口腔矫治器治疗OSAHS患者长期主观疗效评价

目的 观察经口腔矫治器治疗OSAHS患者的主观疗效.方法 对89例接受口腔矫治器治疗OSAHS的患者进行问卷调查,追踪患者的长期耐受性、主观疗效及副作用情况,对长期使用口腔矫治器患者的感觉和行为进行回顾性调查.结果 60%以上患者单纯使用口腔矫治器进行阻塞性睡眠呼吸暂停综合征的治疗,并能每天戴用.其中12.4%的患者使用口腔矫治器达到10年以上.口腔矫治器能够长期有效地改善患者鼾声和睡眠呼吸暂停及低通气相关症状.其不适副作用较轻,86%副作用能够在患者一段时间的适应后消退,不会对患者造成长期影响.经过治疗,OSAHS患者的日常生活、情感、社会交往的影响以及睡眠呼吸暂停引起的其他症状,得到一定改善.结论 使用口腔矫治器治疗OSAHS,患者耐受性高,长期疗效良好,能使患者的生活质量有所提高.     

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.     

Oral aphthous-like ulceration due to tiotropium bromide

Unwanted side-effects of a drug therapy are well known to oral medicine specialists and other colleagues. Usually they manifest itself as dry mouth, taste disturbances, various allergic or toxic reactions on the lips and/or in the oral cavity. However, the list of the drugs which might induce unwanted reactions is everyday becoming longer as more and more drugs are introduced on the market. Certain problems when diagnosing and reporting unwanted side effects of the drugs exist as only accurate method of diagnosis is repeated drug use in controlled clinical setting where fatal consequences due to the anaphilactic shock could be avoided. We report a side effect reaction to tiotropium bromide (Spiriva) cap used with HandiHaler manifesting itself as an oral ulceration in a 65 yrs old male. On the third day of drug intake the patient developed oral ulceration two times in a period of few months. Other medications he has been using for several years. To our knowledge this is a first report as an oral side-effect of this drug used for treatment of chronic obstructive pulmonary disease (COPD).     

Referral patterns, lesion prevalence, and patient care parameters in a clinical oral pathology practice.

OBJECTIVE: The purpose of this study was to determine the following parameters in a referral-based private practice oral and maxillofacial pathology clinic: (1) sources of clinical referrals; (2) types of problems referred; and (3) clinical effectiveness of treatment. STUDY DESIGN: Clinical charts were reviewed for a cohort of 362 patients seen over a 2 1/2-year period (1993-1995). From these charts, we determined the source of referral and the final diagnosis for each patient. In addition, 50 patients were randomly selected and surveyed by telephone; each was asked a series of questions to determine the following: (1) the number of health care practitioners previously seen with regard to the patient's condition; (2) the length of time that the condition had been present before the patient came to the oral and maxillofacial pathology clinic; (3) the costs associated with medications and office visits that had been incurred before the patient came to the oral and maxillofacial pathology clinic; (4) the costs associated with medications and office visits that were incurred at the oral and maxillofacial pathology clinic; and (5) the patient's level of satisfaction with the oral and maxillofacial pathology clinic. RESULTS: Fifty-five percent of the referrals came from dentists, and 45% came from physicians. The 3 problems most commonly seen were candidiasis (12%), burning mouth syndrome (10%), and lichen planus (8%). For the 50 patients who were interviewed, the mean number of health care practitioners seen previously was 2.2 (range, 1-9). The mean time from initial symptoms to evaluation by an oral pathologist was 15 months. The mean approximate cost of medications and office visits before evaluation by an oral pathologist was $350 (range, $30-$4,000; median, $100); this compared with a cost of $94 (range, $50-$300; median, $70) for the patient visit and medications associated with the oral pathology appointment. The difference was statistically significant (P < or = .001). CONCLUSIONS: This preliminary study suggests that the clinical evaluation of oral lesions by an oral pathologist appears to be cost-effective and should be an integral part of a comprehensive health management system. These results should be corroborated by similar multicenter studies.     

