Oral medicine: defining an emerging specialty in the United States

Oral medicine is a specialized area of study within the scope of dental medicine. This discipline is often viewed as the crossroads between medicine and dentistry and has become integral in both pre-and postdoctoral dental education. Oral medicine is recognized as a dental specialty throughout most of the world and currently represents an emerging specialty in the United States. Historically, oral medicine has been loosely defined in the United States without a clear consensus definition. Recent published studies regarding international oral medicine postdoctoral programs and clinical practice have helped to provide more specific information regarding oral medicine from many perspectives. This article will review the literature relevant to defining oral medicine in the United States and present a new definition of this important discipline based on recent studies.

Local drug delivery for oral mucosal diseases: challenges and opportunities

There are few topical formulations used for oral medicine applications most of which have been developed for the management of dermatological conditions. As such, numerous obstacles are faced when utilizing these preparations in the oral cavity, namely enzymatic degradation, taste, limited surface area, poor tissue penetration and accidental swallowing. In this review, we discuss common mucosal diseases such as oral cancer, mucositis, vesiculo-erosive conditions, infections, neuropathic pain and salivary dysfunction, which could benefit from topical delivery systems designed specifically for the oral mucosa, which are capable of sustained release. Each condition requires distinct penetration and drug retention profiles in order to optimize treatment and minimize side effects. Local drug delivery may provide a more targeted and efficient drug-delivery option than systemic delivery for diseases of the oral mucosa. We identify those mucosal diseases currently being treated, the challenges that must be overcome and the potential of novel therapies. Novel biological therapies such as macromolecular biological drugs, peptides and gene therapy may be of value in the treatment of many chronic oral conditions and thus in oral medicine if their delivery can be optimized.

Persistent orofacial muscle pain

The pathophysiology of persistent orofacial myalgia has been the centre of much controversy. In this article we suggest a novel descriptive term; 'persistent orofacial muscle pain' (POMP) and review current evidence that supports the hypothesis that the induction of POMP involves the interplay between a peripheral nociceptive source in muscle, a faulty central nervous system component and decreased coping ability. In this context it is widely accepted that a complex interaction of variable intrinsic and extrinsic factors act to induce POMP and dysfunction.

Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy

OBJECTIVE

To identify and compare clinical and neuroimaging predictors of primary lobar intracerebral hemorrhage (ICH) recurrence, assessing their relative contributions to recurrent ICH.

METHODS

Subjects were consecutive survivors of primary ICH drawn from a single-center prospective cohort study. Baseline clinical, imaging, and laboratory data were collected. Survivors were followed prospectively for recurrent ICH and intercurrent aspirin and warfarin use, including duration of exposure. Cox proportional hazards models were used to identify predictors of recurrence stratified by ICH location, with aspirin and warfarin exposures as time-dependent variables adjusting for potential confounders.

RESULTS

A total of 104 primary lobar ICH survivors were enrolled. Recurrence of lobar ICH was associated with previous ICH before index event (hazard ratio [HR] 7.7, 95% confidence interval [CI] 1.4-15.7), number of lobar microbleeds (HR 2.93 with 2-4 microbleeds present, 95% CI 1.3-4.0; HR = 4.12 when >or=5 microbleeds present, 95% CI 1.6-9.3), and presence of CT-defined white matter hypodensity in the posterior region (HR 4.11, 95% CI 1.01-12.2). Although aspirin after ICH was not associated with lobar ICH recurrence in univariate analyses, in multivariate analyses adjusting for baseline clinical predictors, it independently increased the risk of ICH recurrence (HR 3.95, 95% CI 1.6-8.3, p = 0.021).

CONCLUSIONS

Recurrence of lobar ICH is associated with previous microbleeds or macrobleeds and posterior CT white matter hypodensity, which may be markers of severity for underlying cerebral amyloid angiopathy. Use of an antiplatelet agent following lobar ICH may also increase recurrence risk.

Spouses' cardiovascular reactivity to their partners' suffering

A laboratory study of older adults with osteoarthritis and their spouses was conducted to examine the unique influence of exposure to suffering on caregivers' risk for impaired psychological and physical health. Spouses' blood pressure (BP) and heart rate (HR) were monitored during 2 tasks designed to capture their partners' suffering. First, spouses watched their partners (and a stranger) carry heavy logs across an 8-ft space for 3 min, a task that elicited pain expression. Second, spouses spoke about their partners' suffering (and also about a typical meal with their partners). Results showed that spouses' BP and HR increased when watching and talking about their partners' suffering, and exposure to a partner's suffering was more physiologically stressful than to a stranger's suffering. These findings suggest that heightened physiological stress caused by exposure to a loved one's suffering may be one pathway to caregivers' increased risk for cardiovascular disease.

Effects of Cognitive Adaptation on the Expectation-Burnout Relationship Among Nurses1

Burnout has traditionally been thought to result from unrealistically high expectations although research has provided only equivocal support. We explored the impact of cognitive adaptation disposition, including mastery, optimism, and self-esteem, on the expectations-burnout relationship. Nurses (N = 341) who were recruited at professional conferences completed questionnaires that assessed cognitive adaptation, burnout, and initial and current expectations of control. As expected, cognitive adaptation predicted fewer unmet expectations of control, which in turn predicted lower burnout. In addition, optimism and self-esteem predicted lower burnout regardless of perceived initial expectations, whereas mastery lessened the negative consequences of initially high expectations on burnout.

