It is known from the existing literature that metal ions within orthodontic appliances are prone to corrosion due to the salivary and bacterial interplay in the oral cavity. The results from the most ...studies show that levels of salivary nickel and chromium do not increase after the installment of orthodontic appliances.
However, there are no studies on salivary levels of titanium, cobalt, copper and zinc in these patients. Salivary levels of nickel (Ni), titanium (Ti), chromium (Cr), cobalt (Co), copper (Cu) and zinc (Zn) were measured in 42 patients with ceramic brackets and in 42 patients with metal conventional brackets prior to insertion of orthodontic appliances and six months after insertion of orthodontic appliances by means of inductive coupled plasma/mass spectrometry. Statistical analysis was performed by use of Wilcoxon signed rank test and Mann Whitney test with level of significance set at 0.05.
The results showed that salivary level of titanium increased significantly six months after installment of orthodontic appliances. Salivary level of chromium and zinc significantly decreased after installment of orthodontic appliances. There were no significant differences in salivary levels of nickel, titanium, chromium, copper, cobalt and zinc between the patients with metallic and those with ceramic brackets.
We might conclude that the salivary level of titanium increased significantly six months after installment of orthodontic appliances unlike salivary levels of chromium and zinc which significantly decreased after installment of orthodontic appliances, regardless of bracket type which was used.
IntroductionOrthopantomography is amongst the most commonly used dental imaging modalities. Calcifications in the projection of carotids on orthopantomographs are found in 3-15% of general population ...and commonly represent calcified atherosclerotic plaques. Carotid atherosclerotic changes are one of the most frequent causes of stroke, which is the second most common cause of death and the leading cause of disability globally. Our aim was to determine the relationship between calcifications in the projection of carotids on orthopantomographs, carotid stenosis and stroke, and the correlation between stroke risk factors, calcifications on orthopantomographs and the degree of carotid stenosis. Materials and methodsDoppler ultrasound and brain MRI were performed in 41 patients with unilateral or bilateral calcifications on orthopantomographs. Anamnestic data relevant to stroke risk were gathered. ResultsSignificant stenosis >50% was found in almost 15% of our patients. There was a significant correlation between hypertension and carotid calcifications. No statistically significant correlation between calcifications and significant stenosis was found. Patients with previous stroke were approximiately 5 years older than those without stroke. ConclusionPreliminary results show no statistically significant correlation between calcifications on orthopantomography and significant carotid stenosis, but further investigation is needed.
Adenoid cystic carcinoma is a less commonly diagnosed cancer that may affect the major or minor salivary glands. We present a 70 year old male patient who was admitted to the Department of Oral ...Medicine, School of Dental Medicine in Zagreb, Croatia due to pain in the right maxilla. In this case we report a case of the patient with unilateral pain in the maxilla & eye which lead to the diagnosis of adenoid cystic cancer without any visible oral lesions.
Oral mucositis (OM) is a serious inflammation of the mucosa and occurs in patients with head and neck cancer (HNC) who are being treated with radiotherapy (RT) and/or chemotherapy (CT), and in ...patients undergoing hematopoietic stem cell transplantation (HSCT). The inflammation accompanied with painful ulcerations inside the oral cavity impairs its function making the basic functions like eating and speech hard or even impossible. It usually occurs at the end of the first week of RT and lasts for several weeks after cessation. The intensity of OM can sometimes lead to discontinuation of RT. The degree of mucositis regarding chemotherapy depends on the type of antineoplastic drug, therapeutic procedure, duration of the therapy and dose, as well as previous exposure of the oral cavity to toxic agents.Prolonged or repeated administration of lower doses of chemotherapy is associated with a higher chance of developing oral mucositis comparing to a bolus, while chronomodulation of chemotherapy reduces the possibility of mucositis without affecting antineoplastic activity. The treatment of OM is symptomatic, as there is still no effective treatment. In this review paper, several contemporary options for alleviating the symptoms of oral mucositis are listed.
Oralni mukozitis (OM) ozbiljna je upala sluznice i javlja se u bolesnika s karcinomom glave i vrata (HNC) koji se liječe radioterapijom (RT) i/ili kemoterapijom (CT) te u bolesnika koji su podvrgnuti transplantaciji hematopoetskih matičnih stanica (HSCT). Upala praćena bolnim ulceracijama unutar usne šupljine narušava njezinu funkciju, čineći osnovne funkcije poput prehrane i govora teškim ili čak nemogućim. Obično se javlja na kraju prvog tjedna radioterapije i traje nekoliko tjedana nakon prestanka. Intenzitet oralnog mukozitisa ponekad može dovesti do prekida radioterapije. Stupanj mukozitisa kod kemoterapije ovisi o vrsti antineoplastičnog lijeka, terapijskom postupku, trajanju terapije i dozi, kao i o prethodnoj izloženosti usne šupljine toksičnim agensima. Produljena ili ponovljena primjena nižih doza kemoterapije povezana je s većom šansom za razvoj oralnog mukozitisa u usporedbi s bolusom, dok kronomodulacija kemoterapije smanjuje mogućnost mukozitisa bez utjecaja na antineoplastično djelovanje. Liječenje oralnog mukozitisa je simptomatsko jer još uvijek nema učinkovitog lijeka. U ovom preglednom radu navodi se nekoliko suvremenih opcija za ublažavanje simptoma oralnog mukozitisa.
Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin (1). Simultaneous involvement of the oral mucosa is extremely rare, but it may be the only ...affected area (2). A 55-year-old woman was referred to the Department of Oral Medicine, School of Dental Medicine University of Zagreb due to whitish lesions on the right ventrolateral part of the tongue and buccal mucosa with desquamative gingivitis (Figure 1, a-c). The lesions were asymptomatic but indurated on palpation. Histology was conclusive for oral lichen sclerosus (OLS). The lesions on gingiva were successfully treated with betamethasone ointment, three times a day for two weeks. One year earlier, she had been referred to the Department of Dermatology and Venereology with progressive pruritus and dyspareunia, white patches, obliteration of the labia minora, and stenosis of the introitus (Figure 2). Histology was conclusive for vulvar LS (Figure 3, a and b). She was successfully treated for 5 months with clobetasol propionate 0.05% ointment. The patient was taking levothyroxine to treat hypothyroidism associated with Hashimoto's thyroiditis and was otherwise healthy. Oral LS is clinically characterized by the appearance of white macules, papules, or plaques mostly appearing on labial mucosa but also on buccal, palate mucosa and on the lower lip (2,3). On the genitals, it typically manifests as atrophic white plaques, which may be accompanied by purpura or fissuring (1). While vulvar LS is often associated with pruritus, dyspareunia, and dysuria, OLS is often asymptomatic, although pain, soreness, pruritus, and tightness when opening the mouth can be present (1,2). Oral manifestations of LS, as well as association of anogenital and oral LS, are rarely reported in the literature (4-6). Tomo et al. searched the Medline database for papers reporting oral LS cases with histological diagnosis confirmation from 1957 to 2016 and found only 34 cases of oral LS with histopathologic confirmation of the diagnosis (4). Kakko et al. reported 39 histologically proven cases of OLS (2). Attilli et al. (5) reviewed the clinical and histologic features of 72 cases of LS with oral/genital involvement. They reported that LS was diagnosed with exclusive genital lesions in 45, exclusive lip involvement in 20, and orogenital involvement in only 7 cases (5). Some believe that many cases of clinically diagnosed lichen planus may actually be LS and that isolated oral mucosal LS may not be as rare as is generally thought (2). While vulvar LS can occur at any age with increasing incidence with age, the median age of patients with OLS was 34 years and most of the patients were female (1,2,5). Due to the small number of patients in the literature, treatment recommendations for OLS are not available. In case of symptomatic oral lesions, topical or intralesional corticosteroids are considered to be the first-line treatment (2). First-line treatment for anogenital LS is a potent to very potent topical corticosteroid ointment, and second-line therapies include topical calcineurin inhibitors 1% pimecrolimus and 0.1% and 0.03% tacrolimus (1). For treatment-resistant genital LS, oral retinoids, methotrexate, and possibly local steroid injections for single lesions are mainly applicable for women (1). There is limited evidence for systemic treatments for both conditions. If it is not treated, genital LS is associated with a greater degree of scarring and an elevated risk of progression to squamous cell cancer; however, malignant transformation of OLS has not been reported (1-6). Due to the very rare presentation in the oral cavity, it is important to notice these lesions during a dental exam.
SAŽETAK
CiljeviCilj ovog istraživanja bio je prikazati utjecaj pandemije na promjene u smjernicama za klinički rad te na broj pacijenata Klinike za stomatologiju Kliničkoga bolničkog centra (KBC) ...Zagreb u razdoblju normalnog rada prije pandemije te kroz sljedeće godine.
MetodeIz baze podataka Bolničkoga informacijskog sustava KBC-a Zagreb retrospektivno su prikupljeni podatci o ukupnom broju slučajeva na Klinici za stomatologiju u pojedinom razdoblju te o ukupnom broju slučajeva na pojedinim zavodima, u razdoblju od 1. siječnja do 11. studenog u kalendarskim godinama 2018., 2019., 2020. i 2021.
