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Background Heart transplants have become a successful treatment for some cardiovascular diseases. To prevent rejection of the transplanted heart, patients have to take immunosuppressive medication. Aims The aims of this study were to identify and review oral health complications after heart transplantation. Methods The electronic database PubMed was searched for relevant articles. The search yielded 332 papers, of which 24 matched the criteria for this review. Results Gingival hyperplasia was observed in 8.3-67% of the patients. Heart transplant patients who received professional periodontal treatment starting six months after transplantation showed significantly better scores on the Gingival Index (GI) and gingival hyperplasia. In comparison to a control group, heart transplant patients did not differ significantly in the DMF(T) index. The incidence of fungal infection in patients receiving a heart transplant varied between 10% and 25%. Heart transplant patients had a 4.3 times higher chance of developing oral cancer. Conclusion Patients who underwent a heart transplant and subsequently used immunosuppressive medicines appear to have a higher risk of gingival hyperplasia, periodontal conditions, the presence of Candida species and oral malignancies, in comparison to healthy individuals. The association between heart transplants and dental caries was unclear. It is recommended that heart transplant patients receive frequent oral examination and professional dental cleaning.

The biochemical composition of articaine differs from other amide anaesthetics. The lipophilic part of articaine consists of a thiophene ring, whereas other amide anaesthetics contain a benzene ring. When used correctly, local anaesthetics are remarkably safe. However, all local anaesthetics are potentially neurotoxic. In rare cases a prolonged abnormal perception/sensation may be present after the expected duration of action (paraesthesia). In several countries retrospective studies have been conducted that examined the incidence of persistent paraesthesia after the use of local anaesthetics. In most studies the number of paraesthesia cases after the use of articaine was higher than the market share of this anaesthetic. In animal studies and in cell culture experiments, however, articaine did not have a higher toxicity compared to other amide anaesthetics. Further studies of the cause of paraesthesia after administration of local anaesthetics seem to be warranted.

H. S. Brand of the Academic Centre for Dentistry Amsterdam, and movie buff, continues his new series of columns on films featuring dentists with Pearl Harbor (2001), directed by Michael Bay.

Introduction Recent health promotion campaigns have encouraged the public to consume at least five portions of fruit and vegetables per day. Many see consuming fruit smoothies as a way of achieving this. Objective To ascertain the potential or otherwise for fruit smoothies to bring about dental erosion. Design Laboratory study. Method This was an in vitro investigation in which five varieties of shop bought fruit smoothies, including a 'thickie' were investigated, with respect to their initial pH, titratable acidity and effect upon exposure to the surface microhardness and profile of extracted human teeth. In addition their performance was compared to negative (Volvic™ water) and positive (orange juice) control drinks as well as a homemade smoothie, based upon the recipe of one of the commercially bought drinks, from which ingredient omissions were made. Results The majority of the drinks investigated had a baseline pH below the critical pH of enamel (5.5) and required comparable volumes of 0.1M NaOH to raise their pH to neutrality as the positive control. Only two drinks (Volvic™ still mineral water, the negative control, and the yoghurt, vanilla bean and honey 'thickie') displayed a higher pH, though to neutralise the thickie, a lesser quantity of alkali addition was required. The immersion of the tooth samples in the drinks brought about reductions in their surface hardness (expressed as a percentage change of median hardness) but these were only significant (p

BackgroundOral dryness or hyposalivation is a major clinical problem. Several chairside tests or visual inspections of the oral cavity have been proposed for the assessment.ObjectiveTo identify whether photographs of the tongue could be used to identify oral dryness.Material and methodsTwenty-five dentists and 25 individuals with another academic background were recruited. They assessed the severity of the oral dryness of 50 patients, based on an intraoral picture of each patient. The oral dryness was quantified with a five-point Likert scale and the scores were subsequently compared with the salivary flow rate and the level of xerostomia of these patients.ResultsNo relation was found between the unstimulated salivary flow rate of a patient and the average oral dryness score, determined by dentists (p = 0.260) as well as non-dentists (p = 0.806). Also no relation was found between the self-reported xerostomia level of the patient and the average dryness score assessed by the dentists (p = 0.171) or non-dentists (p = 0.477).ConclusionIt does not seem possible to diagnose oral dryness by mere visual inspection of photographed tongues. Thus, for correct diagnosis of oral dryness further clinical investigation of the oral cavity and collection of saliva is indicated.

Background An oromucosal spray has been developed from the major components of marijuana (cannabis), including tetrahydrocannabinol (THC) and cannabidiol (CBD), in alcohol with a peppermint flavouring, designed to be administered as a spray under the tongue or on the buccal mucosa to relieve pain in multiple sclerosis. Although the available evidence indicates its efficacy in this respect, some patients develop oral burning sensation, stinging or white lesions, probably burns. Objective To investigate the oral side-effects of oromucosal cannabis spray in multiple sclerosis (MS) patients. Design A small open observational study. Subjects and methods A series of nine patients with MS who had been using a marijuana oromucosal spray for at least four weeks, were asked to attend for oral examination. Patients were asked whether they had ever experienced symptoms (dryness; bad taste; stinging) associated with use of the spray. A standard oral examination was carried out using a dental light, and the presence of any mucosal lesions recorded. Where mucosal lesions were present, patients were advised to discontinue the spray and re-attend after four weeks for re-examination. For ethical reasons, biopsies were not undertaken at the first visit. Results Of nine patients invited to participate, eight attended. All admitted to a stinging sensation on using the oromucosal cannabis spray, and four had visible oral mucosal white lesions in the floor of the mouth. Conclusions Although the white lesions observed were almost certainly burns, resolving or improving on discontinuation of use of the medication, the high alcohol concentration of the oromucosal cannabis spray raises concern in relation to chronic oral use.