Evaluation of endovenous sedation using BIS monitoring in dentistry. A systematic review

Background

The aim of the present review was evaluate the utility and validity of the Bispectral Index (BIS) in dental treatment carried out under endovenous sedation, and compare its efficacy with clinical sedation scales.

Material and Methods

Electronic and manual literature searches were conducted by two independent reviewers for articles published up to April 2017 in several databases, including Medline and Cochrane Library.

Results

Sixteen articles met the inclusion criteria. A correlation was identified between BIS and clinical sedation scales. A BIS range between 75 and 84 showed a high probability of corresponding to an Observer’s Assessment of Alertness and Sedation Scale (OAA/S) value of 3; a scored 3 on the Ramsay scale corresponds around 85 on the BIS; while BIS values between 57 and 64 corresponded to a University of Michigan Sedation Scale value of 3. BIS monitoring provides continuous measurement of the patient’s hypnotic state or state of consciousness, awareness, and recall. It proved impossible to perform an analysis of statistical data drawn from the studies reviewed due to the disparity of inclusion criteria among the works.

Conclusions

BIS for sedation monitoring might make possible to evaluate sedation levels objectively in real time, reducing the dose of the sedative required, increasing safety, and minimizing secondary effects.

Key words:Bispectral analysis, BIS monitoring, intravenous sedation, dental treatment, anesthetics.

Effects of the neuromuscular bandage as rehabilitative treatment of patients with drooling and intellectual disability: an interventional study

BACKGROUND

The aim of this work was to assess the effect of neurological bandages (Kinesio Taping) for managing saliva flow in patients with drooling and intellectual disability.

METHODS

Quasi-experimental study included 30 patients (20 male and 10 female participants) mean age of 15 years with intellectual disability and drooling [Public Special Education Centre in Cartagena (Murcia, Spain)]. Treatment consisted of the application of a strip of neuromuscular bandage applied in the suprahyoid area for a 3-month period. Efficacy was assessed by means of three clinical scales: the Sialorrhea clinical scale, the drooling rating scale and the drooling impact scale. These evaluations were performed at baseline, after 1 and 3 months of intervention.

RESULTS

Clinical improvements were obtained, showing statistically significant reductions in drooling after 1 month (P < 0.001) and 3 months (P < 0.001).

CONCLUSIONS

The application of neuromuscular bandages in the suprahyoid muscle area can be a useful option for managing drooling in patients with intellectual disability.

Comparing student and staff perceptions of the "Educational Climate" in Spanish Dental Schools using the Dundee Ready Education Environment Measure

OBJECTIVE

To compare the perceptions of students and teachers of the "Educational Climate" (EC) in Spanish public dental schools.

METHODS

A group of 1064 students and 354 teachers from six Spanish public dental schools responded to the DREEM questionnaire. This has 50 items grouped into five subscales: perception of learning (Learning); perception of teachers (Teachers); academic self-perceptions (Academic); perception of the atmosphere in the faculty (Atmosphere); and social self-perceptions (Social). The DREEM scale provides results for each item, each subscale and the overall EC.

RESULTS

The EC scores were 123.2 (61.6%) for the students and 134.1 (67.0%) for the teachers (P<.001). The scores of the students and teachers for the subscales were, respectively: 27.9 (58.1%) and 30.2 (63.0 %) for Learning (P<.001); 26.8 (60.9%) and 32.6 (74.1%) for Teachers (P<.001); 20.7 (64.7%) and 20.5 (64.0%) for Academic (P=.333); 29.9 (62.3%) and 33.7 (70.3%) for Atmosphere (P<.001); and 17.9 (64.0%) and 16.9 (60.5%) for Social (P<.001). The students identified six problematic items (12.0 %) compared to only two (4.0 %) highlighted by the teachers.

CONCLUSION

The students and teachers considered the EC to be "more positive than negative" in Spanish public dental schools; and the different subscales to be "positive and acceptable." The teachers did, however, evaluate the EC, and specifically the learning-teaching process, more positively than their students, identifying fewer problematic educational aspects. Both groups agreed on the need to: improve support systems for students who suffer from stress and reduce teaching based on "factual learning."

