口腔黏膜下纤维性变的病因、致病机理、诊断与治疗

口腔黏膜下纤维性变是一种能形成瘢痕、组织纤维化的慢性疾病。流行病学研究显示,咀嚼槟榔是导致口腔黏膜下纤维性变的危险因素。在中国的口腔黏膜下纤维性变患者均有咀嚼槟榔的习惯。研究证实,嚼槟榔、吸烤烟和饮白酒可增加口腔黏膜下纤维性变的风险。口腔黏膜下纤维性变被广泛认为是一种口腔癌前病变,病理表现为慢性炎症、结缔组织内广泛的胶原纤维沉积、上皮固有层或其下结缔组织内的局部炎症改变。口腔黏膜下纤维性变的癌变发生率为7%~30%。口腔黏膜下纤维性变的治疗主要采用曲安奈德和丹参酮注射液行黏膜下局部注射,对改善患者的张口度及口腔黏膜的烧灼痛效果良好,其治疗总有效率可达93%。本文就口腔黏膜下纤维性变的病因、致病机理、诊断与治疗进行阐述,以供同道们临床参考之用。     

Novel therapies for oral lichen planus

Oral lichen planus (OLP) is a chronic mucocutaneous disorder commonly found in middle‐aged women. Despite the progress in research and advance in knowledge on OLP, a successful management is still difficult to achieve. The main aim of OLP treatment is to control the symptoms of the affected patients. Steroids and other immunosuppressive drugs have been recommended and widely used in the treatment of OLP. Topical corticosteroids are the mainstay of OLP treatment, but strong evidence on their effectiveness is lacking. The effectiveness of alternative ways of managing OLP has been recently reported. Topical aloe vera, topical pimecrolimus and oral curcuminoids are the most promising of the new treatment modalities. Other interesting modalities are topically applied thalidomide and amlexanox. Nevertheless, the careful assessment between the risks and benefits of these drugs is crucial and larger and well‐conducted trials need to confirm the above encouraging results.     

Treatment approaches to common symptomatic oral lesions in children

A variety of oral mucosal lesions can be symptomatic in children. This article describes the classic clinical appearance of the most common oral diseases and provides treatment recommendations that are tailored to the pediatric age group. When possible, more than one drug alternative is given for each of the different oral conditions for an improved success rate. It is essential for the clinician to understand that this article should be used as a guide for managing oral and perioral lesions in children and adolescents. Specific dosages and formularies of drugs may require modification in the young child. Consultation with a primary care physician and pharmacist often is needed to ensure the best possible outcome, especially when immunosuppressive drugs are indicated. Most importantly, oral lesions that do not respond to therapeutic protocols should be referred to the appropriate specialist for definitive diagnosis and treatment.     

二膦酸盐相关颌骨骨坏死临床治疗研究进展

二膦酸盐类药物是临床上治疗骨转移癌最为常用的药物。近年来发现,患者长期应用该类药物可产生二膦酸盐相关颌骨骨坏死（bisphosphonate-related osteonecrosis of the jaw, BRONJ）这一较为严重的并发症。患者一旦出现BRONJ的临床症状（如口腔瘘管、红肿、开口受限及骨折等）,生活质量严重下降,常就诊于口腔科。因此,口腔科医生对于这种疾病治疗方法的了解非常重要。现将近年来针对这种疾病的常用治疗方法做一综述,以期对口腔临床工作起到帮助作用。     

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??Bisphosphonates are the most commonly used drugs to treat bone metastases. In recent years?? many authors found that long-term use of bisphosphonate drugs can lead to bisphosphonate-related osteonecrosis of the jaws ??BRONJ??. The life quality of patients with the BRONJ symptoms ??oral fistula?? swelling?? limited opening and fractures??will be seriously affected. These patients often seek help in dentistry??therefore the treatment knowledge of this disease is very important. This article reviews the recent literature about treatment for this disease??hoping to help oral clinical work.     

