ONJ Does Not Affect Osteoporosis Medications, to Become Weak and Break the Jaw Joint (Temporomandibular Joint Or TMJ), and Dental Health, and (Fracture) Easily

Total Page:16

File Type:pdf, Size:1020Kb

ONJ Does Not Affect Osteoporosis Medications, to Become Weak and Break the Jaw Joint (Temporomandibular Joint Or TMJ), and Dental Health, and (Fracture) Easily Osteoporosis causes bones infection may be difficult to heal. ONJ does not affect Osteoporosis Medications, to become weak and break the jaw joint (temporomandibular joint or TMJ), and Dental Health, and (fracture) easily. These pain or discomfort in the jaw joint is not related to fractures can happen from ONJ or to bisphosphonate or denosumab treatment. Osteonecrosis of the Jaw simple falls or even from Though sometimes painful and progressive, ONJ can usual day-to-day activities be present without symptoms; it usually heals with (ONJ): (eg lifting, bending). Any appropriate treatment. bone can fracture with What You Need to Know osteoporosis; however, the How is ONJ Diagnosed? most common fractures are of the spine, hip, and Dentists or oral surgeons can diagnose ONJ by wrist. Osteoporosis can affect men and women of all examining the soft tissue covering the jaw bones. If ages but is most common amongst women after the jaw bone is not covered by a healthy soft tissue menopause. lining and remains uncovered or exposed for more than 8 weeks of appropriate treatment, this confirms Fractures from osteoporosis are preventable with the diagnosis of ONJ. appropriate medications. Bisphosphonates are a class of drugs which can safely and effectively ONJ can occur in the general population in the decrease the risk of fracture in osteoporotic patients. absence of any bisphosphonate or denosumab They represent a major advance in the treatment of therapy or other drugs, and usually heals within 12 osteoporosis and other bone diseases. Some of the weeks. ONJ can also develop in people who have risk oral bisphosphonates which are commonly factors for ONJ including poor blood supply to the prescribed include alendronate (Fosamax, Binosto), bone cells in the jaw. It can also develop after major ibandronate (Boniva) and risedronate (Actonel, dental surgery which involves cutting the bone, Atelvia)). Zoledronic acid (Aclasta, Reclast) given chemotherapy, steroid therapy (such as prednisone) intravenously once yearly is also used for and from poor dental health and diabetes. osteoporosis. Bisphosphonates remain in the skeleton for several years even after they are stopped. Bisphosphonates help reduce the risk of Is ONJ Caused by the Osteoporosis Therapy fracture and help maintain healthy bones. -- Bisphosphonates or Denosumab? Brought to you by Denosumab (Prolia) is also an effective treatment for ONJ has been noted in patients with cancer receiving the International Task Force on ONJ osteoporosis and can effectively lower the risk of high doses of intravenous zoledronic acid or fracture. Denosumab is given twice yearly by denosumab to reduce the complications associated subcutaneous injection and does not remain in the with cancer that has spread to the bones. In these skeleton for prolonged periods of time. patients, the risk increases with higher doses and with longer duration of treatment. In patients with What is Osteonecrosis of the Jaw? cancer, ONJ has been estimated to occur in 1 to 15% Osteonecrosis of the jaw (ONJ) is a rare oral of individuals receiving high dose bisphosphonate or condition in which the jaw one’s ability to heal is denosumab therapy. impaired and may cause a wound which does not heal. The bone is bare and is not covered by the oral In patients with osteoporosis, denosumab or tissues. bisphosphonate medications are used in lower doses (much lower than in patients with cancer) and the This bare bone can become infected and lead to pain risk appears to be only minimally higher then seen in and swelling. The bone can then break and the the general population not taking any bisphosphonates and denosumab are extremely Laurie K. McCauley, Felie O’Ryan, Ian R. Reid, bisphosphonate or denosumab therapy. The