Side-effects and patient acceptance of 0.2% versus 0.1% chlorhexidine used as post-operative prophylactic mouthwash

In a double-blind parallel group study including 30 patients, the side-effects and patient acceptance of chlorhexidine mouthwash 0.2% and 0.1% were studied. Side-effects such as loss of taste, burning sensation of the oral mucosa, subjective dryness of the oral cavity and discoloration of teeth and tongue were encountered. There was no statistically significant difference between the chlorhexidine groups with respect to the frequency of the reported side-effects. However, the taste of chlorhexidine 0.1% was significantly better accepted than chlorhexidine 0.2%. 4 patients discontinued the use of chlorhexidine 0.2% before the end of the trial. The quality of the experienced side-effects was stated by the patients as the reason for the discontinuation of chlorhexidine 0.2%. The present work concludes with the recommendation of chlorhexidine 0.1% compared to chlorhexidine 0.2% as a prophylactic mouthwash after oral surgical interventions.     

A prospective study of findings and management in 214 patients with oral lichen planus.

The findings in this prospective study of 214 patients with oral lichen planus were similar to those found in our 1985 evaluation of 570 patients with oral lichen planus. These two groups of patients with oral lichen planus patients constitute the largest series from one clinic. Oral lichen planus was found mainly in women and most commonly on the buccal mucosa. Spontaneous remissions were infrequent (6.5%), as were malignant transformations (2.3%) in a mean follow-up of 7.5 years. The erosive form of oral lichen planus was most common and was almost always associated with pain. Reproducibly successful management of this T-lymphocyte disease was obtained by selective use of systemic and/or topical corticosteroids. Oral lichen planus was not associated with any evident systemic disease, drug, smoking, or genetic predisposition. Although statistically Candida albicans does not appear to occur disproportionately in large samples of patients with oral lichen planus, in some of the Candida-positive patients, antifungal medications appeared to be useful.     

Dental management of the tropical disease human African trypanosomiasis: an unusual case of pseudobulbar palsy

Human African trypanosomiasis (sleeping sickness) is a parasitic tropical disease endemic to sub-Saharan Africa. Due to migration and holiday travel patterns cases are increasing in the United Kingdom. The neurological sequelae have dental management implications both directly from the consequent physical disability and indirectly from the oral side-effects of the medications used to manage symptoms. Changes in disease demographics require the dental profession to increase its awareness of migration medicine and the appropriate dental management of such diseases.     

平阳霉素局部给药对口腔鳞癌术前化疗疗效观察

目的 :观察平阳霉素局部应用在口腔鳞癌术前化疗中的疗效 ,寻找平阳霉素最有效的给药途径。方法 :43例病人随机分为两组 ,分别以静脉滴注和局部病灶内浸润注射给药。结果 :以静脉给药 2 3个病例中特效 4例 ,占 17.4% ,显效 11例 ,有效 5例 ,无效 3例。局部给药组 2 0个病例中特效 12例 ,占 60 % ,显效 6例 ,有效 1例 ,无效 1例。静脉给药无副作用 2例 ,占 8.7% ,局部给药无副作用 12例 ,占 60 %。结论 :平阳霉素局部应用比静脉给药治疗口腔鳞癌 ,疗效好 ,副作用少 ,建娱平阳霉素术前化疗采用局部给药的方式。     

氮芥术中动脉内给药对口腔癌术后伤口愈合及近期疗效的影响

目的：探讨术中动脉内化疗的临床应用。方法：对实验组１１例口腔癌（９例舌癌,２例口底癌）患者行联合根治术及皮瓣修复术,氮芥术中舌动脉内给药（浓度为１ｍｇ／ｍｌ,剂量为５ｍｇ）,对照组１６,例口腔癌（１３例舌症,３例口底癌）患者仅行手术,并同期行皮瓣修复。术后观察患者全身和局部反应并作近期随访。结果实验组无明显全身及局部反应,１１例皮瓣全部存活,近期随访（３－１２个月）,实验组局部复发率为９．１％（１     

Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people

Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2011; 39: 276–288. © 2010 John Wiley & Sons A/S Abstract – Objective: To investigate the associations between age, gender, systemic diseases, medications, labial and whole salivary flow rates and oral and ocular dryness in older people. Methods: Symptoms of oral and ocular dryness, systemic diseases, medications (coded according to the Anatomical therapeutic chemical (ATC) classification system), tobacco and alcohol consumption were registered, and unstimulated labial (LS) and unstimulated (UWS) and chewing‐stimulated (SWS) whole salivary flow rates were measured in 668 randomly selected community‐dwelling elderly aged 65–95. Results: Presence of oral (12%) and ocular (11%) dryness was positively correlated. Oral dryness was associated with low UWS, SWS and LS, and ocular dryness with low UWS and SWS. Oral and ocular dryness was related to female gender, but not to age. Only four persons in the healthy and nonmedicated subgroups reported oral and ocular dryness. The numbers of diseases and medications were higher in the older age groups and associated with oral and ocular dryness, low UWS, SWS and LS. On average, women were slightly older, reported more oral and ocular dryness and had lower UWS, SWS, LS and higher numbers of diseases and medications. High prevalence and odds ratios for oral dryness were associated with metabolic, respiratory and neurological diseases and intake of thyroid hormones, respiratory agents (primarily glucocorticoids), psycholeptics and/or psychoanaleptics, antineoplastics, proton pump inhibitors, antidiabetics, loop diuretics, antispasmodics, quinine and bisphosphonates. Ocular dryness was especially associated with neurological diseases and intake of psycholeptics and/or psychoanaleptics. Intake of magnesium hydroxide, antithrombotics, cardiac agents, thiazides, beta‐blockers, calcium channel blockers, ACE inhibitors/angiotensin II antagonists, statins, glucosamine, paracetamol/opioids, ophthalmologicals and certain combination therapies was related to oral and ocular dryness. Conclusions: In older people, oral and ocular dryness are associated with low salivary flow rates, specific as well as high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. New detailed information concerning associations between medications and oral and ocular dryness has been obtained using the ATC classification system.     

Potential oral manifestations of cardiovascular drugs

Oral Diseases (2010) 16 , 769–773 Objective: The aim of this work was to determine the frequency and nature of oral manifestations secondary to use of cardiovascular drugs. Methods: Five hundred and thirty one patients attending an adult cardiology clinic in Saudi Arabia were questioned about the occurrence of oral dryness, dysgeusia, or burning sensation and were clinically evaluated for the presence of oral mucosal or gingival disease. Data were statistically analyzed with chi‐squared tests, odds ratios and Student’s t‐test. Results: Oral symptoms and/or signs were recorded in 75 (14.1%) patients with xerostomia being the most common (7.5%), followed by lichenoid (lichen planus‐like) lesions (3.6%) and dysgeusia (1.9%). Xerostomia was significantly more frequent in patients with a history of diabetes mellitus and in female patients (P < 0.05). There were no statistically significant differences (P > 0.05) between patients with or without oral manifestations when age, gender, cardiovascular risk factor, cardiac disease, type of cardiac drug used or the number of medications were assessed. There was a trend for xerostomia to be less frequent in patients receiving therapy with angiotensin converting enzyme inhibitors and a slight trend of xerostomia to be more likely with increased number of non‐cardiac and total number of agents per subject. The number of non‐cardiac and total medications taken by patients with potential oral manifestations tended to be greater than that of patients without oral manifestations. Conclusions: The frequency of potential oral manifestations in patients receiving cardiovascular agents was 14.1%. The occurrence and character of the oral manifestations had no significant relation with individual cardiac drugs, although there was a trend for oral manifestations to be likely with increasing number of drugs.     

Pain medication as an indicator of interference with lifestyle and oral function during recovery after third molar surgery.

