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Objectives: Pain is a major factor in health quality in Sjögren's syndrome (SS), but little is known about the factors that contribute to pain severity. Because pain perception has been linked to catastrophizing in other diseases, we assessed subjects with primary SS (pSS) to explore a possible link between pain, illness appraisal, and catastrophizing.Method: A total of 92 subjects who met American-European consensus criteria for the diagnosis of pSS completed a questionnaire that included health history, medication use, illness perceptions, pain severity, mood, fatigue, pain anxiety, and pain catastrophizing. Linear regression was used to test the effect of each variable on pain severity. Multivariate models were constructed using backwards elimination to assess the significant predictors of pain severity.Results: From linear regression analysis, catastrophizing was more strongly predictive of pain severity than age, fatigue, depression, or anxiety in both seropositive and seronegative pSS patients. In the multivariate model identified using backwards selection, four variables (pain catastrophizing, fibromyalgia status, serological status, and the conviction that illness would have severe consequences) predicted 55% of the variance in pain severity.Conclusions: Pain catastrophizing was a significant predictor of pain severity in both seropositive and seronegative pSS patients. This study suggests that behavioural interventions designed to reduce pain catastrophizing and negative appraisal of illness could be of benefit in pSS patients. Research is needed to test the effect of psycho-educational therapies on key patient-reported outcomes, particularly pain, depression, and fatigue, in pSS. [ABSTRACT FROM AUTHOR]

Gonorrhea is a worldwide sexually transmitted disease (STD) caused by Neisseria gonorrhoeae. Gonorrhea is the second most often reported STD in the United States behind chlamydia. An estimated 600,000 people each year in the United States are infected. Only about half this number of cases are reported. From 1975 through 1997, the national gonorrhea rate declined 74.3%. After a small increase in 1998, the gonorrhea rate has decreased each year since 1999. In 2003 the South had the highest gonorrhea rate among the four regions of the country. Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. In 2003 the Gonococcal Isolate Surveillance Project found about 16% of collected isolates were resistant to penicillin and/or tetracycline. Since 1998 the number of ciprofloxacin-resistant isolates has been increasing with 270 (4.1%) being reported in 2003. Oral gonorrhea is rare, nonspecific, and varied and may range from slight erythema to severe ulceration with a pseudomembranous coating. The patient with gonorrhea poses little threat of disease transmission to the dentist. However, patients who have or have had gonorrhea should be approached with a measure of caution because they are in a high-risk group for additional STDs. The CDC has published recommendations for standard precautions to be followed in controlling infection in dentistry that have become the standard for preventing cross-infection. Strict adherence to these recommendations will, for all practical purposes, eliminate the danger of disease transmission between dentist and patient. Dentists should be aware of local statutory requirements regarding reporting STDs to state health officials. Syphilis, gonorrhea, and AIDS are reportable diseases in every state. Local health departments or state STD programs are sources of information regarding this matter. [ABSTRACT FROM AUTHOR]

Sjögren's syndrome (SS) is a chronic inflammatory disease characterized by xerostomia. Although a common observation in SS is increased susceptibility to caries, the level of periodontal disease has not been described in these individuals. The purpose of this study was to determine the periodontal status of 14 SS female subjects who had a mean age of 52.9±11.6 years. Plaque, gingival, and calculus indices as well as probing depth (PD) and attachment level (AL) were determined on 7 index teeth in each subject Result indicated that individuals with Sjögren's Syndrome did not exhibit significant periodontal disease. [ABSTRACT FROM AUTHOR]