Chemopreventive potential of phenolic compounds in oral carcinogenesis

OBJECTIVE

To evaluate the chemopreventive potential of phenolic compounds - potassium apigenin, cocoa, catechins, eriocitrin and rosmarinic acid in oral carcinogenesis induced in hamsters by means of the topical application of 7,12-dimethylbenz(a)anthracene(DMBA).

STUDY DESIGN

An experimental study at the University of Murcia.

METHODS

50 male Syrian hamsters (Mesocricetus auratus) were divided into five groups of ten: Group I (control group): 0.5% DMBA; Group II: 0.5% DMBA+1.1mg/15ml potassium apigenin; Group III: 05% DMBA+2.5mg/15ml cocoa catechins; Group IV: 0.5% DMBA+6mg/15ml eriocitrin; Group V: 0.5% DMBA+1.3mg/15ml rosmarinic acid. The flavonoids were administered orally. All the animals were sacrificed after 12 weeks. Macroscopic, microscopic and immunohistochemical (PCNA and p53) analyses of the lesions were performed.

RESULTS

All the groups treated with phenolic compounds showed lower incidences of tumour, greater differentiation and lower scores in the tumour invasion front grading system in comparison with the control group. Potassium apigenin and rosmarinic acid achieved the best results, the former considerably reduced the carcinoma tumour volumes developed and both significantly reduced the intensity and aggression of the tumours. Immunoexpression of PCNA and p53 were significantly altered during DMBA-induced oral carcinogenesis.

CONCLUSIONS

Animals treated with phenolic compounds, particularly potassium apigenin and rosmarinic acid, showed a lower incidence of tumours.

Psychometric validation of the Spanish version of the Dundee Ready Education Environment Measure applied to dental students

AIM

To carry out a psychometric evaluation of the Spanish-language version of the Dundee Ready Education Environment Measure (DREEM) applied to dental students.

METHODS

A total of 1,391 students from nine Spanish public schools of dentistry responded to the DREEM questionnaire. To analyse the reliability of the DREEM questionnaire, the internal consistency was assessed and a 'test-retest' carried out. Validity was evaluated through analysis of item response rate, floor and ceiling effects, corrected item-total and item-subscale correlations and factor structure. A confirmatory factor analysis was performed to analyse the structure of the original DREEM scale.

RESULTS

Cronbach's alpha coefficient for the 'Educational Climate' (EC) global scale was 0.92. In the subscales, the 'observed' Cronbach's alpha coefficients ranged between 0.57 and 0.79 and were higher than the 'expected' ones; except for the Social subscale. In the DREEM questionnaire, all of the corrected correlation coefficients between the items and the EC global scale, and the items and their corresponding subscales, were >0.2; except for items 50 and 17. All goodness-of-fit indices of confirmatory factor analysis showed acceptable values (close to one or zero, depending on the case), and there was consistency in the results.

CONCLUSIONS

The Spanish-language version of the DREEM questionnaire is a reliable and valid instrument for analysing the EC for dental students and its factor structure is supported by the data. Although our findings indicate that the DREEM may be as culturally independent as was originally stated, more research should be directed at verifying the factor structure in various languages and cultural environments.

Analysis of the 'Educational Climate' in Spanish Public Schools of Dentistry using the Dundee Ready Education Environment Measure: a multicenter study

AIM

To analyse the 'Educational Climate' (EC) of dental students in Spain.

METHODS

The study group consisted of 1391 students from nine Spanish Public Schools of Dentistry, who responded to the questionnaire based on 'Dundee Ready Education Environment Measure' (DREEM). This questionnaire has 50 items that are grouped into five domains: Learning, Teachers, Academic, Atmosphere and Social.

RESULTS

The global score on the EC was 123.1 (interpretation: 'EC more positive than negative'). The scores obtained in the different domains were: 28.0 in Learning (interpretation: 'a generally positive perception of learning'), 26.8 in Teachers (interpretation: 'teachers are going in the right direction'), 20.8 in Academic (interpretation: 'feeling more on the positive side'), 29.7 in Atmosphere (interpretation: 'a generally positive atmosphere') and 17.7 in Social (interpretation: 'social perception acceptable'). In seven items (14%), an average of <2 was detected, showing that there are some educational problem areas. Regarding the EC in the different Schools of Dentistry, an average of >100 was achieved in all of them, although there were two centres that showed significantly higher values of EC.