Recurrent aphthous stomatitis

The cause of recurrent aphthous stomatitis (RAS) remains unknown despite considerable research. This article reviews the evidence for current theories regarding this disorder, including possible suspected relationships with microbial and immunologic factors, and presents medical diseases that mimic RAS lesions in certain patients. Topical management of the common form of minor RAS is described along with systemic therapy currently available to patients with severe forms of this disease.

Property crime victims' decision to notify the police: social, cognitive, and affective determinants

Previous research suggests that 3 general processes underlie the decision of property crime victims to notify the police: One that is cognitively driven by reward/cost considerations, one that is affectively driven, and another that is socially driven. This study is the first to employ a community sample of crime victims to compare the 3 processes within a single study. Computer-assisted interviews were conducted with 422 property crime victims (n = 129 burglary, n = 293 theft) located via a random digit dialing procedure. Logistic regression analyses showed that each process independently accounted for a significant amount of the variance in victim reporting, and that there were no interactions among the three processes in predicting reporting. Of the 3 processes, social influence was the best predictor of reporting. Analysis of the affect-driven process showed that reporting was primarily a function of the level of fear rather than anger or the level of generalized arousal upon discovering the crime.

Update on herpesvirus infections

Herpesviruses are responsible for many illnesses that affect the oral and maxillofacial region. The most common of these are primary or recurrent HSV infection, but knowledge of the manifestations of the eight herpesviruses that cause infections in humans will provide clinicians with a better understanding and basis for diagnosing and managing patients with these diseases. Immunocompromised patients are at greater risk for serious illness: therefore, clinicians treating transplant patients, patients receiving cancer chemotherapy, or HIV-infected individuals should be aware of the various clinical manifestations of infection with herpesviruses.

Seizure disorders: update of medical and dental considerations

Seizure disorders and epilepsy represent neurologic conditions that commonly are seen among patients requiring dental treatment. When dentists possess a working knowledge of seizures, in addition to an understanding of updated therapies for seizure management and oral complications associated with pharmacological therapy, they are able to treat patients with these disorders more effectively. Neurologic consultations and selecting an appropriate venue for treatment may need to be addressed prior to treatment, depending on the level of seizure control. Laboratory tests designed to evaluate medication levels, leukocyte counts, and clotting ability also may be required. Frequent recall visits may be necessary for seizure disorder patients who display adverse oral complications from medication, such as gingival hypertrophy, xerostomia, and oral yeast infections.

Etiology and Management of Recurrent Aphthous Stomatitis

Recurrent aphthous stomatitis (RAS) is an ulcerative condition that affects the oral mucosa without evidence of an underlying medical disorder. RAS is characterized by the appearance of round, shallow ulcerations surrounded by inflammation that chiefly involves the nonkeratinized mucosa. The etiology of RAS is unknown, but has a strong hereditary component and appears to be related to an immune reaction against the oral mucosa. RAS must be distinguished from other diseases that cause recurring oral ulcers such as Behçet's syndrome, systemic lupus erythematosus, and Crohn's disease. This paper reviews the current theories regarding the etiology of RAS, the clinical evaluation of patients with recurring aphthous ulcers, and describes current treatment options for this condition.

Biological responses of Lumbriculus variegatus exposed to fluoranthene-spiked sediment

Lumbriculus variegatus was used as a bioassay organism to examine the impact of the sediment-associated polycyclic aromatic hydrocarbon (PAH) fluoranthene on behavior, reproduction, and toxicokinetics. The number of worms increased between the beginning and end of the experiment at 59 microg x g(-1) fluoranthene, but at the next higher treatment (108 microg x g(-1)) the number of worms found was lower and not different from the control. Worms exposed to 95 microg x g(-1) also exhibited increased reproduction when fed a yeast-cerophyl-trout chow mixture. On a total biomass basis, only the 95 microg x g(-1) exposure with food exhibited a statistically significant increase over the nonfed control. Evaluation of reproduction at the two highest treatments was compromised by a brief aeration failure 2 days before the end of the experiment. The behavioral responses were followed as changes in biological burial rate (sediment reworking rate) of a 137Cs-labeled marker layer. The biological burial rate increased toward a plateau as the concentration increased from the control (3.9 microg x g(-1) dry weight total PAH) to 355 microg x g(-1) dry weight fluoranthene in sediment. The aeration failure had minimal impact on the determination of reworking rate because all the data for the rate determination were collected prior to the aeration failure. Uptake and elimination rates declined with increasing treatment concentration across the range of fluoranthene concentrations, 59-355 microg x g(-1) dry weight sediment. The disconnect between the increasing biological burial rates and the decreasing toxicokinetics rates with increasing exposure concentration demonstrates that the toxicokinetic processes are dominated by uptake and elimination to interstitial water. The bioaccumulation factor (concentration in the organisms on a wet weight basis divided by the concentration in sediment on a dry weight basis) ranged from 0.92 to 1.88 on day 10 and declined to a range of 0.52 to 0.99 on day 28 with the lowest value at the highest dose.