Vesiculo-erosive oral mucosal disease--management with topical corticosteroids: (1) Fundamental principles and specific agents available

Vesiculo-erosive diseases of the oral mucosa pose a major challenge in oral medicine, because they are chronic, painful, and interfere with the daily activities and quality of life of the patients, including disturbing eating, drinking, talking, and personal relationships. Many are autoimmune diseases, and corticosteroid therapy is currently central to their treatment. These diseases present with inflammation and alterations to epithelial integrity, through cell and/or humoral immunity-mediated attack on epithelial-connective tissue targets. Until recently, despite their serious adverse effects, it was necessary to prescribe systemic corticosteroids to control severe erosive oral diseases. Now, however, many of these diseases can be controlled by high-potency topical corticosteroids, which have proved to be highly efficacious and to cause fewer adverse effects compared with systemic corticosteroids. Nevertheless, although topical corticosteroids are still the most widely used drugs in the practice of oral medicine, the scientific body of evidence for their use in the oral cavity is virtually non-existent, and therefore many of the protocols followed are, of necessity, drawn from experience of their use in a dermatological setting. This review aims to set out the key aspects of the use of topical corticosteroids in oral medicine. The issues covered include the indications and basic rules for their use, the types of corticosteroids, the drug selection, and the specific formulations.     

Perioperative considerations of the patient on cancer chemotherapy

Chemotherapeutic treatment of cancer has made great progress over the past 25 years and is frequently used as an important component of combined-modality therapy with surgery and radiation. Individuals undergoing cancer treatment with chemotherapeutic drugs frequently experience oral complications that may require oral surgical intervention. This article reviews the categories of drugs that are used and their side effects, and possible management strategies for patients undergoing cancer treatment with chemotherapy drugs in oral surgery practice.     

糖皮质激素性骨质疏松与口腔疾病

随着糖皮质激素在临床上的广泛应用,糖皮质激素性骨质疏松症发病率明显增加。口腔颌面部作为全身骨组织的重要组成部分,其与糖皮质激素性骨质疏松的联系也日益受到关注。该文就国内外有关糖皮质激素性骨质疏松对颌骨、牙槽骨、牙齿的影响,以及其与牙周炎、牙种植和口腔正畸治疗的关系等方面的研究状况作一综述。     

口腔颌面部静脉畸形诊治：经验与进展

静脉畸形是临床上最常见的先天性血管畸形,可发生于全身各个部位。其病变位置及范围的多样性,使得静脉畸形的诊断和治疗富有挑战性。目前,口腔颌面部静脉畸形的治疗方法主要包括硬化治疗、手术治疗、激光治疗等。本文通过对近几年文献的回顾,结合作者经验,对静脉畸形诊断和治疗的相关进展进行了总结。     

Tongue brushing and mouth rinsing as basic treatment measures for halitosis

Tongue brushing and mouth rinsing are basic treatment measures for halitosis, and as such are categorised as treatment needs (TN)-1. Although TN-1 is used for treatment of physiologic halitosis treatment, pseudo-, extra oral pathologic or halitophobic patients must also be managed with TN-1 as well as other treatments. Since the origin of physiological halitosis is mainly the dorso-posterior region of the tongue, tongue cleaning is more effective than mouth rinsing. However, practitioners should always instruct their patients on how to brush their tongues to prevent harmful effects. Another approach using a chlorhexidine mouthwash is most effective in reducing oral malodour. However, chlorhexidine should not be used routinely; therefore, zinc-containing mouthwashes have been recommended for use. People can also use chewing gum to reduce oral malodour. Surprisingly, however, it has been noted that sugarless chewing gum increased methyl mercaptan, one of the principal components of oral malodour. Mint did not reduce the concentration of methyl mercaptan either, although these products are widely used for their ability to mask oral malodour. There is a need for the development of a novel food or chewing gum that could considerably reduce VSC levels in mouth air to complement TN-1.     

Overdose, adverse effects, and safety of oral medications

Overdose of oral medications can be a major concern. This article reviews the clinical presentations, toxic dosages, adverse effects, and the recommended treatments for the most commonly used oral medications in dentistry. Clinicians need to be aware of the toxicities and adverse effects of the most commonly used oral medications, and recognize the signs and symptoms as early as possible for expedient treatment and referral.     