Purpose This study was designed to assess the impact of taking pain medications, as a more comprehensive indicator of perceived pain, on the extent of interference with lifestyle and oral function during recovery after third molar surgery. Patients and Methods Recovery data after the removal of 4 third molars were available for patients enrolled in an institutional review board-approved, prospective, multicenter clinical trial. A self-administered health-related quality of life instrument, designed to assess a patients perception of recovery for pain, lifestyle, and oral function, was completed each postsurgery day (PSD) for 14 days. Taking pain medications was a proxy for a patients perceived level of pain, adding a more sensitive behavioral component to the report of pain. Each PSD day, the patients who thought that their pain was sufficient to require taking medications (an opioid, a nonsteroidal anti-inflammatory, or the combination) were compared with patients not taking pain medications. The extent of interference in lifestyle (daily activity, social life, recreation, sleep) and in oral function (eating, chewing, mouth opening) as self-reported on a scale of 1 (no trouble) to 5 (lots of trouble) were compared for those taking and not taking medications using Cochran-Mantel-Haenszel row mean statistics ( P < .05). Results The 445 study patients were mostly female (63%) and white (86%). Median age was 20 years (IQ, 18, 24 years). Median surgery time was 30 minutes (IQ, 20, 40 minutes). Both mandibular third molars were below the occlusal plane in 60%. Almost all patients took pain medication on PSD 1. By PSD 7, 48% of patients were taking pain medication, decreasing to 20% by PSD 11. Patients with pain sufficient to take an analgesic reported a greater extent of interference for all lifestyle and oral function measures. Recovery was significantly delayed for PSD 2 through 14 for patients who took medications ( P < 0.01). Recovery for females taking pain medications was significantly delayed compared with that for males. Conclusions Patients with pain sufficient to prompt taking pain medications were likely to report interference with recovery for lifestyle and oral function. A patients choice to take pain medication appears to be a better indicator of a patients perceived pain and the impact of that pain on recovery than numerical pain scales. This method provides more sensitive behavioral information during the period of recovery after third molar removal.     

Delayed contact sensitivity on the lips and oral mucosa due to propolis-case report

We report a rare case of a patient who was referred to the Department of Oral medicine in Zagreb, Croatia. The patient was 20 years old, otherwise healthy and not taking any medication. She presented with irregular erosions partially covered with pseudomembranes that involved both lips and retrocomissural mucosa. Discrete erosion was also noticed on her lower lingual gingiva in the area 42. She reported a propolis solution self-medication for treatment of recurrent aphthous ulcers. After ten days of propolis application, lip and oral lesions developed. Patch test to propolis was proven. We highlight the fact that some folk medicine medications, such as propolis, although being known for many decades to be helpful in various conditions, in some individuals might lead to unwanted side-effects due to its antigenic potential. Additionally, every colleague, during the differential diagnosis of the oral lesions must bear in mind unwanted reactions to folk medicine products.     

Chlorhexidine with an Anti Discoloration System. A comparative study

Abstract  Correct oral hygiene is believed to be the basis of primary and secondary prevention. Sometimes, using a toothbrush or other mechanical instruments for oral hygiene may be difficult and it may become necessary to use an antiseptic. Chlorhexidine is an essential component in many available preparations on sale, because of its marked antiseptic qualities. One of the most frequent side-effects is the appearance of stains on the teeth and mucous membranes, which particularly disturbs the patient. A new mouthwash containing chlorhexidine has recently become available, besides maintaining its antiseptic qualities, also avoids the side-effect of staining. Objectives: The aim of this study was to check the capacity of the new mouthwash, which contains chlorhexidine and Anti Discoloration System (ADS), not only to prevent plaque formation like the other mouthwashes containing chlorhexidine but also to avoid staining that is one of the most frequent side-effects. Study design: The comparative study was carried out on a sample of 15 patients treated with two mouthwashes both containing 0.2% chlorhexidine, but different in that the first does not contain ADS, which is instead present in the second, a new product. The results obtained show that in the 15 patients treated, there is no statistically significant difference in the ability of the mouthwash to prevent bacterial plaque, however evidence of the stain was much less with the new mouthwash.     

Intra-oral findings and general health conditions among institutionalized and non-institutionalized elderly in Greece

BACKGROUND: The aim of the study was to record the findings from intra-oral examination and the general health conditions encountered in a group of Greek individuals 65 years of age or older. PATIENTS AND METHODS: The study subjects were derived from the elderly attending 12 randomly selected community centres located in Athens and neighbouring municipalities, consisting the non-institutionalized study group and from the elderly living in three ecclesiastical nursing homes, consisting the institutionalized study group. The research data comprised information from the subjects' interviews, self-defined health status, medical records and intra-oral examination on the following variables: sex, age, general health condition, dentate or not, use of dentures and oral conditions. Fisher's exact two-sided test was used for statistical analysis. RESULTS: Overall, 316 patients were examined; 120 male (38%), 196 female (62%), mean age 78 years (range: 65-99). Of those, 150 were non-institutionalized (59 male, 91 female) and 166 institutionalized (61 male and 105 female). The vast majority (90%) of the patients had at least one general health problem, for which they were taking daily medication. Twenty-three different medical conditions were recorded. The most frequent medical problems were hypertension (56%), cardiovascular problems (41%), depression/anxiety (39%), arthritis (18.5%) and visual problems (16%). The vast majority of the study patients (79%) were edentulous, while 33% were not wearing or using their dentures. Almost half of them (47%) had at least one oral condition. Twenty-seven different oral conditions were recorded. The most frequent oral findings were denture-induced stomatitis (17.2%), dry mouth (14.6%), atrophy of tongue papillae (10.5%), fissured tongue (9.8%) and haemangioma (6.8%). No cases of malignant lesions were observed. CONCLUSIONS: The present study confirms that in this particular age group, general health problems are frequent, variable, coexistent, necessitating the daily administration of multiple medications, while oral examination by a specialist is an essential part of the multidisciplinary medical care in this group of individuals.     