Background: Salivary dysfunction in Sjögren disease can lead to serious and costly oral health complications. Clinical practice guidelines for caries prevention in Sjögren disease were developed to improve quality and consistency of care., Methods: A national panel of experts devised clinical questions in a Population, Intervention, Comparison, Outcomes format and included use of fluoride, salivary stimulants, antimicrobial agents, and nonfluoride remineralizing agents. The panel conducted a systematic search of the literature according to pre-established parameters. At least 2 members extracted the data, and the panel rated the strength of the recommendations by using a variation of grading of recommendations, assessment, development, and evaluation. After a Delphi consensus panel was conducted, the experts finalized the recommendations, with a minimum of 75% agreement required., Results: Final recommendations for patients with Sjögren disease with dry mouth were as follows: topical fluoride should be used in all patients (strong); although no study results link improved salivary flow to caries prevention, the oral health community generally accepts that increasing saliva may contribute to decreased caries incidence, so increasing saliva through gustatory, masticatory, or pharmaceutical stimulation may be considered (weak); chlorhexidine administered as varnish, gel, or rinse may be considered (weak); and nonfluoride remineralizing agents may be considered as an adjunct therapy (moderate)., Conclusions and Practical Implications: The incidence of caries in patients with Sjögren disease can be reduced with the use of topical fluoride and other preventive strategies., (Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: The Brief Cognitive Symptoms Inventory (BCSI) is a short, self-report scale designed to measure cognitive symptomatology in patients with rheumatic disease. To facilitate research and clinical practice, we tested the internal consistency and validity of the BCSI in patients with Sjögren syndrome (SS)., Methods: Patients who met the American-European Consensus Group criteria for SS and healthy controls completed a questionnaire assessing symptoms including cognitive complaints. We calculated Cronbach's alpha to assess internal consistency and Pearson correlation coefficients to test for association between BCSI, symptoms, and demographic variables. Total score distribution was analyzed to establish cutoff criteria for differentiation of case versus non-case. We compared neuropsychological outcomes of patients with SS above and below the threshold BCSI score to assess the association of cognitive symptoms with objective cognitive deficits., Results: Complete data were available on 144 patients with SS and 35 controls. Internal consistency of the BCSI was good. Scores were similar in all patient groups and patients reported more cognitive symptoms than controls (p < 0.0001). BCSI scores correlated moderately with pain, depression, anxiety, fatigue, and health quality. High scores for cognitive dysfunction were reported by 20% of the patients with SS and only 3% of controls. Patients with cognitive scores > 50 had more depression, fatigue, pain (effect size all > 1), and worse performance on multiple cognitive domains., Conclusion: The BCSI should be a useful tool for the study of cognitive symptoms in SS. Both self-report and standardized tests should be considered in screening for cognitive disorders in SS.

Objectives/introduction: Clinical trial accrual for oral dysplasia is difficult in the United States and elsewhere. Patients with dysplastic oral leukoplakia progress to frank invasive carcinoma at a rate of 5-37% over 5 years. We compared two clinical trial screening efforts to hopefully devise better accrual strategies to these types of clinical trials., Methods: For the first trial, we identified 244 patients with dysplastic oral leukoplakia in our university database and a media campaign. Patients were notified and screened by examination and biopsy. For the second clinical trial, we established a preneoplastic lesions clinic and teaching and communications network with regional oral healthcare professionals., Results: Only one of 244 patients accrued to the first clinical trial through an organized screening effort based on database/medical records review. The second clinical trial accrued 16/30 screened patients through redirected efforts in teaching, communications, and a preneoplastic lesions clinic., Conclusion: We conclude that significant difficulties resulted from medical record/database review of leukoplakia patients as a screening method for leukoplakia clinical trial entry. We feel that persistent direct contact and education of healthcare professionals who are likely to examine leukoplakia patients improved accrual to the second clinical trial., (© 2012 John Wiley & Sons A/S.)

Background: The emergence of health information technology provides an opportunity for health care providers to improve the quality and safety of dental care, particularly for patients with medically complex conditions., Methods: The authors randomized each of 15 dental clinics (HealthPartners, Bloomington, Minn.) to one of three groups to evaluate the impact of two clinical decision support (CDS) approaches during an 18-month study period. In the first approach--provider activation through electronic dental records (EDRs)--a flashing alert was generated at the dental visit to identify patients with medically complex conditions and to direct the dental care provider to Web-based personalized care guidelines. In the second approach--patient activation through personal health records--a secure e-mail was generated or a letter was mailed to patients before dental visits encouraging them to ask their dental care provider to review the care guidelines specific to their medical conditions., Results: The authors evaluated the rate of reviewing care guidelines among 102 providers. Participants in the provider and patient activation groups increased their use of the system during the first six months, which had a generalized effect of increasing use of the guidelines for all patients, even if they were not part of the study (P < .05). The study results showed that provider activation was more effective than was patient activation. However, providers did not sustain their high level of use of the system, and by the end of the study, the rate of use had returned to baseline levels despite participants' continued receipt of electronic alerts., Conclusions: The study results demonstrated that review of clinical care guidelines for patients with medically complex conditions can be improved with CDS systems that involve the use of electronic health records., Clinical Implications: As the U.S. population ages, dentists must be vigilant in adapting care for patients with medically complex conditions to ensure therapeutic safety and effectiveness. Expanded use of CDS via EDRs can help dental care providers achieve this objective.