CONCLUSIONS

Spanish dental students felt that their EC was more positive than negative and considered that the different domains were positive and acceptable. However, they pointed out the existence of several educational problem areas associated with the development of a traditional curriculum. Accordingly, and in parallel with the implementation of an innovative curriculum in all Spanish Dental Schools in the coming years, immediate educational goals must address the problem areas identified, thereby further promoting a more positive perception of EC.

Association of autoimmune diseases with oral lichen planus: a cross-sectional, clinical study

BACKGROUND

The aim of this study was to investigate the association between autoimmune disease and oral lichen planus (OLP), comparing OLP patients with a control population.

METHODS

This cross-sectional clinical study evaluated the prevalence of autoimmune diseases in male and female patients with OLP. The variables analysed were age, sex, tobacco and alcohol consumption, the clinical form of OLP, time of evolution and the presence of autoimmune diseases.

RESULTS

Autoimmune diseases were present in 7% of OLP patients (10/130) and 4% of the control group (6/130) without statistically significant difference (P = 0.67). The estimated odds ratios (with 95% confidence intervals) of the presence of autoimmune disease in OLP sufferers was 1.033 (0.97-1.10). A logistic regression model for presence/absence of the risk autoimmune disease found statistically significant differences in relation to age.

CONCLUSIONS

At present, there is no definitive hypothesis that explains the coexistence of OLP and autoimmune disease; further research is required into the mechanisms whereby this coexistence occurs.

Synergic effect of curcumin or lycopene with irradiation upon oral squamous cell carcinoma cells

OBJECTIVE

An in vitro study was carried out to evaluate the effect of curcumin, lycopene, and irradiation upon oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

Curcumin and lycopene were administrated at doses of 3, 4.25, 5.50, and 6.75 μM in PE/CA-PJ15 OSCC cultures irradiated with different doses (1, 2.5, and 5 Gy), followed by evaluation of the effects upon cell viability, apoptosis, and migration after 24, 48, and 72 h of incubation.

RESULTS

The application of curcumin or lycopene to the tumor cells during 24, 48, and 72 h without irradiation exerted an inhibitor effect upon cell viability and increased cell apoptosis. The maximum reduction in cell viability and the peak apoptotic effect was recorded with the 5.50 and 6.75 μM doses, for both curcumin and lycopene. Likewise, curcumin and lycopene exerted a synergic effect upon both variables on applying irradiation. Lastly, the 5.50 and 6.75 μM drug doses, together with 5 Gy of irradiation, yielded the greatest decrease in cell migration capacity with both curcumin and lycopene.

CONCLUSIONS

Curcumin and lycopene increase cytotoxic activity in the PE/CA-PJ15 cell line and reduce cell migration capacity, while the combination of curcumin or lycopene with irradiation exerts a synergic effect.

Dental students' knowledge of and attitudes toward anticoagulation dental treatment: assessment of a one-day course at the University of Murcia, Spain

The aim of this study was to determine a group of Spanish dental students' knowledge of and attitudes toward anticoagulated patients and clinical practice and to assess the need for additional education in this area. A survey with sections on demographics and knowledge of general coagulation, anticoagulation treatment, clinical practice, local hemostatic measures, and antibiotic prophylaxis was distributed to students before and after a one-day course on oral anticoagulation. The response rate was 67.1 percent (n=96). Of the respondents, 78.1 percent (seventy-five) were women. The students who benefited most from the course were third-year students since they had the lowest level of knowledge at the beginning of the course (p>0.05). Fifth-year students and postgraduates had a good initial level of knowledge (87 percent). This study identified a lack of knowledge among this group of Spanish dental students prior to the course, but participating in the course led to considerable improvement.

