Search

Objectives: The purpose of this case report is to illustrate the consequences of dental surgical extractions in patients who are receiving or have received IV bisphosphonate. Materials and methods: A 52-year old man suffering from multiple myeloma was treated with Zometa for one year. At the end of the therapy he underwent some surgical extractions that caused two areas of mandibular osteonecrosis after a few months. The authors obtained the patient's informed consent to report his medical data and pictures. Results: The two necrotic areas were treated in different ways and the treatments are still in progress. After 5 months, a slight improvement has been observed in the exposed bone areas. Conclusions: In the management of the osteonecrosis of the jaw it is important to assess the cost-benefit ratio, trying to improve health expectations and perspectives in a patient who is already affected by a systemic disease. © 2010 Elsevier Srl. All rights reserved.

The philosophy of Dentistry Science at University of Milan-Bicocca foresee clinical/operative criteria into Preventive and Therapeutical Dentistry activities. This philosophical formulation determined a planning on different areas of intervention such as Surgical, Pedo-orthodontic and Oral Hygiene Sciences carried out within teaching, research, clinical activities and management. In particular, within Oral Hygiene Science, it has been established a Territorial Preventive Dentistry Coordination (TPDC) which, also thanks to technological systems, allows to connect all the Oral Hygiene Centres of the University Hospital of Monza and Brianza among each others. The structures connected to each others are St. Gerardo Hospital in Monza, the Don Gnocchi Institute in Milan, the FERB in Bergamo and the "Il Sole" Association. St. Gerardo Hospital treats patients of all ages range and usually, the most perfomed dental services are scalings (22,24%) and control examinations (24,36%); at FERB's are control examinations (27,30%), orthodontic support measures (21,27%) and furrow sealing (17,92%), since the target of patients is mostly paediatric; at Don Gnocchi's Institute are implant (31,80%) and surgical support measures (23,02%), because the target is mostly geriatric, as well as at Il Sole's Association where performances are mainly implant (29,81%) and surgical support measures (18,27%). The TPDC helps all the Oral Hygiene Centres to gather and compare all their information, in order to improve diagnostic, therapeutical and prognostic techniques.

This paper discusses current approaches in the treatment of oral cancer. MATERIALS AND METHODS. The mainstays of treatment in early stage of oral cancer are either radiotherapy or surgery. Advanced diseases are treated either by surgery with postoperative radiotherapy or by definitive radiotherapy, with surgery as last option if necessary. In recurrent and metastatic disease, chemotherapy is the standard treatment option and is generally used with palliative intent. Surgical treatment of malignant tumours in the oral cavity often results in an unfavourable anatomic situation for prosthodontic rehabilitation. Many of these problems can be, at least partially, solved by the use of endosseous oral implants. RESULTS. Although disease responds well at early stage, the risk of a second primary cancer is high, with a development rate of about 4% per year. For non-metastatic locally advanced disease, there is a relatively high risk of tumour recurrence (locoregionally or at distance), despite the use of post-operative radiotherapy after resection. The prognosis for patients with recurrent /metastatic disease remains poor. Oral rehabilitation needs a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. CONCLUSIONS. At early stage, the goal of the treatment is to maintain a favourable efficacy/toxicity ratio and to reduce the incidence of second primary tumours. The immediate aim of the treatment in advanced stage should be to increase survival, locoregional control and organ preservation and to reduce both the formation of distant metastases and the incidence of severe acute treatment induced toxicities, particularly mucositis. In recurrent and metastatic disease, the goal is to improve response rates to chemotherapy and, wherever possible, to prolong survival without reducing quality of life. The development of endosseous implants and bone grafting has allowed to increase the possibilities of oromandibular reconstruction in patients with oral cancer.

