Medication-induced hyposalivation: etiology, diagnosis, and treatment

Polypharmacy in the nation's growing geriatric population will require increasingly complex pharmacologic management of multiple disease states. This brief review describes normal salivary function, potential causes of salivary dysfunction, oral health concerns associated with hyposalivation, diagnostic tests, and options for patient care. Medications can reduce salivary flow, creating the condition known as xerostomia. A major complication of xerostomia is the promotion of dental caries. Asking several standardized questions regarding symptoms may help confirm salivary gland hypofunction. The general approach to patients with hyposalivation and xerostomia is directed at palliative treatment for the relief of symptoms and prevention of oral complications.     

Recurrent aphthous stomatitis: etiology,diagnosis, and treatment

Recurrent aphthous stomatitis is a very common condition seen frequently by dentists in practice. Although the majority of cases are benign and resolve in less than two weeks, these ulcerations may be indicative of underlying systemic diseases ranging from vitamin deficiency to autoimmunity. Awareness of these correlations can help the dentist make or aid the diagnosis of potentially serious conditions. There are treatments of which the practitioner should be aware that may ameliorate the pain of the ulcerations or shorten their duration. The diagnosis and management of this important condition is reviewed in this article.     

Periodontal abscess

This review focuses on the classification of periodontal abscesses, which are localized purulent infections of periodontal tissues, and discusses their etiology and clinical characteristics.     

Short tooth syndrome: diagnosis, etiology, and treatment management

The periodontal-restorative team is uniquely positioned to provide the esthetic procedures that today's sophisticated patient population has come to expect. Not only is health and function of great desire but also esthetics is in demand. Armed with periodontal-plastic procedures and technically advanced restorative materials, the periodontal-restorative team can provide these patient needs. The challenge becomes making the correct diagnosis and selecting the appropriate treatment regimen.     

Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment

Temporomandibular joint (TMJ) disorders have complex and sometimes controversial etiologies. Also, under similar circumstances, one person's TMJ may appear to deteriorate, while another's does not. However, once degenerative changes start in the TMJ, this pathology can be crippling, leading to a variety of morphological and functional deformities. Primarily, TMJ disorders have a non-inflammatory origin. The pathological process is characterized by deterioration and abrasion of articular cartilage and local thickening. These changes are accompanied by the superimposition of secondary inflammatory changes. Therefore, appreciating the pathophysiology of the TMJ degenerative disorders is important to an understanding of the etiology, diagnosis, and treatment of internal derangement and osteoarthrosis of the TMJ. The degenerative changes in the TMJ are believed to result from dysfunctional remodeling, due to a decreased host-adaptive capacity of the articulating surfaces and/or functional overloading of the joint that exceeds the normal adaptive capacity. This paper reviews etiologies that involve biomechanical and biochemical factors associated with functional overloading of the joint and the clinical, radiographic, and biochemical findings important in the diagnosis of TMJ-osteoarthrosis. In addition, non-invasive and invasive modalities utilized in TMJ-osteoarthrosis management, and the possibility of tissue engineering, are discussed.     

The etiology, diagnosis, and treatment of TMJ dysfunction-pain syndrome. Part III: treatment

There is general agreement that TMJ dysfunction-pain syndrome is multicausal. Definitive diagnosis is sometimes difficult, and as a result, empirical methods must be utilized. However, in most patients, etiologic causes can be established and specific treatment plans utilized for correction. There are many approaches and methods for palliative treatment which are usually used in combination. Since TMJ dysfunction is multicausal, many clinicians favor one definitive treatment procedure over another, with generally positive results. Those not intimately involved with the treatment of patients with TMJ dysfunction-pain syndrome regard the current state of the art as in complete disarray. If palliative therapy were separated from causative therapy, a new clarification would be possible. Definitive techniques and methods that improve the health of the joint and/or the muscles will usually improve the condition of the patient. There are different approaches to the same disease or dysfunction. This does not alter the essence of the problem, but only how it is viewed and treated by different clinicians. There is much to learn, and only by more documented research can the gaps in current knowledge be filled so that better service can be rendered to our patients.     