Er,CR:YSGG lasers induce fewer dysplastic-like epithelial artefacts than CO2 lasers: an in vivo experimental study on oral mucosa

Our aim was to assess wounds made by lasers (CO(2) and Er,Cr:YSGG) for their epithelial architectural changes and width of damage. We allocated 60 Sprague-Dawley(®) rats into groups: glossectomy by CO(2) laser at 3 different wattages (n=10 in each); glossectomy by Er,Cr:YSGG laser at two different emissions (n=10 in each), and a control group (n=10). Histological examination assessed both prevalence and site of thermal artefacts for each group. Both lasers (CO(2) and Er,Cr:YSGG) caused the same type of cytological artefacts. The 3W Er,Cr:YSGG laser produced the fewest cytological artefacts/specimen, and was significantly different from the other experimental groups: 3W CO(2) laser (95% CI=0.8 to 1.0); the 6W CO(2) laser (95% CI=0.1 to 2.0) and the 10W CO(2) laser (95% CI=1.1 to 3.0). CO(2) lasers (3-10W) generate epithelial damage that can simulate dysplastic changes with cytological atypia that affects mainly the basal and suprabasal layers. Irradiation with Er,CR:YSGG laser (2-4W) produces significantly fewer cellular artefacts and less epithelial damage, which may be potentially useful for biopsy of oral mucosa.

Isolated gingival metastasis from lung carcinoma

Metastases to the gingiva are uncommon. They can be a diagnostic challenge clinically because of their rarity and tendency to mimic benign lesions. We present the case of an undifferentiated small cell lung carcinoma in a 76-year-old man whose left lower gum showed a lesion similar to pyogenic granuloma. Biopsy confirmed gingival metastasis of lung cancer. We make a differential diagnosis of proliferative lesions and metastatic tumors.

Efficacy of topical Aloe vera in patients with oral lichen planus: a randomized double-blind study

BACKGROUND

  Different treatments have been used in application to symptomatic oral lichen planus (OLP), with variable results, perhaps caused by the refractory nature of the disease. The objective of this study was to evaluate the efficacy of the topical application of aloe vera (AV) in OLP compared with placebo.

METHODS

A total of 64 patients with OLP were randomized in a double-blind study to either AV (32 patients) or placebo (32 patients), at a dose of 0.4 ml (70% concentration) three times a day. A Visual Analog Scale was used for rating pain, with the application of a clinical scale for scoring the lesions, the Oral Health Impact Profile 49 (OHIP-49), and the Hospital Anxiety-Depression (HAD) scale. The patients were evaluated after 6 and 12 weeks.

RESULTS

No statistically significant differences were recorded between both groups in relation to pain after 6 and 12 weeks. In the AV group, complete pain remission was achieved in 31.2% of the cases after 6 weeks, and in 61% after 12 weeks. In the placebo group, these percentages were 17.2% and 41.6%, respectively. There were no adverse effects in any of the groups. In relation to quality of life, significant differences were observed between the two groups in the psychological disability domain and total OHIP-49 score.

CONCLUSION

The topical application of AV improves the total quality of life score in patients with OLP.

A prospective, randomized study on the efficacy of tongue protector in patients with burning mouth syndrome

OBJECTIVE

To apply a tongue protector with habit-modifying therapy through self-control, in the patients with burning mouth syndrome (BMS).

METHODS

A prospective, randomized study was made of 65 consecutive patients with BMS. Fifty subjects were randomized to two groups: group A (informed) and group B (informed and the application of a tongue protector). The symptoms were evaluated by VAS, whereas the psychological profile was assessed using the HAD, with application of the quality of life questionnaires SF-36 and OHIP-49. The duration of treatment was 2 months.

RESULTS

Fifty patients (46 females and 4 males) completed the study. The VAS scores in group B were 8.2 at baseline and 4.5 after 2 months. The respective scores in group A were 7.1 and 5.6 - the differences between the two groups being significant (P < 0.001). In group B the OHIP-49 yielded lower scores for most of the scales, with significant differences vs group A. In group B the SF 36 yielded significant differences vs group A in physical role, bodily pain, general health and emotional role.

CONCLUSIONS

Parafunctional traumatism of the tongue should be taken into account in the pathogenesis of BMS with a view to exploring new therapeutic options.

Clinical assessment of oral lichen planus based on different scales

BACKGROUND

Different oral lichen planus (OLP) scoring scales have been developed, though none has received unanimous acceptance from all authors. This study involves the clinical application of two symptom and sign measurement scales for assessing OLP.

MATERIAL AND METHOD

One hundred patients were diagnosed clinically and confirmed as having OLP by biopsy, according to the WHO criteria. A visual analog scale (VAS) was applied (0-10) along with two semi-quantitative tests for assessing the symptoms and signs.