Efforts to reduce the severity of postradiotherapy xerostomia include the use of salivary substitutes to gain symptomatic relief, salivary gland stimulants, agents delivered to protect the glands during radiotherapy (RT), and physical means to partially spare the major salivary glands from RT while adequately irradiating tumor targets. These means include advanced RT treatment planning and salivary tissue transfer to nonirradiated areas. The relative potential gain from each of these strategies is discussed in this article. The combination of partial salivary gland sparing and radiation protectors/stimulants may provide additive or synergistic gains in reducing the severity of xerostomia.

Xerostomia is commonly measured and graded using objective measures of major salivary gland output and observer-rated toxicity grading. The separation between the different grades is somewhat ambiguous in the current toxicity grading systems. We propose a new grading system based primarily on the functional deficits associated with xerostomia. Salivary flow rates have been added as a criterion to the grading system, notwithstanding the weak correlation reported in most studies between the symptoms and objective functional measures. In addition to the observer-rated toxicity grading, recording of patient-reported quality of life, using validated instruments, is encouraged.

Background: This article is a follow-up on a 1998 article in JADA. The blood pressure, or BP, of 23 of 24 normotensive patients was monitored at 15-minute intervals for a total of nine days, in three consecutive sessions of four, two and three days, respectively, separated by a few weeks., Methods: Twelve patients were reached by phone seven years after the prior chronobiologically interpreted monitoring to ascertain their cardiovascular status since the initial monitoring., Results: Only two of the 12 patients reached in follow-up had abnormalities in all three sessions, and only these two patients reported having experienced an adverse vascular event (one a myocardial infarction, the other coronary artery bypass graft surgery). The difference in outcome between the patients with chronobiological abnormality in all three sessions vs. the pool of those with abnormality in only two, one or none of the sessions is statistically significant., Conclusions: Even a five-day (and sometimes a longer) profile, while greatly preferred to single measurements, may not suffice for a definitive diagnosis of certain patients. Retrospectively, the 864 measurements, on the average, on each person in our study could have served for a recommendation to each person. Chronobiologically interpreted BP and heart rate monitoring for a week or longer as a start detects high-risk states that may be missed by conventional casual measurements that are rarely accompanied by one-day profiles., Clinical Implications: The dentist has an important opportunity for conveying the importance of monitoring BP and heart rate for a week to detect an abnormal variability, and for implementing this monitoring. Dentists can educate patients regarding the need for screening and for interpreting the results for variability, and contribute to their overall health by referring them to their physicians when treatment is indicated.

A major complication of irradiation therapy for head and neck cancer is salivary gland dysfunction and xerostomia. The purpose of this clinical investigation was to evaluate the effects of a commercially available oral moisturizer (Optimoist) on salivary flow rate, symptoms of xerostomia, oral pH, oral microflora, and swallowing in postirradiation head and neck cancer patients (XRT) and patients with Sjögren's syndrome (SS). Subjects who were post-XRT and subjects with SS (n = 24; mean age = 54.1) discontinued their use of any salivary substitute or moisturizer for 2 weeks prior to entering the study. Baseline whole unstimulated saliva was collected for 5 minutes using a standard sialometric technique. Candida albicans and Lactobacillus cultures were performed using kits from Orion Diagnostica, Inc., and a pH analysis was performed on the salivary sample using a Markson (model 00663) pH meter. Swallowing was assessed by clinical measures by videofluoroscopic techniques. Several subjective assessments were performed to evaluate symptoms of xerostomia. Subjects were instructed in the use of a daily diary and to use only the provided article ad libitum for a period of 2 weeks. After the 2-week period, the results indicated significant subjective and objective improvements in signs and symptoms of xerostomia. Whole unstimulated salivary flow rate improved from (mean +/- SEM) 0.1150 +/- 0.02 to 0.2373 +/- 0.09 mL/min. Salivary pH did not change. Global subjective improvement in xerostomia improved in 58% of the subjects. Candida colonization decreased in 43% of the subjects. There was no change in Lactobacilli colonization. Swallowing objectively improved in 75% of subjects. These results indicate significant improvement in both signs of hyposalivation and symptoms of xerostomia with the use of Optimoist in postirradiation head and neck cancer patients and patients with SS.