risk of important in preventing fractures, this should be Salvatore L. Ruggiero, Akira Taguchi, Sotirios ONJ with low dose bisphosphonate or denosumab discussed with the health care provider who Tetradis, Nelson B. Watts, Maria Luisa Brandi, treatment in osteoporosis patients is estimated to be prescribed the osteoporosis treatment. Edmund Peters, Teresa Guise, Richard Eastell, Angela between 1 in 10,000 and 1 in 100,000 per year of use M. Cheung, Suzanne N. Morin,Basel Masri, Cyrus and appears to be increased only slightly, if at all, How is ONJ Treated? Cooper, Sarah L. Morgan, Barbara Obermayer- compared with the risk for ONJ in the general If ONJ does occur, treatment is usually managed by Pietsch, Bente L. Langdahl, Rana Al Dabagh, K. population who have not taken any osteoporosis the dentist and/or oral surgeon and includes Shawn Davison, George K. Sándor, Robert G. Josse, therapy. maintaining good oral hygiene, controlling pain and Mohit Bhandari, Mohamed El Rabbany, Dominique treating areas of infection with antibiotics and oral D. Pierroz, Riad Sulimani, Deborah P. Saunders, How can ONJ be Prevented? antibiotic mouth rinses. Making sure patients take Jacques P. Brown, Juliet Compston on behalf of the The International ONJ Task lots of fluids and appropriate nutrition is also International Task Force on Osteonecrosis of the Force recommends that necessary. In certain circumstances, surgical Jaw. Case-Based Review of Osteonecrosis of the Jaw everyone should maintain treatment is required to remove dead bone tissue. (ONJ) and Application of the International good oral hygiene and see This will be determined by the dentist and oral Recommendations for Management From the their dentist every 6 months surgeon. International Task Force on ONJ, published in J. Cli. (or as recommended based Desito., 1-17, 2017 Additional Task force on oral disease risk). Routine Summary: members are: Ethel Siris, Sakae Tanaka, Bo dental work, such as dental The International Task Force on Osteonecrosis of the Abrahamsen and Akira Itabashi cleaning, fillings or root Jaw has been established to look at research canals should be performed as usual and do not priorities in order to help us understand the causes require stopping your osteoporosis treatment. It is of ONJ as well as the most effective forms of important to stop smoking. If possible, before treatment. starting high dose intravenous bisphosphonate or denosumab therapy in patients with cancer, a Osteoporosis is a serious disease. Treatment with detailed dental examination should be completed bisphosphonates or denosumab is a safe and with Xrays of the jaw bones. Any necessary dental effective way to reduce your chances of breaking a surgery should be completed before starting high bone. Talk to your doctor about your concerns and dose intravenous bisphosphonate or denosumab make sure your dentist is aware if you are taking a therapy in patients with cancer. The bisphosphonate or denosumab. recommendations for patients with osteoporosis receiving low dose bisphosphonate or denosumab If you are experiencing any of the following therapy are similar to those which apply to all symptoms please contact your dentist: individuals. They include maintenance of good oral Infection of the gum, drainage of the gums, poor hygiene and visiting your dentist regularly. If oral gum healing, numbness of the jaw, jaw pain or surgery is needed, it is ideal to have the surgery swelling or bare bone in the mouth. completed before starting low dose oral or intravenous yearly is phosphonate therapy or A JOINT MESSAGE FROM denosumab therapy if possible. Individuals with risk The International Task Force on ONJ : ASBMR, factors for ONJ who are taking bisphosphonate or AAOMS, CAOMS, CAOMP, ECTS, IBMS, IOF, ISCD, denosumab therapy may be advised to stop IAOMS, JSBMR, NOF, Osteoporosis Canada , PAOS, treatment after dental surgery and to restart therapy TES Aliya A. Khan, Archie Morrison, David L. Kendler, after the surgical site has completely healed. This Rene Rizzoli, David A. Hanley, Dieter Felsenberg, usually takes place 1-2 months after the surgery. As .