RESULTS

The Escudier test yielded an overall site score of 3.8 +/- 1.83 (mean +/- SD), with an activity score of 1.6 +/- 2.59 (mean +/- SD), and a total weighted score of 7.4 +/- 4.78. The pain VAS score was 1.9 +/- 2.06. The Malhotra scale (range 1-7) yielded a maximum total score of 2.9 +/- 1.21, corresponding to grade 1. The Spearman correlation coefficient between the Escudier and Malhotra scales was 0.54 - the difference proving statistically significant (P < 0.001).

CONCLUSION

Uniform OLP scoring system measures need to be adopted.

Solitary oral neurofibroma

Neurofibroma is a benign tumor of the peripheral nerve sheath characterized by proliferation of Schwann's cells, perineural cells and endoneurial fibroblasts. The tumor occurs most often in the head and neck regions. We describe the occurrence of an isolated neurofibroma in the upper lip of a 14-year-old girl.

A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain

OBJECTIVES

This study describes the clinicopathological characteristics of a group of patients with oral lichen planus (OLP) in south-eastern Spain.

MATERIALS AND METHODS

A retrospective descriptive study was made of 550 patients clinically and histopathologically diagnosed with OLP in the period 1991-2007. Patient gender, age, the prevalence of hepatitis C, symptoms and malignization were recorded. The clinical forms were classified as reticular-papular and atrophic-erosive.

RESULTS

Of the 550 patients, 128 (23.3%) were men and 422 (76.7%) women. The mean age was 56.35 +/- 13.67 years (range 14-91). The prevalence of hepatitis C was 3.5%. The red clinical forms were the most frequent, with 359 cases (64.2%). The lesions were asymptomatic in 159 patients (28.9%). Five patients developed oral squamous cell carcinoma (0.9%); none of these subjects was smokers.

CONCLUSIONS

Patients with OLP present different clinical manifestations. Women were more frequently affected by the disease, and the malignant transformation rate was under 1%.

Use of antifungal agents for oral candidiasis: results of a national survey

BACKGROUND

Candida albicans is an opportunistic agent that colonizes the oral mucosa.

OBJECTIVES

To determine the attitude of Spanish dentists toward the oral treatment of candidiasis.

METHOD

Between May and November 2006, a questionnaire was circulated to a random selection of 1134 dentists obtained from the General Dental Council's main list. The survey consisted of a block of socio-demographic items followed by another block related to the diagnosis and treatment of oral candidiasis. Replies to the questionnaire were received from 840 (74%) dentists.

RESULTS

50.4% of respondents were men, and 48.1% were female with a mean age of 38 and 12.2 years of professional experience. Miconazole was the most popular choice of antifungal agent prescribed (59.3%), followed by nystatin (57.7%) for topical use. Systemic antifungal agents were used by 30.20% of dentists, with a strong association between their use and the number of years in practice, gender and professional qualifications (P < 0.005).

CONCLUSION

Most Spanish dentists make clinical diagnosis and treat oral infections by C. albicans themselves with topical drugs (miconazole and nystatin) as a first choice. Systemic treatments are more commonly chosen by male dentists with long professional experience, especially by stomatologists.

Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay?

Worldwide, oral cancer has one of the lowest survival rates and poor prognosis remains unaffected despite recent therapeutic advances. Reducing diagnostic delay to achieve earlier detection is a cornerstone to improve survival. Thus, intervention strategies to minimize diagnostic delays resulting from patient factors and to identify groups at risk in different geographical areas seem to be necessary. The identification of a 'scheduling delay' in oral cancer justifies the introduction of additional educational interventions aimed at the whole health care team at dental and medical practices. The access to and the kind of healthcare system in a particular country are also relevant in this context, particularly the referral system. The design of a simple, clear, fail-safe, fast-track referral scheme for those suspected with cancer may diminish greatly the length of the delay. Moreover, there is a need for future investigations, which are methodologically adequate, that consider cultural and geographical aspects and use patient survival as the final outcome, that are able to recognize the agents/factors responsible for diagnostic delay by patients as well as healthcare providers and those attributable to the healthcare systems.

