Xerostomia: recognition and management

Awareness and recognition of xerostomia are essential in order to help patients minimize dryness symptoms, to institute preventive measures and to limit oral complications. The dental professional has the opportunity to ask every patient if they are experiencing dry mouth. In particular, complaints of dryness while eating, or difficulty swallowing dry foods, or the necessity of using liquids to ease swallowing are important clues that salivary function may be impaired. As part of a routine oral examination, one should examine the oral cavity carefully for signs of salivary gland dysfunction. Findings such as an increase in caries activity, mucosal alterations, infection or salivary gland enlargement may indicate salivary dysfunction. Evaluation should be conducted proactively at each patient visit. Early recognition will minimize damage and dysfunction and allow appropriate management to begin. Although the salivary dysfunction may be irreversible, preventive measures and conservative treatments can avoid or limit mucosal breakdown, infections and permanent damage to teeth. Adequate symptomatic relief is possible with local palliative and systemic measures in many patients. Appropriate management of symptoms and increasing saliva output may help patients feel more comfortable and improve their quality of life.     

Xerostomia: diagnosis and treatment planning considerations

Long-term xerostomia results in a poor prognosis for the remaining dentition, existing restorations, and denture acceptance. The dentist must be able to recognize xerostomia by the clinical signs and the potential for xerostomia on the basis of a medical history, since xerostomia may not always be the patient's chief complaint. A literature review concerning the etiology, diagnosis, and management of xerostomia is presented.     

Xerostomia. Diagnosis and treatment

Comprehensive examination and treatment were made of 57 patients with xerostomia on the background of different salivary glands diseases. Mexidol was used for treatment in the form of external blockade in the region of the salivary glands. Expressed clinical effect was observed in 67% of patients with considerable reduction or disappearance of oral cavity xerostomia, decrease of glands swelling and general condition improvement. Indices of lipid peroxidation and of antioxidant protection of mixed saliva of xerostomic patients differed from analogous control data and depended upon the type of xerostomia involved.     

Melanoma: etiology, treatment, and dental implications

Melanoma is one of the most serious skin cancers. It arises from neural crest-derived melanocytes located in the epidermis or dermis of the skin. Melanoma also can arise from melanocytes located in other regions of the body such as the eye, meninges, digestive tract, mucosal surfaces, or lymph nodes. There are no proven causes of melanoma but the most commonly associated factor is episodic exposure to the sun. Melanoma is a common cancer that has been increasing in incidence for the last 35 years. The median age at the time of diagnosis is 53 years. It is much more common in whites than in people of color. Five-year survival rates for melanoma of the skin have been increasing since 1976. There are four types of melanoma: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lintiginous melanoma. Clinical signs indicating possible melanoma are asymmetry, border irregularity, color variation, increase in diameter, elevation, ulceration, and bleeding of pigmented lesions. Histopathologic findings (tumor thickness, tumor invasion), surface ulceration, spread to lymph nodes, and distant metastases are used to project patient prognosis. Treatment consists of surgical excision, lymph node dissection, limb perfusion, regional chemotherapy infusion, radiation, intralesional immunotherapy, systemic chemotherapy, and/or interferon-alpha, depending on the staging of the melanoma. Oral melanomas are rare; however, approximately 20% of all melanomas are found in the head and neck region. The role of the dentist is to be alert for changes in pigmented lesions of the oral mucosa and skin of the head and neck. Lesions suspected of melanoma must be biopsied, which usually involves referral of the patient.     

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.     

Periodontal abscess: etiology, diagnosis and treatment

The periodontal abscess is an acute destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp. The prevalence of periodontal abscess is relatively high and it affects the prognosis of the tooth. Periodontal abscesses can develop on the base of persisting periodontitis but can also occur in the absence of periodontitis. The cause of the development of periodontal abscess originating from chronic periodontitis is the marginal closure of a periodontal pocket, or the pocket lumen might be too tight to drain the increased suppuration due to changes in the composition of subgingival microflora, alteration of bacterial virulence or host defenses. Diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination (pocket depth, swelling, suppuration, mobility, sensibility of the tooth). The most prevalent group of bacteria: P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros. Previous studies have suggested that the complete therapy of the periodontitis patients with acute periodontal abscess has to do in two stages: the first stage is the management of acute lesions, then the second stage is the appropriate comprehensive treatment of the original and/or residual lesions. The management of acute lesions includes establishing drainage via pocket lumen, subgingival scaling and root planing, curettage of the lining pocket epithelia and seriously inflamed connective tissue, compressing pocket wall to underlying tooth and periodontal support, and maintaining tissue contact. Some authors recommend the incision or to establish drainage and irrigation, or a flap surgery, or even extraction of hopeless teeth. We recommend the use of systemic antibiotics as a preventive measure of systemic disease or in case of systemic symptoms.     

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.     

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.     

Xerostomia and you

The aims of management of patients with xerostomia include the provision of a definitive aetiology and diagnosis, and a prognosis for the salivary dysfunction. Salivary flow assessment and function testing, other relevant laboratory tests, and even referrals should be performed as necessary. Management of the condition depends on diagnosis and severity, and includes enhancement of salivary flow, oral lubrication, control of soft-tissue infections and discomfort, and prevention of dental caries.     

Implant surgery complications: etiology and treatment

Implant surgery complications are frequent occurrences in dental practice and knowledge in the management of these cases is essential. The aim of this review was to highlight the challenges of treatment plan-related, anatomy-related, and procedure-related surgical complications as well as to discuss the etiology, management and treatment options to achieve a satisfactory treatment outcome.     

Sinus augmentation complications: etiology and treatment

Sinus augmentation, either osteotome or lateral window approach, is a predictable procedure to augment vertical height that allows for proper implant placement in areas with previous limited restorative options. Like any surgical procedures, there is always a risk of encountering either intrasurgical or postsurgical complications. A Medline literature search of articles published from 1984 to 2006 related to complications following sinus augmentation were selected and analyzed. To make it easier for understanding, sinus augmentation complications were classified into following categories: systemic disease and mediations related; anatomy and surgical procedure related; sinus pathology related; infection related; and prosthetic related. Depending on the source or cause of complication, treatment may include palliative approach to surgical intervention. This article will review a newly proposed complication classification, discuss treatment modalities for each encountered complication and propose methods to avoid these complications.     

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.     

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.