Oral mucosal lesions and oral hygiene habits in the home-living elderly

summary A large epidemiological health investigation, the Helsinki Ageing Study (HAS), was performed in 1989–1991 in Helsinki, Finland. We report here the prevalence of oral mucosal lesions in 338 76-, 81- and 86-year-old home-living elderly people, who completed the oral health investigation at the Institute of Dentistry, University of Helsinki. One or more lesions were found in 128 subjects (38%). Fifty-one per cent of the edentulous complete-denture wearers and 31% of the elderly with some natural teeth had mucosal lesions. The most common finding was inflammation under the denture, which occurred alone or combined with other lesions in 25% of the denture wearers. The three most common mucosal changes not related to denture wearing were coated changes of the tongue (7%), angular cheilitis (6%) and varicose veins under the tongue (4%). No differences were found in the number of mucosal lesions among the three age groups. Angular cheilitis and inflammation under removable dentures were more frequent in women than in men. However, no other differences were found in the presence of mucosal lesions between sexes. The total number of mucosal lesions correlated positively with the number of medications used daily. Ninety-six per cent of the subjects with complete dentures, and 98% of those with some natural teeth reported cleaning their dentures at least once a day. Of the denture wearers, 88% reported cleaning their oral mucosa also, as part of their oral hygiene routine. The presence of mucosal lesions was related to self-reported cleaning of the denture-bearing mucosa. However, no association was observed between cleaning frequency and presence of mucosal changes.     

Prevalence of oral mucosal disorders in institutionalized and non-institutionalized psychiatric patients: a study from AVBR Hospital in central India

Dental treatment is reported to be the greatest unattended health need of people with a disability. The aim of the present study was therefore to quantify the prevalence of oral diseases with a psychosomatic component (recurrent aphthous stomatitis, burning mouth syndrome, and oral lichen planus) in psychiatric patients and to screen these patients for any other oral disorders, so that better care could be provided. In this cross-sectional, single-assessment study, 150 psychiatric patients were evaluated for presence of oral disorders. They were screened based on their socio-demographic profiles, clinical profile, and standardized psychiatric scales. The prevalence of recurrent aphthous stomatitis (RAS), burning mouth syndrome (BMS), and oral lichen planus (OLP) was 19.33%(29 patients), 20.66% (31 patients) and 5.33% (8 patients), respectively, amongst all psychiatric patients. The prevalence of burning mouth syndrome was much higher in patients taking psychiatric medications (25%) than in drug-na?ve patients. On screening for other oral disorders, 35.33% of psychiatric patients had at least one other such disorder. We concluded that this patient group experiences a considerable burden of occult oral disorders necessitating thorough oral care. We also described the possible causes of the higher prevalence of oral disorders in psychiatric patients.     

Oral mucous membrane pemphigoid. A study of sixty-five patients

Sixty-five patients with oral mucous membrane pemphigoid were examined, treated, and followed for a mean of 3.5 years. Seventy-two percent were women, and the mean age was 59 years. In most patients multiple oral sites were involved and the gingiva was affected in 94% of the patients. Seven patients had ocular lesions (symblepharon), and seven others had nasal, vaginal, or pharyngeal involvement. Persons with skin lesions (bullous form) were not included in this series. Topical and systemic anti-inflammatory/immunosuppressive medications were successful in controlling signs and symptoms. There were no spontaneous remissions. Candidiasis, tobacco, other diseases, and drugs did not appear to be related to the pemphigoid.