Recommended publications
  • Related Osteonecrosis of the Jaw in Patients with Sjögren's Syndrome
    Open access Research BMJ Open: first published as 10.1136/bmjopen-2018-024655 on 13 February 2019. Downloaded from Increased risk of bisphosphonate- related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study Min-Tser Liao,1,2 Wu-Chien Chien,3,4,5 Jen-Chun Wang,6 Chi-Hsiang Chung,3,4,7 Shi-Jye Chu,8 Shih-Hung Tsai6,9 To cite: Liao M-T, Chien W-C, ABSTRACT Strengths and limitations of this study Wang J-C, et al. Increased Objective The aim of this study was to explore whether risk of bisphosphonate- patients with Sjögren’s syndrome (SS) were susceptible ► The strength of our study is its population-based related osteonecrosis of to bisphosphonate (BP)-related osteonecrosis of the jaw the jaw in patients with cohort design with a large number of patients and (BRONJ) after tooth extraction in the entire population of Sjögren’s syndrome: long-term follow-up, which aims to evaluate the Taiwan. nationwide population-based association between Sjögren’s syndrome and os- Design A nationwide population-based retrospective cohort study. BMJ Open teonecrosis of the jaw (ONJ) after tooth extraction. 2019;9:e024655. doi:10.1136/ cohort study. ► The National Health Insurance Research Database Setting Data were extracted from Taiwan’s National bmjopen-2018-024655 registry could not provide detailed information re- Health Insurance Research Database (NHIRD). Prepublication history and garding laboratory results, family histories and ► Methodology Medical conditions for both the study and additional material for this health-related lifestyle factors. control group were categorised using the International paper are available online.
    [Show full text]
  • • Acute Pericoronitis • End-Stage Renal Disease • Acute Infectious Stomatitis an Acute Apical Abscess Should Not Be a Contraindication to Extraction
    • acute pericoronitis • end-stage renal disease • acute infectious stomatitis An acute apical abscess should not be a contraindication to extraction. It has been shown that these infections can resolve very quickly when the affected tooth is removed. However, it may be diffi - cult to extract such a tooth, either because the patient is unable to open sufficiently wide enough or because adequate local anesthesia cannot be obtained. There are few true contraindications to the extraction of teeth. Note: In some instances, the pa - tients’ health may be so compromised that they cannot withstand the surgical procedure. Examples of contraindications include: • End-stage renal disease • Severe uncontrolled metabolic diseases (i.e., uncontrolled diabetes mellitus) • Advanced cardiac conditions (unstable angina) • Patients with leukemia and lymphoma should be treated before extraction of teeth • Patients with hemophilia or platelet disorders should be treated before extraction of teeth • Patients with a history of head and neck cancer need to be treated with care because even minor surgery can lead to osteoradionecrosis. Note: These patients are often treated with hyperbaric oxygen therapy prior to (20 sessions) and following extractions (10 sessions). • Pericoronitis: infection of the soft tissues around a partially erupted mandibular third molar Note: This infection should be treated prior to removal of the maxillary third molar. • Acute infectious stomatitis and malignant disease are relative contraindications • Treatment with IV bisphosphonates increases the risk of osteonecrosis of the jaw Note: Causes of excessive bleeding after dental extractions include: injury to the inferior alveolar artery during extraction of a mandibular tooth (usually the third molar), a muscular arteriolar bleed from a flap procedure, or bleeding related to the patient’s history (i.e., patients who are on warfarin or drugs for platelet inhibition, patients who have hemophilia or von Willebrand disease, or who have chronic liver insufficiency)..
    [Show full text]
  • PATIENT FACT SHEET Osteonecrosis of the Jaw
    PATIENT FACT SHEET Osteonecrosis of the Jaw Osteonecrosis of the jaw (ONJ) is a condition where While there is a very low risk of ONJ occurring in people the jawbone is exposed and not covered by gums; a taking any of these medications, the risk may be slightly condition of poor healing. Bone weakens and dies. higher in people who require invasive dental procedures, There is no test to measure ONJ risk, but some factors such as a dental extraction or dental implant, if they also are known to raise this risk in very rare circumstances. take bisphosphonates. CONDITION Bisphosphonates, like alendronate (Fosamax), Patients who receive intravenous (injection into vein) DESCRIPTION risedronate (Actonel and Atelvia), ibandronate (Boniva), bisphosphonates as part of their cancer treatment are zoledronic acid (Reclast) and denosumab (Prolia), may at higher risk for ONJ than those who receive the much raise ONJ risk. This may be due to loss of bone’s ability to lower doses for osteoporosis treatment. Older age, repair itself, a drop in blood vessel formation or infection. diabetes, gum disease and smoking also raise ONJ risk. People with ONJ may experience pain, soft tissue swelling and drainage in the mouth, and an exposed jawbone for eight weeks or longer. Other possible signs are bad breath, loose teeth and signs of infection on gums. SIGNS/ SYMPTOMS People with osteoporosis who develop ONJ receive A rheumatologist has experience in treating osteoporosis conservative treatments, such as oral rinses, with antiresorptive medications and managing the risk antibiotics and oral analgesics to ease pain. These of osteonecrosis of the jaw.
