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Background: Dental patients with primary or secondary adrenal insufficiency, or AI, may be at risk of experiencing adrenal crisis during or after invasive procedures. Since the mid-1950s, supplemental steroids in rather large doses have been recommended for patients with AI to prevent adrenal crisis., Methods: To evaluate the need for supplemental steroids in these patients, the authors searched the literature from 1966 to 2000 using MEDLINE and textbooks for information that addressed AI and adrenal crisis in dentistry. Reference lists of relevant publications and review articles also were examined for information about the topic., Results: The review identified only four reports of purported adrenal crisis in dentistry. Factors associated with the risk of adrenal crisis included the magnitude of surgery, the use of general anesthetics, the health status and stability of the patient, and the degree of pain control., Conclusions: The limited number of reported cases strongly suggests that adrenal crisis is a rare event in dentistry, especially for patients with secondary AI, and most routine dental procedures can be performed without glucocorticoid supplementation., Clinical Implications: The authors identify risk conditions for adrenal crisis and suggest new guidelines to prevent this problem in dental patients with AI.

Background: Compared with the general population, patients with systemic lupus erythematosus, or SLE, have an increased prevalence of functionally impaired cardiac valves due to the presence of Libman-Sacks lesions. These lesions may place patients with SLE at risk of developing infective endocarditis, or IE., Methods: The authors performed a retrospective chart review to determine the association between SLE with valvulopathy and IE. They reviewed the records of 361 patients from two health care facilities who had the diagnostic code of SLE., Results: Of the 275 records that met the 1982 revised American Rheumatism Association criteria for SLE, 51 (18.5 percent) were for patients who had a clinically detectable heart murmur that resulted in echocardiography being performed. Nine (3.3 percent) of the 275 patients had a clinically significant valvular abnormality, three (1.1 percent) had a potentially significant valvular abnormality, and one (0.4 percent) had a history of IE that was diagnosed two years before her diagnosis of SLE was made., Conclusions: The findings suggest that 18.5 percent of this cohort of patients with SLE had a clinically detectable heart murmur that would require further investigation to determine its significance. Furthermore, between 3.3 and 4.4 percent of the study population had cardiac valve abnormalities that potentially required antibiotic prophylaxis before certain dental procedures. However, the authors identified no cases that demonstrated an association between IE and diagnosed SLE., Clinical Implications: Dentists should query their patients with SLE about their cardiac status and consult with the patient's physician if the cardiac status is unknown. Patients with confirmed valvular abnormalities should receive antibiotic prophylaxis for designated bacteremia-producing dental procedures.

The authors surveyed 5,002 dental outpatients to determine the prevalence and patterns of drug use. They found that drug use increased significantly with age and that a significant number of patients took medications that had potential for adverse dental effects. Thus, dentists should be aware of patient medications and the effects those drugs have on dental treatment.

The clinical course of peripheral ossifying fibroma is slow and the growth of most lesions is limited in size, usually up to 1.5 cm. Complaints are rare unless the surface becomes ulcerated, or the lesion compromises oral function or esthetic appearance. Treatment is surgical excision with close postoperative follow-up. Tooth extraction is seldom necessary. Proper surgical intervention, which includes excision of reactive tissue down to periosteum, affords a low recurrence rate of 14% to 16%.

A cellular blue nevus located on the palate of a 72-year-old female is reported. This intraoral finding is uncommon and should be distinguished from clinical entities it closely resembles. Practitioners should be aware that a pigmented palatal lesion in fact may be a malignant melanoma. Surgical excision with microscopic examination is the only means by which an accurate diagnosis can be made.

A patient with a lymphangioma involving the labial commissure is reported. Key features of this disorder include its occurrence in young patients, asymptomatic nature, compressibility, and slow growth. Clinicians should understand that the lymphangioma may appear as a soft, grayish-blue, dome-shaped nodule, an irregular and papillary vesicular mass, or as a diffuse swelling. Appropriate clinical and radiographic tests are recommended before surgical excision. Histologically, the features of the lymphangioma may closely resemble those of a hemangioma.

A patient with white sponge nevus involving the buccal mucosa, labial mucosa, and soft palate is reported. The salient clinical and histological features of the disease were discussed. This diagnosis should be considered when bilateral white lesions of buccal mucosa are encountered. Early onset, a familial history, and the asymptomatic nature are key features to the disease. If historical data and clinical features are suspect, an incisional biopsy is adequate for diagnosis.