Sjögren's syndrome (SS) is a progressive autoimmune rheumatic disorder. Its precise etiology is unknown, although several contributing factors have been identified. One theory is that the condition results from complications related to infection with the Epstein-Barr virus. Primary exposure to or reactivation of Epstein-Barr virus elicits expression of the human leukocyte antigen complex. This is recognized by T lymphocytes (CD 4+) resulting in the release of cytokines (tumor necrosis factor, interleukin-2, interferon-gamma, and others). A genetic marker specific for Sjögren's syndrome, HLA-DR4, has been identified. According to the World Health Organization, the prevalence of Sjögren's syndrome is unknown. A recent epidemiologic study in Sweden estimated the prevalence in the adult population to be 2.7%. In the United States, 10 years ago, the number of patients with Sjögren's syndrome was thought to be fewer than 100,000. This number today is estimated to be more than 1 million. Sjögren's syndrome has been reported in nearly every major country of the world, and the geographic distribution of cases appears to be relatively uniform. Sjögren's syndrome typically affects women (90%) during the fourth or fifth decade of life. Isolated cases of Sjögren's syndrome in children have been reported.

Sjögren's syndrome is a chronic and uncomfortable inflammatory condition for the individuals who suffer from it. There are many and varied systemic and oral complications associated with Sjögren's syndrome. It is also a complex and challenging condition for the dentist to diagnose and manage. The key concepts are early recognition and intervention to prevent the secondary complications from hyposalivation. To the degree possible, salivary flow should be restored by either artificial salivas or stimulated by secretogogues or both, which is usually the case. Atrophy and secondary infections of the oral mucosa should be properly identified, effectively treated, and frequently monitored. Pilocarpine HCl (Salagen) has been shown to be effective in increasing salivary flow in patients with SS. Preventive and supportive therapy including supplemental fluorides, dietary assessment, and frequent professional recalls are imperative to maintaining the oral health of the patient with SS.

Objective: Recurrent aphthous stomatitis is a very common condition, currently treated with anti-inflammatory agents, which palliate the symptoms. The purpose of this clinical trial was to compare a medication commonly used to treat recurrent aphthous stomatitis, Kenalog-in-Orabase, and a newer agent, Debacterol., Method and Materials: Sixty patients diagnosed with recurrent aphthous stomatitis were enrolled in the study. Twenty patients were assigned to each of the two treatment groups, and 20 age- and sex-matched patients were assigned to the control group, which received no treatment. After the diagnosis was made, clinical examinations and ulcer measurements were performed, and a subjective evaluation of symptoms (100-mm visual analog scale) was completed by each subject. The subjects did not use any other medications. Both agents were applied topically (the frequency varied depending on the group of subjects) at specified intervals. Ulcer measurements and subjective evaluations were made at days 0, 3, 6, and 10 for all subjects., Results: In both treatment groups, by day 10, 100% of the ulcers had clinically healed and were no longer causing pain. Patients in the Debacterol group reported a significantly greater decrease in pain at 3 days (> 70%) than did subjects in the other groups (< 20%), although the size of the ulcer did not differ significantly in any of the groups. After day 6, 80% of the ulcers in the Debacterol group had clinically disappeared and no longer caused symptoms, as compared to about 30% in the other groups., Conclusion: Patients subjectively reported significantly greater relief from symptoms with Debacterol than with Kenalog-in-Orabase or no treatment. The relief of symptoms associated with recurrent aphthous stomatitis may or may not correspond to clinical improvement, and these two topical medications may affect signs and symptoms of the lesions differently.

Objective: The purpose of this study was to compare the quantities of oral Candida albicans in patients with primary and secondary Sjögren's syndrome before and after the use of orally administered pilocarpine hydrochloride for 1 year., Method and Materials: Twelve female subjects with primary (n = 4) and secondary (n = 8) Sjögren's syndrome (mean age +/- SEM = 56.7 +/- 5.7 years) were enrolled in the study, after meeting rigid enrollment criteria. Oropharyngeal collection of samples and culturing was performed on each subject. Cultures specific for Candida albicans were plated into a culture media tube using the Oricult kit and also by serial dilutions and plating by a streptomycin-vancomycin technique. Cultures were incubated for 48 hours at 37 degrees C. The subjects used 5 mg of pilocarpine hydrochloride, administered orally three times daily, for 1 year, after which both of the Candida cultures were repeated. None of the subjects used antifungal medications, none smoked, and all were dentate., Results: There was a significant difference in the prevalence of Candida after the use of pilocarpine hydrochloride for both groups. At the start of the study, 75% of all subjects were positive for Candida. Following the use of pilocarpine, 25% had positive cultures. There was also a decrease in the prevalence of clinical manifestations of infection from 75% of subjects to 25%. There was a significant decrease in the numbers of Candida cultured following the use of pilocarpine., Conclusion: Long-term administration of pilocarpine hydrochloride resulted in a significant reduction in Candida albicans colonization in patients with primary or secondary Sjögren's syndrome.