    [Show full text]
  • Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies
    International Journal of Molecular Sciences Review Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies Lucía Melguizo-Rodríguez 1,2, Victor J. Costela-Ruiz 2,3, Francisco Javier Manzano-Moreno 2,4, Concepción Ruiz 2,3,5,* and Rebeca Illescas-Montes 2,3 1 Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences (Ceuta), University of Granada, 51001 Granada, Spain; [email protected] 2 Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain; [email protected] (V.J.C.-R.); [email protected] (F.J.M.-M.); [email protected] (R.I.-M.) 3 Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain 4 Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, 18071 Granada, Spain 5 Institute of Neuroscience, University of Granada, 18016 Granada, Spain * Correspondence: [email protected]; Tel.: +34-958243497 Received: 17 June 2020; Accepted: 15 July 2020; Published: 21 July 2020 Abstract: Saliva is a highly versatile biological fluid that is easy to gather in a non-invasive manner—and the results of its analysis complement clinical and histopathological findings in the diagnosis of multiple diseases. The objective of this review was to offer an update on the contribution of salivary biomarkers to the diagnosis and prognosis of diseases of the oral cavity, including oral lichen planus, periodontitis, Sjögren’s syndrome, oral leukoplakia, peri-implantitis, and medication-related osteonecrosis of the jaw. Salivary biomarkers such as interleukins, growth factors, enzymes, and other biomolecules have proven useful in the diagnosis and follow-up of these diseases, facilitating the early evaluation of malignization risk and the monitoring of disease progression and response to treatment.
    [Show full text]
  • Oral and Maxillo-Facial Manifestations of Systemic Diseases: an Overview
    medicina Review Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview Saverio Capodiferro *,† , Luisa Limongelli *,† and Gianfranco Favia Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; [email protected] * Correspondence: [email protected] (S.C.); [email protected] (L.L.) † These authors contributed equally to the paper. Abstract: Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease. Keywords: oral cavity; head and neck; systemic disease; oral signs of systemic diseases; early diagnosis; differential diagnosis Citation: Capodiferro, S.; Limongelli, 1. Introduction L.; Favia, G. Oral and Maxillo-Facial Oral and maxillo-facial manifestations of systemic diseases represent an extensive and Manifestations of Systemic Diseases: fascinating study, which is mainly based on the knowledge that many signs and symptoms An Overview. Medicina 2021, 57, 271. as numerous systemic disorders may first present as or may be identified by head and https://doi.org/10.3390/ neck tissue changes.
    [Show full text]
  • Medication Related Osteonecrosis of Jaw
    Jemds.com Case Report Medication Related Osteonecrosis of Jaw Prasanthi Sitaraman1, Arvind Muthukrishnan2 1Department of Oral Medicine and Radiology, Saveetha Dental College, Tamilnadu, India. 2Department of Oral Medicine and Radiology, Saveetha Dental College, Chennai, Tamilnadu, India. PRESENTATION OF CASE A 41 year old female patient reported with the complaint of pain in the right posterior Corresponding Author: mandibular region for the past 5 months. History revealed that patient was diagnosed Dr. Prasanthi Sitaraman. with breast cancer before 4 years following which she underwent mastectomy, Department of Oral Medicine and radiotherapy and chemotherapy. PET / CT taken post chemotherapy showed bone Radiology, Saveetha Dental College, Saveetha Institute of Medical and Technical metastasis to the lumbar spine for which she was prescribed I.V. zoledronic acid to Sciences (SIMATS), 162, Poonamallee High be administered every 3 months. Patient was under I.V. zoledronic acid for a total of Road, Chennai - 600077, Tamilnadu, India. 36 months. E-mail: [email protected] Patient underwent surgery for extraction of impacted lower third molar before 7 months. The extraction site did not completely heal following which the tooth DOI: 10.14260/jemds/2020/602 adjacent to the extraction site became mobile. The mobile tooth was also extracted before 5 months following which she developed pain and swelling in the region. How to Cite This Article: Patient was diagnosed with osteoradionecrosis and underwent curettage and Sitaraman P, Muthukrishnan A. Medication related osteonecrosis of jaw. J Evolution antiseptic dressing for 2 months. However, there was no reduction in pain. Pain was Med Dent Sci 2020;9(37):2770-2772, DOI: gradual in onset, continuous, gnawing, in the extraction site, aggravated by 10.14260/jemds/2020/602 mastication and relieved by medication.