RezultatiKroz pandemijsko razdoblje najznatniji pad broja pacijenata u većini organizacijskih jedinica evidentan je 2020. godine u odnosu na 2018. godinu. Zabilježeno smanjenje broja pacijenata u 2020. u odnosu na 2018. iznosio od 30,27%, dok je 2021. u odnosu na 2018. broj pacijenata bio manji za 9,73%. Klinički zavod za oralnu kirurgiju i Klinički zavod za ortodonciju imali su gotovo nepromijenjen broj pacijenata u 2020. godini u odnosu na 2018. godinu, a u 2021. godini je u odnosu na 2018. godinu zabilježeno povećanje broja pacijenata. Stomatološka ambulanta Rebro i Jednodnevna kirurgija Klinike za stomatologiju također su zabilježile porast broja pacijenata. Te su jedinice Klinike za stomatologiju u vrijeme epidemioloških preporuka o uvođenju hladnog pogona odrađivale i ostale, manje hitne dijagnoze koje bi odgađanjem dovele do loših posljedica. Za vrijeme kolektivnoga godišnjeg odmora svih ostalih organizacijskih jedinica Klinike za stomatologiju ove jedinice preuzimaju na sebe pružanje svih potrebnih usluga Klinike za stomatologiju.
ZaključakPandemija COVID-19 dovela je do smanjenja broja pacijenata na razini Klinike za stomatologiju. Nemogućnost pravovremenog liječenja zuba dovela je do povećane potrebe za ekstrakcijama te do povećanja broja pacijenata na Zavodu za oralnu kirurgiju. U 2021. godini bilježi se veći ili manji porast broja pacijenata na pojedinim zavodima, koji međutim, u promatranom razdoblju još nije dostigao brojeve iz 2018. godine. U idućim mjesecima očekuje se daljnje povećanje broja pacijenata i elektivnih stomatoloških zahvata.
A 70-year-old patient was admitted to the Department of Oral Medicine for multiple oral ulcerations on the left buccal mucosa, around 0.5 cm in diameter, as well as on the gingiva. Otherwise, the ...patient suffered from chronic lymphocytic leukemia, hypogammaglobulinemia,
chronic renal insufficiency, with complete afunction of the right kidney, asthma, hypertension, gastritis and prostate hyperplasia. Differential diagnosis of oral ulcerations included drug induced oral ulcerations, paraneoplastic pemphigus, viral ulcerations (cytomegalovirus, herpes simplex viruses),
fungal ulcerations (candidiasis, aspergillosis, histoplasmosis, cryptococcosis) and bacterial ulcerations, as well as neutropenic ulcers. One of the possible explanations was that the lesions were due to the use of drugs, the more so as oral lesions evolved when the doses of allopurinol and chlorambucil were
increased, and subsided when the doses of both drugs were decreased. However, we could not establish for sure whether the lesions were due to allopurinol or chlorambucil. According to literature data, allopurinol is one of the most frequent drugs known to induce skin adverse reactions, therefore we
assumed that it was the culprit drug. Unfortunately, several weeks later the patient died from sepsis, pneumonia with respiratory insufficiency and multiorgan failure.
Svrha: Iz postojeće literature poznato je da metalni ioni iz ortodontskih naprava mogu korodirati zbog djelovanja sline i bakterija u usnoj šupljini. Rezultati većine studija upućuju na to da se ...razina nikla i kroma u slini ne povisuje nakon postavljanja ortodontskih naprava. No nema istraživanja o razini titanija, kobalta, bakra i cinka u slini ortodontskih pacijenata. Ispitanici i postupci: Razina nikla (Ni), titanija (Ti), kroma (Cr), kobalta (Co), bakra (Cu) i cinka (Zn) mjerena je u slini četrdeset i dvoje pacijenta s keramičkim metalnim bravicama i isto toliko njih s konvencionalnima i to prije postavljanja ortodontskih naprava s pomoću induktivne spregnute plazme/masene spektrometrije i šest mjeseci poslije toga. U statističkoj analizi korištena su dva testa – Wilcoxonov signed rank i Mann-Whitneyev s razinom značajnosti od 0,05. Rezultati: Rezultati su pokazali da se razina titana u slini povisila šest mjeseci nakon postavljanja ortodontskih naprava. Razina kroma i cinka, pak, značajno se snizila nakon postavljanja ortodonskih naprava. Nije bilo statistički značajne razlike u razini nikla, titanija, kroma, bakra, kobalta i cinka u slini između pacijenata s metalnim i keramičkim ortotontskim
bravicama. Zaključak: Možemo zaključiti da se razina titanija u slini značajno povisila šest mjeseci nakon postavljanja ortodontskih naprava za razliku od razine kroma i cinka koja se značajno snizila šest mjeseci poslije njihova postavljanja, bez obzira na vrstu korištenih bravica.
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