Objective: An immediate chairside technique (Latex Candida) for the detection of Candida albicans was compared with a simple tube culturing technique (Oricult) and the traditional laboratory culturing technique in patients with Sjögren's syndrome., Method and Materials: Subjects with primary (n = 9) and secondary (n = 9) Sjögren's syndrome (mean age of 56.7 years; all female) and an age- and sex-matched group of control subjects (n = 9) were selected. Three different methods for culturing Candida albicans were performed for each subject. One culturette was plated on a trypticase soy-agar streptomycin-vancomycin medium plate and incubated for 48 hours at 37 degrees C. Another swab was plated on a reagent paper with the Latex Candida test kit. The third swab was placed in a culture media tube using the Oricult kit and incubated for 48 hours at 37 degrees C., Results: All three techniques indicated a significant difference in the prevalence of Candida between the control group and both Sjögren's groups. The Latex Candida technique indicated that 78% of all Sjögren's subjects were positive for Candida, while the other two tests indicated that 83% were positive., Conclusion: The Latex Candida technique was comparable to Oricult and streptomycin-vancomycin culturing techniques for negative results and was correctly positive for 90% of cases.

Objective: Various investigators have reported a high prevalence of oral Candida species in patients with salivary gland dysfunction (SGD). The purpose of this study was to assess the prevalence of oral Candida albicans, its oral manifestations, and to compare the number of colony-forming units of Candida albicans in patients with primary Sjögren's syndrome and secondary Sjögren's syndrome with the whole unstimulated salivary flow rate in each group., Method: An age-sex-matched group of control subjects was selected for comparison. Oropharyngeal collection of samples and culturing was performed on each subject. Quantitative cultures specific for Candida albicans were performed., Results: The frequency distribution indicated that > 80% of all SS subjects were positive for Candida albicans vs. none of the controls. The most common lesion was angular cheilitis followed by chronic atrophic candidiasis. The subjects with Sjögren's syndrome also demonstrated significantly high numbers of Candida albicans colony-forming units., Conclusions: This study indicates significantly higher Candida albicans colonization in patients with primary or secondary Sjögren's syndrome as compared to a control population. Candida albicans colonization was higher in patients with secondary Sjögren's syndrome than in patients with primary Sjögren's syndrome; however, the amount of Candida albicans was not universally relative to salivary flow.

Pilocarpine HCl has been shown to stimulate parotid and submandibular gland salivary flow. The purpose of this study was to determine whether this cholinergic-muscarinic drug also stimulates labial (minor) salivary gland (LSG) flow and to relate that with whole unstimulated salivary (WUS) flow rates. Subjects diagnosed with primary Sjögren's syndrome (SS-1; n = 9) or secondary Sjögren's syndrome (SS-2; n = 9) were enrolled in this study after meeting stringent enrollment criteria. An age-gender matched control group was also enrolled. The labial saliva was collected in a standardized manner on Periopaper for 5 min and the volume was analysed by the Periotron. Whole unstimulated salivary samples were collected for 5 min by the method of Mandel and Wotman (1976). Each subject was dosed with pilocarpine HCl (5 mg; tablets; p.o.). After 60 min the LSG flow as well as the WUS flow was determined again as previously. The results indicated a significant (> 180%) increase in both labial salivary gland flow as well as whole salivary flow in the SS-1 and SS-2 subjects (mean +/- s.e.m.): [SS-1: WUS = 0.1080 +/- 0.03 vs 0.2242 +/- 0.03 ml per 5 min; LSG = 93.1 +/- 22.2 vs 167.8 +/- 15.9 microliters/5 min; P < 0.001; SS-2: WUS = 0.1384 +/- 0.02 vs 0.2775 +/- 0.09 ml per 5 min; LSG = 97.7 +/- 20.2 vs 182.8 +/- 17.9 microliters per 5 min; P < 0.001]. These results indicate a significant increase in labial salivary gland flow as well as whole salivary flow as stimulated by pilocarpine HCl in Sjögren's syndrome patients.