Lichen sclerosus of the oral mucosa: clinicopathological features of six cases

Lichen sclerosus is a chronic inflammatory mucocutaneous disease, rarely involving the mouth. There are only 20 well-documented cases of oral lichen sclerosus reported in the English-language literature. This report describes the clinicopathological features of 6 cases of oral lichen sclerosus; 5 in women. There were 12 lesions, mainly on the lips (50%) and buccal mucosa (25%). The affected areas appeared as irregular whitish patches, harder than the surrounding tissue. Half of the patients were symptomatic and presented with no associated skin and/or genital lesions. All cases were biopsied, and histopathological features were evaluated using hematoxylin-eosin and Verhoeff's stains, S-100 immunohistochemical reaction and transmission electron microscopy. Management of the oral lesions consisted of surgical excision, intralesional triamcinolone acetonide, oral colchicine, and regular follow-up. There is no effective curative treatment, but there are some options for patient management; and colchicine may be considered an additional choice.

Quantitative analysis of epithelial papillae in patients with oral lichen planus

BACKGROUND

The oral mucosa is relatively vulnerable to pathological processes, and is often affected by autoimmune and malignant diseases. The oral epithelium is normally non-homogeneous, and joins to the connective tissue through interlocking of its downward projections in the form of papillae.

OBJECTIVE

This study aims to conduct a histomorphometric study of the epithelial papillae in patients with oral lichen planus (OLP).

MATERIAL AND METHOD

This study was based on 100 cheek mucosa biopsies from patients with OLP (66 white reticular and 34 atrophic-erosive) (13 males and 87 females, with a mean age of 54.95 +/- 13.64 years). A histological and morphometric evaluation was made, based on imaging analysis with MIP software 4.5 for studying the papillary structure in the patients with OLP.

RESULTS

The mean epithelial thickness was 227.5 +/- 78.5 microm. The different papillary measures--BLS (distance from basal layer to epithelial surface), DPS (distance from dermal papilla top to epithelial surface), DPW (dermal papilla width), and DPD (interdermal papilla distance between two papillae)--yielded no statistically significant differences with respect to age, sex, smoking and clinical form. However, a significant correlation was observed in relation to papilla width and inflammatory infiltrate (P = 0.031).

CONCLUSIONS

The application of this imaging system is useful for measuring variations in epithelial papillary architecture.

Study of oral changes in patients with eating disorders

BACKGROUND

The prevalence of eating disorders is very high in industrialized countries, especially in young women. The principal orodental manifestations are erosion of the dental enamel, caries and dental sensitivity.

OBJECTIVES

Our aim was to study oral complications in female with eating disorders.

METHODS

We study oral complications (dental, mucosal and salivary) in 17 female patients from the Hospitalized Patients Eating Disorders Unit.

RESULTS

We found alterations in salivary flow and pH, as well as salivary gland enlargement.

CONCLUSIONS

A significant alteration in oral tissue occurs; this has an adverse impact on oral health, producing an accumulation of local irritants which favour the appearance of oral diseases. Preventative measures are therefore recommended for this group of patients.

Spanish dental hygienist attitudes to dental radiological protection: assessment of a 1-day pilot course

OBJECTIVES

To determine hygienists' knowledge of and attitudes to X-ray equipment and film processing, and to assess both after a 1-day course.

STUDY POPULATION

One-hundred and four dental hygienists from the south-east of Spain attending a 1-day course in oral radiology.

METHODOLOGY

A questionnaire comprising different sections related with socio-demographic items, X-ray equipment and the processing of dental films was answered before and after a 1-day pilot course on radiation protection.

RESULTS

The response rate was 89.42% (n = 93). Of the participants 94.6% were women, with a mean age of 29.52 (SD 6.861) and 7.20 years of professional experience (SD 5.089). The level of knowledge before the course was 48.28%, which increased to 85.62% after the course (P < 0.001).

CONCLUSIONS

The prescribed standard was reached by <23.65% of those attending the course at the beginning. Although attending the course led to a considerable improvement, it did not always result in a high level of knowledge of basic radiation equipment and processing.

