Necrotizing sialometaplasia. A disease simulating malignancy.

Periodontal diseases are among the most common diseases affecting humans. Dental biofilm is a contributor to the etiology of most periodontal diseases. It is also widely accepted that immunological and inflammatory responses to biofilm components are manifested by signs and symptoms of periodontal disease. The outcome of such interaction is modulated by risk factors (modifiers), either inherent (genetic) or acquired (environmental), significantly affecting the initiation and progression of different periodontal disease phenotypes. While definitive genetic determinants responsible for either susceptibility or resistance to periodontal disease have yet to be identified, many factors affecting the pathogenesis have been described, including smoking, diabetes, obesity, medications, and nutrition. Currently, periodontal diseases are classified based upon clinical disease traits using radiographs and clinical examination. Advances in genomics, molecular biology, and personalized medicine may result in new guidelines for unambiguous disease definition and diagnosis in the future. Recent studies have implied relationships between periodontal diseases and systemic conditions. Answering critical questions regarding host-parasite interactions in periodontal diseases may provide new insight in the pathogenesis of other biomedical disorders. Therapeutic efforts have focused on the microbial nature of the infection, as active treatment centers on biofilm disruption by non-surgical mechanical debridement with antimicrobial and sometimes anti-inflammatory adjuncts. The surgical treatment aims at gaining access to periodontal lesions and correcting unfavorable gingival/osseous contours to achieve a periodontal architecture that will provide for more effective oral hygiene and periodontal maintenance. In addition, advances in tissue engineering have provided innovative means to regenerate/repair periodontal defects, based upon principles of guided tissue regeneration and utilization of growth factors/biologic mediators. To maintain periodontal stability, these treatments need to be supplemented with long-term maintenance (supportive periodontal therapy) programs.

/pdf/principles-of-periodontology-2k9znz6m63.pdf

Principles of periodontology.

Introduction: The remit of this working group was to update the existing knowledge base in non-surgical periodontal therapy. The published systematic reviews from the fourth EAP Workshop formed the starting point for this update and in addition specific innovations not covered in previous workshops were included.

Material and Methods: The literature was systematically searched and critically reviewed. Five manuscripts were produced in five specific topics identified as areas where innovative approaches have been developed in non-surgical periodontal therapy and which were deemed to be strategically important for patient care and clinical practice.

Results: The results and conclusions of the review process are presented in the following papers, together with the group consensus statements, clinical implications and directions for future research:
A systematic review of the effects of full mouth debridement with and without antiseptics in patients with chronic periodontitis.
Advances in Power Driven Instrumentation.
Laser application in non-surgical periodontal therapy – a systematic review.
Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm.
The cost-effectiveness of supportive periodontal-care for patients with chronic periodontitis.

Innovations in non-surgical periodontal therapy: Consensus Report of the Sixth European Workshop on Periodontology.

Risk stratification for the development of chronic postsurgical pain

This review gives an update on recent epidemiologic data on periodontal diseases and a description of current periodontal services in Europe. A Medline search of articles published within the last decade with the keywords epidemiology, prevalence, periodontitis, tooth loss, and Europe was performed. Data on provision of dental services originated from international databases. Epidemiologic data on the prevalence of edentulism, the number of missing teeth, the prevalence of probing depth (Community Periodontal Index - CPI >or= 3 or Pocket Depth - PD >or= 4 mm), and clinical attachment loss (CAL >or= 4 mm) displayed a fragmentary picture within Europe. With respect to the limited data on periodontal health, Spain, Sweden, and Switzerland ranked as the healthiest among European countries in contrast to Germany where increased tooth loss and the highest prevalence of CAL >or= 4 mm were reported. The role of dental auxiliaries especially of dental hygienists and/or the medico-legal framework in which they work, appears to be an important factor in provision of effective periodontal care. Actual epidemiologic data on periodontal diseases are non-homogeneous and absent from several European countries. This emphasises the need for more national representative epidemiological studies with a uniform design to permit comparability between different nations. Merging actual epidemiologic data with former data on provision of periodontal care may help to explain differences in periodontal parameters on a population basis and to define future provision of dental care.

Periodontal health in Europe: future trends based on treatment needs and the provision of periodontal services--position paper 1.

