normal physiological limits of the ageing oral tissue and hence what is abnormal and requires further investigation to facilitate appropriate referral.

  3. Gastrophysics of the Oral Cavity.

    Science.gov (United States)

    Mouritsen, Ole G

    2016-01-01

    Gastrophysics is the science that pertains to the physical and physico-chemical description of the empirical world of gastronomy, with focus on sensory perception in the oral cavity and how it is related to the materials properties of food and cooking processes. Flavor (taste and smell), mouthfeel, chemesthesis, and astringency are all related to the chemical properties and the texture of the food and how the food is transformed in the oral cavity. The present topical review will primarily focus attention on the somatosensory perception of food (mouthfeel or texture) and how it interacts with basic tastes (sour, bitter, sweet, salty, and umami) and chemesthetic action. Issues regarding diet, nutrition, and health will be put into an evolutionary perspective, and some mention will be made of umami and its importance for (oral) health.

  4. Oral clonidine for proctalgia fugax.

    Science.gov (United States)

    Swain, R

    1987-08-01

    A report is made of the successful use of oral clonidine for proctalgia fugax by the author on himself. The author, a 30 year old otherwise healthy man, has been having attacks of proctalgia fugax for several years. He had hitherto left the condition untreated. Last year, in a severe attack, he tried oral clonidine 150 micrograms twice a day and found it to be dramatically effective. He was completely relieved in three days and tapered off the drug thereafter. A further attack of proctalgia fugax after a month was again treated successfully with oral clonidine. The presumed aetiology of proctalgia fugax is discussed and the possible mechanism of action of clonidine in this condition is outlined. Further trials of clonidine appear to be worthwhile for this condition which has been described as incurable.

  5. Combined oral contraceptives: venous thrombosis.

    Science.gov (United States)

    de Bastos, Marcos; Stegeman, Bernardine H; Rosendaal, Frits R; Van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Stijnen, Theo; Dekkers, Olaf M

    2014-03-03

    Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. We selected studies including healthy women taking COC with VT as outcome. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene

  6. Oral complications of HIV disease

    Directory of Open Access Journals (Sweden)

    Jair C. Leao

    2009-05-01

    Full Text Available Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS. A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.

  7. Oral History: Methodology for Dialogue

    OpenAIRE

    DAVID, Priscila [UNESP

    2013-01-01

    A história oral, como metodologia qualitativa de pesquisa, traz outras dimensões ao debate historiográfico. Por meio dela o historiador consegue visualizar diversos pontos de vista de um determinado fato histórico. Neste aspecto, cabe ressaltar que sua utilização depende da compreensão de que o diálogo entre pesquisador e entrevistado apresenta especificidades. Utilizar-se da história oral requer a compreensão de que a pesquisa somente é possível mediante a vontade do pesquisador, o qual deli...

  8. Dispensacion de anticonceptivos hormonales orales

    OpenAIRE

    Molinero Crespo, Ana María; Diego Martinez , Cristina de; Méndez Mora-Figueroa, Pilar; Esteso, Pilar; García Valiente, Paloma; González, Ana; Peiró Martínez, Alicia; Pérez Martín, Vanessa

    2010-01-01

    El 80% de las mujeres españolas en edad fértil utilizan métodos anticonceptivos. Los anticonceptivos orales hormonales son los que obtienen mayor grado de satisfacción entre las usuarias siendo el segundo método utilizado. Método Estudio observacional descriptivo en 7 farmacias de la Comunidad de Madrid. Durante seis meses (enero-junio de 2009) se realizó una entrevista en el mostrador a las usuarias de métodos anticonceptivos hormonales orales para conocer qué tipo de paciente los dema...

  9. Cancer of the oral cavity.

    Science.gov (United States)

    Montero, Pablo H; Patel, Snehal G

    2015-07-01

    Cancer of the oral cavity is one of the most common malignancies worldwide. Although early diagnosis is relatively easy, presentation with advanced disease is not uncommon. The standard of care is primary surgical resection with or without postoperative adjuvant therapy. Improvements in surgical techniques combined with the routine use of postoperative radiation or chemoradiation therapy have resulted in improved survival. Successful treatment is predicated on multidisciplinary treatment strategies to maximize oncologic control and minimize impact of therapy on form and function. Prevention of oral cancer requires better education about lifestyle-related risk factors, and improved awareness and tools for early diagnosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Oral clonidine for proctalgia fugax.

    OpenAIRE

    Swain, R

    1987-01-01

    A report is made of the successful use of oral clonidine for proctalgia fugax by the author on himself. The author, a 30 year old otherwise healthy man, has been having attacks of proctalgia fugax for several years. He had hitherto left the condition untreated. Last year, in a severe attack, he tried oral clonidine 150 micrograms twice a day and found it to be dramatically effective. He was completely relieved in three days and tapered off the drug thereafter. A further attack of proctalgia f...

  11. Staging N0 oral cancer

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Sørensen, Jens Ahm; Grupe, Peter

    2005-01-01

    PURPOSE: To compare sentinel lymph node biopsy, magnetic resonance imaging (MRI), Doppler ultrasonography, and palpation as staging tools in patients with T1/T2 N0 cancer of the oral cavity. MATERIAL AND METHODS: Forty consecutive patients were enrolled (17 F and 23 M, aged 32-90 years), 24 T1......%, but the sensitivity of MRI 36% was low. The specificities were 100%, 85%, and 93%, respectively. By combined sentinel lymph node biopsy and ultrasonography the overall sensitivity could have been 100%. CONCLUSION: Sentinel lymph node biopsy improved staging of patients with small N0 oral cancers. Combined sentinel...