Knowledge and attitude towards risk factors in oral cancer held by dental hygienists in the Autonomous Community of Murcia (Spain): A pilot study

The objective was to study the knowledge and attitude on risk factors in oral cancer held by dental hygienists working in private dental practices in the Autonomous Community of Murcia, Spain. An anonymous phone survey was made after obtaining consent from the interviewee. A simple randomized study was carried out and 240 dental hygienists were selected. The questionnaire was divided into three different parts: (1) professional data and years of practice; (2) knowledge of the risk factors in oral cancer and (3) education and training needs on oral cancer. The response rate was 58.3%. Regarding knowledge of the risk factors in oral cancer, 100% correctly identified tobacco and 90% alcohol, while only 50.7% identified sun exposure with labial cancer. Only 51.4% of the dental hygienists routinely gave advice to their patients on prevention of oral cancer. Furthermore, 57.1% did not consider themselves sufficiently well trained to discover suspected oral cancer lesions, and 84.3% recognized that their academic training on the early diagnosis and prevention of oral cancer was insufficient for their professional activity. To reduce morbidity and mortality of oral cancer it is necessary to implement training programs on oral cancer for dental hygienists, so they may acquire the necessary skills for its detection and prevention.

New barriers in oral cancer. Patient accessibility to dental examination—A pilot study

Delay in the diagnosis of oral cancer has been classified as both 'patient delay' and 'professional delay'. A cross-sectional, descriptive study was designed (representative sample). Six hundred and sixty-nine telephone calls were made to private dental clinics distributed throughout Spain. The study was based on a telephone conversation with a simulated, standardized patient. The group 1 patient (with lingual ulceration) and the group 2 patient (seeking prosthodontic treatment), both following a prepared script. The average waiting time for group 1 was significantly shorter (p = 0.000) than for group 2 (3.3 days against 8.0) (Xi-Xj = 4.71;95% CI = -6.180,-3.243). When we compare the average waiting times for group 1 with the professional status, the delay was significantly shorter when the appointment was made by the dentist (p = 0.000). Dentists gave higher priority to patients with lingual ulceration over those who requested prosthetic treatment.

Gingival lesions as a first symptom of pemphigus vulgaris in pregnancy

The erosive gingival lesions associated with vesiculobullous diseases can be an important early clinical manifestation of serious diseases such as pemphigus vulgaris (PV). PV is a vesiculobullous disease of the skin and mucosa which tends to be chronic and which normally affects people of 40-60 years of age. Its incidence varies from 0.5 to 3.2 cases per 100,000 per year. Mucosal lesions are located mainly in the oral and pharyngeal mucosa, although conjunctiva, larynx, nasal mucosa, vulva, vagina, cervix, and ano-rectal mucosa may also be involved. It is a serious mucocutaneous disease of an autoimmune nature, whose appearance during pregnancy is extremely rare.

Fracture in the chin area: An unusual case of mandibular torus fracture

Mandibular torus fracture as a result of accidental trauma has not been reported to date in the dental literature. This study describes the case of a young adult male who suffered multiple fractures affecting the teeth and mandibular torus secondary to chin area trauma due to a bicycle accident; the first manifestation of bone damage being left unilateral paraesthesia of the lip. An occlusal x-ray study of the affected area was made to evaluate possible fracture, as unlike centred periapical x-rays and orthopantomography, it is able to reveal the existence of a fracture line of the alveolar wall. In the associated presence of paraesthesia, a computed tomographic study is advisable.

The clinicopathological characteristics of oral lichen planus and its relationship with dental materials

The objective of this work was to carry out a clinicopathological study to ascertain whether clinical and histopathologic differences existed between oral lichen planus OLP patients with and without metal restorations. The predominant clinical form in both groups was reticular white, with no statistically significant differences between the forms associated or not with metal. The histological variables showed no statistically significant differences between the groups.

Comparison of a new test for the measurement of resting whole saliva with the draining and the swab techniques

A quantification method for measuring whole saliva is described. This whole saliva test (WST) consists of a Whatman paper strip, is easily carried out, innocuous, low-cost and single use. Due to its characteristics, it could be considered as the oral equivalent of Schirmer's tear test. A sample of 159 healthy subjects (81 males and 78 females; mean age 31.62 years) participated in this comparative study of this new procedure and two other tests, the draining and the swab test. Correlation was statistically positive among the three types of tests.