Objective: To systematically evaluate the evidence for effectiveness of supportive periodontal care (SPC) provided in specialist care and general practice for patients with chronic periodontitis; to construct a model for the cost effectiveness of SPC. Search Strategy: Electronic database searches of MEDLINE, EMBASE and SCOPUS were performed with hand searching of relevant journals and Workshops of Periodontology. Selection Criteria: SPC for patients with chronic periodontitis, at least 12 months follow-up and clinical attachment level as a primary outcome. Results: Three articles addressed the question (Nyman et al. 1975, Axelsson & Lindhe 1981, Cortellini et al. 1994): As CAL for patients undergoing "specialist" SPC were 0.1 mm (2 years), 0.2 mm (6 years) and - 0.01 mm (3 years) respectively. In generalist care the As CAL during SPC were - 2.2, - 1.8 and - 2.8 mm. Differences between specialist and generalist SPC were an extra 20.59 tooth years and 3.95 mm attachment loss for generalist SPC. Incremental cost-effectiveness ratios were an extra E288 for one tooth year or an extra E1503/1 mm reduction in loss of attachment for SPC delivered in specialist care. Conclusion: SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.

The cost‐effectiveness of supportive periodontal care for patients with chronic periodontitis

The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review

Objective The aim of the study was to systematically identify criteria used to diagnose patients with trigeminal nerve injury. Study Design A systematic review of the literature registered in the PROSPERO database. Inclusion criteria were patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury. Results In total, 28 articles were included. Diagnostic tests included clinical neurosensory tests (89%), thermal quantitative sensory testing (QST; 25%), electromyography (7%), and patient interview (14%). Neuropathic pain was assessed by using the visual analogue scale (39%); patient use of neuropathic medication (7%); questionnaires, including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing clinical neurosensory tests, application of diagnostic terms and diagnostic grading of nerve injury was found to be inconsistent among the included articles, making direct comparison of results difficult. Conclusions Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment, and outcome reporting among stakeholder organizations to improve knowledge in this field.

Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review.

Purpose To present ten cases of chronic post-surgical neuropathic pain (CPSP) arising after placement of maxillary dental implants, in order to raise awareness of this potential complication of treatment. Materials and methods Data collected from the case notes of consecutive patients presenting to the orofacial pain clinic, with neuropathic pain arising after placement of maxillary dental implants. Results Nine out of 10 patients were female, with an average age 55.4 years. Six patients had a significant medical history (depression, peripheral neuropathic pain, irritable bowel syndrome and fibromyalgia). Six patients had single implants placed, four had multiple implants. Four patients experienced pain during implant placement. Onset of pain was immediate in nine patients. Pain intensity (visual analogue scale) ranged from 2 to 9 (average 5.6). Pain was constant in all patients. Exacerbating factors included stress, tiredness, low mood and cold weather. Implants were removed in two patients however pain did not resolve. Pain management was complex; including medication (anti-epileptics and tricyclic antidepressants), Botox injections and cognitive behavioural therapy, however pain did not completely resolve in nine cases. Conclusions Persistent pain after dental implant placement may occur with no apparent organic cause and without any neurosensory deficits. Practitioners must be aware of chronic post-surgical neuropathic pain as a possible complication of implant placement, particularly in patients with a significant medical history. Consideration should be given as to whether these patients are suitable for implant rehabilitation. Patients reporting very severe and prolonged postoperative pain following implant surgery should be considered at risk of CPSP and referred to a specialist in orofacial pain.

Chronic post-surgical pain following the placement of dental implants in the maxilla: A case series.

Introduction Sensory neuropathies of the mandibular division of the trigeminal (V3) nerve can be debilitating, causing difficulty with daily function. It has a variety of causes, including iatrogenic injury, usually caused by third molar removal, local anaesthetic administration, implant placement or endodontic treatment. Non-iatrogenic causes include infection, primary or secondary neoplasia and various medical conditions.Objective To review the aetiology, evaluation and management of V3 neuropathy in a retrospective case-series of patients referred to a specialist nerve injury clinic over an eight-year period, particularly focusing on the non-iatrogenic causes of this presentation.Methods A retrospective analysis of the case notes of 372 patients referred to the specialist nerve injury clinic between 2006 and 2014 was carried out to establish the cause of the neuropathy and subsequent management or referral. The assessment protocol of trigeminal neuropathy used in the clinic is also outlined.Results Most patients (89.5%) presented with neuropathy due to iatrogenic injury. Of the non-iatrogenic causes (10.5%), malignancy accounted for a fifth of presentations, and infection almost two-fifths, demonstrating the importance of prompt identification of a cause and management by the clinician, or referral to the appropriate specialty. Other, more rare causes are also presented, including multiple sclerosis, sickle-cell anaemia and Paget's disease, highlighting the importance to the clinician of considering differential diagnoses.Conclusions This case series demonstrates the less frequent, but nevertheless important, non-iatrogenic causes which clinicians should consider when assessing patients with trigeminal neuropathy.

Maria Devine

Papers

The cost‐effectiveness of supportive periodontal care for patients with chronic periodontitis

The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review

Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review.

Chronic post-surgical pain following the placement of dental implants in the maxilla: A case series.

An Update on the Causes, Assessment and Management of Third Division Sensory Trigeminal Neuropathies