Prevention and treatment of chemo- and radiotherapy-induced oral mucositis

The administration of many chemo-radiotherapy regimens in patients with cancer may be complicated by toxicities that limit the clinicians' abilities to deliver the most effective doses of active agents. Oral mucositis is a major dose-limiting toxic effect and the most important cause of morbidity in patients undergoing chemo-radiotherapy for head and neck cancers, in patients undergoing bone marrow transplantation and those receiving certain chemotherapeutic agents for a variety of human malignancies. The intent of this paper is to review preventive strategies and treatment approaches for patients with established oral mucositis. Many agents of differing mechanisms of action have been used in the prevention and treatment of oral mucositis induced by anticancer therapies. Currently, no intervention is completely successful at preventing or treating oral mucositis. The several solutions, drugs and methods used and studied in the prophylaxis and therapy of chemotherapy or radiotherapy-induced oral mucositis reflects the need of new, more efficient tools in the management of this complication. Current studies and our increasing understanding of the etiology and pathogenesis of oral mucositis will lead to new approaches to the management and improved quality of life for these patients.     

Traditional Chinese medicine and oral diseases: today and tomorrow

Oral Diseases (2010) 17 , 7–12 With a history of over 2000 years, traditional Chinese medicine (TCM) evolves into a unique system of diagnosing and treating illnesses. It is a challenge to convey the fundamentals of this traditional medicine to our Western colleagues because of the differences in language, philosophy and concept of diagnosis and treatment. This review attempts to tackle these barriers by introducing several widely used Chinese medicines for treating oral diseases. China Journals Full‐text Database and Pubmed were used as the searching engines. Although many studies have demonstrated that the Chinese medicines are effective in treating oral diseases including recurrent aphthous stomatitis, oral lichen planus, leukoplakia, and Sjögren’s syndrome, most of them lacked standard criteria of post‐treatment assessment and laboratory evidence. Randomized controlled clinical trials with specific assessment criteria are required to close the gap between TCM and evidenced‐based medicine.     

Local drug delivery for oral mucosal diseases: challenges and opportunities

There are few topical formulations used for oral medicine applications most of which have been developed for the management of dermatological conditions. As such, numerous obstacles are faced when utilizing these preparations in the oral cavity, namely enzymatic degradation, taste, limited surface area, poor tissue penetration and accidental swallowing. In this review, we discuss common mucosal diseases such as oral cancer, mucositis, vesiculo-erosive conditions, infections, neuropathic pain and salivary dysfunction, which could benefit from topical delivery systems designed specifically for the oral mucosa, which are capable of sustained release. Each condition requires distinct penetration and drug retention profiles in order to optimize treatment and minimize side effects. Local drug delivery may provide a more targeted and efficient drug-delivery option than systemic delivery for diseases of the oral mucosa. We identify those mucosal diseases currently being treated, the challenges that must be overcome and the potential of novel therapies. Novel biological therapies such as macromolecular biological drugs, peptides and gene therapy may be of value in the treatment of many chronic oral conditions and thus in oral medicine if their delivery can be optimized.     

Opinions of UK specialists about terminology, diagnosis, and treatment of atypical facial pain: a survey

There are few robust, evidence-based data about what constitutes the diagnosis of atypical facial pain and how it is best treated. We therefore aimed to find out the current opinion of those on specialist lists in the United Kingdom (UK) on whether they use the term atypical facial pain, how they reach their diagnosis, and what treatment they offer. We sent out questionnaires to 240 specialists randomly selected from the UK lists of those most likely to deal with atypical facial pain (oral and maxillofacial surgeons, oral medical specialists, ear nose and throat surgeons, anaesthetists, psychiatrists and neurologists). We divided the replies according to whether the specialists were medically or dentally based. Of the 209 valid questionnaires, 143 were returned (a response rate of 68%); 127 of the 143 used the term atypical facial pain, the others used various other terms. The two groups used significantly different criteria, mainly to exclude other conditions to achieve a diagnosis. About half used haematological tests and most used radiographic investigations routinely, and there were no significant differences among the specialities. No unified pattern of referral between different units was found. Treatment was mainly by antidepressant and anticonvulsant drugs, and counselling.     