INTRODUCTION. Ageing of population has recently revealed the necessity of dedicated health centres for elderly patients. Researching a correct management of this kind of patients, based on an adequate psychological approach, appears to be of paramount importance both for oral and general health. AIM OF WORK. The Authors report their experience at the Dental Clinic of the University of MilanoBicocca together with Don Gnocchi Foundation. MATERIALS AND METHODS. This study includes two groups of patients, the first one from institutionalized geriatric people, the second one from all sufficient people. Systemic and oral pathologies incidence is considered. RESULTS. The odontostomatological pathologies are serious in institutionalized subjects than in all sufficients subjects. CONCLUSIONS. Their work started in 2004 with a screening of elderly people (whether self-sufficient or not) living in the Don Gnocchi Foundation's area.

Dental hygienist becomes integral part of numerous operating protocols, which are actuated to codify and improve clinical activity and scientific research of University Hospital. A purpose of dental hygienist is carrying out with dentistry personnel a succession of specific preventive-therapeutic programs, devoted to different kinds of patients, improving conditions of mouth and organism health of these ones. One of these protocols is that applied to dental treatment and prevention of old patients resident in Don Gnocchi Foundation, Palazzolo Institute. This Institute, share of University Hospital of Monza and Brianza, houses inside 822 old people, with average age of 89, who join the current study from November 2006. At first personnel checks autonomy levels and cooperation for all the patients and at the same time they notices conditions of oral health, with possible presence of removable prosthesis, partial or total and also levels of plaque, blood index and parodontal probing. Every day Hygienist shows all the patients how to carry out personal hygienÈs and their own prosthesis cleaning's manoeuvres. He executes directly these ones on patients partially cooperating or absolutely not cooperating. After these surveys staff picks up same data and levels of prosthesis cleaning. In the end of protocol (6 months) the same personnel carries out for the second time all the surveys and compares those with previous ones. All the surveys show improvements in prosthesis cleaning, blood index and plaque levels. There isn't any effectiveness in this operative protocol without hygiene and prevention activities done by dental hygienist in OPHR with cooperation of other medical specialists.

In diversi lavori presenti in letteratura, è stato evidenziato che l’acqua in circolo nei riuniti odontoiatrici può raggiungere una concentrazione batterica di gran lunga superiore a quella consentita per legge nell’acqua potabile. Le ragioni ritenute responsabili di questo fenomeno sono la contaminazione diretta dei circuiti idrici da parte di batteri provenienti dalla rete dell’acqua potabile o aspirati, per refl usso o capillarità, dalla superfi cie esterna della testina dei manipoli. Lo scopo di questo lavoro è di valutare, con analisi microbiologiche in vivo, le capacità di controllo della contaminazione batterica delle linee idriche dei riuniti odontoiatrici off erte da un sistema combinato basato su cicli periodici di disinfezione e immissione in continuo di perossido di idrogeno a 300 e 600 ppm all’interno delle linee idriche. I risultati ottenuti hanno evidenziato che il sistema adottato consente - con una concentrazione di 600 ppm di perossido di idrogeno erogato in continuo nei circuiti idrici del riunito testato, combinata con un ciclo di disinfezione quotidiano - di portare la carica batterica contaminante al di sotto della soglia di rilevabilità dei test culturali microbiologici adottati. Different papers showed that bacterial contamination od dental unit waterlines can reach much higher concentrations than allowed for potable water, according to European Community Standards. Reasons for that are recognized in direct contamination from bacteria present in potable water that supplies dental units or aspirated from the outer surface of dental hand pieces. Data obtained show that a daily disinfection cycle in combination with concentrations of 600 ppm of hydrogen peroxide continuously supplied in dental unit waterlines allowe to reduce bacterial contamination under the level of sensitivity of the adopted microbiological assay.

Dentist and Dental Higyenist cooperation is strategical for an appropriate treatment of the pedo-orthodontic patient. In our University this kind of synergy was applied to caries prevention and to the initial identification of dental-maxillo-facial malformations in childhood. At the same time only a team approach allowed us to correctly treat complex cases such as hemato-oncological patients.