Difficulty with speech is a common complaint of patients with xerostomia resulting from salivary gland dysfunction. The purpose of this pilot study was to assess and compare speech tasks in three patient groups with salivary gland dysfunction arising from different etiologies (primary Sjogren's syndrome, secondary Sjogren's syndrome with systemic lupus erythematosus, and irradiation therapy for head and neck cancer) and a matched control group. Diadochokinetic speech tasks were quantified clinically and videofluoroscopically. The results indicated that significantly fewer speech tasks were completed, with or without water, by the groups with salivary gland dysfunction than by the control group. Videofluoroscopy provided excellent quantitative analysis, yielding results similar to those of the clinical measurement. In a subjective self-assessment, subjects with salivary gland dysfunction reported more problems with speech than did control subjects.

Dysphagia is a common complaint from patients with salivary gland dysfunction. The purpose of this study was to assess and compare dysphagia in two patient groups with salivary gland dysfunction (primary Sjörgen's syndrome and secondary Sjögren's syndrome with systemic lupus erythematosus, and a matched control group. Subjects diagnosed with primary Sjögren's syndrome (n = 13) and secondary Sjögren's syndrome with systemic lupus erythematosus (n = 15) were selected for the study. An age- and sex-matched group of control subjects (n = 14) was selected for comparison. Dysphagia assessments, including videofluoroscopy were performed. Dysphagia was quantified clinically and videofluoroscopically by measurement of 10 seconds of basal or dry swallows as compared with 10-second 10-ml water bolus swallows in all subjects. Subjective evaluations were recorded on a calibrated 10-cm visual analog scale. The results indicated a significant difference in the dry swallows as compared with the water bolus swallows for both salivary gland dysfunction groups and for both dry swallows and water bolus swallows as compared to controls. Videofluoroscopy yielded significantly prolonged pharyngeal transit times in both salivary gland dysfunction groups as compared with control. Subjective results indicated a greater degree of dysphagia symptoms in both the salivary gland dysfunction groups (p < 0.001). Conclusions from this study indicate clinically significant dysphagia in patients with salivary gland dysfunction associated with Sjögren's syndrome compared with a control population.

Dysphagia is a common complaint from patients with salivary gland dysfunction (SGD). The purpose of this study was to assess and compare dysphagia in three patient groups with SGD: primary Sjögren's syndrome (SS-1); secondary Sjögren's syndrome with systemic lupus erythematosus (SS-2-SLE) and a group of patients who had post-irradiation therapy (PIT) (for head and neck cancer xerostomia) and a matched control group. Subjects diagnosed with SS-1 (n = 7); SS-2-SLE (n = 7) and PIT (n = 7) were selected for the study. An age-sex-matched group of control subjects (n = 7) was selected for comparison. Dysphagia assessments, including videofluoroscopy, were performed. Subjective evaluations were recorded on a calibrated 10-cm visual analog scale. The results indicated a significant difference in the DS as compared to the WBS for all SGD groups and for both DS and WBS in each SGD group as compared to controls. Videofluoroscopy also yielded significantly prolonged pharyngeal transit times (PTT) in all SGD groups as compared to controls. Subjective results indicated a greater degree of dysphagia symptoms in all of the SGD groups (p < 0.001). Conclusions from this study indicate clinically significant dysphagia in patients with SS-1, SS-2-SLE and PIT as compared to a control population.

The clinical presentation of hereditary hemorrhagic telangiectasia with various manifestations has been well described as has florid osseous dysplasia. There have been no cases reported of the two pathologic entities in the same patient. We present a case with the simultaneous occurrence of hereditary hemorrhagic telangiectasia and florid osseous dysplasia with important considerations for differential diagnosis, and we discuss whether this case presents a potential syndrome.

A national survey of urologists was conducted regarding the need for prophylactic antibiotic coverage for patients with penile implants when undergoing invasive dental treatment. A total of 1,756 questionnaires was sent to urologists in the United States and 297 responses were received, for a participation rate of 17%. The low response rate might be partly related to a low level of concern by urologists due to the lack of reported cases of penile implant infections following invasive dental procedures and the lack of the literature calling attention to this possible association. This is supported by the fact that none of the responding urologists had noted any case of infection of the prosthesis following dental treatment. The majority of urologists who responded did not recommend antibiotic prophylaxis for penile implant patients undergoing invasive dental treatment. The majority of urologists who recommended prophylaxis selected a cephalosporin. None of the responding urologists indicated that they were aware of infection developing in any penile implant patients following invasive dental treatment. The dentist is advised to consult with the urologist of patients with penile implants on an individual basis to determine the need for antibiotic prophylaxis.

On the basis of recent developments, liver transplantation is no longer considered an experimental procedure. The history and current status of human liver transplantation are reviewed. The complications and side effects of the agents used for immunosuppression are presented. The dental treatment of the patient before and after liver transplantation is discussed in detail.