  12. Oral Health and Experiences of Oral Care in Radiotherapy Patients ...

    African Journals Online (AJOL)

    Background: In spite of careful planning and modern techniques, radiotherapy inevitably involves side-effects due to exposure of surrounding normal tissues. Patients treated for head and neck cancer who experience oral symptoms do not always consider these symptoms to be related to their disease or its treatment.

  13. Oral history, trauma and September 11, comparative oral history

    NARCIS (Netherlands)

    Leydesdorff, S.; Pierre, P.

    2013-01-01

    It is argued in this article that the study of the trauma of september 11 can gain from other studies of disaster, Oral history is an excellent tool to study these trauma's, since traumatized stories are fragmented and layered. Listening will bring about a confrontation with the creaton of

  14. Oral cryotherapy reduced oral mucositis in patients having cancer treatments.

    Science.gov (United States)

    Spivakovsky, Sylvia

    2016-09-01

    Data sourcesCochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CANCERLIT, CINAHL, the US National Institutes of Health Trials Registry and the WHO Clinical Trials Registry Platform.Study selectionRandomised controlled trials (RCTs) assessing the effects of oral cryotherapy in patients with cancer receiving treatment compared to usual care, no treatment or other interventions to prevent mucositis. The primary outcome was incidence of mucositis and its severity.Data extraction and synthesisTwo reviewers carried out study assessment and data extraction independently. Treatment effect for continuous data was calculated using mean values and standard deviations and expressed as mean difference (MD) and 95% confidence interval. Risk ratio (RR) was calculated for dichotomous data. Meta-analysis was performed.ResultsFourteen studies with 1280 participants were included. Subgroup analysis was undertaken according to the main cancer treatment type. Cryotherapy reduced the risk of developing mucositis by 39% (RR = 0.61; 95%CI, 0.52 to 0.72) on patients treated with fluorouracil (5FU). For melphalan-based treatment the risk of developing mucositis was reduced by 41% (RR =0.59; 95%CI, 0.35 to 1.01). Oral cryotherapy was shown to be safe, with very low rates of minor adverse effects, such as headaches, chills, numbness/taste disturbance and tooth pain. This appears to contribute to the high rates of compliance seen in the included studies.ConclusionsThere is confidence that oral cryotherapy leads to a large reduction in oral mucositis in adults treated with 5FU. Although there is less certainty on the size of the reduction on patients treated with melphalan, it is certain there is reduction of severe mucositis.

  15. Nutrition and Oral Health: Experiences in Iran

    Directory of Open Access Journals (Sweden)

    Zohre Sadat Sangsefidi

    2017-08-01

    Full Text Available Background: Oral health is a crucial factor for overall well-being and there is a mutual relationship between nutrition and oral health. The aim of this study was to review the publications which have examined the association between nutrition or diet and oral health status or oral disease in Iran. Methods: The electronic databases of PubMed, Scopus, Google scholar, scientific information database (SID, and Magiran were searched using key words of diet, nutrition, oral health, oral disease, and Iran to reach the related articles published up to 2016. The English and Persian articles with cross-sectional, clinical trial, prospective, and case-control designs were selected. The Persian studies were then translated into English. The animal studies were not investigated. Results: The findings showed that nutrition and diet were associated with oral health. However, the majority of studies focused on evaluation of the relation between nutrition and dental caries. Further, a few studies were conducted on the association between nutrition and other oral problems such as periodontal disease or oral cancer. Moreover, the limited nutritional or dietary factors were investigated in the literature. Conclusions: Nutrition and diet are related to oral health and prevention of oral disease. Further studies are therefore recommended to evaluate the association between nutrition and oral health with considering various dietary or nutritional factors and different types of oral problems in Iran.

  16. Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer.

    Science.gov (United States)

    Nakajima, Nobuhisa

    2017-06-01

    Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed. There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p oral intake groups, respectively ( p oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3. Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

  17. Oral Communication across the Curriculum

    Science.gov (United States)

    Ediger, Marlow

    2011-01-01

    Proficiency in oral communication is necessary in school and in society. To do well in the different curriculum areas, pupils must speak with clarity and understanding. For example, in a discussion group in the social studies involving the topic "the pros and cons of raising taxes," pupils need to express knowledgeable ideas with appropriate voice…

  18. What dentition assures oral function?

    DEFF Research Database (Denmark)

    Gotfredsen, Klaus; Walls, Angus W G

    2007-01-01

    OBJECTIVE: To evaluate the relationship between dentition and oral function. MATERIAL AND METHODS: A search of the English literature was undertaken using PubMed and appropriate keywords. Citations were identified and hand sorted to confirm their validity against our inclusion criteria. Four spec...

  19. War, Journalism, and Oral History.

    Science.gov (United States)

    Rice, Gary

    2000-01-01

    Describes a project where students conducted oral history with either a war correspondent or a U.S. combat veteran for the course "War and the News Media: From Vietnam through Desert Storm and Beyond." Discusses how the students prepared for the interviews and the evaluation of their projects. (CMK)

  20. Oral Hygiene. Learning Activity Package.

    Science.gov (United States)

    Hime, Kirsten

    This learning activity package on oral hygiene is one of a series of 12 titles developed for use in health occupations education programs. Materials in the package include objectives, a list of materials needed, a list of definitions, information sheets, reviews (self evaluations) of portions of the content, and answers to reviews. These topics…