The etiology,diagnosis, and treatment of TMJ dysfunction-pain syndrome. Part II: Differential diagnosis

Differential diagnosis is based on the pain history in combination with the clinical findings of muscle spasm and occlusion in relation to the condylar displacement as observed in the TMJ radiographs. Most often TMJ dysfunction-pain syndrome produces symptoms that have a pattern of occurrence or can be associated with function. Neurologic, vascular, and conversion pain occur at random without a pattern of occurrence and with no relation to function. Atypical TMJ dysfunction pain can occur by itself or in combination with other unrelated pain causes. Differential diagnosis is usually aided by injections of local anesthetics and diagnostic trials of an anterior bite plate and relaxant drugs. Medical consultation is advised when a diagnosis of TMJ dysfunction-pain syndrome cannot be established. Hysterical conversion is extremely rare, although occasionally a patient may have pain of unknown origin.     

Vertical malocclusions: etiology, development, diagnosis and some aspects of treatment.

Vertical malocclusions develop as a result of the interaction of many different etiological factors; one of the most important of these factors is mandibular growth. Variations in growth intensity, function of the soft tissues and the jaw musculature as well as the individual dentoalveolar development further influence the evolution of these malocclusions. This article reviews the most common etiological factors and their possible contribution to the development of vertical malocclusions with special emphasis on the role of mandibular growth in the development of open bite and deep bite. The role of the cephalometric morphological analysis in the differential diagnosis of vertical malocclusion is emphasized. Aspects of orthodontic treatment of vertical malocclusions are illustrated with individual cases.     

Xerostomia: etiology,recognition and treatment

BACKGROUND: Clinicians may encounter symptoms of xerostomia, commonly called "dry mouth," among patients who take medications, have certain connective tissue or immunological disorders or have been treated with radiation therapy. When xerostomia is the result of a reduction in salivary flow, significant oral complications can occur. TYPES OF STUDIES REVIEWED: The authors conducted an Index Medicus--generated review of clinical and scientific reports of xerostomia in the dental and medical literature during the past 20 years. The literature pertaining to xerostomia represented the disciplines of oral medicine, pathology, pharmacology, epidemiology, gerodontology, dental oncology, immunology and rheumatology. Additional topics included the physiology of salivary function and the management of xerostomia and its complications. RESULTS: Xerostomia often develops when the amount of saliva that bathes the oral mucous membranes is reduced. However, symptoms may occur without a measurable reduction in salivary gland output. The most frequently reported cause of xerostomia is the use of xerostomic medications. A number of commonly prescribed drugs with a variety of pharmacological activities have been found to produce xerostomia as a side effect. Additionally, xerostomia often is associated with Sj?gren's syndrome, a condition that involves dry mouth and dry eyes and that may be accompanied by rheumatoid arthritis or a related connective tissue disease. Xerostomia also is a frequent complication of radiation therapy. CONCLUSIONS AND CLINICAL IMPLICATIONS: Xerostomia is an uncomfortable condition and a common oral complaint for which patients may seek relief from dental practitioners. Complications of xerostomia include dental caries, candidiasis or difficulty with the use of dentures. The clinician needs to identify the possible cause(s) and provide the patient with appropriate treatment. Remedies for xerostomia usually are palliative but may offer some protection from the condition's more significant complications.     

The etiology, diagnosis, and treatment of TMJ dysfunction-pain syndrome. Part I: Etiology

Craniomandibular pain has five major causes: neurologic, vascular, the temperomandibular joint itself, muscular, and hysterical conversion. When the pain source is purely in the muscles it has been termed MPD (myofascial pain dysfunction) by Laskin. However, when the TMJ itself is also involved it is called TMJ dysfunction-pain syndrome.