Antimicrobial resistance with focus on oral beta-lactamases

Over the last 10-15 yr antibiotic resistance has increased in the oral microflora. The beta-lactam antibiotics, i.e., penicillins and cephalosporins, are the most frequently used antimicrobial agents. Unfortunately, the efficiency of these drugs is increasingly being challenged by the emergence of resistant bacteria, which is mainly due to their production of beta-lactamases. In this paper, mechanisms of antibiotic resistance are reviewed, with emphasis on beta-lactamases. This review also discusses how the presence of beta-lactamases in oral microorganisms may affect the treatment of oral diseases. Dentists can influence the emerging global crisis of antibiotic resistance by carefully evaluating the indications for antibiotic treatment. General guidelines for when and how to use antibiotics in dentistry are reviewed.     

Antibiotic therapy of bacterial infections of the oral cavity

More than 300 commencial bacterial species may be found in the oral cavity. Other microorganisms, such as mycoplasms, mycetes, protozoa and viruses are present as well. The virulency of the saprofites and additional contamination by outside microorganisms are factors determining the development of infectious process in the oral tissues. Moreover, streptococci and anaerobes are the most frequent aetiology agents. The antibiotic therapy should comply with the general treatment criteria, on the one hand, and should be specific for these microorganism, on the other. The penicillines (ampicillin, bacampicillin and especially amoxycillin) process pharmacokinetic properties which make them a favorable choice for treatment. These drugs are effective in case of streptococcal infections, with cariogenic processes involvement and dissemination (endocarditis, glomerulonephritis). Other, frequently used drugs are spiramycin, erythromycin, josamycin and myocamycin that are selectively taken up by the oral tissues and present in large quantities in the saliva. The macrolides have a large spectrum of action on microorganisms normally found in the oral cavity. Lincosamides (lincomycin and clindamycin) are active on anaerobes and are drugs of choice for treatment of staphylococcal osteomyelitis. Tetracycline therapy is restricted usually to parodontite cases caused by Actinobacillus actinomycetemcomitans and Capnocytophaga. In conclusion, the choice of antibacterial therapy should be based on the bacterial aetiology, as well as on the intrinsic drug characteristics (pharmacokinetic, side effects, toxicity etc.).     

Effect of nystatin and chlorhexidine digluconate on Candida albicans

Polyene antibiotics such as nystatin and amphotericin B are among the most widely recommended drugs for use against oral candidiasis. It is also generally accepted that chlorhexidine gluconate is an appropriate adjunct or an alternative to specific antimycotic drugs. The aim of the present study was to examine the effect of the combination of nystatin and chlorhexidine digluconate on Candida albicans in vitro. The minimum inhibitory concentration (MIC) value for the combination of the two drugs was found to be significantly higher than the values for each of the drugs alone, approximately 33 times the MIC value for the nystatin solution and 4 times the value for chlorhexidine digluconate. The results of the MIC study and the presence of a precipitate in all combinations of nystatin and chlorhexidine digluconate showed that the combination of the drugs is not effective in vitro against Candida albicans. The most likely reason is that a low solubility chlorhexidine-nystatin salt is formed, thus rendering the combined drug complex ineffective as an antibiotic agent.     

放射粒子近距离治疗口腔颌面部恶性肿瘤新进展

随着影像和数字化技术的发展,放射粒子近距离治疗口腔颌面部恶性肿瘤已成为手术和传统放疗等治疗方法的有效补充。3D打印导板引导放射粒子植入术,因具有良好的靶区适形性、精准可控的治疗剂量、较低的副反应及微创性等优点,成为目前放射粒子治疗口腔颌面部恶性肿瘤临床应用最广泛的方法。