    [Show full text]
  • Bisphosphonates, Osteonecrosis, Osteogenesis Imperfecta and Dental Extractions: a Case Series
    Clinical PRACTICE Bisphosphonates, Osteonecrosis, Osteogenesis Imperfecta and Dental Extractions: A Case Series Contact Author Stephane Schwartz, DDS, MSD, FRCD(C); Clara Joseph, DMD, MSc; Dr. Schwartz Deborah Iera, DDS, FRCD(C); Duy-Dat Vu, DMD, MSc, FRCD(C) Email: Stephane.Schwartz@ muhc.mcgill.ca ABSTRACT Over the past 4 years, numerous cases of osteonecrosis of the jaw in patients treated with bisphosphonates have been reported. Since 1998, children and adolescents with osteogenesis imperfecta have received bisphosphonates to increase their bone density and reduce the incidence of bone fractures. The results have been convincing, but recent reports of osteonecrosis of the jaw have caused great concern when these patients require dental extractions. The dental records of 15 children and adolescents with osteogenesis imperfecta, involving 60 dental extractions, mostly of primary teeth, done between 2001 and 2006, were reviewed. All patients but one had had or were having bisphosphonate treatment at the time of the extractions. No patient developed osteone- crosis. Further studies and data that allow clinicians to design adequate and safe treat- ment plans for this unique population are needed. For citation purposes, the electronic version is the definitive version of this article: www.cda-adc.ca/jcda/vol-74/issue-6/537.html he purpose of bisphosphonate therapy genesis imperfecta. Osteogenesis imper- is to slow the rate of bone resorption. fecta is often associated with severe dental TMostly, this therapy is used to treat dif- problems, such as dentinogenesis imperfecta ferent types of cancers (myelomas, metastatic (gray-brown friable teeth, bulky crowns and breast or prostate cancers), bone diseases or early calcification of the pulpal space) and severe osteoporosis.1,2 Since 2003, when the malocclusions (drastic open bites, impacted link between bisphosphonate therapy and bone molars; Figs.
    [Show full text]
  • Oral & Maxillofacial Surgery
    1 Oral & Maxillofacial Surgery Current Awareness Newsletter May 2015 2 Contents Your Friendly Local Librarian… ................................................................................................................ 2 New from the Cochrane Library of Systematic Reviews ......................................................................... 3 Recent Literature Searches on Oral and Maxillofacial Surgery............................................................... 3 Current Awareness Database Articles on Oral and Maxillofacial Surgery .............................................. 4 Oral surgery ......................................................................................................................................... 4 Bisphosphonate-related osteonecrosis of the jaw ............................................................................. 5 Maxillofacial ........................................................................................................................................ 7 Cleft lip and palate ............................................................................................................................ 11 Journal Tables of Contents .................................................................................................................... 15 Head and Neck .................................................................................................................................. 15 British Journal of Oral and Maxillofacial Surgery .............................................................................
    [Show full text]
  • Osteonecrosis of Jaw: Common Etiologies, Uncommon Treatments
    East Tennessee State University Digital Commons @ East Tennessee State University Appalachian Student Research Forum 2019 ASRF Schedule Apr 12th, 9:00 AM - 2:30 PM Osteonecrosis of Jaw: Common etiologies, uncommon treatments Utsab Panta Adam chan East Tennessee State University Debalina Das East Tennessee State University Follow this and additional works at: https://dc.etsu.edu/asrf Panta, Utsab; chan, Adam; and Das, Debalina, "Osteonecrosis of Jaw: Common etiologies, uncommon treatments" (2019). Appalachian Student Research Forum. 201. https://dc.etsu.edu/asrf/2019/schedule/201 This Oral Competitive is brought to you for free and open access by the Events at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in Appalachian Student Research Forum by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact [email protected]. Osteonecrosis of Jaw: Common etiologies, uncommon treatments Utsab Raj Panta1, MD, Adam Chan1, Debalina Das1, MD, MPH 1East Tennessee State University, Department of Internal Medicine Introduction Case presentation continued Images Discussion continued First described in 2002, osteonecrosis of Later, patient complained of a piece of the jaw (ONJ, or avascular necrosis of the Case reports and series suggest benefit bone penetrating the skin of her chin and jaw) is an uncommon but potentially from hyperbaric oxygen therapy in wound presented with continuous drainage from serious side effect of treatment with healing, pain, and quality of life at three sinus tract in her mandible, which was bisphosphonates. Although months, however no significant diagnosed as osteonecrosis attributed to typically identified in patients with differences exist with outcomes beyond bisphosphonates, previous radiation multiple myeloma and other three months.