In this study the Authors report some cases of moderate maxillary bone atrophy (Cawood Howell class IV) with a transversal ridge width lower than 4 mm where an implant supported rehabilitation was hardly achievable. Six months after the insertion of an autologous bone graft taken from mental simphysis, 42 implants were positioned in 18 patients (8 males and 10 females, mean age 47.1 years). Implant osteointegration was checked by evaluation of bone loss, soft tissue condition, pocket depth, plaque and bleeding index and patients' satisfaction. At the end of the follow-up no implant was lost. Mean marginal bone loss was 0.17 mm. In the treatment of moderate maxillary atrophies this technique has proved to be successful and predictable. Even if it involves two surgical sites at the same time, thus requiring perfect patient's compliance, it offers the unquestionable advantage of using local anaesthesia only.

Aim: dentists both as clinical practice and research increased progressively their interest in leukemia, because the oral complications are common during the outcome of the disease, dental management is complex, and the mouth is a potential source of morbidity. Dental Clinic of University of Milan-Bicocca has prepared, in collaboration with the Hematologic Pediatric Department, guidelines for dental treatment of children affected by leukemia. Dentists, who take care of leukemic children, have several roles: diagnostic, preventive, therapeutic and supportive role. Diagnostic role: head and neck signs resulting from leukemic infiltrates include cervical lymphadenopathy, oral bleeding, gingival infiltrates, oral infections, and oral ulcers. Thrombocytopenia and anemia manifest in pallor of the mucosa, petechiae, and ecchymoses, as well as gingival bleeding. Spontaneous gingival bleeding is common when the platelet count falls below 20.000/mm3. Preventive role: dental treatment to eliminate potential sources of oral infection, such as teeth with caries, pulpitis, moderate to severe periodontal disease, is accompanied by a significant reduction in the rate of septicemia. The early diagnosis of oral infection is mandatory because oral disease is considered a true source of potentially life-threatening infection from gram-positive and gram-negative bacilli. The oral flora is the most likely sources of septicemia in 50% of cases. Therapeutic role: it is dentists' duty to develop screening evaluation and remove sources of infection before chemotherapy has started, following subsequent guidelines: complete oral examination, removal of orthodontic brackets, conservative therapy, professional hygiene, resolution of inflammation, extraction of compromised teeth, even if platelet transfusion and intravenous combinated antibiotics may be required before. The use of absorbable gelatin or collagen sponges, topical thrombin, or the placement of microfibrillar collagen held in place by packing or splints are helpful. Supportive role: as survival rate of children with cancer increased significantly during the past decades, late effects of antineoplastic therapy become important to be forwarded. Children with acute lymphoblastic leukemia received brain radiation and chemotherapy to prevent a relapse. Craniofacial deformities and dental anomalies are quite common in children who receive this therapy, expecially before age 5. The most common abnormalities reported in children were deficient mandibular development, dental agenesis, arrested root development, microdontia, and enamel dysplasia. Conclusions: Leukemic children need special care. Appropriate oral hygiene and health should be manteined and restored before development of irreversible dental damage: only a close cooperation among pediatric hematoncologists, pediatric dental surgeons, and dental hygienists could guarantee these. In the last 5 years we have treated 317 leukemic children and have made 5292 dental care. Our experience suggests that even if detrimental impact of antineoplastic therapy on oral cavity is unavoidable, it could be diminished with an adequate and correct preventive or curative therapy contributing to a better quality of life of children treated for leukemia.

Leucopenia is a disease caused by a reduction of circulating leukocytes. Leucopenia may be caused by alterations of extrinsic factors of myeloid line cell or by intrinsic alterations of cell growth line. Systemic symptoms are directly related to PMNs blood level. Clinical manifestations are related to bacterial infections. The dentist's role in diagnosis is important, since oral signs and symptoms may be the first to appear. Oral signs of neutropenia include ulcers, periodontal disease and opportunistic infection. Therapy should aim to prevent and control opportunistic infections.