    [Show full text]
  • Prevention of Herpes Zoster Recommendations of the Advisory Committee on Immunization Practices (ACIP)
    Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Recommendations and Reports June 6, 2008 / Vol. 57 / RR-5 Prevention of Herpes Zoster Recommendations of the Advisory Committee on Immunization Practices (ACIP) INSIDE: Continuing Education Examination depardepardepartment of health and human servicesvicesvices Centers for Disease Control and PreventionPrevention MMWR CONTENTS The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Introduction ..........................................................................1 Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Methods ...............................................................................2 Background ..........................................................................2 Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR Early Release 2008;57[Date]:[inclusive page numbers]. Biology of VZV ...................................................................2 Clinical Features of Zoster and PHN ..................................3 Centers for Disease Control and Prevention Diagnosis ..........................................................................5 Julie L. Gerberding, MD, MPH Director Zoster Transmission ...........................................................5 Tanja Popovic, MD, PhD Epidemiology of Zoster and Complications .......................6 Chief Science Officer Treatment and Nonspecific Management of Zoster
    [Show full text]
  • Oral Health in Elderly People Michèle J
    CHAPTER 8 Oral Health in Elderly People Michèle J. Saunders, DDS, MS, MPH and Chih-Ko Yeh, DDS As the first segment of the gastrointestinal system, the At the lips, the skin of the face is continuous with oral cavity provides the point of entry for nutrients. the mucous membranes of the oral cavity. The bulk The condition of the oral cavity, therefore, can facili- of the lips is formed by skeletal muscles and a variety tate or undermine nutritional status. If dietary habits of sensory receptors that judge the taste and tempera- are unfavorably influenced by poor oral health, nutri- ture of foods. Their reddish color is to the result of an tional status can be compromised. However, nutri- abundance of blood vessels near their surface. tional status can also contribute to or exacerbate oral The vestibule is the cleft that separates the lips disease. General well-being is related to health and and cheeks from the teeth and gingivae. When the disease states of the oral cavity as well as the rest of mouth is closed, the vestibule communicates with the the body. An awareness of this interrelationship is rest of the mouth through the space between the last essential when the clinician is working with the older molar teeth and the rami of the mandible. patient because the incidence of major dental prob- Thirty-two teeth normally are present in the lems and the frequency of chronic illness and phar- adult mouth: two incisors, one canine, two premo- macotherapy increase dramatically in older people. lars, and three molars in each half of the upper and lower jaws.
    [Show full text]
  • Oral Manifestations of Sjogrens Syndrome
    Review Oral manifestations of Rheumatology Future Sjögren’s syndrome Carol M Stewart† & Kathleen Berg †Author for correspondence: University of Florida Center for Orphaned Autoimmune Disorders, PO Box, 100414 JHMHC, University of Florida College of Dentistry, Gainesville, FL 32610, USA n Tel:. +1 352 392 6775 n Fax: +1 352 392 2507 n [email protected] Sjögren’s syndrome is a chronic autoimmune disease complex characterized by inflammation of the exocrine glands, primarily resulting in keratoconjunctivitis sicca, hyposalivation and xerostomia, or dry mouth. Dry mouth is one of the most easily recognized components and may lead the clinician to diagnosis. Hyposalivation is more than an inconvenience, having a significant adverse effect on health and quality of life. Early recognition of this condition may minimize some of the adverse sequelae. A dental evaluation in patients with confirmed or suspected Sjögren’s is recommended. The focus of this review article is to highlight oral manifestations of Sjögren’s syndrome to include pathogenesis, clinical presentation, implications for health, diagnostic tools, management strategies and future perspectives. CME Medscape: Continuing Medical Education Online Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation.
    [Show full text]